Integrated Pest Control Management (IPM) In
Healthcare Facilities.
Management Systems for Infection Prevention and Control
Presenter KZ Makae
Day 3 – Environmental Health
2. INTRODUCTION: �
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Integrated Pest Management (IPM) is a systematic approach to preventing and controlling pests through a combination of environmental, physical, biological and chemical control measures. The primary objective is to reduce pest populations to levels that do not present unacceptable public health or Infection Prevention and Control risks. The growing concern about environmental health problems associated with pesticide use and its lifecycle management is rapidly entering the public discourse. There is a growing need to explain and justify the use pesticides and exposing populations and the environment to such chemicals. The Department is therefore required to manage this process expediently through implementation of the policy to ensure effectiveness in managing divergent views on pesticide use and to achieve pest free healthcare facilities.
The traditional approach of eliminating pests through chemicals usage only as out-dated and not an existing practice in our health facilities anymore. Currently a holistic IPM system is used and achieved through the Environmental health practitioner’s interventions and the use of pest control contractor. The strategy focuses on long term sustainable prevention or suppression of pest problems, using chemicals as a last resort, with minimum impact on the environment, human health and non-target organisms.
Traditional pest control entails periodic broad-based application of pesticides in reaction to pest infestations. This approach presents particular concerns for asthmatics and children as evidence suggests that pesticides, like pests, can trigger asthma, linked to damage to the respiratory and nervous systems, injury to the reproductive organs, and dysfunction of the immune and endocrine systems, birth defects, and cancer. People with pre-existing conditions (e.g., TB, HIV, AIDS, Cancer, allergies, malnourishment, and diabetes), the elderly, pregnant women and children are particularly at risk.
The goal is to reduce harmful exposures to pests/ or biological agents incidents while still controlling pest infestations and problems.
We see our vision as one that provides a healthy and attractive environment for staff as well as patients, consistent compliance to the related legislation i.e. bylaws, Norms and Standards of Environmental Health and OHSC.��Situation: Pesticides are by their design hazardous or poisonous chemicals designed to kill or repel as they are undesirable or that may threaten human health. In many cases pesticides are designed to impact the immune, reproductive, or nervous system of insects or act as a anti-coagulant for rodents. Most pesticides contain volatile compounds and residues that may also contribute to poor indoor air quality. In addition to killing pests, pesticides may affect beneficial organisms and exacerbate asthma and cause other acute adverse health conditions such as nausea, headaches, rashes, skin and eye irritation, difficulty breathing or wheezing, dizziness or mental confusion, disorientation, seizures, coma and death in humans. Most studies also indicate the causal relationship between pesticides use and chronic conditions such as birth defects, reproductive disorders, nervous and immune system disorders and cancer. �
3. LEGISLATIVE FRAMEWORK: �
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Fertilizers, Farm Feeds, Agricultural Remedies and Stock Remedies Act, Act 36 of 1947, section 2.��Any species, strain or biotype of plant, animal or pathogenic agent injurious to plants and plant products, materials or environments, and includes vectors of parasites or pathogens of human or animal disease and animals causing public health nuisance ��Must ensure that all workers are protected in terms of Occupational Health and Safety Act of 1993, (Act 85 of 1993) and related Regulations. ��Shall ensure that pest control operators operate within the framework Farm Feeds, Agricultural remedies and Stock Remedies Act, Act No. 36 of 1947 and related Regulations such as Pest Control Operator Regulations, Regulation No. 98 of! 18 February 2011.��Hazardous Chemical Substances Act, Act No. 15 of 1973 and Promotion of Access to Information Act, Act No. 2 of 2000. ��
4. THE PRINCIPLES OF IPM MANAGEMENT:�
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IPM focuses on:
Uses prevention:
sensitive medical equipment.
Core Steps of hospital IPM:
�Healthcare facilities contain many conditions that may attract pests if environmental controls are inadequate, i.e. Food, Water, Waste, Warm buildings, Shelter, Poor housekeeping, Structural defects, Regulated pesticides;
5. HOW PEST CONTROL CONTRIBUTE TO DISEASE TRNASMISSION:�
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Disease Transmission:
Patients in healthcare facilities are more vulnerable than the general population, making effective pest prevention non-negotiable services. �,
Biological Transmission: Some pests act as vectors/ infectious agent develops or multiplies within the pest before being transmitted to humans, i.e. mosquitoes- transmitting malaria in endemic regions. �•Although common in many healthcare facilities, EHPs and team should understand the concept because healthcare facilities must prevent breeding sites and protect vulnerable patients. �
Mechanical Transmission:
Occurs when microorganisms are carried on the outside of the pest's body, i.e. a fly lands on contaminated waste and then lands on uncovered food. �Microorganisms are transferred without multiplying inside the pest. Organisms that may be spread mechanically include i.e. �• Salmonella species, �• Shigella species. �• E. Coli. �• Staphylococcus aureus. �
6. IDENTIFY COMMON HEALTHCARE PESTS:
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Common Pests | Factors That Attract Pests | High-Risk Areas | Risk Rating | Control Measures | Responsible |
Cockroaches | • Food crumbs�• Standing water�• Hidden shelter | • Hospital kitchens�• Staff kitchens�• Equipment bases | High | • Scrub beneath equipment�• Repair plumbing leaks�• Apply targeted baits | • Kitchen Staff�• Maintenance Team�• Pest Contractor |
Rodents (Mice/Rats) | • Unsealed dry food�• Structural gaps�• Waste accumulation | • Dry food stores�• Loading bays�• Laundry rooms | High | • Seal gaps under external doors�• Store food in gnaw-proof bins�• Set up routine traps | • Facilities Manager�• Maintenance Team�• Pest Contractor |
Flies | • Overflowing trash�• Exposed faecal matter�• Food odours. | • Waste storage areas�• Kitchen surfaces�• Patient wards | High | • Empty trash bins frequently.�• Install fly screens and traps�• Keep food covered | • Cleaning Staff�• Kitchen Staff |
Lice | • Close body contact�• Shared personal items�• Unwashed bedding/linen | • Patient wards- MHF.�• Laundry facilities�• Waiting areas | High | • Wash linen at high temperatures�• Treat affected patients promptly�• Educate staff on precautions. | • Nursing Staff�• Laundry Staff�• Infection Control Team |
Wasps | • Sweet food/drinks�• Exposed bin waste�• Sheltered roof | • Outdoor dining areas.�• Waste storage areas�• Roof spaces | Medium | • Keep outdoor bins tightly sealed�• Safely remove nests early�• Cover outdoor food and drinks | • Groundman Staff�• Pest Contractor |
Bees | • Flowering plants�• Water sources�• Hollow wall cavities | • Facility gardens�• Plant rooms�• External structural gaps | Medium | • Call professional bee relocators�• Seal external wall cavities�• Post warning signs if swarm appears | • Facilities Manager�• Humane Bee Relocator |
Birds | • Open roof spaces�• Exposed structures�• Outdoor food scraps | • Roof spaces�• Ventilation systems�• Facility gardens | Medium | • Block entry points to roofs�• Clear blocked gutters regularly�• Install bird deterrents | • Maintenance Team�• Facilities Manager |
Bed Bugs | • Shared bedding�• Fabric clutter�• Passenger luggage | • Patient wards-hospital/MHF.�• Laundry facilities�• Waiting areas | Medium | • Enhance linen cleaning practices�• Conduct prompt inspections�• Isolate infested furniture | • Nursing Staff�• Laundry Staff�• Pest Contractor |
Mosquitoes | • Standing water�• Outdoor clutter�• Open windows | • Facility gardens�• Plant rooms�• Sewage systems | Low | • Drain all standing water�• Maintain outdoor gardens�• Fix structural water defects | • Groundskeeping Staff�• Maintenance Team |
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7. CONDUCT PEST CONTROL RISK ASSESSMSNT:
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Step 1- Identify High- Risk Areas.
Inspect facilities- pest breeding areas i.e. laundry, kitchen(s), sewage systems, patients departments, loading bays, food storages, plant rooms, garden, mortuary.
Step 4- Assess the Risk. Consider- harmed? Could food be contaminated? Could patents be exposed? How quickly can the infestation spread?
High- Risk clinical areas require immediate intervention.
Step 3 Identify Contributing Factors. Determine why pest are present.
Poor housekeeping. Inadequate waste management. Food spillages. Standing water. Leaking pipes. Poor drainages. Clutter/ Rubble. Damaged doors. Broken windows. Cracked walls. Overgrown vegetation.
Removing these conditions often eliminates the infestation.
Step 5-Recommend Corrective Actions. Focus on-
Eliminate water sources. Eliminate food sources. Remove shelter. Preventing access. Improve sanitation. Repairing buildings. Monitoring results.
Chemical control should be considered only after environmental controls have been implemented.
Step 2- Look for Evidence of pest Activity.
i.e. live or dead pests, droppings, egg cases, nests, gnaw marks, feathers, shead skins, bite damages, unusual odours or insect fragments.
Evidence is more crucial than seeing the pest.
STOP AND REFLECT:
Norms and Standards- Monitoring standards for vector control
2.3.1 Premises must be monitored for the breeding of vectors to prevent conditioner that may contribute to disease transmission and spread.
2.32 Inspections referred to in 2.8.i must be structured as follows:
Pest Risk Assessment Process:
8. RECOMMEND PREVENTATIVE ENVIRONMENTAL CONTROL MEASURES:
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Good Housekeeping
Waste Management
Water Management
Structural Maintenance
Landscaping
Pest Monitoring.
Pest Sight Reports.
Role of Staff.
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9. THE SAFE USE; STORAGE AND DISPOSAL OF PESTICIDES:�
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A. Principles of Responsible Pesticide Use.
B. Select an Appropriate Pesticide.
C: Safe Storage of Pesticides.
D: Safe Handling of Pesticides.
E: PPE.
F: Application of Pesticides.
G: Pesticide Spills.
H: Disposal of Pesticides and Empty Containers.
I: Contract Management.
J: Documentation.
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10. MONITOR AND AUDIT AN IPM PROGRAMMES:
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11. ENVIRONMENTAL HEALTH PRACTITIONER’S PROGRAMME:
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Indicator | Examples |
Pest sightings. | Number per month. |
Pest- related complaints. | Number per month. |
High-risk infestations. | Number identified. |
Corrective actions completed. | Percentage completed on time. |
Building defects repaired. | Percentage completed. |
Contractor’s compliance. | Audit score. |
Pesticides application. | Number justified by monitoring. |
Audit compliance. | Overall IPM compliance score. |
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12. ENVIRONMENTAL HEALTH PRACTITIONER’S ROLE IN HEALTHCARE PEST MANAGEMENT:��
Case Study.
Rodent activity near the hospital kitchen.
Repeated reports of rodents are received from hospital kitchen staff.
EHP conducts an investigation.
Findings.: outside waste bins are overflowing. Overgrown vegetation around waste storage. Damaged drainage cover. Gaps beneath the delivery door. Dry food stored directly on the floor. Pest contracts reports are not reviewed by management.
Corrective Measures: multidisciplinary team.
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Staff Education:
Incidents Reporting and Investigation:
Environmental Health Leadership:
Compliant to Pest Control legislation and relating.
Environmental Health Leadership
Advocate for IPM in area of the facilities.
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13. REFERENCES:�
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References:
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THE END:
THANK YOU.
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