1. Sutton, Douglas ARNP, NP-C, EdD
  2. Thomas, Debera J. ARNP, BC, DNS

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HEALTH CARE FACILITIES, HOMES, even cruise ships and luxury hotels can-and do-become infested with bedbugs (Cimex lectularius). In the United States, bedbug infestations have increased tenfold since 1999.1 In this article, we'll help you assess and care for a patient who's been bitten.


Uncovering bedbugs

Bedbugs are small, wingless insects that feed on blood, mostly of humans. These parasites have flattened, oval bodies and are usually no more than 1\4 inch long. Before eating, they range in color from almost white to deep brown. After a meal, they're dark red or black and almost double in size.


Bedbugs don't live on their host. After feeding, they seek shelter in dark places close to sleeping areas, such as mattresses, bed frames, cracks in the floor, carpets, or even behind electrical outlets or loose wallpaper. A telltale sign of bedbug infestation is a group of small, dark spots of blood on a mattress.

Figure. A bedbug (Ci... - Click to enlarge in new windowFigure. A bedbug (

Bedbugs can also seek shelter in luggage, used furniture, or clothing-and hitch a ride anywhere in the world.


Itching for a bite

Although bedbug bites are painless, the injected saliva can cause skin reactions and pruritus in some patients. Skin lesions, which resemble mosquito bites or fleabites, are most common on the arms and legs and around the waist. When you perform a physical assessment, you may see small clusters of bites in orderly rows or extremely pruritic, erythematous papules or wheals. Less common but more severe manifestations include grouped vesicles, giant urticaria, and bullous eruptions that may result in skin loss.2


Treatment is symptomatic and includes topical emollients, topical corticosteroids, oral antihistamines, or some combination of these. Tell your patient that scratching will make itching worse and may lead to a secondary skin infection, such as impetigo.


Many patients feel disgusted or unclean after learning they've been bitten by bedbugs, but fortunately these pests don't carry disease.


Identify, contain, and eradicate

Because bedbugs don't live on hosts, a patient with bedbug bites doesn't need to be isolated, but you should inspect any articles of clothing that might harbor bedbugs. Use standard precautions.


If your patient brought any clothing or personal items to your facility, place them in plastic bags. After she's discharged, her bed linens, pillows, and towels should be bagged separately for laundering, and the area should be thoroughly cleaned following facility policy and procedure.


To avoid repeated bedbug attacks, your patient needs to eradicate the pests in her home. Teach her or her family to launder bedding and other washable items in hot water and to use the clothes dryer on high heat for at least 5 minutes.3 Nonwashable items can be put in a plastic bag and frozen for several days to kill the bugs.


Advise the patient to eliminate household clutter to reduce hiding places and thoroughly wash, vacuum, or clean everything else. Tell her to use a stiff brush to clean out cracks and crevices and then to seal these gaps. Bed frames should be dismantled and drawers removed for inspection and cleaning, and carpets and rugs should be steam cleaned. Used vacuum cleaner bags should be sealed and discarded. Tell her to pull her bed away from any shelving or walls and coat the legs of the bed frame with a 2-inch (5-cm) band of petroleum jelly or mineral oil. Don't spray the mattress with insecticide; encasing it in a plastic mattress cover will contain and eventually kill any bedbugs in the mattress.


Completely eradicating bedbugs may require interventions by a pest control company.




1. Doggett SL, et al. The resurgence of bed bugs in Australia. Environmental Health (Australian). 4(2):30-38, 2004. Accessed November 15, 2007. [Context Link]


2. Harvard School of Public Health. Bed bugs: Cimex lectularius. Accessed August 17, 2006. [Context Link]


3. North Dakota Department of Health. Disease fact sheet: Bedbugs. Accessed August 17, 2006. [Context Link]