I presented a poster on my research at the North Carolina Nurses Association Conference last week, and got good feedback.
The conference was sold out, which has never happened before. Go NC nurses! I sat at a table with a state representative who is also a nurse and learned about how our state legislature has passed the STOP bill to help regulate opioid prescriptions. We broke into small groups to talk about solutions, and there is a photo of what our group came up with (legalize marijuana for one, improve access to rehab for another). While I was at the conference, I went running on some trails that were supposedly “just behind the hotel”, and after fighting my way through spider infested woods (the common house spider is HUGE…and RED…I love spiders, but man…) at dusk, had a run in the dark (yep, cause that’s how I roll) that was empowering and just generally awesome. I am giving mad props to Umstead State Park in Cary, NC.
SAFETY FIRST NURSING UPDATE
This morning I had an interview for a PRN (that’s “as needed” for you non medical folk) position at a local home health agency. This was the first interview I have had since being fired from my previous home health position (you can listen and/or read all about it in episodes #5 & #6, and get legal information on how to handle this if it happens to you in episode #10). I was a ball of anxiety – you have to tell people you were fired if you are a nurse. We are the most trusted people in America, so we have to tell the truth. It feels so awful to click the “yes” box for the question, “have you ever been discharged”? The interview went well – I took some calming breaths in the car beforehand and set my intention for how it would go. I was upfront and honest, and they were SO KIND. All I can do now is wait, higher ups have to review the info from the board of nursing before it can be approved…even if you don’t get disciplinary action (which I did not) they can pull your records and read all about it. YUCK. Someday, someone will give me another chance, and this will be a bad memory, but for now, it is hard. I have to work hard to stay positive and feel good about myself. If I get the job I will get to work with folks who are in adult protective services, so that would be a huge bonus. Those are my peeps.
And speaking of dealing with stress, I am reading an incredible book by Bessel van der Kolk called The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma (2014). I am going to be reviewing the book once I finish it, and testing out mind body treatments to help me with my reactivity issues related to childhood trauma. I am so glad I had the book with me when I went to my first Motheread Inc. circle. Motheread is a nationally acclaimed private, non-profit organization that helps adults and children learn to use the power of language to discover more about themselves, their families, and their communities. It was founded in Raleigh, NC and has since spread around the nation.
I was invited to Motheread after attending a Middle School Networking event last week. At one point during the event, we were sitting in a large group to discuss how we can support getting trauma informed care into the hands of those who need it. “Trauma Informed Care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma Informed Care also emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.” (http://www.traumainformedcareproject.org/). I was actually planning to do my podcast this week on trauma informed care, but got sidetracked by the Motheread experience. We started talking, and this big, beautiful, brown woman started sharing about how plenty of resources are available for African American women in our town, but that access is the issue. She was brutally honest about how hard it is to go out and ask for help – the shame you feel, how you might feel like a terrible mom and a terrible person for not having enough food for your kid, or a safe place to rest your head. She spoke about how if a black woman and a white woman are asking for a local charity to pay their heating bill, maybe the white woman will get it because the black woman has been there a few times already, and there is only so much money, and why can’t she get her situation figured out? I looked at her and said, “I want to be an advocate – how can I support you”? we emailed and she invited me to motheread. I showed up thinking maybe I would be teaching someone to read (something I do nightly with my kids). Thank God I was wrong. What I got was a room full of women, all colors, ages, shapes, ethnicities and sizes talking all at once, sharing, hugging, kissing, supporting each other – so obviously caring for one another. A young woman came in and everyone applauded her – she has a job, she has a new place to live, her child is in day care! She said about herself: “I am striving for greatness” …and this is where we finally get to the main topic…bed bugs.
As a former home health nurse, I am aware that bed bug infestation is becoming epidemic in parts of the country. I know it was a big issue for the healthcare company I used to work for. How do you safely care for patients in their homes without transferring infectious agents to the next home or to your home, and support eradication of these annoying pests?
I’ve done a lot of research in the last 24 hours, and there is a lot of great information out there, and I learned about some of my own misconceptions. For example, the entire group was under the impression that all the bedding and furniture would need to be thrown out, however I found a great deal of information to support that this is NOT THE CASE!
When you Google bed bugs you get lots of ads and information from pest control services, and they have a story to tell to sell their products, so I dug a bit deeper.
I went to the Centers for Disease Control and typed in bed bugs and it redirected me to the Environmental Protection Agency site, which was updated in May of 2017.
They also have links to three other resources, which I also read and included information from those sites as well.
Bed bugs are blood-sucking insects in the Cimicidae family. Both the immature bugs (nymphs) and adults feed on sleeping or sedentary humans, mostly at night. The common bed bug, Cimex lectularius, is found in North America, Europe and Central Asia, but there are tropical species as well. Bed bugs can feed on other species of mammals including birds, mice, and rabbits. They lay between 200-500 tiny white eggs during their lifetimes, usually 2-5 eggs per day on rough surfaces such as wood or paper near the hosts’ sleeping place. A gluelike material covers the eggs, which hatch in about 10-15 days at room temperature. Bed bugs can go without feeding for 20-400 days (YUP!) depending on temp and humidity. There are five progressively larger nymphal stages, each requires one blood meal before molting to the next stage. The entire life cycle takes between 5 weeks to 4 months. Most people don’t know they have been bitten because they are sleeping and the saliva injected during the feeding produces a natural anesthetic, which can also cause a large itchy swelling afterwards. In addition to causing injury, they can leave odors and ugly fecal spots on bed sheets.
Bed bugs are being found in some of the finest hotels in the world, and are no longer seen as pests associated with crowded or dilapidated housing.
It’s important to know that if you live in an apartment complex, bed bugs can easily move from apartment to apartment, and people may not even know they are infested because not everyone reacts to bed bug bites. If you find you have bed bugs in your bed, and then you move to sleep on the couch, they will follow you, and then your couch will be infested! They tend to only follow you where you sleep.
Things you need for Do-It-Yourself:
Trash bags (Large leaf bags are best)
Tools for hunting and destroying bugs: flashlight, Old credit card or flat head screw driver, clear tape, plastic bags, a cloth and hot soapy water
Vacuum cleaner with lots of bags
Zippered, bed bug proof covers for all mattresses and box springs
Bug interceptors (go under legs of bed to catch and kill bugs)
- Remove clutter – keep clothing off floor
- Get rid of cardboard – use plastic boxes
2. Don’t throw your bed away! Make your bed an island
- Move it 6 inches from the wall
- Strip and vacuum the mattresses and box springs
- Remove all bed bugs, larvae and eggs from bed, frame and headboard – sticky tape is useful
- Place bed-bug proof covers on mattress and boxspring (any bugs left inside will starve)
- Double bag your bedding and wash in hot water and dry for 30 minutes (discard inner bag after putting bedding into washer)
- Bed frame: eggs are tough to remove – they won’t get vacuumed up, this is where insecticide sprays and diatomaceous earch are useful for every crack and crevice
- Tuck all bedding under mattress – don’t allow it to touch the floor
- Place bed bug interceptors under each leg of the bed – these are a great way to track progress – notice how many bugs fall into the trap daily.
- Remove anything under the bed
3. Clean all items
- Heat treat clothing – in a dryer on high heat for 30 minutes. Steam can be very effective. Use a 1 gallon (minimum) commercial steamer – the object being treated should be 160-180 F immediately after the steam brush has passed. You can use an infrared thermometer to monitor the temp – use care because steam can burn your skin.
- Store clean items in a sealed plastic bag to ensure they remain bug free
- Inspect and clean furniture, baseboards, behind outlet and switch covers – sticky tape is useful for cleaning – be sure to double bag it
- Use sealed plastic bags to transport items being moved from one area to another
- Remove and clean drapes and drapery hardware
- Remove bed bugs from all furniture
- Vacuum thoroughly, remove and dispose of vacuum bags (vacuuming doesn’t remove eggs)
- Seal the vacuum bag in a plastic bag
- Place in trash outsideEliminate bed bug habitats
- Caulk cracks or crevices around baseboards
- Repair wallboard damage, ensure wallpaper is not loose
- Check electrical outlets and wall switches for evidence of bed bugs
4. Kill the bed bugs
- Heat treatment using a clothes dryer on high heat, place plastic bags in the sun or a hot, closed car. 7 lbs of items in clear bags in direct sunlight on a 95 degree day will get hot enough to killall bed bug life stages in one afternoon.
- Leave items in freezer set to zero degrees for 4 days
- Use pesticides sparingly. Only use those specifically labeled for bedbugs AFTER you have done all these other things – they only kill the bugs that are out in the open, not the ones that are hiding (the EPA site lists them all, with pros and cons – you can use a fogger, but only use them after you have tried everything else, and air out the room before going back inside. Be sure to extinguish all pilot lights and cover all food)
- Plant based sprays like Neem oil, EcoRaider and Bed Bug Patrol have been found to be surprisingly effective.
- If repeated treatments are needed, consider desiccants like diatomaceous earth (only use food grade, and work it into cracks and crevices, you don’t want to inhale it, though it is safe to eat)
5. Continue to inspect for bed bugs every 7 days
I am so surprised at the number of people I meet who don’t know about 211. My mom was trying to find a new dentist and I told her to call 211, and she was like “what’s that?” So, I called 211, which is an information and referral service provided by United Way of North Carolina. Accessible via an easy-to-remember, three-digit number, families and individuals can call to obtain free and confidential information on health and human services and resources within their community, but it is also a national service – you can dial 211 from anywhere and get your questions answered.
I learned from 211 that if you live in public housing, they are supposed to “deal with it”. Bedbug control falls under the Environmental Health Division of your County Health Department (In Asheville, that number is (828) 250 5016). I called and left a message for the Director of Environmental Health requesting more information on how bed bugs and public housing are handled, and Jessica Silver, Director of Environmental Health for Buncombe County Health and Human Services called me back the next morning (great service!). Ms. Silver was kind enough to share that she had a friend with a bed bug problem about one year ago in her own home, and she asked that I talk about the emotional toll it takes on a person. We talked about how her friend felt ashamed because bed bugs are traditionally seen as something that happens to “dirty people”. She spent thousands of dollars to get rid of her bed bugs, and mentioned how hard it was on her children because they couldn’t have people over to their house during the treatment period. She has a few other suggestions:
- Make a report to the housing authority
- Contact Pisgah Legal Services for free or low cost legal advice if you have trouble getting a response
- She gave a GREAT tip for how to seal your bags of clothing for transport to the laundry – get the gigantic lawn bags, put the items in the bag, as you press down and remove air from the bag, twist the top shut, fold it over and duct tape it, then put it in a second lawn bag.
- She also suggest using a spray bottle of 91% alcohol to treat your shoes and clothing to ensure you don’t take the bed bugs out of the home when you enter and leave.
She also suggested contacting the maintenance department for the building, which we have done!
Where to get and pricing:
I found the least expensive shopping to be on Amazon: Interceptors $11 for 4. EcoRaid is about $20 for 16oz, and diatomaceous earth is about $7 for 8 oz. mattress and box spring covers started at about $20 each.
Calculate the price for plastic and garbage bags and extra vacuum cleaner bags – the total for DIY runs about $100 (if you only have one bed) – compare that to the cost of a new bed…and the waste of throwing out the old one.
Remember, there is NO SHAME in having bed bugs. They are opportunistic, hitch hikers – anyone can get them!
WRAPPING IT UP
The focus of the group I was with today was on empowering the women in the group to ask for help and finding solutions as a team. I offered to look for furniture for the woman striving for greatness. I feel honored to be included in the group, and am so excited to return next Wednesday to see how everyone is doing.
I had to scoot out early and missed a lot of the sharing that goes on, which I hated. These women are so strong and interesting and powerful (I wish they knew it). I’m hoping to inspire them to write and share some of their stories – I know they will support patient safety efforts – by providing perspective from Black, brown, Latina, African American, white (well, really peach colored, kinda…) women on how we can best assist them in their quest for greatness. I’d like to open a dialogue about how important it is to donate food that you would actually eat to food pantries – we are perpetuating poor health and supporting type II diabetes by cleaning out our cabinets when we go on a “whole 30” binge or decide to go low carb. This is a public service announcement – put peanut butter and tuna in those bins before you dump your pasta and tomato sauce containing high fructose corn syrup.