Bedbug outbreaks across the United States require a proactive approach, according to Marc Lame, clinical assistant professor at the Indiana University School of Public and Environmental Affairs and an expert in pest management. Lame says operators of housing that is susceptible to infestations -- such as hotels, college dorms, apartments and shelters -- should make plans for preventing and responding to the problem.

"They need to have an action plan right now, and they need to have some detection programs in place," he said. "If they don't, they will have bedbugs, and they will have real problems."

Bedbugs are small, reddish-brown insects that live in the cracks and folds of mattresses, sofas and sheets. They hide during the day and come out at night, puncturing the skin of their hosts and feeding on blood. Bedbugs don't spread disease, but their bites can cause severe itching and occasionally lead to infection.

Bedbugs were nearly eradicated in the U.S. after World War II, but they have made a comeback, spread by increasing world travel in an era when persistent pesticides such as DDT are no longer used.

"It's what some people call a perfect storm," Lame said. "And people who rely on pesticides are finding that bedbugs have built up a tremendous amount of resistance, just like they did with DDT in the 1950s. Pesticides aren't working that well; therefore, pesticides should be integrated into bedbug management rather than seen as the magic bullet."

Lame consults widely on Integrated Pest Management, an approach for controlling pests without heavy use of chemical pesticides. IPM principles call for taking steps to prevent infestations and using aggressive monitoring to catch them early. That means inspecting sheets for signs of bedbugs and possibly using bedbug monitoring devices. It also means educating housekeeping staff, facility managers, residents, customers and tenants to watch for and report the first sign of bedbugs.

Lame said bedbugs can show up anywhere, from homeless shelters to high-priced hotels, but stigma can make people reluctant to report them. And there can be confusion and legal uncertainty about who is responsible for eradicating bedbugs -- for example, a landlord or tenant.

"There are institutions that, for understandable but silly reasons, don't want their customers to think that is something they have to deal with," he said.

People living in institutional housing can use mattress covers to ensure bedbugs don't infest mattresses. Travelers should inspect their luggage and may use specially made heating chambers to keep from introducing hitch-hiking bedbugs into their homes.

Once bedbugs do show up, Lame said, the best course is usually to call a pest management professional who is experienced at eradicating bedbugs. Industrial steam, vacuuming and abrasives such as diatomaceous earth are some of the methods used for removing and controlling bedbugs.

"People have to be very persistent about getting rid of them," Lame said. "By far the most important thing is that communities need to educate people so that they are empowered to detect infestations early and become partners in their eradication."