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