Health Care Facilities Manageme

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					Integrated Pest
Management in
Health Care
Facilities


Reducing Pesticide
Exposure for
Vulnerable Populations
                         Maryland Pesticide Network
                            & Beyond Pesticides
                          in collaboration with Maryland
                              Hospitals for a Healthy
                                   Environment

                                                Maryland
                                                Pesticide
                                                Network
                                                 MPN
      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 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
                                                                  Maryland
                                                                  Pesticide
                                                                  Network
                                                                   MPN
37 Commonly
Used Pesticides



 Health Effects:


  16 are likely, probable or possible carcinogens
  13 are linked to birth defects
  15 are reproductive toxins
  18 cause kidney or liver damage
  28 are sensitizers/irritants                      Maryland
                                                     Pesticide
                                                     Network
                                                      MPN
37 Commonly
Used Pesticides



Environmental
Effects:

 9 are groundwater contaminants
 12 can leach through soil
 14 are toxic to birds
 30 are toxic to fish and other aquatic life
 16 are toxic to bees                          Maryland
                                                Pesticide
                                                Network
                                                 MPN
   2003 National Survey of Hospitals
               Found…

  100% use chemical              18% use a product
     pesticides                    being phased out by
                                   EPA due to its
     73% hire a pest control      unacceptable risk
     company to manage the
     majority of structural       36% use products no
     program activities            longer registered by
                                   EPA


Respondents: 22 major hospitals (“Healthy Hospitals Report”)

                                                       Maryland
                                                       Pesticide
                                                       Network
                                                        MPN
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


                                                   Maryland
                                                   Pesticide
                                                   Network
                                                    MPN
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.
                                                     Maryland
                                                     Pesticide
                                                     Network
                                                      MPN
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


                                                 Maryland
                                                 Pesticide
                                                 Network
                                                  MPN
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.

                                    Maryland
                                    Pesticide
                                    Network
                                     MPN
 The Solution: Integrated Pest Management
       (IPM) at Health Care Facilities
 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
 Least hazardous pesticides are only used as
  a last resort, minimizing exposure to toxic
  and other effects.
                                             Maryland
                                             Pesticide
                                             Network
                                              MPN
        Health Care Community
            Support of IPM

 American Hospital       American Society for
  Association              Health Engineering
  Certification Center
                          Hospitals for a
                           Healthy Environment
 American Society for
  Healthcare
  Environmental           University of
                           Maryland School of
  Services
                           Nursing

                                          Maryland
                                          Pesticide
                                          Network
                                           MPN
     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
                                              Maryland
                                              Pesticide
                                              Network
                                                 MPN
     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
                                            Maryland
                                            Pesticide
                                            Network
                                             MPN
     Integrated Pest Management in
    Health Care Facilities Pilot Project
   Phase II Pilots Partners:
    Mercy Hospital
    The Forbush School
    St. Joseph‟s Medical Center
    Harbor Hospital
    plus one retirement community



                                     Maryland
                                     Pesticide
                                     Network
                                      MPN
                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
                                             Maryland
                                             Pesticide
                                             Network
                                              MPN
         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
                                            Maryland
                                            Pesticide
                                            Network
                                             MPN
        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.
                                           Maryland
                                           Pesticide
                                           Network
                                            MPN
    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
                                                      Maryland
                                                      Pesticide
                                                      Network
                                                       MPN
    Activities and Accomplishments
   Facility-Specific IPM Policies
    -- Working with all facilities to implement and
        execute an official IPM policy to ensure
        longevity of facility‟s 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
                                                Maryland
                                                Pesticide
                                                Network
                                                 MPN
    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


                                             Maryland
                                             Pesticide
                                             Network
                                              MPN
    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

                                               Maryland
                                               Pesticide
                                               Network
                                                MPN
         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




                                                Maryland
                                                Pesticide
                                                Network
                                                 MPN
       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.
                                                Maryland
                                                Pesticide
                                                Network
                                                 MPN
Sanitation was
generally good –
some exceptions.

For cockroaches,
focus needs to be
exclusion and
reducing harborage,
not spray-applied
pesticides
                         Door sweeps,
                         caulking; no
                         cardboard or files
                         in critical areas.




Hang brooms, mops,
head up, seal refuges.

Clutter prevents
cleaning, inspection.
  Remove bird
  nest.

  Repair
  rodent/cock-
  roach
  exclusion
  screen.
Remove mulch from
building – replace with
large gravel.
            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 Maryland
                                            Pesticide
                                            Network
                                             MPN
             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

                                             Maryland
                                             Pesticide
                                             Network
                                              MPN
                  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


                                              Maryland
                                              Pesticide
                                              Network
                                               MPN
For More
Information                   Mike Boeck
                          Project Director
                            410-605-0095
              mboeck@beyondpesticides.org

                                Ruth Berlin
                Maryland Pesticide Network
                        410-849-3909 ext. 1
                        berlinmpn@aol.com
                       www.mdpestnet.org

                               Jay Feldman
                         Beyond Pesticides
                              202-543-5450
              jfeldman@beyondpesticides.org
                   www.beyondpesticides.org
                                      Maryland
                                      Pesticide
                                      Network
                                       MPN

				
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