1. Guidelines Specific to Long Term Care A good general resource:

2. Issues Specific to Long Term Care Patient or resident satisfaction Family satisfaction for the welfare of their loved ones Reputation of a facility Local, State, and Federal guidelines and regulations regarding housing standards Unique considerations of older adults and other vulnerable populations

3. Unique Considerations for Older Adults Limited Mobility? Existing Skin Conditions? Poor Vision? Mental or Cognitive Difficulties? Communication Difficulties? Need Assistance to Prepare for Treatment?

4. 4 Special Considerations for Vulnerable Populations Lack of choice in housing, frequent relocation Lack of resources –Few sources of financial assistance at this time Inability to recognize an infestation –Elderly, disabled Require assistance to prepare for treatment

5. Observati on Inspectio n ConfirmationCleaningTreatment Future Prevention Follow up Have a Plan & Be Proactive! Prevention

6. Facility Level Prevention Intake procedures that screen incoming clients for skin-condition (if medically appropriate), and their belongings for evidence of infestation Promptly respond to sightings or complaints Any donations to the facility should be screened Develop a facility specific policy and policy statements

7. Facility Level Prevention The routine use of insect monitors may help to identify infestations early Facility repairs will help to keep bed bugs from spreading, and make treatment for bed bugs more efficient Certain types of furniture are more easily inspected, cleaned, treated, and may be less hospitable to bed bugs Maintain a bed bug vacuum

8. Education Prevents Infestations Train employees to recognize the signs of bed bugs –Early detection and follow-up will save much needed resources Educate clients to recognize bed bugs –Dispel the stigma –Be careful when visiting or travelling Facilities that may see the same clients that you are seeing should also be aware of bed bugs – local consortiums are good outlets for education and information sharing –A community approach is the only way to reduce the burden of bed bug infestations –If all facilities are not on board you may still have epicenters of spread

9. Observation & Monitoring Visual inspection –Time consuming, difficult to detect early infestation Monitors –Sticky traps, interceptors, dry ice baited, CO2 + heat Canine scent detection –Very promising, high sensitivity –Dependent upon the team – trainer and dog Detection may be hindered by hesitation to report by tenants In multi-unit housing, must inspect adjacent units

10. Document all observations Take action promptly Report: Date What you found What you did

11. Got bed bugs? Now what? If found and controlled early in the infestation, the spread of bed bugs can be stopped. The first responses should be to: Report the problem Do NOT throw the mattress outcover it Do NOT sprayleave this to the PMP Prevent carrying the bed bugs to other places Prepare the unit for the PMP Inspect adjacent units Educate your clients

12. Mattresses and furniture dont always have to be thrown out! Use a Mattress Encasement! Trap live bed bugs inside and make it more difficult for bed bugs to hold onto mattress Zip, seal, and check for rips Leave it on (dont let it rip) Many PMPs will require

13. Treatment Technologies Insecticides –Pyrethroids (liquids, dusts) –Insect growth regulators (IGR)(hydropene) –Diatemaceous Earth Heat Treatment –Steam (cracks/furniture) –Dry Heat (can treat entire unit) Cold Treatment (liquid CO2) Encasement

14. New Technology Heat is an effective treatment New technology allows us to raise the temperature of an entire home or unit. The upper thermal tolerance of the bed bug is ~117°F.

15. Requirements for Successful Treatment Scrupulous preparation Choice of treatment methodologies best suited to the situation Post-treatment monitoring and re-treatment if necessary Identification and remediation of high risk behavior to avoid re-infestation

16. One bed bug, HALF a year…

17. Management's role Find out the PMPs requirements for unit prep and plan ahead! Example: Who takes apart and reassembles furniture? Have the professional inspect and treat units adjacent to the infested one. Communicate the situations/populations in units to the professional (respiratory problems, chemical sensitivities, pregnant women, the elderly, or children present).

18. The PMP's role ALWAYS thoroughly inspect the unit and the adjacent walls Provide preparation and follow-up instructions in multiple languages Follow the labelespecially when treating mattresses! Return in three weeks to look for and treat hatched nymphs

19. Facilities, maintenance, and support service roles Be discreet Empty dumpsters weekly Mark and/or damage furniture left out for the trash so it cant be reused Inspect the laundry room weekly Help residents prepareeducate and provide physical or financial support Be very cautious when working in unitsnever set items on or under beds, recliners, or sofas!

20. The resident's role Inspect regularly if possible Report bed bug sightings immediately and seek help from staff Use plastic bags when transporting infested items Dont bring home furniture found on the street Follow preparation instructions from the PMP

21. Challenges for Long Term Care Client may not tell you about the problem –They might not know or understand –They may be ashamed Bed bugs may cause a a lot of distress –Client may be angry or depressed about it –Bed bugs may compound other problems Health problems may necessitate an alternate treatment strategy

22. Strategies for Long Term Care Set (and follow) policies to prevent bed bugs at intake Constant vigilance! Dont wait for clients to complain Use mattress encasements Hire experienced professionals for treatment

23. Be able to identify infested units Reduce the items you carry in/out Items to be carried in/out –Contained in a plastic bag –Left in places least likely to be accessible by bed bugs Avoid sitting down on infested furniture Check your clothes and shoes after leaving If you find them, Dont take them home with you

24. Areas least likely to have bed bugs: –Kitchens –Bathrooms –Well traveled walkways –Center of large clean areas Table tops Bare floors Bathtubs Avoiding bed bugs

25. Guidelines and Resources Many resources are available online for use in education and planning: –Fact sheets –Training resources –Comprehensive manual For information specific to Michigan and as educational and training resources are developed, check: www.michigan.gov/bedbugs

26. Resources NEW!