Bed Bugs

Providing the infection prevention professional with information to assist in developing a program to detect, eliminate and prevent bed bugs in the long term care organization

Ruth Anne Rye, RN, BSInfection Prevention Consultant: LTC

Learners Objectives

Discuss the historical perspective of bed bugs

Describe bedbug entomology List elements of a bed bug

management plan Discuss anecdotal episodes of ved

bug infestations in healthcare facilities in Michigan

http://video.nationalgeographic.comvideo/animals/bugs-animals/otherbugs/cockroach_german/

History: THEN

Archeologists found fossilized bed bugs while excavating a 3,500 year old site in Egypt

Introduced into US and Canada by colonists, not native Americans

Early 20th century rated in top3 in and around structure; 1 in 3 residences

After WWW2 with discovery and accepted use of DDT infestations greatly reduced

1972 EPA banned use of DDT Resistance developed but controlled with

pesticides – lindane and malathion

NOW

US experiencing alarming resurgence in bed bug population

Probably associated with• Increased resistance to pesticides• Greater national and international travel• Lack of knowledge regarding control• No “magic bullet” insecticides• Continuing decline of effective programs

at national, state, and local health agencies

Entomology

Belong to category of blood-sucking ecoparasites (external parasites)

Cimex lectuanus Small, flat, reddish brown, wingless Approximate length of apple seed Seek warmth and carbon dioxide Feed on blood of humans

Continued …

• Experts in hiding during the day in Seams of mattresses, box springs, headboards,

• Cracks or crevices of furniture• Under any clutter or objects around

beds• Behind wallpaper• Main means of room-to-room spread

is through ventilation ducts

Epidemiology

Ability to spread near and far – can travel over 100 ft in one night

Local spreading called “active dispersal”, i.e. hitching a ride

Supported by the environment – many sleeping under one roof, persons moving between rooms and convening in common areas

Tend to live within 8’ of where people sleep. Referred to as “nest” parasite because they reside in human nest

Fear light

Identification/Manifestations

Bite injects an anesthetic and anticoagulant – person doesn’t feel, allows uninterrupted feeding up to 5 min.

Bite marks on person – face, neck, arms, hands, any other body part

Bite mark often circular, with central hemorrhagic crust or vesicle at bite site

Distribution may be linear, curve, or random – several to many

Manifestations, continued….

May be itchy, with or without macular wheal, slightly swollen, red – similar to mosquito or flea bite

Emit sweet, musty odor Visible reaction may not appear for two

weeks after bite May show no reaction May see live bugs, e.g in folds of

mattresses and sheets, or exoskeleton Rusty-colored blood spots from blood-

filled fecal material on sheets, bed clothes

Manifestations, continued

Mental health-related symptoms Anxiety Insomnia May exacerbate previous mental

health illness

Develop a PLAN!

Utilize the expertise and strength of a multidisciplinary TEAM representing

• Leadership/Administration• Infection Prevention• Maintenance/Plant engineering• Safety• Nursing• Housekeeping• And others as determined by organization – consider pest

control company, local public health

o Designate authority, establish chain-of-command, and mechanism to maintain clear and consistent communication

Organize Plan in logical order

For instance divide into sections Detect – Eliminate – Preventor Recognize – Report – Respond Remediate

Consider using algorithm

Recognize

Refer to previous slides Manifestations/Identification

REPORT and REACT

Immediately and directly report to person with authority to act, who will put PLAN into place and

Notify pest control/management company

RESPOND

Treat resident’s symptoms PRN

OTC antihistamines Topical steroids if severe pruritis

Anaphylaxis can occur

Have you seen this at entry points?

Integrated Pest Management (IPM)

Michigan Regulation 637 Pesticide Use, Rules 14, 15 (revised 2008)Michigan Department of Agriculture and Rural Development

IPM is a coordinated process that uses themost appropriate pest control methoda sandstrategies in an environmentally andeconomically sound manner.Assesses – considers options - implements

Integrated Pest Management Approach

… is the most comprehensive program for control and elimination of bed bugs. This program incorporates knowledge of insect life cycle, environmental control, and pest control methods.

P.M Service agreement: Addendum that addresses specific bed bug services

Cost of service – detect and treat separate from other IPM services

Type & details of service to expect Preparation required by the organization (you!) Realistic expectations Schedule for completion Client education Limitation of liability Exclusion for damages – replacement and health-

related issues Recordkeeping (shared) – times and locations of

found bugs, and all activities related to occurrence

Pest Management Company

Will inspect/detect identify eradicate Recognize that bed bug infestation will

not go away without intervention Goal is to eliminate their source of food,

water, shelter Intervention will be most effective when

bed bug population is low

Confirm infestation

Visual inspection – look for live bugs and viable eggs

Tools - powerful flashlight, and others Collect specimen and submit for determination

(either entomologist or IPM professional)

Canine detection (scent detection)• Useful if no live bug found• Locate all rooms/areas• Confirm success of treatment

Must be recognized by the National EntomologyScent Detection Canine Association

Treatment warranted?

Pre-Treatment

Residento Bathe or showero Change clotheso Transfer to another room – remain

out of room until deemed “bug free”- not with another resident

o If impossible to move, resident should not leave room until room deemed “bug free”

Pre-treatment, continued

Environment Remove resident bed linens –

sheets, pillowcases, mattress pads, etc. and seal in bag. Immediately wash and dry on hottest settings - dry at least 30 minutes

Remove mattress from bed frame and box springs and stand straight up

Environment continued

Inspect baseboards, electrical outlets, carpeting, underside of furniture

Empty closets, bedside tables, dresser drawers – anything where bug could hide. Seal tightly in plastic bag

Remove all items from walls

Treatment options

Physical – primary means Vacuming Steam Heat Cold “freeze” treatment Fumigation

Chemical (pesticides) – secondaryIf used incorrectly the toxic effects may bedeleterious to persons and may spread bugs tounaffected areas.

Post-Treatment and PREVENTION

Monitor for early detection E.g. traps – passive, active, moat-style Proper laundry handling Aggressive housekeeping EDUCATE personnel, residents, others

include elements of plan - how to identify, report and plan

Regular skin assessment of residents Destroy nearby bat and bird harborage Caulk cracks and crevices in walls Encase mattress and springs