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IPM in a Medical Treatment Facility

IPM in a Medical Treatment Facility. John D. Nelson, BCE Entomologist Tripler Army Medical Center. References. AR 40-5, Preventive Medicine TB MED 561, Occupational and Environmental Health Pest Surveillance AR 200-5, Environmental Quality, Pest Mgmt. DODI 4150.7, Pest Mgmt. Program.

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IPM in a Medical Treatment Facility

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  1. IPM in a Medical Treatment Facility John D. Nelson, BCE Entomologist Tripler Army Medical Center

  2. References • AR 40-5, Preventive Medicine • TB MED 561, Occupational and Environmental Health Pest Surveillance • AR 200-5, Environmental Quality, Pest Mgmt. • DODI 4150.7, Pest Mgmt. Program. • TIM No. 20 - Pest Mgmt. Operations in a Medical Treatment Facility • TIM No. 29 - IPM Mgmt. In and Around Buildings

  3. Outline • TAMC – Pest Mgmt. Program Summary • “Urban” IPM in a Hospital Environment (MTF) • MTF Pests • Pest Mgmt. Process • IPM Program Elements • Case Study – Crazy Ants • Opportunities / Iniaitives

  4. Tripler Army Medical CenterPest Mgmt. Administration • Pest Mgmt. services non-standardized in MTFs across DA, DoD • Tenant of USAG-HI (installation) • USAG-HI Entomologist maintains PMP for entire installation; TAMC has autonomous program • Pest Mgmt. activities transferred from DPW to TAMC in 1998 • TAMC Entomologist administers the PMP, serves as COR for pest control service contracts • Responsible for pest control activities in CAC 500 bldgs. • Subcontractors carry out pest mgmt. actions within TAMC (funded by logistics division) • MOA between Logistics Div. and Dept. Prev. Med. • Funding: 20K LOG, 5K Dept. PV, 20K EPR funds

  5. TAMC Pest Mgmt. Personnel • Entomologist • Dept. of Prev. Med., Env. Health Section. • Pest Mgmt. Coordinator • Medical Entomologist • Currently “one-man-show” • 91S • GS-9 Technician • Contractors

  6. Facility

  7. Installation Description 2,159,509 sq. ft.

  8. Hospital SettingImportant Issues • Little to no threshold tolerance • Nosocomial infectious agents (mechanical transmission) • Sensitive environments – pests may affect sterility of supplies and equipment • Immunocompromised individuals • Infants/children • Anxiety – pests may interfere with patient comfort or recovery • High liability potential – if pests implicated in compromising quality of patient care

  9. Hospital Environments • Sensitive environments • Surgical suites • Sterile facilities • ICUs • Patient wards/rooms • Waiting areas • Food handling / service establishments • Food areas • Nonfood areas • Admin, Maintenance, & Utility areas • Lounges / Break-rooms • Waiting rooms • Locker rooms • Offices

  10. MTF Demographics • Generals / senior officers • Surgeons • Other physicians • Nurses • Senior / junior enlisted • Civilians • Patients (AD & Beneficiaries) • Contractors

  11. Field Environment Monitoring Multiple strategies Economic thresholds Some insects tolerated Minimal human interaction Human Environment Monitoring Multiple strategies Aesthetic thresholds Very few insects tolerated Constant human interaction Agricultural vs. Urban IPM

  12. Urban environment • Manmade environment • Conditions suitable/comfortable for humans & pests • Consistent world wide • Specific assemblage of pests

  13. Urban IPM Components • Inspection • Education - clients and technicians • Analyzing pest problem • Taking short term corrective actions • Implement long-term, preventive action • Sanitation / Exclusion • Monitoring, documenting, and evaluating results • Follow-up • Measurement of customer satisfaction critical

  14. Essential Program Elements(keys for success) • IPM treatment strategies - variety • Knowledgeable coordinator • Pest id • Treatment recommendations • Reevaluation • Long-term solutions • Comprehensive plan • Decision models • Paper trail/record keeping • Public relations • Contractor relations

  15. Pests • Ants • Roaches • Rodents • Birds • Termites • Arachnids • Ectoparasites • Flies • Wasps / Bees

  16. Pest Management Process Complaint Inspection/Consultation Sanitation/Education Structural modification Treatment Monitoring

  17. 1) Complaint • Avenues • Telephone • Email • Website – Sharepoint (internal) • Direct – “Hey you…” • PMC Inspection – routine and random • Priority assignment • FY 06’ Avg. response time ≤ 48 hrs.

  18. Pest Complaint Percentagesn=275 FY 06’

  19. 2) Inspection / Consultation • Talk to POC • History of problem • Pest species • Source of problem • Food / water • Other concerns or issues • DD Form 1532-1 (or equivalent)

  20. 3) Education • Food / water sources • Important species • Control methods used • Concerns warranted? • Attainable expectations? • Listen & communicate • Training opportunity / Empowerment

  21. Pests in Paradise Primer

  22. 4) Structural Modification & Sanitation • Elements • Door / windows • Cracks / crevices • Water • Landscape • Plants • Water containers • Garbage / recycle cans • Harborage

  23. Pest Requirements FOOD WATER SHELTER

  24. 5) Treatment • Physical, biological, and or chemical control • Pesticides, baits (must be labeled for hospital use) • No preventive treatments allowed by regs • Coordinator or Contractor as PCO? • Common Sense Rule • Work order generation • On-call priority designations

  25. Control Options • Sanitation • Education • Monitoring • Exclusion • Trapping • Baiting • Pesticide application

  26. Problem Areas • Lockers • Break rooms • Plumbing • Restaurants • Office goodies • Patient waiting rooms

  27. 6) Monitoring • Pesticides should only be applied with supportive monitoring data • Population estimation • Decision levels • Baseline information • Conducted regularly (fixed traps, customer survey, or pest log)

  28. Pest Control Contract Problems • No direct control • Control options • Quality of work • Liability of environmental regulations • No vested interest in organization • Difficult to terminate • More difficult to rehire new company

  29. Contract Relations • Recruiting quality companies • Communication • Quality Control • Professionalism • Client satisfaction • Efficacy • Timeliness • Safety • Compliance with laws / regs

  30. Pest Ants of HI • big-headed • crazy • glaber • pharaoh • long-legged • carpenter • ghost • argentine

  31. Ant Requirements • Food • protein • fat • sugar • Water • Shelter (harborage) - sometimes • carpenter ants • glaber ants

  32. Ant Food Preferences & Colony Structure

  33. Ant IPM - Baiting • Low toxicity • Feeding preference • Pre-baiting • Closest to source • NO insecticide use • Bait acceptance • Re-inspection / refresh baits

  34. Ant IPM - Bait Types • Stations - various • Gels – various • Liquids - sugar/boric acid • Custom mixtures

  35. Ant IPM Start Ant Aesthetic Threshold: A/D = Ants per day (+) A/D > 10 (Complaint) (-) A/D < or = 10 (Satisfaction) (+) Pest Complaint (-) Inspection / identification (+) (-) Education/Sanitation/ Environmental modification (+) Group A Group B (-) Seek and destroy colonies (outside) Interior/exterior Baiting 1-month follow-up inspection (+)

  36. Group A Species Glaber Ants Long-legged Argentine Carpenter Big-headed Group B Species Crazy Pharaoh Ghost Ant IPM

  37. Pathogens Associated with Pharaoh Ants in Hospitals • Pseudomonas aeroginosa • Staphlococcus spp. • Steptococcus pyogenes • Salmonella spp. • Clostridium spp. • Many others...

  38. Crazy Ant Case Study Paratrechina longicornis (Latr.)

  39. Crazy Ant Complaints • Several urgent complaints from A-wing, 2nd floor • Party Friday - Department of Surgery • Refreshments left out over the weekend – covered with ants • Ants now in exam rooms and doc offices • Origin – perimeter of hospital

  40. Crazy Ants Contract PCO Managed • Boric acid sugar-based gel bait • Perimeter treatment • Cyfluthrin (Tempo WP) • Cypermethrin (Demon WP) • Re-infestation- one month • Re-treatment with same strategy • Infestation continuing and spreading to other areas

  41. Crazy Ant Biology • Large colonies • Multiple queens – colonies split readily • Shifting food preferences – difficult to bait • Very mobile – invades quickly • Associated with nectar producing plants • Tends aphids/scale insects

  42. Crazy Ants Coordinator Managed • Reevaluation of infestation • Boric acid & Hydromethylnon baits inside • Rapid control - no re-infestations • Continual sporadic infestations • Perimeter treatments • Exclusion • Educate staff

  43. Crazy Ants Perimeter Program • Vegetation management • Monthly monitoring • Exclusion • Perimeter treatments • Borate baits (Terro II) • Hydromethylnon baits (Amdro, Maxforce granules) • Bifenthrin (Talstar granules) • Follow-up treatments as necessary

  44. Crazy Ant Complaints PCO Coordinator Perimeter Program

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