Your hospital may have a bed bug problem

Robin Wulffson MD's picture
bed bugs, blood sucking, skin irritation, hospitals, infestations
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According to a new medical paper, bed bug infestations have resurfaced worldwide both within and outside of the hospital setting. Researchers in the United States and Australia published their findings in the November edition of the journal Infection Control and Hospital Epidemiology.

Although the thought of nasty insects lurking in your bed often evokes a horrific response, the little critters primarily cause skin problems in humans. The authors note that a major stigma is placed upon individuals or institutions found to harbor them. They explain that it is important for healthcare facilities to be prepared for this pest by implementing policies, carefully selecting materials used for hospital furniture, and educating providers on early identification and control.

The authors explain that, following a quiescent phase between 1950 and the 1990, bed bugs have reemerged worldwide. They note that many factors are believed to have played a role in this resurgence, including resistance to the most commonly used pesticides and an increase in international travel. Because they found that peer-reviewed literature on the frequency and management of bed bug infestations within hospital facilities was currently lacking, they proposed to summarize the main concepts with regard to the epidemiology and clinical implications of bed bugs and provide guidance on the management of these insects, with a major emphasis on infestations within healthcare settings.

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The authors explain that the Hemiptera order is composed of two clinically relevant insect groups: the Cimicidae (which includes bed bugs) and the Reduviidae (which includes triatomine bugs, which transmit Trypanosoma cruzi, the agent of Chagas disease). The two species of Cimicidae associated with humans are Cimex lectularius (temperate climates, such as the United States) and Cimex hemipterus (largely tropical climates). Bed bugs are hematophagous (blood suckers). They are flat when not blood engorged, and have five juvenile stages. The youngest stage is off-white in color and approximately 1 mm in length, and as the insect grows it becomes darker. Adults are a brownish red and 4–6 mm in length. Blood meals are required for progression through the juvenile stages to the adult stage, adults can live for several months without any blood meals. Under ideal circumstances, they have been reported to live up to two years; however, in temperature-regulated environments they live for only up to approximately five months at 72° Fahrenheit. Females produce an average of 5–8 eggs per week for a total of 18 weeks. Bed bugs are attracted mainly to carbon dioxide, body heat, and other ill-defined olfactory cues, feeding primarily at night from any mammal but preferentially from humans. Furthermore, their bites are painless because of the extremely fine needlelike stylets that penetrate the skin. An important characteristic of bed bugs is that they are wingless; therefore, they do not fly or jump, but rather they depend on physical contact to move from one surface to another.

As previously noted, skin reactions are the usual result of bed bug bites. Systemic symptoms such as anemia or fever are unusual. Another concern associated with bed bug bites is the potential for these insects to transmit infectious diseases. Even though bed bugs have been found to carry infectious organisms, such as hepatitis B virus, in the field, it has never been proven (experimentally or in clinical practice) that any organism can be transmitted by bed bugs.Furtherrmore, there is experimental evidence that even with presence of high human immunodeficiency virus loads in blood, bed bugs fail to transmit the virus.7-9

The authors expressed concern because one study tested five bed bugs for bacterial organisms and recovered methicillin-resistant Staphylococcus aureus from two of them and vancomycin-resistant enterococci from three of them. These insects were collected at the time of hospital admission from three residents of a single Vancouver shelter.

The authors concluded that bed bugs have reemerged during the past decade all over the world. The clinical consequences of these insects are mainly dermatologic. However, a major stigma is still present among individuals or facilities found to harbor bed bugs. Therefore, there is a need to educate healthcare workers on how to screen for and respond to bed bugs. Hospitals need to be prepared for this pest by implementing policies before infestations arise. Additionally, further research is needed to determine the role played by bed bugs and other arthropods in the horizontal transmission of pathogenic bacteria, as well as the role that various types of materials used for hospital furniture play in increasing the propensity of infestations.

Reference: Infection Control and Hospital Epidemiology

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