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Integrated Pest Management (IPM) in the Health Care Setting. Ann McCampbell, MD Healthy Environments in Health Care Workgroup Health Care Without Harm July 9, 2004. ***Adapted from presentation given by Kagan Owens of Beyond Pesticides at CleanMed 2004.

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Integrated pest management ipm in the health care setting l.jpg

Integrated Pest Management (IPM) in the Health Care Setting

Ann McCampbell, MD

Healthy Environments in

Health Care Workgroup

Health Care Without Harm

July 9, 2004

***Adapted from presentation given by Kagan Owens of Beyond Pesticides at CleanMed 2004.


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Why Look at Hospital Pest Management Practices?

  • Hospitals are intended to be places of health and healing, yet many hospitals use pesticides that can harm patients and staff

  • Hospital environments need to be free of hazardous pesticides as well as pests


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Common Hospital Pests

  • Flies

  • Cockroaches

  • Ants

  • Spiders

  • Rodents

  • Weeds

  • Plant insects


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Common Sites of Pest Infestations

  • Cafeterias

  • Loading Docks

  • Storage Areas

  • Bathrooms

  • Waste disposal areas

  • Patient rooms


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What is a Pesticide?

  • Chemicals designed to kill or repel insects, plants and animals that are undesirable or threaten human health

  • Pesticides include:

    • Herbicides (weedkillers)

    • Insecticides (bug sprays)

    • Fungicides

    • Rodenticides

    • Other


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A pesticide product contains:

Active ingredients

“Inert” ingredients

Synergists

Contaminants and impurities

Metabolites

What is in a Pesticide?


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U.S. EPA

  • U.S. EPA states:

    “By their very nature, most pesticides create some risk of harm to humans, animals and the environment…”

 - U.S. EPA, What is a Pesticide?, 2002.


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Acute adverse effects

Nausea & vomiting

Headaches

Rashes

Dizziness

Aching joints

Flu-like symptoms

Asthma trigger

Linked to chronic effects

Cancer

Birth defects

Genetic damage

Neurological problems

Development of chemical sensitivities

Health Effects of Pesticides


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Vulnerable Populations

  • Particularly vulnerable populations:

    • Pregnant women

    • Infants and children

    • Elderly

    • Those with compromised immune, respiratory or nervous systems

    • Those with allergies or sensitivities to pesticides


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Pesticides and Cancer

  • Non-Hodgkin’s lymphoma has been linked to the use of the herbicide 2,4-D

  • Children living in households where insecticides are used suffer elevated rates of leukemia, brain cancer and soft tissue sarcoma


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American Medical Association

“Particular uncertainty exists regarding the long-term health effects of low dose pesticide exposure…

Considering [the] data gaps, it is prudent … to limit pesticide exposures … and to use the least toxic chemical pesticide or non chemical alternative.”

- AMA, Council on Scientific Affairs. 1997.


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Department of Veteran Affairs

“Pest management in health care facilities differs from control practices in other institutions.

The effect on patients in various stages of debilitation and convalescence, and in varied physical and attitudinal environments, requires that a cautious policy be adopted concerning all uses of pesticides.

The use of any pesticide establishes a risk of uncertain magnitude.”

-Department of Veteran Affairs. 1986. Pest Management Operations,

Chapter 2. Environmental Management Service.


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Pesticide registration does not equal safety

Risk benefit assessment

Toxicity testing only on active ingredient

Cumulative and synergistic effects not tested

Inadequate testing for impacts on vulnerable populations

Pesticide Regulation Insufficient


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100% use chemical pesticides

73% hire a pest control company to manage the majority of structural (indoor) pests

36% hire a pest control company to manage the majority of outdoor pests on hospital grounds

Hospital Pesticide Use Survey


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37 Most Commonly Used Pesticides

  • 62% are insecticides

  • 27% are herbicides

  • 8% are rodenticides

  • 3% are fungicides


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Most Commonly Used Insecticides at Surveyed Hospitals

Pyrethroids

Carbamates

Botanicals

Inorganics

Synergists

Others

Organophosphates


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37 Most Commonly Used Pesticides

Health Effects:

  • 16 are likely, probable or possible carcinogens

  • 13 are linked to birth defects

  • 15 are reproductive toxins

  • 22 are neurotoxins

  • 18 cause kidney or liver damage

  • 28 are irritants


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Pyrethroids Are Not Flowers

  • Neurotoxic

  • Burning of skin, dizziness, headache, vomiting, muscle twitching, seizures

  • Endocrine-disruptors

  • Possible human carcinogens

  • Toxic synergist PBO (piperonyl butoxide)

  • Deltamethrin persists for years in environment


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Ontario College of Family Physicians

  • “The literature does not support the concept that some pesticides are safer than others;”

  • “Exposure to all the commonly used pesticides … has shown positive associations with adverse health effects.”

  • “Our message to patients should focus on reduction of exposure to all pesticides …”

    - Ontario College of Family Physicians, Pesticides Literature Review, April 23, 2004.


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What is Integrated Pest Management (IPM)?

  • IPM is a pest management strategy that focuses on long-term prevention and suppression of pest problems through nontoxic means such as:

    • Sanitation

    • Structural maintenance

    • Mechanical/physical controls

    • Cultural practices

    • Biological controls

  • Pesticides are used only as a last resort.


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Model Hospital IPM Policy

  • Policy Goals

    - To manage pests in a manner that will not harm humans or the environment

    - To reduce or eliminate the use of toxic pesticides

    - To provide notification to the hospital community if a pesticide is applied


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What IPM Is Not

  • Routine use of pesticides (calendar spraying)

  • Pesticide applications when area occupied or may become so during 24 hours after application

  • Fogging, bombs, tenting, broadcast and space spraying

  • Pesticide use for aesthetic reasons


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What IPM Is Not

Does not use high hazard pesticides:

  • U.S. EPA Toxicity Categories I and II

  • U.S. EPA Class A, B, C carcinogens

  • California Proposition 65

  • Carbamates, organophosphates, pyrethroids, phenoxy herbicides

  • U.S. EPA List I: Inerts of Toxicological Concern


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EPA Recommends IPM

“IPM can reduce the use of chemicals and provide economical and effective pest suppression”

- U.S. EPA, Pest Control in the School Environment: Adopting Integrated Pest Management, 1993.


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New York State Attorney General

“IPM will reduce pesticide exposures to patients and to hospital staffers and thus protect health. Additionally, adoption of [IPM] will save money. Pesticides are not cheap. Any approaches that sensibly reduces their use will help to contain hospital costs.”

-Attorney General of New York State, 1995.


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Key Elements of an IPM Program

  • Pest Prevention

  • Monitoring

  • Education

  • Record Keeping

  • Least Hazardous Approach to Pests

  • Pesticide Use Notification


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IPM Techniques

Eliminate Food - Restrict Entry - Control Habitat

  • Sanitation

  • Vacuuming

  • Pest-proofing waste disposal

  • Structural maintenance

  • Mechanical traps

    Inspect - Detect - Correct


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Eliminate Routine Spraying

  • Instead, have contractor or staff perform a pest inspection monthly or quarterly to determine whether pests are present and whether action is needed

  • When taking action, use the least toxic method that will effectively suppress or eliminate pest populations


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Flies - Safer Management

  • Sanitation

  • Exclusion

  • Flypaper

  • Fly swatters

  • UV light traps indoors

  • Traps with non-toxic attractants outdoors


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Cockroaches – Safer Management

  • Sanitation

  • Food stored in pest-proof airtight containers

  • Eliminate corrugated cardboard

  • Eliminate moisture sources

  • Block entry points

  • Vacuum

  • Glueboards, pheromone traps

  • Boric acid bait


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Weeds, Lawns, and Landscape – Safer Management

  • Maintain lawn health (mowing and watering)

  • Pull or cut weeds

  • Corn gluten meal

  • Mulch

  • Physically remove insect pests or knock off with high pressure water

  • Spray plants with soapy water

  • Use beneficial, predatory insects

  • Pest-resistant vegetation


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Boric acid

Insecticidal and herbicidal soaps

Diatomaceous earth / silica gel

Microbe-based insecticides (B.t.)

Parasites and predators

Non-volatile insect and rodent baits in tamper-resistant containers

Liquid nitrogen (cold treatments)

EPA Exempt natural pesticides (FIFRA 25(b))

Least Hazardous Pesticides


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Hospital Pesticide Use Notification

One of the key elements of an IPM program is to notify patients and staff of pesticide use

  • Provide written notice and/or post signs 72 hours before an application

  • Leave signs in place for 72 hours after application

  • Provide name and phone number of whom to contact for additional information


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San Francisco General Hospital

Massachusetts General Hospital

Oregon Health and Science University

Brigham and Women’s Hospital

Hackensack University Medical Center

Veterans Hospitals

Examples of Hospital IPM Programs


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IPM Is Cost Effective

  • Additional startup costs

  • Decreases the money spent over long-term

  • Some activities can be absorbed into existing budget:

    • Training of maintenance, cleaning and food service staff

    • Maintenance and structural repair


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IPM is Cost Effective

  • GSA - “IPM can be pragmatic, economical, and effective on a massive scale”

  • University of Rochester - 50% reduction in material costs and substantial reduction in personnel costs

  • Monroe County Schools (IN) saves $13,600 annually in pest management costs


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Create IPM Policy

Establish IPM Coordinator

Create specifications for IPM contracts

Involve hospital staff in the creation and implementation of IPM program:

Legal and risk management staff

Administrators

Housekeeping

Facilities/maintenance personnel

Cafeteria staff

IPM Implementation


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For More Information

  • Healthy Hospitals, Controlling Pests Without Harmful Pesticides, by Kagan Owens, Beyond Pesticides, 2003

  • www.beyondpesticides.org

  • www.noharm.org


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Integrated Pest Management (IPM) in the Health Care Setting

For more information:

Ann McCampbell, MD

Ph: (505) 466-3622

E-mail: DrAnnMc@aol.com

***Adapted from presentation given by Kagan Owens of Beyond Pesticides at CleanMed 2004.