Bed Bug Prevention and Control for Health Workers

Bed bugs are now a common pest in the U.S. Although bed bugs do not transmit diseases, their bites can cause itchiness and significant discomfort. Workers who frequently visit homes or work in an infested home face the risk of being bitten by bed bugs or spreading bed bugs to their own homes or other places. In this publication, we describe basic information about bed bugs as well as recommendations on how to prevent bed bug infestations and simple non-chemical methods to control them.

Bed Bug Appearance and Life Cycle

Bed bug eggs are white, elongated, and about 1/26 of an inch (1 mm) in size. After hatching, they go through five nymphal stages before they become adults. If they have not fed recently, adults are brown, with a flat, oval-shaped body. They are balloon-like, reddish-brown, and more elongated if they have fed recently. Nymphs vary in size; the smallest (youngest) are about the size of a poppy seed and the adults are about the size of an apple seed (Figure 1). The total development time from egg to adult can take place in about 37 days at optimal temperatures (> 72°F) and with access to a host. Adult bed bugs have a life span of nearly one year depending on regular access to blood meals and favorable temperatures. A female bed bug lays about one to two eggs per day and up to 500 eggs during her lifetime. Bed bugs can survive for about 4.5 months without feeding at 70°F.

Bed Bug Behavior

Bed bugs feed exclusively on blood that they acquire from their human hosts and typically feed every 3–7 days. They are mostly active at night and typically hide during the day. However, they may also feed during the daytime hours when infestations are severe or after a long period of starvation. Once they have fed, they immediately return to their hiding places.

Bed bugs typically hide in beds, sofas, and other upholstered furniture where people sleep or rest. They tend to hide along folds of bed sheets, seams and corners of mattresses, box springs, and headboards and foot boards.

Bed bugs usually bite exposed body parts like the neck, arms, and hands (Figure 2). People’s reactions to the bites range from no symptoms at all, to pain, itchiness, and raised welts at the bite sites. Highly sensitive individuals can suffer whole-body systemic reactions. However, because not everyone reacts to bed bug bites, we cannot rely on bite symptoms to determine if bed bugs are present.

Within a multi-unit dwelling, bed bugs spread between adjacent units through hallways, common walls, or ceilings. Long-distance dispersal between buildings occurs when visitors bring bed-bug infested items from one location to another location or by bringing in infested furniture.

Bed Bug Inspection

Why Do We Need It?

Finding bed bugs early is important so you can eliminate them easily, avoid the need to hire expensive professional pest control services, and avoid unintentionally spreading bed bugs to your own home or other clients’ homes.

How Do You Find Bed Bugs?

Wear gloves and use a good flashlight to inspect the furniture. Look for signs of bed bug activity, including live or dead bed bugs, eggs, shed skins, or brown or black fecal spots (Figure 3). Bed bugs tend to stay close to sleeping and resting areas. Inspection should start at the bed and upholstered furniture that is used frequently by the client. Around the bed, they can be found on the bed linen corners, pillowcases, blanket corner, bed skirts, mattress covers, near the piping, seams and tags of the mattress and box spring, and in cracks on the bed frame and headboard (Figure 4).

If the room is heavily infested, you may find bed bugs further away from the bed or sofa and on various items or on the walls. Bed bugs can be found on clothing, wheelchairs, and items on or close to the bed and sofa, such as books, and albums.

It is often difficult to detect bed bugs when only a small number are present or after a bed bug treatment. Placing an interception device under the furniture legs is an effective method to detect bed bugs that are present in small numbers (Figure 5). These “pitfall-style” traps are designed to intercept bed bugs that are dispersing from the furniture or trying to reach the furniture for a blood meal. The outer wall is rough to allow bed bugs to climb up. However, the bugs are unable to climb the smooth inner walls and become trapped in the interceptor.

To detect bed bugs, place interceptors beneath the legs of beds and upholstered furniture. It is best to pull the bed or sofa away from the wall, and eliminate any other bridges between the furniture and the floor (e.g., tuck in sheets, remove bed skirt, and don’t let clothing hang from the bed to the floor). Some furniture may lack a frame, or the furniture legs may be too big. In these cases, pitfall traps may be placed against the walls and legs of furniture. Interceptors should be inspected every week or two to detect bed bugs. It is beneficial to clean interceptors at least once a month, and dust them with talc to remain effective.

Prevention

Health workers who visit homes with suspected bed bug infestations may take the following precautionary steps:

1. Place personal items in a sealed plastic bag or container.
2. Do not sit on upholstered furniture.
3. Change to clean clothing immediately after returning home or before returning home, and launder the used clothing.

Bed Bug Control

There are several effective non-chemical and chemical strategies to control bed bugs. Here, we only discuss non-chemical treatments that are easily done by anyone, without the need for special training or certification.

Frequent Laundering

This is a simple and very effective method to kill bed bugs hiding on bed linens, pillowcases, and clothing. Weekly washing and hot drying will kill bed bugs on these items. Hot drying alone is also very effective for things like pillows or stuffed animals that cannot be placed in a washing machine.

Decluttering

Place items around bed and sofa in plastic bags or bins to prevent bed bugs from using them as harborage sites. Infested items can also be stored in separate bags or bins for six months to kill bed bugs (Figure 6).

Mattress and Box Spring Encasement

Installing zippered encasements to the mattress and box spring will reduce potential harborage sites and make treatment easier. Both fabric and plastic zippered mattress encasements are useful. Fabric encasements are more comfortable and durable. However, plastic encasements offer a much more affordable option.

Interceptors

Place pitfall-style traps under bed legs and sofa legs for bed bug detection and control.

Heat

A temperature of 122°F will kill all life stages of bed bugs instantly. A clothes dryers, portable heaters, and steamers are effective tools to kill bed bugs through exposure to lethal temperatures.

The easiest and most convenient method to treat bedding and most clothing is to put them in a clothes dryer for 30 minutes.

A portable heat chamber can be purchased for approximately $200 and is very useful for treating items that cannot be placed in a washer or dryer, such as luggage, shoes, books, suitcases, or any other item that can tolerate heat of up to 160°F without risk of combustion or damage to the item (Figure 7).

Various steamers ranging in price from $100 to $700 can be used to treat bed frames, sofas, wheelchairs, rugs, etc. “Slow and steady” is the rule for steam treatments. One study found that 10 to 30 seconds per foot was sufficient to kill all stages of bed bugs using both inexpensive consumer steamers and more expensive commercial steamers. Repeat treatment is often needed as one-time treatment may miss some bed bug hiding places (Figure 8).

Freezing

Using low temperature is beneficial when small infested items cannot be treated by heat. Wrap small items in plastic bags and place them in a household freezer (0°F) for 4 days.

Summary

Knowing how to find bed bugs along with some simple methods to control them will help protect yourself and your clients, save money, and ensure a healthy working environment. You can eliminate bed bugs safely and effectively by using a combination of non-chemical methods. Monitoring the results and being vigilant in the utilization of control methods until no bed bugs are found is important to ensure bed bugs are eliminated. For further information, please visit a web-page maintained by U.S. Environmental Protection Agency.

Photo credits: Jody Green (Figure 1); Changlu Wang (Figures 2, 5–6, and 8); Salehe Abbar (Figure 4); Jean O. Jones (Figure 7).

 

November 2020