Integrated Pest Management in Health Care Facilities

1. Integrated Pest Management in Health Care Facilities ProjectNew moms projectstudent outreach project Matt Wallach, Project Director, Maryland Pesticide Network & Beyond Pesticides

2. Integrated pest management (IPM)in health care facilities project Reducing harmful chemicals for patients, staff, and the environment through the adoption of green practices.

3. Why look at Hospital Pest Management Practices? To protect the health of vulnerable patients and staff from the dangers of toxic pesticides through toxic-free pest management that promotes healthy indoor and outdoor environments. Create a facility free of pests and hazardous pesticides in order to protect people who are at the highest risk because of: • immune and nervous system weakness • those with breathing problems • allergies and reactions to chemicals

4. Why look at Hospital Pest Management Practices? A significant number of facilities (45%) recognize that their pest management program should reduce reliance on pesticides by addressing the root causes of pest infestation, such as poor sanitation and mechanical or structural sealing, an indication of their commitment to the care of their patients and residents.

5. Why Reduce Pesticide Use? Vulnerable Groups • infants and children • pregnant women/fetuses • the elderly • compromised immune and nervous systems • those with asthma or respiratory problems • cancer patients and survivors • those sensitive to chemicals

6. Precaution IPM is a commitment to precaution. IPM is a commitment to measures that prevent pests and the need for toxic chemicals.

7. Reducing Toxins in the facility with IPM IPM is a pest management strategy that provides long-term pest prevention and suppression through a combination of practices such as: • Regular pest population monitoring • Site inspections • Occupant education • Structural, mechanical, cultural, and biological controls Least-toxic pesticides are only used as a last resort

8. IPM and pest hazards • Pesticides treat but do not solve or prevent pest issues • IPM can eliminate fly breeding areas and entryways into a facility • Proper IPM implementation removes the cardboard, water, and dirty surfaces that rodents and roaches enjoy

9. Ipm implementation Eliminate Food - Restrict Entry Control Habitat Inspect - Detect - Correct • Sanitation • Vacuuming • Pest proofing waste disposal • Structural maintenance • Mechanical traps

10. Least-toxic pesticides • Boric acid (borates, disodium octoborate tetrahydrate) • Diatomaceous earth / silica gel • Microbe-based insecticides (B.t.) • Soap-based products • Non-volatile insect and rodent baits • Liquid nitrogen (cold treatments) • EPA Exempt natural pesticides (FIFRA 25(b))

11. IPM in Health Care Facilities Project - the process When we work with Health Care Facilities we offer: • Written Pesticide Use Survey • Facility and Grounds Walk-Throughs by IPM Team • Vendor Contract and IPM Plan Review • Written Assessment Reports and Recommendations • Model IPM & Natural Land care policy, plan and vendor contracts • Development of IPM policy • Employee training in IPM • Implementation Assistance Staff understand their role in maintaining a pest-free facility without the use of toxic chemicals. They understand the difference between IPM and conventional pest management

12. IPM in Health Care Facilities Project - IPM Coordination To effectively implement an IPM program it is essential for the health care facility to establish an IPM coordinator position. The IPM coordinator is responsible for: • Tracking actions of pest management technician • Reviewing technician and complaint logs • Coordinating addressing pest conducive conditions identified by technician • Periodically accompanying technician on walk-through of facility • Approving use of least-toxic pesticides as a last resort • Overseeing contract agreements with vendor

13. IPM in Health Care Facilities Project - the walk-through Assessment Focus on conducive conditions in pest vulnerable areas: • Loading docks and receiving areas • Kitchen, food storerooms, cafeterias, dishwashing • Staff lounges and break rooms • Lavatories and locker rooms • Custodial storage and utility rooms • Mechanical and operations areas • Dumpsters and anywhere trash is handled • External grounds (habitat and entryways)

14. IPM in Health Care Facilities Project - the walk-through Assessment

15. Working with the Technician Hospital Staff must be made aware of the conditions at the hospital This example log shows positive work by hospital staff. There are no pests, no pesticide applications, and no recommendations If there are pests, the technician will identify the conditions conducive to pests, list the chemical or non-chemical actions, and list recommendations for the hospital to eliminate the pest conducive conditions.

16. IPM in Health Care Facilities Project Before IPM Implementation No understanding of what chemicals are applied by the technician No cooperation of hospital staff and hospital departments to deal with prevention of pest problems Limited understanding of how cleaning clutter and cracks contribute to pest problems After IPM Implementation Technician works and communicates with vendors, maintenance, housekeeping to ensure a pest free environment Greater understanding by all hospital staff of what is applied when a product is needed The hospital becomes a cleaner, healthier place, with less clutter, cracks, and cleaner conditions

17. New moms project Protecting babies from pesticides

18. Why We Created the New Moms Projectat UMMC We are committed to protecting the health of a new baby

19. Why We Created the New Moms Projectat UMMC • Infants and children are the most vulnerable to the health effects of pesticide exposure. • UMMC works to reduce pesticides throughout the facility to protect patients from unnecessary exposure to hazardous chemicals – so educating new parents is a next logical step.

20. Pesticides and Children’s Health The third National CDC Body Burden report tested 3,000 people for various chemicals; the 6-to-11 year old children tested had very high levels of pesticides in their bodies – four times the amount thought to be acceptable by EPA. Our children are exposed to pesticides in: • Air, Food, and Water • Parks and Schools • Day Care Centers and in their own homes A 2005 study concludes that children up to 4 ½ years old put their hands to their mouth as much as 19.4 times per hour.

21. Pesticides and Children’s Health 2 3 Long-term potential consequences of even one pesticide exposure at a critical state in fetal development include adverse health impacts on children’s neurological, respiratory, immune, and endocrine systems, even at low levels of exposure. The developing brains and bodies of children are in a complex and fragile stage that regulates tissue growth and organ development.

22. Pesticides and Children’s Health Continued Studies show that pesticide exposures are associated with: • Birth/Developmental Defects • A study found that organophosphate (OP) pesticides exposure by pregnant women may affect both length of pregnancy and birth weight. In some cases, household uses of OPs have been cancelled because of the extreme health risks to children, but agricultural, golf course, and mosquito control uses remain on the market. • Childhood Cancers • A study in the Journal of the National Cancer Institute found that household and garden pesticide use can increase risk of childhood leukemia as much as sevenfold. • Neurodevelopmental delays • Endocrine disruption

23. Pesticides and Children’s Health Continued • Asthma • A study found that children exposed to herbicides in their first 12 months were more than 4 ½ times as likely to develop asthma. Children who were exposed to pesticides in general were nearly 2 ½ times as likely to develop asthma. • Autism Spectrum Disorders (ASD) • A study linked the pesticide bifenthrin with increased rates of autism. Bifenthrin is an endocrine disrupting pesticide that was banned by the European Union in 2009. • Anxiety, depression and aggression • Attention-Deficit/Hyperactivity Disorder (ADHD) • A study analyzing umbilical cord blood from 600 children found that boys who were exposed to higher levels of organochlorines – polychlorinated biphenyls (PCBs) and DDE (a metabolite of DDT) – in the womb scored lower on focus and concentration tests.

24. Reducing Toxins in the facility with IPM UMMC is a community leader with capacity to educate patients on healthy lifestyles and safer alternatives to toxic pesticides found in baby care, cleaning, and pest management products UMMC puts an emphasis on housekeeping, recognizes the importance of maintenance, strives to be a pesticide-free facility and only uses least-toxic pesticides as a last resort The nurses at UMMC educate the patients in the mother/baby unit on the dangers of toxic pesticides and how they can protect the health of their baby and family.

25. The New Moms Project - background • Throughout 2011, the IPM in Health Care Facilities Project in collaboration with the nurses in the mother/baby unit at UMMC created educational materials for the new parents. • Donated samples of safe products for pest management, cleaning and baby care were collected for distribution to the new parents. • The project launched in December 2011.

26. The New Moms Kit

27. Inside the New Moms Kit

28. Inside the New Moms Kit

29. The Survey 4. Before reading the booklet and watching the video on protecting your baby from pesticides, did you use cleaning and/or baby care products like the non-toxic samples in the kit the hospital gave you? _ A lot _ A little _ Not at all 1. Please write the date that you gave birth to your baby ____________________ 2. Before reading the “Make Your Home Safe for Baby” booklet and watching the video on protecting your baby from pesticides, a) How much did you know about safer ways to control pests? _ A lot _ A little _ Nothing at all b) What was your main method of pest control? Check all that apply_ We used an Exterminator _ We sprayed pesticides _ We used ant and/or roach bait stations _ We did not use any pesticides _ We used only natural/non-toxic pest control products Please list products 3. If an exterminator services your house or apartment, do you know what pesticides are used? _ Yes _ No _ We do not use an exterminator 5. After reading the brochure and watching the video on protecting your baby from pesticides, what following changes have you made or do you plan to make to protect your baby and your family? Check all that apply _ Change how you store food and clean your kitchen _ Use caulk and door strips to keep out bugs _ Use natural products for pest control: _ sometimes _ all the time _ Use natural/non-toxic cleaning products: _ sometimes _ all the time _ Use safe/natural products on your new baby’s skin such as soaps, baby wipes, and diapers: _sometimes _all the time _ Avoid sitting, lying, or playing on any grass with a “CAUTION PESTICIDE APPLICATION” sign 6. Do you believe that using the information in the brochure and the CD will improve the health of your baby and everyone in your household? _ Yes _ No

30. Survey: Early Results 100 percent of the respondents indicated that they believe that using the information in the brochure and the CD will improve the health of their baby and everyone in their household.

31. Replication? This project can easily be replicated in other Maryland health care facilities interested in practicing IPM and education on the dangers of toxic pesticides and safer alternatives to protect the health of staff and patients - especially newborns. The IPM in Health Care Facility Project assists MD facilities at no cost on implementing a defined IPM program and New Moms project.

32. Student outreach project Educating students and making changes in the community

33. The IPM Community Outreach Project • Our goal is to first educate students on the dangers of pesticides, IPM, and safer alternatives to pest control • Then have students educate community members, community leaders and community market and restaurant owners about alternatives to the hazards of pesticides.

34. Local Market and Restaurant Project Overview Teams of students approach community stores and restaurants and talk about: Students earn credit toward their student service learning requirement!

35. Students learn! Students learn: • About the dangers of pesticides • About the flaws in the regulatory process • Where pesticides are found • How to identify pest conducive conditions • How to make recommendations to stores and restaurants which will result in less pesticides used in their businesses and communities

36. Products Commonly Found in Stores

37. Thoroughly inspect the property and record: Gather Background Information on the Pest Problem(s) • Potential sources of pest • Conditions conducive to pest infestations (structural, environmental, behavioral) • Potential problems associated with the pests

38. Questions? Matt Wallach IPM in Health Care Facilities Project mwallach@beyondpesticides.org 410-605-0095