Residential facilities that house patients overnight are at risk for a rarely recognized nuisance: bed-bug infestations. But experts say remaining vigilant and proactive about the tiny pests can make a world of difference for a problem that can easily get out of hand and become costly.

“The nature of treatment centers puts them at risk for infestations in the facility. Patients may freely move between a variety of activities and other patients’ rooms,” says Angela Tucker, an expert in pest management and manager of technical services at Terminix. “In addition, some patients may leave the treatment center for off-site therapy or family visits.”

Bed bugs can be found virtually anywhere people gather, according to Cindy Mannes, VP of public affairs for the National Pest Management Association. And while she says the pests do not transmit diseases, bed-bug bites can become red, itchy welts.

Because bed bugs are found everywhere people are and due to their “hitchhiking” nature, these pests often tag along on a person’s belongings, according to Tucker.

“Bed bugs do not have wings and cannot fly; nor do they jump,” she says. “Their primary mode of movement is walking or running.”

Adult bed bugs are reddish-brown in color, oval shaped, flat and measure about one-fourth of an inch long, Tucker says. Young nymphs are smaller and could be white or yellow-orange in color. Bed bug eggs are tiny and white, and the adult female will glue her eggs inside cracks and crevices, which can make them difficult to see.

How to avoid bed bugs

Because of bed bugs’ traveling nature, Tucker says it’s necessary for residential centers to establish protocols that address the pests, such as inspection of personal belongings and furniture within the facility. Policies also should include what to do if a staff member finds bed bugs.

It’s equally important that the policies are explained to patients, family members, caseworkers and other visitors, she says.

“Everyone needs to understand why these policies are in place and their role in preventing an infestation and reporting possible bed bug sightings to the appropriate staff members.”

Mannes agrees that facilities should develop a written action plan in advance of any problems. The action plan should include specific procedures and responsibilities for responding to an incident. Likewise, she says facilities should provide an information sheet to everyone that explains how to avoid bringing bed bugs into a facility.

Some tips for avoiding an infestation, according to Mannes, include:

• Prohibit the use of secondhand furniture;
• Require furniture, luggage and other personal belongings be inspected by a professional and declared free of bed bugs, or heat treated or fumigated before coming into the facility;
• Regularly vacuum or steam clean areas prone to bed bugs, including under and around beds, upholstered furniture, luggage racks and wall/floor junctions;
• Reduce clutter;
• Seal cracks, crevices and holes near beds;
• Repair or replace peeling wallpaper or paint;
• Keep laundry carts in the hallway during service;
• Keep the clean and dirty linens separate on carts and in the processing room;
• Do not place dirty laundry in linen storerooms or closets that house clean linens; and
• If dirty laundry is outsourced to another facility, do not use the same vehicle for clean linens unless clean and dirty laundry can be completely isolated from each other.

Tucker says that infestations are often localized, and early detection can at least reduce their movement throughout the facility. Thus, it’s important to not only have policies in place that help avoid the pests but also ones that help to reduce the chance of making a small infestation a larger one.

“A potential policy may be that when bed bugs are identified in a patient room, that person’s cloth items should be washed, dried and placed in plastic bags,” she says. “Only items that are washed and dried should be worn outside of the patient room.”

How to check for bed bugs

If a bed-bug infestation is suspected, there are some ways team members can check to confirm.

“Bed bugs have evolved to feed on human blood. They also have no real defense against humans and cannot fly away. These two facts mean that bed bugs are typically found near humans, particularly near our resting areas,” Tucker says.

That’s why it’s important to routinely inspect areas such as head boards, bed frames, mattresses, box springs, sofas, group rooms and other areas where patients may rest.

Mannes advises to check for small red to reddish-brown fecal spots on mattresses, upholstery or walls. Team members, armed with a small flashlight for assistance, can pull back sheets and inspect mattress seams and box springs, particularly at the corners, for pepper-like stains or shed bed-bug skins.

Another indication of bed bugs will be evident on the patients—red, sometimes itchy, bite marks that appear, especially on the legs, arms and other body parts that are exposed while sleeping, she says. Additionally, heavily infested areas could have a sweet odor.

What to do about an infestation

Experts say that it’s important to call a licensed professional if signs of an infestation are discovered. A professional can help confirm the infestation and recommend a treatment plan.

“Identification is critical, as some states have regulations that prevent [pest-] product use without the confirmation of pests,” Tucker says. “Perhaps most importantly, operators should remember not to panic and to follow their planned policy. Failure to do so may result in a longer time frame to gain control of the bed bugs.”

The time frame will depend on the size of the population, control methods used and the availability of the pest-management staff, Tucker adds.

“The use of heat may take anywhere from a half-day to several days based on the size of the area that must be treated. Chemical products will take less time, and often require more than one application to be successful,” she says. “In addition, the chemicals must be applied in accordance with their instructions. For example, if a chemical can be reapplied every seven to 10 days, then the treatment schedule must reflect that.”

Mannes says rooms that have been serviced for bed bugs should be rescheduled for follow-up inspection, reserviced as needed and kept offline until the bed bugs have been controlled successfully. Additionally, affected and adjacent rooms should be inspected for the next two to three months to make sure that no isolated pockets of the pests remain.

“Also inspect waiting rooms, laundry rooms, lounges, cafeterias, children’s play areas and other areas as appropriate,” Mannes adds.

When it comes to affected personal belongings, Mannes advises to wash all clothes and linens, including ones that haven’t been worn or used, in hot water. Then, they should be dried on high heat to ensure that all bed bugs and their eggs have been removed.

“To many people’s surprise, best management practices discourage the disposal of items infected with bed bugs, as this may result in the spread of bed bugs to new locations,” she says. “While most items can be treated, items that are badly damaged and deteriorated may not justify the effort and expense to treat them and should be discarded.”

Alicia Hoisington is a freelance writer based in Ohio.

Can I lose my license over a bed-bug infestation?

Kathryn Edgerton, partner at Nelson Hardiman and who has represented about 70 addiction treatment facilities, says that addiction treatment centers are required to keep their facilities clean, safe, sanitary and in good repair, free of flies and other types of insects. That said, anyone can request that a facility be inspected. If a complaint is filed, the department of healthcare services might initiate an investigation -- probably within 10 working days.

“If the investigator finds a deficiency—one example would be a bed-bug infestation—the investigator will notify the facility of the deficiency, provide a date by which it needs to be corrected and any civil penalty assessed,” Edgerton says.

In her experience, a bed-bug infestation would be considered a Class B deficiency, Edgerton says. This type of deficiency relates to the operation or maintenance of a facility that has a direct or immediate relationship to the safety, or the physical or mental health of residents. These types of deficiencies must be corrected within 30 days unless the investigator assigns a shorter time frame. If facilities take care of infestations according to investigators’ instructions, license revocation shouldn’t be a concern. Revocation of a license could come into play if a facility has multiple Class B deficiencies with failures to correct them.