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Upholstered furniture provides bed bugs with more places to hide than other types of seating.

A full-blown bed bug infestation can develop anywhere if allowed to go unchecked; however, in a hospital or surgery center environment, due to frequent bedding changes, fewer places to hide and regular attention from staff, an advanced bed bug infestation is a low risk in most facilities. However, a hospital or surgery center’s risk of bed bug introduction is relatively high. The more patients, guests and employees a facility has, the higher the risk of introduction. Therefore, PMPs treating these facilities should know the areas at highest risk for introduction, and they should educate employees and implement proactive inspections based on the level of risk.

In Rentokil Steritech’s experience, the following areas pose the highest risk for bed bug introduction:

  1. Waiting rooms and lobbies
  2. Emergency rooms (ER) and emergency room exam rooms
  3. Patient rooms and maternity suites
  4. Doctor/nurse/employee sleeping quarters
  5. Employee locker rooms or personal storage areas
  6. Patient intake areas

Waiting rooms and lobbies. Waiting rooms and lobbies are often designed to provide comfort to patients and their family members or friends. These areas are often furnished with soft or upholstered furniture. Because these areas see some of the highest turnover of people within a hospital environment, the possibility for bed bug introduction is also high, as anyone could potentially or unknowingly introduce bed bugs from their home or another location. The availability of soft or upholstered furniture makes a perfect hiding environment for bed bugs.

Emergency rooms and emergency room exam rooms. Like waiting rooms and lobbies, emergency rooms see a high turnover of patients and visitors to a hospital, making them a high-risk point of entry. Increasing that risk, especially in urban population centers, may be the likelihood that transient populations are more likely to visit an emergency room for a variety of reasons. These individuals may be more likely to introduce bed bugs to a facility than the population-at-large; therefore, hospitals should gauge their emergency room needs based on their typical patient makeup in this area.

Seating in ER environments can vary widely from hospital to hospital, and may be less likely to include upholstered furniture, allowing any introduced bed bugs to be spotted sooner due to there being fewer places for the bed bugs to hide.

Patient rooms and maternity suites. Patient rooms, especially those that make comfort accommodations for visiting family and guests, are one of the most likely areas of bed bug introduction in a hospital. Patients may unknowingly transport bed bugs from their home or resident environment. While many patients are put into hospital gowns, any personal items that they bring or store in their room could be a vehicle for introduction. Often, these items are tucked into closets or drawers or placed on chairs next to the bed, left for hours or days unchecked, providing opportunities for bed bugs to crawl out.

Visiting guests also may introduce bed bugs to a facility. In patient rooms or maternity suites that provide upholstered furniture for the comfort of visitors who may stay overnight, bed bugs may have more of a chance to become established before they are noticed, as they can hide in the soft furniture without being noticed for longer periods of time.

Specific at-risk points in patient rooms and maternity suites include patient beds, sleeping chairs/fold-out sleepers, any closet areas where personal items are stored and any floor/wall covering that may be present.

Doctor/Nurse/Employee sleeping quarters. Due to the round-the-clock care hospitals provide, sleeping quarters for doctors, nurses and other staff members are often available. The range of bed types can vary widely from facility to facility, including couches, hospital beds, cots and even full beds. Some bed types may be more conducive to allowing bed bugs to hide.

In general, the more upholstered and intricate a bed is, the more likely it is to provide a hiding place for bed bugs. Unfortunately, employee sleeping quarters are often not considered or go uninspected, so the chances of a bed bug problem becoming established may be increased here.

Employee locker rooms or personal storage areas. Areas where hospital employees store personal items can be a hotspot for bed bug introduction, as bed bugs can be brought into a facility on a wide variety of personal items, from clothing to shoes, coats and winter apparel such as scarves and gloves. Items that remain in lockers undisturbed for longer periods of time offer bed bugs more opportunity to crawl out.

While the chances of a bed bug infestation becoming established in these areas are low, due to the lack of sleeping humans to feed upon, they should be included in all proactive inspections.

Patient intake areas. Areas where patients are held between arriving at the hospital and being admitted may be at an increased risk for bed bug introduction. In these rooms, potential patients are still wearing their own clothes and may have several personal items. They often are accompanied by family members or friends who also pose a risk for introducing bed bugs. Any hitchhiking bed bugs have an opportunity to crawl off a person, their clothing or their personal items in these areas.

Additionally, since these rooms have a high rate of patient turnover, they may be at higher risk for introduction because they see a higher volume of patients than standard patient rooms. As such, PMPs should develop a more frequent inspection plan for patient intake areas, which could help reduce the likelihood of introduced bed bugs making their way into the larger facility.

Although bedding in such areas is changed frequently, hitchhiking bed bugs have an opportunity to crawl off a person, their clothing or their personal items in patient intake areas.
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TREATMENTS/INSPECTIONS. Proactive measures, including routine visual inspections, and/or a canine inspection, and treatment measures, including conventional treatment with pesticides and/or heat treatment in conjunction with low-impact residual pesticide applications, are key to managing infestations.

Proactive measures. Based on risk level, a facility and its pest management team should develop a plan for proactive inspection. Proactive inspections identify potential introductions on a regular basis.

Proactive inspections in hospitals typically include areas of risk in every inspection, and patient rooms on a rotation based on size. For example, a hospital with 200 patient rooms may inspect 50 patient rooms per quarter, so that every patient room receives an inspection at least annually.

Proactive inspections can be conducted in two primary methods: traditional inspection, conducted by pest control experts performing a manual inspection, or a more rapid method of inspection that employs the use of a specially trained canine team that can detect bed bugs. Manual inspection can be time consuming and require additional labor, so budget-conscious facilities may wish to investigate canine inspection. However, the use of canines in a health-care facility may be off-putting for some health-care professionals and requires coordination with the availability of rooms.

Treatment measures. For the treatment of bed bug issues, PMPs often perform a conventional treatment with pesticides and/or a heat treatment used in conjunction with minimal application of residual pesticides.

Conventional treatment will involve a pest control professional removing infestations with a vacuum, and then the application of pesticide products to all areas of suspected activity and/or potential bed bug activity. While typically very effective, there are some potential objections to the use of this method. As with any manually conducted pest control service, there is a margin for human error. Of greater concern, however, particularly in a hospital, may be the use of powerful pesticides within a sensitive environment. Hospitals pursuing bed bug service should understand what products their provider will use to address potential bed bug issues. Due to the application of pesticides, rooms receiving this type of treatment typically need to remain “out of service” for a period of several days to allow the products to work; this is often not a luxury that many hospitals have. Finally, conventional treatment, while effective, may not be able to fully eliminate infestations in furnishings, meaning that some furnishings may need to be discarded.

Overall, heat treatments have been proven to be the preferred option. Containerized heat treatments have proven to be extremely effective in treating localized bed bug issues. In this method, all furniture and other decorative objects (subject to sensitivity) are placed into a container/tent/chamber and heated to a temperature proven to kill all bed bug life stages. PMPs couple containerized heat treatments with minimal applications of low-impact residual pesticides to ensure that isolated pests do not survive. Heat treatment is typically much faster than conventional treatment and in many cases, a room can be returned to service in under 24 hours.

SUSPECTED INTRODUCTION. A more common course of action in hospitals and surgical centers is to call a PMP when a bed bug introduction or infestation is suspected. When incorporated as part of a bed bug protocol, this method can be effective for quickly addressing newly introduced problems. However, problems often arise when a facility has no plan of action and staff members in the facility don’t know what to do. A written plan of action for what to do when a bed bug introduction or infestation is suspected should be developed in coordination with the facility’s pest control partner so that all parties have an understanding of what is to happen when a call for service is placed.

Quarantine procedures. In cases of suspected bed bug introduction, the first line of thinking is often to remove items from the area. However, this can lead to the inadvertent spread of a bed bug problem deeper into a facility.

Instead, Rentokil Steritech recommends quarantining an area where a suspected bed bug issue has been identified until a pest control expert can be notified and come out to conduct an identification and inspection. Any patients in a quarantined area can be moved, but health-care facilities should take caution that only the patient is moved, and if possible, a physical inspection of the patient is conducted to ensure there are no bed bugs on their person.

If quarantining an area is not possible, any furniture or items removed from the area should be moved to an area specifically designated for the quarantine of potentially bed bug-infested items. Appropriate inspection methods should be conducted along the path of movement of these items on the way to quarantine.

The author is a Board Certified Entomologist and Bed Bug Line of Business Manager, Rentokil North America.