Bed bugs tend to gather together in hidden and undisturbed places where a person sleeps, or sits for an extended period of time. They are usually found in the bed, along the seams and sides of the mattress and box spring, the headboard, and bed frame, creating clusters of live bed bugs, shed skins, dark-colored fecal spots, and eggs. In heavily infested locations bed bugs can be found anywhere in the room. As bed bugs grow they shed their amber-colored, transparent skins, leaving behind what look like hollow bed bugs.

What is the risk of having bed bugs?
Bed bugs must bite to feed on blood. They have pointed mouth parts, like mosquitoes, and feed for just a few minutes at a time. They must feed to grow and although they primarily feed at night, bed bugs will bite during the day if necessary.  Bed bugs have never been shown to transmit disease to humans. The most common symptom of bed bug bites are itchy welts on the skin of most but not all sufferers. Reactions vary widely from person to person and bites alone cannot be used to confirm bed bugs. Bites may develop secondary infections through scratching. Anemia has been reported in the elderly and very young in cases where homes are heavily infested. Asthma has also been linked to the presence of bed bugs in homes, though not yet in the Unites States.

Bed bugs can be transferred among people, and that places a great deal of social, emotional and financial stress on sufferers. Control is challenging and costly, and there is still a certain amount of social stigma attached to living with bed bugs. Having bed bugs may restrict the social lives of people. Sufferers avoid visiting friends and family and often throw away belongings, at great cost, and minimal benefit. Tenant-landlord disputes over who is responsible continue to take place and these battles can be damaging to both parties.

How can we get rid of them?
Pesticides alone, or the use of any single method, will not eliminate bed bugs. A strategy that includes a number of methods is absolutely necessary, especially in multiple unit facilities like apartments, shelters, dormitories, group homes, and hotels.  The following are needed for effective bed bug control:
• Cooperation of landlord, management, and resident to focus on the problem
• Accurate identification to be sure it is a bed bug and not another pest
• Identification of the source (especially if bed bugs are moving from an adjacent room or apartment unit)
• Thorough inspection of the facility and identification of all possible hiding spots
• Cleaning and organization of the living area
• Reducing clutter in the home
• Bagging and removal of bedding and clothing from the affected area
• Washing sheets and blankets and drying on HOT setting
• Encasing the mattress and box spring in a zippered encasement
• Washing or treating the headboard and bed frame
• Cleaning and removing bed bugs from other items
• Isolating the cleaned (bed bug free) items until bed bugs are gone
• Careful and targeted use of insecticides, following label instructions
• Inspection and treatment of all surrounding adjacent units
• Follow up inspections and all other procedures as needed (there should be at least one follow up inspection 3 weeks after initial treatment)

Management of bed bugs should begin at the first sign of a problem. The longer an infestation is allowed to exist, the more difficult and expensive it will be to control. It may take several months to get rid of bed bugs if there is a large infestation.

There must be cooperation among tenants and the management staff in multiple dwelling facilities. A bed bug management program must be coordinated for the entire building as well as the individual room or person, because bed bugs can go undetected for long periods of time and can spread very easily through walls, on electrical and plumbing conduits. Cooperation from the tenant includes following the pest reporting procedures, cleaning and preparation of the room for treatment, and taking measures to avoid reintroduction of bed bugs.

Building management must ensure that tenants are aware of these procedures and are provided with the necessary contact information they need to report a complaint. Complaints must be addressed in a timely manner. Most building managers cannot deal with a bed bug infestation without the help of a pest management professional (PMP). The PMP should be involved at an early stage. Professionals know how and where to look for bed bugs, and can thoroughly assess an infestation to ensure the right measures are taken.

Identification of Bed Bugs

Bed bugs are small but visible insects. There are three main life stages: the whitish egg (about 1 mm in length), five pale juvenile (nymph) stages that range from 1mm to 4.5 mm (1/4 inch), and the adult which can be as long as 7 or 8 mm (3/8 inch) when fed. The newly hatched nymph is very pale until it feeds. Then it looks like a tiny droplet of blood. Each nymph stage will feed and become filled with red blood. The adult is about the size and shape of an apple seed, and dark red to brown in color and as flat as a credit card before feeding.

When searching for bed bugs it is important not to overlook the nymphs, which can be difficult to spot. Look for nymphs where droppings and stains appear, especially in crevices on fabric and wood surfaces.

A newly hatched bed bug is smaller than a poppy seed  and the color of a sesame seed. The stains from bed bug fecal droppings can appear as rounded bumps or blackish, soaked-in stains. This adult bed bug is waiting to feed on blood. Adult bed bugs are very flat and fit into crevices as thin as a credit card before they feed. Nymphs are even thinner. Once fed, they are longer and plump until they begin to digest the blood meal.

Bed Bug Bites and the Bites of Other Arthropods

Bites are usually the early warning sign of a bed bug infestation. Bed bugs feed only on blood. Each life stage feeds, except the egg. They insert the fine stylets from their beak directly into the skin in search of a tiny blood vessel, and may move and bite repeatedly until they find the right spot. At each point the beak releases saliva into the skin. The saliva contains proteins and enzymes that will cause an allergic reaction in many people. Allergic reactions vary widely from practically no reaction, to small itchy red or white bumps, to blisters or pustules.  Not every person in a household will react the same way and many times only one person will show signs of bites, leading others to believe it cannot be bed bugs.

It is difficult, if not impossible, to distinguish bed bug bites from those of other biting pests without other circumstantial evidence that will link to a specific pest. It is critical to confirm bed bugs in the sleeping or living area through inspection to be sure that bites are caused by bed bugs. Bed bug bites can resemble mosquito and flea bites.”