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Bed Bugs and Long-Term Care: Emerging Healthcare Issue. A primer for providers. By: Erik Foster, MS Medical Entomologist Michigan Department of Community Health. DISCLAIMER.

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bed bugs and long term care emerging healthcare issue

Bed Bugs and Long-Term Care:Emerging Healthcare Issue

A primer for providers

By: Erik Foster, MS

Medical Entomologist

Michigan Department of Community Health


The following presentation presents a grim and often discouraging picture of a very unwelcome insect pest. However, bed bug management IS possible. Through education, training, cooperation, and persistence facilities can keep bed bugs at bay or at levels that are controllable.

what you will learn today
What you will learn today
  • Why are bed bugs a problem now?
  • What are bed bugs?
  • What are the health concerns with bed bugs?
  • Can you tell if bed bugs are present?
  • Provider guidance for bed bug prevention and control
  • How to prevent bed bugs from going home with you
  • Resources
brief history of bed bugs
Brief History of Bed Bugs

The human bed bug is thought to have evolved from bat feeding relatives during the time early humans were living in caves

There are dozens of species in the genus, most feeding on birds and bats

Early bed bug control method

brief history of bed bugs5
Brief History of Bed Bugs

Pre WWII estimates placed bed bug infestation rates in the U.S. as high as 1/3 homes

Over the past 50 years, the human bed bug was rarely encountered in the U.S. due to improvements in living standards and the use of residual insecticides such as DDT

media frenzy 2010
Media Frenzy -2010

Business Insider. Aug 18, 2010 Sept 9, 2010

WWJ Radio News Room. Aug 24, 2010

NY Daily News. July 10, 2010

  • Drives public perception
  • New York
    • Theaters
    • Clothing Stores
    • Transportation
  • Michigan
    • High-rises in Detroit
    • Public Housing
    • Hospitals
why the resurgence
Why the Resurgence?

Bed bugs never truly went away

Increases in global travel

Lack of institutional knowledge due to rarity of bed bugs in the U.S.

Reported resistance of bed bugs to currently used classes of insecticides

Lack of public knowledge

Expense of treatment

are bed bugs a public health issue yes
Are Bed Bugs a Public Health Issue? YES!

Bed bugs are a HUMAN PARASITE – they live ONLY on human blood

Head lice and scabies are other examples of public health “nuisance pests”

“Measurable physical and mental health effects from prolonged infestations” (CDC/EPA)

Bed bugs are spread through human travel, contact, and commerce – environmentally communicable

Bed bugs often affect vulnerable populations disproportionately

Citizens and agencies look to public health authorities for information and guidance on health issues

the bed bug resurgence pest management survey
The Bed Bug ResurgencePest Management Survey
  • Bed bug infestations are not required to be reported in most jurisdictions
  • Survey of 950 pest management firms of various size worldwide
  • The pest management industry provides valuable data on the distribution and trends of bed bug infestations

Potter et al. 2010

public concern
Public Concern

Potter et al. 2010

bed bug emergence in michigan
Bed Bug Emergence in Michigan

First public health indication in 2006 – Detroit

WSU: Mother brings in mattress left outside

Noticeable increase in public concerns/complaints to MDCH beginning in 2008

Realization of lack of available educational resources for local agencies

Housing and tenant/landlord issues difficult to resolve

MDCH acknowledgment that bed bugs are a public health issue

public health and pest management industry findings

County with increased bed bug infestations as reported by the local health department survey

County where pest management firms have confirmed bed bugs and are seeing increased requests for treatment

Public Health and Pest Management Industry Findings
risk factors for a bed bug infestation demographic
Risk Factors for a Bed Bug Infestation-Demographic

Infestations primarily urban - for now:

  • Low-income rental housing
  • Multi-unit rental housing
  • Adult foster care facilities
  • Long-term care facilities
  • Homeless shelters
  • Single family homes
  • Hotels
  • Schools and Childcare Facilities
risk factors for a bed bug infestation behavioral
Risk Factors for a Bed Bug Infestation-Behavioral
  • Lack of knowledge about bed bugs!
  • Acquiring Used Furniture/Bedding
  • International and Domestic Travel
  • Transient lifestyle
  • Tenant/client fear of reporting infestations
  • Institutional lack of protocol/proactive response
biology of the bed bug
Biology of the Bed Bug

Small - 3/16 inch long, oval, flat, reddish - brown insects

Obligate human ectoparasite

Nocturnally active, and feed almost painlessly

Normally found within 5-20 feet of host

Give off a distinctive “musty, sweetish” odor



biology of the bed bug19
Biology of the Bed Bug
  • Undergo metamorphosis through 5 nymphal stages requiring a blood meal at each stage (feed within 3-15 minutes)
  • Life cycle takes 4-5 weeks (egg-to-egg) in ‘good’ conditions [ 75-80% RH; 83-90o F]
  • Female may lay 200-500 eggs in her lifetime
  • Do not fly or jump
life cycle
Life Cycle

Bed bugs progress through five stages.

Optimal conditions = 5weeks egg to egg.



can be confused with

Cockroach nymphs

Other kinds of bug bites

Can be confused with…


Cockroach Nymph

Bat Bug

Other insect bites

bed bug biology
Bed Bug Biology
  • Sense and seek warmth and CO2
  • Adults can survive >1 yr. without feeding (Nymphs: 3-4 mo.)
  • Can remain fully active at <45o F
  • “Prefer” humans but feed on other hosts, too!
  • Becoming resistant to many commonly available pesticides
bed bug behavior
Bed Bug Behavior
  • Live indoors amongst our belongings
  • Will infest cluttered AND pristine environments
  • Easily hide in cracks, crevices in bed frames, mattresses, personal electronics, and baseboards, etc.
  • Normally found within two meters of host
  • Transmitted through the movement of people and their belongings
  • Nocturnally active, attracted to heat and carbon dioxide
  • Infestations can quickly build to extremely high levels due to rapid reproduction, difficulties in initial detection, and lack of knowledge about how to treat
where bed bugs live
Where bed bugs live
  • In the building
  • In any crack or crevice where a credit card edge could fit
  • In anything near where people rest

Bed bug crawling into a screw hole to hide

Bed bugs using ceiling light fixture as harborage