a b s t r a c t

Bed bugs are one of the most important human ectoparasites in the United States, and a growing problem in the emergency department. We evaluated 40 emergency department (ED) patients found with a bed bug. The data show that ED patients with bed bugs are statistically more likely to be male, older, more likely to be admitted to the hospital, have higher triage Emergency Severity Index scores, and arrive by ambulance than the general ED patient population (p b 0.05). On average bed bugs were found 108 min after a patient arrived to the ED, after 35% of subjects had already received a blood draw, and after 23% had already received a radiology study; putting other ED patients and staff at risk for acquiring the infestation. We found that 13% and 18% of subjects had wheezing and a papular rash, respectively on physical exam. Of those patients found with a bed bug in the ED, 42% reported having bed bugs at home and 21% reporting having a possible home infestation.

(C) 2017

The common bed bug, Cimex lectularius L., is arguably the most im- portant human ectoparasite in the United States [1-2]. After obtaining institutional review board approval we surveyed 40 ED patients who had a bed beg found on or in close proximity to them. The data was analyzed using descriptive statistics, Chi-squared test for 2 x 2 table analysis, and the unpaired t-test. The data is summarized in Table 1. Sixty percent (n = 24) of the subjects were male compared to 39% for the overall ED population (p = 0.007). The average age was 62 years (standard deviation (SD): 16.5, range 27-92 years) and this compared to an average age of 44 years old (SD: 20) for all patients in our ED (p b 0.001).

One, four, 20, 12, and one subjects were triaged as emergency sever-

ity index (ESI) level 5, 4, 3, 2, and 1, respectively, with two surveys not reporting a triage ESI level. A statistically significant higher percentage of our subjects were triage ESI level 2 or 3-31% and 54% respectively - compared to the overall ED population of 1% (p b 0.001) and 35% (p b 0.014). In addition, 65% of our subjects were admitted to the hospi- tal, compared to an overall ED admit rate of 25% (p b 0.001).

Five subjects (12.5%) had wheezing on lung auscultation, and seven (18%) had a skin rash. All of the rashes were papular and none were bul- lous. Three subjects (7.5%) were clinically intoxicated with alcohol or other illicit substance upon presentation to the ED. Three subjects

* Corresponding author at: university hospitals Cleveland Medical Center, Case Western Reserve University, Department of Emergency Medicine, 11100 Euclid Ave., B-517K, Cleveland, OH 44106, USA.

E-mail address: [email protected] (J.M. Sheele).

¹ Joint first co-authorship.

(7.5%) received an ED psychiatric evaluation, compared to an ED aver- age of 3% (p = 0.1). Out of 33 subjects who answered the question; fourteen subjects (42%) reported bed bugs at home, 12 (36%) reported no bed bugs at home, and seven (21%) reported that they were un- sure/maybe about bed bugs at home.

Police brought in one study subject, one walked, 12 (30%) came by private vehicle/bus, and 26 (65%) came by ambulance. This compares to the overall ED average where 27% come by ambulance and 62% come by private vehicle/bus. Seven subjects had their bed bugs identi- fied by emergency medical services (EMS) providers, 33 were found in the main treatment area, and 2 were found while in triage. A bed bug was found by 12 nurses, nine EMS personnel, eight attending phy- sicians, six resident physicians, three medical technicians, two Triage nurses, one patient, one environmental service staff, and one hospital police officer. On several surveys, multiple hospital staff jointly reported being the first to identify the insect or multiple insects were found at different times on the same patient by different persons. Bed bugs were found on the patients’ clothes or belongings (n = 22), the ED bed or bedding (n = 21), elsewhere in the ED patient room (n = 2), in the patient’s ear (n = 2), and the ambulance stretcher (n = 1). If a bed bug was not detected before the person was placed into a treatment bed it took an average of 133 min before the insect was found. Thirty five percent of patients had already received a blood draw and 23% of patient had already been transported to radiology before the bed bug was identified.

Fourteen subjects reported bed bugs at home, had an average age of

65 years old, 64% were males, nine arrived by EMS and four by private vehicle/bus, the average ESI was 2.6, 11 were admitted to hospital

http://dx.doi.org/10.1016/j.ajem.2016.12.076

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Table 1

Summary of survey data.

Gender (n = 40)

% of subjects (n)

% of overall ED patients

p-Value

and none received a psychiatric evaluation. The bed bug was found an average of 187 min after ED arrival (range: 0-750 min) and this was statistically insignificant when compared to those who reported bed bugs at home (p = 0.13).

In summary, bed bugs in our ED are associated with patients that are

Male 60.0 (24) 39 0.0065

Female 40.0 (16) 61 0.0065

Triage level (n = 39)

(79%), four had a papular rash (29%), two had wheezing, none were in- toxicated, and one received a psychiatric evaluation. The bed bug was found an average of 79 min after ED arrival (range: 0-240 min). This in- dicates that patients who know that they have bed bugs at home are not always notifying hospital staff of their infestation.

Twelve subjects reported no bed bugs at home, had an average age of 59 years old, 58% were males, six arrived by EMS and five by private vehicle/bus, the average ESI was 3.1, seven were admitted to hospital (58%), none had a papular rash, one had wheezing, two were intoxicated,

older, male, sicker, more likely to be admitted to the hospital, and arrive to the ED by ambulance, when compared with the general ED patient population (p b 0.05). Additional studies are needed to determine the relationship between bed bugs and human disease and the overall impact on the healthcare system.

Funding declaration

This research received no financial support.

Conflicts of interest

None.

Acknowledgements

We thank Jacqui Lingler for assisting with maintaining research reg- ulatory documents. We thank Drs. Barry Brenner and Justin Yax for their help with the study.

References

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