BEDBUGS

1

• BEDBUGS
• NOT JUST IN NURSERY RHYMES
• ANYMORE!!!!

Nancy Boggs, RN, BSN, MA, LNHA Off-Site
Supervisor TriHealth SeniorLink
2
A FEW BEDBUG FACTS

• Official name is Cimex Lextularius
• Small, wingless insect AKA Red Coats,
  Chinches, or Mahogany Flats
• Came to North America in the 1700s from Europe
• Feed solely on the blood of warm-blooded animals
  preferably humans.
• Were very common in the United States before
  WWII.
• Largely eradicated in the 1940s and 1950s
  through the use of DDT
• Resurgence worldwide--especially in North
  America, Europe and Australia
• According to the CDC are not known to cause
  serious illness
• Very difficult and expensive to eradicate!!!!!

3
Cimex Lectularius
4
Side View
5
How Can I Identify a Bed Bug

• Hatchlings are size of poppy seeds
• Adults are about ¼ inch long, oval, flat
• Light tan to deep brown or burnt orange
• Cast skins of bed bugs are often present
• Do not fly but actively seek shelter when
  disturbed

6
Bedbug Nymph
7
Relative Size of a Bed Bug
8
Burnt Orange Specimen
9
Mattress Binding with Cast Skins
10
Bedbug Colony
11
Are Bed Bugs Harmful?

• Seek out people and animals at night
• Painlessly sip blood and inject tiny amount of
  saliva
• Sensitivity to the saliva over time causes
  allergic reactions (bites)
• Itching and irritation can lead to secondary
  infections which can be serious
• Hard to distinguish from other insect bites
  without knowledge of persons home environment
• Often treated with antihistamines and
  corticosteroids
• Do not transmit any infectious agents

12
Bed Bug Bites
13
Typical Presentation
14
Raised Bumps and Welts
15
Inflamed Foot
16
Subtle Allergic Reactions
17
Lower Leg, Ankle and Foot
18
More Severe Reaction
19
Infected Lesions in Trunk Area
20
Raised Welts
21
Scalp Lesions
22
Severe Reaction and Infection
23
Bed Bug Life Cycle

• Females lay 1-12 eggs per day
• Eggs coated with sticky glue that helps them
  lodge on rough surfaces or cracks and crevices
• Eggs hatch in 6-17 days as nymphs
• Nymphs have different stages each requiring a
  blood meal
• Reach adulthood in 5 weeks to 4 months
• Can live from 12-18 months with over 3
  generations per year

24
Bedbug Eggs
25
Bed Bug Life Cycle
26
Eggs Shells and Fecal Matter
27
Bed Bug Nymph
There are five instars or molts
28
Exuvium or Cast Skin
29
Females mate up to five times after a blood
meal.
Adult female
Adult male
30
Modes of Travel

• Usually brought in to the home on luggage,
  clothing or used furniture
• Hotels, motels and apartments are high risk
  places to encounter bed bugs
• Once introduced spread from room to
  roomapartment to apartment
• Often hide in upholstered furniture in public
  places
• Can ride in the crevices of pant cuffs, seams and
  hems

31
Can Travel in Luggage
32
Used Bedding is a BargainNOT!!!!!
33
Fecal Material on Used Mattress
34
Signs of Bed Bug Activity

• Dark spotting and staining on mattresses and box
  springs
• May see eggs and eggshells, molted skins of aging
  nymphs and the bugs themselves
• May notice a sweetish smell in heavily infested
  areas
• Hide during the day but can be found in
  mattresses, box spring frames, behind head boards
  and picture frames
• Can crawl in and out of cracks in the wall and
  electrical outlets
• May crawl up drapery and can be seen at crawling
  on walls in heavy infested areas.
• Like to hide in cluttered rooms and closets

35
During feeding, the adult expands with engorged
blood and leaves behind a small fecal droplet.
Feeding
Fecal Droplet
36
Bed Bug Treatment

• Use the services of a reputable professional
  exterminator and follow his or her
  recommendations explicitly
• Follow all instructions given by the exterminator
  about preparation before and cleanup after
• Vacuum thoroughly before and after each
  professional treatment with a bag-vacuum cleaner
  and discard bag outside of home
• Remove clutter from the environment before
  treatment and discard any non-essential items
• Discard heavily infested bedding and upholstered
  furniture wrap in plastic before removal
• Treat items to be returned to the home using
  Sterifab or by laundering in hot water

37
Bed Bug Treatment Continued

• Steam treat items with a high pressure steamer if
  not appropriate to launder or spray with
  Sterifab.
• Wash and dry all clothing and linens in hot water
• Keep all laundered linen and clothing in sealed
  plastic until infestation is completely cleared
  this could take up to six months
• Be vigilant in checking home at least weekly,
  even after no further bed bug activity is noted.
• Cover bedding in zippered mattress covers
  plastic or finely woven fabric rated for bed bugs
  and dust mites.
• Put dry clean only clothing in dryer on high
  for 10 to 20 minutes.
• Seal cracks and crevices in home.

38
Bed Bug Prevention

• Reduce clutter around the house
• Seal cracks and crevices
• Check all secondhand beds, bedding, furniture and
  clothing
• Examine the bed and headboard area when traveling
  (Pull back the sheets and mattress cover!!!)
• Keep your luggage off of the floor
• Wash, dry or freeze second hand clothing right
  awayeven if it comes from someone you think you
  know!!
• Educate your teen-age and college-age children on
  what to look for.
• Consider using air mattresses if residing in a
  high risk environment

39
Recommendations for Workers

• Wear light colored, washable clothing if you work
  in healthcare or in frequent direct contact with
  the public.
• Wash your clothing after one wearing or spray
  with Sterifab
• Spray your shoes and lower legs with Off or
  other insect repellant with a high DEET content
  whenever you are working in a high risk
  environment.
• Carry a portable stool if your work involves
  visiting people at home.
• Avoid put your purse, brief case or tool bag on
  the floor
• Consider removing your clothes in the garage (or
  inside the front door) and bagging them before
  entering your home if you work in a high risk
  environment.

40
Recommendations for Supervisors

• Require staff to wear protective disposable
  clothing when working in an environment that is
  known to be actively infested
• Consider installing automatic insecticide
  dispensers in your workplaceespecially in coat
  rooms, high traffic areaseven commercial
  vehicles
• Consider using the services of a professional
  exterminator on a monthly or even weekly basis in
  your work place if you serve high risk
  populations.

41
What do we do nowwe got em at work!!!!!!

• Do not panic!!!!!
• Involve everyone in developing a plan
• Educate! Educate! Educate!
• Be up front with your patients, customers or
  clients
• Work with management to provide information and
  support to employees
• Train staff in preventive practices and demand
  complianceprovide updates
• Educate patients, families, caregivers and
  providers

42
Engage Community Resources

• Work with landlordseducate
• Stay abreast of resources available through local
  government
• Contact the Health Department with complaints and
  concerns
• Contact HUD oversight agencies when dealing with
  public housing issues
• Understand applicable housing regulations

43
HUD LOCAL OFFICE

• Cincinnati
• 15 East 7th StreetCincinnati, OH 45202-3188
• Phone [phone]Fax [phone]TTY
  [phone] Jurisdiction Thirteen counties
  in Southwestern Ohio  James A. Cunningham,
  Field Office DirectorContact the Director's
  Office  Office Hours 800 a.m. to 430
  p.m.Monday through Friday

44
ADDRESSING THE PROBLEM

• Acknowledge the reality as first cases appear
• Recognize stages of staff emotion disbelief,
  denial, panic, fear, anger, fragmentation of team
  members
• Rally the troops let them know Weve got to get
  our act together because these little critters
  are not going away.
• Develop a bed bug policy
• Organize a swat team
• Form a bedbug committee to manage the problem
  and refine strategies

45
Strategies That Really Work

• Educating and reeducating every single employee
• Finding effective products
• Sterifab
• Protective Clothing
• Automatic aerosol dispensers
• Portable stools
• GoodNight Spray
• Zippered Mattress Covers
• Developing a relationship with a quality
  exterminatorlearning how to work with other
  exterminators

46
STERIFAB
47
MPE Protective Apparel1-888-688-2046
48
More Products From Millers Precision Enterprises
Boots
Hood
49
Good Night Spray
50
Microfiber and Plastic Mattress and Box Spring
Covers
51
More Strategies That Really Work

• Keeping corporate leadership informed and
  enlisting their support
• Partnering with landlords and Public Housing
  Agencies
• Using oversight agencies when landlords are slow
  to respond
• Finding alternative short-term and permanent
  housing for our participants
• Educating our contracted providers
• Developing and refining additional tools
• Comprehensive bedbug policy
• Standard service plan
• Participant and family contracts
• In-service materials

52
Helping Participants

• Understanding the stigma historically connected
  with bedbugs
• Remembering that patient care still comes first
• Treating everyone with dignity and sensitivity
• Tolerating the idea that not everyone considers
  bedbugs a big deal
• Knowing that no one-size treatment fits all
• Accepting that these critters are here to
  staydeal with it and move on!!!!

53
Acknowledgements

• Harvard School of Public Health Website
  WWW.hsph.harvard.edu/bedbugs
• County of San Diego Department of Environmental
  Health Website www.co.san-diego.ca.us/deh/chd/vect
  or/vbedbugs
• Tammy Berkel, Owner, Valley Pest Control
• Mary Rohs, OTR/L, M.Ed., LNHA, SeniorLink Service
  Operations Manager
• Dora Winters, Lead Health Care Tech
• Stephen L. Doggett, Department of Medical
  Entomology, University of Sydney

54
Good Night, Sleep Tight