Integrated Pest Management in Health Care Facilities Reducing Pesticide Exposure for Vulnerable Popu

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Integrated Pest Management in Health Care
FacilitiesReducing Pesticide Exposure for
Vulnerable Populations

• Maryland Pesticide Network
• Beyond Pesticides
• in collaboration with Maryland Hospitals for a
  Healthy Environment

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Why Look at Pest Management Practices in Health
Care Settings?

• An environment free of pests and hazardous
  pesticides is critical for vulnerable
  populations, including
• newborns, infants, and children
• the elderly
• patients with compromised immune, nervous, and
  respiratory systems
• patients with allergies or sensitivity to
  chemicals
• patients subject to cross-reaction with
  medications
• Particular uncertainty exists regarding the
  long-term health effects of low dose pesticide
  exposureconsidering 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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37 CommonlyUsed Pesticides
Health Effects

• n 16 are likely, probable or possible carcinogens
• n 13 are linked to birth defects
• n 15 are reproductive toxins
• n 18 cause kidney or liver damage
• n 28 are sensitizers/irritants

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37 CommonlyUsed Pesticides
Environmental Effects

• n 9 are groundwater contaminants
• n 12 can leach through soil
• n 14 are toxic to birds
• n 30 are toxic to fish and other aquatic life
• n 16 are toxic to bees

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2003 National Survey of Hospitals Found

• n 18 use a product being phased out by EPA due
  to its unacceptable risk
• n 36 use products no longer registered by EPA

• n 100 use chemical pesticides
• n 73 hire a pest control company to manage the
  majority of structural program activities

Respondents 22 major hospitals (Healthy
Hospitals Report)

• Maryland Pesticide Network
• MPN

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2005 Survey of Maryland Health Care Facilities
Found

• 93 outsource pest control
• 70 outsource lawn care
• The majority of facilities indicated that their
  pest control strategy and vendors give priority
  to chemical methods.
• Respondents 32 hospitals and 11 elder care
  facilities

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Maryland Health Care Facilities Pest Management
Survey

• 25 Commonly Used Pesticides
• Health Effects
• 11 linked to cancer
• 12 associated with neurological effects
• 10 associated with reproductive effects
• 5 cause birth defects or developmental effects
• 12 are sensitizers or irritants
• 10 cause liver or kidney damage
• 6 are suspected endocrine disruptors.

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Maryland Health Care Facilities Pest Management
Survey

• 13 Commonly Used Land Care Pesticides
• Environmental Effects
• 2 potentially leach and contaminate groundwater
• 8 are toxic to birds
• 8 are toxic to fish
• 10 are toxic to aquatic organisms
• 3 are toxic to bees

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Maryland Health Care Facilities Pest Management
Survey

• A significant number of facilities (45)
  recognized that their IPM program should address
  the root causes of pest infestation, such as poor
  sanitation and mechanical or structural sealing,
  to reduce reliance on pesticides, an indication
  of their commitment to the care of their patients
  and residents.

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The Solution Integrated Pest Management (IPM) at
Health Care Facilities

• n IPM is a strategy that focuses on long-term
  prevention and suppression of pest problems
  through a combination of practices including
• Regular pest monitoring
• Site inspections
• Occupant education
• Structural, mechanical, cultural, and biological
  controls
• n Least hazardous pesticides are only used as a
  last resort, minimizing exposure to toxic and
  other effects.

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Health Care CommunitySupport of IPM

• n American Hospital Association Certification
  Center
• n American Society for Healthcare Environmental
  Services

• n American Society for Health Engineering
• n Hospitals for a Healthy Environment
• n University of Maryland School of Nursing

• Maryland Pesticide
• Network
• MPN

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Integrated Pest Management in Health Care
Facilities Pilot Project

• Initiated in 2005 by project partners Maryland
  Pesticide Network and Beyond Pesticides in
  collaboration with Maryland H2E
• Enables IPM implementation through pilot
  partnerships with a select group of Maryland
  health care facilities pilots
• Establishes a model for IPM at health care
  facilities across the state and beyond

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Integrated Pest Management in Health Care
Facilities Pilot Project

• Phase I Pilot Partners
• The Johns Hopkins Hospital
• University of Maryland Medical Center
• Johns Hopkins Bayview Medical Center
• Broadmead Retirement Community
• Erickson Retirement Communities
• (Riderwood and Oak Crest)
• Springfield Hospital Center
• Sheppard and Enoch Pratt Hospital

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Integrated Pest Management in Health Care
Facilities Pilot Project

• Phase II Pilots Partners
• Mercy Hospital
• The Forbush School
• St. Josephs Medical Center
• Harbor Hospital
• plus one retirement community

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Pilot Process

• Assess current pest management practices
• -- Written survey
• -- Facility/grounds walk-through by team of IPM
  experts
• -- Vendor contract review
• -- Written reports and recommendations
• Facilitate implementation of (or improve on) IPM
  program
• -- Establish and implement IPM policy
• -- Employee training in IPM
• -- Community outreach
• -- Ongoing assistance

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Community Outreach Project Objectives

• To educate underserved communities surrounding a
  select group of Baltimore City health care
  facilities about the health risks of pesticides
  and safer non-chemical strategies
• To reduce community exposure to pests and toxic
  pesticides through safer pest management
  practices
• To engage community and municipal leaders on pest
  and pesticide dangers in their communities

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Community Outreach

• Education of Leadership and Community
• Presentations on the hazards of pesticides, IPM
  and alternatives to pesticide use.
• Distribute educational materials and brochures.
• Develop and distribute surveys to leadership and
  community to determine knowledge and current use
  of pesticides.

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Activities and Accomplishments

• Phase I Facilities
• -- Pest Management Practices Surveys
• -- Facility Walk-Throughs
• -- Reports/Recommendations (indoor and grounds)
  to All Phase I Pilot Facilities
• -- Stages of Implementation Vary
• Phase II Facilities
• -- All Surveys/Walk-Throughs to be Completed by
  the end of February 2008
• Soil Sampling Completed at 7 Pilot Facilities
• -- Reports by the end of February
• -- Natural Turf Transition Pilots Planned at 2
  Facilities

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Activities and Accomplishments

• Facility-Specific IPM Policies
• -- Working with all facilities to implement and
  execute an official IPM policy to ensure
  longevity of facilitys program
• -- Formally adopted by Sheppard Pratt covering
  two pilots
• -- Substantial progress with other Phase I
  facilities
• Contract Review/Vendor Procurement
• -- Consultation and services as requested

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Activities and Accomplishments

• Natural Turf Management Training
• -- One Hour Natural Turf Management Orientation
  delivered to Erickson system groundskeepers
• -- One Day Natural Turf Management Training
  attended by 22 pilot facility and other
  managers, including other MD H2E facilities

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Activities and Accomplishments

• Community Outreach Initial meetings through
• -- Historic East Baltimore Community Action
  Coalition (HEBCAC) to neighborhoods near The
  Johns Hopkins Medical Center
• -- Southwest Baltimore Communities Organized to
  Improve Life (COIL) to neighborhoods near the
  University of Maryland Medical Center

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Educational Materials

• CD training for new employees
• In-depth CD training for facilities staff (e.g.,
  environmental services, housekeeping,
  maintenance, food services)
• IPM is Part of Your Aftercare brochure for
  patients

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Findings at Pilot Facilities

• Rats outside and cockroaches inside have been the
  most difficult to manage. Mice, ants and birds
  are also problems.
• Spray-applied liquids are used frequently indoors
  for cockroaches.
• Lack of communication and cooperation between
  departments and between managers and service
  providers hinders effective pest control and
  increasing pesticide applications.
• Inadequate housekeeping and maintenance.

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Sanitation was generally good some
exceptions. For cockroaches, focus needs to be
exclusion and reducing harborage, not
spray-applied pesticides
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Door sweeps, caulking no cardboard or files in
critical areas.
Hang brooms, mops, head up, seal
refuges. Clutter prevents cleaning, inspection.
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Remove bird nest. Repair rodent/cock-roach
exclusion screen.
Remove mulch from building replace with
large gravel.
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Strategic Findings

• Engagement of service vendors substantially
  expedites transition to IPM
• -- Most vendors serve dual role as service
  provider and resident expert on pest
  management, responsible for both what will be
  done and how
• -- Vendors operate in a highly competitive
  business sector where customer satisfaction
  rules
• -- Regular communication between facility
  manager and vendor is key to adapting IPM
  strategy to facility conditions

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Strategic Findings

• In lieu of legal or corporate requirements, Green
  Committees, associations such as H2E, and
  networks of professional facility and service
  provider managers are key to IPM transition
• Education on pesticide risks and the efficacy of
  IPM has been the missing link health care
  facilities want to do the right thing when
  presented the opportunity

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Next Steps

• Assisting Facilities on Implementation
• IPM Policies Established Across Pilots
• Communication of Project Successes
• Outreach to All Maryland Health Care Facilities
• Model Implementation Tools (policies, guidance,
  training resources)
• Facility-specific IPM Transition Consultation and
  Support

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For More Information

• Mike Boeck
• Project Director
• 410-605-0095
• mboeck_at_beyondpesticides.org
• Ruth Berlin
• Maryland Pesticide Network
• 410-849-3909 ext. 1
• berlinmpn_at_aol.com
• www.mdpestnet.org
• Jay Feldman
• Beyond Pesticides
• 202-543-5450
• jfeldman_at_beyondpesticides.org
• www.beyondpesticides.org