HOW NEW YORK HOSPITALS SHOULD TREAT BED BUG ISSUES A White Paper by Bell Environmental Services WHY ARE BED BUGS A SIGNIFICANT PROBLEM FOR HOSPITALS? Bed bugs are an epidemic throughout New York City including in many public places and hospitals. In 2010, the NYC Department of Health and Mental Hygiene stated that 400,000 or 1 in 15 people in New York City had bed bugs in the last year. Though bed bugs affect people in all socio‐economic levels, they are a greater problem among people at the lower end of spectrum who do not have the resources to be able to pay for effective pest control solutions, i.e. the New York residents who are more likely to be patients at public hospitals or use emergency room services instead of regular medical care. Medical Issues Caused By Bed Bugs Bed bugs are a medical problem in that they cause itchy bites to human skin and can lead to secondary infections. Bed bugs have recently been shown to carry MRSA. In a 2011 study published by the Center for Disease Control, three bedbugs from one patient contained methicillin‐resistant Staphylococcus aureus (MRSA), and the two from the other patients each contained vancomycin‐resistant Enterococcus faecium (VRE). Bed bugs also give psychological distress and social stigma. A presentation to the 2011 American Psychiatric Association conference stated that bed bugs are also a cause of considerable psychiatric distress including included anxiety, depression, and relapse of controlled bipolar disorder. Others patients in this study were diagnosed with monosymptomatic delusional disorder ‐‐ imagining that one is crawling with pests, even though no infestation exists. Bed Bugs Are Cryptic In Nature Bed bugs hide in crevices, cracks, wall seams, and almost any other cramped shelter. This means a bed bug infestation can be hidden in plain sight in any part of a building, not typically near food and kitchens as with other pests. Bed bug elimination is similar to trying to remove a moving needle from a haystack. A newly hatched bed bug is 1.5mm in size (the size of the tip of a ball point pen) and translucent. The eggs are also 1mm in size and have a pearly translucent appearance. A non‐engorged bed bug is as thin as a credit card. Their small size enables them to hide deep in cracks and crevices, on any item. For example, there are 7 places for bed bugs to hide on 1 wooden hanger. Bed bugs can hide inside the head of a screw. These Hitchhiking Insects Spread Throughout and Reinfest Facilities Bed bugs are wingless insects; they do not fly or jump. To get around, they crawl from place to place, often into personal items when they are looking for a new safe hiding spot after being disturbed. While bed bugs can’t fly, they can move into bags, clothing, and accessories easily. These insects hitchhike into hospitals on patients, visitors, and staff. Even if a particular bed bug issue is solved, the reinfestation risk is high as these insects can be transported into a facility immediately after treatment. When a host is available, bed bugs will feed about once every seven to ten days. In between meals these insects stay well hidden inside cracks and crevices so a problem may not be easy to detect. If for whatever reason the hosts become unavailable, the bed bugs will eventually go into a dormant state in which they can survive, but not develop or reproduce. Adult bed bugs have been known to live for over one year without a blood meal in this state. Once in a hospital, bed bugs rapidly multiply, feed on patients, staff, and visitors and travel to homes. Bed bugs do not go away on their own and have no natural predators. Sensing that there is no blood meal readily available to them, bed bugs will forage for one, searching for a new host with sensors that pick up on body heat and carbon dioxide that is the byproduct of our respiration. Their search for a blood meal can lead them into adjacent units and hallways of 155 Route 46, Fairfield, N. J. 07004  (973) 575‐7800 ext. 1  Fax: 973‐575‐1177 www.bell‐environmental.com  bedbugs@bell‐environmental.com hospitals and to people who can transport them elsewhere. Because they’re so persistent, bed bug control is the only way to be certain a bed bug infestation has been eliminated. BED BUG TREATMENT SERVICES ARE DIFFERENT THAN REGULAR PEST CONTROL SERVICES The pest control efforts necessary to eliminate bed bugs is very different and more labor intensive than other pest control efforts. They focus on living and sleeping areas instead of eating areas or places that have water. There are no effective baits against bed bugs. To eliminate bed bugs it is best to treat an entire residence or location, and not perform spot treatments of just an affected bed. Detailed treatments are focused on cracks and crevices and include servicing all furniture and equipment in a room. It is also key to inspect, and if necessary, treat areas neighboring an infested room. Bell Environmental’s InstantFreeze method provides the most thorough treatment available because it is safe to use on any surface including medical equipment and electronics. Bed Bug Treatments Should Not Rely on Pesticides Or Chemicals There are safe and effective solutions for bed bugs that do not use conventional pesticides. These pesticide‐free solutions do not have any of the following concerns. The items of concern for hospitals using conventional pesticides for bed bug control are:  Humans, Especially Patients, Cannot Come In Contact With Pesticides All chemicals approved for use on bed bugs include labels that all have warnings for pesticides, including one which is basically rubbing alcohol. Humans should not come in direct contact with these chemicals after they are applied.  New York City Public Hospitals using pesticides must use products that are permitted under Local Law 37. Enacted in 2005, New York City’s Local Law 37 prohibits the use of certain pesticide products based on their toxicity and potential to cause cancer and/or reproductive effects in any property owned or leased by New York City, including the hospitals and offices of the NYCHHC and other city agencies. These prohibitions apply whether a chemical is used by City personnel or its contractors. These rules also apply to the NYFD, other departments and agencies, and public housing.  Rooms should be closed 24‐hours in advance of treatment. Under Local Law 37, many chemical products that can be used require a pre‐notification posting 24‐hours in advance of pesticide usage that chemicals will be used in a location. It is appropriate for a hospital to close the area scheduled for treatment, as it would not want to expose its patients to bed bugs. By closing rooms for 24 hours hospitals forgo the ability to bill Medicaid, Medicare, or Insurance companies for patient services for a day.  Most Pest Control Companies Are Not Equipped To Provide Immediate Dispatch For Bed Bug Issues. In our conversations with hospitals they often point out that it takes at least one business day before the pest control company is onsite to treat bed bug issues. Most pest control companies treat bed bugs as part of their overall services and are not set up to perform rapid dispatches with dedicated personnel to solve issues.  Chemicals Cannot Be Used To Treat Medical Equipment. In a detailed crack and crevice treatment for bed bugs, the entire area, including electronic and computer equipment needs to be treated as bed bugs have been known to do hide in these places. Pest control companies should not apply insecticide sprays or dusts into computer equipment. These applications can cause short circuits and other serious problems. In addition, it is important to note that heat cannot be used on medical equipment and electronics without risking damage.  Rooms Must Be Vacated Following a Chemical Treatment. Typically hospitals rooms are kept closed for 48 hours (between 24‐72 hours) following a pesticide treatment. Following a chemical treatment, the area must be properly ventilated before it is reopened to patients and staff; there are potential odor issues; if a mattress was treated with chemicals, it must be dry before the bed is made; the hospital staff needs to clean the room. Bell Environmental Services White Paper – How New York Hospitals Should Treat Bed Bugs – Page 2 155 Route 46, Fairfield, N. J. 07004  (973) 575‐7800 ext. 1  Fax: 973‐575‐1177 www.bell‐environmental.com  bedbugs@bell‐environmental.com 
Patient Relocation Can Affect Care and Cost Revenue. Patient relocation also affects treatment and billing. What does a hospital do with its patients in the rooms that were closed for bed bugs and subsequent treatment? We know of situations in which hospitals’ psychiatric wards were closed for several days for bed bug treatments, complicating patient care and the hospitals lost tens of thousands of dollars in billing. CHEMICAL‐FREE BED BUG SERVICES ON A LARGE SCALE AND RAPID RESPONSE BASIS Bell Environmental Services performs bed bug control services in hospitals and healthcare facilities using a unique, non‐
toxic, non‐chemical method of rapidly freezing and thereby eliminating bed bugs in all stages and their eggs upon contact. InstantFreeze accomplishes its freezing action by transforming liquid carbon dioxide into a snow in a process similar to creating dry ice.  Bed bugs live in cracks and crevices and are immune to most pesticides.  Bed bugs need to be killed on contact.  We use a frozen carbon dioxide method (InstantFreeze) to treat every inch of the room that bed bugs can occupy.  InstantFreeze is safe to use on every surface of the room.  We can use InstantFreeze to treat the medical equipment and electronics.  There is no residual for you to clean up.  The time to treat a patient room takes about 1 hour.  Move the patient out in the hall and let us get to work.  Staff and patients can immediately reoccupy the room after treatment. Bell Environmental is the only company with the ability to meet the requirements that large hospitals, public agencies, and businesses have to solve their bed bug issues. These organizations often have large facilities, many locations with transient customers, patients, occupants, visitors, employees and frequent interaction with the public. They cannot afford downtime as they use a pest control service as it could compromise public health, safety, and business operations.  Bell Environmental guarantees response to hospitals’ requests for service on‐site 4 hours after receiving a complaint. The work will commence and be completed within one work day. These services will be available to hospitals 24/7/365.  Bell Environmental guarantees that rooms are treated thoroughly with the carbon dioxide snow method. The treatment does not require evacuation. The rooms can be used and staff can resume normal duties immediately after treatment.  Bell Environmental can produce a 15‐20 man service team to treat large locations swiftly and efficiently and/or multiple locations simultaneously, as required.  Bell Environmental has 2 Carbon Dioxide units for every 1 service personnel on the entire 15‐20 man service team. This equipment‐to‐personnel ratio ensures that any on the job equipment damage will not interfere with the ability to complete necessary and expedited services.  Bell Environmental has hundreds 20‐lb. siphon carbon dioxide tanks that are kept filled at all times, as required, in order to treat large locations swiftly and efficiently and /or multiple locations simultaneously.  Bell Environmental has two entomologists on staff in supervisory positions over the bed bug technicians. These supervisors are on call 24/7/365 for our hospital and corporate clients.  Bell Environmental has the ability to provide educational seminars and other training and materials to hospital staff in identifying bed bug infestations in health care facilities. THERE IS NO SUBSTITUTE FOR THE CARBON DIOXIDE FREEZING METHOD IN HOSPITALS The treatment method to solve bed bugs has critical in terms of providing results. The most effective treatments to eliminate bed bugs in an on‐site location are thorough, labor‐intensive treatments using physical means, primarily extreme hot and cold temperatures. Carbon dioxide freezing and steam are two approaches that are non‐toxic and do not contain harsh pesticides or chemicals. As stated above chemical treatments are inappropriate in hospital environments and force room closures. Bell Environmental Services White Paper – How New York Hospitals Should Treat Bed Bugs – Page 3 155 Route 46, Fairfield, N. J. 07004  (973) 575‐7800 ext. 1  Fax: 973‐575‐1177 www.bell‐environmental.com  bedbugs@bell‐environmental.com Bell Environmental uses the carbon dioxide freezing method for our detailed crack and crevice treatments. CO2 freezing is a superior and more thorough solution than steam. Our InstantFreeze technology has equivalent effects to steam and superior range when treating bed bugs. Carbon dioxide freezing is a contact kill that hits bed bugs, larvae, and their eggs at ‐108F, and is dry, leaving no residue or moisture. We use InstantFreeze to provide safe and thorough crack and crevice treatments that solve customers’ problems. Every item within the service area, including medical equipment, monitors, and computers etc. must and can be thoroughly treated with the liquid carbon dioxide. InstantFreeze won’t damage sensitive medical equipment, mechanical hospital beds, furnishings, computers, electronic equipment, or artwork, which all need to be treated as part of a thorough bed bug treatment. Steam Is Limited In Its Range Of Use Because Electronics Should Not Be Treated With Water While steam is non‐toxic and can be effective, steam treatments are severely limited in a number of ways that the carbon dioxide freezing method is not. Steam heat applies scalding water vapor directly to the bed bug, essentially steaming them to death. Since only water vapor is used, steam also poses a major problem: steam heat can damage anything that’s sensitive to either high temperatures or excessive moisture, like electronics, decorations, furniture, etc. Bed bugs occupy the cracks and crevices of electronics (clock radios, televisions, computers, etc.) that are in affected rooms and these items need to be treated as part of bed bug control. If steam is used to treat computers and electronics, it will damage them. Certain furniture may also be damaged or stained by the use of steam. Alternatively the pest control companies using steam do not treat these items, so their treatments are not nearly as thorough and the likelihood of eliminating bed bugs is much lower than Bell Environmental’s InstantFreeze. Vacuuming Is Not An Effective Solution In Low Level Infestations Bed bug victims may vacuum once learning they have bed bugs, but vacuuming is not a solution to a bed bug problem. In high level infestations, when visible bedbugs are numerous, Hepa Vacuums may be used to control visible population before a pest control operator begins crack and crevice treatment. However, in low level infestations, the use of a Hepa Vacuum does not make the bed bug control treatment more effective. Bed bugs like to generally hide in areas where vacuums are unable to reach, i.e. deep in cracks and crevices and inside wall voids. In addition, vacuums are unable to suck up the sticky egg clusters as it’s actually the contact of the brush that removes the sticky eggs from the surface, not the suction. Bell Environmental Services White Paper – How New York Hospitals Should Treat Bed Bugs – Page 4 155 Route 46, Fairfield, N. J. 07004  (973) 575‐7800 ext. 1  Fax: 973‐575‐1177 www.bell‐environmental.com  bedbugs@bell‐environmental.com