BEDBUGS NOT JUST IN NURSERY RHYMES ANYMORE!!!! Nancy Boggs, RN, BSN, MA, LNHA Off-Site Supervisor...
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Transcript of BEDBUGS NOT JUST IN NURSERY RHYMES ANYMORE!!!! Nancy Boggs, RN, BSN, MA, LNHA Off-Site Supervisor...
BEDBUGSBEDBUGSNOT JUST IN NURSERY RHYMESNOT JUST IN NURSERY RHYMES
ANYMORE!!!!ANYMORE!!!!
Nancy Boggs, RN, BSN, MA, LNHA
Off-Site Supervisor
TriHealth SeniorLink
A FEW BEDBUG FACTS A FEW BEDBUG FACTS Official name is Cimex LextulariusOfficial name is Cimex Lextularius Small, wingless insect AKA “Red Coats”, “Chinches”, or Small, wingless insect AKA “Red Coats”, “Chinches”, or
“Mahogany Flats”“Mahogany Flats” Came to North America in the 1700’s from EuropeCame to North America in the 1700’s from Europe Feed solely on the blood of warm-blooded animals Feed solely on the blood of warm-blooded animals
preferably humans.preferably humans. Were very common in the United States before WWII.Were very common in the United States before WWII. Largely eradicated in the 1940’s and 1950’s through the Largely eradicated in the 1940’s and 1950’s through the
use of DDTuse of DDT Resurgence worldwide--especially in North America, Europe Resurgence worldwide--especially in North America, Europe
and Australiaand Australia According to the CDC are not known to cause serious illnessAccording to the CDC are not known to cause serious illness Very difficult and expensive to eradicate!!!!!Very difficult and expensive to eradicate!!!!!
Cimex LectulariusCimex Lectularius
Side ViewSide View
How Can I Identify a Bed BugHow Can I Identify a Bed Bug
Hatchlings are size of poppy seedsHatchlings are size of poppy seeds Adults are about ¼ inch long, oval, Adults are about ¼ inch long, oval,
flatflat Light tan to deep brown or burnt Light tan to deep brown or burnt
orangeorange Cast skins of bed bugs are often Cast skins of bed bugs are often
presentpresent Do not fly but actively seek shelter Do not fly but actively seek shelter
when disturbedwhen disturbed
Bedbug NymphBedbug Nymph
Relative Size of a Bed BugRelative Size of a Bed Bug
Burnt Orange SpecimenBurnt Orange Specimen
Mattress Binding with Cast SkinsMattress Binding with Cast Skins
Bedbug ColonyBedbug Colony
Are Bed Bugs Harmful?Are Bed Bugs Harmful? Seek out people and animals at nightSeek out people and animals at night Painlessly sip blood and inject tiny amount of Painlessly sip blood and inject tiny amount of
salivasaliva Sensitivity to the saliva over time causes allergic Sensitivity to the saliva over time causes allergic
reactions (bites)reactions (bites) Itching and irritation can lead to secondary Itching and irritation can lead to secondary
infections which can be seriousinfections which can be serious Hard to distinguish from other insect bites Hard to distinguish from other insect bites
without knowledge of person’s home environmentwithout knowledge of person’s home environment Often treated with antihistamines and Often treated with antihistamines and
corticosteroidscorticosteroids Do not transmit any infectious agentsDo not transmit any infectious agents
Bed Bug BitesBed Bug Bites
Typical PresentationTypical Presentation
Raised Bumps and WeltsRaised Bumps and Welts
Inflamed FootInflamed Foot
Subtle Allergic Reactions Subtle Allergic Reactions
Lower Leg, Ankle and FootLower Leg, Ankle and Foot
More Severe Reaction More Severe Reaction
Infected Lesions in Trunk AreaInfected Lesions in Trunk Area
Raised WeltsRaised Welts
Scalp LesionsScalp Lesions
Severe Reaction and InfectionSevere Reaction and Infection
Bed Bug Life CycleBed Bug Life Cycle
Females lay 1-12 eggs per dayFemales lay 1-12 eggs per day Eggs coated with sticky glue that helps Eggs coated with sticky glue that helps
them lodge on rough surfaces or cracks them lodge on rough surfaces or cracks and crevicesand crevices
Eggs hatch in 6-17 days as nymphsEggs hatch in 6-17 days as nymphs Nymphs have different stages each Nymphs have different stages each
requiring a blood mealrequiring a blood meal Reach adulthood in 5 weeks to 4 monthsReach adulthood in 5 weeks to 4 months Can live from 12-18 months with over 3 Can live from 12-18 months with over 3
generations per yeargenerations per year
Bedbug EggsBedbug Eggs
Bed Bug Life CycleBed Bug Life Cycle
Eggs Shells and Fecal MatterEggs Shells and Fecal Matter
Bed Bug NymphBed Bug Nymph
There are five instars or molts
Exuvium or Cast SkinExuvium or Cast Skin
Adult female Adult male
Females mate up to five times after a blood meal.
Modes of TravelModes of Travel
Usually brought in to the home on Usually brought in to the home on luggage, clothing or used furnitureluggage, clothing or used furniture
Hotels, motels and apartments are high Hotels, motels and apartments are high risk places to encounter bed bugsrisk places to encounter bed bugs
Once introduced spread from room to Once introduced spread from room to room—apartment to apartmentroom—apartment to apartment
Often hide in upholstered furniture in Often hide in upholstered furniture in public placespublic places
Can ride in the crevices of pant cuffs, Can ride in the crevices of pant cuffs, seams and hemsseams and hems
Can Travel in LuggageCan Travel in Luggage
Used Bedding is a Bargain—Used Bedding is a Bargain—NOT!!!!!NOT!!!!!
Fecal Material on Used MattressFecal Material on Used Mattress
Signs of Bed Bug ActivitySigns of Bed Bug Activity Dark spotting and staining on mattresses and box Dark spotting and staining on mattresses and box
springssprings May see eggs and eggshells, molted skins of aging May see eggs and eggshells, molted skins of aging
nymphs and the bugs themselvesnymphs and the bugs themselves May notice a sweetish smell in heavily infested May notice a sweetish smell in heavily infested
areasareas Hide during the day but can be found in Hide during the day but can be found in
mattresses, box spring frames, behind head mattresses, box spring frames, behind head boards and picture framesboards and picture frames
Can crawl in and out of cracks in the wall and Can crawl in and out of cracks in the wall and electrical outletselectrical outlets
May crawl up drapery and can be seen at crawling May crawl up drapery and can be seen at crawling on walls in heavy infested areas.on walls in heavy infested areas.
Like to hide in cluttered rooms and closetsLike to hide in cluttered rooms and closets
During feeding, the adult expands with engorged blood and leaves behind
a small fecal droplet.
Feeding Fecal Droplet
Bed Bug TreatmentBed Bug Treatment Use the services of a reputable professional Use the services of a reputable professional
exterminator and follow his or her exterminator and follow his or her recommendations explicitlyrecommendations explicitly
Follow all instructions given by the exterminator Follow all instructions given by the exterminator about preparation before and cleanup afterabout preparation before and cleanup after
Vacuum thoroughly before and after each Vacuum thoroughly before and after each professional treatment with a bag-vacuum professional treatment with a bag-vacuum cleaner and discard bag outside of homecleaner and discard bag outside of home
Remove clutter from the environment before Remove clutter from the environment before treatment and discard any non-essential itemstreatment and discard any non-essential items
Discard heavily infested bedding and upholstered Discard heavily infested bedding and upholstered furniture; wrap in plastic before removalfurniture; wrap in plastic before removal
Treat items to be returned to the home using Treat items to be returned to the home using Sterifab or by laundering in hot waterSterifab or by laundering in hot water
Bed Bug Treatment ContinuedBed Bug Treatment Continued Steam treat items with a high pressure steamer if Steam treat items with a high pressure steamer if
not appropriate to launder or spray with Sterifab.not appropriate to launder or spray with Sterifab. Wash and dry all clothing and linens in hot waterWash and dry all clothing and linens in hot water Keep all laundered linen and clothing in sealed Keep all laundered linen and clothing in sealed
plastic until infestation is completely cleared; this plastic until infestation is completely cleared; this could take up to six monthscould take up to six months
Be vigilant in checking home at least weekly, Be vigilant in checking home at least weekly, even after no further bed bug activity is noted.even after no further bed bug activity is noted.
Cover bedding in zippered mattress covers: Cover bedding in zippered mattress covers: plastic or finely woven fabric rated for bed bugs plastic or finely woven fabric rated for bed bugs and dust mites.and dust mites.
Put “dry clean only clothing” in dryer on high for Put “dry clean only clothing” in dryer on high for 10 to 20 minutes.10 to 20 minutes.
Seal cracks and crevices in home.Seal cracks and crevices in home.
Bed Bug PreventionBed Bug Prevention Reduce clutter around the houseReduce clutter around the house Seal cracks and crevicesSeal cracks and crevices Check all secondhand beds, bedding, furniture Check all secondhand beds, bedding, furniture
and clothingand clothing Examine the bed and headboard area when Examine the bed and headboard area when
traveling (Pull back the sheets and mattress traveling (Pull back the sheets and mattress cover!!!)cover!!!)
Keep your luggage off of the floorKeep your luggage off of the floor Wash, dry or freeze second hand clothing right Wash, dry or freeze second hand clothing right
away—even if it comes from someone you think away—even if it comes from someone you think you know!!you know!!
Educate your teen-age and college-age children Educate your teen-age and college-age children on what to look for.on what to look for.
Consider using air mattresses if residing in a Consider using air mattresses if residing in a “high risk” environment“high risk” environment
Recommendations for WorkersRecommendations for Workers Wear light colored, washable clothing if you work in Wear light colored, washable clothing if you work in
healthcare or in frequent direct contact with the healthcare or in frequent direct contact with the public. public.
Wash your clothing after one wearing or spray with Wash your clothing after one wearing or spray with SterifabSterifab
Spray your shoes and lower legs with “Off” or other Spray your shoes and lower legs with “Off” or other insect repellant with a high DEET content whenever insect repellant with a high DEET content whenever you are working in a “high risk” environment.you are working in a “high risk” environment.
Carry a portable stool if your work involves visiting Carry a portable stool if your work involves visiting people at home.people at home.
Avoid put your purse, brief case or tool bag on the Avoid put your purse, brief case or tool bag on the floorfloor
Consider removing your clothes in the garage (or Consider removing your clothes in the garage (or inside the front door) and bagging them before inside the front door) and bagging them before entering your home if you work in a high risk entering your home if you work in a high risk environment.environment.
Recommendations for SupervisorsRecommendations for Supervisors Require staff to wear protective disposable Require staff to wear protective disposable
clothing when working in an environment clothing when working in an environment that is known to be actively infestedthat is known to be actively infested
Consider installing automatic insecticide Consider installing automatic insecticide dispensers in your workplace—especially dispensers in your workplace—especially in coat rooms, high traffic areas—even in coat rooms, high traffic areas—even commercial vehiclescommercial vehicles
Consider using the services of a Consider using the services of a professional exterminator on a monthly or professional exterminator on a monthly or even weekly basis in your work place if even weekly basis in your work place if you serve high risk populations.you serve high risk populations.
What do we do now—we got ‘em at What do we do now—we got ‘em at work!!!!!!work!!!!!!
Do not panic!!!!!Do not panic!!!!! Involve everyone in developing a planInvolve everyone in developing a plan Educate! Educate! Educate!Educate! Educate! Educate! Be up front with your patients, customers Be up front with your patients, customers
or clientsor clients Work with management to provide Work with management to provide
information and support to employeesinformation and support to employees Train staff in preventive practices and Train staff in preventive practices and
demand compliance—provide updatesdemand compliance—provide updates Educate patients, families, caregivers and Educate patients, families, caregivers and
providersproviders
Engage Community ResourcesEngage Community Resources
Work with landlords—educateWork with landlords—educate Stay abreast of resources available Stay abreast of resources available
through local governmentthrough local government Contact the Health Department with Contact the Health Department with
complaints and concernscomplaints and concerns Contact HUD oversight agencies when Contact HUD oversight agencies when
dealing with public housing issuesdealing with public housing issues Understand applicable housing regulationsUnderstand applicable housing regulations
HUD LOCAL OFFICEHUD LOCAL OFFICE CincinnatiCincinnati 15 East 7th Street15 East 7th Street
Cincinnati, OH 45202-3188 Cincinnati, OH 45202-3188 Phone:Phone: (513) 684-3451 (513) 684-3451
Fax:Fax: (513) 684-6224 (513) 684-6224TTY:TTY: (513) 684-6180 (513) 684-6180 Jurisdiction:Jurisdiction: Thirteen counties in Southwestern Ohio Thirteen counties in Southwestern Ohio James A. CunninghamJames A. Cunningham, Field Office Director, Field Office DirectorContact the Director's Office Contact the Director's Office Office Hours:Office Hours: 8:00 a.m. to 4:30 p.m. 8:00 a.m. to 4:30 p.m.Monday through FridayMonday through Friday
ADDRESSING THE PROBLEM ADDRESSING THE PROBLEM Acknowledge the reality as first cases Acknowledge the reality as first cases
appear appear Recognize stages of staff emotion: Recognize stages of staff emotion:
disbelief, denial, panic, fear, anger, disbelief, denial, panic, fear, anger, fragmentation of team membersfragmentation of team members
Rally the troops; let them know “We’ve got Rally the troops; let them know “We’ve got to get our act together because these little to get our act together because these little critters are not going away.”critters are not going away.”
Develop a bed bug policyDevelop a bed bug policy Organize a “swat team”Organize a “swat team” Form a “bedbug committee” to manage Form a “bedbug committee” to manage
the problem and refine strategiesthe problem and refine strategies
Strategies That Really WorkStrategies That Really Work Educating and reeducating every single Educating and reeducating every single
employeeemployee Finding effective products Finding effective products
– SterifabSterifab– Protective ClothingProtective Clothing– Automatic aerosol dispensersAutomatic aerosol dispensers– Portable stoolsPortable stools– GoodNight SprayGoodNight Spray– Zippered Mattress CoversZippered Mattress Covers
Developing a relationship with a quality Developing a relationship with a quality exterminator—learning how to work with exterminator—learning how to work with other exterminatorsother exterminators
STERIFAB STERIFAB
MPE Protective ApparelMPE Protective Apparel1-888-688-20461-888-688-2046
More Products From More Products From Miller’s Precision EnterprisesMiller’s Precision Enterprises
Boots Hood
Good Night SprayGood Night Spray
Microfiber and Plastic MattressMicrofiber and Plastic Mattress and Box Spring Covers and Box Spring Covers
More Strategies That Really WorkMore Strategies That Really Work
Keeping corporate leadership informed and Keeping corporate leadership informed and enlisting their supportenlisting their support
Partnering with landlords and Public Housing Partnering with landlords and Public Housing AgenciesAgencies
Using oversight agencies when landlords are slow Using oversight agencies when landlords are slow to respondto respond
Finding alternative short-term and permanent Finding alternative short-term and permanent housing for our participantshousing for our participants
Educating our contracted providersEducating our contracted providers Developing and refining additional toolsDeveloping and refining additional tools
– Comprehensive bedbug policy Comprehensive bedbug policy – Standard service planStandard service plan– Participant and family contractsParticipant and family contracts– In-service materialsIn-service materials
Helping ParticipantsHelping Participants Understanding the stigma historically Understanding the stigma historically
connected with bedbugsconnected with bedbugs Remembering that patient care still comes Remembering that patient care still comes
firstfirst Treating everyone with dignity and Treating everyone with dignity and
sensitivitysensitivity Tolerating the idea that not everyone Tolerating the idea that not everyone
considers bedbugs a big dealconsiders bedbugs a big deal Knowing that no one-size treatment fits allKnowing that no one-size treatment fits all Accepting that these critters are here to Accepting that these critters are here to
stay—deal with it and move on!!!!stay—deal with it and move on!!!!
AcknowledgementsAcknowledgements
Harvard School of Public Health Website Harvard School of Public Health Website WWW.hsph.harvard.edu/bedbugsWWW.hsph.harvard.edu/bedbugs
County of San Diego Department of County of San Diego Department of Environmental Health Website Environmental Health Website www.co.san-diego.ca.us/deh/chd/vector/vbedbugswww.co.san-diego.ca.us/deh/chd/vector/vbedbugs
Tammy Berkel, Owner, Valley Pest ControlTammy Berkel, Owner, Valley Pest Control Mary Rohs, OTR/L, M.Ed., LNHA, SeniorLink Mary Rohs, OTR/L, M.Ed., LNHA, SeniorLink
Service Operations ManagerService Operations Manager Dora Winters, Lead Health Care TechDora Winters, Lead Health Care Tech Stephen L. Doggett, Department of Medical Stephen L. Doggett, Department of Medical
Entomology, University of SydneyEntomology, University of Sydney
Good Night, Sleep TightGood Night, Sleep Tight