DURHAM REGION BED BUG ACTION PLAN

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1. Executive Summary DURHAM REGION BED BUG ACTION PLAN 2. Introduction/Overview 2.1 Biology TABLE OF CONTENTS 3. Durham Region Action Plan 3.1 Aim & Objectives 3.2 Stakeholder Roles & Responsibilities 3.2.1 Public Health 3.2.2 Social Services Income Support 3.2.3 Long -Term Care (LTC) Facilities 3.2.4 Multi-Unit Housing 3.2.5 Non-Profit Housing 3.2.6 Temporary Housing 3.2.7 Property Managers / Landlords 3.2.8 Residents / Tenants 3.2.9 Pest Control Operators 3.2.10 Community Care Mental Health 3.2.11 Child Welfare 3.2.12 Health Care Facilities Acute Care 3.2.13 Health Care Facilities Mental Health 3.2.14 Hospitality Industry 3.2.15 Boards of Education 3.2.16 Child Care 3.2.17 First Responders 3.2.18 Municipal Community Facilities 3.3 Legislation, Regulation and Enforcement 4. Integrated Pest Management 5. Surveillance and Evaluation 6. Conclusions and Recommendations 7. References 8. Appendix A Durham Region Bed Bug Working Group Members 9. Appendix B Durham Region Bed Bug Working Group Terms of Reference 2

10. Appendix C Durham Region Client Referral List 11. Appendix D Bed Bug Response Flowchart 12. Appendix E Pre-Treatment Preparation Checklist 13. Appendix F Bed Bugs and Occupational Health for Service Providers 14. Appendix G Site-Specific Guidelines for Prevention and Management of Bed Bug Infestations 14.1 Multi-unit Housing 14.2 Shelters and Transitional Living 14.3 Long-term Care Facilities and Retirement Homes 14.4 Schools and Day Care Centres 14.5 Hospitality Industry 15. Appendix H Bedbugsinfo.ca Resources Everything You Wanted to Know About Bed Bugs Pamphlet Bed Bug Inspection Tool Kit (IPM Guide) Fact Sheets General Information Bed Bug Myths Bed Bug Bites Tenant Rights Regarding Bed Bugs Bed Bug Travel Tips Pest Control Information 16. Appendix I Education and Community Awareness Resources 17. Appendix J Don t Let the Bed Bugs Bite (DCAS) 3

1.0 EXECUTIVE SUMMARY The Durham Region Health Department (DRHD) led the development of the Durham Region Bed Bug Action Plan (BBAP) in collaboration with several stakeholders to respond to local challenges with respect to bed bugs in Durham Region. The participation of key stakeholders was invaluable to grasp an understanding of the bed bug issues and challenges and understand the roles of each agency and sector. It was also an opportunity for stakeholders to share their experience, programs and strategies for success. Section 3.3 of the BBAP provides a summary of the roles and responsibilities of these agencies and sectors. The appendices of the BBAP also have several useful resources and templates to assist agencies, associations and the public and provide guidance and information on the identification, prevention and control of bed bugs in the community. The plan also contains four key recommendations; continued collaboration and consultation through scheduled meetings of the Bed Bug Working Group; ongoing surveillance and evaluation; common language in local municipal by-laws aimed at providing a consistent level of service throughout Durham region; and the DRHD will continue to provide information sessions for the community, train-the-trainer sessions for key stakeholders and a comprehensive community awareness program. 4

2.0 INTRODUCTION/OVERVIEW Over the past few years there has been a resurgence of bed bugs across Canada and other countries. In Durham Region calls to the Durham Region Health Department (DRHD) have increased dramatically since 2006 from a low of 27 in 2007 to a high of 228 in 2011. The number of calls year-to-date indicates that this trend continues to increase. While bed bugs are not known to transmit diseases to humans, they can cause significant negative effects on quality of life. According to several reports, the impacts of bed bugs include sleep disturbances, anxiety, stress, depression, allergic reactions and psychological trauma. Individuals who lack financial resources and/or those with physical or mental health challenges are often most impacted by bed bugs as their ability to address bed bug infestations or prevent recurrence is compromised. During the latter part of 2010 and beyond, it became evident that there is a need for a coordinated approach in Durham Region to provide guidance, assistance and support to the community in relation to bed bugs and that Durham Region residents would benefit from the implementation of programs and consistent approaches to addressing bed bug infestations and complaints. In response to local challenges with bed bug infestations, the DRHD organized a Bed Bug Stakeholder Meeting on January 19, 2011. This meeting was attended by approximately 70 attendees representing various agencies and sectors across the Region. This session resulted in the formation of a Durham Region Bed Bug Working Group (BBWG), with the objective of developing a Draft Durham Region Bed Bug Action Plan. Just prior to the DRHD Bed Bug Stakeholder Meeting, the government announced $5 million in funding to support public health units in addressing bed bugs in their communities. The province s 36 boards of health were able to apply for one-time 100% provincial funding to support bed bug-related programs that emphasize coordination with other local services, education and awareness and/or provide supports to vulnerable populations. On January 27, 2011, the MOHLTC sent public health units a funding application form that was to be completed and submitted to the MOHLTC by February 10, 2011. DRHD submitted an application for funding and received $223,458 which provided for the temporary hiring of a Senior Public Health Inspector and a parttime Public Heath Inspector to work on the Bed Bug project. Funding was also used to undertake a public awareness campaign and educational activities. The Bed Bug Working Group (BBWG) is comprised of members from Social Services (Housing and Income Support), long-term and health care facilities, first responders, 5

shelters, the local chapter of the mental health association, landlord and tenant groups and the hospitality industry. The BBWG met in July 2011 to develop terms of reference, review group membership and to define deliverables of the DRHD and BBWG under the areas of education and outreach supports for priority populations and surveillance and evaluation. Stakeholders discussed the issues and challenges experienced in their sector in relation to bed bugs and defined the major components that our local Bed Bug Action Plan should contain. At the September meeting the Bed Bug Action Plan components were prioritized under the following three themes: Education and Outreach, Supports to Priority Populations and Surveillance and Evaluation. Stakeholders were divided into two groups and provided input as to their needs under the relevant action plan components. During the October meeting, BBWG members were requested to provide any relevant statistics pertaining to bed bug calls, infestations and pest control treatments. Participants at the meeting were divided into two groups and provided feedback and input regarding the existing and potential future initiatives for the two main components of the plan; the bed bug awareness campaign and supports to priority populations. In addition, BBWG members provided input as to the needs of their staff and clients throughout the development of the draft action plan via less formal methods of communication. The following Draft Durham Region Bed Bug Action Plan is the culmination of the efforts of the Bed Bug Working Group and provides guidance and information on the identification, prevention and control of bed bugs along with site specific guidelines for housing and facilities in an effort to provide a consistent, coordinated approach to bed bugs within Durham Region. This document is intended to be made available to stakeholders and the public via the Durham Region website. 6

2.1 BIOLOGY What are Bed bugs? Bed bugs are small wingless biting insects with oval shaped bodies. Adult bed bugs are a reddish brown, 5 to 6 millimeters when unfed to almost 10mm when fully blood engorged. An unfed adult is similar in size and shape to that of an apple seed. The size of the juveniles varies between 1 to 4mm depending on growth stage. Their life-cycle, from egg to egg, may take four to five weeks under good conditions. They have five nymphal developmental stages (instars), each needing at least one blood-meal to develop to the next instars. Bed bugs are nocturnal, but they will feed in full daylight when hungry. Each female may lay 200 to 500 eggs in her lifetime. Both male and female bed bugs feed on blood. In the absence of humans they feed on mice, rats, birds and other animals including pet dogs and cats. Feeding takes about 10 to15 minutes for adults, less for nymphs, and is repeated about every three days throughout their estimated typical 6 to12 month lifespan. Adult bed bugs can survive for over a year without feeding. By day they hide in dark, dry places in beds, mattresses, cracks in walls, floors, and furniture; they are also found behind pictures and wallpaper; hiding places are also used for breeding. They sense and seek warm-blooded hosts mainly through the perception of body temperature and by detection of carbon dioxide (Ter Poorten and Prose 2005). Following emergence from their hiding places, bed bugs can migrate up to 20 feet to reach a victim (Kolb et al. 2009). Public Health Significance According to the World Health Organization, bed bugs can carry 28 human pathogens; however they are not known to transmit them when they take a blood meal from a human. They are mainly important as a biting nuisance and are not considered a health hazard. Some people, especially those exposed for a long time, show little or no reaction to the bites, which appear as small red spots that may not even itch. People never bitten before may suffer from local inflammation, intense itching and sleepless nights. The bite produces a hard whitish swelling that often continues to bleed. There can also be a delay in the appearance of a clinical 7

reaction to a bed bug bite, even in the order of 9 to 14 days, and this can cause confusion as to the origin of the bites. Scratching may cause secondary infections. Social Impacts Although good evidence is lacking, it is possible that economically-disadvantaged individuals may disproportionately share a larger burden of adverse impacts of bed bug infestations. The social stigma associated with bed bug infestations and potential costs of eliminating an infestation may increase the levels of psychosocial stress. This may also reduce their ability to access resources that can provide assistance to improve their overall health and well being. People who have experienced a bed bug infestation talk of feeling ashamed, fearful, overwhelmed, and frequently describe extreme levels of isolation. Research into the impact of bed bug infestations shows debilitating impacts, including very high levels of anxiety, stress, depression, sleep deprivation, and intense preoccupation verging on delusional states. Sufferers have reported taking medication to cope with the experience and some have reported ongoing mental health issues. 8

3.1 AIM & OBJECTIVES Aim: The aim of the Durham Region Bed Bug Action Plan is to provide a coordinated approach, effective response and useful resources to community partners, priority populations and the general public regarding bed bugs in Durham Region. Objectives: To define roles and responsibilities of agencies related to bed bugs, To minimize the impact of bed bugs on local priority populations through building community capacity, To increase awareness of the general public and priority populations regarding bed bug identification, prevention and control, To identify sources of credible information regarding bed bugs to the public, priority populations, agencies and the media, To promote and provide information on Integrated Pest Management methods and best practices related to the prevention and control of bed bugs, and To develop and implement a surveillance system to determine the magnitude of the issue and to evaluate awareness and control efforts. 9

3.2 STAKEHOLDER ROLES AND RESPONSIBILITIES 3.2.1 PUBLIC HEALTH The role of the Durham Region Health Department is to provide the public with information on bed bug identification, prevention and control. Public health inspectors in the Environmental Health Division also make referrals to agencies that may offer assistance to individuals impacted by bed bugs. Ongoing Environmental Helpline response, provided by public health inspectors, ensures that members of the community receive reliable information, educational resources, guidance and referrals to agencies that provide assistance in addressing bed bug infestations. STAKEHOLDER AGENCY: Durham Region Health Department One of the primary roles of the Durham Region Health Department (DRHD) is to increase public awareness regarding bed bugs. To this end, the DRHD developed a bed bug community awareness campaign aimed at both the general community and priority populations. A key component of the public awareness initiative is to provide local priority populations with the information and supports needed to minimize the impact of bed bugs. Priority populations are those who may be at risk to increased impacts from bed bug infestations as their ability to address them may be compromised by factors such as physical, mental health and addiction challenges. Through partnership and collaboration with community stakeholders, the DRHD has strived to address challenges faced by stakeholders and their clients and streamline access to supports and services in our community related to bed bugs. 3 ROLES & RESPONSIBILITIES Awareness & Education Strategies To increase awareness amongst key stakeholders and priority populations; and prevent the spread of bed bugs in the community; the following strategies have been implemented: Health promotion and community awareness activities include the following: o Promote www.bedbugsinfo.ca as a reliable source of information, o Disseminate resources from www.bedbugsinfo.ca (e.g., pamphlets, fact sheets) via stakeholders, 10

o Provide educational sessions and train-the-trainer workshops to community partners (i.e., social services, first responders and by-law enforcement), o Maintain up-to-date bed bug information on the Region s website www.durham.ca, o Implement a community-wide bed bug awareness campaign, o Provide bed bug displays at community events and venues, and o Provide information and referrals to supportive agencies from inquiries received on the DRHD s Environmental Help Line. Provision of pest specimen identification o Identify insects at the DRHD Environmental Health Division office. Provision of a bed bug surveillance program/database and evaluation of the program o Monitor calls received on the Environmental Help Line related to bed bug inquiries and complaints, o Track health promotion activities provided by the DRHD (e.g., dissemination of resources, presentations, displays), and o Conduct surveys to determine the effectiveness of health promotion activities aimed at increasing community and priority population awareness of bed bugs. 3.2.2 SOCIAL SERVICES - INCOME AND EMPLOYMENT SUPPORT The Social Services Department provides services to more than 25,000 residents of Durham Region each month. The Income and Employment Support Services Division delivers the Ontario Works Program which provides financial help and basic health benefits to residents in need. Their Employment Resource Centre provides a wide range of services to help people find work. STAKEHOLDER AGENCY: Durham Region Social Services Department - Income and Employment Support Services Income and Employment Support staff interact with clients who visit their offices or call for financial and employment assistance (i.e. applying for social assistance benefits); and therefore respond to bed bug inquiries and concerns from their clients on an ongoing basis. There are numerous opportunities for them to provide information regarding bed bugs to their clients. Increasing bed bug awareness and dispelling misinformation associated with bed bugs should reduce the social stigma associated with bed bugs and increase the early bed bug identification and eradication. 11

ROLES & RESPONSIBILITIES In order to increase bed bug awareness amongst staff and clients; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Promote www.bedbugsinfo.ca as a reliable source of information, Disseminate resources to clients via caseworkers and Employment Counsellors (e.g. pamphlets, fact sheets from www.bedbugsinfo.ca), Provide education sessions for Social Services staff, Provide information supporting the benefits of early identification and reporting of bed bug infestations, and Provide information regarding the rights and responsibilities of landlords and tenants. Control Strategies Provide assistance to Ontario Works clients with the eradication of bed bug infestations through access to various types of mandatory or discretionary health related benefits based on eligibility. Assist with cleaning and/or replacement of a client s personal belongings when the client submits a request for CSUMB (Community Start Up and Maintenance Benefit). 3.2.3 LONG-TERM CARE (LTC) HOMES A major challenge for LTC homes is the introduction of bed bugs into their homes by new residents who may have a bed bug infestation in their previous home and bring bed bugs with their personal belongings. Visitors may also introduce bed bugs to the facility when they are visiting or bringing personal items for their family member. There may also be challenges in identifying the presence of an infestation in residents rooms and the subsequent follow up and reporting of the infestation. STAKEHOLDER AGENCY: Durham Region Social Services Department Long-Term Care and Services for Seniors Division The Regional Municipality of Durham operates four long-term care homes. Their services are geared toward physically frail and/or cognitively impaired adults who require supervision and/or assistance with activities of daily living and personal care in a secure, safe and caring environment. These facilities and homes employ a range of skilled health professionals to meet the multiple complex care needs of the residents. 12

ROLES & RESPONSIBILITIES To increase awareness amongst staff and residents; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide train-the trainer sessions regarding bed bug management for staff, Provide staffed displays and distribute posters throughout long-term care homes, Provide bed bug information to staff, residents and visitors regarding identification, prevention, early reporting and control (e.g., pamphlets and fact sheets from www.bedbugsinfo.ca), Provide Workplace Newsletters with information on bed bugs to staff, Provide bed bug information to families during family & resident council meetings, and Promote www.bedbugsinfo.ca as a reliable source of information. Control Strategies Establish Best Management Guidelines regarding bed bug prevention and control, Develop and implement bed bug policies to educate staff, service providers, clients & their families, Develop and implement policies and procedures regarding bed bug inspections during routine cleaning, and Develop and implement policies and procedures regarding regular inspection of residents rooms, bedding, common areas, wheel chairs and motorized equipment, etc. 3.2.4 MULTI-UNIT HOUSING Bed bug infestations can be difficult to control and eliminate, especially in multi-unit dwellings. If not addressed immediately, infestations can easily spread to adjacent units or throughout a building impacting many people and increasing the costs associated with eradication. In order to address a bed bug infestation effectively, it is vital for all parties involved to work together (i.e. property managers/landlords, tenants and pest control operators). Proactive treatment through pre-established treatment plans can effectively eliminate infestations. STAKEHOLDER AGENCY: Durham Region Social Services Department - Housing Services The Region of Durham, Housing Services Division is part of the Social Services Department. The Region provides funding for operating and rent-geared-to-income 13

subsidies for approximately 6,800 social housing units operated by non-profit housing agencies across Durham. The Division consists of three teams. Housing Operations manages the regionally owned portfolio of units occupied by single, family and senior households. This team also works with private landlords that participate in rent supplement programs. Homelessness Initiatives funds and monitors programs that assist households to obtain housing or to prevent homelessness. This portfolio includes: managing the waiting list for rent-geared-to-income housing, funding and administering the programs for emergency and domiciliary hostels and the Emergency Motel Program. The Housing Outreach Workers and Eviction Prevention programs are also funded through this team. Housing Administration is responsible for setting policy and monitoring legislative compliance of 45 housing providers who operate 6,800 rental units throughout the Region. ROLES & RESPONSIBILITIES Housing Operations personnel directly manage rental units located in 23 sites across Durham. These sites include high rise and low rise buildings, semi detached homes, four-plexes, row houses and town homes. Employees are regularly on site to inspect units, conduct maintenance and repairs, address tenant issues and collect rents. Employees also monitor the repair work undertaken by contractors within these units. They ensure contractors are aware of bed bug issues within specific units and are following appropriate protocols to reduce the spread of bed bugs to other units. Operations staff also liaises with private landlords that have rent supplement agreements with the Region. Regional staff provides advice and guidance to the landlords and/or rent supplement tenants on how to deal with bed bug issues. The Durham Region Housing Services Division is well placed to support the Region in its efforts to increase public awareness to prevent the spread of bed bugs in the community. Homelessness Initiatives team members are often required to field calls from applicants, emergency hostel providers, community program staff, and the general public regarding problems with bed bugs. Families experiencing problems with bed bugs are often under stress. Team members provide callers with information about the appropriate management of bed bugs and support tenants in working with their landlords to eradicate the infestation. Housing Administration supports social housing providers by advising them of their responsibilities to residents under their by-laws, the Residential Tenancies Act and the Co-operative Corporations Act. Complaints from residents regarding maintenance issues are often escalated to this team, who liaise on the resident s behalf with their 14

housing provider. This team offers housing providers training on a variety of issues, including bed bugs. To increase awareness amongst staff and residents; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide ongoing information and awareness sessions to residents, social housing staff and community workers about bed bug identification, prevention and control, Disseminate information from www.bedbugsinfo.ca (e.g., pamphlets and fact sheets) to tenants, staff and landlords, and Promote www.bedbugsinfo.ca as a reliable source of information. Control Strategies Establish and implementation of policies that encourage the early detection and prompt reporting of and response to bed bug infestations to landlords, Establish and implementation of policies that encourage the use of licensed pest control companies, Provide information to residents and landlords regarding pre-treatment preparation, and how to choose a pest control company (see Appendices E and H), and Develop processes that encourage cooperation amongst landlords, tenants, shelters, hostels and pest control companies for effective eradication of existing bed bug infestations and prevention of further infestations. 3.2.5 NON-PROFIT HOUSING Many non-profit housing facilities are multi-unit dwellings. Residents of non-profit housing buildings may encounter similar challenges in eradicating bed bug infestation as residents in other types of multi-unit dwellings. Residents who may have additional challenges such as disabilities may be more severely impacted. They may require assistance to access the necessary supports to deal with the infestation. In order to successfully eradicate a bed bug infestation, it is essential for residents and landlords to work collectively. Once an infestation has been identified, all parties involved (i.e., resident, landlord and pest control operator) must be proactive and work together in implementing treatment strategies, evaluating their effectiveness and assessing the need for further treatment. STAKEHOLDER AGENCY: Durham Non-Profit Housing Durham Non-Profit Housing is a social housing provider that owns and manages more than 1,100 apartment and townhouse rental units at 18 sites across Durham Region. The mission of the Corporation is to help meet the housing needs of the Region's 15

diverse population through the provision of a practical, well-maintained and affordable housing portfolio integrated within the community. The Corporation assists with related services to support residents in their housing. Durham Region Non-Profit Housing Corporation was developed as a result of the growing awareness of the need to meet the housing requirements of senior citizens, the physically and mentally challenged, and family households whose shelter needs were not being met by the private sector. ROLES & RESPONSIBILITIES To increase awareness amongst landlords and residents; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide ongoing education and information to residents/staff about bed bug identification, prevention and control through workshops, Disseminate information using pamphlets, fact sheets, posters and displays, and Promote www.bedbugsinfo.ca as a reliable source of information. Control Strategies Promote early detection, prompt reporting and response of bed bug infestations, Hire licensed pest control companies to address infestations, Follow proper unit preparation steps to ensure successful treatment and prevention, Keep accurate records of infestations and treatments conducted, and Encourage cooperation amongst landlords, tenants and pest control for effective eradication and prevention of further infestations. Landlords/Property Managers should provide tenants with: o Information they require to understand behaviour and habits, as well as what actions and control measures are required to deal with the infestation, o Adequate notice of treatment dates and times, o Instructions for pre-treatment preparation, and o A checklist to assist tenants with the pre-treatment preparation requirements (see Appendix E). Tenants/Residents should: o Report suspected infestations promptly to their landlord, o Reduce clutter and maintain their unit/home in a manner to reduce conditions that may lead to bed bug infestations, o Cooperate with the landlord/property manager and the pest control operator in treating an infestation, and o Follow proper unit preparation steps for inspection and treatment, and take reasonable measures to prevent re-infestation. 16

3.2.6 TEMPORARY HOUSING Bed bugs can present a difficult issue in shelters and transitional housing because of the transient nature of those persons who use this service. In addition, residents who occupy temporary housing may require additional supports regarding bed bug awareness and the benefits of early reporting of bed bug issues. STAKEHOLDER AGENCY: Cornerstone Community Association Durham Inc. Cornerstone Community Association provides services to individuals who are homeless and require support to remain in the community. Support is provided through facilities such as emergency shelters, transitional housing, and permanent housing. Cornerstone owns and operates a multi-unit apartment building in Oshawa and also accesses apartments committed to their organization in other housing units in the Region. ROLES & RESPONSIBILITIES To increase awareness amongst staff and tenants; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide ongoing education to staff and tenants about bed bug identification, prevention and control, through workshops and other strategies, Provide tenants with bed bug prevention information during the signing of their lease agreement, Provide tenants, clients and staff with education and ongoing updates in best practices and new methods for the prevention and control of bed bugs, Promote www.bedbugsinfo.ca as a reliable source of information, Encourage tenants to report infestations, and Work with tenants to ensure proper pre-treatment unit preparation is followed. Control Strategies Implement a bed bug policy that defines responsibilities of staff, tenants, residents, guests and pest control providers, Define procedures for infestations and recommendations for staff to prevent and control the transfer of bed bugs between rental units and other facilities, Ensure preventative maintenance, intensive follow-up and facilitation of needed resources whether from staff, contract or external agencies in special cases, and Develop and provide the following tools for staff and tenants: o Checklist for prevention and treatment of bed bugs, and o Pre-treatment preparation instructions. 17

3.2.7 PROPERTY MANAGERS/LANDLORDS Landlords, property owners and managers play a key role with regards to controlling bed bugs. Bed bug infestations in multi-unit dwellings can be difficult to eradicate. Responding quickly to infestations may reduce costs and increases the likelihood for a successful outcome. Landlords are responsible for providing and maintaining a residential complex including the residential units in it. Tenants are responsible for cleanliness of the areas that they occupy and control. Therefore, from a legal perspective, as well as a practical standpoint, it is essential that landlords and tenants work together to eliminate bed bugs. STAKEHOLDER AGENCY: (GTAA) Greater Toronto Apartment Association The GTAA represents the interests of its members: owners, managers and the professional service providers in the rental housing industry. ROLES & RESPONSIBILITIES To increase awareness amongst landlords; and prevent the spread of bed bugs in the community the following strategies are proposed: Awareness & Education Strategies Provide information sessions to tenants to increase awareness of bed bugs, Provide the resources available on www.bedbugsinfo.ca as well as a Pretreatment Preparation Checklist (see Appendix E) to tenants, and Promote www.bedbugsinfo.ca as a reliable source of information. Control Strategies Landlords may be required to retain the services of a licensed pest control operator when bed bugs have been identified. To effectively control bed bugs, a landlord s responsibilities should include the following: Control the spread of bed bugs through mutual cooperation and open communication with tenants, Institute an Integrated Pest Management (IPM) Program, with an emphasis on awareness and prevention, Consider requesting that new tenants report that they are moving from a bed bug infested premises, Consider disclosing the presence of bed bugs in a building to prospective tenants, 18

Encourage tenants or guests to report bed bugs and keep records of bed bug or other pest complaints on site in a log book, Respond quickly to all complaints, Refer tenants and guests to the appropriate support agencies (e.g. medical, mental health, financial, social services) for help if necessary (see Appendix C- Client Referral List), Obtain the services of a licensed pest control company with experience in managing bed bugs using IPM principles. Request tenants to follow instructions from the pest control company, Provide information on the proper removal of bed bug infested furnishings in order to prevent the spread of bed bugs along hallways and in elevators, Ensure use of prompt and proper disposal of potentially infested furnishings (see Appendix E), and Keep accurate records of infestations and treatments conducted. 3.2.8 RESIDENTS/TENANTS Controlling bed bugs in a residential tenancy requires collaboration from all parties. This includes owners, landlords, property management, tenants and pest control. A tenant s early identification of a bed bug infestation will lead to a greater chance for a successful eradication of the pest. STAKEHOLDER AGENCY: Durham Community Legal Clinic (DCLC) The DCLC provides referrals, legal information, legal advice, and representation before Courts and Tribunals, Tenant Duty Counsel, community development and law reform. The DCLC offers legal advice to low income residents of Durham Region. The DCLC periodically hosts information sessions to community agencies. In addition, the DCLC can provide information on legal rights and responsibilities of landlords and tenants and general bed bug control information directly to tenants through the following avenues: Conduct client consultation (i.e. in person or via telephone), Provide non-staffed displays in the office lobby, and Distribute pamphlets and other resources. ROLES & RESPONSIBILITIES Awareness & Education Strategies Provide information on bed bug identification, prevention and control to tenants by directing them to www.bedbugsinfo.ca or through local community agencies such as the Durham Community Legal Clinic, Provide fact sheets from www.bedbugsinfo.ca (see Appendix H), and 19

Provide information from the Durham Region Bed Bug Action Plan, (i.e. Client Referral List - Appendix C, Bed Bug Response Flowchart - Appendix D and Pre-Treatment Checklist Appendix E). Control Strategies Encourage cooperation and collaboration between tenants and landlords. Tenants are responsible for cooperating with a landlord s efforts to control bed bugs. If the pest control operator believes there is a need to also treat neighbouring units, the landlord may have the right to enter to inspect and treat other apartments as well as the affected apartment, Encourage tenants to properly prepare their unit that is to be treated by the pest control operator. Disseminate information to tenants regarding the necessary precautions when disposing items that may have bed bugs on them (see Appendix E), and Encourage tenants to: o Follow all advice and instructions to support the IPM program implemented by the building management even if they personally do not have an infestation of bed bugs, o Report bed bugs to the building management immediately, o Familiarize themselves with signs of bed bugs and frequently check their living space for evidence of an infestation, and o Discuss with neighbouring tenants the need to support the IPM program in place and cooperate with management. 3.2.9 PEST CONTROL OPERATORS Licensed pest control operators have access to regulated pest control products that the general public does not have access to. These regulated products are necessary where an infestation exists. The pest management company must hold a valid operator license issued by the Ontario Ministry of the Environment (MOE) to run a business that uses pesticides. Persons applying pesticides that are employed by the pest management company must hold a Structural Exterminator License or be a Technician or Trainee working under the supervision of the Structural Exterminator License holder. The exterminator must carry his or her license, issued by the MOE, or have it available at the extermination site. Pest control companies have an excellent opportunity to incorporate education and training for their clients. This service may include a large information session for a municipal/regional housing provider or in a tenant s home with the landlord and tenant present. STAKEHOLDER AGENCY: Structural Pest Management Association of Ontario (SPMAO) 20

The SPMAO is the largest and oldest professional Structural Pest Management Industry Association in Ontario. The SPMAO is a non-profit organization with a Board of Directors comprised of representatives from their members. SPMAO represents over 150 licensed companies that actively protect the health and safety of all Ontarians. SPMAO hosts workshops and training sessions for their members and also provides them with latest policies, standards and best practices. The SPMAO has developed a Best Practices document for the treatment of bed bugs in multi-unit buildings. ROLES & RESPONSIBILITIES Awareness & Education Strategies To assist landlords and tenants in controlling bed bugs, pest control operators should disseminate information such as the following: Resources from www.bedbugsinfo.ca, Provide information from the Durham Region Bed Bug Action Plan, (i.e., Client Referral List - Appendix C and Bed Bug Response Flowchart - Appendix D and Pre-Treatment Checklist Appendix E), Documents available from their own internally developed resources, and Resources available at www.spmao.ca. Control Strategies Licensed pest control companies have the experience, tools (including insecticides) and resources to control bed bug infestations. The services provided to the client to help control bed bugs may include information on: Prevention, Identification, Pre-treatment preparation, Control measures, Mattress encasements, Bed bug monitors, Climb-up interceptors, and Residual insecticide application. A licensed pest control operator with experience and training in bed bug control plays a fundamental role in Integrated Pest Management and can provide the greatest success in eliminating a bed bug infestation. 3.2.10 COMMUNITY CARE - MENTAL HEALTH Mental Health Service Providers are committed to the well being of their staff and clients and aim to eliminate the occurrence and reoccurrence of bed bugs in their housing and other sites. 21

A bed bug policy is necessary to develop and implement practices and/or procedures for staff to: Reduce the likelihood of staff coming into contact with bed bugs, Reduce opportunities for the movement/transport of bed bugs from one home to another, and Assist and support clients and others in the prevention and control of bed bugs. STAKEHOLDER AGENCY: Canadian Mental Health Association-Durham Branch (CMHA) CMHA Durham is part of a nation-wide charitable organization that promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness. Their Mental Health Centre promotes and enhances the mental, emotional, and physical well-being of our community. They do this through education, collaboration, advocacy, and the provision of a broad range of direct services that meet our community's needs. CMHA Durham fulfills its mission by: Providing a range of services and community-based mental health programs, Educating the broader community regarding mental health issues, Working closely with other related services in the community, and Responding to the needs of the community by establishing new programs. Rental housing units are also provided throughout Durham Region and each tenant has a case management worker who visits the tenant and assists them with life skills. ROLES & RESPONSIBILITIES In order to increase awareness amongst staff and clients and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide bed bug training sessions for case management workers who visit tenants of CMHA rental housing units, Facilitate discussions with staff about bed bugs and how to avoid or deal with them, Post resources such as fact sheets from www.bedbugsinfo.ca at all CMHA- Durham sites, Provide all clients with a fact sheet at admission, and a checklist as to what they can do to prevent or eliminate the problem, Provide clients with access to written information about bed bugs, Promote www.bedbugsinfo.ca as a reliable source of information, and Provide information from the Durham Region Bed Bug Action Plan, (i.e., Client Referral List - Appendix C, Bed Bug Response Flowchart - Appendix D and Pre-Treatment Checklist Appendix E). 22

Control Strategies Train staff and volunteers to recognize signs of bed bugs, reporting methods, and improve knowledge of bed bug policies and/or protocols, Develop a bed bug protocol outlining safety precautions for staff when meeting with clients (at home or other locations) and other procedures to deal with infestations, Ensure a copy of the protocol is available at all work sites, Provide bed bug inspection tool kits at each residential building and other work sites as well as implementing a plan to maintain supplies (see Appendix H), Encourage clients to report bed bug problems to staff, Assist in the confirmation and positive identification of suspected bed bugs (e.g., contacting pest control company, DRHD), and Take preventative measures to reduce opportunities for the transport of bed bugs between clients homes and staff. 3.2.11 CHILD WELFARE STAKEHOLDER AGENCY: Children s Aid Society - Durham Durham Children's Aid Society has been protecting children in the community since 1905. They are responsible for providing child protection services to children under the age of 16 and their families who live in Durham. ROLES & RESPONSIBILITIES The Children s Aid Society has agency staff members whose job function is to conduct home visits and deal with clients who come into their office. Volunteer staff members also attend family homes. Staff may therefore come into contact with bed bugs while in a client s home that is infested or if they are brought into the office. In addition, they also have a clothing depot and store belongings of their crown wards (children in their care who live on their own) on site from time to time. Staff and volunteers are expected to take certain precautions to minimize personal contact with or transmission of bed bugs. To increase awareness amongst staff and clients and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide information and training (e.g., train-the trainer sessions) regarding bed bug prevention and control for staff, Disseminate information from www.bedbugsinfo.ca (e.g., pamphlets and fact sheets) to agency staff and clients, and Promote www.bedbugsinfo.ca as a reliable source of information. 23

Control Strategies Provide information and procedures for staff to follow during home visits to reduce the spread of bed bugs (i.e., Safety First Manual and Durham Children s Aid Society Don t Let the Bed Bugs Bite Recommendations for Staff pamphlet Appendix J), and Ensure staff members take preventative measures to control the exposure of bed bugs between client homes and staff. 3.2.12 HEALTH CARE FACILITIES - ACUTE CARE Hospitals deliver health care services to the residents of our community; they receive patients (both long term and short term) as well as the patients visitors who come into the hospital. It is possible that a patient/and or visitors can bring bed bugs into a hospital with their belongings; although these are typically transient introductions and infestation is unlikely to result. Even though most hospital environments are not conducive to bed bug infestations, it is vital for staff to be trained in bed bug identification, prevention and control as well as recognizing signs of an infestation, should they occur. STAKEHOLDER AGENCIES: Lakeridge Health, Markham-Stouffville Hospital Corporation (Uxbridge Cottage Hospital Site), Rouge Valley Health System Together, the Lakeridge Health, Rouge Valley Health System and the Uxbridge Cottage Hospital serve more than 600,000 residents of the Durham Region. On average, the entities five acute-care hospitals, one specialty hospital and various off site locations manage over 715 in-patient beds and deliver care to approximately 1,600 people each day; with over 5,000 staff and physicians along with nearly 1,500 volunteers. ROLES & RESPONSIBILITIES In order to increase awareness amongst staff and patients; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide information and training (e.g. train-the-trainer sessions) to ensure staff are aware of bed bug prevention and control measures, Implement an awareness program for staff through various communication, tools (e.g. web-based newsletters distributed to staff via email, posters promoting www.bedbugsinfo.ca as well as displays and dissemination of resources during events such as Infection Control Week), Provide resources to patients and their families regarding bed bugs, and Promote www.bedbugsinfo.ca as a reliable source of information. 24

Control Strategies: Develop policies and procedures that contain the following components: o Guidelines for the management of bed bug sightings and suspected infestations in order to prevent the spread of bed bugs in a hospital environment, o Guidance on how to identify bed bug signs during routine cleaning and inspection of hospital rooms/common areas, and o Actions to be taken once a suspected or confirmed bed bug infestation is reported (e.g., contact precautions, use of bed bug monitors and contact pest control company) 3.2.13 HEALTH CARE FACILITIES - MENTAL HEALTH Mental Health Facilities deliver specialized health care services to patients suffering from mental illness. Bed bugs can be brought into the hospital with patients belongings. It is important for mental health facilities to have a bed bug management policy in order to ensure that staff members are properly trained in bed bug identification and control, and to provide workplace guidelines for the management of suspected or confirmed bed bugs in the facility. STAKEHOLDER AGENCY: Sciences Ontario Shores Centre for Mental Health Ontario Shores is a public hospital providing a range of specialized assessment and treatment services to those living with complex and serious mental illness. ROLES & RESPONSIBILITIES In order to increase awareness amongst staff and patients; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Implement an awareness program that may include train-the trainer sessions, or information sessions for staff regarding bed bug identification, prevention and management, Provide bed bug awareness information via intranet, and newsletters that go to staff, clients and patients, Disseminate awareness resources to staff, clients and patients (e.g., bed bug information package including pamphlets, fact sheets from www.bedbugsinfo.ca - see Appendix H), and Promote www.bedbugsinfo.ca as a reliable source of information.. 25

Control Strategies Develop policies and procedures that contain the following components: o Staff training regarding signs of bed bugs in clinical areas and on patient s items (e.g. actual insects, cast skins, or excessive insect bites on a patient), o Guidelines for the management of bed bug sightings and suspected infestations in order to prevent the spread of bed bugs in a hospital environment, o Actions to be taken once a suspected or confirmed bed bug infestation is reported (e.g. contact precautions, use of bed bug monitors and contact pest control company) 3.2.14 HOSPITALITY INDUSTRY Hotels and motels are at an increased risk for bed bugs due to the transient nature of their occupancy. While bed bug exposures may not be 100% preventable the development of an infestation can be avoided. Education and awareness that is targeted to all levels of staff can reduce the risk of spreading the pest to their guests and throughout the community. STAKEHOLDER AGENCY: Durham Hotel Association The Durham Hotel Association serves the region by providing hoteliers and industry members a regular forum at which to meet and discuss industry issues.their membership includes 13 hotels with a total of 2,016 beds. ROLES & RESPONSIBILITIES Awareness & Education Strategies Guest services including cleaning and maintenance staff have an excellent opportunity to monitor daily for the signs of bed bugs. Therefore bed bug identification awareness amongst staff is critical to control bed bugs. Hotel owners and managers can utilize several methods to reach out to hotel staff, such as the following: Increase awareness amongst staff using methods such as pay cheque insertions, staff bulletin boards, staff meetings, etc., and Disseminate resources and develop procedures for staff to follow to reduce the spread of bed bugs. Promote www.bedbugsinfo.ca as a reliable source of information. Control Strategies: It is recommended that hotels implement an Integrated Pest Management (IPM) program in order to respond to bed bugs. 26

Hoteliers have a responsibility to enact control measures outlined in the IPM program as soon as bed bugs have been identified. This may include the following: Implement a bed bug monitoring program where applicable, Remove guest rooms from service until such time as the potential infestation is investigated by a pest control operator, Conduct enhanced inspections of any adjacent rooms to check for signs and/or the presence of bed bugs, and Seal mattresses and furniture from affected rooms prior to their removal from the room. 3.2.15 SCHOOL BOARDS Schools may provide a location for bed bugs to be spread from one person s belongings to another person s belongings. Bed bugs can be introduced into schools from homes via bags, backpacks, clothing, books and other items. Although school environments may not be conducive to bed bug infestations, a Bed Bug Response Plan is still important in order to support bed bug prevention and control in the school and to effectively respond to suspected bed bug sightings should a bed bug issue occur. Schools may choose to alert parents/caregivers when bed bugs have been identified and provide bed bug information from www.bedbugsinfo.ca. STAKEHOLDER AGENCY: Officials (OASBO) Ontario Association of School Business This Ontario Association of School Business Officials (OASBO) is a professional association that develops, shares and promotes leading business practices in education. The OASBO has several standing committees representing various business functions such as Health and Safety. ROLES & RESPONSIBILITIES To increase awareness amongst staff, students and their families; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide information to staff regarding signs of bed bugs in the classroom and on children s items (e.g., actual insects, cast skins, or excessive insect bites on a child) and actions required should bed bugs be discovered, Provide bed bug awareness resources (e.g. pamphlets and fact sheets from www.bedbugsinfo.ca) to students and their families via the school administrator, Provide bed bug information via individual school newsletters (coordinated school board committee), 27

Offer bed bug information sessions for parents/caregivers and students in conjunction with other agencies, Promote www.bedbugsinfo.ca as a reliable source of information, and Provide information from the Durham Region Bed Bug Action Plan, (i.e., Client Referral List - Appendix C, Bed Bug Response Flowchart - Appendix D and Pre-Treatment Checklist Appendix E). Control Strategies Develop and implement a Bed Bug Response Plan (currently under development by the Durham District School Board), Provide resources regarding bed bug prevention and control to parents and students living in an infested home in order to prevent the further spread of bed bugs in the community, Implement a bed bug monitoring program throughout the school in response to a confirmed case, and Develop policies and procedures that include components such as; o Reducing clutter and the storage of student and staff personal items, o Cleaning schedules focusing on lost-and-found areas, upholstered furniture and wall mounted items (e.g. pictures, clocks, bookcases), and o Regular inspection of the school for signs of bed bugs. 3.2.16 CHILD CARE Child care programs provide a location for bed bugs to be spread from one person s belongings to another. Bed bugs can hitch a ride on backpacks, clothing, books and other items enabling them to travel to and from child care centres. Although child care centre environments may not be as conducive to infestations as other settings, such as multi-unit buildings, homes and hotels (with the exception of home child care), a bed bug response plan is still important. Protocols need to be established in order to support bed bug prevention and control in the child care settings and to effectively respond to suspected bed bug sightings, or infestations, should a bed bug issue occur. Since bed bugs tend to bite people when they are asleep, a bed bug problem may be more likely to develop in rooms where children nap. Child care centres should alert parents/caregivers when cases of bed bugs have been identified (with their child) and urge vigilance in the home to protect the health and safety of the family and school community. STAKEHOLDER AGENCY: Durham Region Children s Services The Durham Region Children s Services Division is the service manager for child care programs and initiatives in Durham Region. This division aims to provide effective and efficient delivery of directly operated services and programs while taking on a leadership role in the development, delivery and maintenance of these high-quality, affordable and 28

accessible children's services and programs; recognizing both individual needs and the diversity of our communities. ROLES & RESPONSIBILITIES To increase awareness amongst staff, children and their families; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies Provide training to staff regarding signs of bed bugs in the classroom and on children s items (e.g., actual insects, cast skins, or excessive insect bites on a child) and actions required should bed bugs be discovered, Provide education and awareness resources (e.g., pamphlets, fact sheets from www.bedbugsinfo.ca) to students and their families via the administrator, Distribute newsletters containing information on bed bugs, Provide information sessions for parents/caregivers, Promote www.bedbugsinfo.ca as a reliable source of information, and Provide information from the Durham Region Bed Bug Action Plan, (i.e., Client Referral List - Appendix C, Bed Bug Response Flowchart - Appendix D and Pre-Treatment Checklist Appendix E). Control Strategies Collaborate with the parents of children living in an infested home to develop strategies for preventing the further spread of bed bugs, and Develop policies and procedures that include components such as: o Reducing clutter and the storage of children and staff personal items, o Cleaning schedules focusing on lost-and-found areas, upholstered furniture and wall mounted items (e.g. pictures, clocks, bookcases), and o Regular inspection of the day care for signs of bed bugs. 3.2.17 FIRST RESPONDERS For the purpose of this document, first responders include Emergency Medical Services (EMS), Durham Region Police Services (DRPS), and Municipal Fire Services. First responders provide an important emergency service in our community, and at times are required to enter homes in the event of a crisis as part of a response to emergency calls. As such, opportunities may exist for bed bugs to hitchhike onto first responders clothing and equipment. Bed bugs may also be present on the client or their possessions. STAKEHOLDER AGENCY: Durham Region Emergency Medical Services (EMS) 29

ROLES & RESPONSIBILITIES To increase awareness amongst first responders and prevent the spread of bed bugs in the community the following strategies are proposed: Awareness & Education Strategies Implement an awareness program for all staff through a variety of methods (e.g., train-the-trainer workshops, on-line learning modules, posters), Promote www.bedbugsinfo.ca as a reliable source of information, and Provide pamphlets and other resources from www.bedbugsinfo.ca (see Appendix F and H). Control Strategies Recognizing an infestation and having polices in place can prevent the spread of bed bugs within the community, first responder workplaces, and the first responder s home. The following measures will help to reduce the spread of bed bugs within the community. Provide basic training to all first responders in the identification, prevention and control of bed bugs, Provide first responders with on-site protocols and procedures for bed bugs to ensure staff members take preventative measures to control the exposure of bed bugs between clients, their homes and staff, and Develop and implement policies and procedures to address bed bug sightings in either a client s home, a first responder s vehicle or workplace. 3.2.18 Municipal Community Facilities Arenas, recreational centres, senior activity centres and community centres are owned and operated by their municipality respectively while library boards govern municipal libraries. These facilities are available for use by: the general public, their members, and many types of organizations. Each facility will have their own unique challenges for pest control including controlling for bed bugs. While a bed bug infestation is not likely to occur there is an increased risk in a facility such as one with public use lockers where a member of the public may unknowingly bring in a bed bug and leave it behind to hitchhike onto the next unsuspecting person. Libraries may also be at an increased risk for bed bugs for the following reasons: Libraries are often furnished with upholstered furniture which may be difficult to clean and ensure its free of bed bugs, and Priority populations such as the hard-to-house, may seek daytime shelter during extreme heat or cold days. 30

ROLES & RESPONSIBILITIES In order to increase awareness amongst staff, the general public, members and organizations; and prevent the spread of bed bugs in the community, the following strategies are proposed: Awareness & Education Strategies: Provide training to staff regarding signs of bed bugs (e.g., actual insects, cast skins) and actions required should bed bugs be discovered, Provide bed bug awareness resources (e.g., pamphlets, fact sheets from www.bedbugsinfo.ca) to staff, the general public, members and organizations, Provide bed bug information via community newsletters or other publications, Promote www.bedbugsinfo.ca as a reliable source of information, and Offer information sessions to staff and the public to increase awareness. Control Strategies: Develop a Bed Bug Response Plan with identified strategies for each type of community facility, Implement a bed bug monitoring program throughout the facility, and Develop policies and procedures that include components such as the following: o Limit upholstered furniture and acquire furniture that is easily cleanable. This will enable greater success for bed bug removal, o Implement cleaning schedules focusing on lost-and-found areas, upholstered furniture and wall mounted items (e.g., pictures, clocks, bookcases), o o Inspect facilities regularly for signs of bed bugs, and Liaise with a licensed pest control operator to review plans and policies. 31

3.3 LEGISLATION AND ENFORCEMENT Within the provincial and municipal framework there are statutes, tribunals, by-laws and other resources that are available to assist in the management of bed bugs. While bed bugs are not explicitly referred to in provincial legislation, such as the Residential Tenancies Act, 2006, it is implied in section 20 (1). This is demonstrated in an order under section 20 of the RTA issued by Landlord and Tenant Board member Rosa Votta, file number SWT-01844: Determinations: 2. The Landlords failed to keep the rental unit free of a bed bug infestation. Therefore, I find the Landlords failed to meet the Landlords obligations under subsection 20(1) of the Act. The eight municipalities of Durham Region maintain and enforce their own Property Standards by-laws. The by-laws define the parameters for the municipal law enforcement officers however within each municipality internal policy defines their level of involvement. The following is a scan of provincial legislation, the Landlord and Tenant Board and local by-laws as they pertain to bed bugs. Provincial Law The Residential Tenancies Act, 2006 (RTA) The RTA gives residential landlords and tenants specific rights and responsibilities, and sets out a process for how these rights and responsibilities can be enforced. For example, landlords have a duty to maintain a residential complex, including the rental units in it. This includes controlling of pests such as cockroaches, mice and bed bugs. A landlord s responsibility to repair and maintain rental units is described in section 20 of the Act: Landlord s responsibility to repair 20. (1) A landlord is responsible for providing and maintaining a residential complex, including the rental units in it, in a good state of repair and fit for habitation and for complying with health, safety, housing and maintenance standards. 2006, c. 17, s. 20 (1). Same (2) Subsection (1) applies even if the tenant was aware of a state of nonrepair or a contravention of a standard before entering into the tenancy agreement. 2006, c. 17, s. 20 (2). 32

Landlords have the right to enter to inspect and maintain rental units. Treating an apartment for bed bugs is not considered an emergency therefore; tenants must be given notice in writing 24 hours ahead of time. Section 27 of the Act describes a Landlords right of entry into a unit with notice: Entry with notice 27. (1) A landlord may enter a rental unit in accordance with written notice given to the tenant at least 24 hours before the time of entry under the following circumstances: 1. To carry out a repair or replacement or do work in the rental unit. 2. To allow a potential mortgagee or insurer of the residential complex to view the rental unit. 3. To allow a person who holds a certificate of authorization within the meaning of the Professional Engineers Act or a certificate of practice within the meaning of the Architects Act or another qualified person to make a physical inspection of the rental unit to satisfy a requirement imposed under subsection 9 (4) of the Condominium Act, 1998. 4. To carry out an inspection of the rental unit, if, i. the inspection is for the purpose of determining whether or not the rental unit is in a good state of repair and fit for habitation and complies with health, safety, housing and maintenance standards, consistent with the landlord s obligations under subsection 20 (1) or section 161, and ii. it is reasonable to carry out the inspection. 5. For any other reasonable reason for entry specified in the tenancy agreement. 2006, c. 17, s. 27 (1). A tenant s responsibility for cleanliness is described in Section 33 of the Act. Tenant s responsibility for cleanliness 33. The tenant is responsible for ordinary cleanliness of the rental unit, except to the extent that the tenancy agreement requires the landlord to clean it. 2006, c. 17, s. 33. There are several exemptions under the RTA 2006, c 17, s 5. Some of the exemptions are included below: living accommodation intended to be provided to the traveling or vacationing public or occupied for a seasonal or temporary period in a hotel, motel or motor hotel, resort, lodge, tourist camp, cottage or cabin establishment, inn, campground, trailer park, tourist home, bed and breakfast vacation establishment or vacation home, living accommodation that is a member unit of a non-profit housing co-operative, short-term living accommodation provided as emergency shelter, 33

living accommodation provided by an educational institution to its students or staff (dormitories), and living accommodation whose occupant or occupants are required to share a bathroom or kitchen facility with the owner, the owner s spouse, child or parent or the spouse s child or parent, and where the owner, spouse, child or parent lives in the building in which the living accommodation is located. The Landlord and Tenant Board (LTB) The Landlord and Tenant Board s role is to provide information about the RTA and to resolve disputes between most residential landlords and tenants. The RTA gives the Board authority to enforce the laws prescribed within. On January 25, 2011, the LTB became part of the newly designated social justice tribunals cluster. The mandate of these tribunals consists of providing all Ontarians with timely access to specialized, expert and effective dispute resolution among a wide range of matters. One of the Board s responsibilities is to provide information about the Act to landlords and tenants. In many cases, once landlords and tenants are aware of their rights and obligations they can resolve their own problems. However, if a landlord and tenant cannot resolve their problems, then another responsibility of the Board is to resolve these problems for them. Landlords and tenants can file an application with the Board. Once an application is filed, the parties have an opportunity to have their problems addressed at a hearing. At the hearing, a member of the Board will make a decision on the application based on the evidence presented by the landlord and tenant. Alternatively, if both the landlord and tenant agree, a mediator from the Board can work with them and try to help them reach their own agreement. Further information regarding landlords and tenants rights and responsibilities can be found at www.bedbugsinfo.ca. Pesticide Use and Legislation in Ontario A pesticide product must be both registered under the federal Pest Control Products Act (administered by Health Canada s Pest Management Regulatory Agency (PMRA)) and classified by the MOE under the Pesticides Act and Ontario Regulation 63/09 for legal sale and use in Ontario. 34

The use of homemade pesticides is illegal for managing bed bugs. Homemade pesticides have not undergone PMRA s evaluation and registration process so there is no way of knowing whether they will work as planned and may pose a risk to people, pets and the indoor environment. Health Canada has a brochure which provides information on the risks associated with using homemade pesticides available on its website (www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/homemade-artisanaux-eng.php) Ontario classifies federally registered pesticide products under the Pesticides Act and Ontario Regulation 63/09 as follows: Pesticides used for manufacturing end use pesticide products are in Class 1. Commercial pesticide products labeled for the management of bed bugs used with licensed exterminators are in Class 2, 3 and 4. Domestic pesticides labeled for the management of bed bugs are in Class 5, 6 and 7 and can be used by a structural licensed exterminator or by a person in his or her premises or by that person s full-time employee to manage bed bugs. In the case of a tenanted apartment suite or rental unit within the meaning of the Residential Tenancies Act, 2006, only the person who occupies the premises can use a Class 5, 6 or 7 product to manage bed bugs without requiring a Structural Exterminator s License unless exempt under Ontario Regulation 63/09. An apartment building owner or superintendent (who does not hold a Structural Exterminator License) is only permitted to use a Class 5, 6 or 7 product in common areas or un-rented units unless exempt under Ontario Regulation 63/09. An exemption is provided in Ontario Regulation 63/09 for the use of a Class 5 or 6 products containing only diatomaceous earth labeled for the management of bed bugs. It can be used by any person, including an apartment building owner or superintendent if permission of entry in accordance with the Residential Tenancies Act is provided by the tenant, without need of an operator license (i.e. a license to run a pest management company) or a Structural Exterminator License. However, it is recommended that a Structural Licensed Exterminator be contracted to use pesticides to manage bed bugs. Refer to the MOE website for further information on pesticide classification and the pesticide database (www.ene.gov.on.ca/environment/en/category/pesticides/index.htm). Occupational Health and Safety Act Employers have duties under the Occupational Health and Safety Act and its applicable regulations, including taking every precaution reasonable in the circumstances to protect the health and safety of a worker. A fact sheet titled Bed bugs and Occupational Health found at www.bedbugsinfo.ca outlines precautions that employers and workers may take to protect themselves from occupational exposure to bed bugs and can be found at www.bedbugsinfo.ca and in Appendix F. 35

Municipal Law The Regional Municipality of Durham The regional system of municipal government consists of two tiers. The first tier is the regional level, which operates at a broader scale to provide planning, financing, and servicing including public health programs and services for the Region. The eight area municipalities constitute the second tier, and operate at a more local scale, handling services such as local planning, fire protection, tax collection, parks and recreation and municipal law enforcement including property standards. Durham Region does not have a regional property standards by-law that would respond to pests, vermin and infestations. These property standards by-laws are within the purview of the lower tier municipal governments and are explained in greater detail below. The Local Municipalities of Durham Region Local municipal by-laws that pertain to pests control are written in municipal property standards by-laws. Pests can include vermin, insects and rodents. The eight lower tier municipalities of Durham Region property standards by-laws that pertain to pests have been identified in the table below. Municipal Property Standards By-Laws Sections Pertaining to Pests* Municipality Property Standard By-Law Town of Ajax 4.1.1 All vacant lots and every yard shall be kept clean and free from objects or conditions that might create a fire, health or By- Law 70-2003 accident hazard. 4.2.1 All buildings and the exterior portions of buildings shall be kept free of pests such as rodents, vermin, birds, termites and insects at all times. Township of Brock By-Law 1562-98PP Municipality of Clarington By-Law 2007-070 3.04 Dwellings shall be kept free of rodents, vermin and insects at all times. 3.05 Buildings shall be kept free of rodents, vermin, insects and the presence of their nests, droppings and chew holes at all times. Where evidence of said items are apparent, methods used for exterminating such pests shall be in accordance with the provisions of the Pesticides Act R.S.O. 1990, c. P. 11 and the responsibility for the extermination shall rest with the owner of the property unless otherwise stipulated in the lease or rental agreement. 36

City of Oshawa By- Law 1-2002 City of Pickering By- Law 5943/02 Township of Scugog By-Law 97-98 Township of Uxbridge By-Law 98-151 Town of Whitby By-Law 856-79 Schedule A 5.12.1 All properties shall be kept free of pest infestation (including rodents, vermin and insects, reptiles, or other wild animal, pigeons, or other wild birds) at all times. 46. A building shall be kept free of rodents and vermin at all times and methods for exterminating rodents or vermin or both shall be in accordance with all applicable legislation, including any By-laws of the City of Pickering. 3.04 Dwellings shall be kept free of rodents, vermin and insects at all times. Methods used for exterminating such pests shall be in accordance with the provisions of the Pesticides Act. 3.04 Dwellings shall be kept free of rodents, vermin and insects at all times. Methods used for exterminating such pest shall be in accordance with the provisions of the Pesticides Act. 4. (1) All yard areas shall be maintained in good condition and shall comply with the following: (c) to be kept free of all rodents and injurious insects; 8. (3) All accessory buildings shall be kept free of all rodents, termites or other injurious insects 10. (2) The exterior walls of a building and their components shall be maintained so as to retard deterioration due to weather, insects or other causes. Where necessary, they shall be so maintained by the painting, restoring or repairing of the walls, coping or flashing, water proofing of joints and the wall itself, installing or repairing of termite shields, treating the soil with chemicals or using other suitable means. * Current Property Standard By-Laws at the time of publishing. Municipal Roles & Responsibilities Local property standards are enforced by municipal law enforcement officers. In the course of their duties they may be required to investigate areas where bed bugs are known to be present. Where bed bugs are present in residential tenancy situations a tenant may be able to contact their local municipal law enforcement officer when there is an inadequate response to bed bugs by the landlord. Prior to contacting the municipality a tenant must notify their landlord/property manager of the bed bugs immediately in person or by phone and follow up in writing. If a landlord fails to respond adequately the tenant should consult with the Landlord and Tenant Board to determine the best course of action which may include filing a form T6 (Tenant Application about Maintenance) and/or contacting their local municipality s law enforcement office. It should be noted that municipal by-laws follow up vary by municipality. There are several 37

strategies a municipality can employ to increase bed bug awareness within the community: Train-the-trainer sessions to facilitate ongoing training for other officers, Municipal law enforcement officers can provide printed resources from www.bedbugsinfo.ca to clients who are concerned about bed bugs, and Clients can be directed to www.bedbugsinfo.ca. Officers who are trained in bed bug identification, prevention and control can be better equipped to identify an infestation, and provide information to their clients. Trained officers can also prevent the spread of bed bugs within their workplace, home and the community by taking precautionary measures such as: Entering units with minimal equipment/accessories (e.g. bags, purses), Leaving coats/jackets in the vehicles, Refraining from sitting or placing equipment on bedroom or living room furniture, Avoid conducting visits in areas with soft upholstered furniture and speak to clients in kitchen or front entrance areas. Municipalities that respond to bed bug complaints are in a position to further aid in controlling for bed bugs in the community through enforcement of their property standards by-laws. Where the by-laws apply, an officer can issue a Property Standards Order to the owner of a property enforcing that they provide the necessary controls to eliminate bed bugs from the subject property. Although orders are an effective tool to achieve compliance, there are a few negative aspects including the following: 1. Orders can be appealed, 2. Orders can only be enforced 21 days after the Order is served to the owner, 3. Non-compliance with the Order usually results in a monetary fine and does not ensure compliance. The eight municipalities municipal law enforcement divisions were surveyed regarding their response to bed bug complaints under the provisions of their property standard bylaw. The following municipalities stated they do respond to bed bug complaints: Town of Ajax Municipality of Clarington Township of Brock City of Oshawa The following municipalities stated they do not respond to bed bug complaints: City of Pickering Township of Scugog Township of Uxbridge Town of Whitby 38

4.0 INTEGRATED PEST MANAGEMENT An Integrated Pest Management (IPM) Program is the most effective program for eliminating bed bugs because it utilizes all necessary methods, minimizing the risk of pesticide exposure by reducing the necessity for repetitive pesticide use and safeguards the indoor environment by maximizing the effectiveness of bed bug management options. An IPM program places emphasis on prevention through education of clients, residents, facilities managers, and landlords. This education component also includes the training of professionals and service providers such as visiting nurses, social workers, tradespersons and others who must, as part of their job, visit or come into contact with persons who have a bed bug infestation. IPM programs will only work when there is a strong commitment by the resident, pest management service providers, property owners and support agencies (e.g., agencies that assist seniors, people in low income housing, persons with disabilities, and those agencies that promote public health). Managing a bed bug infestation in apartment buildings, hotels, hostels, dormitories, hospitals, long-term care homes, etc., can be very challenging. An IPM program requires all parties to maintain their responsibilities to ensure the continuity of a successful program. An IPM program for bed bug management includes the following eight components: 1. Planning the IPM program preferably before there is a bed bug problem. It is important to set an acceptable threshold or tolerance for bed bugs. An IPM program must have a plan with set goals and it is important to share these plans with others. These goals need to be monitored in order to assess the program and provide an evaluation of its success. Prevention and early detection strategies are much less costly than ignoring the problem and having to incur the costs of managing a heavy bed bug infestation. 2. Educating everyone and raising awareness of bed bug habits including where bed bugs can hide, the need to reduce clutter and proper disposal of untreatable items with an emphasis on prevention; is an important part of the IPM process. The administrators and facility managers of homeless shelters, group homes, dormitories, apartment buildings, and other types of residential housing, commercial and industrial facilities should seek to better educate residents and staff about bed bugs and how to prevent them. 39

3. Identifying the pest correctly. Ensure the pest is actually a bed bug. An untrained person can easily misidentify cockroach nymphs, pantry pests, or other pests as bed bug nymphs. Confirm that what you find is a bed bug by consulting with an entomologist or a pest management company. Signs of Bed Bugs: Bed bug nymphs range in size from a poppy seed to an apple seed and adults range in size from an apple seed size to much larger when engorged with blood, Droppings in the form of dark coloured stains or bumps on hard surfaces are usually found on bed linen but also on any other surface where they feed or hide, Shed skins because bed bugs moult between the five nymph stages, Eggs, although very small and adhered to surfaces, will be found amongst droppings or in crevices where adults and nymphs hide, Bed bug bites. Bite reactions look very different from one person to another. Some bed bug bites are large or small welts, some have a red dot in the centre, or a scab, others don t, and some look like mosquito bites or pimples. Often bites are in groups where one bed bug has begun to feed, been disturbed and starts feeding again. Some may be just single bites. Persons who have a suppressed immune system may not show any bite reactions, and Since bed bug bites may be mistaken for other pest bites or stings (e.g. fleas, mosquitoes, black flies, wasps) it is recommended that you consult a health professional if in doubt. 4. Inspecting all living areas for potential or suspected infestations. A thorough inspection of the premises is recommended before any cleaning or re-arranging has occurred. An initial inspection provides a sense of the full extent of the problem and prevents the disturbance and spread of bed bugs before treatment. Some professional pest management companies will perform a visual inspection to determine where bed bugs are most predominant. Some companies use trained dogs to sniff out viable eggs and bed bugs. This should always be followed up by a visual confirmation of live bed bugs. Adult bed bugs can hide in cracks and crevices as thin as a few sheets of paper. Young bed bugs can hide in even smaller spaces. When conducting an inspection, move slowly to avoid disturbing hiding bed bugs, so they don t scatter. Keep in mind that with low infestations, the bed bugs will be concentrated close to sleeping areas. Items away from the sleeping area will be less likely to be infested. Prioritize inspection areas from high to low levels of infestation and focus inspection and treatment in the most heavily infested areas. It is important to consider that a bed bug infestation in a living area (e.g., bedroom, apartment suite, dormitory room, shelter, room or hospital or long-term care unit) might spread to adjacent rooms or units or those below, above or to the sides. This is especially true if the bed bug population is high or if pesticides are used in the room or unit where the bed bugs were originally discovered. Adjacent units 40

should be inspected and if bed bugs are found or residents notice bites, they should be treated as if infested. Toolkit: A recommended bed bug inspection tool kit includes: Magnifying glass, Strong-beamed flashlight, Plastic vials or zip-top bags and forceps for collecting specimens, A putty knife, spatula or probe, such as a credit card tool, made by cutting any plastic card into a long triangle, for checking in narrow spaces, Compressed air (e.g., used to clean computer key boards) for flushing bed bugs out of hiding (use carefully so as not to blow bed bug eggs, that have not been securely cemented to a surface by a female bed bug, to other areas of the room), Screwdrivers for removing light switches and electrical plates, A small tool kit for disassembling furniture, Cotton swabs, glass-cleaning or baby wipes for checking for dropping stains, Digital camera may be needed to take photographs with the occupant s permission, Sticky traps (may be of some use but have limitations for catching bed bugs), and Interceptors placed under bed or other furniture legs to monitor bed bug activity. Interceptor. Bed leg is placed in the inner section. Talcum powder is incorporated in the interceptor to prevent bed bugs from climbing out. Interceptors: Bed bug interceptors are a cost-effective inspection tool that requires no expertise to use. They provide early detection of low level infestations and can even prevent bites from occurring by providing a barrier between areas around the bed where bed bugs hide and the bed. As a bed bug crawls up and over the outside surface of the interceptor it will fall into the outer ring. Any bed bugs climbing down the bed leg will be trapped in the inner well. 5. Keeping records, including when and where pests are found. It is important to keep good records in an IPM program. Bed bug information records should be maintained by the pest management company or the landlord and indicate: Date of the complaint, Type of complaint including bites, bug sightings and damage to property, 41

Unit or room number, Date of first pest inspection, Results of the inspection, what was found, level of infestation (e.g., low, moderate, high), Details on how well the area was prepared, Pest management strategies that were used, such as vacuuming, steam treatment/vacuuming, cleaning, heat or cold treatments or pesticide treatments, and Follow up with residents to share information and inform on proper procedures to prevent re-infestation. 6. Preparing for treatment. Once bed bugs are located and identified and the extent of the infestation has been determined, room or unit preparation must be done. Preparing and organizing a room for bed bug management can be as burdensome as changing residences. In most cases, room preparation is done by the resident; however, it may be carried out by a service provider or even the pest management company. It is, however, an extremely important first step to manage bed bugs, because bed bugs thrive in a cluttered living area. The reduction of household clutter is absolutely necessary for managing bed bugs. Preparation should be done in a systematic manner. Room preparation includes organizing belongings and placing them in bags, laundering all clothing and bedding, moving furniture away from the walls, and emptying furniture of items for better treatment. The first step is to separate bed bug free items from infested items. Using plastic bags of different colours (e.g., clear vs. green or tags), will help differentiate these items. All infested items or those items suspected of being infested can be: Laundered in hot water at least 45 C, dried on a high setting for at least 30 minutes and placed in a plastic bag, sealed tightly and tagged as infested and laundered, Dry cleaned (e.g. drapes, rugs, garments) and placed in a plastic bag, sealed tightly and tagged as infested for dry cleaning, and Treated by heating or freezing and placed in a plastic bag, sealed tightly and tagged as infested for heat or cold treatment. Empty all drawers, closets and remove all items from shelves, dressers and tables etc. and place in an appropriately tagged plastic bag. Place all items that are not infested by bed bugs in plastic bags, seal tightly and tag as bed bug free. Move these items to a non-infested area. Note that it is possible that although no bed bugs are found their eggs may still be present in crevices in these items. It may be preferable to consider all items as possibly infested if a bed bug infestation is found in proximity to the room or unit. 42

The second step, in preparing an infested room for treatment, is to remove all drawers from dressers and bureaus and pictures from walls and place them on top or beside these furnishings. Move all furniture away from walls. Do not introduce any items into the infested room or remove any items, except for those encased or bagged and tagged as infested items until the room has been properly treated. For example, after laundering and drying sheets and pillow cases do not place them back onto the bed until the mattress, box spring and the entire room have been properly treated. If any infested item cannot be treated it is recommended that the item be discarded. Disposing of Infested Items: Encase infested articles destined for disposal in plastic bags or wrap and seal them in plastic to avoid bed bugs from dropping off while transporting them to a garbage collection area. It is a good practice to demolish items to prevent others from unknowingly taking infested items. For example, slash mattresses and plush furniture, break-up box spring frames, and label bags containing infested items with the words Infested with bed bugs to help prevent the spread of bed bugs. 7. Performing treatments using several methods to manage bed bugs including physically removing bed bugs, steam treatment or use of pesticides according to label directions. Managing bed bugs is a labour intensive, time consuming and costly activity; however, bed bugs can be managed with a coordinated effort of all responsible parties. Despite the challenges, the technology of bed bug management is improving. Pest management companies are becoming more knowledgeable as bed bugs become a greater issue. There is no single tool or activity that when used alone, will manage bed bugs, including the use of registered and classified pesticides. Multiple techniques are always required because bed bugs are small, good at hiding, and reportedly a bed bug that is getting nourishment on a fairly consistent basis within the average house can survive in excess of one year. Bed bugs are resistant to many of the pesticides used against them, allowing some to survive chemical treatment. When treating a living area for bed bugs, it is important to focus on containing the infestation. Do everything possible to avoid spreading bed bugs to new locations. A combination of the following activities will be needed for bed bug management: Cleaning and organizing the bed, bedroom, other living areas, furniture and belongings, including elimination of clutter, Physically removing bed bugs, droppings and eggs using a vacuum. Some bed bug eggs can be removed by vacuuming; however, since they adhere to surfaces many eggs will likely remain, Using barriers, such as mattress and box spring encasements and interceptors, may be useful in reducing bites and harborage and sticky barriers may be useful for monitoring purposes, Applying steam to kill all life stages along with vacuuming to remove dead bed bugs, 43

Using thermal heat or cold treatments by a professional to kill all life stages, Eliminating bed bug hiding spots: o Fix peeling wallpaper and paint, o Caulk or seal cracks and crevices around the room and on furniture, o Seal floors or the spaces between floor boards or tiles, and o Make other repairs to the living area to reduce hiding spots. Using pesticides: o Follow all label directions and precautions, o Use only federally registered products classified for use in Ontario, and o Contract the services of a professional who is trained in the proper use of pesticides (i.e. a Structural Licensed Exterminator). What to Look for When Hiring a Pest Management Professional The following should be considered when hiring a pest management company: The pest management company must hold a valid Operator License issued by the MOE to run a business that uses pesticides, Choose a pest management company that is a member of a professional pest management association. Member companies will have an established place of business, a code of ethics and ongoing training programs. Ask how long they have been in business and how they train staff. Check with better business services to check the record of company business practices, The pest management company should have a staff entomologist or access to one or a person who is trained to identify pests such as bed bugs, Choose a pest management company based on its quality of service, not the price. Obtain several proposals for service if possible and compare them. Ask what type of insurance coverage the company holds and if the company has had any claims. Request the company provide references of satisfied customers, Persons applying pesticides that are employed by the pest management company must hold a Structural Exterminator License or be a Technician or Trainee working under the supervision of the Structural Exterminator License holder. The exterminator must carry his or her license, issued by the MOE, or have it available at the extermination site, The Structural Licensed Exterminator should have experience with bed bug management. Ask how long he or she has had experience in managing bed bugs, A pre-inspection should be conducted to assess the scope of the work, The proposed work should follow the principles of IPM, The Structural Licensed Exterminator should be straightforward and open when discussing details of the service being provided. Ask the company to provide in writing, how long they estimate the job will take using an IPM program and if hired note how long the exterminator spends doing the work, Understand what guarantees are being offered. Bed bug management may be difficult to guarantee, because re-infestation from an outside source is possible and eggs can hatch several days after being laid if not removed by vacuuming, killed by steam or the hatching nymphs killed by contact with a pesticide. 44

Compliance and Enforcement: If you have questions or suspect unlawful use of pesticides, please contact your local MOE District Office during regular business hours. Contact information can be found in the blue pages of your local telephone directory or see a listing on the MOE s website. After business hours, call the MOE s Pollution Hotline at 1-866-MOE-TIPS (1-866-663-8477). 8. Evaluating the IPM program and following up with inspections and additional management procedures if necessary. To know whether an IPM program is successful, it is important to lay out what goals are desired and to determine how to monitor the success of the goals over time. Some goals may be long-term and others short-term. IPM involves planning future goals and evaluating how these goals were achieved by reviewing accomplishments. A successful IPM program determines and records existing pest situations, and then sets up a plan to measure progress to obtain the desired results. Ongoing evaluation is an important component of an IPM program. Questions about pesticides can be directed to the MOE s Public Information Centre at 1-800-565-4923 or 416-325-4000. For more information, or to view An Integrated Pest Management Program for managing bed bugs visit www.bedbugsinfo.ca 45

5.0 SURVEILLANCE AND EVALUATION A mandatory component of the bed bug funding application to the MOHLTC is the conducting of surveillance and evaluation in relation to bed bugs. To this end, the DRHD endeavours to collect data on the degree of infestations and the populations most impacted in the health unit. This allows for assessment of the scope of the bed bug issue and the effectiveness of implemented interventions. At the outset of the bed bug project the DRHD had data on the number of investigations conducted by DRHD staff and calls for information on bed bugs received via the DRHD s Environmental Helpline. There was a lack of other available data on the prevalence of bed bug infestations in the Durham Region. In order to determine the prevalence of bed bug infestations within Durham Region the DRHD collaborated with other health units to develop a Rapid Risk Factor Surveillance Survey (RRFSS) Bed Bug module. The purpose of RRFSS is to provide timely data relevant to local public health needs. RRFSS is used to monitor key public health issues yet is adaptable to collect information on emerging issues. The results from RRFSS are used to support program planning and evaluation, to advocate for public policy development, and to improve community awareness regarding the risks for chronic diseases, infectious disease and injuries. In the case of bed bugs, data collected in addition to the prevalence of bed bugs included; the percent of adults who have looked for information on bed bugs, the percent of adults who have seen or heard about the website bedbugsinfo.ca and the percent of adults who have visited the website www.bedbugsinfo.ca. The Rapid Risk Factor Surveillance System (RRFSS) is an on-going telephone survey occurring in various public health units across Ontario. On a monthly basis, a random sample of 100 adults aged 18 years and older is interviewed regarding risk behaviours of importance to public health, such as smoking, sun safety, use of bike helmets, water testing in private wells From May to September 2011, DRHD surveyed 1,203 Durham Region adults aged 18 and over using the RRFSS Bed Bug module. Preliminary data shows that most Durham Region adults (92%) had heard about bed bugs and half of those who had not had bed bugs in their home were very or somewhat concerned about bed bugs getting into their home. The survey also revealed 17% of residents had looked for information on bed bugs in the past year with the internet being the most common source of information. Only 8% had heard about the bedbugsinfo.ca website and 2% had visited the site. This preliminary data provided evidence for the implementation of the community-wide bed bug awareness campaign conducted during early 2012. The RRFSS Bed Bug modules will be asked again during 2012 and the results will be used to determine the effectiveness of our public awareness campaign and the level of bed bug infestations in the community. 46

DRHD also collects data on the number of calls we receive regarding bed bugs via our Environmental Helpline. As part of the bed bug project we contracted our service provider to implement enhancements to our complaint/service request module of our database. The enhancements to our complaint/service request module enable us to generate reports indicating the number of calls regarding bed bugs by municipality, the nature of the caller s request, the type of housing they are inquiring about and any actions taken by our staff (e.g. provision of information, insect identification, referral to other agencies etc). The DRHD will continue to use this data to target bed bug awareness efforts and to determine those municipalities and sectors most affected by bed bugs. The DRHD will also evaluate the effectiveness of the Durham Region Bed Bug Action Plan for stakeholders and agencies within one year following the implementation of the plan. 47

6.0 CONCLUSIONS AND RECOMMENDATIONS At the outset of the process that has led to the development of the Draft Durham Region Bed Bug Action Plan, stakeholders overwhelmingly indicated that there was a need for a coordinated, consistent approach to the bed bug issue along with a need for increased bed bug education and awareness both for stakeholders and their clients. Moreover, the one-time funding made available by the government was designed to support bed bug-related programs that emphasize coordination with other local services, education and awareness and/or provide supports to vulnerable/priority populations. As a result, the Bed Bug Working Group membership was chosen to represent a broad range of stakeholders from the community and sectors who serve priority populations. Considerable effort was put in to the process of gathering input and feedback from stakeholders so that the resulting BBAP was truly reflective of local needs and would be a useful document for members of the BBWG, their clients and the community as a whole. Recommendation 1 Accordingly, a key recommendation of this plan is that the collaboration and communication that has begun with the bed bug project and BBWG be continued. In order to facilitate collaboration, semi-annual meetings of the BBWG are recommended in order to provide a forum for discussion on the elements of the plan that are meeting stakeholder needs and for suggestions on revisions to the plan where a new or changing need is identified. Recommendation 2 As discussed in the surveillance and evaluation section of the plan, there is an ongoing need to identify the size and scope of the bed bug issue within the Region and if awareness, education and control efforts are having the desired effect. In order to identify needs of the key stakeholders and the community and ensure ongoing collection of information on the size, scope regarding the local bed bug issue and it is recommended that stakeholders and agencies continue to monitor and record the number of bed bug calls, bed bug infestations and pest control interventions. It is also recommended that this data continue to be shared with the DRHD and reviewed at the proposed semi-annual meetings of the BBWG. Recommendation 3 As discussed throughout the preceding BBAP, bed bugs affect everyone and are not an indicator of poor sanitation. They can be found in many different places such as hotels, businesses, health-care facilities and private homes. Anyone can get bed bugs. 48

As a result, a consistent approach to bed bugs across the Region is a necessity. Again, a key recommendation that arose from the Bed Bug Stakeholder Meeting in January 2011 was a need for a consistent approach to bed bugs in Durham Region. At the time of the writing of this plan there are different levels of service provided by municipal by-law enforcement departments in response to bed bug infestations in rental dwellings. Therefore, it is a recommendation of the Draft Bed Bug Action Plan that all local municipal by-law enforcement departments include common language regarding bed bugs in their appropriate municipal by-law which should include clearly identifying who is responsible for controlling bed bugs and the mechanism for enforcement should the property owner not takes appropriate action against bed bugs. The DRHD is available to assist with the facilitation of the process around developing common wording for bed bug response and responsibility in local by-laws. Recommendation 4 The final recommendation of the BBAP is that DRHD continue to provide the services identified in the roles and responsibilities section of this document. These activities include: the provision of education sessions and train-the-trainer workshops to community partners, the provision of up-to-date bed bug information on the Region s website, the provision of bed bug displays at community events and venues and the provision of information and referrals to supportive agencies. The DRHD will also continue to monitor the number and nature of bed bug calls received and to track health promotion activities and conduct surveys to determine the effectiveness of health promotion activities. In conclusion, it is the hope of the DRHD that the Draft Bed Bug Action Plan provides a coordinated approach, effective response and useful resources to community partners, priority populations and the general public regarding bed bugs in Durham Region. This document is a living document and as such, ongoing communication and collaboration among stakeholders and agencies is essential to ensuring that it is truly reflective of local needs. 49

7.0 REFERENCES Chen H, Copes R. (2010). A review on bed bugs: epidemiology, health effects, and surveillance activities. Ontario Agency for Health Protection and Promotion. Retrieved from: http://www.oahpp.ca/services/environmental-and-occupational-health.html Doggett, S.L. (2011). A Code of Practice for the Control of Bed Bug Infestations in Australia (4 th Edition Draft). Australian Environmental Pest Managers Association Ltd. Retrieved from: www.bedbug.org.au Government of Ontario. (2011). bedbugsinfo.ca. Fact Sheets: General Information. Retrieved from: http://bedbugsinfo.ca/tools Tenant Rights Regarding Bed Bugs. Retrieved from: http://bedbugsinfo.ca/tools Pest Control Information. Retrieved from: http://bedbugsinfo.ca/tools Government of Ontario. (2011). An Integrated Pest Management Program for Managing Bed Bugs. Retrieved from: http://bedbugsinfo.ca/tools Michigan Department of Community Health and the Michigan Bed Bug Working Group. (2010). Michigan Manual for the Prevention and Control of Bed Bugs Retrieved from: http://www.michigan.gov/documents/emergingdiseases/bed_bug_manual_v1_full_redu ce_326605_7.pdf New York City Department of Health and Mental Hygiene: Bed Bug Basics Retrieved from: http://www.nyc.gov/html/doh/bedbugs/html/home/home.shtml Residential Tenancies Act, 2006 S.O. 2006, CHAPTER 17. Retrieved from: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_06r17_e.htm Woodgreen Community Services. (2009). Bed Bugs Are Back Are We Ready? Bed Bug Report. Retrieved from: http://www.woodgreen.org/linkclick.aspx?fileticket=6wssimttpgy%3d&tabid=115 World Health Organization. (2008). Public Health Significance of Urban Pests. Retrieved from: http://www.euro.who.int/ data/assets/pdf_file/0011/98426/e91435.pdf 50

8. APPENDIX A: DURHAM REGION BED BUG WORKING GROUP MEMBERS

Appendix A: Durham Region Bed Bug Working Group Members Name Agency/Organization Position Ken Gorman Laura Freelend Durham Region Health Department Durham Region Health Department Director, Environmental Health Division Manager, Environmental Health Division Dr. Hong Ge Durham Region Health Department Public Health and Preventive Medicine Consultant Anthony Di Pietro Nella Correia Felicea Nobile Barbara Graham Durham Region Health Department Durham Region Health Department Canadian Mental Health Association-Durham Branch Durham Region Social Services Department Senior Public Health Inspector Senior Public Health Inspector Team Leader, Corporate Services - Facilities, Property and Administrative Services Property Manager Housing Services Division Susan Hanley Durham Non-Profit Housing Manager, Housing Operations Christine McGee Jennifer Craig Debbie Read Cornerstone Community Association Durham Durham Region Social Services Department -Income and Employment Support Services Durham Region Social Services Department - Long Term Care and Services for Seniors Housing Administrator Assistant to the Director of Income and Employment Support RN, ICP Infection Prevention & Control Christopher Brown Lakeridge Health - Oshawa RN, ICP Infection Prevention & Control Paul Schaedlich Ontario Shores Centre for Mental Health Sciences Manager, Environmental Services Edith McDermott Emily Robb Ontario Shores Centre for Mental Health Sciences Durham Community Legal Clinic Infection Prevention and Control Practitioner Tenant Duty Legal Worker Kevin Feagan City of Oshawa Manager, Municipal Law Enforcement Services Corporate Services Department

Peter Stackaruk Durham Region EMS Quality and Development Facilitator Paulina Alamo Durham Hotel Association Vice President Robb Quinn Daryl Chong Gary Gibson Fergus Ferguson Susan Jackson Structural Pest Management Association Greater Toronto Apartment Association Ontario Association of School Business Officials Durham Region Works Department - Facilities Durham Children s Aid Society Association member President & CEO Manager Health and Safety, Durham District School Board Supervisor of the Family Access Program

9. APPENDIX B: DURHAM REGION BED BUG WORKING GROUP TERMS OF REFERENCE

Appendix B: Durham Region Bed Bug Working Group TERMS OF REFERENCE PURPOSE: The Durham Region Bed Bug Working Group (BBWG) is a local committee which has been convened to develop a coordinated local action plan for issues within the Region of Durham. The plan will be developed throughout 2011, and will be submitted to the Health & Social Services Committee and Regional Council for approval. The BBWG is sponsored by the Region of Durham Health Department. ROLES AND RESPONSIBILITIES: to develop a draft Durham Region Bed Bug Action Plan to address issues in collaboration with stakeholders to provide a forum for the sharing of current surveillance data related to bed bugs within the member s jurisdiction to provide a forum for the identification of priority populations impacted by bed bugs to identify opportunities to streamline the development and delivery of services (i.e., resources, information, educational materials, in-services etc.) in order to assist priority populations in an efficient and effective manner MEMBERSHIP: Membership of the BBWG shall consist of the following representatives: Durham Region Health Department {DRHD} (4 representatives) Durham Region Emergency Medical Services Durham Region Social Services Department (Housing Services, Income Support and Employment Support Services & Long-Term Care and Services for Seniors) Municipal By-law Enforcement Canadian Mental Health Association (Durham Chapter) Ontario Association of School Business Officials Durham Non-Profit Housing Corporation Durham Region Works Department (Facilities) Health Care Facilities (3 representatives) Durham Region Hotel Association Shelter Representative Tenant Representative Landlord Representative *Ontario Ministry of the Environment *Structural Pest Management Association of Ontario * Advisory members of the committee Additional representatives may be invited to participate on the committee from time to time as the need arises. The total number of committee members will be approximately 15-20 individuals who will provide a balanced perspective from a wide range of stakeholders advising and assisting in the development, completion and maintenance of a Durham Region Bed Bug Action Plan. Members have the ability to appoint an alternate to attend meetings if they are unavailable.

REPORTING RELATIONSHIP: This working group reports to the Director, Environmental Health Division who in turn provides recommendations and reports from the BBWG to the Health & Social Services Committee and Regional Council. MEETINGS: Meetings will be chaired by DRHD and held a minimum of once a month or at the call of the Chair. Additional work on the plan may be conducted through a variety of communication channels including face-to-face meetings, written correspondence, telephone and e-mail. MINUTES: The DRHD will prepare and distribute agendas and documents to the members. Meeting minutes will be recorded by DRHD staff. Draft minutes of all meetings will be circulated to committee members prior to the next meeting. Official copies of the minutes will be maintained by the DRHD. July 7, 2011

10. APPENDIX C: DURHAM REGION CLIENT REFERRAL LIST

Appendix C: Durham Region Client Referral List Client Referral List: Who Can Help? Durham Region Health Department - Environmental Health Division Durham Region Health Department has an Environmental Help Line staffed by certified Public Health Inspectors Monday to Friday (8:30 am - 4:30 pm) who respond to complaints and inquiries about bed bugs. By calling the helpline at (905)723-3818 or 1-888-777-9613 ext. 2188, a Public Health Inspector can assist you with identifying bed bugs, provide information about landlord and tenant rights & responsibilities, pest control information as well as providing contact information for agencies that may provide assistance. Through this helpline, you can also request bed bug pamphlets and other helpful resources to help inform you about bed bug identification, prevention and control. You may also request a bed bug display to promote awareness in the community. For additional information and links to resources visit our website at www.durham.ca Government of Ontario The Government of Ontario has developed a website containing fact sheets and pamphlets about bed bug prevention, identification and management. A complete Integrated Pest Management Program guide, PowerPoint presentations for health promotion and educational purposes and other helpful tools are also available via this website. These resources can be obtained at www.bedbugsinfo.ca in many different languages. Landlord and Tenant Board The Landlord and Tenant Board s role is to provide information about the Residential Tenancies Act, 2006 and to resolve disputes between most residential landlords and tenants. For more information visit the website at www.ltb.gov.on.ca or call toll free at 1-888-332-3234. Durham Community Legal Clinic (DCLC) The DCLC provides referrals, legal information, legal advice, and representation before courts and tribunals, Tenant Duty Counsel, community development and law reform. The DCLC offers legal advice and bed bug control information to low income residents of Durham Region. For more information visit www.durhamcommunitylegalclinic.ca or call (905) 728-7321 or 1-888-297-2202. Durham Region Social Services Department - Income and Employment Support Services The Income and Employment Support Services division delivers the Ontario Works Program which provides financial help and basic health benefits to residents in need. This division may assist with the control of bed bugs through various types of mandatory or discretionary health related benefits. Where the client needs assistance with cleaning or replacement of their personal belongings a request may be made for CSUMB (Community Start Up and Maintenance Benefit). For more information visit www.durham.ca or to find out if you qualify, contact Central Intake at (905) 428-8982 or 1-877-678-6333.

Durham Region Social Services Department - Housing Services The Homelessness Initiatives team members are often required to field calls from applicants, emergency hostel providers, community program staff, and the general public regarding problems with bed bugs. Households experiencing bed bugs are often under stress. The staff members in Housing Services provide callers with information about the appropriate management of bed bugs and support tenants in working with their landlords to control the infestation. Housing Administration supports social housing providers by advising them of their responsibilities to residents under their by-laws, the Residential Tenancies Act, 2006 and the Co-operative Corporations Act. Resident complaints regarding maintenance issues are often escalated to this team, who liaise on the resident s behalf with their housing provider. This team offers housing providers training on a variety of issues, including bed bugs. For more information visit www.durham.ca or contact the Housing Services Division at (905) 666-6222. Canadian Mental Health Association (CMHA)-Durham Branch CMHA Durham is part of a nation-wide charitable organization that promotes the mental health of all, and supports the resilience and recovery of people experiencing mental illness. Their mental health centre promotes and enhances the mental, emotional, and physical well-being of our community through education, collaboration, advocacy, and the provision of a broad range of direct services that meet our community's needs. Rental housing units are also provided throughout Durham Region and each tenant has a case management worker who visits the tenant and assists them with life skills. For more information visit www.durham.cmha.ca or call (905) 436-8760 ext 133. Pest Control Treatment Companies To find a licensed Pest Control Treatment Company that meets the treatment Standard s set by the Structural Pest Management Association of Ontario. Contact: Structural Pest Management Association of Ontario (800) 461-6722 www.spmao.ca Or National Pest Management Association (703) 352-6762 www.pestworld.org

11. APPENDIX D: BED BUG RESPONSE FLOWCHART

APPENDIX D: BED BUG RESPONSE FLOWCHART Do you: Travel Have bites on arms, legs, torso, head or neck Have reports of bed bugs in other units in your apartment building Have overnight guests Obtain used items (i.e. furniture) Yes No Monitor for bed bugs Familiarize yourself with the signs and features of bed bugs. Look for: live / dead bugs, skin casts, fecal/blood spotting Positive signs found No signs found Capture live specimen to confirm identification Contact landlord/property manager A thorough inspection by a trained pest control operator of the premises is recommended before any cleaning or rearranging has occurred. Bed bugs confirmed No bed bugs found Prepare for treatment Preparation should be done in a systematic manner with direction from pest control operator See Pre-treatment Preparation Checklist (Appendix E) Provide pest control access to all areas of the home for each visit. Effective control may require 2 or more treatments

12. APPENDIX E: PRE-TREATMENT PREPARATION CHECKLIST

Appendix E: Pre-Treatment Preparation Checklist PRE-TREATMENT PREPARATION CHECKLIST What Do I Need To Do Before Pesticide Treatment? Before the pesticide treatment begins, all occupants, including pets, must leave the unit and not enter for a minimum of three to four hours after the technician leaves (or a time frame prescribed by the technician). Aquariums may remain in place as long as the filtrations and aeration systems are turned off for six hours and the tank is adequately covered. Anyone who is pregnant or has allergies or asthma should take the necessary precautions. Before Treatment All clutter should be removed from the unit. If possible, steam clean, wet vacuum or shampoo any carpeting and furnishings. Vacuum mattresses thoroughly including the crevices, handles and buttons. Vacuum bed frame, baseboards and objects/flooring close to bed. Discard the vacuum bag (placed in tightly sealed garbage bag before disposal). All contents of dressers are to be placed in garbage bags to be transported. Next place them in the dryer cycle on hot for a minimum of 30 minutes. All articles on top of dresser are to be removed and placed in plastic bags for treatment. All clothing items and bed linens must be placed in sealed garbage bags and emptied directly into the washing machine. Soiled bedding should be washed in hot water (separate from all other laundry) or dry cleaned before or soon after the treatment to avoid resurgence of bed bugs. The garbage bags used for transporting clothing articles to the laundry room should be discarded outside the premise as they may contain bed bugs. Your clean laundry should be placed in new clear garbage bags and sealed during the treatment process. All closets including linen closets are to be emptied. Clean articles should be placed in the dryer on high heat for a minimum of 30 minutes. All soiled articles need to be washed in hot water and then dried in high heat. Bookshelves, nightstands or other furniture in the immediate area must be emptied so that the technician can spray the undersides of the furniture. Place all items in tightly sealed garbage bags and leave them in the room to be treated. All chair covers, throws and pillows from sofas and chairs must be laundered prior to treatment. Pillows should also be placed in the dryer on high heat for a minimum of 30 minutes. All toys from baby cribs should be washed in soapy hot water and stuffed toys should be placed in dryer on high heat for a minimum of 30 minutes.

Furniture and items should be moved at least 30 cm (12 inches) away from the walls to facilitate spraying of the baseboards. Shelving and drawers should be clean. Note: For severe infestations, water soluble bags should be used if possible to collect sheets and clothing and put directly into the wash. Laundromat dryers may have lower heat settings so the full cycle should be used. Disposal of Furniture Discarding beds, bedding, and furniture is NOT a sound approach to bed bug control as they can be easily re-infested. Furniture that is infested with bed bugs that cannot be salvaged needs to be disposed of in a manner that will prevent the further spread of bed bugs. If you decide to throw out bed bug infested furniture: Take apart, deface or damage the piece of furniture to ensure it cannot be reused. Mattresses should be damaged to render them unusable. Wrap the furniture/mattress in plastic so bed bugs cannot escape. This should be done in the unit before the items are removed. Mark your furniture with clear warnings and put in trash shortly before pick-up, so it doesn t sit for a long time. FOR MORE INFORMATION VISIT: www.bedbugsinfo.ca Source: www.bedbugsinfo.ca

13. APPENDIX F: BED BUGS AND OCCUPATIONAL HEALTH FOR SERVICE PROVIDERS

14. APPENDIX G: SITE-SPECIFIC GUIDELINES FOR MANAGEMENT AND PREVENTION OF BED BUG INFESTATIONS

Appendix G: Site-Specific Guidelines for Management and Prevention of Bed Bug Infestations 14.1 MULTI-UNIT HOUSING Bed bug infestations in multi-family housing can be particularly troublesome. An infestation in one apartment, if not handled properly, can spread to adjacent units or throughout a building and affect many people. The information in this section is designed to help residents and property managers work together to fight bed bugs in multi-family housing, and to provide specific suggestions for multi-family housing operators in handling an infestation. In order to successfully eradicate a bed bug infestation, it is essential that all parties involved work together. Unfortunately, it is all too common for residents and property managers to let their frustration manifest itself by blaming each other. There are a few important ideas to keep in mind: Nobody asks for a bed bug infestation. Regardless of how the infestation started, it was certainly unintentional. No one profits or benefits from an infestation continuing. If there is no cooperation, everyone loses. Many people are uninformed about bed bugs, and don t understand what must be done to treat them. If you feel that a resident, landlord, or property manager isn t handling the situation properly, suggest that they read through this guide Once a bed bug infestation has been identified, it takes a lot of work to get rid of it. Effective treatment requires the cooperation of three parties working together: resident, landlord and pest management professional (PMP). Without the participation of all three it will be nearly impossible to eliminate an infestation. There should be no shame associated with having bed bugs in an apartment. It is not an issue of cleanliness although clutter makes it more difficult to eradicate bed bugs, cleanliness cannot prevent the problem from occurring. Denial, shame and blame only make the situation worse. Once an infestation has been identified, the most important thing is to be proactive about treating it. Once it has been established that there is an infestation in an apartment, the property manager and resident should meet to discuss a treatment plan. Since there may be a lot of work and expense involved, it may be helpful to sign a treatment agreement provided by the property manager. The residence should be scheduled for treatment with a PMP as soon as possible, and receive written instructions on how to prepare. The residence needs to be checked on the day before to make sure it has been prepared properly. Without proper preparation, the PMP will not be able to effectively treat the unit. Treatment should be postponed if the unit is not ready. Residents should plan to be home on the day of treatment to wash all of the clothing and bedding. It may also be effective at this point for the property manager to notify other residents that bed bugs have been identified in the facility/complex. The notification should include basic information about bed bugs, how they spread, and a contact number for residents who may be concerned. Prompt reporting of bed bug infestations will help reduce the time and expense of treatment, so it is important that residents feel comfortable reporting a potential infestation.

Immediate Actions (To help reduce bites immediately) A couple of simple steps can dramatically improve the quality of life for a resident in an infested apartment. These steps can help reduce bites from bed bugs while a treatment plan is initiated or is ongoing: 1. A thorough vacuuming of the apartment is recommended to reduce the number of bed bugs present, especially in the sleeping areas and around and under the bed. Discard vacuum bag (placed in tightly sealed garbage bag before disposal). 2. Headboards and bed frames should be carefully inspected and cleaned of any signs of bed bugs or eggs. They are easily cleaned and scrubbed with standard household cleaning agents. 3. Encase the mattress and box spring to 4. Prevent bed bugs from reaching residents. 5. The bed should be moved away from the wall, bed skirts should be removed and bedding should be prevented from touching the floor to prevent bed bugs from climbing onto the bed. 6. Speak to a pest management professional about bed bug interceptors that can be placed below the legs of the bed to trap bed bugs as they try to climb to the bed. Resident Responsibilities A resident s primary responsibility is to cooperate with the pest management professional and property manager in treating a bed bug infestation. This means reporting any suspected infestations to property management, preparing the unit for inspection and treatment, following any instructions given by the PMP, and taking measures to prevent reinfestation. Residents need to understand that if they fail to cooperate with treatment, they may be found legally liable and possibly even evicted from their apartment. Residents should not attempt to eradicate bed bugs on their own; doing so may spread bed bugs to other units, or be more dangerous than the bed bug problem itself. Preparing an apartment for bed bug treatment is a time and labor-intensive process. Property managers should discuss the process with residents and provide a checklist such as the one in Appendix E. For residents with special needs, it may be wise to enlist a family member, friend, or staff member to assist with the treatment steps and preparation. For detailed information on how to prepare an apartment for treatment, see the preparation recommendations in the Integrated Pest Management Program for Managing Bed Bugs at www.bedbugsinfo.ca Property Management Responsibilities Landlords are required to provide housing that is free from bed bugs. Once the property manager has been made aware of a bed bug infestation, they should immediately arrange an inspection of the unit and if necessary schedule treatment with a pest management professional. Treatment can be expensive, but delaying treatment may cost more in the long run. Depending on the level of infestation, property management staff may consider wearing protective suits and booties when doing work in an infested apartment. White suits will make bed bugs easier to spot. The maintenance staff should bring as little into the apartment as possible. Be cautious about the potential to move bed bugs to a new location on clothing or equipment.

In order for treatment to be effective, all the affected units must be treated at the same time. Ask the PMP to inspect any adjacent units (above, below, beside, and across the hall) to determine the extent of the infestation. The resident might ask the manager to dispose of infested bedding or other upholstered furniture. The building manager should wrap the items in plastic and remove them to the dumpster. Once outside, the furniture should be destroyed if possible and clearly marked with bright yellow or red spray paint as Bed Bug infested before it goes in the dumpster. This is to prevent the infested furniture from being recovered by another resident and brought back into the building. Importance of Investigative Work It can be helpful to determine the source of the bed bugs. The goal of an investigation is to prevent re-infestation, not to assign blame. Did either the resident or manager obtain used furniture recently? Did they visit another resident in the building or elsewhere that complained of bed bugs? If the source can be identified, it is important to figure out if it is located in the same building. Other possibly affected apartments should be inspected as well. Ask residents to inform building staff whenever bed bug activity is seen, or if bedbugs are discovered in the common areas. Record Keeping It is important that infestation locations be tracked around the building. A building manager can do this by keeping a binder with a separate section for each floor and a map of the various units on that floor. In the binder, copies of the service tickets from your PMP and notes from inspections along with treatment agreements should be kept. Whenever bed bugs are discovered in one unit, the building staff may automatically check the neighboring units. A staff person should accompany the PMP on the day of treatments. Building staff should carefully log what was done. Strategies to Assist Residents There are no easy answers on how to calm someone down who is being bitten by bed bugs. When a resident calls, offer to come up with your maintenance supervisor right away to investigate and inspect. Be prepared to discuss a treatment plan if bed bugs are discovered, including the following: Strategies for immediate relief from bed bug bites Strategies for preventing spread to the common areas and other apartments in the building Provide a time line of what actions will be taken and when, so the resident can properly prepare Once you have discussed the treatment program, ask the resident to sign a treatment agreement Good communication with all residents about the problem is very important. Keep residents informed and they will help you enforce the treatment plan with hesitant residents. The more residents know about bed bugs, the more they will cooperate with rules that help keep the building bug free. It may be beneficial to have a pest management professional also come in and speak to your residents about bed bug prevention and detection.

14.2 SHELTERS AND TRANSITIONAL LIVING The appearance of bed bugs in homeless shelters is becoming increasingly problematic. The transient lifestyle of the homeless population makes them particularly vulnerable to bed bugs due to potential exposure to bed bug infestations in emergency shelters, transitional housing, other multi-occupancy dwellings, motels and hotels, homes of friends, etc. Outlined below are key considerations for shelter staff to consider when faced with a bed bug infestation: Prevention: Screening Homeless shelters and other emergency housing facilities should incorporate bed bug screening into intake and assessment procedures, as clients may bring along bed bugs from their previous living arrangements. Exposure to bed bugs can be incorporated into questions related to other pests such as lice and scabies. It is possible that in some cases, bites will be evident, but the client may not know or be concerned that they have been exposed to bed bugs. Questions should be phrased sensitively, as this may be the first educational experience a person has about bed bugs. Suggestions include: Have you stayed in a place where you think you may have been exposed to bed bugs in the past three months? Has anyone in your family been bitten by bed bugs or do they have bites or blisters that you re concerned about? Bed bugs, lice, scabies and other things can cause medical concerns. Do you need help with a bed bug, or any other pest, issue? Shelter Policies and Policy Statements Client indicates that they believe they have been exposed to bed bugs or they know they have bed bugs, immediate help is necessary to avoid spreading them within the shelter or home. Provide literature to the individual or family about bed bugs and their management and prevention. Contact Durham Region Health Department or visit www.durham.ca or www.bedbugsinfo.ca for information to provide to clients. When placing an individual or family into a shelter, notify the administration of the bed bug issue. Respond to bed bug complaints immediately. It is important to never refuse shelter to clients with signs of bed bug infestations. Rather, incorporate a Bed Bug Treatment Agreement into compliance with the shelter s rules. If a client refuses to follow procedures for bed bugs, such as inspecting belongings, laundering, or medical attention, the shelter staff may need to build this into their case plan. It would be appropriate to review shelter procedures regarding bed bugs with the client, and hold the resident responsible by having all parties sign the agreement. It is crucial to have the cooperation of both the shelter staff and the resident in order to most effectively eliminate a bed bug infestation. Agencies and facilities managers should have policies in place that will help to prevent the spread of bed bugs. Suggested policy statements and reasoning for bed bug prevention include:

Your belongings must be free of bed bugs, or you must be willing to work with facility staff to rid your belongings of bed bugs. This will prevent the introduction of bed bugs into our facility, and will help the resident to avoid future bed bug issues. You may not bring into this facility items collected from the street, discarded items, donated furniture. With the increased number of bed bug cases, items on the streets are much more likely to contain bed bugs (the reason for being discarded). Therefore it is not safe to bring discarded or abandoned items into our facility. If you have possibly been exposed to bed bugs, or suspect that you may have bed bug bites, you must tell the facilities manager. Early detection and management is very important for the control of bed bugs. Otherwise the number of bed bugs will increase rapidly. The client must consult with a medical provider or social worker if bed bugs are suspected. There is help for clients with mental, physical, and financial needs that limit their ability to deal with bed bugs. You must follow pre-treatment guidelines for a room you occupy. Following pretreatment guidelines will allow management to help get the bed bug infestation under control. Without cooperation control will not be possible. Handling Complaints Bed bugs and other pests sometimes elicit fear and panic in people. Most are unwilling to live with pests, especially those that bite. However, some individuals are resigned to living with bed bugs and may be the source of an infestation in an adjacent unit or room. Complaints about pests or bites must therefore be handled IMMEDIATELY and with concern, but also with a logical approach that relies on science and pest control expertise. The typical course of events would be complaint, inspection (of one or many units), confirmation, cleaning, treatment, future prevention, and follow up to be sure the problem was handled adequately. Designation of a pest management coordinator in your organization can streamline the handling of complaints and infestations. There should be one person in charge of overseeing the inspection and treatment process. Often this is the building or facility manager. Encourage clients to speak openly about bed bugs and other pests and to ask for help. Be sensitive to their concerns. Use resources available to you, and gather the contact information of experts, such as your pest control company s staff entomologist, to ensure a quick response. Furniture and Room Guidelines Bed bugs thrive under certain conditions which are enhanced by the availability of hiding spots close to their human hosts. Bed bugs have a strong preference for paper, cloth and wood, over metal and plastic. Porous surfaces provide more humidity and egg-laying locations. Furniture choices can greatly contribute to the control of bed bugs. Guidelines for furniture include: Eliminate head boards completely. Bed bugs hide and thrive in head boards. Replace all plush furniture with metal and plastic, or items easily cleaned with soap and water.

Adding smaller cushions that can be placed in a dryer is one way to make residents more comfortable. Cushions should be dried on a hot setting if bed bugs are an issue. Use only white or light colored sheets. Use wooden baby cribs, but choose models that are painted white. This will allow for much better inspection and reduce need for treatment. Do not use pesticides on baby cribs! Vinyl-covered or seamless mattresses are recommended for adult beds and cribs. If vinyl mattresses have holes, consider repairing them with tape or discarding them. Do not discard regular (non-vinyl) mattresses, only to replace them with other regular mattresses. Bed bugs will re-infest the new bedding quickly. Use mattress encasements (see below). If a box spring is being used, be sure to encase it too. The box spring is more likely to harbor bed bugs than the mattress. Wooden dressers, wardrobes, tables and other furniture can be painted white for easy inspection. Any crevices where a credit card will fit should first be sealed Discard any wicker furniture. Wicker provides infinite harborage to bed bugs and is almost impossible to treat effectively. Mattress Encasements Mattress encasements are zippered enclosures that cover the entire mattress, as if it were bagged. Encasements should always be used for non-vinyl mattresses and box springs in bed bug prevention and management. Special bed bug-proof encasements are made of high quality cloth material, so they do not tear easily, and they have no folds around the zipper for bed bugs to find shelter. Cheaper vinyl encasements are available but need to be installed carefully to avoid tears in the vinyl. If a small hole appears, duct tape can be used to repair it. Holes MUST be repaired to prevent bed bugs from either gaining protection on the inside of the cover, or to prevent bed bugs from escaping from the infested bedding. Encasing both mattress and box spring eliminates the need to discard bedding by trapping bed bugs inside and providing a smooth simple outer surface that can be inspected, vacuumed and cleaned easily. It is highly recommended that mattresses and box springs be encased, to preserve the sleeping area and to make bed bug inspections quick and easy. Other Room Guidelines Moldings and joints around the room perimeter (floor, doors, cabinets, and windows) should be caulked with silicone sealant to eliminate hiding spots for both bed bugs and cockroaches. Openings around pipes or other structures that come through walls, floors and ceilings must be sealed. This will help with bed bugs, mice and cockroaches. People should keep sleeping in the room to avoid spreading bed bugs to other rooms or apartments, when possible. Residents should not store belongings under the bed when dealing with a bed bug infestation. This provides plenty of hiding spots that are difficult to clean.

Signs of Room-to-Room Spread Often, bed bugs infesting a room or unit will make their way to an adjacent room or unit through electrical, heat and phone line conduits. It has even been documented that bed bugs can cross hallways and move between units under doors. It is important to identify cases where this happens and approach the spread from both sides of the wall or hall. Evidence that may suggest room to room movement of bed bugs includes: Bed bugs in ceiling light fixtures Bed bugs hiding in and coming out of electrical and switch plates on walls and bed bug droppings found on the inside of the switch plates, or near ducts Bed bugs frequently found in unusual locations, such as the kitchen or bathroom. In such a case, it may be that the kitchen or bathroom is located adjacent to an infested bedroom or heavily infested unit, and bed bugs are traveling along water pipes. Donations of Clothing and Other Household Items Donations of clothing, shoes, coats, toys and other personal belongings are vital to many programs that help the disadvantaged. But sometimes when people discover bed bugs in their homes, they discard many personal belongings, and it is unclear how much of these discarded personal belongings make it to the donation stream. It is therefore important to be very careful about donated items to avoid the introduction or spread of bed bugs in your facility or home. Suggested precautions for donations include: Wash and especially DRY on HOT all clothing, shoes, coats, linens, blankets, and plush toys before distribution. Sort donations on a clean linoleum floor. Prevent the escape of bed bugs into your facility by sorting inside a perimeter of carpet (double-sided) tape placed around the working space. This creates a sticky barrier that bed bugs cannot cross. Shake out clothing; inspect books and toys carefully using the identifying guide in this manual. Ban all cardboard boxes for donations from your facility. Instead use clear plastic bags. Keep sorted and laundered items away from items that have not been checked or treated. Treatment If a facility is facing a bed bug infestation, the most effective program recommended for eliminating bed bugs is one that utilizes Integrated Pest Management approach. A more indepth explanation of this approach is outlined in the Integrated Pest Management Program for Managing Bed Bugs found at www.bedbugsinfo.ca. This manual addresses inspection, identification, record keeping, cleaning, clutter reduction, and pesticide use. Control practices require the cooperation of both the client and the shelter staff. Helping a client immediately with bed bugs is critical. Help may be in the form of medical attention, laundering clothes, and isolating their belongings while a control strategy is formed. More specifically, those in need who are suffering with bed bugs will need specific things in order to cooperate in the process of eliminating bed bugs from a shelter or group home. These include:

Instructions for preparing their belongings and rooms or apartments for bed bug treatment. Plastic bags for storage of belongings and clothes. Bags must be tied tightly or sealed well to prevent transfer of bed bugs into or out of bags. Access to laundry, particularly a dryer, to clean clothes, linens, pillows, plush toys, coats, and shoes of bed bugs. Heat will kill all life stages. Access to laundry may require money for use of a Laundromat. Cleaning supplies or services. Some may need help in the form of physical labor for cleaning. Emotional support may be required. Many bed bug sufferers describe post-traumatic stress disorder-type symptoms associated with the stress of their infestation. Access to basic necessities, such as clothes or children s toys. If displaced from their home as a result of bed bugs, the client may need legal help. (see Appendix C-Client Referral List) A person or family with bed bugs may require an advocate to help them get fair treatment with housing, schools, and other services. 14.3 LONG TERM, NURSING, AND ASSISTED LIVING HOMES Hospitals Most hospital environments are not conducive to bed bug infestations. Rooms are designed to discourage harborage of potentially infectious pathogens and surfaces are cleaned regularly. Furniture is typically metal and rooms are sparsely furnished and free of clutter, for ease of cleaning. It is possible that a patient could bring bed bugs into a hospital in their belongings. These are typically transient introductions and infestation is unlikely to result in a modern setting. However a bed bug brought in from one patient may leave with the next patient. If a hospital suspects a bed bug infestation, they should contact a licensed pest management professional for assistance. Long-Term Care Homes Long-term care, nursing and assisted living homes face special challenges when it comes to dealing with bed bugs. Residents often have limited mobility and may have physical or mental health difficulties that make it difficult or impossible to communicate that they are being bitten. Furthermore, residents may be hesitant to report bed bug concerns for fear of being stigmatized or evicted. Therefore, it is critical that these facilities be especially vigilant for any signs of bed bugs. Sleeping rooms and common areas should be regularly inspected for bed bugs. Bedding can also be checked for signs of infestation when it is changed. In long-term care facilities, many patients use wheelchairs, or motorized cars for movement. These items can become infested by bed bugs and spread them to common areas or other resident s rooms. Be aware that these items should also be inspected carefully if bed bugs are suspected. Staff who assists residents with bathing should be trained to look for and report skin lesions. There are a number of skin conditions that can affect people in long-term care settings, including MRSA (methicillin-resistant Staphylococcus aureus), scabies, and pressure sores. Bed bug bites should be considered when a patient is experiencing

inflammatory lesions in which other causes have been ruled out and typical treatments have failed. Intake evaluations for new residents should include bed bug screening. Facilities should be very cautious about allowing residents to bring in their own furniture. If the facility allows outside furniture to be brought in, the items should be inspected to ensure that they are bed-bug free. Shared equipment like wheelchairs, trays, and carts should be stored away from sleeping areas and should be disinfected between uses. If a bed bug infestation is suspected in a long-term care home, it is vitally important that the facility contact a licensed pest management professional immediately. The longer an infestation is allowed to develop, the more difficult it can be to eradicate. The pest management professional should conduct a thorough inspection and work with the facility management to develop a treatment plan. Because it may not be practical to relocate the affected residents, treatment strategies should conform to an Integrated Pest Management plan so as to minimize exposure to pesticides. When an infestation is confirmed, it is important to be sensitive to the concerns of affected residents. Residents may feel ashamed and may not want others to know that they are having a problem with bed bugs. These concerns will have to be balanced with the need to control the infestation. Reassure residents that the bed bug infestation is not their fault, and that bed bugs are not indicative of poor hygiene or housekeeping. With the resident s consent, notify family members and other regular visitors that bed bugs have been found in the facility, and provide them with educational materials so that they can check for bed bugs in their own homes. In these instances, investigative work may also be helpful to determine whether visitors to the facility may be bringing bed bugs in. The point of this exercise is not to place blame, but to educate, control, and prevent bed bugs from being introduced again. If a resident s room is continuously infested after treatment attempts, the bed bugs may be being brought in by visitors. There is also a possibility they may be coming from an adjacent unit. Education and evaluation of visitors, and inspection and treatment (if necessary) of adjacent units will help to prevent infestations. Staff, residents, and family members are encouraged to report bed bug infestations promptly to facility management.

14.4 SCHOOLS AND CHILD CARE CENTERS Background In general, school and institutional child care center environments are not conducive to bed bug infestations. Bed bugs prefer an environment where they can hide during the day and come out at night to feed on a sleeping host. Because most schools and institutional child care centers do not provide this type of environment, major infestations of school and child care center buildings are rare. However, bed bugs hiding in clothing or backpacks can hitchhike to and from schools and child care centers, potentially providing a hub for bed bug spread. Because bed bugs can travel in belongings, it is prudent for schools and child care centers to keep individual children s belongings separate. School and child care centers with napping infants and toddlers may provide the type of environment suitable to support a bed bug population (NOTE: In-home child care environments may become infested with bed bugs by the occupying family or by children in care). If children in this type of setting are experiencing skin conditions that might be associated with bed bug bites, then it may be necessary to investigate the school or child care setting as well as the child s home setting. Policy Recommendations Currently there is no scientific evidence demonstrating that enforced exclusion policies are effective at reducing bed bug transmission in the school environment. It is recommended that schools develop a response plan based on the management principles outlined in this section. An appropriate response plan would include the following: An established school Integrated Pest Management Plan (IPM) plan. Train staff to identify bed bugs and the signs of bed bugs in the classroom and children s items. This may include actual insects, cast skins, or excessive insect bites on a child. Any student with bed bugs identified on their person or in their belongings may remain in school until the end of the day (see Procedures below). Respond promptly to bed bug complaints within the school and through contact and counseling with parents/caregivers. The longer bed bug infestations are allowed to persist, the harder they are to eradicate. Parents/caregivers should promptly respond to bed bugs in the home for the health and safety of the family and school community. ROLES AND RESPONSIBILITIES Parents have the ultimate responsibility for their children. This includes: Assisting in the prevention and management of bed bugs through regular checks when bed bugs are found in the class, on the child, or in the home, educating themselves and their children, and making immediate arrangements for inspection/treatment when bed bug infestation is suspected or confirmed. School communities have responsibility for: Developing school procedures to support prevention and control. Policies and procedures should include the following elements: o Individual school bed bug policy.

o Strategies to address issues with students with recurring evidence of bed bug infestation in the home, or repeat violators of the school s bed bug policy. o Training and designating an individual(s) to evaluate chronic cases within the school and/or school district that will work together with other local agencies to achieve compliance with the school s bed bug policy. o Disseminating current information about bed bugs. o Holding educational sessions for parents/caregivers and children if necessary. o Alerting parents/caregivers when cases have been identified and urging vigilance at home. o If tenant/landlord conflicts impede timely treatment, parents should be advised to talk with local agencies responsible for housing and Property Standards enforcement, or the Durham Region Health Department. Procedures Procedures to follow if a bed bug is found If a bed bug is found on a child in school or child care center, it does not mean the child brought the bed bug into the school or child care center. Bed bugs do not infest people, they only feed on them. Bed bugs can crawl onto or off of a person (or their belongings) at any time. If a suspected bed bug is found on a child, a child s belongings, or anywhere else in a school or child care center, the following procedures should be followed: 1. If the bug was found on a child or a child s belongings, the child should be discreetly removed from the classroom so that the school nurse or a qualified individual can examine the child s clothing and other belongings. Any bugs found should be removed and collected for identification. Try to keep the specimens as intact as possible. 2. The school principal or center program director should contact their pest management company for assistance in identifying the specimen(s). It is important to confirm that the bugs found really are bed bugs before proceeding. 3. If the specimen is confirmed to be a bed bug, then the school principal or nurse or center program director should notify the affected class or classes. 4. If a confirmed bed bug was found on a child, then the school principal or nurse or center program director should inform the child s parents or guardian by phone. An inspection report should be sent home with the student, and completed promptly. Educational materials such as those found at www.bedbugsinfo.ca should also be provided to the family. 5. In most instances, students should not be excluded from school or child care due to bed bugs. Schools and child care centers should not be closed due to the discovery of bed bugs. As discussed above, infestation of a school or child care center building is unlikely, rather the school or child care center may become a source of dispersal to others in the school environment. For instance, bed bugs brought into the school in a child s book-bag or on their clothing could drop off in the classroom or in a locker. The bed bugs might then be picked up and taken home by another student or staff member inadvertently. 6. For children/students who repeatedly come to school with bed bugs, institute clothing and school item sanitation:

In an infested home, parents should store their child s freshly laundered clothing in sealed plastic bags until they are put on in the morning. This prevents bed bugs from hiding in the clothing and being carried to school. Backpacks, lunchboxes, and other items that travel back and forth to school can also be inspected daily and stored in sealed plastic containers at home to prevent bed bugs from getting into them. 7. In the unusual instance where a child repeatedly reports to school showing evidence of bed bugs despite previous notification, education, and counseling with parents, further investigation is needed. Repeated bed bug presence may be due the following: Inability of parents/caregiver to recognize the scope of an infestation at home. Failure to effectively treat a recognized infestation this might be due to pest management failure, landlord/tenant dispute, lack of financial resources, repeated re-infestation from outside of the home (all places a student sleeps or visits, consider family members as well), non-vigilance or lack of concern on the part of the parent. Failure to adhere to recommended clothing and school item sanitation recommendations. Investigate other sources of bed bugs on school property such as lockers, buses, common areas or other areas where students routinely congregate. If any of the above issues are thought to be the cause, targeted intervention may be warranted: This may include treatment of school facilities and property if an infestation is found in the school or on buses. Ongoing pest management should be overseen by the school principal or designee or the center program director and must conform to the school/center s integrated pest management plan. Investigative work may be required to figure out where repeated bed bug findings are originating. If a parent is or claims to be diligently dealing with an infestation and the student continues to come to school with bed bugs, there may be an alternative source or reason that the parents haven t been successful. Things to consider are: o Where the child spends time after school, before school, or with other family members. Any of these places could have an infestation and the child may be bringing bed bugs from this location or bringing them back home to the detriment of control efforts. o Cars and other modes of transportation can become infested. Inspect all the modes of transportation the child uses. o Parents need to cooperate with the preparation of the home for treatment. This includes all of the pest management professional s pre-treatment instructions. If these instructions are not exactly followed, treatment failure may result. See Appendix E -Pre-Treatment Preparation Checklist. o The family must follow the recommendations for clothing and personal school item sanitation set out by the school. While bed bug treatment is ongoing, it is important to remain vigilant in keeping bed bugs out of clothing and personal items brought to school. Schools may want to suggest or require having a spare set of clothing sent for the child in a sealed plastic bag. If bed bugs are found, have the child change into the clean clothes and place infested clothes into the bag. Clothing may also be placed in a hot dryer (highest heat setting, include shoes) for 30 minutes prior to the child dressing in the morning. High heat will kill all stages of bed bugs.

o The treatment of a bed bug infestation can be very costly. In instances where a family is having financial difficulty and can not afford professional treatment, the family should be directed to Durham Region Social Services to determine if they are eligible for public assistance funds. o In cases where tenant/landlord dispute is delaying effective treatment, parents should be directed to contact the Landlord and Tenant Board or the municipality s municipal law enforcement office. Landlords/property managers are responsible for providing a vermin-free living environment. o Treatment failure may result from inexperienced, unlicensed pest management. In rare or extreme cases, a school may have to confront a situation where a parent or caregiver is incapable or unwilling to remedy a bed bug infestation in the home. These cases are difficult because a school must consider several important factors: o Providing a healthy, pest-free environment for students to learn is a prime responsibility of the school. o Providing a healthy, pest-free environment for staff is also a responsibility of school administrators. o Providing a safe and healthy living environment is a responsibility of the parent or caregiver, and NOT the school. o Repeated bed bug introductions by a student constitute a risk to other students and staff. While bed bugs do not transmit disease, they are a significant burden. Once established in a home they can cause physical and psychological symptoms, and present a significant economic investment to eradicate. These facts are also true at the school level. Repeated inspections and potential treatment by pest management professionals, anxiety, frustration and lost instructional time on the part of staff, and administrative efforts constitute a serious cost both economically and in educational efficiency. Bed bug infestations are not only an individual family and school concern, but are of concern for the entire community. The longer bed bug infestations are allowed to persist, the more likely it is for spread in the community and any place that people congregate for long periods may become a hub for this spread. Individuals and institutions have their respective responsibilities, but it is incumbent on the community itself to attempt to help its members, particularly those less fortunate, to address an infestation. Be aware of emerging issues that are impacting community members and work to address these issues in the community. For questions regarding school policy development, contact your local school board.

14.5 HOSPITALITY INDUSTRY Implications of bed bugs in the hospitality industry: Pest control costs Lost revenue Complaints Negative publicity Lasting damage to the reputation of the hotel affecting current and future occupancy levels Potential litigation Staff Training and Early Detection Hotels can do very little to prevent bed bugs from being introduced into their hotel. You cannot tell which guests may be bringing bed bugs with them. Therefore, it is critical for hotels to be vigilant for the early signs of a bed bug infestation. These signs may include: Small brownish or reddish marks left on bedding. Bed bugs, eggs, or cast skins especially around seams of mattresses and behind headboards. Live bed bugs anywhere in the room. Complaints from guests who wake up with itchy bites. Well-trained housekeepers are the staff members most likely to detect an early infestation. Although bed bugs are good at hiding, they often leave telltale marks on bedding. Housekeeping staff should be trained to look for small, brownish or reddish marks left on sheets, pillows, or the seams of mattresses or bedding. Housekeepers should also be encouraged to report any signs of bed bugs, and their vigilance should be praised and recognized, even when they are mistaken. Remember, the goal is for your staff to discover any bed bugs before your guests do! Maintenance staff should also be trained to recognize bed bugs. Maintenance staff may encounter bed bugs hiding in wall cracks, behind electrical outlets, in bed frames or under the edges of carpet and peeling wallpaper. Again, vigilance is key have all staff trained to recognize and report any sign of bed bugs in your hotel. Guest Complaints A guest complaint is the worst way to find out about a bed bug infestation. Although some complaints may prove to be false alarms, it is important to take every incident seriously. Not everyone reacts to bed bug bites in the same way - some people don t develop a reaction until several days later, and others may not react at all. Therefore, an infestation may be present in a hotel room for a while before anyone complains. A manager should offer to speak with the guests about their concerns, and the room should be carefully inspected by a pest management professional.

It is critical to keep detailed records of everything that is done in response to a bed bug complaint. Documentation of the complaint, the hotel s response, the PMP s inspection, and any bed bug treatment performed help decrease negative public relations stemming from the incident and can be tremendously valuable in the event of a lawsuit. Dealing with a Possible Infestation At the first sign of bed bugs, the affected room(s) should be taken out of service, and guests moved to another room. No one, not even housekeeping, should enter the room until it has been inspected by a PMP. If the PMP conducts a thorough inspection and finds no evidence of bed bugs, then the room can be placed back in service. However, if the PMP finds any evidence of a bed bug infestation in the room, then they should also inspect all adjacent rooms (both sides, above, below, and across the hall). If the PMP confirms the existence of bed bugs in the guest s room, make sure the room the guest(s) were moved to be carefully inspected as well. Bed bugs can attach themselves to the guests clothing or luggage and easily be spread under such circumstances. Any infested rooms identified by the PMP should remain out of service until they have been completely and successfully treated. This may take several visits from a PMP. As mentioned previously, it is good practice to keep records of any bed bug treatments performed in the hotel. Always remember, a hotel s housekeeping staff is the first and most important line of defense. Make sure to keep current staff vigilant and train new staff on how to identify the tell-tale signs of bed bugs Other Ways to Fight Bed Bugs Choose furniture of plain design. A metal chair offers fewer places for a bed bug to hide than a wicker one. Don t use second-hand furniture. Choose light-colored bedding easier to see bugs and blood spots. Choose bedding that does not hang down to the floor. Use tightly fitting, zippered, bed-bug proof mattress and box spring encasements. Putting them in place ahead of time (proactively) makes bed bugs easier to see since encasements have no piping or tags and they re light-colored Vacuum guest rooms regularly. Use an attachment to get in cracks and crevices. Keep soiled bed linens in a sealed plastic container, separate from clean linens to prevent bed bugs from spreading by cross-contamination of bedding. Avoid bringing housekeeping carts into guest rooms keep them in the hallway where they are less likely to pick up hitchhiking bed bugs. Seal cracks in walls and wooden floors. Repair peeling wallpaper. Bag furniture that may be infested with bed bugs when removing them from the room. Source: Michigan Manual for the Prevention and Control of Bed Bugs

15. APPENDIX H: BEDBUGSINFO.CA RESOURCES

How do I find a pest control company? Getting rid of bed bugs requires pesticides and other treatments that should only be used by professionals. There are many licensed pest control companies in Ontario who have the training and experience to manage a bed bug infestation. To find a licensed company near you visit www.spmao.ca or www.pestworld.org EVERYTHING YOU WANTED TO KNOW { What are bed bugs? ABOUT BED BUGS. Bed bugs are small insects (about the size of an apple seed) with oval-shaped bodies and no wings. They usually come out and bite at night. It is possible for anyone, anywhere to experience a bed bug infestation, but they can be prevented and controlled. bedbugsinfo.ca. Catalogue No. 015702 Mar/11 ISBN: 978-1-4435-6459-5 (PDF) Queen s Printer for Ontario How to find bed bugs and control them. bedbugsinfo.ca bedbugsinfo.ca

PREVENT IDENTIFY ACT How do I stop bed bugs from entering my home? Even the cleanest homes can get bed bugs, but regular inspection and cleaning can help you prevent an infestation. To prevent bed bugs from coming into your home you should: Vacuum your mattress often Clean up clutter Seal cracks and crevices with caulking Inspect used furniture or clothes before buying Never bring discarded bed frames, mattresses, box springs, upholstered furniture or electronics into your home Inspect your luggage and its contents when you return from a trip How can I find bed bugs? Use a flashlight to look for bed bugs and their droppings. Or use a hot hair dryer, thin knife or playing card to force them out of hiding spaces and cracks. Check in the seams of your mattress, inside your box spring and along your bed frame. Also look in cracks and crevices in and around your bed and check surrounding furniture and baseboards. What does a bed bug bite feel and look like? Some people have no reaction at all. But for some people they can turn into itchy welts. Often bed bug bites appear as a group of three, which people sometimes call breakfast, lunch, and dinner. They usually go away by themselves and don t need treatment. Although bed bugs and their bites are a nuisance, they are not known to spread disease in humans. What can I do if I have bed bugs? If you find bed bugs, talk to your landlord, building manager, local Public Health Unit or a pest control professional. You should also: Vacuum your mattress, bed frame, baseboards and anything else around your bed every day Wash your clothing, bed sheets, blankets, mattress pads and pillows in hot water and dry them on high heat for 30 minutes Remove unnecessary clutter Seal cracks in bed frames, floors, walls and between baseboards Repair or remove peeling wallpaper Tighten loose light switch covers Seal openings where pipes, wires or other utilities come into your home Carefully bag, label and dispose of infested items that can t be cleaned MYTH 1 2 3 It s too cold for bed bugs in Canada. Bed bugs survive all over Canada, even with our cold winters. MYTH You can t see bed bugs. It s easy to spot adult bed bugs. They re about the size and shape of an apple seed and a reddish brown colour. MYTH You can get rid of bed bugs by throwing out your bed. They re called bed bugs but they don t just live in your bed. They can live in almost any dark crack or crevice in your home.

BED BUG TOOL KIT A thorough inspection of the premises is recommended before any cleaning or rearranging has occurred. An initial inspection provides a sense of the full extent of the problem and prevents the disturbance and spread of bed bugs before treatment. Some professional pest management companies will perform a visual inspection to determine where bed bugs are most predominant. Some companies use trained dogs to sniff out viable eggs and bed bugs. This should always be followed up by a visual confirmation of live bed bugs. Adult bed bugs can hide in cracks and crevices as thin as a few sheets of paper. Young bed bugs can hide in even smaller spaces. When conducting an inspection, move slowly to avoid disturbing hiding bed bugs, so they don t scatter. Keep in mind that with low infestations, the bed bugs will be concentrated close to sleeping areas. Items away from the sleeping area will be less likely to be infested. Prioritize inspection areas from high to low levels of infestation and focus inspection and treatment in the most heavily infested areas. It is important to consider that a bed bug infestation in a living area (e.g. bedroom, apartment suite, dormitory room, shelter, room or hospital or long-term care unit) might spread to adjacent rooms or units or those below, above or to the sides. This is especially true if the bed bug population is high or if pesticides are used in the room or unit where the bed bugs were originally discovered. Adjacent units should be inspected and if bed bugs are found or residents notice bites, they should be treated as if infested. Tool Kit: A recommended bed bug inspection tool kit includes: Magnifying glass. Strong-beamed flashlight. Plastic vials or zip-top bags and forceps for collecting specimens. A putty knife, spatula or probe, such as a credit card tool, made by cutting any plastic card into a long triangle, for checking in narrow spaces. Compressed air (e.g. used to clean computer key boards) for flushing bed bugs out of hiding (use carefully so as not to blow bed bug eggs, that have not been securely cemented to a surface by a female bed bug, to other areas of the room). Screwdrivers for removing light switches and electrical plates. A small tool kit for disassembling furniture. Cotton swabs, glass-cleaning or baby wipes for checking for dropping stains. Digital camera may be needed to take photographs with the occupant s permission. Sticky traps (may be of some use but have limitations for catching bed bugs). Interceptors placed under bed or other furniture legs to monitor bed bug activity. Bed leg is placed in the inner section. Talcum powder is incorporated in the interceptor to prevent bed bugs from climbing out. Bed bug interceptors are a cost-effective inspection tool that requires no expertise to use. They provide early detection of low level infestations and can even prevent bites from occurring by providing a barrier between areas around the bed where bed bugs hide and the bed. As a bed bug crawls up and over the outside surface of the interceptor it will fall into the outer ring. Any bed bugs climbing down the bed leg will be trapped in the inner well. Source: An Integrated Pest Management Program for Managing Bed Bugs www.bedbugsinfo.ca

Bedbugsinfo.ca FACT SHEET { In recent years Ontario and other Canadian provinces and territories have seen an increase in the number of bed bug reports. It is possible for anyone, anywhere to experience a bed bug infestation. Bed bugs are small biting insects that multiply quickly and travel easily. Bed bugs can be prevented and controlled. The sooner everyone responds, the more successful we will be at controlling this pest. PREVENT How do I prevent bed bugs FRom ENTERINg my APARTment or home? Although even the cleanest homes and hotels can have bed bugs, regular inspection and house cleaning, including vacuuming your mattress, can help prevent or discover an infestation in its early stages. Clean up clutter to help reduce the number of places bed bugs can hide and to make inspection easier. Seal cracks and crevices with caulking, even if you don t have bed bugs. This will help prevent bed bugs and other pests from coming entering your home or apartment. Be careful when buying used furniture or clothes. Make sure to inspect the used item, and feel free to ask if the items were checked for bed bugs. Never bring discarded bed frames, mattresses, box springs, upholstered furniture or electronics into your home. These items may be infested with bed bugs. How do I keep from BRINging THEm home when I TRAVEl? When travelling, inspect the room and furniture and look for blood spots, droppings or live insects. Request a different room if you find evidence of bed bugs. Inspect luggage when you return home, preferably before you bring your luggage into the house, and wash clothing in the hottest water possible followed by 30 minutes in a hot dryer immediately after returning from a trip. IDENTIFY What are bed bugs? Bed bugs are insects with oval-shaped bodies and no wings. Bed bugs usually bite at night and will bite all over, especially around the face, neck, upper torso, arms and hands. There are currently no known cases of infectious disease transmitted to people by bed bug bites. How can I find THEm? Use a bright flashlight to look for bed bugs or their dark droppings in bedroom furniture, windows and doorframes. Or use a hot hair dryer, a thin knife or an old playing card to force them out of hiding spaces and cracks. For more INFormATIon VISIT bedbugsinfo.ca

Check: behind your headboard and around cracks and crevices of your bed. in the seams and tufts of your mattress. inside the box spring and along the bed frame. along bedroom baseboard cracks. in and around nightstands. other bedroom items, including window and door casings, pictures, mouldings, nearby furniture, loose wallpaper, cracks in plaster and partitions and clutter. What does a BEd bug BITE FEEl ANd look like? Most bed bug bites are initially painless, but could turn into large, itchy skin welts. Some people have no reaction at all. Most bed bug bites eventually go away by themselves and don t need treatment. ACT What can I do if I have bed bugs IN my APARTment or home? Consult with your landlord, building manager, local Public Health Unit or a pest control professional to confirm that you have bed bugs. Use a nozzle attachment on the vacuum to remove live adult bed bugs and immature bed bugs (called nymphs) and their eggs. Vacuum all crevices on your mattress, bed frame, baseboards and any objects close to the bed. It is essential to vacuum daily and empty the vacuum bag immediately or seal it and place it in the freezer for several days. Wash all your clothing, bed sheets, blankets, mattress pads, pillows and their cases in the hottest water possible and place them in a hot dryer for 30 minutes. Consider covering your pillows and mattress with a plastic cover. Remove all unnecessary clutter. Seal cracks and crevices between baseboards, on wood bed frames, floors and walls with caulking. Repair or remove peeling wallpaper, tighten loose light switch covers, and seal any openings where pipes, wires or other utilities come into your home (pay special attention to walls that are shared between apartments). Dispose of infested items that cannot be cleaned and get rid of clutter. Seal all items tightly in a plastic garbage bag and discard in a clearly labelled outside container. Should I use a PEST control company? Bed bug control requires an integrated pest management (IPM) approach that includes proper preparation and inspection, identification and housekeeping. This will ensure the risk of pesticide exposure is minimized, the environment is protected, and the effectiveness of the treatment is maximized. Getting rid of bed bug infestations usually requires the use of pesticides. Only professionals should apply pesticides for bed bugs. Foggers and bug bombs are not effective against them. There are many licensed pest control companies in Ontario who have the proper training and experience to manage a bed bug infestation. To find a licensed company near you go to: www.spmao.ca www.pestworld.org Catalogue No. 015700 March 2011 2011 Queen s Printer of Ontario For more INFormATIon VISIT bedbugsinfo.ca

Bedbugsinfo.ca FACT SHEET Bed Bug { Myths 1. You CAn t SEE BEd bugs Adult bed bugs are easily spotted. Adult bed bugs are 3mm - 5mm in size - about the size and shape of an apple seed - and a reddish brown colour. 2. Throw out your BEd and you ll BE rid of BEd bugs They may be called bed bugs but they don t just live in your bed. They can occupy almost any dark crack or crevice in a room. Almost everything including clothing, bedding, furniture and electronics can be treated to remove bed bugs. By disposing of infested furniture prior to it being inspected and treated, you can actually spread bed bugs. If you need to dispose of furniture or a mattress, make sure it is sealed with plastic and mark the item to indicate it has been infested by bed bugs. If possible, destroy items prior to disposal to make them unusable. 3. You only get BEd bugs if you live in a low-income neighbourhood Bed bugs are an exposure pest and are not necessarily associated with living conditions. Bed bugs can happen to anyone, anywhere. You get bed bugs by coming into contact with them. Increasingly, people who frequently travel become exposed to bed bugs and bring them back home. 4. You need to wash all of your clothes for a BEd bug treatment to BE EFFECTive Yes as a general rule washing in hot water and drying on the hot setting can help destroy bed bugs in clothing. But you might not have to wash all your clothes. The first thing you need to do is have your home or apartment inspected by a professional pest control expert. 5. it s too cold for BEd bugs in Canada Even with our cold winters bed bugs continue to survive in all parts of Canada. Bed bugs can be found in almost every country and region. Bed bugs are a global pest. For more information visit bedbugsinfo.ca It s easy to get incorrect information about bed bugs and their impact on our lives. Knowledge of bed bug facts will help you understand what you need to do to control them. Here are some common bed bug myths and the real facts.

6. You CAn t get BEd bugs from a neighbour AS long AS HE doesn t visit you and keeps his door SHut. Migration of bed bugs from a neighbour is a lot more common than people believe. In apartments or condos the risk of migration is greater because bed bugs can travel through cracks, vents or spaces in a shared wall. If you think your neighbour has an issue with bed bugs, check your bed and living area on a weekly basis to make sure bed bugs are detected at the earliest stages. Speak to your landlord or condo association. A building-wide effort to control bed bugs is needed. 7. You CAn t HAve BEd bugs when you HAve not travelled anywhere recently Travel, whether overseas or in Canada, is not the only possible source of bed bugs. We find it hard to imagine where we might have picked up bed bugs. Yet situations such as a trip abroad, riding public transit, having a houseguest or purchasing a piece of second hand furniture can offer bed bugs a free ride into your home or apartment. 8. it can t BE BEd bugs BECAuse you get bitten but your partner does not The simple fact is that two people sleeping in the same bed may both be bitten by bed bugs but respond in a different way. Some people immediately have a reaction to the bites while others show little or no sign. 9. Bed bugs are resistant to all pesticides Bed bugs are not resistant to all pesticides, but they are becoming increasingly resistant to over used pesticides. Home pesticide sprays or foggers do not work on bed bugs. Pest control companies continue to develop new ways to treat bed bugs. It is best to let a trained and licensed bed bug pest control expert select and apply the right pesticide. 10. THEre are over THE counter bug sprays or remedies THAT will get rid of BEd bugs. Over the counter bug spray, rubbing alcohol, and kerosene are some of the home remedies being used to try to eradicate bed bugs. However, such home remedies are considered to be ineffective and some are fire hazards. The best way to get rid of bed bugs is to hire a licensed pest control expert and follow their instructions. 11. if you sleep in a metal BEd you don t HAve to worry ABout BEd bugs. Although it is true that metal beds are less hospitable to bed bugs, simply replacing all beds with metal ones will not solve a bed bug problem. In some cases, metal beds may cause bed bugs to hide in less obvious areas of the bed, making the matter worse. And throwing out your metal bed will not simply solve the problem, but it could also expose others to an infestation. 12. You CAn get sick from BEd bug bites Bed bugs dot not spread disease among humans. Bed bug bites can get infected if you scratch them excessively. Some people can develop allergic sensitivities to bed bug infestations. The most significant health effects appear to be the psychological, including stress, anxiety, depression, and fatigue that can be caused by the presence of bed bugs in the home. Catalogue No. 015704 March 2011 2011 Queen s Printer of Ontario For more information visit bedbugsinfo.ca

Bedbugsinfo.ca FACT SHEET BED BUGBITES WHAT DO BED BUG BITES LOOK LIKE? Bed bugs usually bite at night, and will bite all over a human body, especially around the face, neck, upper torso, arms and hands. Individual responses to bed bug bites will vary. Some people do not react to bed bug bites. But for those who do, bite marks may appear within minutes or days, usually where skin is exposed during sleep. They can be small bumps or large itchy welts. Because the bites may resemble mosquito and other insect bites, a bump or welt alone does not mean there are bed bugs. The most common rash is made up of localized red and itchy flat sores. Often bed bug bites appear as a group of three, which people sometimes call breakfast, lunch, and dinner. Small raised red swelling bites are also common. In rare cases, some people may develop large raised, often itchy, red welts. ARE BED BUG BITES A THREAT TO MY HEALTH? Although bed bugs and their bites are a nuisance, they are not known to spread disease in humans. Bed bug bites can be very itchy and irritating. Most welts heal in a few days but in unusual cases, the welt may persist for several weeks. The most significant health effects appear to be the psychological, including stress, anxiety, depression, and fatigue caused by the presence of bed bugs in the home. Anxiety about being bitten can lead to sleeplessness, which can affect one s wellbeing. Properly and effectively responding to bed bugs helps to reduce anxiety. HOW DO I TREAT BED BUG BITES? Most bed bug bites go away by themselves and don t need treatment. Keep the skin clean and try not to scratch. Usually an anti-itch ointment will help, but if bites become infected, you should see a doctor. If the bites are very itchy, your doctor may prescribe cream or antihistamines to relieve the itchiness. Oral antibiotics may be prescribed for any secondary skin infection from excessive scratching. Catalogue No. 015706 March 2011 2011 Queen s Printer of Ontario FOR MORE INFORMATION VISIT bedbugsinfo.ca

Tenant Rights in ONTARIO Regarding Bed Bugs Who is responsible when a bed bug infestation is discovered in my apartment? If you have a problem with bed bugs or other insects or pests, you should immediately inform your landlord, your superintendent or property manager, or someone else who is responsible for ensuring homes are pest-free. As a tenant, you are responsible for cooperating with your landlord s efforts to control bed bugs. It is the landlord s responsibility to maintain the rental unit so that is fit for habitation and complies with health standards. When can the landlord enter to inspect my apartment? Landlords have the right to enter to inspect and maintain rental units. Tenants must be given notice in writing 24 hours ahead of time. Treating an apartment for bed bugs is not considered an emergency, so your landlord should give you proper notice and adequate time to properly prepare your unit before application of pesticide. What is the best solution to controlling bed bugs? Early detection and fast action is important to addressing an infestation. Only licensed pest control companies should be used. If the job is not done properly, the bed bugs may come back or continue to spread. What if other units have bed bugs? Do all tenants have to co-operate? If the pest control operator believes there is a need to also treat neighbouring units, your landlord may have the right to enter to inspect and treat your apartment as well as the affected apartment. For more information visit bedbugsinfo.ca

What if you cannot properly prepare your apartment for treatment of the bugs? Proper preparation is key to successful treatment and prevention of bed bugs. Landlords should tell you what you need to do in order to make treatment effective. Be prepared. This can take a lot of work, including clearing out shelves, laundering all clothing and bedding, moving furniture away from walls and removing clutter. It is every tenant s responsibility to make sure they properly prepare the apartment according to the landlord s instructions. If you are unable to do this or have questions, make sure you speak to your landlord about it right away. Family members, friends, neighbours or community members may be able to provide additional support with the preparations. Landlords can apply to Ontario s Landlord and Tenant Board for an order to evict a tenant if a tenant seriously and unreasonably interferes with the landlord s efforts to deal with bed bugs. Who pays for pest control costs? Landlords are responsible for the costs for treatment. What if your landlord fails to take action? If a landlord refuses to help when a tenant notifies them of a bed bug problem, tenants may obtain assistance or advice from a legal clinic or from the Landlord and Tenant Board. Another option available to tenants whose landlord does not maintain their building properly is to file an application about maintenance with Ontario s Landlord and Tenant Board (LTB). If the Board finds that the building or unit is not maintained adequately, there are several remedies that can be ordered. These include an abatement of rent, an order requiring the landlord to conduct the necessary repairs, or a rent freeze until the problems are resolved. If you are interested in filing an application with the LTB, you can contact the Board by telephone at 1-888-332-3234 toll-free (416-645-8080 in the Toronto area), or visit its website at www.ltb.gov.on.ca. Where can I get more information on bed bug prevention, detection and control? bedbugsinfo.ca Catalogue No. 015714 March 2011 2011 Queen s Printer of Ontario For more information visit bedbugsinfo.ca

Bedbugsinfo.ca FACT SHEET BED BUG { TRAVEL TIPS All travellers to areas within and outside of Ontario are potentially exposed to bed bugs. Carrying bed bugs back home with you after travelling could lead to a bed bug infestation in even the cleanest home. Make sure you take the proper steps to avoid bed bug hitchhikers while travelling. STEPS TO ENSURE A BED BUG FREE STAY AT YOUR HOTEL: 1. Try to avoid booking a hotel without first inquiring if it has a bed bug problem. 2. Pack clothes into oversized sealable plastic bags and leave them inside luggage during the trip, or hanging in the closet never on the bed or floor. 3. Leave luggage outside or in the bathroom and perform a mini-inspection around the bed: peel back the bed sheets and check the mattress, running your fingers along the upper and lower seams. Make sure to check the mattress tag, as bed bugs often hide there. Check for blood stains and bed bug droppings as well, since they re often the easiest to spot. 4. Check the bedside table. Look for signs of bed bugs in the drawers and along the wall on the side of the bed that is less likely to be disturbed by cleaning staff and guests. 5. If bed bugs are detected, request another room. Be sure to inform hotel management. Just moving to a different room may not be the total answer. You should repeat the inspection of any new or different room you are offered. 6. When you pack to leave, inspect your luggage carefully first, and inspect every item as you pack to help detect any bugs or their signs. 7. If you find bed bugs, have bites, or know that you ve spent time in a room harbouring the bugs, vacuum your suitcases, backpack, or camera bag. Wash everything washable in the hottest water possible and dry on the highest setting possible for 30 minutes. 8. After your trip, unpack luggage outdoors, re-inspect clothing and then put everything into the dryer on the highest setting possible for at least 30 minutes or the freezer for two weeks (for delicates). Vacuum luggage thoroughly. And buy the hard, smooth kind without inviting pockets, since bedbugs struggle over smooth surfaces and polished metal. Catalogue No. 015710 March 2011 2011 Queen s Printer of Ontario FOR MORE INFORMATION VISIT bedbugsinfo.ca

Bedbugsinfo.ca Pest Control Info Fact Sheet: How to hire, work with and prepare for a pest control company The accepted best way to deal with bed bug infestations is Integrated Pest Management (IPM). IPM combines a variety of techniques and products that pose the least risk to human health and the environment. After careful assessment by you or your landlord, a professional pest control service may be called in to apply pesticide spray or steam treatment. Only licensed pest control companies should apply pesticides for bed bugs. Foggers and bug bombs are not effective against them. Choose the right company. Be clear about what you want done and make sure they do a good job. Controlling bed bugs may take several treatments. Make sure that the company you hire has a committed treatment plan. Choosing and Working with a Pest Control Company In Ontario pest control companies are licensed. You can find a local licensed company through either the National Pest Management Association or the Structural Pest Management Association of Ontario at: www.spmao.ca www.pestworld.org The proposed work should follow all of the principles of Integrated Pest Management, not just pesticide application. The pest control company should be straightforward and open when discussing details of the service provided. Understand what guarantees are being offered. Bed bug management may be difficult to guarantee, because re-infestation from an outside source is possible. It may require several treatments to control the infestation. How do I know if they are a good company? Always deal with a qualified and licensed pest management company. Consider asking to see their license. A good company should: Be a member of a professional organization, such as the National Pest Management Association, Canadian Pest Management Association, Structural Pest Management Association of Ontario or Ontario Integrated Pest Management Association Have experience with bed bug management. Inspect your property before giving you a price quote or begin any pesticide application. Give you a written inspection report, and an action plan of how to prepare for treatment and prevent further infestation. Base quotes on inspection findings. The cheapest services are rarely the best. Visit often until the job is done. Employ qualified, well-trained pest management professionals. Educate you on how to prevent bed bugs. Work with you until the bed bugs are gone. Treat you with respect. For more information visit bedbugsinfo.ca

What should I ask the pest control professional? When you speak to the professional ask them to: Tell you when it s safe to re-enter a treated room. Never spray the top of mattresses or sofas, and if needed, to use only small amounts of pesticides on the seams only. Use vacuum, cleaning, steaming and other mechanical approaches to remove and kill bed bugs and their eggs. If pets or children are present, manage the use of pesticides accordingly. Work with you until the problem has been controlled. Notify your landlord to inspect adjacent apartments for bed bugs. Agree on a service treatment plan and pricing structure. Clearly explain what you and the company are each responsible for. If repairs are not part of the service agreement, then the company should provide you with a list of repairs you need to do to solve the problem. Walk around your home with you during each visit and explain the work being done. Point out any conditions that contribute to bed bugs in or near your property, and provide a written inspection report. Remember to do your part, and follow up on the company s recommendations. What do I need to do before pesticide treatment? Before the pesticide treatment begins, all occupants, including pets, must leave the unit and not enter for a minimum of 3-4 hours after the technician leaves. Aquariums may remain in place as long as the filtrations and aeration systems are turned off for six hours and the tank is adequately covered. Anyone who is pregnant or has allergies or asthma should take the necessary precautions. Before treatment: All clutter should be removed from the unit. If possible, steam clean, wet vacuum or shampoo any carpeting and furnishings. Vacuum mattresses thoroughly including the crevices, handles and buttons. Vacuum bed frame, baseboards and objects/flooring close to bed. Discard the vacuum bag (placed in tightly sealed garbage bag before disposal). Remove all clothing from dressers and place in clean plastic bags or plastic totes. Bookshelves, nightstands or other furniture in the immediate area must be emptied so that the technician can spray the undersides of the furniture. Place all items in tightly sealed garbage bags and leave them in the room to be treated. For more information visit bedbugsinfo.ca

Laundering All clothing items should be placed in garbage bags, sealed and emptied directly into the washing machine. Your clean laundry should be placed in new clear garbage bags and sealed during the treatment process. The garbage bags used for transporting clothing articles to the laundry room should be discarded outside the premise as they may contain bed bugs. For severe infestations, water soluble bags should be used if possible to collect sheets and clothing and put directly into the wash. It is important to launder items using hot water, as cold water will not kill bed bugs or their eggs. All clean clothes should be put in the dryer on high for a minimum of 30 minutes. Some clothing may require dry cleaning. Beds All bedding must be removed before the pest control technician arrives. Soiled bedding should be washed in hot water (separate from all other laundry) or dry cleaned before or soon after the treatment to avoid resurgence of bed bugs. Pillows should also be placed in the dryer on high heat for a minimum of 30 minutes. After treatment, bed skirts should be avoided; bedding tucked in tightly; and the bed kept a few inches away from the wall. Baby cribs All linen should be laundered. All toys should be washed in soapy hot water and stuffed toys should be placed in dryer on high heat for a minimum of 30 minutes. Dressers and night tables All contents of dressers are to be placed in garbage bags to be transported. Next place them in the dryer cycle on hot for a minimum of 30 minutes. All articles on top of dresser are to be removed and placed in plastic bags or plastic totes. Bookshelves, nightstands or other furniture in the immediate area must be emptied so that the technician can spray the undersides of the furniture. Furniture and items should be moved at least 30 cm (12 inches) away from the walls to facilitate spraying of the baseboards. Shelving and drawers should be clean. Closets All closets including linen closets are to be emptied. Clean articles should be placed in the dryer on high heat for a minimum of 30 minutes. All soiled articles need to be washed in hot water and then dried in high heat. Laundromat dryers may have lower heat settings so the full cycle should be used. Sofas and chairs All chair covers, throws and pillows must be laundered prior to treatment. Disposal of furniture Discarding beds, bedding, and furniture is NOT a sound approach to bed bug control as they can be easily re-infested. Furniture that is infested with bed bugs that cannot be salvaged needs to be disposed of in a manner that will prevent the further spread of bed bugs. If you decide to throw out bed bug infested furniture: Take apart, deface or damage the piece of furniture to ensure it cannot be reused. Mattresses should be slashed or otherwise damaged to make it unusable and wrapped. Wrap the furniture in plastic so bed bugs cannot escape. This should be done in the unit before the mattress is removed. Mark your furniture with clear warnings and put in trash shortly before pick-up, so it doesn t sit for a long time. Catalogue No. 015708 March 2011 2011 Queen s Printer of Ontario For more information visit bedbugsinfo.ca

16. APPENDIX I: EDUCATION AND COMMUNITY AWARENESS RESOURCES

Appendix I: Education and Community Awareness Resources Bedbugsinfo.ca: Resources 1. Pamphlets Everything You Wanted To Know About Bed Bugs 2. Fact Sheets: General Information Bed Bug Myths Bed Bug Bites Tenant Rights Regarding Bed Bugs Bed Bug Travel Tips Pest Control Information Bed Bugs and Occupational Health for Service Providers 3. IPM Guide 4. Bed Bug DVD: Everything You Wanted To Know About Bed Bugs Durham Region Health Department: Promotional Material 1. Bed Bug Posters 2. Banner Bug Displays Bed Bug Presentations 1. Don t Let Them Bug You Bed Bugs 101 (for service providers) 2. Don t Let Them Bug You Bed Bugs 101 (for general public)

17. APPENDIX J: DON T LET THE BED BUGS BITE PAMPHLET (Durham Children s Aid Society)