Adebisi Adeyeye, RN,MPH, CIC
Montefiore Medical Center
APIC Greater New York Meeting
February 16, 2011

 Nothing to disclose.

 Review history and resurgence of
Bedbugs.
 Examine biology of Bedbugs.
 Discuss impact on Public health and
Infection Control.
 Explain Prevention and Control Methods.

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Past several decades, most countries have been bed bug free, and many have never seen bed bugs.
 Many have forgotten the popular bedtime phrase,
“…sleep tight, don’t let the bed bugs bite!
(Michigan Department of Community Health, 2010).
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Recently have made a dramatic resurgence.
They don’t discriminate.
 Difficult to control.

Source: Michigan community health department, 2010

 Occurs Worldwide.
 Evolved from cave in the Middle East.
 Originally fed on Bats.
 Equal opportunity pest requires warm, sleeping body.
 Not caused by lack of cleanliness.

 85 species belonging to the family Cimicidae in the insect order Hemiptera (“true bugs”).
 All Hemiptera (piercing mouth parts)suck on juice, inserts and blood of vertebrates.
 2 species known to bite humans:
 Cimex lectularius Linnaeus.
 Cimex hemipterus Fabricius. (tropical).

 Infested areas have sweet musty odor form the glands.
 Distinguished from similar insects:
 Extreme dorsal-ventral (back-stomach).
 Flattening, lack of wings.
 And reddish brown coloration.
 About seven (7) mm in length.

 Five nyphmal (immature)stages before molting to an adult; last 4-24 days.
 Requires one meal time during the stages.
 Adult feed every 3-7 days.
 Females must mate to lay eggs.
 Traumatic insemination.
 Produces over 500 eggs in their life time.

Source: Michigan community health department, 2010

 Normally feeds at night or early morning.
 Uses heat and carbon dioxide sensors.
 Recognize human hosts through olfactory
(smell) receptors on their antennae and mouthparts.
 Feed 3-15 minutes, then leave the host.
 Saliva contains anesthetic agent, so the host is unaware of the bite.

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Not known to transmit but pest of significant public health importance.
Blood -sucking ectoparasites (external parasites) similar to head and body lice.
Bed Bugs have variety of negative consequences:
 Physical Health
 Mental Health
 Economic Burden

 Bite often similar to mosquito bite in appearance –
“wheal and flare” reaction.
 Reaction varies by individual.
 Allergic reaction to injected saliva.
 Most common on exposed skin.
 Differential diagnosis – true confirmation by specimen collection, identification.
 Secondary infections of the skin such as impetigo, ecthyma, and lymphanigitis, cellulitis .

Source: Michigan community health department, 2010

Source: central Ohio.org

Source: Michigan community health department, 2010

 Bed bugs affect the mental health of people living in infested homes leading to:
 Anxiety, insomnia and Sense of shame
 Emotional distress, panic, and stigma
 Family disruption – stress, financial, and relocation.
 Decreased quality of life for entire household.

 Potential for misdiagnosis, incorrect treatment.
 Discomfort, distraction.
 Sleep deprivation, daytime drowsiness.
 Symptomatic Treatment.
 Prevent Secondary Infection.

 Great economic burden on the society.
 Exact dollar amount cannot be quantified.
 Economic losses from health care, lost wages, lost revenue and reduced productivity can be substantial.
 Cost of effectively eliminating bed bugs significantly more than the cost of eliminating other pests; bed bug are difficult to control.

 Desperation leading to drastic measures:
 Use of dangerous chemicals and Improper use of chemicals.
 Loss of household property.
 Barriers for many families and hospitals:
 Limited finances, Numerous treatment
 Need for long term surveillance

 Identification is important in treatment
 Inspection: Inspecting corners of bed, sleepers.
 Tools needed: Flashlight, Magnifying glass, container jars and Forceps, tweezers, or a thin probe to help collect specimens.
 Credit card: a thing long triangular piece of an old credit cart.
Michigan State, 2010

Michigan State community health Department, 2010

 Several companies now offer bed bug detection using dogs, specifically trained for locating bed bugs.
 The dogs are a highly efficient and sensitive tool, but not100% accurate. A 2-dog system is sometimes used to reduce the problem of “false positives”.
 The dog handler team should be recognized by a certifying organization: National Entomology
Scent Detection Canine Association.

Source: Bell Environmental


Control requires a significant investment of time and resources.
 Multiple techniques and multidisciplinary approach are required and effective.
 Elimination of a bed bug infestation is achievable.
 Developing policies and a sound plan.
 Effective communication with staff about the problem is very important.

 Educating staff and patients about bed bugs and how to prevent them.
 Several facts sheet available on bed bugs:
 CDC , New York state, Ohio state, Michigan
State.
 Isolation Precautions
 Contact Precautions

Components of a sound treatment plan include:
 Education.
 Identification.
 Isolation precautions.
 Treatment (both non-chemical and pesticides).
 Post-treatment Assessment
 Customer service and service recovery for patients

 Place clothes, shoes, pillows, and bedding into large clear plastic bags and seal them tightly .

 Launder all clothing and bedding (use the highest heat settings for washing and drying if possible).
 Vacuum carpet.
 Dispose infested items: before discarding wrap in plastic and label infested with bed bugs.


Chemical Methods
 Pesticides are an important tool in the fight against bed bugs
 Misuse a potential Public health concern
 Not recommended in health; resistance a concern
 Non-Chemical Method
 Steam treatment
 Thermal Remediation Using Ambient Heat
(Convection Heat)
 Freezing and the Use of Dry Ice or Liquid CO2

Source: Bell Environmental

 Identify the problem.
 Multidisciplinary approach.
 Communication! Communication!
 Human resources Involvement.
 Risk management involvement.

Workman’s compensation.
 Difficult problem, No easy answer.

 Controlling bed bug infestation is challenging.
 Limited resources to combat this problem and bed bugs frequently are not seen as a priority.
 Potential of infestation at staff house.
 Litigation.
 Huge expenses for treatment: $1,0000 per treatment/ room.
 Several Treatment necessary.

OBSTETRICAL
PATIENTS
VISITORS &
FAMILIES
Family Centered Care
Rapid/Constant Turnover
Community Infestation
Overnight
Sleeping Personal Bedding –Pillows/Blankets
Excess Clothing/ Lack of Storage
BED BUG
INFESTATION
Inappropriate Sleeper
Beds
Increase Clutter In
Patient Rooms
Unawareness of Community
Infestation
Movement of Furniture Between Rooms
ENVIRONMENTAL
PERSONNEL
Lack of Vigilance
Source: Adeyeye et.al, 2009


Bed bugs are here to stay.
 Resistance is a very huge problem.
 Knowledge of the best practice to prevent and control bed bug infestations is essential.
 Coordinated community efforts is necessary to eliminate the problem.
 No one can solve the problem alone: seek help.
 Expensive: A million dollar problem!!!!

???????
Thank you
Questions

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Adeyeye, A., Adams, A., Herring, L. & Currie, B. (2010). “Bed Bug Infestation on A Maternity Unit in a
Tertiary Care Center” Presented at the fifth decennial International Conference on Health Care Associated
Infections March 18-22, 2010.
Central Ohio Bed Bug Task Force Information (2009, April). Guidelines for Reducing the Risk of
Transporting Bed Bugs Retrieved from http://centralohiobedbugs.org/ .
Centers for Disease Control and Prevention (2011). Bed Bugs. Retrieved from http://www.cdc.gov/nceh/ehs/Topics/bedbugs.htm
Cornell Bed Bug Guide(2010). Retrieved from http://www.nysipm.cornell.edu/publications/bb_guidelines/
Michigan State Department of Community Health. (2010). Retrieved from http://www.michigan.gov/bedbugs .
Rossi, L., Jennings, S. (201o). Bed Bugs: A Public Health Problem in Need of a Collaborative Solution.
Journal of Environmental Health. 72(8): 34-35.