Confirmed bed bug infestations should be managed by trained professionals. Managing a bed bug infestation is a difficult task that requires removing or treating all infested material and follow-up monitoring to ensure the infestation has been eliminated. Management will require employing several nonchemical methods such as vacuuming, washing bedding at a high temperature, using steam or heat treatment, and sealing up hiding places.
Insecticides may be required to eliminate serious infestations. Several active ingredients are federally registered for bed bugs for over-the-counter use, but few have been demonstrated as effective. Pest management professionals (PMPs) have access to a wide range of effective registered products; however, insecticide resistance among bed bug populations is increasingly common. The best approach is to combine chemical and nonchemical tactics with increased sanitation and habitat modification practices. Prevention and monitoring of bed bug infestations are paramount and should be ongoing.
The presence of raised wheals, blisters, rashes, or any other dermal symptom associated with arthropod bites should never be used for diagnosis, since several household pests are known to bite humans, and since reactions vary widely between individuals. You can confirm a bed bug infestation only by detecting the pests themselves or their signs, which include fecal spots, blood spots, egg cases, and shed skins (exuviae).
Current research indicates 85% of bed bugs are found in or near the bed, so inspections for infestations should initially focus on the mattress, box spring, bed frame, and headboard. Lift the mattress and inspect all its seams and surfaces as well as those of the box spring. You may need to dismantle the bed. Keeping in mind bed bugs can utilize cracks and crevices as small as the width of a credit card, make sure to thoroughly inspect all potential harborage sites. Use a flashlight and a small mirror to aid in the inspection process. It can take a good deal of time, patience, and perseverance to detect low-level infestations.
Remember, these nocturnal insects are small. Although you can see adults and aggregations of nymphs with the unaided eye, seeing the eggs requires a hand-magnifying lens. Make sure to look for dark spots of dried bed bug excrement, blood spots where engorged bugs were inadvertently crushed, or the insects' light-colored shed skins. A foul, rotting, bloody meat, or acrid "buggy" smell might be present in heavily infested areas.
A number of nonchemical control methods can be used to manage bed bugs. These methods are directed at killing or removing bugs or restricting their access to beds or bedding material. You can remove bed bugs and eggs with the suction wand of a strong vacuum; however, you must target the seams of mattresses and box springs, along perimeters of carpets, under baseboards, and in other areas where bed bugs live. A single vacuuming rarely gets all bugs and eggs and should, therefore, be repeated. Portable steam cleaners and other steam delivery devices can kill all bed bug life stages, so these items can also be used to clean mattresses and furniture. Care must be taken, however, to ensure steam penetrates into the areas harboring bed bugs and their eggs.
Commercial heating services are available to treat entire rooms in homes for bed bug infestations. The current recommendation for effective commercial heating services calls for a temperature of at least 140F for two hours or 130F for three hours (the minimum lethal temperature is 113F), which will kill most bed bugs and eggs. In California, providers of heat services must be licensed and bonded by the Structural Pest Control Board. Chilling to a temperature of 32F or lower and maintaining this temperature for several days will also kill bed bugs.
Mattress encasements specifically designed to prevent bed bugs from establishing harborages on mattresses are commercially available and have been shown to be effective through laboratory research. Encasements are particularly useful for hotels or other facilities with many beds. Encasements can also be used to contain bed bugs within mattresses when they can't be discarded or when control tactics such as steam or insecticide application are unavailable or undesirable. Bugs trapped inside encasements will eventually die due to starvation.
Insecticide applications alone won't control bed bug infestations. Insecticides must be combined with infestation prevention measures-a program of removing and cleaning infested beds, bedding, and other harborage sites-as well as nonchemical tactics such as steam or heat delivery and an ongoing evaluation and detection program to ensure treatment was effective and to manage future infestations early on.
The most effective bed bug pesticides are available to commercial pesticide applicators only. Professionals also have the equipment and expertise that allow for a more effective and precise application of insecticides. In addition, professionals have the training to detect and isolate infestations, which often allows for more effective long-term management.
Insecticides may be applied as liquids directly to cracks, crevices, bed frames, baseboards, and other similar sites, or they may be applied as dusts in cracks and crevices. Pesticides aren't generally applied to mattresses or bedding because of potential risk to people. Using over-the-counter total-release aerosol foggers has been shown to be ineffective for bed bug control and potentially harmful to residents; therefore, they aren't recommended.
Fumigation using the active ingredient sulfuryl fluoride is commercially available for bed bug control in California and can be highly effective. However, this is a highly specialized and regulated treatment method, best for remedial control only. Since fumigants have no residual effects, other methods or a combination of methods will be needed to prevent reinfestations.
Some bed bug populations have developed resistance to pyrethroid insecticides and no longer can be effectively controlled by them. Therefore, there is growing interest in alternatives such as the mixtures, botanicals, and IGR listed above. Some studies, however, suggest that mixtures containing pyrethroids continue to drive resistance, that oils have little to no residual action, and that chlorfenapyr and hydroprene may take many days to kill bed bugs.
Insecticides applied as dusts cling to the pest's cuticle, wearing away the insect's protective wax covering or poisoning the insect when it grooms itself. Several dust products used in bed bug management include borates, diatomaceous earth, silica gel, and formulations containing pyrethrin or pyrethroids. These materials can provide long-term control as part of an integrated program if they are placed in out-of-the-way places, such as under baseboards or in wall voids, that don't get wet. Bed bugs may not groom themselves to the same degree as other pests, such as cockroaches, so insecticide dusts requiring consumption, including borates, may be less effective than anticipated.