Don't get sick from pests, get rid of them: a guide for keeping your residents--and your business--safe from ants, rodents, and other harmful invaders.

Nursing home administrators agree that providing a healthy environment for residents is a top priority. Keeping insects, rodents, and other pests out, of course, is part of that mission. Lethal fire ant attacks in long-term care facilities in recent years have made the public and industry insiders all too aware that pests can pose a very real threat to residents.

Pests also threaten nursing homes themselves. Negative publicity from an infestation can ruin a facility's reputation, and multimillion-dollar lawsuits can put the business on the line. Last April, for example, a Houston nursing home was hit with a $1.5 million judgment after a resident died as a result of more than 2,000 fire ant stings.

Unfortunately, long-term care facilities are inviting targets for many pests. Heavy traffic in and out of multiple entries, combined with busy food service, laundry and storage areas, make effective pest prevention daunting. Making the task even harder, pesticides must be used sparingly, if at all. Overexposure to certain pesticides can cause adverse health effects, especially among older or immunocompromised residents.

An administrator must know which pests to prevent, and where the facility's vulnerabilities are. Typically, five types of pests cause the most trouble, and certain areas within nursing homes are more susceptible to infestation.

The Enemies

Ants. Pharaoh ants have been known to climb into open wounds, IV bags, or used bandages. Because they nest in walls, pharaoh ants can be difficult to find and control once they become established in a facility. The wrong control procedures can lead to disaster.

Fire ants, particularly the red imported variety, can be an even greater health threat. They have attacked residents and patients in healthcare facilities in more than 10 documented cases, several of them fatal. (For more on fire ants, see Nursing Homes/Long Term Care Management, September 2001, p. 68.)

Flies. Flies are more than a nuisance; they also can spread germs rapidly. Covering distances quickly, they might feed on garbage one minute and a resident's food the next. Flies carry Staphylococcus, E. coli, and Salmonella, and can drop bacteria wherever they land. They reproduce rapidly and are hard to control once they gain entry.

Cockroaches. The mere sight of a cockroach is enough to startle and disgust residents and families. But more alarming to nursing home administrators is that roaches carry germs that can cause pneumonia, diarrhea, and food poisoning. Cockroach droppings can also inflame allergies or asthmatic conditions.

Rodents. Rodents are keenly aware of and attracted to the food served throughout long-term care facilities. In the Middle Ages, rats carried the black plague through their fleas. Today, rodents carry diseases with perhaps less menacing names--Hantavirus and typhus--but with dangerous symptoms. Most recently, scientists found that rats in Hong Kong were transmitting SARS. In addition to threatening residents' health, rodents can also cause property damage by chewing and burrowing in walls or other structures.

Birds. While often not regarded as pests, birds can infect humans with up to 40 viruses and 60 transmutable diseases, including salmonellosis, a form of food poisoning, and encephalitis, or inflammation of the brain. If left unchecked, dried bird droppings can enter a building's ventilation system and be inhaled by residents and employees. Inhalation of these airborne particles can cause histoplasmosis, a potentially fatal respiratory infection.

The Batttefields

Pests will infest any location where they can find food and moisture. Many nursing homes, unfortunately, offer both in abundance.

The residential setting within a long-term care facility is the first "hot spot." Depending on the housekeeper's vigilance, a room or apartment might be come attractive to pests. If residents leave food out or otherwise fail to keep a clean living space, pests will likely appear.

Many nursing homes have multiple dining areas serviced by one or two full kitchens, a situation which presents the same pest challenges that restaurants face. Because of regular food deliveries, pests can hitch a ride into the kitchen on incoming parcels or can invade the premises through open doors, cracks, and crevices. Care must be taken to limit chemical applications in food-preparation areas when planning a control strategy.

Employees, too, can create an attractive environment for pests. Locker rooms or break areas can be inviting to pest invaders if employees bring their own food to work. Pests will find food that is left in a locker or closet. In addition, employees might bring bags, jackets, extra shoes, or other accessories on which pests can sneak into nursing homes.

Ironically, areas dedicated to cleanliness can pose problems. A janitor's supply closet might stay locked most of the time, preventing regular treatment by a pest management professional. Wet mops or buckets of water provide a moist haven for many insects. In the laundry room, stacks of dirty clothes provide shelter and warmth for pests. And if the room is used heavily, finding time to treat it might be difficult.

How can you treat these areas safely and effectively? Integrated Pest Management (IPM) is a philosophy that stresses a combination of chemical and nonchemical methods to control pests. The driving principle behind IPM is to control the problem with limited pesticide use by making an environment unattractive to pests.

Battle Plan

Pests will avoid areas that don't give them what they need. Generally, this means food, water, and shelter. As noted earlier, the variety of microenvironments within a long-term care facility make it a tough place to treat with just one set of procedures. For example, the same techniques used to treat a resident's room might not be appropriate for a food preparation area, dining area, or laundry room. But there are some basic IPM building blocks that are useful in multiple areas. Let's take a look at some of these practices, working from the outside of the facility to the inside:

* Mount outdoor fluorescent lights at least 100 feet from the building to draw fries and other flying insects away from the entrance doors.

* Use sodium vapor lights at entrances and exits. Insects are less attracted to these light sources.

* Make sure that all exterior doors fit tightly and caulk any and all crevices, especially those on the exterior of the building(s).

* Install ultraviolet light traps near service doors and loading docks to intercept flying insects before they enter the building.

* Inspect shipments for pests or evidence of pest presence such as droppings, chew marks, or exoskeletons before moving them into a receiving area.

* Make sure your vendors are taking steps to prevent pests from infiltrating their deliveries while in transit or storage.

* Minimize outside airflow at receiving areas by using plastic-strip doors. Unpack shipments and dispose of any empty boxes at this location.

* Make sure floors stay free of litter, food, and other debris.

* Cover and seal bulk-food storage containers and garbage containers.

* Store mops, brooms, or other cleaning supplies off the floor in a housekeeping closet.

* Do not place storage racks flush against the wall. As a general rule, keep an 18" gap between the wall and the rack.

* Install fly lights or glue traps if there are any fly "hot spots" inside the facility.

* Check and clean floor drains regularly. Flies will breed in clogged or filthy drains.

* Keep tiled ceilings intact. Broken or missing tiles should be replaced. Ceiling voids can be used as a crawl space for rodents or a breeding ground for flies.

* Maintain a strict waste management system by securing trash bins throughout the building. Empty trash cans regularly and schedule petiole pickup, so collected refuse doesn't sit around the building.

* Make sure food isn't left in employees, lockers overnight. Provide a secure storage area, such as a refrigerator, for all food. Require workers to regularly clean out their lockers; giving a pest management technician a chance to treat the area.

Choosing Your "Commanders"

Because unchecked pest infestations and the misapplication of pesticides both could be serious blunders for a long-term care facility, many choose to outsource their pest management to trained professionals. In most cases, professional pest management providers have the advantage of in-depth scientific knowledge about pest behavior and years of experience in pest prevention.

Because there are numerous pest management providers to choose from, narrow the field by asking industry colleagues about reputable companies. When discussing potential providers, ask questions that separate credible, experienced providers from the rest, such as:

* Does the provider specialize in commercial pest control?

* Are the provider's technicians aware of the special needs of a long-term care facility?

* Is the provider a member of national, state, or local pest control associations?

* Are the provider's technicians licensed and/or certified by the state?

* What kind of training do the technicians receive?

* What is the average response time to an emergency? Is there an extra charge for such emergency responses?

* Does the provider offer a money-back guarantee on its service?

* How long has the provider been in business?

Once you have a handful of companies on your list, you will need to examine them more closely to choose the right one for your needs. Here are a few tips:

* Contact three or four companies and insist that they tour your facility before submitting a bid.

* Ask a lot of questions on the site tour. Professionals will know the answers.

* Be sure to address which specific pests are included in the contract. Ask about additional charges when extra services are needed for a noncontracted pest.

* Make the purchase decision based on value, not price. In many cases, the lowest priced service does not equate with other bids. Be sure you are comparing apples to apples.

Strategic Planning

Because of the multiple sensitive environments that exist in a long-term care setting, a thorough and customized IPM plan is the best way to protect and treat the facility. IPM is not a one time event. Instead, IPM requires ongoing sanitation, pest monitoring, and prevention. Nursing homes can treat the causes of pest problems rather than the symptoms by making facilities unattractive to pests, instead of simply trying to eliminate pests when they are found. The bottom line: Effective IPM is a joint venture of the nursing home staff and the pest management provider. Pest management programs that adhere to this philosophy are the most effective way to prevent pests over the long term in nursing homes and many other healthcare environments.

Zia Siddiqi, PhD, BCE, is Director of Quality Assurance for Orkin, Inc. He has studied urban, industrial, and agricultural pests, and has designed pest control programs in numerous countries. Frank Meek, BCE, is National Pest Control Technical Manager for Orkin, Inc. He is an acknowledged leader in the field of pest management. Orkin has more than 250,000 commercial customers, making it one of the largest commercial pest control providers in North America. For more information, send e-mail to zsiddiqi@ rollinscorp.com, or [e-mail]. Call 1-800-675-4666 if interested in a free inspection. To comment on this article, e mail [e-mail].