MDS Alert

Surveyors are looking — and residents could be at risk.

Nursing facilities end up being “home” for many thousands of the United States’ elderly population. While residents are no longer in charge of the upkeep of their new home, facilities need to keep on top of the very real and present threat of “household” pests.

Beyond the myriad disease and discomfort — physical and emotional — that pests can bring to residents and staff alike, surveyors are also scanning the environment for signs of pests and vermin, under Appendix PP guidance for F925.

“So, what can go wrong when a surveyor is looking for signs of vermin or infestation in a certain area? A lot! This Ftag has been cited at an Immediate Jeopardy level multiple times under the LTCSP, ranging all the way from Scope/Severity J (Isolated) through L (Widespread) in facilities throughout the country,” warns Linda Elizaitis, RN, BS, RAC-CT, CDS, president of CMS Compliance Group in Melville, New York.

Look for These Species

With people coming in and out every day, it’s no surprise that hangers-on can accompany them or their belongings. Mites, fleas, and bedbugs can hitch a ride into your facility with residents, visitors, or staff and cause painful bites — wounds that could potentially cause bigger problems if infection sets in. These pests can also multiply quickly, causing a facility-wide infestation if the situation is not tended to immediately.

Beyond discomfort, disease is a threat — E.coli and salmonella can be transmitted via cockroaches, ants, flies, and rodents, says arrow exterminating Company inc. in Lynbrook, New York, on their website. And rodents can carry much more serious disease, like leptospirosis or even bubonic plague.

Plus, the threat of pests manifests in different ways. Some pests, like rodents or cockroaches, and their droppings can contaminate water or food, while others can cause injury through bites or stings.

Understand Treatment Options

If your facility can reevaluate its current pest management program or start anew, there are a few different options for ridding the place of pests, as well as keeping them at bay.

While traditional pest-control options, such as spraying, are available, exterminators have developed newer, safer means of controlling pest populations by focusing on prevention and a multipronged strategy. If surveyors can see evidence of these pests, there’s a good chance that staff and residents are aware of their presence. And while there are options for controlling an infestation situation, prevention is the safest and easiest route to a pest-free facility.

Experts in pest control recommend an integrated pest management (IPM) strategy, which they say is safer for everyone involved.

“There is no question that IPM is the system of choice particularly in sensitive environments. IPM methodologies used to mitigate pest populations include tactics such as mechanical, physical, and cultural control strategies. These are called ‘nonchemical’ pest-management actions,” says Michael Deutsch M.S., BCE, technical director at Arrow Exterminating Company Inc.

“Routine pesticide applications are not IPM. IPM is a six-step program including:

            1. Inspection,
            2. Accurate identification of the pest(s),
            3. Evaluation of the pest issue,
            4. Recommendations,
            5. Actions to mitigate the pest, and
            6. Monitoring and follow-up.  

“IPM results in long-term pest population suppression and environmental conservation,” Deutsch says.

Bigger Issue May Require Bigger Response

If you have a pest issue, your facility probably requires professional treatment, especially if residents could be at risk. In this situation, your facility may not be able to avoid the use of a chemical response, even if you’re mitigating pest presence with IPM.

“However, chemical pesticides are also used in an IPM program to compliment nonchemical tactics,” Deutsch says.

The severity of the situation — in both the potential for injury and the general safety of residents and staff — may require an immediate response.

For example, multiple facilities over the past two decades have faced multimillion-dollar settlements after situations where residents, while in bed, have been swarmed and stung by fire ants. Even if these insects aren’t a threat to your facility, geographically, other pests, like wasps could be an issue.

 “Clearly, there are instances where a pesticide is necessary to quickly remove a nest of, for instance, stinging insects like bees and wasps to reduce the risk of exposure to the residence. However, even with this type of threat, IPM dictates that the product chosen to be the least toxic material available that will result in eliminating the risk of exposure,” he says.

Watch Entry Points

Doors and windows are obvious entryways for flying insects, but other means of access exist. Kitchens and employee breakrooms are hotspots for pests because of accessibility to food, Arrow Exterminating says. Don’t forget to keep an eye on resident rooms if your facility allows residents to eat in private.

Watch your plumbing for issues too — many pests, including some types of flies, cockroaches, and rodents seek water.

“Clogged drains and leaky pipes are targets for these pests as are damp basements, plumbing closets, and laundry rooms,” Arrow Exterminating says. “Don’t let leaky faucets and pipes go unchecked. Fasten shower drain covers to the floor and inspect the caulk around water fixtures to ensure that they are sealed against rats and roaches.”

Educate Staff on Issues

Staff who are responsible for maintaining your facility’s plumbing and various rooms are the frontline on determining whether there are pests present. Educate staff who perform laundry duties on how to spot signs of pests by inspecting mattresses and checking the seams of linens. Washing and/or drying laundry at hot temperatures (over 115 degrees Fahrenheit) can kill bedbugs and their eggs, as well as fleas.

Make sure staff know to alert the correct superiors or administrators so appropriate staff can enact necessary procedures.

“Whatever your protocol is to address pest problems, it needs to include proactive preventative measures in addition to alerting appropriate personnel through a maintenance log, email system or whatever other mechanism your facility uses to ensure that there is a swift response to pest ‘sightings,’” Elizaitis says.