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By Zia Siddiqi, PhD, BCE
The last thing any healthcare professional wants is forpatients with weakened immune systems to be exposed to disease-causing agentswhile in the hospital. In such an environment, where even small deviations fromproper 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 staphylococcusto salmonella to meningitis, and pose a serious threat to infection control inany healthcare setting. Unfortunately, hospitals can be prime targets for pestinfestations. The food service operations are a powerful pest attractant, andthe fact that food is often served throughout the facility only makes mattersworse. Meanwhile, around-the-clock foot traffic of patients and staffcoming and going provides pests with virtually endless opportunities to enterand makes it difficult to treat pest problems discreetly. Finally, pesticide use must be limited in such facilities toavoid chemical exposure among staff and patients, making control all the morechallenging.
IPM: An Infection Control Imperative
The best way to protect a healthcare facility from pests is toemploy a program that adheres to the principles of integrated pest management(IPM). Hopefully, IPM is becoming a familiar term among environmental servicesprofessionals, because it denotes a more environmentally responsible approach topest management. IPM helps reduce pesticide use by combining a variety oftechniques to combat pests instead of relying solely on pesticides for control.
IPM practitioners understand that pests seek habitats thatfulfill their basic survival needs, namely food, shelter and water. Reducing or eliminating access to these elements will afford ameasure of control over pests and reduce their presence in any facility longbefore pesticides are used.
Programs that go beyond traditional chemical-based preventionare a must in hospitals, where pesticide residuals could have harmful effects onpatients and visitors, particularly children, pregnant women and the elderly. Anumber 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 ofIPM conducted by Atlanta-based pest control company Orkin, Inc. and Virginia Polytechnic Institute and State University showedthat IPM was both more effective at controlling cockroaches than conventionalchemical pest control methods and more economical in the long-term because itproactively targeted the source of pest problems and, hence, reduced the cost ofmaintaining the pest management program.
The Instruments of Success
The success of a healthcare IPM program depends upon fourconditions: cooperation and commitment from all parties involved, goodcommunication among these groups, ongoing maintenance and sanitation, andknowledge of pest biology and behavior.
Environmental services personnel, facility staff, theinfection control committee, and pest management professionals all havedifferent priorities, but if the IPM program is to work, these groups must bewilling to work together. Lasting solutions will almost always depend on severaldepartments 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 programssuccess. 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 pestmanagement professional is fundamental, as employees are the professionalseyes and ears between service visits and can keep him well apprised of any pestactivity so he can respond accordingly.
Ongoing maintenance and sanitation must also be high onfacility managements list of priorities if IPM is to succeed. Thoroughcleanings will help eliminate debris, excess moisture and harborage areas thatcould invite infestations. If done well, such upkeep can be just as effective aspesticides in preventing pests. Conversely, an unclean environment will make itnearly impossible to keep pests out completely, even with pesticides.
Finally, knowledge of pest biology and behavior, the latestpest control techniques, and the ins and outs of the hospitals operations isimperative 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 detailedinspection of the interior and exterior of the hospital. During this inspection,the pest management professional can identify structural features and sanitationconcerns 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 lockerrooms, the shipping and receiving docks, and medical-waste holding rooms. Inthese high-risk areas, special attention should be paid to potential pest entrypoints, food sources and moisture. Whenever possible, such elements should beremoved. At the very least, pest access must be blocked.
All pests need an entrance to the hospital, and most of themdont use the front door. So, the inspection of the hospitals exterior isjust as important as the review of the interior. Any cracks or holes larger thanone-eighth of an inch should be repaired, since cockroaches can squeeze throughcracks 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 discouragepests from living near or approaching the hospital. All vegetation touching thebuilding should be trimmed back at least two feet from the exterior, as itprovides harborage for rodents and easy access to the building for pests likeants and cockroaches. In addition, standing water and mulch around the facilityshould be removed, as they can also protect pests and provide them withmoisture.
After the initial inspection and identification of pest hotspots, a successful IPM program relies upon monitoring and prevention. Although the IPM professional monitors the effectiveness ofthe IPM program during every visit, the hospitals staff needs to also take anactive role in monitoring for pest-related issues. Everyone involved in theprogram from facility staff to nurses to doctors has a responsibility tomonitor the area for pests. If a pest sighting occurs, it should be documentedand action should be taken within 24 hours.
Diagnosis and Treatment
The first step after pests have been detected is to accuratelyidentify the targeted pest. Identifying the pest will enable you to discern why the pest is thriving and choose the correct and mostefficient treatment options. As an environmentally conscious approach to pestmanagement, IPM stresses the use of non-chemical tactics like the elimination ofa pest attractants or physical removal of pests using traps.
If such non-chemical methods are ineffective in solving theproblem, then chemical treatments may be used, with preference given toleast-toxic formulations. When using any pesticide, the treatment must beappropriate for the target pest and should be applied sparingly to the targetedsite. Baseboard spraying should be avoided. It not only increases the chances ofhuman exposure to the pesticide, but it may decrease the chance of pestexposure, as the crawling pests most often targeted with sprays spend most oftheir time out of sight in cracks and crevices.
Due to the sensitive nature of hospital settings, the bestpractice is to notify staff and patients of any residual-active pesticideapplications that is, pesticides that remain toxic for a period after theyare applied. Such notification should include the name of the pesticide and itsactive ingredients, the date, time and site of application, the method ofapplication, the date and time activity in the area can recommence, and theapplicators name and contact information.
After any existing infestations are treated, the focus turnsto prevention. Elimination of one pest problem doesnt guarantee the areawill remain pest-free. The next step is to ensure pests dont return. Pest activity should be constantly monitored and reported bythe pest management professional and facility staff. Likewise, bait stations andtraps should be checked regularly. Vigilant monitoring makes it easier to catchand respond to budding pest problems before they become more serious. In somecases, routine facility maintenance on pest entry points or staff education onthe importance of IPM probably will be required.
The Annual Check-Up
Your IPM program should be reviewed annually to identify itsstrengths and any areas that need improvement. For reviews of this kind to work,detailed documentation of all pest control activities is needed. Records shouldinclude 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 beunannounced and performed by someone not directly responsible for the IPMprogram. Some pest management providers offer audits by corporate qualityassurance managers, or facility management may choose to conduct the audits. Inany case, auditors should review all pest management documentation and conductan in-depth inspection of the facility, concentrating on the areas of confirmedpest activity. A beneficial audit not only evaluates the current IPM program,but provides suggestions to improve it.
IPM promotes partnership between the pest managementprofessional and the hospital. Just as medical professionals join together tocombat diseases, so should the participants in the IPM program join together tocombat pests. Reducing pests and pesticides in healthcare facilities is acritical link in the infection control chain.
Zia Siddiqi, PhD, BCE, is director of quality assurance forOrkin, Inc. Siddiqi is co-author of Integrated Pest Management, the firstinstallment in the Recommended Practice Series published by the American Societyfor Healthcare Environmental Services (ASHES). Orkin and ASHES are collaboratingto promote more effective and environmentally friendly pest control practices inhealthcare settings through IPM.