HS-44 8/13
Protocol for Suspected Bed Bugs When a bed bug is found, it can be difficult to determine the source. A bed bug found on a person or belongings may have come from another person. Similar to head lice, it is very important to address the issue with care and sensitivity. There is no association between cleanliness and bed bug infestations. Anyone can experience an infestation. If a suspected bed bug is found in school, it should be collected for identification. Other bed bug‐like species may be found in schools, including bat bugs or swallow bugs. To collect the specimen, use a piece of tissue or forceps to place the bug in a plastic bag, double bag, then tape the outer bag closed. Do not crush the specimen. If the specimen will not be identified immediately, place the bag in a freezer for several hours to kill the bed bug and prevent escape. Do not mail or transport live specimens, as they are skilled escape artists. Collect the following information for each specimen: Date found, name and contact information of the person collecting the specimen, location found (e.g., on a student, on student’s belongings or on walls or furniture), room number, school name, school principal name and phone number. If the specimen is confirmed to be a bed bug, the site administrator and school nurse should be notified and the following steps are recommended: 1. The classroom or other area where the bed bug was found should be carefully inspected by a custodian. Inspection should including desks, floors, walls and storage areas for student belongings. 2. A thorough cleaning may be needed including vacuuming with special attention to cracks and crevices in furniture and equipment, walls and floors, and laundering washables in hot water and drying on the highest heat setting. Vacuum bags should be sealed in a plastic bag for disposal before moving to another area. Delicate fabrics can be soaked in warm water and laundry soap for several hours before rinsing. Infested items that cannot be cleaned or treated with high heat (>120°F for several hours) should be disposed of in sealed plastic bags. If necessary, the CCSD Facilities Department can perform a steam cleaning, as heat is effective in the eradication of bed bugs. Additionally, a licensed pest management professional can treat infested areas. 3. If the bed bug was found on a student’s clothing or other belongings, the child’s parent/guardian should be notified. There is no need to send the student home. 4. Similar to head lice, the school nurse should manage the case, including re‐inspecting clothing and belongings upon return to school and 10 days after the initial determination of bed bugs. Re‐inspection by the custodians of desks and classroom will also be done in 10 days. Student belongings such as backpacks can be isolated in tight‐ sealing plastic containers or bags to reduce potential for bed bug dispersal, both at home and in school while the problem is being resolved. 5. Parents of all children using the room where the bed bug was found should also be notified and provided with basic information about bed bugs including description, signs and symptoms, strategies to monitor for and eliminate infestations in homes including cleaning, laundering and specially designed mattress and box‐spring covers that can entrap bed bugs and reduce harborage opportunities. The information should include where to go for additional help. Refer to “What you need to know about Bed Bugs” (Southern Nevada Health District publication). Adult Bed Bug Adult Bed Bug
Exhibit 3
Page 1 of 5
HS-44 8/13
Description of Bed Bugs What are bed bugs? Bed bugs are reddish‐brown, oval, flattened six legged insects with two antennae, which feed on the blood of people while they sleep. Adult bed bugs are oval, wingless and rusty red colored and have flat bodies, antennae and small eyes. The dark‐colored eyes stand out, and the sides of the collar‐like pronotum curve slightly around the head and is covered with long hairs. Female bed bugs lay their eggs in secluded areas, depositing one or more eggs per day and hundreds during a lifetime. The eggs are white, oval and about 1 mm long and are difficult to see on most surfaces without a magnifying glass. Bed bugs do not fly but can move rapidly over floors, walls, ceilings and other surfaces. They are visible to the naked eye but often hide in cracks and crevices. They feed on human blood using piercing sucking mouthparts. They feed at night, hide by day and are shy, and develop from egg to adult in 5‐8 weeks. Although the bite does not hurt at the time, it may develop into an itchy welt similar to a mosquito bite. Bed bugs do not transmit disease, but they can cause significant itchiness, anxiety and sleeplessness.
Exhibit 4
Page 2 of 5
HS-44 8/13
Bed Bugs – General Information School nurses are in a unique position to assist students, parents, and staff when bed bug bites or bed bugs are found. The school nurse will need to determine what actions, if any, are necessary and handle the situation with sensitivity. Although bed bugs have nothing to do with cleanliness or socioeconomic status, there is still a stigma associated with having bed bugs. As a result, parents may be hesitant to admit to having bed bugs, and students may not want others to know they have an infestation at home. Bed bug bite symptoms: 1. The most common symptom is a small, round red mark on the skin resembling a bite from a mosquito, ant, or flea. 2. Some bites will develop swelling around the site (welt) or blister. 3. Student may complain of itching. 4. Refer to “Pictures of Bed Bug Bites,” (exhibit 5). Student with possible bed bug bite(s): 1. Treat insect bite per protocol (refer to Pub. 648 and see below). 2. The school nurse may ask the student/parent about exposure to insects. 3. If the school nurse suspects bed bugs, send home “What you need to know about Bed Bugs,” (Southern Nevada Health District). Treatment of bites: 1. Cleanse the skin with soap and water. 2. Apply benzalkonium chloride or Bactine and bandage if the area is bleeding from scratching 3. Apply ice pack to relieve itching. Calamine lotion can be applied to intact skin. 4. Inspect bites for secondary infection and, if present, the school nurse will make a medical referral and the student will be sent home. Signs of secondary infection include: a. Swelling b. Pain c. Heat d. Pustules e. Fever Bed bug found on student: 1. Capture the bed bug, if possible, for identification. Refer to “Protocol for Suspected Bed Bug,” (exhibit 3). 2. Inspect the student’s clothing and belongings. 3. Place belongings (backpack, jacket, etc.) in a sealed plastic bag or tub. 4. The school nurse will contact the parent/guardian and send information home with student, “What you need to know about Bed Bugs,” (Southern Nevada Health District) and “Bed Bug Treatment Verification” (exhibit 8). The student can return to class. 5. Send “Bed Bug Notice to Parent/Guardian” (exhibit 7) and “What you need to know about Bed Bugs” (Southern Nevada Health District) home with other students in the classroom. 6. Maintain student confidentiality. 7. Notify custodial staff to conduct a thorough inspection and vacuuming/cleaning of classroom. Page 3 of 5
HS-44 8/13
Bed bug found in classroom/other area of the school or suspicion of bed bugs: 1. Infestations of bed bugs in schools are rare. 2. If bed bugs are found in a classroom/other work area or two or more students present with apparent bed bug bites from the same classroom, the school nurse will be notified. 3. Health Office personnel will alert custodial staff to assist with area inspection. 4. Health Office personnel will instruct the teacher to place all student belongings in sealed plastic bags. 5. “Bed Bug Notice to Parent/Guardian” (exhibit 7) and “What you need to know about Bed Bugs” will be sent home with all classroom students. 6. School nurse will notify school administrator of the need for pest control (CCSD Facilities Department).
Page 4 of 5
HS-44 4 8/13
Picttures of B Bed Bug B Bites (Exh hibit 5)
Page 5 of 5 P
