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When we think of pest control, we may think of toxic sprays and the unpleasant fumes left behind. The fumes can make a healthy person feel bad; certainly sick patients don’t need to be submitted to it. Less toxic means of eliminating pests would be desirable anywhere but even more so in a healthcare facility. However, it would appear that the terms environmentally friendly and pest control would be at cross-purposes, because traditional means of eliminating pests called for use of toxic chemicals. Can the "greening" of the hospital environment really include the area of pest control? Is it truly possible to eliminate pests effectively without presenting the potential for harming staff, patients, and the environment?

"Absolutely," insisted Patti Costello, executive director, American Society for Healthcare Environmental Services (ASHES), Chicago, IL. "From an environmental perspective, a healthcare perspective, and a pest-management perspective, integrated pest management (IPM) is the means by which pest control should be handled in healthcare facilities. Chemicals should be used only as a last resort."

It may be a new thought for some of us, but using chemicals as a last resort is a theme you’ll hear again and again when IPM versus spraying is discussed among environmental services and pest-control professionals. Frank Meek, BCE, technical director, Orkin, Inc., Atlanta, GA, told Healthcare Purchasing News: "Many people think pest control means regularly scheduled spraying, but that doesn’t need to be the case anymore. Many healthcare facilities are choosing more environmentally friendly IPM programs. IPM focuses on prevention, making chemical treatments the last option."

Integrated pest management is based on seven steps: inspection, preventive action, identification, analysis, treatment selection, monitoring, and documentation. "While environmental services will be responsible for the development and execution-implementation," explained Costello, "they’ll still be working with a pest-management company in most, if not all, cases. The pest-management company will help the facility to develop the IPM program that bests suits its type of facility."

Stoy Hedges, entomologist and director of technical services, Terminix, Memphis, TN, told HPN that eliminating pests while minimizing the impact on humans and the environment is Terminix’s objective: "With an integrated pest-management program, the pest-management provider works with a facility manager or administrator to identify the cause of an infestation and eliminate factors that lead to the problem. With any IPM program, the identification and elimination of the cause is the first step. Applications are used judiciously when needed to treat active pest harborages."

Jani-King environmental services staff clean and disinfect patient beds, ensuring that a food source for bugs are removed.

Applications, or treatments, used in conjunction with an integrated pest-management plan could include the following:

• Crack and crevice treatment, using a dust, aerosol, or water-based product to treat areas where pests may hide or visit

• Void treatment, in which a product is used that targets small, enclosed spaces where pests might live

• Baits, placed in areas where pests are thought to travel or in spots where they are found to be living

• Spot treatments, in which water-based products are applied to very focused areas where pests are thought to be harboring

To prevent pest infestations, it’s important to know what attracts them in the first place. They have the same needs we do: food, water, shelter, and comfortable temperatures, said Meek. "IPM focuses on mitigating pests’ access to these through sanitation and facility maintenance. Addressing the causes of pest problems, and not just the symptoms, eliminates the need for scheduled pesticide treatments. If treatments are absolutely necessary, they are more targeted and rely on less volatile materials."

Meek believes that communication is essential to a successful pest-management program. "Make sure to communicate with your staff and your pest-management professional, and ensure they are talking to each other, too. A reputable pest-management provider can train your staff on how to identify conditions that will attract pests. In turn, your staff should have a central place to report pest sightings and any conditions that are conducive to pest infestations. You should review your IPM program quarterly and conduct annual third-party audits as well. This will allow you to take any corrective actions needed to keep your IPM program running smoothly."

Other keys to success were mentioned by Hedges: "The biggest key is prevention, which is accomplished by the facility adhering to its cleaning and maintenance schedules. Other keys to success include timely reporting of pest sightings to the pest management provider and the facility’s commitment to correcting conducive conditions when these are identified by the pest-management provider."

Indeed, facilities need to keep a close eye on cleanliness and maintenance for IPM to work. It takes commitment on the part of every department to be constantly vigilant in a number of ways, and it requires adequate funding to pay for the elbow grease needed to get the job done. Relying totally on spraying to keep down pest infestations is the lazy way these days.

"IPM is about cleaning and maintaining a facility properly, so as to control rodents and pests from coming into the building," Mark Regna, director of healthcare services, Jani-King, Dallas, TX, explained. "It encompasses actions such as reducing the amount of food brought into non-food areas, making sure doors close properly, making sure the trash is removed from the building quickly, caulking holes, and reporting breeches in outside walls. Spraying for pests and rodents is a last-ditch effort for a building that has not been maintained properly."

Costello highlighted the need to focus on good sanitation: "Sanitation probably is the number 1 element of IPM. It’s no secret that one fly carries enough disease-causing microorganisms to make an adult sick. Each one of the seven steps of IPM involves a process. The representative from the pest-control company will work with environmental services to do regular floor inspections. They’ll go over the five pest activity zones: entry points, water sources, food sources, sites where they potentially may be harbored, and employee areas such as lockers where food may be stored. Those five areas are looked at closely during floor inspections, searching for and identifying where potential problems may occur, whether it is fruit flies and gnats, which usually originate in a floor drain, or flies coming in the emergency room doors. Once you eliminate those five areas, you’re going to make it extremely difficult for any type of vermin to exist, because it becomes a hostile environment to them."

Sure, IPM requires more attention to details than would relying only on spraying. One person alone, even one department alone, just can’t do it, so teamwork is another theme you’ll hear from environmental services and pest-control professionals.

"The key to successful pest control in healthcare facilities is teamwork," said Costello, ASHES. "It’s a joint effort. It requires cooperation and commitment from everyone, not just environmental services. Cooperation is needed from every department head and from all employees. All need to be alert to issues such as to how often trash gets picked up, how well trash is maintained, and where boxes delivered for food service are located. Rarely will there be a big problem in and of itself. Usually a problem arises because pests are hitching a ride into the facility; so, it has to be a team effort all around. It has to be a culture of wanting to be sure that you’re operating in a facility that is as pest-free as possible. Everyone has to do their part. There must be cooperation, commitment, and communication among all involved parties, as well as paying close attention to maintaining sanitation, and really just knowing your stuff. No one is asking environmental services staff to be entomologists, but knowing pest behavior and what attracts and harbors them is half the battle. Open, exposed garbage attracts flies, food on the floor attracts ants and mice, boxes tend to attract cockroaches, so you want to get rid of them as quickly as possible, it’s knowing what constitutes a friendly environment for vermin to live, eliminating their food and water sources in the hospital environment; you just have to know what you’re looking for. It’s basically how you operate in your own house: you wouldn’t leave cookie crumbs and ice cream dribbles on your kitchen floor because it will attract ants. You don’t leave your garbage bin open on a hot summer day because it will attract flies. It’s the same thing, just on a much larger scale."

A Terminix service professional inspects a kitchen, searching for any conditions that might be conducive to pests as well as actual evidence of pest activity.

The importance of facility-wide involvement with the cleaning professionals was also highlighted by Regna, Jani-King: "We take a team approach with facilities, to ensure they’re being maintained properly, so that rodents and pests do not penetrate the building in the first place. The dietary departments are always the biggest issues for bringing pests into facilities. Food service staff in a healthcare setting should work with their suppliers to make sure deliveries don’t bring in pests. We literally have staff who do nothing but pick up trash and get it out of the facility as fast as they can. Staff cuts in environmental services can result in trash getting backed up, because trash can’t be moved out as fast as it should be. It’s very important to have enough staff available to remove waste from a facility. You need to make sure bed pans and urinals are removed and either processed or disposed of properly. That’s typically a nursing function not an environmental services function, but it still plays a role in the IPM system. Bathrooms need to be clean and disinfected. Patient trays need to be removed in a timely manner. Food taken up to the nurses’ break room draws ants from the outside in, so you need to reduce the amount of food that’s brought into non-patient areas. These types of things reduce the need to spray. Our job is to prevent the need for spraying by maintaining a clean, safe environment. It’s a team approach between environmental services, nursing, and everyone else in the building. It’s a whole environmental philosophy."

The IPM system is more environmentally friendly, but does it cost more to implement? Costello stated firmly: "An environmentally friendly pest-control program can be equally or more cost-effective than traditional methods. Preventative action versus prescriptive action after the fact is going to be more cost-effective, because it always costs more money to fix than to prevent. Prevention absolutely is more cost-effective."

Meek, Orkin, added: "The saying ‘an ounce of prevention is worth a pound of cure’ rings true for IPM. Sometimes IPM can mean an upfront investment, but you can save money in the long-run by reducing the need for costly reactive pest treatments. Also, many of the proactive facility maintenance and sanitation practices involved with IPM are already being implemented by your environmental services and infection control departments."

"You also have to look at the cost savings brought about by keeping disease-carrying pests away from immune-compromised patients," said Meek. "Though small, pests like flies and cockroaches can carry pathogens that threaten the health of your patients and staff. According to the CDC [Centers for Disease Control and Prevention], secondary infections generate $5 billion a year in additional healthcare costs. Keeping pests out is a proactive way to cut down on the risk of patients contracting a secondary infection."

Whether a facility has been maintained well already is a factor in how much it costs to implement IPM, according to Hedges, Terminix: "In some cases, eco-friendly programs can be very cost-effective, but at other times it can be quite expensive. Reducing the amount of treatments requires correcting the conditions that are supporting or contributing to an infestation. Repairing or eliminating these conditions can sometimes be costly, because significant repairs or building maintenance may be required. In other cases, the effort needed to correct a contributing condition is relatively small."

Information on the IPM program is available through a number of sources. You may want to begin by reading ASHES’ Recommended Practice: Integrated Pest Management. Call 1-800-242-2626 and request catalog number WS 057958, or order online at http://www.ashes.org/ashes/learn/
tools_and_resources/publications.shtml. Better yet, here’s a way to get the document for free. "Orkin and ASHES recently launched HealthcarePest
Control.com, an interactive online handbook that provides free training resources on smarter healthcare pest-control practices," Meek told HPN. "At HealthcarePestControl.com, you can use an interactive self-assessment to ‘score’ your pest-control program against best practices recommended by ASHES, Orkin, and Practice Greenhealth." Once you’ve completed the self-assessment, you may request a free copy of ASHES Recommended Practice: Integrated Pest Management."

ASHES’ conferences are also a source of information. At this year’s annual conference (San Antonio, TX, September 7-11), there will be two sessions related to IPM. They offer CEU.

Terminix and Jani-King also have helpful resources. "At Terminix, we offer facilities the opportunity to have our team of experts conduct on-site training sessions with the facility’s employees," said Hedges. "This step helps ensure that we are working together as a team to eliminate current infestations and prevent future problems." "Jani-King offers our Clean Hands Clean Services program to clients," said Regna. "It’s all about cleaning and disinfecting surfaces to make the environment conducive to patient care. This program can assist in the reduction of rodent and pest population by maintaining the facility properly."