Working the Bugs Out of Infection Control
Using Integrated Pest Management to Reduce Risk of Vectorborne
By Zia Siddiqi, PhD, BCE
The last thing any healthcare professional wants is for patients with weakened immune systems to be exposed to disease-causing agents while in the hospital. In such an environment, where even small deviations from proper procedure could compromise sterility and threaten a patients health, pests and the many germs they carry are absolutely unacceptable.
Pests are vectors for serious illnesses, from staphylococcus to salmonella to meningitis, and pose a serious threat to infection control in any healthcare setting. Unfortunately, hospitals can be prime targets for pest infestations. The food service operations are a powerful pest attractant, and the fact that food is often served throughout the facility only makes matters worse. Meanwhile, around-the-clock foot traffic of patients and staff coming and going provides pests with virtually endless opportunities to enter and makes it difficult to treat pest problems discreetly. Finally, pesticide use must be limited in such facilities to avoid chemical exposure among staff and patients, making control all the more challenging.
IPM: An Infection Control Imperative
The best way to protect a healthcare facility from pests is to employ a program that adheres to the principles of integrated pest management (IPM). Hopefully, IPM is becoming a familiar term among environmental services professionals, because it denotes a more environmentally responsible approach to pest management. IPM helps reduce pesticide use by combining a variety of techniques to combat pests instead of relying solely on pesticides for control.
IPM practitioners understand that pests seek habitats that fulfill their basic survival needs, namely food, shelter and water. Reducing or eliminating access to these elements will afford a measure of control over pests and reduce their presence in any facility long before pesticides are used.
Programs that go beyond traditional chemical-based prevention are a must in hospitals, where pesticide residuals could have harmful effects on patients and visitors, particularly children, pregnant women and the elderly. A number of organizations recommend IPM as the pest control methodology of choice, including the Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency (EPA), Hospitals for a Healthy Environment (H2E), and the American Society for Healthcare Environmental Services (ASHES).
In addition to these powerful endorsements, a 2003 study of IPM conducted by Atlanta-based pest control company Orkin, Inc. and Virginia Polytechnic Institute and State University showed that IPM was both more effective at controlling cockroaches than conventional chemical pest control methods and more economical in the long-term because it proactively targeted the source of pest problems and, hence, reduced the cost of maintaining the pest management program.
The Instruments of Success
The success of a healthcare IPM program depends upon four conditions: cooperation and commitment from all parties involved, good communication among these groups, ongoing maintenance and sanitation, and knowledge of pest biology and behavior.
Environmental services personnel, facility staff, the infection control committee, and pest management professionals all have different priorities, but if the IPM program is to work, these groups must be willing to work together. Lasting solutions will almost always depend on several departments or parties working together to upgrade sanitation, housekeeping, repair and occupant practices, so you have to foster a team mentality.
Communication among all parties is also crucial to the programs success. Everyone involved needs to understand the principles and goals of IPM, as well as their roles in the pest control effort. Good communication between facility staff and the pest management professional is fundamental, as employees are the professionals eyes and ears between service visits and can keep him well apprised of any pest activity so he can respond accordingly.
Ongoing maintenance and sanitation must also be high on facility managements list of priorities if IPM is to succeed. Thorough cleanings will help eliminate debris, excess moisture and harborage areas that could invite infestations. If done well, such upkeep can be just as effective as pesticides in preventing pests. Conversely, an unclean environment will make it nearly impossible to keep pests out completely, even with pesticides.
Finally, knowledge of pest biology and behavior, the latest pest control techniques, and the ins and outs of the hospitals operations is imperative with IPM. Such expertise will lead to more accurate pest identification, a better understanding of why the pests are present and how to discourage them, and smarter, less toxic control programs.
The Initial Examination
The first step in an IPM program is to conduct a detailed inspection of the interior and exterior of the hospital. During this inspection, the pest management professional can identify structural features and sanitation concerns that might be attracting pests or aiding their occupancy. Hospitals want a patient-friendly, not pest-friendly facility, so any areas that could harbor pests should be carefully inspected. Pest hot spots include the cafeteria and kitchen, staff locker rooms, the shipping and receiving docks, and medical-waste holding rooms. In these high-risk areas, special attention should be paid to potential pest entry points, food sources and moisture. Whenever possible, such elements should be removed. At the very least, pest access must be blocked.
All pests need an entrance to the hospital, and most of them dont use the front door. So, the inspection of the hospitals exterior is just as important as the review of the interior. Any cracks or holes larger than one-eighth of an inch should be repaired, since cockroaches can squeeze through cracks this size, and mice only need holes the width of a dime to enter. Special attention should be paid to the walls around pipes, windows and vents for possible entry points.
The facilitys landscaping can also be used to discourage pests from living near or approaching the hospital. All vegetation touching the building should be trimmed back at least two feet from the exterior, as it provides harborage for rodents and easy access to the building for pests like ants and cockroaches. In addition, standing water and mulch around the facility should be removed, as they can also protect pests and provide them with moisture.
After the initial inspection and identification of pest hot spots, a successful IPM program relies upon monitoring and prevention. Although the IPM professional monitors the effectiveness of the IPM program during every visit, the hospitals staff needs to also take an active role in monitoring for pest-related issues. Everyone involved in the program from facility staff to nurses to doctors has a responsibility to monitor the area for pests. If a pest sighting occurs, it should be documented and action should be taken within 24 hours.
Diagnosis and Treatment
The first step after pests have been detected is to accurately identify the targeted pest. Identifying the pest will enable you to discern why the pest is thriving and choose the correct and most efficient treatment options. As an environmentally conscious approach to pest management, IPM stresses the use of non-chemical tactics like the elimination of a pest attractants or physical removal of pests using traps.
If such non-chemical methods are ineffective in solving the problem, then chemical treatments may be used, with preference given to least-toxic formulations. When using any pesticide, the treatment must be appropriate for the target pest and should be applied sparingly to the targeted site. Baseboard spraying should be avoided. It not only increases the chances of human exposure to the pesticide, but it may decrease the chance of pest exposure, as the crawling pests most often targeted with sprays spend most of their time out of sight in cracks and crevices.
Due to the sensitive nature of hospital settings, the best practice is to notify staff and patients of any residual-active pesticide applications that is, pesticides that remain toxic for a period after they are applied. Such notification should include the name of the pesticide and its active ingredients, the date, time and site of application, the method of application, the date and time activity in the area can recommence, and the applicators name and contact information.
After any existing infestations are treated, the focus turns to prevention. Elimination of one pest problem doesnt guarantee the area will remain pest-free. The next step is to ensure pests dont return. Pest activity should be constantly monitored and reported by the pest management professional and facility staff. Likewise, bait stations and traps should be checked regularly. Vigilant monitoring makes it easier to catch and respond to budding pest problems before they become more serious. In some cases, routine facility maintenance on pest entry points or staff education on the importance of IPM probably will be required.
The Annual Check-Up
Your IPM program should be reviewed annually to identify its strengths and any areas that need improvement. For reviews of this kind to work, detailed documentation of all pest control activities is needed. Records should include dates of service, pest activity, target pests, corrective actions, pesticide usage and locations of treatments.
For more reliable results, audits of the IPM program should be unannounced and performed by someone not directly responsible for the IPM program. Some pest management providers offer audits by corporate quality assurance managers, or facility management may choose to conduct the audits. In any case, auditors should review all pest management documentation and conduct an in-depth inspection of the facility, concentrating on the areas of confirmed pest activity. A beneficial audit not only evaluates the current IPM program, but provides suggestions to improve it.
IPM promotes partnership between the pest management professional and the hospital. Just as medical professionals join together to combat diseases, so should the participants in the IPM program join together to combat pests. Reducing pests and pesticides in healthcare facilities is a critical link in the infection control chain.
Zia Siddiqi, PhD, BCE, is director of quality assurance for Orkin, Inc. Siddiqi is co-author of Integrated Pest Management, the first installment in the Recommended Practice Series published by the American Society for Healthcare Environmental Services (ASHES). Orkin and ASHES are collaborating to promote more effective and environmentally friendly pest control practices in healthcare settings through IPM.