Bed Bug Infestations in Care Facilities Expert Overview

This article discusses the standard of care for bed bug detection, bed bug bite treatment, and bed bug elimination, particularly for facilities that care for special populations.

Bed Bug Infestations in Care Facilities

In addition to apartments, hotels, shelters, and cruise ships, bed bugs can also be found in hospitals, schools, and nursing homes. The danger posed to vulnerable populations or residents in special facilities is greater when exposed to these hazardous bugs because of their increased risk of medical complications.

Facilities that care for medically vulnerable populations (such as “YOPI” populations: young, older, pregnant, and immunocompromised) require extra vigilance for evidence of bed bugs to mitigate the risk to these groups.

There is an expectation to provide a safe and hygienic environment for medically compromised individuals. Facilities can demonstrate their adherence to standards of care by employing defined methods regarding the prevention of, recognition of, and reaction to bed bug infestations.

The potential harm caused by bed bugs can extend beyond annoying skin irritations to include negative economic impacts resulting from appalled customers and bad reviews.

Prevention of Infestations in Special Facilities

An important aspect of a pest control program is understanding how pests get in. This requires developing a comprehensive understanding of the facility, special equipment, and vulnerable occupants.

For example, a skilled nursing facility may stock unique pieces of equipment and bandage materials that may serve as potential insect habitats. A facility for memory care patients should consider how to decrease the risk of physical injury or emotional turmoil during inspections or treatment.

Biosecurity considerations are important when bringing pest control contractors into a care facility with vulnerable populations. One goal is to minimize the risk that contractors will bring additional hazardous pests from other facilities into those caring for compromised populations.

These specific insects are challenging to eradicate once established in a building, so prevention is key. Facility staff members should be trained to spot check for signs of bed bugs: the presence of exoskeletons in the folds of mattresses and sheets, or evidence of rusty-colored blood spots from the fecal matter they excrete on mattresses or furniture are a few examples of signs of their presence.

A well-executed facility inspection program can mitigate the risk of exposure to the hazards of bed bug infestations. Careful attention especially should be paid to sensitive areas where contractor access may be limited for biosecurity or patient privacy concerns (disease isolation rooms, intensive care units, etc.).

Some pest control service providers use well-trained bed bug detection dogs, which are excellent additions to many facilities’ surveillance programs.

Clinical Presentation and Treatment

The elderly living in residential care facilities (nursing homes, assisted care facilities, and group homes) are among the more vulnerable populations affected by bed bug infestations.

Bedbugs typically feed at night and gravitate towards exposed skin. These blood-sucking bugs inject an anticoagulant and an anesthetic to create a numbing effect so they can feed uninterrupted. Bed bugs inflict itchy or painful bites that can cause unreasonably dangerous skin rashes, scratches, and even scarring, in these vulnerable and sensitive populations.

However, it may also take two or three days before individuals develop reactions. In some cases, the failure to meet the standard of care for bed bug prevention and detection may create an unreasonably dangerous condition, and harm to the vulnerable individuals may have increased significantly.

While some people have no reaction, others may experience allergic histamine responses, including hives, and blisters. This can lead to severe itching, scratching, skin tearing, and ultimately skin scarring. While residents scratch to relieve the itching, the skin (already thin in elderly populations) can easily tear, becoming vulnerable to bacteria and subsequent skin infections.

The psychological components (i.e., anxiety, stress, and insomnia) can further decline these residents physically and mentally.

Since vulnerable populations may also have compromised eyesight and cognitive challenges, they depend on staff to follow appropriate standards of care to provide quick identification and intervention. As such, it is critical for facility staff to be adequately trained in symptom recognition and presentation in addition to bed bug identification.

Bed Bug Treatments

Non-chemical remedies, which may be important to consider around vulnerable populations, exist for reducing the risk of bed bug infestation. These may include the following:

• Encasing mattress to minimize additional infestation while preventing existing bed bugs from escaping;
• Putting infested bedding and clothing in a hot dryer that reaches temperatures greater than 114F, the thermal death point for bed bugs; and
• Superheating infested rooms with propane or electric heating units to raise the temperature of the room to 135F for a prolonged time. 

The EPA has also registered over 300 pesticides for treating bed bugs. Insecticide use alone, however, rarely eliminates an infestation, demonstrating the importance of prevention and early detection. And using pesticides may be difficult in facilities with vulnerable or immobile residents or patients.

After assessing the facility, Pest Control Professionals may combine different natural, chemical, and biological methods to control an infestation of bed bugs.

The failure to effectively control bed bugs by following industry guidelines can lead to increased exposure risk and potentially dangerous health effects.

Treatments may fail because of the following:

• Not all of the areas with bed bugs were found or identified;
• Inadequate preparation of the infested area (clutter was not cleared away);
• EPA label instruction were disregarded; and/or
• Treatment was not followed up within an appropriate timeframe.

Bed Bug Infestation Expert Witness Investigations

Robson Forensic can provide expert assistance in cases focused on standards of care involving bed bug infestation in facilities for vulnerable populations. We have health care administrators, clinicians with expertise treating vulnerable populations, veterinarians focused on public health, and safety experts with pesticide application backgrounds, as well as experts in fields such as prison operations, facilities engineering, biomedical equipment and other allied fields to assist in these challenging investigations.

For more information, submit an inquiry or call us at 800.813.6736.

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