Bedbug Information and Guidance Bedbugs bite exposed skin of sleeping humans to feed on their blood. Decades ago, bedbugs were eradicated from most developed nations using DDT — a pesticide that has been banned due to it’s toxicity. The risk of encountering bedbugs increases if you spend time in places with high turnover rates of nighttime guests — such as hotels/motels, hospitals, homeless shelters, or other group living environments. Bedbugs are reddish brown, oval and flat, about the size of an apple seed. During the day, they hide in the cracks and crevices of beds, box springs, headboards and bed frames. If you have bedbugs in your home or healthcare organization, professional extermination is recommended.

Bedbug Information and Guidance It can be difficult to distinguish bedbug bites from other insect bites. In general, bedbug bites frequently are: Red, often with a darker red spot in the middle Itchy Arranged in a rough line or in a cluster Located on the face, neck, arms and hands Some people do not have reactions to bedbug bites, while others may experience an allergic reaction, which may include severe itching, blisters, or urticaria. What can the patient do? Prepare a list that includes: A detailed description of symptoms History of recent travel History of recent hotel/motel/shelter stays All medications and supplements being taken If bedbugs are suspected, immediately notify the healthcare team of the source and inspect the facility. The patients must also inspect their homes, mattresses, furniture, and bedding brought to the facility for the insects. This inspection may need to be conducted at night when bedbugs are active.

Bedbug Information and Guidance Potential treatments for bites. The itchy red spots associated with bedbug bites usually disappear on their own within a week or two. A patient’s speedy recovery may be enhanced by the application of: A skin cream containing hydrocortisone An oral antihistamine, such as diphenhydramine (Benadryl) If you develop a skin infection from scratching bedbug bites, the doctor may want to prescribe an antibiotic. The resurgence of bedbugs in developed countries may be linked to: Increased International travel Changes in pest control practices Insecticide resistance Where do bedbugs hide? During the day, bedbugs hide in the cracks and crevices of: Mattresses Box springs Bed frames Headboards Under peeling paint and loose wallpaper Under carpeting near baseboards Upholstered furniture seams Under light switch plates or electrical outlets

Bedbug Information and Guidance How do they spread? Bedbugs do not usually stay on their human hosts after their meal, but they might take refuge and travel in the seams and folds of luggage, overnight bags, folded clothes, bedding, furniture, and anywhere else they can hide. Most people do not realize they can transport stow-away bedbugs potentially infesting new areas. If you travel or frequent group living environments, bedbugs could get into your luggage and/or bags and you may be providing passage for these insects to uninfested areas. While bedbugs may hitchhike on a persons belongings, they can also crawl about as fast as a ladybug. So they can easily travel between floors and rooms in hotels/motels, group living conditions or any place where bedding may be present. Preventing Infestations Inspect secondhand items such as used mattresses, upholstered furniture, and bedding carefully before bringing into your home and potentially cross infesting the dialysis facility. Hotel/Motel/Shelter or Group Living precautions. Check mattress seams for bedbug excrement and place luggage or bags on tables or dressers instead of on the floor.

Bedbug Information and Guidance Sign of uncleanliness? Bedbugs do not care if their environment is clean or dirty. All they need is a warm host and plenty of hiding places. Even pristine homes and group living environments can harbor bedbugs.  Bedbugs are more common in crowded living environments that experience high turnover in occupancy, such as: Apartment complexes Dormitories Homeless shelters Hotels/Motels Most bedbug bites require no medical treatment. You may want to consult the physician if you suspect an allergic reaction or develop a skin infection after scratching the bites.

Bedbug Information and Guidance Look for these signs: Dark specks. Typically found along mattress seams, these specks are bedbug excrement. Empty exoskeletons. Bedbugs molt five times before becoming adults. These empty skins are light brown. Bloody smears. You may find small smears of blood on the sheets where you accidentally crushed an engorged bedbug. Treating your Home and/or Healthcare Facility. Once the patients immediate symptoms are treated; the underlying origin must be identified and treated professionally to eradicate and prevent cross infestation. This may include a combination of pesticides and nonchemical treatments. Nonchemical treatments may include: Vacuuming. A thorough vacuuming of cracks and crevices can physically remove bedbugs from an area. But vacuum cleaners cannot reach all hiding places. Hot water. Washing clothes and other items (bedding) in water at least 120 F (49 C) can kill bedbugs. Clothes dryer. Placing wet or dry items in a clothes dryer set at medium to high heat for 20 minutes will kill bedbugs and their eggs. Freezing. Bedbugs are also vulnerable to temperatures below 32 F (0 C), but you would need to leave the items outdoors or in the freezer for several days.

Bedbug Information and Guidance Some professional exterminators use portable devices to raise the temperature of a room to a lethal temperature. All stages of bedbugs can be killed at 122 F (50 C). In some cases, you may have to throw out heavily infested items such as mattresses or couches.   References: Centers for Disease Control and Prevention and U.S. Environmental Protection Agency. 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). Atlanta: U.S. Department of Health and Human Services. (2010). Retrieved from: http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm Eiston DM, et al. Bedbugs (n.d.). Retrieved from: http://www.uptodate.com/home/index.html Bed bug information. Environmental Protection Agency (EPA, 2012). Retrieved from: http://www.epa.gov/pesticides/bedbugs