Shining a light on these Nocturnal
parasites
Cindy Thistel RN, MSN, CIC
Manager, Infection Prevention and Control
Littleton Adventist Hospital
Purpose
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As an emergency first responder, bed bugs are
part of your future.
– Infestation is on the rise in the U.S. and
– EMS personnel need to know about bed bugs to avoid
picking them up on clothes and transporting them
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We will explore
– Key facts about bed bugs
– Become familiar with what they look like
in a variety of environments
– How can we focus on patient care and still
protect EMS personnel from picking them up?
– How do we keep emergency medical facilities and
transport vehicles from becoming infested?
Where did the saying come from?
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One theory…..Mid 1600's, the Spanish settlers of
St. Augustine Florida made their beds from a wood
frame with rope crossing the frame to hold the
mattress.
Their bedding was stuffed with moss and other
plant materials that had bugs in it. Therefore, it
was very common to get bitten by bugs when you
were asleep in your bed....
Hence, "Good night,
sleep tight, don't
let the bedbugs
bite....”
Why Resurgence?
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Exact cause not known… Experts suspect the
resurgence over last 10 years is associated
with…
– Increased international and domestic travel
– lack of knowledge necessary to
prevent infestation
– Increased resistance
of bed bugs to pesticides.
– Currently no OTC pesticide that kill bed bugs
What is being done about the resurgence?
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CDC, EPA, and other federal agencies are working
closely with state, tribal and local health departments,
academia and private industries to monitor and better
understand the recent resurgence in communities
throughout the U.S.
– CDC partnering with experts in areas of medicine,
entomology, epidemiology and environmental toxicology
to better understand resurgence and the methods and
tools needed for control
– EPA’s primary responsibility is to ensure
the safety and effective use of pesticides
– Other federal agencies such as HUD are involved in
research and education about bed bugs.
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Public Health Departments provide education on prevention
Top 10 Bed bug infested Cities in
North America?
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In early July 2010, Insight Pharmaceuticals,
makers of Pronto Plus, an over-the-counter
bedbug insecticide, wrote that Denver was
sixth on the list!
Sept 2010 - Denver Public Library had
to destroy 31 rare books that
were hundreds of years
old after a recent infestation.
– Had to fumigate four areas of its
Central Library
What are bed bugs?
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Blood-feeding insects that prefer human blood
Do not transmit or spread disease
Usually feed every 5-10 nights (young 3 min &
adults 10-15 minutes)
Adults are 1/4” long, flat, oval, and have no wings
Lives about 1.5 years
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Generally brown in color except after a blood meal.
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Eggs are about 1/25th” long
Fastened to cracks, crevices or rough surfaces
The eggs hatch in one to three weeks.
What are bed bugs?
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Bit is usually not felt - as they feed they inject an
anesthetic and anticoagulant into their victim.
Injected fluid often causes the skin to itch and become
swollen. Scratching causes sores which may become
infected.
Most infestations are only noted after bites appear.
No bites Doesn’t Necessarily Mean No Bugs
 Study
showed bites are NOT a good
early indicator
– Introduced each of 900 volunteers to 1 to 3
bed bugs from a lab colony for a feeding
 Almost
immediately, 3.7% reacted with mild to
serious skin irritation
 Within 18 days, an additional 0.8% exhibited some
level of reaction
– Total was only 5% reacted
– Elderly have diminished response to skin
irritants-less likely to exhibit a reaction
Why do they like us so much?
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We have less hair than most mammals.
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Heat – Our bodies emit it.
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Carbon Dioxide – We exhale it.
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Perspiration – Still unclear but it’s believed
that there may be a compound in our
perspiration that attracts bed bugs.
Why do they like us so much?
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We’re Convenient - Human dwellings and
gathering places give bed bugs a perfect
combination of a…..
– Reliable and convenient food source
– cooler spots nearby to live and hide such as
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Mattresses
Box springs
Behind wooden
headboards & Pictures
Couch cushions
Furniture
Carpet
Baggage
Boxes
Clothing
Wall paper
Where can you find them?
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Their presence is NOT an indication of socioeconomic
level or hygiene … can happen to anyone!
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VERY successful at hitchhiking and hiding. Most
hitchhikers are females.
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Hotels, Theaters, Apartments, Homes, Cruse ships,
Airlines, close sleeping quarters
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Can be located in any area of your home, but they
are most commonly found close to their host within
8 feet
Resilient - can survive for
10 months to a year
without feeding.
Where can you find them?
Knowing What to look for is the 1st step?
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Fecal Spots –
Dots of dried
blood along mattress
seams, the box spring,
behind the headboard,
or anywhere
else bed bugs harbor
Knowing What to look for is the 1st step?
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Cast Skins–These appear
to be hollowed out bed
bugs and are the sheds
from the nymphal stage
Eggs – About 1mm long
and rice shaped these
can be difficult to see
Severe bed bug infestations
tend to have a sweetish,
foul odor which is caused
by an oily liquid they emit.
Mattresses
Carpet Infestation
Furniture Infestation
Under Picture & Wall socket
Preventing Home Invasion
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Think twice before combing the alleyways and
resale stores for a bargain. Check second hand
furniture before bringing home
Use a protective cover to encase your mattress and
box springs.
Eliminates hiding places by reducing clutter
May need to dispose
of items
Preventing Home Invasion
 When
traveling:
–Hotels:
Use
luggage racks to hold luggage
rather than setting on floor or bed
Check the mattress and headboard
before sleeping
Upon returning home
– unpack directly into the washing machine
– Inspect your luggage carefully
Prevention is Important
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Presence of bed bugs is not an indicator of
poor sanitation…
BUT……..pests of
any kind are
accompanied by
perception of being
“dirty”. Can damage
a reputation!
Prevention is the key to avoiding bed bug
problems, therefore we need to be
proactive to keep them from entering our
transport vehicles and facilities.
Acute Care Hospitals are a Less conducive
environment for bed bugs…..
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Quick patient turnover
Clinical beds have metal
frames (no crevices).
Plastic-covered mattresses and pillows
prevent bed bugs from reaching porous
areas to live in.
Ripped and torn mattresses must be
replaced IMMEDIATELY!
Acute Care Hospitals are a Less conducive
environment for bed bugs…..
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Stringent cleaning practices create a hostile
environment for pests and is most likely to keep
them from spreading to other rooms.
We routinely place a patient
belongs in a plastic bag.
Can happen more easily in maternity, hospice, long
term patient care and psychiatric units
– Why… they are more likely to bring luggage, bedding and
other personal effects and stay a longer period of time
How can we focus on patient care and still
protect EMS from picking them up?
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Your Role….avoid picking up bed bugs and
transporting them
Wear simple clothing
– Avoid shirts with buttons and pockets
– Avoid pants with cuffs, cargo pockets
and multiple zippers
– Simple shoes with minimal threads (can be put
in hot dryer)
 Tuck
pant legs into your socks or boots
How can we focus on patient care and still
protect EMS from picking them up?
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When entering an establishment, have a team
member on bed bug alert
If bug evidence is found have a code
word to warn colleagues.
Have large plastic bag available
to put on floor to kneel on for
patient care
Set all equipment down
on the plastic
How do we keep facilities and transport
vehicles from becoming infested?
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Always avoid placing your medical bag on
upholstered furniture, bedding or on
carpeted floors.
If you think your equipment has been
infested you can bag it in the plastic bag
on the way out for later cleaning
How can we focus on patient care and
still protect EMS from picking them up?
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Avoid using the patients' own sheet as a sling to
move patients
Have plastic sheeting or body bags in
vehicle
Do not transport the patient’s bed linens
If obvious infestation, put on bunny suit and put
clothes in plastic bag before entering cab
Bag all equipment that went into home in plastic
and tie off.
If any Suspicions???
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Communicate
suspicions to ED
Clean and disinfect
ambulance. Observe
for bed bugs
Open any equipment
you bagged, inspect
for bed bugs and
disinfect
If any Suspicions???
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Place all patients clothes and belongings in
plastic bag and send home with family
– Clothes must be placed in hot dryer for 30
min….including shoes
– Family can inspect personal belongings
carefully for bugs
Have Patient shower and provide fresh
clothing. Place them in a another clean
room and
 Close off original room. Have ES inspect
closed off room
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Detection: May need to call in a
Professional
 Bed
 Pest
bug detecting dog
Management
Professional
Getting Rid of them?
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Call in a professional if your not sure.
Professionals have chemicals, High heat
and freezing methods.
If in mattress, soft furniture or carpet…
vacuum then steam clean
For clothing that can take the heat, launder
in HOT water and dry in dryer. Combo of
heat and soap will kill the bugs and remove
eggs. Otherwise dry cleaning.
Wash down walls/crevices and floors with
91% isopropyl alcohol (spray bottle)
Questions?
KNOW THE ENEMY
Bed bugs leave tell-tales signs such as blood
stains near the bite site.
 Dark deposits (fecal spots) occur on sheets,
mattresses and & walls
 In severe infestations, a sweet, musty odor
from the insects’ scent glands may be
present.
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Sleep Tight, Don’t let the
Bed Bugs Bite!