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Twenty-five years ago when Laurie Combe began her career as a school nurse, “we didn’t even talk about bed bugs.”

Today, the pests are a common problem that nurses manage along with tending to students’ stomach aches, scraped knees and other medical needs. “It’s an issue that causes great anxiety on school campuses,” said Combe, who is health services coordinator for a Houston-area school district and president-elect of the National School Nurses Association.

Bed bugs aren’t the only pest of concern. In the Northeast, ticks, mosquitoes, lice and stinging pests topped the list, according to a 2017 survey of 828 school nurses and health professionals in 12 Northeast states and the District of Columbia. The survey was funded by the Northeastern Integrated Pest Management (IPM) Center and conducted by Kathy Murray, an entomologist with the Maine Department of Agriculture, Conservation and Forestry who leads the state’s school IPM program.

Murray’s goal was to identify pests of concern and provide school nurses in the Northeast with pest-specific resources to help schools adopt better integrated pest management programs.

Because nurses are “oftentimes the frontline” when it comes to public health-related pests in schools, “we figured that school nurses could be a pretty strong advocate for IPM,” explained Murray. “The school nurses have really embraced it. They totally get what IPM is,” she added.

In Combe’s school district, school nurses are an integral part of the IPM team. They have tracked down landlords to address bed bug problems where students live. They work with facility managers to identify areas of standing water where mosquitoes breed — school nurses are “always concerned about vector-borne diseases” like Zika and West Nile virus, said Combe, and habitats that may harbor ticks and rodents.

They also provide guidance to minimize the spread of lice and bed bugs, like changing up coat racks so clothing doesn’t touch, reducing classroom clutter and providing students with separate textbooks for home and school so pests aren’t brought into the building. “The school nurse is always conducting surveillance on their campus for areas of risk,” Combe explained.

HOW PMPs CAN HELP. Still, school nurses “don’t have the technical knowledge about how to identify a pest and what exactly you should do about it” once found, said Murray.

In fact, nearly half (49 percent) of school nurses in the Northeast felt they did not have or were unsure if they had adequate information to address their questions regarding pests, found the school nurse health-pest survey.

This gives pest management professionals an opportunity to “demonstrate your breadth of expertise” and “build the value of professional pest management” with school clients beyond doing pesticide applications, said Allison Allen, who heads the QualityPro and QualityPro School certification programs for the National Pest Management Association.

According to the survey, school nurses reported that informational websites (60 percent), self-paced online learning modules (51 percent) and webinars (43 percent) would be useful for learning about pests and IPM (see chart).

As such, PMPs can direct school nurses to the Northeastern IPM Center website, where Murray is compiling educational resources for nurses in the region. Another site is StopSchoolPest.org, which provides free online training courses in IPM for K-12 school employees. Allen recommended that PMPs who work in schools earn the QualityPro Schools certification, an additional certification for QualityPro companies that shows expertise in servicing sensitive school and educational environments.

PMPs also can provide concise, visual handouts to help identify pests, which “is always a challenge for the school nurse,” said Combe. They’re often shocked, for instance, to see how small a nymphal tick actually is. Allen suggested that PMPs help school nurses to identify pests. NPMA members without an entomologist on staff can use the association’s experts to provide this service. A first step is teaching them how to collect samples, she reminded.

Combe sees an opportunity to collaborate with PMPs on compiling science-based, referenced educational materials to help nurses identify, prevent and mitigate pests. This would be a “time saver” for her and make available different resources beneficial to school nurses.

Murray is creating flowcharts based on materials developed by the Michigan Bed Bug Working Group to give nurses step-by-step instructions when ticks, head lice and stinging insects are found (see page 94). She also distributed materials at the National School Nursing Association conference in June in Baltimore.

Every pest management company has educational materials and literature; give it to the school nurse, who can disseminate it to staff and parents to help identify and prevent pests, Allen said. Also provide sample letters that nurses can use to communicate with parents and staff that a pest was found, what steps are being taken at the school to mitigate it and what to do at home.

And to help improve communication between stakeholders, PMPs should add school nurses to distribution lists to receive service reports. This may help schools from missing key information, such as a need to seal up pest entry points or suggestions for reducing tick habitat on the playground, said Murray.

“Make sure the school nurse knows that your company is an expert in pest management and that you can provide the resources that they need,” said Allen. Just don’t offer advice on pest-borne illnesses. “If you want to know about the pest, talk to the PMP; if you want to know about the disease or the medication, talk to the doctor,” reminded Allen.

The author is a frequent contributor to PCT magazine.