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The Burden of Bed Bugs: A Million Dollar Problem

The Burden of Bed Bugs: A Million Dollar Problem. Adebisi Adeyeye, RN,MPH, CIC Montefiore Medical Center APIC Greater New York Meeting February 16, 2011. Disclosure. Nothing to disclose. Objectives. Review history and resurgence of Bedbugs. Examine biology of Bedbugs.

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The Burden of Bed Bugs: A Million Dollar Problem

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  1. The Burden of Bed Bugs: A Million Dollar Problem Adebisi Adeyeye, RN,MPH, CIC Montefiore Medical Center APIC Greater New York Meeting February 16, 2011

  2. Disclosure Nothing to disclose.

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

  4. Introduction 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). Recently have made a dramatic resurgence. They don’t discriminate. Difficult to control.

  5. Knowing the Bed Bug Source: Michigan community health department, 2010

  6. Knowing the Bed Bug 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.

  7. Biology • 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).

  8. Biology • 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.

  9. Life Cycle • 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.

  10. Nymphal stage to adult Source: Michigan community health department, 2010

  11. Feeding 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.

  12. Impact on Public Health and Infection Control • 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

  13. Physical Effects 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.

  14. Examples of Bed Bug Bites Source: Michigan community health department, 2010

  15. Examples of Bed Bug Bites Source: central Ohio.org

  16. Example of Scabies Rash Source: Michigan community health department, 2010

  17. Mental Health • 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.

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

  19. Economic Burden 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.

  20. Adverse Outcome • 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

  21. Identification • 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

  22. Tools Michigan State community health Department, 2010

  23. Bed bug detecting dogs 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.

  24. Roscoe (Bell Environmental) Source: Bell Environmental

  25. Control 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.

  26. Education • 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

  27. Control 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

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

  29. Treatment of Infested Materials 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.

  30. Treatment Methods • 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

  31. Cryonite Machine( Liquid CO2) Source: Bell Environmental

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

  33. Challenges 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.

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

  35. Conclusion 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!!!!

  36. ??????? Thank you Questions

  37. References 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.

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