Maintaining year-round vigilance against bed bugs

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Eric Braun
Eric Braun

During the summer months, many industries become increasingly concerned with potential bed bug infestations. The uptick in travel in the U.S. during this time is a key driver for spreading infestations, as travelers frequently pick up and/or leave bed bugs behind during hotel stays. Those in the long-term care industry don't have the luxury of this shortened exposure period.   

Regular resident turnover throughout the year means there's a persistent threat of bed bugs and/or their eggs hitchhiking in on their luggage and other personal belongings. In addition, the constant flow of visitors puts long-term care facilities at risk, as bugs and eggs can stow away on their clothing or personal items.

Knowing that long-term care facilities are vulnerable to bed bug infestations year-round, there are a few things to keep in mind that will help caregivers and other staff identify a potential problem before it spreads. It's important to know that looking for bites on residents is not a reliable way to monitor for a bed bug problem. Some people will have no visible reaction, and for those who do develop a reaction, it's not possible to distinguish bed bugs bites from the bites of other, more common insects.

There are several elements to look for that are strong indicators of a bed bug infestation. These signs can be found on mattresses along the seams, tufts, and under tags; in box springs; on upholstered furniture and anywhere else people spend an extended period of time sleeping or sedentary. The best indicators of bed bugs include:

  • Fecal spotting – Bed bug droppings resemble markings from a fine-tipped marker and can be observed as spots or streaks on fabric surfaces. Less commonly, the digested blood left behind by bed bugs can bead up and dry into small specs on hard surfaces. Fecal spotting is the most prevalent and easiest sign to observe.

  • The bugs themselves – Adult bed bugs are approximately 5mm long, similar in size to an apple seed.  Bed bug nymphs vary in size and are usually pale tan in color.  Sometimes a deep red spot can be observed in the gut of bugs that have recently fed.

  • Cast skins – As bed bugs progress through their life stages, they shed their skins and leave them behind in areas where an infestation is present. These skins range in color from tan to brown and may look like small insect shells.

  • Blood spots – Extended or chronic contact with bed bugs may cause tiny spots of blood on bedding or on furniture where a resident spends time sleeping. Bed bug bites are slow to scab because the bugs inject an anticoagulant when they bite.  This can cause tiny droplets of blood to form on the surface of the skin after feeding has completed and the insect has returned to its hiding place.

While education and being able to identify the signs described above are helpful ways for staff members at long-term care facilities to remain vigilant, the best practice for keeping bed bug infestations at bay is through regular inspections performed by a trained professional. A professional with a bright flashlight is capable of spotting signs of infestation that an untrained eye is likely to miss. Pest management professionals can even utilize specially trained dogs to sniff out live bugs and viable eggs in places that are difficult to inspect visually. This is especially efficient for large facilities, as a canine team trained to identify bed bugs can inspect room-by-room much faster than even the most experienced human.

If staff members do observe signs and suspect a bed bug infestation, it's important to bring in a trained professional as soon as possible; self-treating is not an effective or recommended course of action. Applying insecticides containing repellents probably won't kill all the bugs, and may force any surviving bugs into atypical locations, making them more difficult to find and treat. 

If a facility identifies an infestation in a piece of furniture, it's imperative that the staff does not compound the problem by moving these infested items to another room.  Moving contaminated items can spread infestations via bugs and eggs hiding or contained within. If staff does believe it's necessary to dispose of furniture or personal items that show signs of an infestation, the best protocol is to wrap those items in plastic or place them in an industrial trash bag, prior to removing them from their original location.

Pest management professionals can use a variety of techniques to treat a bed bug infestation, ranging from insecticides to less disruptive methods. The use of heat to control bed bugs has been recently adopted by the pest management industry, has been shown to be highly effective at killing all life stages of bed bugs, and is now recognized as one of the most effective treatment solutions available. Heat is used to treat bed bugs in many ways, such as in clothes dryers for clothes and bedding, steamers for upholstery and mattresses, and in the form of heat chambers and portable heaters for furnishings or entire rooms.

Heat treatments offer certain advantages when compared to conventional insecticide treatments. Heat is non-toxic and kills all bed bug life stages, including eggs. Heat can penetrate even the tiniest bed bug hiding places, (ones that are easily overlooked during conventional treatments), and also treats fabrics and upholstery where insecticides cannot be applied.  Heat alone has no long-lasting, residual activity, which means bed bugs can re-infest the item or area following the treatment. Still, when done properly and carefully, heat can eliminate a bed bug infestation in one treatment, and a professional can conduct a follow-up inspection to make sure the infestation has been fully eliminated.

While bed bugs have made a strong comeback in recent years, infestations are uncommon in most areas. Still, due to the difficulty and cost associated with treating, constant vigilance is important. Identifying the signs of an infestation early and bringing in professional help before the problem becomes widespread will minimize the headache involved in dealing with this troublesome pest.

Eric Braun is a board-certified entomologist and the manager for Rentokil Steritech's bed bug line of business. He is an expert in detecting and treating bed bugs in residential and commercial settings.


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