Bed bugs

Bed bugs (Cimex lectularius) are small, elusive, and resilient wingless insects that feed on the blood of mammals, including humans. They are reddish-brown and range in length from eggs of about 1mm to insects of up to 10mm. Bed bug infestations have become prominent worldwide, generating increased public concern. While almost any location where people sleep or gather can be subject to a bed bug infestation, challenges are often greatest among people who are socially disadvantaged or inadequately housed.

Bed bugs can infest settings ranging from homes, to healthcare facilities, shelters, hotels, prisons, dormitories, and office buildings, and occasionally, public transportation. Bed bugs often hide close to a food source in soft furnishings such as the seams of mattresses, box springs, or cushions, but can also hide in cracks and crevices of furniture. In persistent infestations, bed bugs may hide behind gaps in loose wallpaper, baseboards, window casings, or carpets, or among clutter, stored objects, suitcases, or backpacks. Travellers can unknowingly transport bed bugs between locations in their luggage.

Currently, there is no evidence that bed bugs transmit human diseases, although recent research has indicated that bed bugs could potentially transmit MRSA. In general, bed bugs are not considered a substantive public health threat strictly based on communicable disease frameworks. However, bed bug bites can cause some adverse health effects, including allergic skin reactions, secondary infections, and scarring due to the intense scratching their bites provoke, similar to a mosquito or fleabite. Homes infested with bedbugs also have elevated levels of indoor histamines. Perhaps of greatest concern is the psychological impact on people who are living in bed bug infested conditions who can be affected by loss of sleep, anxiety, depression, social isolation, and possible severe mental health impacts.

Signs of a bed bug infestation can include molted bug exoskeletons, live or dead bugs in the folds of mattresses or sheets, rust coloured deposits on mattresses or furniture from their droppings, or a sweet musty odour. Canine detection is sometimes used to pinpoint infestations. Eradiation of an infestation can include non-chemical measures (e.g., encasement measures, heat treatment, frequent vacuuming) and pesticide use. Bed bugs can survive several months without a blood meal, making persistence or re-emergence of an infestation possible, and bed bugs can be resistant to some pesticides, making managing infestations challenging. There have been concerns about improper insecticide use, which can be ineffective or result in harmful exposure or deaths from the use of unregistered products. Given the complex issues arising from bed bug infestations, effective strategies often require an integrated pest management approach, with collaboration across multiple public and private agencies.

The resources listed here are intended to provide information on bed bug identification and prevention, advice on managing infestations in specific settings, the possible health effects of bed bugs, and the use of various control measures, including pesticides.

Bed bug identification and prevention

• Recognizing bed bugs and preventing infestation (Province of Quebec, 2023)
  This website provides guidance on recognizing bed bugs and their eggs, understanding how they spread, and preventing infestation from items brought into the home, or during a move.
   
• Bed bugs: Get them out and keep them out (US Environmental Protection Agency, 2023)
  This website provides a comprehensive collection of resources for identifying and preventing bed bug infestations.
   
• Treatment and preventing spread of bed bugs (Government of Alberta, 2023)
  This website provides tips on the multiple steps needed to control and prevent a bed bug infestation in a home or living facility.
   
• Bed bugs – what are they? (Health Canada, 2022)
  This website explains how bed bugs feed and live, and provides links to additional information on control, prevention, and where to go for provincial and territorial information.
   
• Best management practices for bed bugs (National Pest Management Association, 2016)
  This guidance document developed by industry, regulators, academics, and entomologists provides guidance for controlling bed bugs effectively and safely.
   
• Bed bugs in the NWT (Government of the Northwest Territories, nd)
  This booklet, available in English, French and multiple Indigenous languages of Canada’s north provides a guide to identifying a bed bug infestation and tips on how to treat it.
   
• Accuracy of trained canines for detecting bed bugs (Hemiptera: Cimicidae) (Cooper et al., 2014)
  This article reports on a study testing the accuracy of canine teams for bed bug detection in infested apartments.
   
• Bed bugs and public health: New approaches for an old scourge (Shum et al., 2012)
  This article summarizes experiences from four Canadian cities on dealing with bed bug infestations and the role of public health in managing them.

Bed bugs and control measures in specific settings

• 'When the bedbugs come, that’s another problem’: exploring the lived experiences of bedbug infestations among low-income older adults and service providers who support them (Sheppard et al., 2022)
  This study reports on challenges living with and treating bedbug infestations from the perspectives of low-income older adults and service providers in Toronto, Canada.
   
• Bed bugs in the workplace (Canadian Centre for Occupational Health and Safety, 2022)
  This website sets out key information for employers and workers who may be exposed to bed bugs on preventing infestations, employer responsibilities, and bed bug removal from a workplace.
   
• Commercial bed bug treatment protocols (National Pest Management Association, 2016)
  These fact sheets provide protocols for various businesses and facilities in English and French including: schools, retail, hotels, offices, multi-family housing, and public transportation.
   
• Bed bugs can go camping too! A resource tool for camps (Government of Manitoba, 2015)
  This fact sheet for camp operators provides advice on keeping camps free from bed bugs, and responding to an infestation within a camp.
   
• Bed bugs go to school. A guide for teachers and staff (US Environmental Protection Agency, 2015)
  This fact sheet provides advice on dealing with bed bug infestations in schools.
   
• Bed bug information for health care workers and building staff (Anderson and Wang, 2015)
  This fact sheet provides advice for home health workers, building personnel, first responders and emergency personnel who may access buildings with bed bug infestations.
   
• Bedbugs: A handbook for shelter operators (Toronto Public Health, nd)
  This handbook provides advice on managing bed bugs at intake, dealing with an infestation, and minimizing spread in a shelter setting.

Health effects of bed bugs

• Bed bugs (Hemiptera, Cimicidae): A global challenge for public health and control management (Akhoundi et al., 2023)
  This article provides a review of the range of clinical disorders and psychological concerns caused by bed bugs’ bites, and the available tools used to control them.
   
• Experimental acquisition, maintenance, and transmission of methicillin-resistant staphylococcus aureus by the common bed bug, Cimex lectularius (Herrera et al., 2023)
  This article reports on experimental work that indicates bed bugs could acquire and facilitate transmission of MRSA in some settings.
   
• Investigating the association of bed bugs with infectious diseases: A retrospective case-control study (Sheele et al., 2021)
  This study examines the role bed bugs could play in human disease transmission, and reports on a pilot case-control study to identify differences among emergency department patients with or without bed bugs.
   
• Advances in the biology and management of modern bed bugs (Doggett et al., 2018)
  This book includes chapters synthesizing current knowledge on the health impacts of bed bugs:
  • Bed bugs and infectious diseases (Doggett et al.)          
  • Mental health impacts (Perron et al.)
  • Miscellaneous health impacts (Doggett et al.)
     
• The mental health impact of bed bug infestations: A scoping review (Ashcroft et al., 2015)
  This review article examines the link between mental health effects and bed bug infestations, and identifies knowledge gaps in studies and empirical evidence.

Pesticides and other control measures

• Do-it-yourself bed bug control (US EPA, 2023)
  This website provides advice on identifying the problem, developing a plan, and taking actions to removing bedbugs including the considerations for using a fogger or different types of pesticides.
   
• Bed bugs – importance, biology and control strategies (US Dept. of Defence, 2019)
  This technical guide provides information on detection and surveillance for bed bugs and integrated control strategies and techniques including physical removal, heat treatment, and pesticide use.
   
• Bed bugs: how to I get rid of them? (Health Canada, 2015)
  This website provides general advice on non-chemical control measures as well as precautions for using pesticides.
   
• Review of field tests on bed bug control technologies (Stuart, 2015)
  This NCCEH review article summarizes bed bug control technologies that have been evaluated in the field from 2005-2014.
   
• Phosphine poisoning as an unintended consequence of bed bug treatment (NCCEH, 2015)
  This NCCEH evidence brief summarizes key information about the use of phosphine for bed bug control following Canadian fatalities linked to inappropriate use of the pesticide.
   
• Long-term efficacy of various natural or “green” insecticides against bed bugs: A double-blind study (Goddard, 2014)
  This study reports on the effectiveness of several green insecticide products for control of bed bugs, finding limited effectiveness of some products.
   
• Prevention, identification, and treatment options for the management of bed bug infestations (Fong et al., 2013)
  This article discusses bed bug management strategies and best practices applied in Canada for prevention, identification, and treatment using evidence from existing evaluative studies.
   
• Temperature and time requirements for controlling bed bugs (Cimex lectularius) under commercial heat treatment conditions (Kells and Goblirsch, 2011)
  This article presents the results of experimental work to examine the conditions required to produce maximum mortality from heat exposure for whole-room heat treatments.

This list is not intended to be exhaustive. Omission of a resource does not preclude it from having value.