Long-Term Care Survey Alert

Prevent, detect, safely eradicate these resilient pests.

Bed bug infestations can wreak havoc on resident comfort, not to mention your facility's marketability with consumers. But the critters will have a hard time taking up residence in your nursing home if you follow this five-prong plan.

1. Look for skin welts or unexplained rashes. This may be your first clue that a new admission or current resident has been bitten. And don't assume that bed bugs can't be the problem if one of two people sharing a room isn't affected. People react differently to bed bug bites, explains Mindy Uhle, MPH, HHS, community health consultant with the Iowa Department of Public Health. "Some have an allergic reaction and others may have a dot that goes away quickly. A lot of people do have welts on them, however."

Another problem: "Elderly people may have other skin problems or rashes that mask the problem. So it tends to take a little longer to realize that you have bed bugs in a nursing home," if staff aren't on the lookout for them, cautions Joseph Restifo, owner of K-9 Sweeps, a Las Vegas exterminating company that deals exclusively with bed bugs.

Clinical tip: Whenever a patient has a rash, rule out scabies, a contagious condition, advises dermatologist Robert Norman, MD, in Tampa, Fla. (for more information on diagnosing and treating scabies, see the next Long-Term Care Survey Alert).

2. Teach staff to identify bed bugs. "Adult bed bugs have flat, rusty-red-colored oval bodies and are about the size of an apple seed," states a fact sheet produced by the Maine Centers for Disease Control & Prevention. Restifo teaches people to look for the bugs' cast skins and for their fecal stains, which are black in color. "On fabric, the stains may appear grayish or a muted black."

Smart move: Inspect furniture and other items before residents bring them in. Uhle notes that many places, including apartment buildings, are taking this tack. Look closely at "mattresses and upholstered furniture seams, tufts and frames," advises Patricia Hottel, BCE, technical director for McCloud Services, a pest control company in Chicago. "Bed bugs may also be transported on wheel chairs and these types of items." If you find bed bugs at any time, place the infested items in sealed bags for removal, advises Hottel.

3. Contact a qualified pest control company at the first sign of trouble. You have to identify all of the places where the bugs may be, including beds, baseboards, electrical outlets, furniture-- even personal belongings, urges Restifo.

The goal is to "break the bugs' reproduction cycle the first day you discover them," explains Restifo. "We aim to get rid of 99 percent of the bed bugs by using HEPA vacuums, dry vapor steam, and liquid carbon dioxide to freeze the bugs and kill the eggs," he says. "Only then do we apply field tested residual products." Seven to 10 days after that, the exterminating company staff returns to reinspect the facility and treat, as needed.

"You can also use certified bed bug proof encasements on mattresses and box springs and Climb-Up Interceptor cups under the bed legs," adds Restifo. In addition to using a multi-pronged approach to get rid of the bed bugs, McCloud Services uses traps to monitor for infestations, says Hottel.

4. Try to identify the source of the infestation. If you don't take this step, the facility is at risk for becoming re-infested, Restifo cautions. He backtracks to the six-toeight week period before anyone noticed the bugs to see whether someone brought in furniture then. Restifo also identifies visitors at that time and whether staff traveled. "Sometimes you can't really find the source," however, he says.

In Hottel's experience, most often nursing home residents bring in the bugs. "However, employees may also bring in bed bugs from home on personal belongings."

5. Teach staff how to avoid taking the bugs home. Keep in mind that "bed bugs are very good at hitchhiking on items," cautions Hottel. Thus, some places offer staff a change of clothing to don before leaving work so they put their potentially infested clothing in a sealed plastic bag for transport, she says.

Restifo recommends staff members keep their purses in sealed plastic bags at work during a bed bug infestation. Those who have been exposed to bed bugs at work should remove their clothes in the garage at home and place the items in the clothes dryer until the dryer reaches 120 degrees, he advises. Then let the items continue in the dryer for another 20 minutes.

Resources: For more information on bed bugs, including a picture of one, go to www.maine.gov/dhhs/boh/ddc/epi/disease/pdf/bedbugs_fact_sheet.pdf. For an interactive map of the U.S. showing the most infested areas and recent reports of hotels with bed bugs, visit http://bedbugregistry.com/.