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Bed Bugs: Coming to a Town Near You?

Presented by:

Kathleen Biddlestone RN, BSN, CDDN Infection Control/Quality Assurance Nurse

Cuyahoga County Board of Developmental Disabilities

Active member of Cuyahoga County Bed Bug Task Force

DDNA, San Diego

April 2, 2016

How Did they Get Here? Have been in existence for thousands of years

Cavemen; Pharaoh; Aristotle WW2 Era 1/3 homes had bedbugs Fairly well eradicated by the 1950’s Use of DDT, Chlordane, Lindane DDT eliminated in 1972 Bedbugs returned in late 1990’s

Why here, why now?

Resurgence due to increase in international travel

FDA bans on pesticides

High tenant turnover

Insecticide resistance

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Orkin Statistics 1. Chicago

2. Detroit

3. Columbus, Ohio

4. Los Angeles

5. Cleveland – Akron – Canton, Ohio

6. Dallas – Ft. Worth

7. Cincinnati

8. Denver

9. Richmond – Petersburg, Va.

10. Dayton, Ohio

11. Indianapolis

12. Houston

13. Seattle – Tacoma

14. Washington, District of Columbia – Hagerstown, Md.

15. Milwaukee

Terminix Statistics 1. Detroit, Michigan (4) 2. Philadelphia, Pennsylvania (1) 3. Cleveland-Akron, Ohio (15) 4. Los Angeles, California (14) 5. Dayton (-) 6. Chicago, Illinois (5) 7. Columbus (8) 8. Cincinnati, Ohio (2) 9. Dallas-Forth Worth, Texas (7) 10. San Francisco-Oakland-San Jose, CA (-)

What are they? External parasites (Cimex lectularius)

Approximately the size of an apple seed Nocturnal, active at night, hide by day Do not fly or jump

Climb on surfaces such as wood, paper, cloth Don’t climb well on smooth surfaces such as glass, porcelain, stainless steel

Bed bugs can travel over 100 feet in one

night, but they tend to live within 8 feet of where their hosts are

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Exoskeleton, 6 Legs, 0 Wings, 2 Antennae, 1mouthpiece

Bedbug Feeding Habits Feed on blood, preferably human, but will feed on

warm blooded mammals

Sharp beak pierces the skin of a host, they inject a salivary fluid containing an anticoagulant that helps them obtain blood Also secrete an anesthetic which numbs the site

Nymphs may become engorged with blood within three minutes Mature bed bug usually feeds for ten to fifteen minutes. After feeding, return to hiding When hungry, bed bugs again search for a host

Bed Bug Trivia

• Bed bugs can ingest seven times their own weight in blood, which would be the equivalent of an average-sized male drinking 120 gallons of liquid.

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How Bedbugs are Attracted to Us

Attracted by heat/CO2/keramones Results in bugs mistakenly attracted to heat emitted by electronic devices

Travel Habits

• Walking

• from room to room

• via pipes, cables, wires, duct work

• down a hallway after dropping off an item

• Hitchhiking

Life Cycle

• Adult female lays 1-12 eggs/day, up to 150/lifetime

• “Glued" to surfaces, along seams, books, piping of mattresses, dresser drawers

• Hatch in 1-2 months, depending on temperature, humidity

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Stages of Bed Bug Development

Adult can live for 12- 18 months

Without a blood meal!!!!

How Do I Know if I Have Them?

• “Equal Opportunity Annoyers”

– Non discriminatory

• Do NOT equal poor sanitation, hygiene, housekeeping

• Do NOT equal low income

– Can’t afford treatment

– More likely to use second hand items

– More likely to live in congregate settings

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Evidence of “fecal spots” on mattresses, bedding, baseboards, outlet covers

Appear reddish brown, but may “redden” if exposed to alcohol

Bites Bite marks on exposed body parts that appear after sleeping

May resemble mosquito or spider bites

May or may not itch

May be in a line or clusters

Not all people will show evidence of bites

Do not have a red spot in

the center, often characteristic

of a spider or flea bite

Joint Statement on Bed Bug Control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and

the U.S. Environmental Protection Agency (EPA)

“Although bed bugs are not known to transmit disease, they are a pest of

significant public health importance.”

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Not an Identified Health Risk

Despite the “ICK” factor, based on research to date

Bed bugs are not known to transmit disease

Diseases have not been known to replicate in bed bugs

Viruses and other agents die in their body South African researchers fed bed bugs with AIDS infected blood, but the virus died.

When fed Hepatitis B infected blood, they retained the virus for several weeks, but when they fed on chimpanzees, virus did not transmit.

“Kissing bugs” and Chagas’ disease

Associated Health Concerns

No significant blood loss

Anemia in long standing, excessive infestations, especially in under nourished populations such as

Infants and the elderly

Anxiety, insomnia, emotional distress

Irritant - asthma

Do not vector diseases

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The War on Bedbugs

Education

Prevention

Tips for travelers

http://bedbugregistry.com/

Isolation/Proper identification

Notification

Monitoring

Integrated Pest Management

Workplace Prevention Strategies

Employee education

Have a PLAN!

Make a protocol!

Be prepared

Residential/Vocational Facilities

Consider using a dryer or hot box for high risk items

Monitor individuals who “dumpster dive”

Monitor staff sleeping areas (OSOC)

Hot wash/hot dry all purchased incoming clothing/soft goods

Monitor after visitations/LOAs

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Inspection/isolation of individual’s clothing & personal belongings, daily upon arrival Hot wash/hot dry clothing Inspect, then isolate personal belongings

(sealed plastic bag, plastic tote) Lunch bags Back packs Purses

Avoid shared spaces, i.e. lockers, closets Consider rights and consents

Encasements Must be sealed tightly Left in place 18 months

Free of rips/tears Interceptors

Keep bed away from wall Avoid dust ruffles Keep blankets/sheets off of the floor

Home Visitation

Dress for the Occasion

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Home Visitation Pre-interview: pets in home, illnesses, chemical treatments in last 2-3 months

Wear simple clothes, avoid accessorizing

Avoid shirts with buttons and pockets

Wear light colored clothes (easier to see)

Avoid cargo pants and cuffed pants

Wear shoes that can be heated in a clothes dryer

Pay special attention to shoes

Use shoe protectors

Home Visitation Don’t sit on beds or upholstered surfaces

Bring in minimal belongings-just the necessities

Hang coats up high, don’t let them drag on floors, or lay on couches/beds

Self inspection prior to entering vehicle

Use a lint roller

Heat treat clothing upon return home

Carry a supply of sealable plastic bags

Keep items off of the floor

Office Buildings/Office areas

Consider changing to plastic or metal chairs

Easier to treat, less hiding places for bed bugs

If there is a bed bug sighting, spray with

alcohol based spray, such as Steri-Fab, or

steam

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Know Your Enemy-Proper ID

Developed by Dr. Susan Jones The Ohio State University Department of Entomology

Monitoring

Placement of monitoring “sticky” traps

Carbon dioxide/lure based traps

Buses

Classrooms

Work lines

NOTIFICATIONS

• Things to consider

– Transportation

– Vocational services

– Residential provider

– Parent/guardians

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• School Letterhead • • • • Date • • • Dear Parent or Guardian: • • This letter has been sent to you in response to a bed bug being found in your child’s classroom. Although it is often very difficult to identify the

source of the bed bug and pinpoint how it was brought into the school, our staff is in the process of conducting a thorough inspection of the school and treating appropriately where necessary. We will continue to monitor the situation and consult with public health and pest control professionals to eliminate any bed bugs in the building and to minimize the potential for future bed bug activity in the school.

• • Although beg bugs are a nuisance, they have not been known to spread disease. Anyone who comes in direct contact with bed bugs or their eggs can

unknowingly carry them into their home or workplace. They are easily spread by moving beds, furniture, luggage, or clothing from one location to another. For this reason, it is important that you inspect your child’s backpack, lunch bag and other items regularly for the presence of bedbugs.

• • Bed bug experts recommend that you routinely check your residence for signs of bed bug activity. Eliminating an extensive bed bug infestation can

be a very challenging and costly process, so it is very important to begin treatments and prevention practices as soon as a problem is identified. • • Bed bugs require blood to survive and reproduce, so they will typically look to bite any areas of exposed skin while you are asleep. The bites may not

hurt at first, but may become swollen and itch a few days later, much like a mosquito bite. Most bed bug bites do not usually necessitate medical treatment. Wash the affected area with soap and water and then apply Calamine lotion to help dry out the bumps and stop the itching. If allergic reactions persist, an antibiotic cream or topical steroid, such as Hydrocortisone, will help take care of the infection. Please contact your physician with specific medical questions.

• • If you have any questions regarding bed bugs or our response efforts, please feel free to contact the Principal or School Nurse. Detailed information

on bed bugs and appropriate control measures can be obtained on the __________________ or _______________________________. Thank you for your assistance in this matter.

• • • Sincerely, • • • • Principal or School Nurse

Barriers to Bed Bug Control

Denial of a bed bug problem/stigma Incorrect identification

Ignorance of bed bugs and Management strategies Do-it-yourself mentality Money Clutter Mental health problems Physical incapacity

IPM- Integrated Pest Management

Environmental Heat Cold

Chemicals

PREVENT REINTRODUCTION

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Environmental Controls Vacuum

• Double bag and discard contents immediately

• May add cornstarch or talc to contents of bag to block breathing holes of bedbugs

Steam

Must penetrate all layers

Why Are They So Hard to Eliminate????

CLUTTER=HARBORAGE

Here’s

One

Reason

Why!

They are

masters at

hiding!

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Increased clutter leads to increased costs

Unusual Bed Bug Hiding Places

A prosthetic leg A casket Dance club 911 call center Washing machine factory Tow boat on the Ohio River Wheel chairs/walkers Gel overlay pads Hair extensions

Treatment Costs

Pest control companies may charge $250-$900 per room treated, with an average of $400-$600, depending on local rates, the level of infestation and the types of treatments used.

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The homeowner or tenant is usually required to do extensive work (cleaning, vacuuming, washing fabric items, etc.) before and after the treatment.

Many infestations need two or three treatments; companies with lower prices may not include these follow-up visits in their quotes.

Very few guarantees.

Total costs for getting rid of bed bugs can range from

$1,000-$10,000

Not a Do-it-Yourself Solution

OTC sprays (hardware stores/big box stores)

Must be sprayed directly on the bed bugs

Only ‘kills on contact’

Little to no residual activity

Avoid use of “bug Bombs”

Most bugs are hiding and WILL NOT be

killed

Treatment Basics Chemical Treatment

No single “magic bullet”.

Usually takes multiple treatments, 10-14 days apart.

Use multiple formulations, and often, different insecticides.

Residual insecticide is necessary.

Rotate insecticide use.

Can’t be used on clothing or bedding.

Residents often have to relocate

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Heat Treatment

• Heat entire unit to 135°

• 6-8 hour process

• Probes to monitor temperatures

• Higher cost

• No residual, so often accompanied by chemical treatment

Heat Treatment Requirements

• Monitors in the 4 corners of treated rooms

• “Clock” starts when all 4 reach 120 degrees

• Minimum of 3 hours in critical rooms

• Minimum of 1 hour in adjacent rooms

Discarding

• Not necessarily the solution, as bedbugs can be present in remaining items

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Fumigation Boxes (hard goods) Read and follow manufacturer’s directions Off label use (research in progress) Avoid use in food prep areas Avoid use around pets or children Make or purchase a box or tote Add Nuvan strip Seal tightly Keep outdoors Allow contents to fumigate

HEAT -122 º

YOUR BEST WEAPON!

Dryer heat

30-60 minutes highest heat

Steam

Dry clean

COLD

Much less effective

0º F for at least 4 days

Freezer

Garage

Cold must penetrate all areas of item

Where Do I Begin????

• Guidelines for Prevention and Management of Bed Bugs in Shelters and Group Living Facilities http://www.nysipm.cornell.edu/publications/bb_guidelines/

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Not a War to Fight on Your Own

2 Men Start

Fire Trying to

Get Rid of

Bedbugs

References

• (2013). Retrieved January 17, 2014, from http://www.cuyahogabedbugs.org/ • (2012). Retrieved January 14, 2014, from http://centralohiobedbugs.org/ • (2016). Retrieved February 18, 2016, from http://www.pestworld.org/pest-guide/bed-bugs/ • (2015, December 18). Retrieved February 17, 2016, from http://www.epa.gov/bedbugs • (2008). Retrieved February 1, 2016, from

http://www.nysipm.cornell.edu/publications/bb_guidelines/ Guidelines for Prevention and Management of Bed Bugs in Shelters and Group Living Facilities

• (n.d.). Retrieved February 12, 2016, from http://www.nyc.gov/html/doh/downloads/pdf/vector/bed-bug-guide.pdf Preventing and Getting Rid of Bed Bugs Safely

• [Video file]. (2011, April 17). Retrieved January 15, 2014, from https://www.youtube.com/watch?v=ytTnLOgyEgs&feature=youtu.be How Bed Bugs Find Us.

• [Video file]. (2012, November 28). Retrieved January 14, 2014, from https://www.pctonline.com/video/Jones-bed-bug-bugbombs Update on Bed Bug 'Bug Bombs' from Dr. Susan Jones

•

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Thank you and…..

• Good Night

• Sleep Tight

• Don’t Let the Bed Bugs Bite!