Bed bug infestation is an issue that is very specific to camp nursing as a specialty. We as camp nurses are on the front line of identifying infestations, and are often looked to for information on how to approach an infestation. We will discuss the particulars of bed bugs, how to assess and address infestations with the camp management, and how to treat patients suffering from the effects of a bed bug infestation.
Few things will make more trouble for a camp than a bed bug infestation, or even the perception of an infestation. While bed bugs have risen to media fame in the last several years, rest assured that they have been praying on human hosts for thousands of years. Bed bugs had been nearly eradicated in the early 1940s, but have seen a resurgence due to pesticide resistance, the governmental regulation of effective pesticide, and increased global travel.
Bedbug is the common name for the cimex lectularius; a light reddish brown, flat oval-shaped, six legged insect that in its adult form is about 4cm long. The abdomen of the bedbug may elongate and become reddened after a blood meal. The movement of the legs is ant like, and while they are not strictly nocturnal, they are most active at night when they feed.
Bedbugs are incredibly resilient, with excellent resistance to the elements and a large range of common pesticides. They can survive without a blood meal for about five months; and in cooler environments have survived for over 300 days without food. Generally bed bugs feed once every five to ten days, leaving red raised welts similar to mosquito bites, that appear within a few minutes to about a day after the bite. These are often more itchy than the average bite, and often occur in a distinctive pattern of three bites in a row, which are often referred to as the breakfast, lunch, and dinner bites. Bed bugs are attracted to the carbon dioxide humans exhale, so bites on the upper part of the body are more common than the lower extremities.
Even though they are parasitic, bed bugs spend only 10-20 minutes actually feeding on the host. They then take up residence in harborage areas such as headboards, electrical outlets, bedside clutter, or luggage left close to the bedside. Even though they are technically capable of wintering over in the camp environment, generally they enter camp in luggage, and then quickly spread bunk to bunk and even cabin to cabin in shared clothes, electronics, and personal items. Bed bug infestations spread rapidly; easy availability of hosts, close quarters, and an abundance of objects to hide in, as well as the communal nature of property makes summer camps an ideal environment for the pests.
Patient presentation is usually every nonspecific in bed bug infestations. Most affected persons will believe their bug bites are from other insects, until the infestation becomes serious. As stated before, bites from bed bugs can often present in a row of three bites, but otherwise are present in anyplace skin is exposed while asleep. As the length and severity of the infestation increases, the victim is exposed to more bites and their reaction will often become more severe. Suspicion of infestation should be raised with the presence of the three-bite pattern, or if multiple campers in the same bunk are polluted with bug bites despite regular use of bug spray.
If infestation is suspected, then an inspection of the bunk is in order. Bedbugs have a characteristic smell that is similar to rotting raspberries. They tend to congregate in headboards, bed frames, nearby electrical outlets, and mattress seams. Even if live bugs cannot be found, reddish brown droppings that resemble dried blood may be evident. Checking the bunk at night will increase the chance of finding live bugs. If bugs or droppings are found in one bed, it is reasonable to assume that a full infestation is present in the entire bunk.
The CDC has advised that bedbugs do not directly spread disease to humans (however a recent study by University of Pennsylvania has indicated that bedbugs can be a vector for Chaga's disease.) The bites are generally just an annoyance, however, they can disrupt sleep and the itching from the bites can lead to secondary infection of the skin. The bites can generally be treated with a topical hydrocortisone to relieve itch, and or a oral antihistamine. More serious reactions may require prescription corticosteroids to obtain symptom relief.
From a camp prospective, the most effective way to deal with bedbugs is to prevent them by keeping them off camp. Many camps have employed bud bug sniffing dogs to detect the bugs in incoming luggage. Some commercially available detectors are available, such as the Verifi Bed Bug Detector. These attract bugs, and any trapped bed bugs indicate an infestation that needs to be addressed. Baring such measures it often falls to the camp nurse to be vigilant for signs of infestation and advocate for proper treatment of potentially infested living areas.
Treatment of infestations generally falls into three categories: mechanical, chemical, and environmental. Often successful treatment involves a combination of methods.
Physical methods involve removing areas where bed bugs hide between feeding. These can include wrapping mattresses in tight fabric or plastic, sealing gaps in bed frames and other furniture, and removing clutter and electronics from around the bed. Making the environment less friendly makes re-infestation more difficult. Additionally, frequent vacuuming of the mattress and bed frame can reduce the numbers of bed bugs, although care must be used in disposing of vacuum bags so as not to spread the infestation.
Chemical methods can be used by professional exterminators or bought by lay persons. Presently, over three hundred chemicals are approved for use in eliminating bed bugs, the bugs tend to resistant to some of the more common chemicals, and caution should be exercised when using many of the chemical pesticides around children. Because bed bugs hide in such a wide variety of places and are such hardy creatures, often chemical treatments must be repeated. Limited local application of chemicals is often preferred so as to limit human exposure, but this may actually encourage the spread of bed bugs to other, previously not infested locations. Most professional exterminators have started using fogging systems to treat entire structures and ensure that all potential harborage sites are exposed, however this drastically increases the amount of pesticide used and the amount of time needed to apply the treatment.
Environmental extermination is accomplished by raising the temperature of a room or dwelling to or above 117 degrees for at least two hours or longer to assure at all areas where bedbugs hide have reached the desired temperature. My camp has had immense success with heat treatment. A bunk is scheduled to activities for the entire day. First thing in the morning, maintenance seals the windows and doors with plywood cutouts and using a simple heater common to winter construction sites and some vent ducts, the entire cabin is heated for a few hours. The cost to camp is minimal (we already had most materials, only a thermometer had to be purchased), and the treatment is safe, non toxic, and very effective due to the simple construction of the cabins. If complaints continue, meaning a bug harborage was missed, the treatment is repeated for an even longer heating time.
As with other insect infestations, campers’ letters and calls home will quickly raise alarms in the community of camp parents, who will undoubtedly call camp with vigorous concern. The parents will, and should, be very worried about infestations returning home with the children. Working with your camp director to get ahead of the panic is quite helpful. Send mass emails advising of the situation and what steps are being taken to address it. Create a script for the office to read so that correct information is provided uniformly, this will help keep parental hysteria under control, and help relieve parents anxiety.
Bedbugs are an increasingly common issue that oftentimes catches camps unprepared. Health services are often the first department to identify a potential bed bug infestation, and so may have to field the question of "what do we do about it". Health is also the department that will have the most pressure from campers and staff affected by the outbreak, as the victims of a bed bug infestation demand symptom relief for their numerous itchy bites. Never lose site of the fact that bed bugs do not spread disease, and are not a health concern, but an environmental concern. Be prepared to offer advice and field questions, especially from parents. Also be prepared for a degree of denial from management. Bed bugs carry a social stigma of uncleanliness, and many directors will not want to admit their camp has an infestation. Much like other parasitic pests, there is no connection between hygiene or environmental cleanliness and infestation, and like other infestations the longer the issue goes unaddressed the bigger the problem will be.
All opinions expressed here are my own and do not represent those of my employer. Remember anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers.