The problem of patients and pests

Hospitals are vulnerable to infestation. The modern hospital functions on a 24-hour, 365-day basis, with several thousand staff, patients and other visitors, supported by a wide range of services. As such it resembles a small city, creating a very attractive habitat for a range of pests. So how should pests in a healthcare environment be handled?

There have been times when infestation in hospitals was not being appropriately managed. In the early 1980s, records indicated that about 65 per cent of UK hospitals were infested with oriental cockroaches, and about 10 per cent had pharaohs ants. At that time, Crown Immunity of hospital premises was seen as one reason why infestation was not being taken seriously, and public concern eventually resulted in the lifting of Crown Immunity in 1984. This move, together with the introduction of measures by the Department of Health, including the preparation of a Model Contract for Pest Control, and the establishment within each hospital of a trained nominated officer with responsibility for the management of pest control, brought about a gradual improvement.
  
Importantly, these measures changed the culture of pest control in hospitals, by showing that it was possible to eradicate many pests that had formerly been considered as fixtures. Across the UK, there are many hospitals that formerly had deeply entrenched infestations that have now not had a significant infestation for several years.

Up to speed
There is, however, no room for treading water. The issues around infestation and its control do not stand still. Feedback on recent nominated officer training courses indicates that infestations of cockroaches, bed bugs and other pests in hospitals are still all too common.

Recent reports also indicate that some pests, such as rats and mice, are on the increase across the UK, and this is being reflected in hospitals.

In addition, entirely new pests such as ghost ants have appeared in the UK, and are becoming increasingly widespread.

In addition to changes in pests, changes in the health service also bring new challenges. In some of the latest facilities, pest control appears to have fallen down the gap between the management company and the Trust. Pest control, where this has been considered at all, has sometimes gone out to tender along with catering, cleaning, security, and car parking, with no consideration of existing arrangements or of the specific requirements of the site.
    
Sometimes, significant questions have subsequently come to light about the design of details in new buildings, for example with respect to pigeon roosting sites close to air intakes and clinical facilities.
    
Old buildings can also bring their own problems. On numerous sites, redundant buildings sit empty prior to demolition, and some hospitals have removed these from the pest control contract in order to save costs, which can lead to several problems. At one site, rats became established in a redundant building that was no longer subject to pest control inspection, and started to cause a persistent problem in the nearby Out Patients Department.

Litigation
The risk of litigation in relation to infestation has grown in recent years. The lifting of Crown Immunity created the possibility of legal action under food safety legislation, and for some hospitals this has since become reality. Of course all Trusts will also have a duty to provide a safe working environment for staff, and this extends to the prevention of pest infestation. Similarly any Trust that provides accommodation for staff will also have responsibilities to ensure that this is free of pests, and failure to do so again creates the possibility of claims. In addition, there is the real possibility of claims being brought by members of the public, perhaps in relation to an infestation, illness or infestation which they believe they may have acquired in hospital. As hospitals and Trusts now become increasingly competitive, the indirect costs of high profile litigation on the public and professional perception of the unit may well exceed the direct costs of Court action.
    
Faced with these and other issues, those with responsibility for the management of pest control within Trusts and hospitals need to actively maintain a broad professional competence in this area.

Where can they have come from?
Upon finding an infestation this is normally the first question to be asked, but often the last to be answered, if at all. We can normally identify which factors are conducive to infestation, but it is often very difficult to look at a particular current infestation, and work out its origin with any degree of certainty.
    
Of course we know that feral pigeons  visit the site at intervals, and may become established if they find regular food (particularly if it is deliberately placed out for them), and sheltered roosting sites. Rats, squirrels, foxes, and feral cats are all likely to respond similarly. At the other end of the scale, we presume that most stored food pests such as beetles, moths, mites etc, normally arrive within food products. However some storage insects are also associated with bird’s nests, which may provide an alternative route into a building.
    
Pests such as pharaohs ants, cockroaches and bed bugs do not normally colonise buildings very rapidly under current UK conditions, and the actual infestation routes are often difficult to identify. An infestation that re-appears some months after a treatment programme is much more likely to be based on survivors of the old infestation, rather than on newly arrived pests. Once a hospital is truly free of cockroaches, ants, or other infestations of this type, years can easily pass before a new infestation appears.

Do we need to actually eradicate them?
The reasons for keeping the hospital free of infestation are many, and reducing the risk of litigation and adverse publicity are clearly important. However within the hospital environment, reducing the risk of infection is likely to be uppermost in most peoples minds and with cases of infection contracted within hospitals believed to be running at a high rate, the co-existence of patients and potential sources of infection cannot be tolerated.
    
Studies of insects such as cockroaches, ants and houseflies have shown that these insects acquire a very wide range of human pathogens from their environment (e.g. refuse areas or drains) and are potentially able to transfer these to other areas. The pathogens are carried externally, or via their faeces or vomit. Nonetheless conclusive evidence of human infection by crawling insects is hard to establish although there are several cases that support this theory.
    
With houseflies, there is now recent research overseas to show a statistically clear link between housefly infestation and gastroenteritis.
    
Although disease transmission by some blood-feeding insects is a major problem globally; fleas, bed bugs and mosquitoes are fortunately no more than a severe nuisance in the UK at present. Research has revealed no evidence to link biting insects with infections such as hepatitis and HIV, for example. However the recent upswing in bed bug infestations has created particular problems for those suffering from haemophilia.
    
Rodents are recognised as carriers of a number of diseases and human cases of Weils disease occur regularly in the UK. At-risk groups are seen as those spending time in areas infested with rats, with cases having occurred in construction workers, watersports enthusiasts, sewer workers and others. Birds are also increasingly recognised as capable of transmitting a range of human pathogens. For example outbreaks of Listeria have been shown to be caused by birds pecking milk bottle tops, while E. coli 0157 has been shown to occur in the faeces of gulls that have been feeding on refuse.
    
Although direct effects of infestation on patients and staff are of greatest concern in hospitals, infestations can cause a wide range of other problems. For example, an infestation of food stores is likely to result in quantities of food being discarded and the enforced closure of catering, and damage to electrical cables by rodents is a fire hazard, as well as putting computing and communication systems at risk.

Putting procedures in place
Almost all hospitals and Trusts will have pest control arrangements already in place.

However the process needs to be reviewed at regular intervals, especially prior to re‑tendering for pest control work. Key aspects ensure that each hospital has a nominated officer with responsibility for pest control, and ensure that they have been specifically trained to monitor the NHS pest control contract. Moreover, adopt the NHS model pest control contract, ensure it is tailored to meet your needs, and go through a rigorous competitive tendering process at the next opportunity. Use of this contract has been instrumental in driving down hospital infestation rates in recent years.

Finally, select a competent contractor. The British Pest Control Association (BPCA) is the UK trade association representing organisations with a professional interest in pest control. All BPCA members meet our strict membership criteria, hold the relevant pest control insurances, and are fully qualified and trained to deal with your pest problems.

For further information
www.bpca.org.uk