Bed bug extermination can last forever as long as the treatment killed all the bed bugs (and their eggs) and if new bed bugs are not transported into the location. Factors that can affect the outcome are how severe the infestation is and whether all bed bug sources were properly identified and treated. When working with a pest control professional, the EPA recommends you check and call references; ask if they offer both chemical and non-chemical treatment options, if they recommend both encasements and interceptors, and if they offer two or more service visits and follow-up. Bed bugs are tiny (adults are roughly the size of an apple seed) and can hide anywhere a credit card can slide into. They squeeze into cracks in walls, behind electrical outlet sockets, in bedding, and in other dark places. Learn how to prepare your home for a bed bug treatment for the best outcomes. Michigan State University shares some examples of possible reasons that a bed bug extermination is not 100 percent effective:

• Not all sources (aka hiding places) of the bed bugs were identified during initial inspection.
• Not all sources of bed bugs were treated.
• The insecticides used were not effective or, in the case of heat treatment, there was insufficient contact time.
• Infested items such as bedding or other materials were reintroduced into a cleaned area.

If you are concerned you have a bed bug infestation, look for physical signs of their presence. Bed bugs love to hide in small, dark spaces and typically come out to feed (generally on human blood) after dark — although they will come out in daylight if hungry enough. The Environmental Protection Agency states that indications of an infestation can include seeing shed exoskeletons of bed bugs, rusty spots on your bedding (which are either bug droppings or bloodstains), live bed bugs, bed bug egg casings, a sweet and musty odor (if the infestation is severe), and evidence of bites on your skin.

To spot bed bugs, look in and along mattress seams and bedding, in curtain and furniture folds, inside cracks or crevices in the walls, behind picture frames and mirrors, under loose wallpaper seams, on recently used luggage or backpacks, inside electronics, and inside clothing or cluttered areas such as closets. If you see signs of bed bugs, be careful not to disturb them too much as you don’t want them scattering to other parts of your house.

Bed bugs can happen to anybody and there typically more than 200,000 cases in the U.S. per year. They are sneaky little pests that hitchhike into your home in a variety of ways. Getting a bed bug infestation is not a reflection on how clean a home is; bed bugs can infiltrate the cleanest of places — although their presence is easier to detect and eliminate in clutter-free spaces. Here are some tips from the EPA to prevent bed bugs from entering and taking up residence in your home:

• Carefully inspect secondhand furniture, beds, or couches for any signs of bed bug infestation before bringing them home.
• Use a protective cover (encasement) over mattresses and box springs to prevent bed bugs from hiding in them. Select an encasement in a light color to make bed bug spotting easier. Also choose one of a strong material that won’t tear, and check it often for holes.
• Keep your home clutter-free to eliminate bed bug hiding spots.
• Vacuum your home regularly and dispose of sealed vacuum bags carefully.
• Shared laundry facilities can lead to bed bug exposure in both directions. Transport laundry in plastic bags (if you have an active infestation, use a new bag for the journey home). Remove laundry from the dryer directly into the bag and fold it at home. Use high heat to kill any potential bed bugs.
• The EPA suggests that if you live in a multi-family home, isolate your unit by:
• Installing door sweeps on the bottom of doors to discourage movement into hallways.
• Sealing cracks and crevices around baseboards, light sockets, etc., to discourage movement through wall voids.

Bed bugs are visible to the naked eye, but depending on where they are in their life cycle they can be hard to see. Adult bed bugs are the easiest to spot. According to the EPA, they are roughly the size of an apple seed and the height of a credit card. Adults are flat and oval-shaped, have six legs, and are rusty red in color. Bed bug larvae, also referred to as nymphs, are white-yellow or translucent in color and are much harder to spot due to their small size. The nymphs go through five stages of life, shedding an exoskeleton at each stage. Throughout these stages the nymphs grow in size from approximately 1.5 millimeters to approximately 4.5 millimeters. Bed bug eggs can be the most challenging to see as they are roughly 1 millimeter — about the size of a pinhead — and are white or clear. Bed bugs tend to be more active at night, as this is when they feed.

The EPA recommends integrated pest management as the most effective way to get rid of bed bugs. Integrated pest management (IPM) can be carried out by a pest management professional safely and swiftly. The professional will assess the level of infestation in your home or building. The pro will determine the sources of the bed bugs: whether they are hiding in one location, are occupying multiple locations in one room, or have set up camp in multiple locations throughout the house. Based on the severity of the infestation, IPM can include thoroughly cleaning the area using containment protocols (safely packing infested bedding and other items into plastic to be disinfected), the appropriate pesticide treatment, and the necessary follow-up to eliminate any new hatching eggs. The EPA recommends chemical treatments (when safely applied) because “although bed bugs may sometimes be controlled by non-chemical means alone, this approach is often very difficult, potentially less effective, and usually more resource intensive.” Use caution if you attempt to use pesticides yourself. Carefully follow directions and know that some bed bugs have developed resistance to pesticides. Pesticides that are licensed only for use by professionals are known to be stronger and should be applied with the proper tools and techniques.

There are several signs that can indicate you have bed bugs. The first is actually seeing the little pests skittering through your house. They tend to feed at night (generally where their hosts — people or sometimes animals — are sleeping), but can come out in the day if they’re hungry enough. Adult bed bugs are rusty red in color, as thin as a credit card and the size of an apple seed. Sometimes they can be mistaken for carpet beetles or small cockroaches, so if you’re confused you can use this helpful guide by the EPA for identification. Although they are harder to see, spotting the eggs themselves is a surefire sign. Another common symptom of having bed bugs is finding the exoskeletons of the nymphs near your bedding and other bed bug-friendly locations. The more exoskeletons you find, the larger the infestation likely is, because as they mate and proliferate more and more juveniles are born and cycle through moltings. Rust-colored spots — which the Centers for Disease Control and Prevention explains are blood-filled fecal dropping that the bugs excrete on bedding and furniture — are another sign that bed bugs are living in your home. In addition, a sweet, musty odor can be an indicator of bed bugs.

Bed bugs can travel into your home via luggage, secondhand furniture or clothing, and other items that have been exposed to the little pests. Bed bugs are tiny and flat (about the size of an apple seed and the height of a credit card), so they can easily hide in dark, small places and hitchhike into your home. According to the Centers for Disease Control and Prevention, most people don’t even know they’re transporting bed bugs as they travel from location to location, infecting areas as they travel. The sooner you notice a bed bug infestation in your home, the easier it is to get rid of it. The EPA suggests an integrated pest management plan to get rid of bed bug problems. This means a multi-pronged approach that takes the bug’s life cycle into account, uses chemical treatment where needed, and takes all necessary measures (use of encasements, high heat washing and drying of bedding, etc.) to stop current and future life cycles. Unless you feel confident about controlling a bed bug infestation, it can be wise to hire a pest management professional to prevent the problem from getting bigger.

The cost of bed bug extermination depends primarily on how widespread the pest infestation is and how many rooms need to be treated. Other factors that can affect bed bug extermination costs are the amount of clutter in the location, additional furniture that needs to be treated, and construction of the home. Pest management professionals often have rates for room treatments, which can vary based on these factors. As an example, a pest management company treating a 10-by-15-foot room with light infestation might charge clients about $250, while the same size room with a heavy infestation and large amounts of clutter might cost the clients $300-$400. Clutter and heavier bed bug populations mean more product and longer labor time for the workers. Rates will vary from company to company, and from region to region, but the national average bed bug extermination cost is $320-$400. Bed bug heat treatments are an alternative way to exterminate these pests. Heat treatments are typically charged per square foot and tend to cost more than chemical or non-chemical spray solutions. Although effective, they are not usually recommended for occupied spaces, as the extreme temperatures can damage televisions, window dressings and other home furnishings.

The increase in bed bug infestations in the U.S. is a result of increased travel, lack of knowledge about preventing infestations, increased resistance of bed bugs to pesticides, and ineffective pest control practices, explains the Environmental Protection Agency (EPA). It’s easy to mistake bed bugs for carpet beetles or similar-looking bugs, so infestations are often not noticed when they first occur. Prevention tips include keeping areas free of clutter, regularly washing sheets and mattress covers in hot water (and don’t forget to wash the laundry bag, too), and vacuuming regularly and safely disposing of the sealed vacuum bag. Not everyone has reactions to bed bug bites, which also may be mistaken for the bites of other pests such as mosquitoes, so timely bed bug extermination depends on identification of bed bug activity. If you notice physical signs of an infestation, contact a bed bug extermination professional as soon as possible to learn about chemical and non-chemical (such as heat) treatment options. An integrated pest management plan may incorporate one or more methods.