By Paul Curtis / Special to Healthcare Facilities Today

After decades of relative obscurity, bed bugs (Cimex lectularius) re-emerged in a dramatic fashion, and infestations have become increasingly common. Bed bugs can now be found in almost every part of the country, and in any place that humans frequent.

This includes environments that may not typically be associated with bed bugs, such as public transportation, workplace settings, theaters, and even health care facilities. Unlike other pests, bed bugs are not a product of sanitation concerns. However, health care facilities experience significant human traffic, and contain personal belongings, equipment, furnishings and décor that provide harborage near potential hosts. This combination puts health care facilities in the “high risk” category for bed bug infestations.

What is the challenge?

Bed bugs are legendary for their ability to adapt. They build resistance to control products, and can escape detection by hiding for extended periods of time after feeding, laying eggs and waiting for another host. Moreover, they receive significant attention from the media and concerned families when they show up.

If cryptic behavior, control resistance and low public tolerance thresholds were not enough, new data may indicate that bites can be more problematic than first thought. Modern medical data suggest that repeated exposures to bed bug bites can cause escalating reactions, including serious reactions that are systemic in nature—although research has been limited. This information might be particularly critical in health care settings, where patients may not be as aware or able to avoid them.

In the process of feeding, bed bugs secrete substances, some of which may numb the bite area and slow blood clotting to facilitate feeding. Immunological responses to these salivary proteins can present in a wide range of symptomologies. Many people seem to have no visible reaction to bed bugs. Others may just experience some itchy red spots similar to a mosquito bite. Reactions can be delayed for 5 to 10 days for those who do present symptoms after a bite. Because of delayed bite reactions, bed bugs may get a head start on efforts to find and control them.

In some instances, especially where the host has been bitten repeatedly over time, reactions can change and even become dangerous. One study (1) showed that 18 of 19 individuals had a skin reaction after repeated controlled bed bug exposure. With the repeated exposure, the latency between the bite and the skin reaction decreased from about 10 days to just a few seconds.

New research published in Austral Entomology also focused on the effects of repeated bed bug bites on humans. The article documented the physical responses of two patients who were repeatedly bitten by bed bugs, including one who fed 40-50 bed bugs in one sitting and another who had fed five to six bed bugs after several previous encounters with the pests.

Both patients developed symptoms include itching, swelling, sweating and, in the second patient, even breathing difficulties. In both cases, medical attention was required to resolve the symptoms. These findings contradict conventional thinking about bed bugs that indicate bites do not cause serious health concerns.

What can health care facility managers do to prevent bed bug concerns?

The first step is education. It’s important to understand that bed bugs are attracted to a host, and are transported primarily by people and their belongings. Therefore, populations of bed bugs in a particular facility have more do with the patients, visitors, vendors and staff of an organization than the structure itself. 

Facilities managers should have a published bed bug protocol, and staff should be trained to recognize bed bugs and evidence of their presence. It’s important to implement a regular detection and monitoring program in areas that are most prone to bed bugs, such as lounges, patient and family waiting areas, storage areas for housekeeping and laundry areas.

Intake procedures to screen incoming clients and bag their belongings may also help. Items suspected of infestation should be contained until they can be removed, sanitized or disposed of. Helpful preventative strategies include regular vacuuming or steam cleaning areas prone to bed bugs, such as under and around beds, upholstered furniture and at wall/floor junctions. As always, managers should ensure clutter, cracks, crevices and holes near beds are taken care of efficiently.

Practical guidance for control

If bed bug activity is detected or suspected, try to get specimens for professional identification. If bed bugs are confirmed, the room should be taken out of service and patients relocated. Staff should inspect personal items for bed bugs before moving patients to a new room.

Medical equipment, including wheelchairs, IV stands and beds should be left in the room unless they can be verified as free from bed bugs and eggs. A pest management professional (PMP) should inspect the suspect room, adjacent rooms, the patient’s new room, all furniture and equipment, and lounge and public areas the family may have been using.

Bed bugs are notoriously difficult to eliminate and are often found in locations that make them difficult to detect without the help of a professional. Each situation, even from one room to another, may require different actions to provide control. Follow-up visits are often required to confirm that an infestation is completely resolved. Because there is no cookie-cutter solution for all infestations, consultation with a professional pest control company is critical to establishing the required control actions.

Bed bug service in health care facilities must take into consideration the potential health impacts of insecticide on residents and patients. Emphasis should be on nonchemical methods, wherever practical. If insecticides must be used, the PMP should use only those products and methods approved by the facility, and only in unoccupied rooms. Untrained staff should never apply insecticides to control bed bugs.

Freeze treatment, which uses carbon dioxide converted to a dry ice “snow,” is a popular and ecofriendly method to freeze bed bugs and their eggs and nymphs on contact. It is nonresidual and kills all stages of bed bugs. There is no need to move furniture or electronics. The snow is nontoxic, leaves no mess or stains, and may be safely used on most surfaces.

In working with a service provider, ensure that steps are taken to reach a timely resolution. Take the initiative to find out the PMP’s preparation requirements and plan ahead. Most providers have a written checklist to help prepare facilities for treatment. It is also important to communicate any known situations, such as respiratory problems or chemical sensitivities, to the professional prior to service.

Communication is key

Much of the attention bed bug activity gets from the community and the media is due to uncertainty. Successful strategies include establishing and following proactive policies, and being vigilant in training and communicating with staff and residents.

Letting others know that the facility has considered the possibility and is prepared to respond to these types of issues in an appropriate and timely manner does much to build confidence among the public. It is also important to avoid stigmatizing patients, family or staff, even if they are suspected of having brought bed bugs to the site, and to focus on positive actions to resolve any concerns.

Paul Curtis is a board-certified entomologist, In his role at Terminix, he has collaborated with leaders in the entomological, medical and pest control fields to protect both businesses and homes.

 (1)   Sensitivity to bites by the bed bug, Cimex lectularius.

Reinhardt K, Kempke D, Naylor RA, Siva-Jothy MT.