1. BEDBUGS NOT JUST IN NURSERY RHYMES ANYMORE!!!! Nancy Boggs, RN, BSN, MA, LNHA Off-Site Supervisor TriHealth SeniorLink

2. A FEW BEDBUG FACTS A FEW BEDBUG FACTS  Official name is Cimex Lextularius  Small, wingless insect AKA “Red Coats”, “Chinches”, or “Mahogany Flats”  Came to North America in the 1700’s from Europe  Feed solely on the blood of warm-blooded animals preferably humans.  Were very common in the United States before WWII.  Largely eradicated in the 1940’s and 1950’s through the use of DDT  Resurgence worldwide--especially in North America, Europe and Australia  According to the CDC are not known to cause serious illness  Very difficult and expensive to eradicate!!!!!

3. Cimex Lectularius

4. Side View

5. How Can I Identify a Bed Bug  Hatchlings are size of poppy seeds  Adults are about ¼ inch long, oval, flat  Light tan to deep brown or burnt orange  Cast skins of bed bugs are often present  Do not fly but actively seek shelter when disturbed

6. Bedbug Nymph

7. Relative Size of a Bed Bug

8. Burnt Orange Specimen

9. Mattress Binding with Cast Skins

10. Bedbug Colony

11. Are Bed Bugs Harmful?  Seek out people and animals at night  Painlessly sip blood and inject tiny amount of saliva  Sensitivity to the saliva over time causes allergic reactions (bites)  Itching and irritation can lead to secondary infections which can be serious  Hard to distinguish from other insect bites without knowledge of person’s home environment  Often treated with antihistamines and corticosteroids  Do not transmit any infectious agents

12. Bed Bug Bites

13. Typical Presentation

14. Raised Bumps and Welts

15. Inflamed Foot

16. Subtle Allergic Reactions

17. Lower Leg, Ankle and Foot

18. More Severe Reaction

19. Infected Lesions in Trunk Area

20. Raised Welts

21. Scalp Lesions

22. Severe Reaction and Infection

23. Bed Bug Life Cycle  Females lay 1-12 eggs per day  Eggs coated with sticky glue that helps them lodge on rough surfaces or cracks and crevices  Eggs hatch in 6-17 days as nymphs  Nymphs have different stages each requiring a blood meal  Reach adulthood in 5 weeks to 4 months  Can live from 12-18 months with over 3 generations per year

24. Bedbug Eggs

25. Bed Bug Life Cycle

26. Eggs Shells and Fecal Matter

27. Bed Bug Nymph There are five instars or molts

28. Exuvium or Cast Skin

29. Adult femaleAdult male Females mate up to five times after a blood meal.

30. Modes of Travel  Usually brought in to the home on luggage, clothing or used furniture  Hotels, motels and apartments are high risk places to encounter bed bugs  Once introduced spread from room to room—apartment to apartment  Often hide in upholstered furniture in public places  Can ride in the crevices of pant cuffs, seams and hems

31. Can Travel in Luggage

32. Used Bedding is a Bargain— NOT!!!!!

33. Fecal Material on Used Mattress

34. Signs of Bed Bug Activity  Dark spotting and staining on mattresses and box springs  May see eggs and eggshells, molted skins of aging nymphs and the bugs themselves  May notice a sweetish smell in heavily infested areas  Hide during the day but can be found in mattresses, box spring frames, behind head boards and picture frames  Can crawl in and out of cracks in the wall and electrical outlets  May crawl up drapery and can be seen at crawling on walls in heavy infested areas.  Like to hide in cluttered rooms and closets

35. During feeding, the adult expands with engorged blood and leaves behind a small fecal droplet. FeedingFecal Droplet

36. Bed Bug Treatment  Use the services of a reputable professional exterminator and follow his or her recommendations explicitly  Follow all instructions given by the exterminator about preparation before and cleanup after  Vacuum thoroughly before and after each professional treatment with a bag-vacuum cleaner and discard bag outside of home  Remove clutter from the environment before treatment and discard any non-essential items  Discard heavily infested bedding and upholstered furniture; wrap in plastic before removal  Treat items to be returned to the home using Sterifab or by laundering in hot water

37. Bed Bug Treatment Continued  Steam treat items with a high pressure steamer if not appropriate to launder or spray with Sterifab.  Wash and dry all clothing and linens in hot water  Keep all laundered linen and clothing in sealed plastic until infestation is completely cleared; this could take up to six months  Be vigilant in checking home at least weekly, even after no further bed bug activity is noted.  Cover bedding in zippered mattress covers: plastic or finely woven fabric rated for bed bugs and dust mites.  Put “dry clean only clothing” in dryer on high for 10 to 20 minutes.  Seal cracks and crevices in home.

38. Bed Bug Prevention  Reduce clutter around the house  Seal cracks and crevices  Check all secondhand beds, bedding, furniture and clothing  Examine the bed and headboard area when traveling (Pull back the sheets and mattress cover!!!)  Keep your luggage off of the floor  Wash, dry or freeze second hand clothing right away—even if it comes from someone you think you know!!  Educate your teen-age and college-age children on what to look for.  Consider using air mattresses if residing in a “high risk” environment

39. Recommendations for Workers  Wear light colored, washable clothing if you work in healthcare or in frequent direct contact with the public.  Wash your clothing after one wearing or spray with Sterifab  Spray your shoes and lower legs with “Off” or other insect repellant with a high DEET content whenever you are working in a “high risk” environment.  Carry a portable stool if your work involves visiting people at home.  Avoid put your purse, brief case or tool bag on the floor  Consider removing your clothes in the garage (or inside the front door) and bagging them before entering your home if you work in a high risk environment.

40. Recommendations for Supervisors  Require staff to wear protective disposable clothing when working in an environment that is known to be actively infested  Consider installing automatic insecticide dispensers in your workplace—especially in coat rooms, high traffic areas—even commercial vehicles  Consider using the services of a professional exterminator on a monthly or even weekly basis in your work place if you serve high risk populations.

41. What do we do now—we got ‘em at work!!!!!!  Do not panic!!!!!  Involve everyone in developing a plan  Educate! Educate! Educate!  Be up front with your patients, customers or clients  Work with management to provide information and support to employees  Train staff in preventive practices and demand compliance—provide updates  Educate patients, families, caregivers and providers

42. Engage Community Resources  Work with landlords—educate  Stay abreast of resources available through local government  Contact the Health Department with complaints and concerns  Contact HUD oversight agencies when dealing with public housing issues  Understand applicable housing regulations

43. HUD LOCAL OFFICE  Cincinnati  15 East 7th Street Cincinnati, OH 45202-3188  Phone: (513) 684-3451 Fax: (513) 684-6224 TTY: (513) 684-6180 Jurisdiction: Thirteen counties in Southwestern Ohio James A. Cunningham, Field Office Director Contact the Director's Office Office Hours: 8:00 a.m. to 4:30 p.m. Monday through Friday James A. Cunningham Contact the Director's Office James A. Cunningham Contact the Director's Office

44. ADDRESSING THE PROBLEM  Acknowledge the reality as first cases appear  Recognize stages of staff emotion: disbelief, denial, panic, fear, anger, fragmentation of team members  Rally the troops; let them know “We’ve got to get our act together because these little critters are not going away.”  Develop a bed bug policy  Organize a “swat team”  Form a “bedbug committee” to manage the problem and refine strategies

45. Strategies That Really Work  Educating and reeducating every single employee  Finding effective products –Sterifab –Protective Clothing –Automatic aerosol dispensers –Portable stools –GoodNight Spray –Zippered Mattress Covers  Developing a relationship with a quality exterminator—learning how to work with other exterminators

46. STERIFAB

47. MPE Protective Apparel 1-888-688-2046

48. More Products From Miller’s Precision Enterprises BootsHood

49. Good Night Spray

50. Microfiber and Plastic Mattress and Box Spring Covers

51. More Strategies That Really Work  Keeping corporate leadership informed and enlisting their support  Partnering with landlords and Public Housing Agencies  Using oversight agencies when landlords are slow to respond  Finding alternative short-term and permanent housing for our participants  Educating our contracted providers  Developing and refining additional tools –Comprehensive bedbug policy –Standard service plan –Participant and family contracts –In-service materials

52. Helping Participants  Understanding the stigma historically connected with bedbugs  Remembering that patient care still comes first  Treating everyone with dignity and sensitivity  Tolerating the idea that not everyone considers bedbugs a big deal  Knowing that no one-size treatment fits all  Accepting that these critters are here to stay—deal with it and move on!!!!

53. Acknowledgements  Harvard School of Public Health Website WWW.hsph.harvard.edu/bedbugs WWW.hsph.harvard.edu/bedbugs  County of San Diego Department of Environmental Health Website www.co.san- diego.ca.us/deh/chd/vector/vbedbugs www.co.san- diego.ca.us/deh/chd/vector/vbedbugswww.co.san- diego.ca.us/deh/chd/vector/vbedbugs  Tammy Berkel, Owner, Valley Pest Control  Mary Rohs, OTR/L, M.Ed., LNHA, SeniorLink Service Operations Manager  Dora Winters, Lead Health Care Tech  Stephen L. Doggett, Department of Medical Entomology, University of Sydney

54. Good Night, Sleep Tight