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The Burden of Bed Bugs: A Million Dollar Problem

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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 – PowerPoint PPT presentation

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Title: The Burden of Bed Bugs: A Million Dollar Problem


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, dont let the bed bugs bite!
    (Michigan Department of Community Health, 2010).
  • Recently have made a dramatic resurgence.
  • They dont 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.
  • Workmans 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
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_guid
    elines/
  • Michigan State Department of Community Health.
    (2010). Retrieved from http//www.michigan.gov/bed
    bugs.
  • 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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