Management in Locations with Vulnerable Populations

Although bed bug awareness and treatment techniques continue to evolve, bed bugs are still spreading, especially throughout vulnerable populations.

“What I find is the vulnerable populations often suffer the most chronic infestations,” said Dr. Jody Gangloff-Kaufmann, senior extension associate with the New York State Integrated Pest Management Program at Cornell University. “These vulnerable populations tend to be residents of senior housing, group homes and shelters.”

What makes these facilities uniquely susceptible to bed bug infestations? For starters, the sheer number of people sharing space.

“In a group home, for example, you might have two or three people per room. So there’s no privacy, there’s no space and you have staff,” said Gangloff-Kaufmann. “It’s just a high density of humans in a particular building.”

In addition to regular traffic in and out of the building, senior housing, group homes and shelters often experience high resident turnover. With more people — and belongings — coming and going, there are more opportunities to introduce bed bugs.

Those residents or patients of the facility also may need assistance with everyday tasks, and they are often not in full control of everything that happens in their environment. Because they rely on a facilities director or a landlord to correct the problem, a landlord-tenant dispute can delay or prevent treatment.

Residents may not even experience a reaction to the bed bug bites, in which case the resident and facility management could all be completely unaware of the infestation.

Ultimately, bed bugs are a human issue.

“We have pesticides that kill bed bugs, but they are a socially transmitted pest. Bed bugs are passed from people to people,” Gangloff-Kaufmann said. “They thrive in situations where human behavior inhibits control.”

HELP FROM STAFF/RESIDENTS. Fortunately, pest management professionals can help facility managers begin to establish control with the help of their staff and residents.

Gangloff-Kaufmann said people don’t like to be aware of things they don’t like, but ignoring an unpleasant infestation of bed bugs is a bad decision. She says staff must be trained to the point that they are inherently aware of any signals that bed bugs have taken up residence in the facility.

Pest management professionals can train staff to spot bed bugs in the facility or on belongings, as well as teach them how to identify bed bug bites on residents. Staff also should be familiar with all stages of bed bugs and feeding cycles, and the stains they leave on mattresses and bedding.

It is important for staff to understand that doing their job is necessary, and that they can still safely perform their work in the midst of managing bed bugs. They should be familiar with and actively practice self-protection measures and be aware of how bed bugs can be transferred. Finally, it is crucial they know what they are able to do to quell a bed bug infestation, and what they need to leave to professionals.

An educated group of residents also can be effective in the battle against bed bugs. At the very least, facility management can instruct residents to report what they see. Gangloff-Kaufmann also recommends implementing rules around what types of second-hand furniture or home goods can be brought into the facility.

“There was a time when nearly everything on the curb was probably infested with bed bugs,” she said. “It seems like it’s not like that today, but shelters and group homes have rules for the purpose of preventing bed bugs.”

Residents can even take on a proactive role in bed bug prevention.

“You might go so far as to find some residents willing to actively help with inspection or vacuuming or some kind of positive active role,” said Gangloff-Kaufmann.

She’s even worked with residents who acted as a tenant representative, coming to bed bug working group meetings and then going door to door, disseminating that information to other residents.

Staff and residents also should be familiar with home-to-work protocols when it comes to bed bugs. People working in high-risk locations should isolate the items they wear or bring those items home in an airtight container and then heat treat them. Conversely, if the bed bug infestation is at home, they can prevent spread by maintaining bed bug-free items to wear. Keeping the items isolated in airtight containers until it’s time to leave or heat treating them in the dryer or with a hair dryer will prevent the bed bugs from heading to school or work.

Gangloff-Kaufmann stresses inspections are a big part of bed bug control. When inspecting, pest management professionals know to focus on areas where people sleep or rest, but in these types of environments specifically, that doesn’t just include beds and traditional seating.

Since they are designed to be used outdoors, Gangloff-Kaufmann added that the electronics in the chair or mobility device should be able to withstand steam cleaning. Hospital beds are another piece of equipment with plenty of nooks and crannies, tubing and spaces where bed bugs can hide.

Laundry rooms are another important area to inspect. Bed bugs have been known to survive the washer, and although they cannot tolerate the heat of the dryer, inspecting the dryer filter may turn up evidence of bed bug activity. They are also likely to congregate around or underneath folding tables.

A thorough inspection also should include staff offices, break rooms, TV rooms and communal settings. Be sure to look closely at each item of furniture, as cracks, ripped cushions, flaws and crevices all can be optimal places for bed bugs to hide.

“An inspection is a moment in time and varies in efficacy based on who goes, what the pest control technician sees and what they don’t see, and whether or not they are wearing their glasses that day,” Gangloff-Kaufmann said. “There are a lot of variables.”

Monitoring, however, happens around the clock.

For active monitoring, Gangloff- Kaufmann suggests kairomones and CO2 as attractants, as well as monitors. Monitoring also should include a consistent record of occurrences over time, meticulously maintained by staff in a logbook.

“We tell everyone, whenever we talk about Integrated Pest Management, to keep accurate records because that is integrated pest management,” said Gangloff-Kaufmann. “It’s really important.”

Recording the date, specific location and how many life stages a pest were observed is crucial to detecting trends. Records should be kept for bed bugs, as well as all pests.

That logbook is a point of communication between residents, staff and the pest management professional. “Everyone should be able to consult the book or add information to the book based on what they’ve seen or experienced,” Gangloff-Kaufmann said. It should be kept in one place, with one person or one office in charge, so it is always available to individuals to place reports or complaints. The logbook is also a good place to store information about pest control service tickets and MSDS information about pesticides applied.

FACILITY HISTORY. Whether the facility has never had bed bugs, has a history of bed bugs but no current infestation, or is currently managing bed bugs, Gangloff-Kaufmann has recommendations tailored to the situation.

In the first scenario, a facility that has never had bed bugs, she suggests preventing introductions or transfers by asking new residents about their history with bed bugs. She added that it is important to train staff to ask these questions.

“If someone has been exposed or has been living in a bed bug infestation the staff should know that and should pass that information to you,” she says. “That’s part of the education of the staff. They need to be aware, they need to know if someone is coming from a bed bug situation or if during the day they go out to a place that may have bed bugs.”

Employees should be following work-to-home protocol to prevent introductions as well.

In order to facilitate early detection in the case of an introduction, routine inspections should be completed at least monthly and results should be recorded in a log book. Management should consider using mattress and box spring encasements as a preventive measure as well.

For facilities with a history of bed bugs but no current infestations, Gangloff-Kaufmann says the focus is to prevent reinfestation. She suggests evaluating where residents might pick up bed bugs and enforcing home-to-work protocol, just as a facility with no previous infestation would. Further, she recommends educating staff on how to identify a bed bug, bed bug stains on mattresses or bed bug bites on residents. Staff should constantly monitor and document their findings. Biweekly to monthly inspections are critical. Gangloff-Kaufmann also strongly suggests adding encasements or active mattress liners to high risk areas and bedding.

Finally, for facilities currently managing a bed bug infestation, preventing the spread within and from the facility is crucial. All staff and residents must be able to identify a bed bug, staff should be taking preventive measures to protect themselves and home-to-work protocol must be maintained by all staff and residents. Intense monitoring and weekly inspections should all be recorded diligently. Encasing mattresses and box springs can provide a safe place for someone to sleep while isolating the item so it may be eventually salvaged. A treatment plan must also be put in place by a pest management professional.

“As bed bugs become more of an issue, you have to have more of an intense program,” said Gangloff-Kaufmann.

STRATEGIES FOR CONTROL. When setting out to control a bed bug infestation, extensive preparation can be debilitating, especially for the residents of senior housing, group homes and shelters.

“Years ago we would see a prep sheet and it was two or three pages long and it included everything that someone could think of to prepare a home for bed bug treatment, pulling out the drawers, putting all clothing in plastic bags, removing everything from a closet. How do people deal with this? I don’t know,” Gangloff-Kaufmann said. “It was really hard for residents. There were often cases where people didn’t prep because they didn’t know where to start.”

Recording the date, specific location and how many life stages a pest were observed is crucial to detecting trends. Records should be kept for bed bugs, as well as all pests.

Extensive preparation also can disperse pests away from their harborage, making it harder to predict where they will be.

But if no preparation is completed, there will likely be no treatment happening at all, with the problem continuing to grow and residents suffering. “Is this realistic and justified for a light or brand-new bed bug infestation?” asked Gangloff-Kaufmann. “Probably not.”

The limited preparation concept, however, is a more realistic solution, especially for residents of senior housing, group homes and shelters, who may not be physically capable of completing extensive prep on their own.

Limited preparation does include moving some furniture, however, in the case of such facilities, residential staff can help with the heavy lifting. Although there is risk of damage to personal property, the benefits outweigh the concerns. Limited preparation minimizes bug movement, while offering increased efficacy of control and better chances of success.

Removing clutter, however, is still vital in preparing to treat for a bed bug infestation. Clutter inhibits all pest control, and unfortunately collectors or hoarders are more likely to pick up bed bugs.

“In this case it is not a pest control issue, it’s purely a human issue because behavior change is needed here to alleviate the clutter, the hoarding, in order to do any pest control,” said Gangloff-Kaufmann. “In some cases social workers are brought in to help with this process.”

Once limited preparation is complete, trained staff or residents can use a vacuum to remove bed bugs and the cast skins, eggs, pheromones and allergens they leave behind. Use various tools on a HEPA vacuum or a vacuum with HEPA-filtered bags to dislodge the bugs and their eggs. Focus on the seams of the bed, molding on walls and the edge of carpets. When vacuuming is complete, bag up the vacuum bag or contents of the cannister and dispose of it outside. Then wash any tools used.

To further protect the vacuum and tools, place a knee-high stocking inside the vacuum tube and secure it on the outside with a rubber band or duct tape. Any bed bugs will be trapped in the stocking and can be easily discarded.

Many household items also can be washed and salvaged. Soapy water helps to remove bed bugs, eggs, stains, allergens and pheromones.

Although whole room or building treatment is often out of budget for a senior housing, group home or shelter facility, heat can certainly be used to manage bed bugs on a smaller scale. Tumble soft toys or household items in the dryer at 125°F for 30 minutes. To treat without the tumble, place affected items in a mesh bag hung over and closed into the dryer door, or on top of a shoe rack inside the dryer.

A hair dryer can also get to almost 180°F as soon as it is turned on. Use it on a low air speed to heat the item in the bathtub or on top of a white sheet so you can easily spot bed bugs.

And if the facility has the resources, they can really get innovative with heat, Gangloff-Kaufmann said. She recalled one shelter that created its own heat chambers by buying heating units from a local company in the midst of an upgrade and placing them inside storage containers. Even a box truck parked on the street on a hot day can get warm enough to kill many of the bed bugs hiding in its contents.

For bulky items, steam cleaning can serve as another option, and is especially effective on baby mattresses. Low-moisture steam heated to 140°F will kill all bed bug life stages and leaves no residue.

Isolation is another important tool in combating a bed bug infestation. “Once items are bed bug-free they can be isolated from the infestation,” said Gangloff-Kaufmann. “I advocate that any item, any belonging, any piece of furniture be isolated and stored until those bed bugs have hatched and are dead.” There is always a way to keep an item unless it is so filthy it isn’t worth saving, she said.

Unusual items, like books or wedding albums, that harbor plenty of places for bed bugs to hide can even be isolated in a plastic bag for a year instead of being thrown away.

If you can’t isolate it, encase it.

“Encasements are necessary and they are useful in every case, whether or not you have bed bugs,” Gangloff-Kaufmann said. “If you have non-infested mattresses and you don’t have a bed bug issue, what you’re doing is protecting the mattress and the box spring from infestation and to make easy inspections possible. There is a reason in a high-risk situation to have encasements.”

And during an infestation, an encasement or active mattress liner can help make the bed an island, she said. First encase the mattress and box spring. Then, wash, steam and treat the frame. Pull it away from the wall and any other furniture and place pitfall traps or insect interceptors underneath. Finally, clean the blankets, and never let them touch the floor. As long as the person goes to bed wearing clean clothes, they are able to sleep there safely.

“In addition, they end up being a lure that may attract bed bugs from other parts of the room into those interceptors, which tells us that there are bed bugs. They also tell us maybe how many bed bugs (are there and cause) the death of those bed bugs,” said Gangloff-Kaufmann. “‘Make the bed an island’ is a really good concept.”

And of course, using the right tools and insecticides is an important component of any bed bug management plan.

“With insecticides, there’s no magic bullet product, but there are plenty of insecticides that kill most bed bugs,” Gangloff-Kaufmann said. She does dissuade PMPs from using total release foggers or sticky traps, as they simply are not effective for control, she said.

Resistance is also a concern, with pest management professionals seeing resistance to almost all classes of chemicals. Rotating chemicals helps combat that resistance, she said. Desiccants like DE or silica gel work without much risk of resistance and should be a part of any Integrated Pest Management program, Gangloff-Kaufmann added.

Ultimately, bed bug management in these locations comes down to attentiveness and technique.

“Really, with bed bugs it’s how and where the pesticide is applied that matters and that is based on your monitoring and inspection and the thoroughness of it,” said Gangloff-Kaufmann. Follow-up treatment by the PMP also matters, she concluded.