From Wikipedia:
Confirmation of the presence of bedbugs may be through identification of the insects collected by a homeowner. Some individuals use the internet for insect identification, or they may take the sample to a university extension laboratory, or to a professional pest control firm. The insects may be difficult to find, but infestations are typically concentrated on or about bedding or upholstered furniture, and clusters of the insects, their eggs and immature stages may be found on seams of mattresses, box springs and in folds of upholstered furniture.
The pattern of bites as noted earlier is another means of confirming that the infestation is indeed that of bedbugs. Though bedbug bites can occur singly, they often follow a distinctive pattern of a linear group of three bites, sometimes macabrely referred to as "breakfast, lunch and dinner". These patterns of bites are caused when a bedbug is disturbed in feeding by a person moving, and then the bedbug resumes feeding. Bedbug bites also often occur in lines marking the paths of blood vessels running close to the surface of the skin. The effect of these bites on humans varies from person to person, but often cause welts and swelling that are more itchy and longer-lasting than mosquito bites. Some people, however, have little or no reaction to bedbug bites. Those whose bodies do not initially react may subsequently develop symptoms, however, due to an allergic reaction caused by the development of antigen. Bedbugs never crawl under one's skin and markings implying this may be signs of other skin infections or a severe allergic reaction to bedbug bites.
A technique for "catching" (detecting) bedbugs is to have a light source accessible from bed and to turn it on at about an hour before dawn, which is usually the time when bedbugs are most active. A flashlight is recommended instead of room lights, as the act of getting out of bed will cause any bedbugs present to scatter. Bedbugs can also sometimes be viewed during the day. The flashlight method is best; if you awaken during the night, leave your lights off but use your flashlight to inspect your mattress. Bedbugs are fairly fast in their movements, however, this can vary depending on how recently they have consumed a blood meal, and if treatment has been performed. Some have described their speed of travel as being about that of ants. Immature stages are quite small. A few seconds staring at patterned cover may be needed to notice them.
Some individuals have used glue traps placed in strategic areas around their home (sometimes used in conjunction with heating pads, or balloons filled with exhaled breath, thus offering the carbon dioxide that bedbugs look for) in order to attract and thus detect bedbug infestations. This method has varied reports of success. It likely depends on extent of infestation, and given the choice of a heating pad and low carbon dioxide, it is not unreasonable to presume that the bedbugs will go for a person preferentially -- they have had a long time to evolve in their abilities to find hosts. There are also commercial traps like "flea" traps whose effectiveness is questionable except perhaps as a means of detection, but traps will certainly not work to control an infestation.
Perhaps the easiest method for detection is to place double-sided carpet tape in long strips near or around the bed and check the strips after a day or more. This is also useful in detecting insect presence in general.
Veterinarians may mistake bedbugs' leavings on a pet's fur as "flea dirt".
Bedbugs are known for being elusive, transient and nocturnal. For many, the only way to detect and identify with certainty an infestation is to contact a pest control professional, however, this pest was largely absent as a significant part of pest control services for decades, so the pest control industry is in process of ensuring staff are well trained.
Living with infestation
If it is necessary to live with bedbugs in the short term, it is possible to create makeshift temporary barriers around a bed. Although bedbugs cannot fly or jump, they have been observed climbing a higher surface in order to then fall to a lower one, such as climbing a wall in order to fall onto a bed. That having been said, barrier strategies nevertheless often have beneficial effects: an elevated bed, for example, can be protected by applying double-sided sticky tape (carpet tape) around each leg, or by keeping each leg on a plastic furniture block in a tray of water. Bed frames can be effectively rid of adult bedbugs and eggs by use of steam or, used with caution, by spraying rubbing alcohol on any visible bugs (although this is not a permanent treatment). Small steam cleaners are available and are very effective for this local treatment. A suspect mattress can be protected by wrapping it in a painter's disposable plastic dropcloth, neatly sealing shut all the seams with packing tape, and putting it on a protected bed after a final visual inspection. Bedding can be sanitized by a 120 °F (49 °C) laundry dryer. Once sanitized, bedding should not be allowed to drape to the floor. An effective way to quarantine a protected bed is to store sanitized sleeping clothes in the bed during the day, and bathing before entering the bed.
Vermin and pets may complicate a barrier strategy. Bedbugs prefer human hosts, but will resort to other warm-blooded hosts if humans are not available, and some species can live up to eighteen months without feeding at all. A co-infestation of mice can provide an auxiliary food source to keep bedbugs established for longer. Likewise, a house cat or human guest might easily defeat a barrier by sitting on a protected bed. Such considerations should be part of any barrier strategy.
A camping tent can serve as a "safe" sanctuary for sleeping in the short term to avoid new bites. Keep sleep clothes in the tent to ensure bugs are not introduced to the tent.
Self-treatment
Some individuals have had success conducting their own exterminations by preparing an insecticide mixture of pyrethrins and fresh-water diatomaceous earth. At least one manufacturer produces a household insecticide D-20, (SLA manufactured by Reefer-Galler) with 0.2% naturally derived pyrethrins and 1.0% Piperonyl Butoxide. Natural pyrethrins are more expensive than many alternatives. The function of the pyrethrins is to stimulate the nervous system of the bugs so that the spasms will allow the diatomaceous earth to desiccate, puncture, and kill the bugs through mechanical action. Great care should be taken not to use products with salt-water diatomaceous earth or heat-treated diatomaceous earth (the common industrial forms), which can damage the lungs of any mammal (dogs, cats, or humans) which inhale it (due to its extreme sharp crystalline edges), and has also been known to cause cancer. Fresh-water diatomaceous earth, however, is commonly used to deworm cats, dogs, and humans, and is considered as safe as table salt. What is sold as food-grade diatomite generally contains very low percentages of crystalline silica.
Bedbugs are not coldweather insects and cannot tolerate temperatures below freezing for extended periods of time. Others have used fruit and vegetable insecticides, comprising a mixture of pyrethrins and canola oil, which are usually safe for humans and most pets (aside from fish). While not a permanent fix, spraying rubbing alcohol should kill bedbugs on contact.
In addition, since bedbugs normally disperse, treatment of a bed or mattress is insufficient to eradicate an infestation. Pyrethroid based room fogger should be used the morning after applying a permethrin whole body cream (like Elimite or generic 5% permethrin body cream approved for human topical application by FDA) overnight. 5% permethrin body cream is available without a prescription in Canada but requires one in the United States. Spraying other surfaces that you walk on or sit in with permethrin spray is possible if fogging is not practical. Simultaneous treatment of all human bodies, pets, and all rooms of the home and office is required to prevent reinfestation.
Professional treatment
Selection of professionals
Not all exterminators are familiar with extermination techniques for bedbugs. In the past, fumigation with Cyanogas was used for bedbug control. This was very effective, but also very dangerous. This method is no longer used. Fumigation—that is the use of poison gases—is costly, and though this has been tried as a method of control in isolated cases, it is transient. New infestation can be imported shortly after a fumigation has taken place. Fumigation does work, but it may not be practical, and may not be permitted in most jurisidictions. Care must thus be taken when selecting an exterminator, in order to select a professional who knows how to conduct proper bedbug removal. In the USA the National Pest Management Association can assist in the location of pest control professionals.
Necessary number of professional treatments
A survey of pest control professionals conducted by a pest control professor at the University of Massachusetts stated that 68% of all bedbug infestations require three or more treatments, 26% require two treatments, and 6% require just one. [3] However, this survey does not seem to have taken into account the size of the infestation, the size of the venue being treated, the extensiveness of that venue's preparation for the treatment (thus enabling or inhibiting coverage of the poisons), the skill of the exterminator, whether popular nesting places have been disposed of, and the cause behind the original infestation
Pre-treatment preparation
Proper preparation is a mandatory requirement for control to be effective. Pest control firms should outline this in detail and provide detailed instructions on what to do. This is generally done by the resident; although some firms may offer preparation for an additional charge, this is uncommon. Preparation involves providing access for pest control treatment as well as taking measures to ensure that bedbugs are destroyed or contained. If a home is not properly prepared, successful elimination is practically impossible. Although preparation may be difficult for some people (for example, seniors or handicapped individuals), it is essential for effective treatment, and thus in such cases family members, friends or social or charitable agencies may need to provide assistance.
Packing
All furniture and appliances in the dwelling usually need to be pulled away from the baseboards, and it is commonly asked that all furniture containing potential hiding crevices, such as bookshelves and desks, be emptied and left open for the exterminator to spray. Items in tightly sealed containers are usually safe from bedbug infestation and need not be emptied. Pest Control Operators may declare an item untreatable upon inspection--especially items of wood or paper.
Laundry
Everything that can be laundered should be laundered, and laundered in advance of the treatment, then placed in plastic bags. This would include stuffed animals, drapes and so on.
The items should be securely tied into plastic bags, then emptied directly into the machines. The bags should then be immediately disposed of. It is heat, not water, that kills any bedbugs residing within the laundered items; therefore items should be washed in hot water, regardless of normal washing directions, and should be dried with medium heat (preferably high heat) for 20 minutes or more. (For those who have the ability to measure the temperature of the water in their washing machine, or of the hot air in their dryer, the target heat range is 120°F (49°C).)
If a laundering session such as described is financially prohibitive, some have posited that the items need only be run through the dryer, not the washing machine. However, the extensive water and spinning action associated with washing machines may assist in dislodging bedbugs from where they are residing within clothes and laundered. This remains only "optional," as the heat of the cycle of drying will effectively kill all stages—eggs, immature stage (nymphs) and adults.
For items that require dry cleaning, the dry cleaners should be informed that the items in question are potentially infested, and the items should be bagged. Cleaners may still refuse to accept them.
Steam cleaning and vacuuming of carpets can be helpful. Although bedbugs will not be in the middle of the floor, they may be under the carpets at the edges of rooms. Pesticide is applied at perimeters and is effective, but the more steps are taken to assist removal, the more thorough the elimination will be.
Vacuuming
The mechanical removal of bedbugs by vacuuming is a most important part of preparing for control. Vacuuming alone will not solve the problem, but it will substantially reduce bedbug numbers and thus help reduce the population as part of preparing for treatment. A crevice attachment should be used on the seams of mattresses, on box springs, on bed legs, within furniture interiors, behind pictures, on curtains, and anywhere there is a possibility of the insects hiding (e.g. inside dresser drawers, dresser cases, under chairs, etc.). Carpets should also be vacuumed throughout the home, preferably with a power-head. Baseboards should also be vacuumed using the crevice tool—not swept—prior to the exterminator's arrival. Vacuum bags should then immediately be removed and placed in doubled plastic bags and placed into strong plastic bag for disposal. Spraying inside the vacuum cleaner bag with an aerosol insecticide or 50/50 alcohol/water mix is a good idea. The bags should be stored outside of home before collection. Burning the waste is not practical in the vast majority of urban centres and may be illegal.
Steam treatment
Some pest control firms do offer steam treatment for items like mattresses or upholstered furniture especially when individuals are concerned about pesticides on bedding. This has only a very limited effectiveness, however, it is quite effective in this range of less than 1/2 inch of penetration. This also depends on the time that the steam is applied to the surface of the item. Small steam cleaners for domestic use can be useful for mattresses and the surfaces of upholstered furniture. This is a worthwhile option if there are issues of allergy, and the homeowner takes the time to treat carefully in this limited context.
Managing bedding
There are differing opinions as to whether it is necessary to dispose of mattress, boxsprings, futons, pillows, and other bedding. There is of course often a heavy cost involved in the complete replacement of such bedding. It is clear, also, that getting rid of infested bedding alone does not solve the problem. The decision to replace bedding or not depends on the condition of and often related level of infestation within the items, the comfort level of the owner, whether the owner can afford replacement, and aesthetics. A reasonable rule of thumb is that new bedding does not need to be replaced but if bedding is older and replacement may have been done soon in any case, then of course, replacing it AFTER control is a welcome clean start. Treatment of bedding items must be done with care and according to the label on the insecticide used. Mattresses typically need local treatment with non-residual insecticides at seams and borders. Boxsprings are more difficult to treat as there are more places for the insects to hide. The notion that getting rid of bedding helps solve the problem is misguided. Infestation must be handled first and then if new bedding is desired, the old bedding can be disposed of. Spread of infestation in apartment buildings is increased by tenants deciding to throw away old bedding. An infested mattress or box spring dragged in a hallway to an elevator will cause bedbugs to fall off or even run off the item, and these may then find their way into other units. As noted here, the use of protective encasements to protect bedding after treatment or to enclose bedbugs when the items are being thrown away are invaluable in preventing spread of infestation. It is also suggested to slash or mark up infested items so that others do not take them back into the building.
After the mattress and/or box spring or futon has been treated, placing these inside a vinyl, polyvinyl or polyethylene encasement is a good idea as a secondary means of defense. Bedbugs like to hide near the victim and are commonly found on seams of mattresses, or within the structure of box springs. The mattress encasement serves to reduce this likelihood and in the case of box springs, it seals any remaining insects inside the encasement. The mattress encasement also protects the mattress from the mess of staining caused when bedbugs aggregate on seams. An encasement is a good idea either until the infestation has been totally eliminated or in the case of good quality encasements, useful as a permanent protection for the mattress—and also to enable easier control if infestation recurs.
Those who end up disposing of suspect items should enclose them in vinyl mattress encasements, to prevent shedding bugs and eggs on their way to the disposal site. Care should also be taken to label throwaway items with a warning about the suspected bedbug infestation, as furniture is often reclaimed by dumpster divers.
New items should not be purchased until after the infestation has been thoroughly eliminated. Also, many retailers offer disposal of old mattresses. This can pose obvious problems if new and old mattresses are carried together on the same truck without the proper precautions taken.
Treatment
Exterminators will often apply a "contact kill" spray directly on bedbugs found in the apartment (such as a mixture of cyfluthrin, pyrethrins, and piperonyl butoxide), and then spray lambda-cyhalothrin on baseboards and other favorite hiding places. Lambda-cyhalothrin acts as a "slow kill" barrier which kills bedbugs after they cross it, and is usually microencapsulated, making it safe to pets and humans after it dries. Often, deltamethrin is also injected into larger crevices. The lambda-cyhalothrin and the deltamethrin are at their strongest for the first two weeks following their application, but usually retain effectiveness for up to 60 days.
Gentrol and Phantom can also be used for bedbug control. Gentrol contains the active ingredient (S)-Hydroprene, an insect growth regulator (IGR) that disrupts the normal growth development of cockroaches and stored product pests, drain flies and fruit flies, as well as bedbugs. Phantom® uses an active ingredient known as chlorfenapyr. It is non-repellent and relatively long-lasting.
Successful treatment of a bedbug infestation is often highly dependent on how thorough the pest control professional is. Although the assessment and judgment of the pest control professional should be respected, most treatments cover such areas within homes as closets, curtains, outside and inside furniture crevices (dresser and desk drawers, night tables, etc.), as well as the interior of electrical outlets and behind pictures hangings on walls. If the choice was made to retain bedding, professionals will often either treat or steam-clean bedframes and the undersurface of solid beds. Some higher-end pest control firms also offer to perform the aforementioned vacuuming.
Most infestations are not successfully handled by one treatment alone. Most require exterminators to visit multiple times. In multi-unit dwellings, such as apartment buildings, the whole building will need to be assessed by a review of history of infestations, and good communications to tenants. It may be necessary to carry out inspections. Treating an entire building without an assessement is irresponsible and costly as control is transient and it may be that most of the building is NOT infested. Inspection of all units adjacent to an infested unit should be a mandatory requirement. Studies have shown that there is a risk of about 20 - 40% that adjacent units to an infested unit have infestation as well. In addition, an infested unit may not be the original source of infestation, it may be one of the adjacent units. A recommendation by a pest control firm to treat all units without a proper assessment (and usually without a warranty being offered) is not a useful approach.
Post-treatment
Bedbugs can often be seen alive for up to two weeks following treatment of a dwelling, although they should not be seen in great number (e.g., only one or two). It is important to continue to monitor for bedbugs after the initial treatment.
Vacuuming should not be performed for a period of time following treatment, as some pesticides dry as a fine film, and can be prematurely removed from the environment if vacuumed, allowing infestations to survive the treatment.
Anecdotal evidence seems to suggest that many, and perhaps most, people who successfully deal with bedbug infestations find themselves anxious and fearful about the possibility of reinfestation, for varying lengths of time. These feelings of anxiety may have some relation to delusional parasitosis: "Sometimes an initial and real insect infestation precedes and triggers the delusion [...] Out of desperation the victims may move out of their home, only to report later that the ‘bugs’ have followed them there too." (The Physician’s Guide to Arthropods of Medical Importance, J.A. Goddard, CRC Press, 1993.) The feelings are not always devoid of rational cause, however, given that reinfestations do occur, due to reasons such as ineffective treatment of adjacent units in multi-unit structures, nymphs missed due to their minute size, or secondary infestations sprung from the original infestation (in a car, at an employer, etc.). Delusional parasitosis should not be confused with anxiety about infestation not being completely controlled. Delusional parasitosis is defined as a mental condition in which the victim has delusions about infestation without any real evidence of infestation. Certainly, any person can experience a certain extent of this thinking they are being bitten again, or experiencing itching, but in full blown Delusional Parasitosis, there is no evidence of an infestation and the victim focuses on bits of thread or detritus as insects, or even believes that insects are "eating" personal possessions such as clothing or linens. The victim is literally "consumed" by the delusions.