The Rise in Bed Bugs

Prevention, Management, and Treatment

Mallory C. McKenzie, RPh, PharmD; Edward M. DeSimone II, RPh, PhD, FAPhA


US Pharmacist. 2012;37(8):47-50. 

In This Article


Bed bugs are extremely difficult to eradicate. Elimination can be challenging because bed bugs are very hard to locate and are resistant to many pesticides. Local public health departments may also have limited resources to help exterminate pests. A multifaceted approach is necessary for complete eradication. Goddard and deShazo outline five steps for the successful eradication of bed bugs: "1) proper identification of the bed bug species present; 2) education of persons involved; 3) thorough inspection of infested and adjacent areas; 4) implementation of chemical and nonchemical control measures; and 5) follow-up to evaluate the success of eradication."[13]

When bed bugs are suspected or identified, a licensed pest control professional should be consulted. A combination of chemical and physical removal is usually necessary for complete eradication. Oftentimes multiple rounds of physical and chemical removal will be needed to eradicate bed bugs from an infested site.

Physical Eradication

Removal and disposal of infested furniture and mattresses may be necessary if the infestation is severe. For less severe infestations, bed bugs can be removed with vacuuming. It is usually necessary to scrape bed bugs with the suction end of the vacuum to remove them. Routine vacuuming may not be particularly effective at removing bed bugs because they cling tightly to many surfaces. Vacuuming should be performed every day or every other day until the infestation is gone. The vacuum bag should be removed, properly sealed in a secondary bag, and placed in an outside dumpster. Once a vacuum is used for removal of bed bugs, it should only be used for that purpose. After bed bugs are removed from a mattress, it can be sealed in a mattress encasement or cover. This will trap any remaining bed bugs inside the cover. It is important to keep the mattress cover sealed for at least 1 year because bed bugs can survive up to a year without a blood meal.[6] Box springs should also be covered with some type of encasement and sealed for at least 1 year as well.

Bed bugs are sensitive to temperature extremes; therefore, steam cleaning may also be helpful with bed bug removal. However, steam cleaning may not be as effective as vacuuming because the heat may not reach well-hidden bed bugs. Bed linens, curtains, clothes, and other washable materials should be washed in hot soapy water and dried for at least 20 minutes in a hot dryer. This should kill most bed bugs and their eggs.[6] In order to avoid spreading the infestation, it is generally not recommended to take washable items to a professional dry cleaner.[14] Items that are not easily washable may be placed in a sealed plastic bag in the freezer for at least 4 days. Any discarded materials that may have been infested with bed bugs should be placed in sealed bags and labeled as infested with bed bugs.[6]

Chemical Eradication

Pesticides available to the general public are not recommended for the removal of bed bugs. A licensed pest control company should be consulted for chemical removal. Pesticides that have been effective at removing bed bugs include diatomaceous earth, eugenol, imiprothrin, permethrin, pyrethrins, resmethrin, and tralomethrin. Pesticides should be applied to cracks and crevices on the baseboard and other bed bug hiding places. Only pesticides that are labeled for use on carpets or furniture should be used in such places. Pesticide use should be limited on mattresses and other furniture to minimize exposure to humans. Space treatments such as "bug bombs" are generally not recommended for the elimination of bed bugs because they may cause the bugs to scatter, making their removal more difficult.[6]

There have been cases of human toxicities (e.g., neurologic or respiratory) associated with the use of insecticides to treat bed bug infestations. Most reactions were low in severity, but there was one fatality attributed to the overtreatment of bed bugs.[15] To minimize the risk of toxicity it is important that insectides be applied appropriately by a certified pest control professional. Inhabitants should also be adequately notified of insecticide application, and insecticide-treated bedding should be washed or changed.[15]

Successful eradication of bed bugs is expensive and time-consuming. Once bed bugs are removed, it is important to seal cracks and crevices where bed bugs commonly hide to prevent reinfestation. Rooms should be inspected thoroughly and should not be inhabited again until all bed bugs have been eliminated.