Bedbug Mitigation Efforts Enhanced by Addressing Field Staff Concerns to Exposure

The QI coordinator facilitated the QI process with the six-member QI team. First, they completed a flowchart to identify the sequence of a field visit. Second, they completed an affinity diagram regarding fears of bedbugs, followed by a cause-and-effect diagram to identify key emerging themes and a prioritization matrix to weigh activities based on particular criteria. The main focus of the cause-and-effect diagram goal was identified as "No staff have mental or physical effects from bedbugs." This goal was created through brainstorming and the 5-Whys activity. Last, a solution-and-effect diagram was created to identify forces and factors to support the team's solutions for decreasing fear levels and bedbug exposure. The initiative of creating an internal bedbug protocol was chosen because the team believed it would be the most feasible and most effective for field staff. This project affected CG Health field staff the most, although decreasing their bedbug exposure also decreases the exposure of other clients they are visiting within a particular workday. CG Health field staff are generally less fearful about coming to work and doing their daily job, which involves being in complexes and homes infested with bedbugs. The internal protocol was presented to all field staff after completion and will be shared with any future CG Health employees during their orientation sessions. Following is a list of implementation activities created and completed over the span of the project: • Developed an internal bedbug protocol pertaining to field staff. The protocol includes a reporting process and a standardized assessment. • Purchased and created “pest field kits” consisting of PPE to minimize CG Health employees' bedbug exposure. • Updated the bedbug training/curriculum. • Determined an appropriate budget for bedbug control (e.g., for PPE). • Educated all CG Health field staff from the Family & Community Health Service and Environmental Health Service sections on the new internal protocol, how to communicate with clients about bedbugs, and bedbug myths. • Edited and retested bedbug educational flyers among the target audience for readability and comprehension. • Created an internal reporting document for all home visits that result in the identification of bedbug cases.

The QI team measured the project's impact by completing a post-assessment of employee fear levels. This assessment was identical to the one-question assessment employees took at the beginning of the project. The QI team views the creation and implementation of the following new documents as a success: the bedbug protocol that includes the reporting documentation, the standardized assessment questionnaire, and the bedbug education plan (for CG Health and the community).