5 minute read
Fighting against hospital infestation
from Health Business 19.2
by PSI Media
Fighting against hospital infestation
In some of the latest facilities, pest control appears to have fallen down the gap between the management company and the trust in question. In light of this, Health Business looks at the importance of regular pest control in all parts of the hospital to keep infectious diseases at bay
Health bosses are considering legal action against the contractors who built the £842 million Queen Elizabeth Hospital in Glasgow where there have been a number of infection-related deaths.
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.
Much has been made of the events at Glasgow’s Queen Elizabeth Hospital, where a series of issues with infections where found at a Scottish hospital. Holyrood’s health committee has since set up an inquiry and has written to Scottish Health Secretary Jeane Freeman noting concerns about cleaning, maintenance and testing.
Freeman herself has commissioned a review into infections in Glasgow and what can be learned across the NHS as a whole, insisting that ‘robust measures’ are in place across the country to tackle infections.
Three deaths at the Queen Elizabeth University Hospital remain under investigation from prosecutors, with 63-year-old Mito Kaur’s death found to be the result of a fungal infection related to two previous deaths at the hospital after patients contracted a separate fungal infection linked to pigeon droppings. A 10-year-old boy and 73-year-old woman had contracted cryptococcus, a fungus linked to pigeon faeces, with the Healthcare Environment Inspectorate (HEI) first asked to examine the cleanliness of the hospital in January.
The Scottish Health Secretary has since ordered a full independent investigation into the design, maintenance and construction of the hospital, after the HEI reported that some areas of Scotland’s biggest hospital could not be cleaned properly because they were awaiting repair work. In fact, Audit Scotland has claimed that the total backlog of maintenance across Scotland’s hospitals is approaching £900 million, including hundreds of outstanding maintenance jobs at the Queen Elizabeth University Hospital alone.
Alongside the pigeon droppingrelated deaths, an investigation into the water supply at the Queen Elizabeth University Hospital in Glasgow found ‘widespread contamination’ in taps and drains, after an infection outbreak in two cancer wards at the neighbouring Royal Hospital for Children (RHC) last year. In total, 23 children contracted bloodstream infections in the cancer wards between January and September last year.
In England, there are many hospitals that formerly had deeply entrenched infestations that have now not had a significant infestation for several years. There is, however, no room for treading water. The issues around infestation and its control do not stand still. We know that infestations of cockroaches, bed bugs and other pests in hospitals are still all too common.
In some of the latest facilities, pest control appears to have fallen down the gap between the management company and the trust in question. 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.
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. Sometimes, significant questions have subsequently come to light about the design of details in new buildings, with the topical issue of pigeon roosting sites located close to air intakes and clinical facilities serving as a prime example.
Where can they have come from?
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. 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.
