HealthyHealthy HospitalsHospitals ControllingControlling PestsPests WithoutWithout HarmfulHarmful PesticidesPesticides Written by Kagan Owens, Beyond Pesticides

AA REPORTREPORT BYBY Beyond Pesticides Beyond Pesticides, founded in 1981 as the National Coalition Against the Misuse of Pesticides, is a national, community-based organization of grassroots groups and individuals, which bridges environment, health, urban, and rural concerns to: (i) stimulate widespread education on the hazards of toxic pesticides, and the availability of effective alternative pest management approaches in the context of protecting the public’s health; (ii) influence decision makers responsible for pest management to use safe methods through grassroots action; and, (iii) encourage the adoption of local, state, and national polices that stringently restrict pesticide use and promote alternative approaches that respect health and the environment.

Beyond Pesticides ● 701 E Street, SE Suite 200 ● Washington DC 20003 (202) 543-5450 ● [email protected] ● www.beyondpesticides.org Health Care Without Harm Health Care Without Harm (HCWH) is an international coalition of hospitals and health care systems, medical professionals, community groups, health-affected constituencies, labor unions, environmental and environmental health organizations and religious groups. Its mission is to transform the health care industry worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment.

Health Care Without Harm ● 1755 S Street, NW, Suite 6B ● Washington DC 20009 202-234-0091 ● [email protected] ● www.noharm.org Acknowledgements This report is the vision of a Health Care Without Harm (HCWH) workgroup comprised of Jackie Hunt Christensen, Institute for Agriculture and Trade Policy; Mary Lamielle, National Center for Environmental Health Strategies, Inc.; Ann McCampbell, M.D., Multiple Chemical Sensitivities Task Force of New Mexico; Alice Osherman, MCS: Health and Environment; Catherine Porter, Women’s Cancer Resource Center; Peggy Wolff, Chemical Injury Information Network; Barbara Wilkie, Environmental Health Network; and Carolyn Wysocki, Ecological Health Organization. This workgroup consulted with Beyond Pesticides to compile the Hospital Pesticide Use Survey data and create this report.

Beyond Pesticides and Health Care Without Harm would like to acknowledge all those who provided valuable input into Healthy Hospitals. Sincere appreciation goes to Ann McCampbell, M.D., Multiple Chemical Sensitivities Task Force of New Mexico, and Jay Feldman, Beyond Pesticides, for extensive contributions to the writing and production of this report. Special thanks to Charlotte Brody, R.N., Health Care Without Harm; Jackie Hunt Christensen, Institute for Agriculture and Trade Policy; Lynn Garske, Kaiser Permanente; Kathy Gerwig, Kaiser Permanente; Mary Lamielle, National Center for Environmental Health Strategies, Inc.; Peter Orris, M.D., University of Illinois School of Public Health; Catherine Porter, Women’s Cancer Resource Center; Ted Schettler, M.D., Science and Environmental Health Network; Terry Shistar, Kaw Valley Greens; Julie Trocchio, Catholic Health Association; and Barbara Wilkie, Environmental Health Network, for their thoughtful comments and editorial guidance. Thanks are also due to Beyond Pesticides staff, Meghan Taylor, and interns, Cortney Piper and Edward J. Lubarsky, for their research assistance, and to Rick Bass, Brigham and Women’s Hospital, and Deanna Simon, San Francisco Department of the Environment.

Beyond Pesticides thanks its members, supporters and institutional donors for their financial support vital to this project, including the Firedoll Foundation, Health Care Without Harm, David Katz Foundation, Alida Messinger Lead Charitable Trust, David H. Smith Foundation, Lucy R. Waletzky Fund, and Wallace Genetic Foundation.

Health Care Without Harm also thanks its institutional donors for their support, including Lucy Waletzky.

This document is for educational purposes only and does not constitute legal or health advice. Health care providers and institutions should seek legal and medical advice to ensure that pest management programs meet legal and patient care responsibilities, including compliance with applicable pesticide notification laws and regulations. Healthy Hospitals i Controlling Pests Without Harmful Pesticides ...... 16 ...... 13 ...... 10 ...... 26 ...... 32 ...... 14 ...... 11 ...... 32 ...... 19 ...... 27 ...... 29 ...... 12 ...... 5 ...... 13 ...... 19 ...... 18 ...... 12 ...... 32 ...... 7 ...... 16 ...... 1 ...... 24 ...... 6 ...... 4 ...... 30 ...... 11 ...... 15 ...... 31 ...... 4 ...... 4 ...... 10 ...... 19 ...... 30 ...... 12 ...... 27 ...... 27 ...... 2 ...... 27 Oregon Oregon Health and Science ...... University. Veterans HospitalsVeterans ......

Pesticide Toxicology ...... Pesticide Health Effects of Pesticides ...... The Hazards of “Inert” Ingredients ...... Exposure RoutesPesticide ...... Efficacy and Pesticide Resistance...... Regulation.Pesticide ...... Limited and Misleading Information on LabelProduct ...... DataToxicity Missing ...... Risk Laws Allow Pesticide An “Acceptable” ...... Methodology...... Summary of Survey Findings...... Management PlansHospital Pest ...... Management Hospital (IPM) Integrated Pest Programs ...... versus In-House ManagementContract Pest ...... Use Hospital Pesticide ...... Least Use Hazardous Pesticide ...... Hospital of Use and Products Cancelled Active ...... Ingredients. Pesticide NotificationUse Hospital Pesticide ...... KeepingRecord ...... Health ...... on Effects. Pesticide Training Staff Cost of Management Hospital Pest ...... Key Elements of an IPM Program ...... Education ...... Monitoring...... PreventionPest ...... Least Hazardous Approach to Pests...... NotificationUse Pesticide ...... KeepingRecord ...... IPM is Cost Effective...... Examples of Hospital IPM Programs ...... Integrated Pest Management (IPM): Integrated Pest A Safer Solution ......

Preface by Jackie Hunt ChristensenPreface ...... Executive Executive Summary...... I. Problem The Pesticide ...... II. Survey Use Findings Hospital Pesticide ...... III. Management Practices. Safer Pest ...... Table of Contents of Table BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals

ii Controlling Pests Without Harmful Pesticides iue1 htI naPsiie . Pesticide? a InIs Figure What 1. iue3.ACoe oka rga n oe’ optlsIMPorm. Women’sand Brigham at Look Closer A Figure31. Hospital’s Program IPM . Hospital’sFranciscoGeneralSan at Program. Look IPM Closer A Figure30. . NotificationRequirements Lawn States FigureWith 29. . NotificationModelProgram. Figure 28. . Option. Baits:FigureBetter 27. The . Pesticides Hazardous Least Select of Overview Figure26. . GroundsManagement and Non-toxicFigureLandscape 25. Pests. . HospitalPest Saferfor Managementof Examples Figure24. . Defined PestIntegrated(IPM) Figure Management23. . IPM. Supports Community CareHealth Figure 22...... Figure. 21. Ecological Effects of 37 Pesticide Active Ingredients Most Commonly Used at Surveyed Hospitals . Figure. . 20. Health Effects. of 37 Pesticide. . Active. Ingredients. Most. Commonly Used. at Surveyed Hospitals . . . . PestHospital Management. of Cost Figure19. . PostingHospitalsPesticideFigure Outdoor18. NotificationSigns . PostingHospitalsFigurePesticide Indoor17. NotificationSigns. . PesticideHospitals SurveyedCancelled ProductsFigure Usedat 16. . PesticideCancelled Products Useof Hospital Figure 15. . Family Chemical ByUsedInsecticides, Commonly Most HospitalsSurveyedFigure 14. . PesticideHospitals’FigureChemical Use 13. Outdoor . PesticideHospitals’FigureChemical Use. 12. Indoor HiredCompany. . by PestIn-HouseHospitalor Managed Outdoor Management, Figure 11. . HiredCompany. by PestIn-Houseor StructuralHospitalManagedFigure Management, 10. . Approach IPM Usingan HospitalsFigure 9. . Writtenwith HospitalsFigure 8. Pest Plans Management . Safety PesticideNotFigureEqual Does7. Registration . UsedInsecticides Commonly of Overview Figure6. . UsedHerbicides. Commonly of Overview Figure5. . PesticideHospital IllinoisUse FigureRestriction. 4. . PesticideHospitalFigureReports Incident3. PesticideFigure2. ToxicityWarning . Label. TablesSide Bars, and Charts . Endnotes VI. . V.Appendix. . Recommendations and Conclusion IV. Hospital PesticideHospitalResults. . UseSurvey . Survey Pesticideand Hospital UseLetter Cover . PolicyPestIntegrated(IPM) HospitalModel Management . List Resource Hackensack University Medical Center. . UniversityCenter. MedicalHackensack . Women’sand Brigham Hospital . Hospital General Massachusetts Hospital.Francisco . GeneralSan EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND ...... 1 . 40 . 14 . 52 . 14 . 40 . 20-21 . 22-23 . 47 . 38 . 33 . 33 . 43 . 33 . 33 . 41 . 4 . 30 . 5 . 30 . 7 . 6 . 19 . 13 . 15 . 10 . 16 . 29 . 15 . 9 . 8 . 31 . 25 . 18 . 12 . 26 . 28 . 18 . 17 . 29 . 34-35 36-37 5 Healthy Hospitals 1 Controlling Pests Without Harmful Pesticides 171 hospitals contacted, 22 surveys contacted, 171 hospitals were calls, letters phone numerous after returned members. HCWH visits by and in some cases, surveyOur to gener- was not intended process but we scientific data, ate fully representative an provide that the data collected believe what some of the of instructive “snapshot” facilities are health care preeminent nation’s The survey can also be doing for pest control. or health sys- used as a helpful tool for hospital and tems to assess their pest management over progress pesticide use and to monitor their time. come to assume Although many people have only way to con- that applying pesticides is the health a clean, healthy ensure pests and trol that pests can be shows this report facility, care pesticides successfully managed without toxic effect on the and without having an adverse facilities care Health quality of patient care. do no harm” another opportunityhave “first, to changing the way they view and by pest control this guide to safer and effective following by integrated pest management. Christensen Hunt Jackie Harm Without Care Health 2003 November The potential health risks of phthalate polyvinyl chlo- from leaching plasticizers medical devices; ride (PVC) viable environmentally and Economically waste incinerators, to medical alternatives developing options for including low-cost countries; what comes in The connection between of the facility (purchasing) door the front and what goes out the back (environmen- tal services/housekeeping), and the need all for good communication between departments; and, health impacts of The potential adverse building materials and furnishings used in of a facility. construction or remodeling ● ● ● ● shine the spotlight on pesti- we this report, In commonly hazard cides, another avoidable began to look When we in hospitals. present was very there lit- discovered into this issue, we or on the quantities tle information available types of pesticides being applied inside and our Therefore, outside of hospitals and clinics. a surveyfirst step was to create to gather data ourselves. Report’s World & began with U.S. News We list of 171 hospitals that Hospitals” 2001 “Top facili- but focused on 100 the survey, received HCWH member ties in or near cities where the located or had contacts. Of were groups As Health Care Without Harm has grown and grown has Harm Without Care As Health we diverse, more has become our membership and mercury dioxin looked beyond to have “on not previously that were pursue other issues administrators, of health care the radar screens” including the goal of mak- and clinicians, staff, safer for both environments ing hospital These issues include: patients and workers. Preface was (HCWH) Harm Without Care Health 1996 when representatives born in September at gathered 28 organizations from Those of in Bolinas, California. Commonweal us who participated had a very specific agenda: in opposition to mass” “critical had to see if we focused were We medical waste incineration. and mercu- of dioxin primarily on the hazards ry certainly emissions, although we were implications of thinking about the broader we impacts when environmental health care’s transform the our mission: “to developed industryhealth care a so that it is no longer harm, without com- of environmental source safety or care.” promising not were providers knew that health care We bodies and people’s polluting the environment out of any malicious intent, but because they lacked sufficient information about the hazards that when given believed We of their activities. indus- the data and the choice, the health care do no harm,” and try would choose to “first, indeed, this has most often been the case. organiza- of our member the work Through has Harm Without Care tions, Health of hospi- successfully influenced the reduction and mercurytal emissions of dioxin and the medical waste incinerators. of many closure 427 member organizations include health Our of health profes- systems, organizations care religious groups, environmental sionals, labor, in groups organizations and health-advocacy 52 countries. BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals

2 Controlling Pests Without Harmful Pesticides ● ● ● ● hospitals: show that of the 22 respondingof the survey Pest Management (IPM). The major findings method of pest management called Integrated even at hospitals that report using the safer considerable pesticide use at hospital facilities, vide notification of pesticide use, there is still using least hazardous approaches and/or pro- results show that while some hospitals report in to the 171 top U.S. hospital facilities, as cited Without Harm (HCWH) distributed surveys of hospital pest management, Health Care In order to better understand the current state hospitals. risk and raises questions about the safety of This puts the health of patients and staff at the U.S. are regularly using toxic pesticides. U.S. hospitals indicate that major in and healing. Yet of top the findings of a survey Hospitals are intended to be places for health Summary Executive U.S. News and World Report active ingredient is being phased out by 18% use a pesticide product in which the Environmental Protection Agency (EPA); longer registered for use by the U.S. 36% use pesticide products that are no 77% use chemical pesticides outdoors; 91% use chemical pesticide indoors and ings or both; either on their grounds, inside the build- 100% use chemical pesticide products (2001). Survey ticides. Hospital patients who have compro and visitors be protected from exposure to pes- that patients, staff,health, it is also important clean environment free of pests that threaten While it is essential that hospitals maintain a use to patients, visitors and staff. practices and disclosure of hospital pesticide ability of and need for safer pest management management practices survey, and (c) the avail- tals, (b) the findings of a national hospital pest associated with the use of pesticides in hospi- about (a) a number of potential health hazards hospital officials, the public and policy makers This landmark report is intended to inform ● ● ● ● responding hospitals: thus reducing patients’ toxic exposure. Of the fy staff and patients when pesticides are used, to reduceeffort their pesticide use and/or noti- some of the responding hospitals are making an findings also indicate that at least The survey ● ated with its use; and EPA due to the unacceptable risk associ- training for their staff. 27% have provided pesticide-poisoning tions; and, indoor and outdoor pesticide applica- 14% post notification signs for both pesticide; containing boric acid, a least hazardous 45% use one or more pesticide products pest management; 73% report using an IPM approach to the majority of hospital’s grounds; hire a pest control company to manage al pest management program and 41% age the majority of hospital’s structur- 73% hire a pest control company to man- EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND mised such as cancer, defects, neurological and birth pesticides are also linked to chronic effects, nausea, headaches, rashes, and dizziness. Many and cause other acute adverse effects including in humans pesticides can exacerbate asthma tion to killing pests and beneficial organisms, contribute to poor indoor air quality. In addi- Many of them contain volatile compounds that undesirable or that threaten human health. kill or repel insects, plants, and animals that are Pesticides are hazardous chemicals designed to ticide or nonchemical alternative.” others, and to use the least toxic chemical pes- to limit pesticide exposures to themselves and for homeowners,prudent farmers, and workers nesses. Considering these data gaps, it is either to pesticide usage or pesticide-related ill- terize potential exposure problems related systems are inadequate to charac- surveillance effects of low dose pesticide exposure. Current tainty exists regarding the long-term health on Scientific Affairs states, “Particular uncer- The American Medical Association’s Council tude.” magni- pesticide establishes a risk of uncertain concerning all uses of pesticides. The use of any policy be adopted that a cautious, conservation physical and attitudinal environments, requires of debilitation and convalescence, and in varied effect on patients in various stages Affairs. “The of institutions,” states the Department Veteran fers from control practices in other types of “Pest management in health care facilities dif- heightened reactions to pesticides. medications may also have taking certain ly vulnerable to their toxic effects. Patients allergy or sensitivity to pesticides are particular- infants and children, and those who have an systems, the elderly,immune and nervous 1 2 Healthy Hospitals 3 Controlling Pests Without Harmful Pesticides A Pest , adds by Beyond Pesticides and the Pesticides Beyond by Recommendations using an Integrated While some hospitals are to manag- (IPM) approach Management Pest ing pests, it appears that the majority of U.S. an urgent need to adopt safer hospitals have of pest management practices. Implementation can eliminate the IPM programs cost-effective unnecessary pesticides that use of hazardous the health of patients and staff. threaten entities, the public and government Hospitals, the pest management industry can all take the number of hospitals action to increase IPM programs. adopting least hazardous Management in New York State Hospitals State York in New Management community must be notified prior to the appli- prior to the must be notified community necessary to take order cation in precautions. being imple- successfully are IPM strategies facilities government parks, mented at schools, example, IPM For and hospitals nationwide. Sciences and Health at Oregon programs Hospital, Women’s and Brigham University, Francisco, of San the City University, Harvard Department, New and Recreation Parks Seattle Services the General Schools, City Public York demonstrate that IPM can be Administration implemented. economically and effectively reports, along with the 1995 This report, to Protect Failure report General Attorney’s York New on the types and amounts to the data available facilities across of pesticides used at health care confirms and elaborates on pre- It the country. pesticides are vious findings that hazardous commonly used in U.S. hospitals. in not addressed chemicals are (Antimicrobial this report.) Thus a large number of 4 5 that see about 32 million inpatients, 83 that see about 32 million inpatients, 3 individuals may be exposed to toxic pesticides toxic individuals may be exposed to hospital patients settings. Some in health care effects of especially vulnerable to the toxic are pesticides. million outpatients and 108 million emergency million outpatients and 108 million patients per year. room Why Focus on Hospitals? Why Focus the hospitals in 5,810 registered are There U.S. demon- a special obligation to have Hospitals and strate leadership in instituting effective safer pest management in keeping with the do no basic tenet of “first, medical profession’s harm.” called a method of pest control Fortunately, (IPM) eliminates Management Pest Integrated to pests the need to respond reduces or greatly and helps pesticide products with hazardous for hospital environment a healthier ensure The focus of IPM is and visitors. patients, staff, or elimi- reducing by pest problems to prevent and shelter of pest food, water, nating sources main- and by in hospitals and on their grounds The first taining healthy lawns and landscapes. is pest outbreak a to controlling approach structural sanitation, making repairs improving (such as fixing leaky pipes and caulking cracks), such and using physical or mechanical controls A least hazardous weeders. traps and as screens, chemical is used only when other strategies a pesticide is used, the hospital failed. If have reproductive disorders, and development of development and disorders, reproductive are poisonings Pesticide sensitivities. chemical misdiagnosed or unrecognized, frequently providers most health care largely because ill- minimal training in environmental receive when they have nesses and few know people a pesticide. been exposed to BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals

4 Controlling Pests Without Harmful Pesticides ing, convulsions, skin irritations, flu-like disorientation, inability to concentrate, vomit- ness, headaches, aching joints, mental acute pesticide exposure include nausea, dizzi- vary, typical symptoms that can result from an Although the toxicity of individual pesticides of Pesticides Health Effects cides linked to a wide range of health problems. Everyday the public is exposed to toxic pesti- Pesticide Toxicology landscape use. and many others are registered for lawn and 320 of those are registered for use in hospitals active ingredients registered for use by EPA, annually. Currently, there are 890 pesticide cides—approximately 4.5 billion pounds The U.S. uses an enormous volume of pesti- living organisms.” adversely affect designed to kill or otherwise animals, or the environment because they are pesticides create some risk of harm to humans, (EPA) states that, “By nature, most their very The U.S. Environmental Protection Agency Problem I. The Pesticide health poisonings. major source of environmental and public therefore not surprising that pesticides are a water they drink and the food eat. It is multiple pesticides in the air they breathe, the hospitals, people are frequently exposed to spread use of pesticides, including in 7 6 And yet, with the wide- 8 9 sticking or spreading agents, defoamers. vents, stabilizers, preservatives, surfactants, agent in the pesticide product. They may be sol- Ingredients “Inert” ingredients also include synergists. chemicals that kill or repel living things. Active against a target pest. By definition it is these label, are biologically and chemically active nents of the formulation listed on pesticide Active Ingredients often contain PBO. pesticide products are the pesticides that most Pyrethroid, pyrethrin, and carbamate-containing toxicant and a possible human carcinogen. breakdown the active ingredient. PBO is a liver pesticide synergists that reduce insects’ ability to bicycloheptene dicarbozimide are and n-octyl active ingredient(s). Piperonyl butoxide (PBO) pesticide product to increase the potency of Synergists in another pesticide product. ingredient and/or may be an active ingredients are as or more toxic than the active 95% of the pesticide product. Some “inert” Quite often these ingredients constitute over known as metabolites, which are sometimes more toxic than the parent material. tion, pesticides, when subject to various environmental conditions, break down into other materials ingredients, as well contaminants and impurities. In addi- materials, including active and “inert” other products active against pests. Pesticide products are formulations of a number different rodents, fungi or other pests. Pesticides include insecticides, herbicides, fungicides, rodenticides, and A pesticide product is a mixture of chemicals used to kill, repel or otherwise control insects, weeds, EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND are chemicals that added to a , usually the only compo- are the carrier or sticking FIGURE 1. WHAT IS IN A PESTICIDE? 11 10 applied by licensed applicators. whereas restricted use pesticides may only be use pesticides can be applied by anyone, applied according to label instructions. General EPA and the state in which they are used, By law, pesticide products must be registered by Restricted Use Pesticide General Use Pesticide vs. pound. lite is more hazardous than the parent com- sunlight or living organisms. Often the metabo- when a pesticide is exposed to air, water, soil, Metabolites cides. been identified as a contaminant in some herbi- toxicity.to a product’s For example, dioxin has found in pesticide products and can contribute of the manufacturing process that are often Contaminants and Impurities 12 are breakdown products that form are byproducts Healthy Hospitals 5 Controlling Pests Without Harmful Pesticides 29 28 , found that 72 percent of pes- , found that 72 percent (FIFRA), pesticide manufactur- 30 Federal Insecticide, Fungicide and Fungicide Insecticide, Federal The Secret Ingredients in Pesticides: Ingredients The Secret The Hazards of “Inert”The Hazards Ingredients on on pesticides focuses discussion While most pesticide formulations con- ingredients, active ingredients. of so-called “inert” tain a majority solution, dust, or granule in They form the and gener- is mixed ingredient which the active of the largest percentage ally make up are Many in a pesticide product. ingredients like acetone, fuel oil, solvents petrochemical chemicals. toluene and other benzene-like may the term “inert,”Despite these ingredients biologically or toxicological- not be chemically, can be more ingredients “inert” fact, ly inert. In and/or be an ingredient active than the toxic product. in another pesticide ingredient active the Under Act Rodenticide the active to reveal only required ers are The law allows in a pesticide. ingredients infor- trade secret to remain ingredients “inert” consumers and applicators This leaves mation. chemicals present toxic of the possible unaware of pesticide products ingredients in the “inert” using. they are Attorney State York the New by A 2000 report General, the Risk Reducing contain to consumers available ticide products fewer than ingredients; “inert” 95 percent over list any of the of pesticide products 10 percent on their labels; and, of a ingredients “inert” 394 chemicals ingredients, 1995 list of “inert” in other pesti- ingredients listed as active were cide products. data little toxicity requires general, EPA In ingredients on “inert” manufacturers from However, a pesticide product. registering before to state, known many of these chemicals are , a 10- 21 Some individu- Some 20 23 18 Studies show that children show Studies 17 Non-Hodgkin’s lymphoma has lymphoma Non-Hodgkin’s 16 Pesticides can affect the immune and can Pesticides Unfortunately, most health care providers most health care Unfortunately, 19 22 National Strategies for Health Care Providers: Care for Health Strategies National receive minimal training in environmental ill- in environmental minimal training receive agencies have and other government nesses. EPA Environmental teamed with the National (NEETF) to Foundation Training & Education published They have try this problem. to address the Plan Implementation Initiative Pesticides prevention, plan designed to improve year poi- and management of pesticide recognition the education of increasing sonings by physicians, nurses and other health care about pesticides. providers als with multiple chemical sensitivities (MCS), als with multiple chemical sensitivities chemical sensi- i.e. those with the most severe to adversely to react been reported tivities, have includ- residues, of pesticide minute levels even pesticide applications from ing those resulting earlier. years made months or even Pregnant women, children, the chemically sen- women, children, Pregnant at greater ill are chronically elderly and sitive, than others. exposure pesticide risk from in laboratory animals raise concerns Studies that patients taking certain medications may some pesti- to reactions heightened also have cides. misdiagnosed frequently poisonings are Pesticide All too often victims of pesti- or unrecognized. of their the source realize never cide exposure after visiting a physi- symptoms or illness, even cian. been linked to the use of the commonly used of the commonly to the use been linked killer 2,4-D. weed nervous system and result in increased prob- nervous in increased result system and asthma, and lems with allergies, hypersensitivity to chemicals. living in households where pesticides are used are pesticides where living in households brain cancer rates of leukemia, suffer elevated and soft tissue sarcoma. myeloma. Low- 14 In some In 13 15 FIGURE 2. FIGURE 2. level pesticide exposure over a period of time over pesticide exposure level health effects. in chronic may also result linked to a wide range of chronic are Pesticides birth defects, including cancer, health problems psychological genetic damage, neurological, chemi- and behavioral effects, blood disorders, effects, and cal sensitivities, reproductive and immune sys- kidney, abnormalities in liver, tem function. symptoms and asthma-like problems. insecticides, herbicides and fungicides Many including linked to certain types of cancer, are as well stomach, and prostate, those of the lip, as leukemia, lymphatic cancers, and multiple BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM cases, a person can develop chronic health chronic cases, a person can develop an acute poisoning. following problems PESTICIDE TOXICITY WARNING LABEL WARNING TOXICITY PESTICIDE Pesticide product labels contain a toxicity warning product labels contain Pesticide either “Danger”signal word of for the highest toxicity or for moderate toxicity, “Warning” category, ratings The toxicity the lowest toxicity. for “Caution” of the product. The only apply to the acute toxicity not take into account a warning labels, therefore, do product’schronic effects such as can- ability to cause mutations, multiple chemi- birth defects, genetic cer, damage to long-term cal sensitivities (MCS), or other immune or neurological systems. the respiratory, categories ignore the In addition, the acute toxicity impacts of pesticides substantial variations in health example, individuals who on different people. For have allergies or sensitivities to pesticides can be made very sick from exposures to pesticides even if those pesticides carry a low acute toxicity rating. Healthy Hospitals

6 Controlling Pests Without Harmful Pesticides future pesticide applications “as late in the clinic day as possible.” and/or patients.” The hospital stated that the pest control contractor would make acceptable for use in medical facilities and do not jeopardize the health of staff pital. The hospital wrote a letter in response stating, “The pesticides used … are wrote a letter to the hospital voicing her concerns about chemicals used at hos- applied the pesticide and that there was nothing more they could do. The woman Department of Health, but their investigation found that the company had not mis- ing been poisoned by a pesticide. She reported the incident to Pennsylvania woman’s doctor conducted urine, blood and nerve tests diagnosed her as hav- that it would not hurt her and led to believe the pesticide was safe. The a commercial pest control company in an adjacent room. The applicator told her A woman entered the outpatient area of a the fumes of insecticide Ficam oped difficulty breathing and nausea. She noticed a strong odor. It turned out to be A woman in A hospital staff person in following the exposure with severe fatigue and weakness. breathing, tremors, severe weakness, and confusion. She was in bed for two days to cause a severe reaction that included visual disturbances, headache, difficulty and was driven home. Nevertheless, those few minutes of exposure were sufficient pesticides at the building entrance, about 10 feet from her. She left immediately car, she saw an individual in protective clothing and a respirator spraying lawn care dropped off at the entrance to outpatient lab. As she began get out of application. In a separate incident at this same facility, the woman was being the hospital but was unable to obtain any additional information on pesticide pesticides. She immediately returned home and later placed a number of calls to chemicals had been used in the area. She was told that someone just sprayed weakness and tremors. She asked the only hospital employee in vicinity if any ing early one Saturday morning. She immediately experienced a severe headache, use of pesticides. Oklahoma Department of Agriculture and EPA, the hospital was cited for improper her as having been poisoned by the pesticide. After incident was reported to she became sensitive to a host of chemicals. Dursban 4E TM Pennsylvania HOSPITAL PESTICIDE INCIDENT REPORTS (active ingredient chlorpyrifos) on the job. Following the exposure, 25 Oklahoma was sitting in a hospital waiting room when she devel- TM FIGURE 3. (active ingredient bendiocarb) being sprayed by became sick after she was exposed to New Jersey 24 A medical professional diagnosed EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND hospital for laboratory test- 27 26 inert ingredientsinert are harmless. to minimizeorder the misconception that to try ents as “other” ingredients on product labels in registrants to voluntarily refer to “inert” ingredi- exposure commonly occurs when children or be absorbed through the skin. This type of cide’s vapors. If touched, pesticide residues can applied, one can still be breathing in the pesti- detected, such as after “low odor” products are inhaling the pesticide. And, even if no odor is detects a pesticide’s odor, that person is also them through the skin. When an individual contaminated with pesticides and absorbing nated with pesticides, or by touching surfaces pesticides, consuming water or food contami- breathing in pesticide fumes or dust laden with Human exposure to pesticides takes place by Pesticide Exposure Routes toxic.” ingredientsbe assumed that all inert are non- target species, or the environment, it should not basis of toxicity, hazard or risk to humans, non- the regulations define the term ‘inert’ on the states EPA. “Since neither the federal law nor ingredients,’ believing it to mean ‘harmless,’” “Many consumers are mislead by the term ‘inert hazards. gens, and 127 are regarded as occupational Inventory, 21 are known or suspected carcino- are reportable to the Toxic Chemical Release have been assessed as “extremely hazardous,” 84 statutes governing air and water quality, 14 ardous pollutants in federal environmental in pesticide products are identified as haz- for Alternatives to Pesticides, 209 “inerts” used investigative report by the Northwest Coalition ardous to human health. According to an federal and international agencies to be haz- manufacturers have done so. 32 31 In 1997, EPA began asking pesticide 33 However, few Healthy Hospitals 7 Controlling Pests Without Harmful Pesticides 44 “Some individuals in a pest population may be able to survive initial applications of a chemical designed to kill them, and this survival may be due to genetic differences rather than to escape from full exposure. The breeding population that survives initial applications of pesticide is made up of an ever-increasing proportion of individuals that are able to resist the compound and to pass Pesticide EfficacyPesticide and Resistance synthetic of the release continues to allow EPA a without pesticides into the environment toxic of the efficacy of these products full assessment time. over of pest resistance or the development of hazardous has been the release The result arsenic, organochlorine, materials, including synthetic organophosphate, carbamate, that no and other chemical families, pyrethroid leaving a trail of longer eliminate pests, while effects. toxic adverse a measure, on pesticides is a reactive Reliance to managing pest prob- symptomatic approach schedule routine pesticides on a lems. Applying tends to support the habit of ignoring the caus- often are es of pest infestations. Pesticides the long temporary over and ineffective fixes use. repetitive usually require term. Pesticides tends to kill for ants, for example, Spraying insects, while the queen is safe only the worker the queen can pro- Since back in the colony. is not ants, the pest problem worker duce more solved. of insects, plant of species Hundreds and pathogens, fungi, nematodes, rodents to pesticides. become resistant have weeds become most serious since “… has Resistance use of synthetic and widespread the discovery to the organic compounds,” according The of Sciences (NAS). Academy National explains why this is the case: 1986 report 42 43 , which found evi- Body Burden: the Pollution in the Pollution Body Burden: When pesticides are sprayed out- sprayed are When pesticides 39 National Report on Human Exposure to Exposure on Human Report National , led by Mount Sinai School of Medicine Sinai Mount , led by 40 doors there is almost inevitable pesticide drift doors there via wind or thermal cur- on to non-target areas rents. dence of 89 chemicals, out of 116 tested, in the The chem- blood or urine of study participants. icals found in study participants included types of pesticides (organophosphate, several organochlorine, and carbamate insecticides; and disinfectants). herbicides; pest repellents; Just this year, there have been several studies been several have there this year, Just to pesticides and that confirm that exposure contamination. other chemicals leads to human 2003, the Centers for Disease January In the released (CDC) and Prevention Control second Chemicals Environmental A similar study, People in collaboration with the York in New and Group Working Environmental 2003 in February was released Commonweal, on chemicals found in nine study volunteers. tested for 210 chemi- These individuals were cals, the largest suite of industrial chemicals average found an The researchers surveyed.ever of 91 industrial compounds, pollutants and other chemicals in the blood and urine of all total, 167 chemicals were In nine volunteers. the detec- This included found in the group. of nine organophosphate tion of seven metabolites tested and 10 of 23 organochlorine pesticides and metabolites tested. potential for the chemical to drift from the from to drift for the chemical potential or low of generally are site. Baits application likely to pose the not and are very volatility low sprays. A risks associated with high exposure pesticides, whether of sprayed small percentage the target or outdoors, reaches applied indoors organism. 38 EPA’s 35 Pesticides can also Pesticides 34 FIGURE 4. is easily tracked indoors, contaminating A recent study found that 2,4-D, the most study found A recent 37 36 USE RESTRICTION Non-Occupational Pesticide Exposure Study Exposure Pesticide Non-Occupational found that tested households had at (NOPES) often 10 at levels least 5 pesticides in indoor air, in outdoor measured levels than times greater air. The type of pesticide formulation and applica- tion method influences the potential for a pesticide suspends Spraying human exposure. in a greater the chemical into the air resulting commonly applied lawn herbicide in the coun- try, pets roll around on lawns that have been treat- been that have on lawns around pets roll common a Despite herbicides. ed with to a pesticide harmful exposure misconception, The when a pesticide dries. does not end hours, days and even can linger for residues application. months after an BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM be tracked inside from outdoor applications or from be tracked inside part of a building to an treated a carried from section. untreated pesti- a study looking at the persistence of In of seven cides, airborne concentrations days following tested for three insecticides were in an unoc- their application in separate rooms pesticides of the seven Six cupied dormitory. in which found in air samples in the room were day. third the applied through they were the air and surfaces inside residences at levels the air and surfaces inside residences levels. ten times higher than pre-application 41 ILLINOIS HOSPITAL PESTICIDE ILLINOIS HOSPITAL Illinois is the only state with a law that prohibits the use of certain pesticides while patients are in the treated area. Healthy Hospitals

8 Controlling Pests Without Harmful Pesticides tion and offspring development. because of concern that it could pose a risk to fertility, reproduc- Service fact sheet advises that female employees not spray 2,4-D ins. Michigan found that 2,4-D is frequently contaminated with diox- MCPA. 2,4-D is easily absorbed through the skin and lungs. phenoxy herbicides, such as dicamba, mecoprop (MCPP), and weeds and is often found in fertilizer products along with other they may have more children with birth defects. was used. of canine lymphoma in dogs living households where 2,4-D conducted by the National Cancer Institute found elevated rates active dog are the greatest contributing factors to tracking for Young Children Applications: Comparing Exposure Estimates from Various Media 2,4-D in Air and on Surfaces inside Residences after Lawn levels. The study,times higher than pre-application contaminate the air and surfaces inside residences at levels ten Another study found that 2,4-D is easily tracked indoors and can they have lowered sperm counts Studies on farmers who have been exposed to 2,4-D found 2,4-D is also an endocrine disruptor. Sweden, Canada, Nebraska, Kansas and Washington. Hodgkin’s lymphoma has been documented in several studies and blood systems. The link between 2,4-D exposure non- linked with an increased risk of specific cancers the lymphatic Exposure to 2,4-D and other phenoxy herbicides have also been exposure to 2,4-D has been reported cause liver damage. vulsions, kidney and liver injury, and muscle twitching. Long-term Symptoms of 2,4-D poisoning include drowsiness, vomiting, con- 2,4-D (Trimec and reproductive harm. been shown to decrease blood levels of thyroid hormones increase the production of female sex hormones by male testes. the U.S. 2,4-D is the most commonly used non-agriculture herbicide in 51 Dioxins are highly toxic chemicals that can cause cancer 46 50 It is frequently applied to lawns control broadleaf A 2002 study by researchers at the University of TM ) At A Glance , found that a homeowner applicator and an 52 FIGURE 5. OVERVIEW OF COMMONLY USED HERBICIDES 58 56 and there is growing evidence 53 In animal studies, it has 57 A U.S. Forest EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND Distribution of 49 A study 54 and 47 48 55 product Roundup, is more acutely toxic than glyphosate itself. ed tallowamine (POEA) used in the glyphosate-containing tumors and cancer of the thyroid in exposed animals. have found increases in testicular, kidney, pancreatic and liver ness in people California. ill- ranks first among herbicides as the cause of pesticide-related the California Department of Pesticide Regulation, glyphosate published a similar study in 1996, indoor carpet surfaces and dust after a lawn application. Surface Residues Dislodgeable 2,4-D Turf Residues with Carpet Dust and from TurfApplied Herbicide Acids to Home: Correlation of Hodgkin’s lymphoma and glyphosate exposure. cancer. Recent studies show a link between the cancer non- Recent reports link exposure to glyphosate an increased risk of and miscarriages weight loss in animal tests. eye irritation, nausea, diarrhea, skin and respiratory reactions, chemicals are associated with a range of acute effects, including lidionone, pelargonic acid, sodium sulfite and sorbic acid. These butylcarbamate (IPBC), isobutane, isopropylamine, methyl pryro- tain ammonium sulfate, benziothiazolone, 3-iodo-2-propynyl Besides POEA, glyphosate products have been reported to con- poses. second most commonly used herbicide for nonagricultural pur- herbicide. It is the Glyphosate is a widely used broad-spectrum Glyphosate (RoundupTM) At A Glance genetic damage. products have been shown to cause tion, glyphosate-containing function, and low blood pressure. and upper respiratory tract irritation, vomiting, respiratory dys- humans and animals. Symptoms of exposure include eye, skin, half-lives of up to 174 days. life of 47 days, although there are studies reporting field dowsills. greatest amount of 2,4-D in indoor air and on tables win- of floor dust results in the herbicide into homes. Re-suspension 61 59 It is moderately persistent in soil, with an average half- The study’s lead researcher,The study’s Marcia Nishioka, also , that found residues of 2,4-D and dicamba on 69 62 66 Glyphosate can be acutely toxic to 63 Measuring Transport of Lawn- The surfactant polyethoxylat- 67 65 Animal studies According to 68 In addi- 64 60 Healthy Hospitals 9 Controlling Pests Without Harmful Pesticides A 80 78 Chronic toxicity studies have shown Based on tests with laboratory animals, Based on tests 82 75 EPA classifies some pyrethroids as possi- classifies EPA 76 77 84 EPA considers PBO to be a possible human EPA 83 79 In addition to the symptoms induced by the active 81 ble human carcinogens (Group C). ble human carcinogens (Group increased liver weights in test animals, even at the lowest doses. increased liver weights in test animals, even at the lowest even at Animal studies have also shown hepatocellular carcinomas low exposure levels. and seizures can develop. and seizures can than typical pesticide product contains 5 to 20 times more synergist active ingredient. Pyrethroids, pyrethrins, rotenone and carbamates are the active ingredients most often formulated in combination with PBO. carcinogen (Group C). Pyrethroids have been linked to disruption of the endocrine system. Pyrethroids have been linked estrogenic properties in in- Some pyrethroids have demonstrated vitro laboratory studies. to all insects, both beneficial insects Because pyrethroids are toxic applications. In some cases, and pests are affected by pyrethroid to a lower dose than the insect predator insects may be susceptible relationship. the predator-prey pest on which it preys, disrupting are often formulated with oils or Both pyrethroids and pyrethrins in combination with toxic syn- petroleum distillates and packaged ergists, such as piperonyl butoxide (PBO) and n-octyl bicyclohep- tene dicarboximide. Piperonyl Butoxide At A Glance butoxide (PBO) is a chemical that acts synergistically with Piperonyl potency. the active ingredient of a pesticide product to increase its to reduce It is a liver poison that is added to pesticide products insects’ ability to break down and detoxify the active ingredient. it appears that newborns may be more sensitive to some newborns may be more it appears that adults. pyrethroids than vomiting, ingredients, signs of PBO poisoning include anorexia, and per- diarrhea, intestinal inflammation, pulmonary hemorrhage contact may haps central nervous system depression. Repeated cause slight skin irritation. They 74 They are 73 ) At A Glance TM Oncogenicity test results , Suspend TM 71 72 , Talstar TM FIGURE 6. OVERVIEW OF COMMONLY USED INSECTICIDES OF COMMONLY OVERVIEW FIGURE 6. ) At A Glance , Cynoff TM TM Acephate breaks down to methamidophos, another Acephate breaks down to methamidophos, 70 often formulated with synergists that increase their potency by com- often formulated with synergists that increase their potency promising the ability of insects to detoxify the pesticide. Pyrethroids include the active ingredients bifenthrin, cyfluthrin, cyhalothrin, There cypermethrin, deltamethrin, and permethrin, among others. the differ- is a range of toxicity between formulations and amongst ing pyrethroid compounds themselves. Pyrethroids act by inhibiting the nervous system of insects. found an increased incidence of adrenal medullary tumors and found an increased incidence when compared with experimental pituitary tumors in male rats increased incidence of liver tumors controls. In female mice, an thought to be precursors to tumors, and liver hyperplasic nodules, tested. was seen at the highest doses With the phase out of several organophosphate pesticides prod- the phase With com- ucts, pyrethroids insecticides are becoming some of the most Pesticide monly used insecticides in offices, buildings and homes. control products containing pyrethroids are often described by pest is quite operators as “safe as chrysanthemum flowers,” but this While pyrethroids are a synthetic version of an extract misleading. to be from a chrysanthemum plant, they are chemically engineered more toxic to insects and to take longer to break down. Pyrethroids (Tempo Acephate (Orthene are also toxic to the human nervous system. Signs and symptoms are also toxic to the human nervous system. Signs and and numbness of burning, of pyrethroid poisoning include stinging, the skin, abnormal facial sensation, dizziness, salivation, diarrhea and irritability to sound and headache, fatigue, vomiting, touch. In more severe cases, pulmonary edema, muscle twitching, organophosphate pesticide. EPA has classified acephate as a pos- has classified acephate as a EPA organophosphate pesticide. C). sible human carcinogen (Group This organophosphate insecticide (like other organophosphates, insecticide (like other This organophosphate inhibits acetyl- chlorpyrifos, and malathion) such as diazinon, system enzyme. (AchE), an essential nervous choline esterase include headaches, fatigue, Symptoms of acephate poisoning and in extreme cases, respiratory stomach cramps, nausea, depression. BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals 10 Controlling Pests Without Harmful Pesticides While the “safe” or “harmless.” cator statements characterizing pesticides as is misled on pesticide safety by pesticide appli- leading information on pesticide hazards” and general public receives limited and mis- “The has told Congress on several occasions that, to use. The U.S. General Accounting Office ticides are registered by EPA then they are safe There is a common misconception that if pes- Pesticide Regulation Rodenticide Act .Pesticides are not tested for their cumula- 3. Most toxicity testing is only done on the 2. When EPA registers a pesticide, it consid- 1. environment: not adequately protect human health and the are a number of reasons why the two laws do Protection Act resistant individuals.” ceptible pests and an increase in the proportion of application, which results in a further loss of sus- increasing the pesticide dosage and frequency of not receive a lethal dose, they may react by pesticide users often assume that the survivors did this characteristic on to their offspring. Because tants, or pharmaceuticals. other pesticides, environmental pollu- tive effects or synergistic interactions with formulation. ingredientsof inert or the full product active ingredient. There is limited testing estimated benefits outweigh the hazards. regardless of its toxicity, if it believes the means that EPA can register any pesticide, environmental impacts of a product. This tion to the potential adverse health and ers economic costs and benefits in addi- Federal Insecticide, Fungicide and (FQPA) regulate pesticides, there (FIFRA) and the 85 45 Food Quality ment review or approval of the information their pesticide products, but there is no govern- vide Material Safety Data Sheets (MSDSs) on label. Manufacturers are also required to pro- required to be listed by name on a pesticide As stated earlier, “inert” ingredients are not effects, or display EPA’s carcinogenicity rating. Labels do not provide information on chronic ing from exposure to the active ingredient. about possible immediate health effects result- information is usually limited to warnings recommending protective clothing. Health information, such as tain precautionary appropriate application methods and may con- the user through the label. Labels advise on Most pesticide information is made available to Limited and Misleading on Product Label Information .There is inadequate tracking of pesticide 7. Many pesticides in common use were reg- 6. There is inadequate testing for impacts 5. There and is inadequate testing for short- 4. use, exposures, and poisonings. ardous exposures can continue. tered. In the meantime potentially haz- whether they should continue to be regis- EPA’s re-registration process to determine were enacted and have not completed istered before more stringent regulations are usually done for healthy adult males. endocrine systems. Toxicity assessments neurological, respiratory, and/or chronic illnesses involving the immune, those with chemical sensitivities or other dren, pregnant women, the elderly, and on vulnerable populations, such as chil- effects. and endocrine (hormone)-disrupting long-term neurological, immunological, EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND 87 health information. Therefore, they should not be relied on for labels, the information is still limited. information on health effects than product provided. Thus, while MSDSs provide more nitely. tainerized baits use are allowed to continue indefi- Agricultural, golf course, mosquito control and con- tinue to be used until existing stocks are depleted. non-residential uses, chlorpyrifos products can con- no longer be purchased for many residential and settings. Although, as of December 31, 2001, it can schools, office buildings, hospitals, and other indoor commonly used insecticides in homes, gardens, children. Chlorpyrifos had been one of the most because they posed an unacceptably high risk to products, structural uses of chlorpyrifos-containing ment with Dow AgroSciences to phase out many fos, to be used for 30 years, EPA reached an agree- After allowing Dursban PESTICIDE REGISTRATION DOES 86 NOT EQUAL SAFETY 88 FIGURE 7. TM , active ingredient chlorpyri- Healthy Hospitals 11 Controlling Pests Without Harmful Pesticides Therefore, the law Therefore, 90 91 that toxic pesticides are necessary pesticides are that toxic Pesticide Laws Allow An “Acceptable” Risk An “Acceptable” Allow Laws Pesticide an contain pesticides that regulate The laws assumption that, “eco- states EPA tools in pest management. not pesticide use are from nomic benefits risks to human without potential achieved to the toxicity due environment health and the of pesticide chemicals.” allows harm and illness to occur when these harm and illness to occur allows usually are there reality, used. In chemicals are These include to manage pests. ways non-toxic or exclude maintenance practices that prevent and biological pests, and mechanical devices most cases, the In them. materials that control or mold growth, causes of an insect infestation and corrected. for example, can be identified use of mechanical traps and times, the Other can be effective. attractants pheromone of pesticides because the benefits Nevertheless, that high, it is rationalized assumed to be are disease and poisoning are of some degree “acceptable.” While most common- 89 BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM ly used pesticides do also have food or feed uses ly used pesticides do also have testing, this toxicity and undergo some chronic of complete does not guarantee the existence public expo- Moreover, information. toxicity generally underestimated are to pesticides sures by EPA. Missing Toxicity Data Toxicity Missing and re- registration pesticide EPA While the the is intended to evaluate process registration defi- numerous are there safety of pesticides, has identified EPA process. ciencies in the on older pesticides that are much missing data addi- In process. re-registration undergoing the the categorytion, if chemicals fall under of non-food use pesticides, the toxicity terrestrial The battery rigorous. less are data requirements data, including the potential toxicity of chronic birth reproductive defects, and to cause cancer, of pesticides if they effects, is only required uses. food or feed have Healthy Hospitals 12 Controlling Pests Without Harmful Pesticides pesticide use notification, and under-represents pesticide dependency and/or towards providing tals that have begun to move away from findings probably over-representsurvey hospi- there is a potential bias in the respondents. The that elected to do so, it can be assumed wereBecause the surveys returned by hospitals pesticide usage in any location. difficult to obtain information about often very grounds. It also highlighted the fact that it is schools and other public buildings Hospital Pesticide Use Survey Health Care Without Harm distributed a Methodology FindingsSurvey Pesticide Use II. Hospital reported pesticide use in New York hospitals, response rate, the results were consistent with survey. Although this was a relatively low Twenty-two hospitals (13%) responded to the would be kept confidential. Hospitals were promised that their identity responses werecases the survey incomplete. names of pesticides used at the site. In some Pest Management (IPM). It also asked for the applications, record keeping, and Integrated ing staff, patients, and the public of pesticide use of chemical pesticides, methods notify- 46). included questions about the The survey in 2001 (for a copy of the survey, see pages 44- pitals listed by the U.S. News and World Report to the top 171 hos- 92 here. likely to be greater than what is represented Thus, the use of pesticides in U.S. hospitals is that are being used at hospitals nationwide. the number and toxicity of pesticide products ● ● ● ● ● tals: finds that of the responding hospi- The survey outpatient facility. range from 93 to 998 beds and include one in the response group. The hospitals’ capacities A total of 10,015 hospital beds are represented non-profit hospitals affiliated with a university. pitals in the response group are urban pest control company. The majority of the hos- program was in-house or done by a commercial the pest management program, whether the or Director or others responsible for overseeing the hospital’s Environmental Manager Services survey. wereThe surveys usually completed by and the District of Columbia responded to the Twenty-two hospitals (13%) from twelve states Findings of Survey Summary 77% use chemical pesticides outdoors; 91% use chemical pesticide indoors and hospital’s grounds; age the majority (98% or greater) of the 36% hire a pest control company to man- program; hospital’s pest management structural age the majority (98% or greater) of the 73% hire a pest control company to man- pest management; 73% claim to use an IPM approach to plan; 64% have a written pest management EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND ● ● ● ● ● ● it uses; available to staff for all pesticide products ucts’ Material Safety Data Sheet (MSDS) 91% have copies of the pesticide prod- indoor and outdoor pesticide applications; 14% post notification signs for both ated with its use; EPA due to the unacceptable risk associ- active ingredient is being phased out by 18% use a pesticide product in which the longer registered for use by EPA; 36% use pesticide products that are no hospitals; used pesticide by surveyed pesticide, which was the most commonly containing boric acid, a least hazardous 45% use one or more pesticide products or both; either on its grounds, inside the buildings 100% use chemical pesticide products No - 27% Do Not Know - 9% PEST MANAGEMENT PLANS HOSPITALS WITH WRITTEN FIGURE 8. Yes - 64% Healthy Hospitals 13 Controlling Pests Without Harmful Pesticides Do Not Know/Did Not Answer - 18% No - 9% FIGURE 9. FIGURE 9. Hospital D has also had an IPM program Hospital The company that it ten years. for over services for pest control hires identifies during construc- areas potential problem can be caulked or tion so the open areas does not spray pesti- The hospital sealed. The returned areas. cides in patient care survey also states that the pest control technician used to spray the exterior of the building for cluster flies, but two program for over ten years. It has reduced It ten years. for over program the use of insecticides on its 130-acre sur- The returned 75 percent. campus by states, “With have vey IPM practices, we for our maintained a safer environment patients, and visitors.” Herbicides staff, other methods of only applied when are look- They are failed. have control weed their her- to decrease ways ing into more bicide use. HOSPITALS USING USING HOSPITALS AN IPM APPROACH ● Yes - 73% Yes Hospital B has an IPM program that B has an IPM program Hospital good through pest prevention emphasizes sanitation practices and maintaining Their pro- in optimum repair. structures than a gram has been in place for more used only when are decade. Pesticides are needed, primarily in baits. Records The kept of all pesticide applications. hospital has a full-time licensed pest con- technician that is supervisedtrol an by of pest frequency The entomologist. to is largely seasonal and related problems buildings. the traffic in the various maintenance depart- ground C’s Hospital ment has been implementing an IPM Hospital A’s structural A’s Hospital goal program pest control is to be “pesticide-free.” sanitation, food Good reduc- and water source tion, and pest trapping, successful strategies are implemented in that are They do managing pests. occasionally use boric acid as a preventive products during con- voids inside wall measure or after trapping struction and renovation not com- were and mechanical measures insect pletely successful in suppressing populations. ● ● ● The following are comments are The following hospitals provided that some their pest manage- regarding comments These ment program. hospitals are that some show a successfully implementing IPM approach. least hazardous on an analysis of the sur- Based use findings, these hospitals vey pesticides. few or no hazardous $55 per bed is the average annual cost of annual the average $55 per bed is pest management. 27% have provided pesticide-poisoning provided 27% have to their staff; training of structural pesticide 77% keep records applications; pesticide of outdoor 64% keep records applications; and, BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM ● Hospital Management Plans Pest a plans help direct pest management Hospital hospital in carrying prac- pest control out its surveyedtices. A total of 14 hospitals (64%) a written pest manage- indicate that they have they do hospitals (9%) report Two ment plan. if and six (27%) do not know a plan not have the question. did not answer one or they have Hospital IPM Programs is a pest management An IPM program and managing pest to preventing approach manner possi- in the least hazardous problems that is used IPM is a term ble. Unfortunately, definitions and loosely with many different is not uncom- methods of implementation. It a call mon, for example, for someone to even IPM. traditional pesticide spray program the surveyBecause not define question did or “do “no,” a “yes,” IPM and only requested to whether the hospital response not know” to pest management, the uses an IPM approach can- IPM programs quality of the respondents’ not be gauged. hospitals (73%) indi- A total of 16 responding to pest cate they use an IPM approach they do others (9%) report Two management. if not use IPM and four (18%) do not know the question. they do or did not answer ● ● ● Healthy Hospitals 14 Controlling Pests Without Harmful Pesticides spray programs. thetic pesticides or are, in fact, just traditional to describe programs that include syn- industry increasingly being used by the pest control pesticides, the term IPM is or no synthetic programs use few least hazardousWhile true IPM different definitions of IPM. lights the fact that there are many pesticide products. This high- program uses between 18 and 38 tals (31%) state that their IPM five of the 16 responding hospi- ardous pesticides. For example, by a continued reliance on haz- practices are severely undermined programs, many hospital IPM responding hospitals have IPM cate that the majority of indi- While the returned surveys grounds to continue rise. hospitals that outsource for lawn care and sourcing. HHN expects the number of as the top reasonsspecialized expertise for out- lems, citing cost savings and availability of hiring outside vendors to manage pest prob- More than 85 percent of respondents reported topped the list of hospital-contracted services. Management Survey Health Networks’ (HHN) For three years in a row, the Hospitals and Pest Management versus Contract In-House Cluster Busters flies. Victor using years ago started TM fly paper and TM found that pest control to trap the 93 Contract work) - 4% (80% of Management In-House MANAGEMENT, MANAGED IN-HOUSE Answer - 23% Did Not HOSPITAL STRUCTURAL PEST OR BY HIRED COMPANY ● ment program. own employees to conduct the pest manage- IPM practices than those that use their true contractors generally are less likely to follow Hospitals that use commercial pest control their pest control services. their pest control services. they contract with a commercial company for hospitals report that The majority of surveyed making. gram, which requires informed decision- implement and manage a successful IPM pro- impossible to information makes it virtually the contractor is implementing. This lack of make false assumptions about the type of IPM methods, products, or activities and thus may managers are often unaware of the contractor’s (98% or greater) of the hospitals structur- pest control company for the majority Sixteen responding hospitals (73%) hire a EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND FIGURE 10. 94 In addition, hospital facility of work) - 73% (98% or more Contract Out 132 ● ● ● Program Outdoor No Apparent (75% or more of work) - 18% In-House Management MANAGEMENT, MANAGED IN-HOUSE do the other 80%. has the in-house pest management staff pest management program and structural tal has a company implement 20% of its al (indoor) pest management. One hospi- areas. and outdoor staff manages both structural ment, including one hospital (5%) whose or greater) of their outdoor pest manage- employees take care of the majority (75% Four hospitals (18%) have their own only. pest management tract out for structural seven responding hospitals (32%) con- and outdoor pest management, while out all or a majority of their structural Nine responding hospitals (41%) contract tal’s grounds. company to manage 100% of the hospi- Eight responding hospitals (36%) hire a Answer - 32% Did Not 133 OUTDOOR HOSPITAL PEST OR BY HIRED COMPANY - 14% FIGURE 11. 36% of work) - Out (100% Contract 132 Healthy Hospitals 15 Controlling Pests Without Harmful Pesticides

21%

Others (<5% each) (<5% Others Synergists 27% are herbicides; 27% are and, rodenticides; 8% are fungicides. 3% are

● ● ● Of the insecticides identified as Of part of the 37 most commonly ingredi- used pesticide active surveyedents by hospitals: six three pyrethroids; (26%) are organophosphates; (13%) are carbamates; (13%) are three botanicals; two two (9%) are inorganics; two (9%) (9%) are synergists; and the remain- are other represent (21%) ing five chemical families that only occur once. Inorganics 9% 9% 9% Phenoxy herbicides (e.g., 2,4-D, dicamba, and Phenoxy the most commonly used herbi- are mecoprop) cides identified as part of the 37 most

No - 23%

Botanicals Carbamates 13% 13% FIGURE 13. FIGURE 13. USED INSECTICIDES, BY CHEMICAL FAMILY BY USED INSECTICIDES, HOSPITALS' OUTDOOR OUTDOOR HOSPITALS'

26% CHEMICAL PESTICIDE USE CHEMICAL Organophosphates

FIGURE 14. SURVEYED HOSPITALS MOST COMMONLY MOST COMMONLY FIGURE 14. SURVEYED HOSPITALS Pyrethroids 5% 0% 30% 25% 20% 15% 10% Yes - 77% Yes 62% are insecticides, including synergists; insecticides, 62% are ● Of the 37 most commonly used pesticides Of the hospital identified from ingredients) (active survey responses: No - 4.5% Did Not Answer - 4.5% FIGURE 12. FIGURE 12. HOSPITALS' INDOOR INDOOR HOSPITALS' BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Hospital Pesticide Use Hospital Pesticide hospital (5%) does Although one responding not use chemical pesticides indoors and two other hospitals (9%) do not use chemical pesti- hospitals cides outdoors, all of the responding either on their use chemical pesticide products inside their buildings or both. Not grounds, pest management one of the surveyed hospitals’ of chemical pesticides. A is 100% free programs hospitals (91%) use total of 20 responding inside the hospital chemical pesticide products and 17 (77%) use chemical pesticide products (5%) states hospital One on hospital grounds. that they do not spray pesticides around patients. a list of hospitals (77%) provided Seventeen the 216 pes- Of pesticides used at their facility. different 159 are reported, ticide products active containing 80 different pesticide products a used by The number of products ingredients. one to 38, averaging single facility ranges from per hospital. nearly 13 pesticide products CHEMICAL PESTICIDE USE CHEMICAL Yes - 91% Yes Healthy Hospitals 16 Controlling Pests Without Harmful Pesticides ● ● ● ● ● ● ● ● ● ● ● hospitals (see Figuresurveyed 20): Of the 37 most commonly used pesticides by hospitals. surveyed commonly used pesticide active ingredients by

role in plant reproduction.) 16 are toxic to bees. (Bees play a critical and, 30 are toxic to fish and other aquatic life; 14 are toxic to birds; tial groundwater contaminants; 12 can leach through soil and are poten- 9 are known groundwater contaminants; eye irritation, and other problems; 28 are irritants that can cause skin rashes, 18 cause kidney or liver damage; 22 are neurotoxins; 15 are linked to reproductive problems; 13 are defects; linked to birth gens; 16 are likely, probable or possible carcino- # of cancelled

products HOSPITAL USE OF CANCELLED PESTICIDE PRODUCTS 0 1 2 3 4 ABCDEFGH FIGURE 15. Hospital terized as having low toxicity, yet can still be non-synthetic sources. They are often charac- ticides that are derived from plants or other Hospitals also reported the use of “natural” pes- vents ingredients. or other toxic inert pesticides, as long it is not mixed with sol- alternative to highly volatile synthetic chemical volatility, it has long been embraced as a safer Becausecidal properties. of its extremely low mineral with insecticidal, fungicidal, and herbi- acid, an inorganic chemical, is a non-volatile pesticide product containing boric acid. Boric hospitals (45%) reported using one or more the responding hospitals. Ten of the responding commonly used pesticide products reported by acid as the active ingredient were the most acids (soaps). In fact, products containing boric thuringiensis (B.t.), and potassium salts of fatty ment. These include boric acid, bacillus hazardous to human health and the environ- adopted the use of some pesticides that are less Survey results reveal that many facilities have Least Hazardous Pesticide Use EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND to cause cancer in humans. genic potential, volatility, and possible ability concern because of its high acute toxicity, aller- thetic pesticides, its use is still a cause of down faster than pyrethroids and other syn- this chemical is naturally derived and breaks plant family.of the chrysanthemum Although toxinpyrethrin, derived from a nerve a member (32%) reported the use of products containing quite hazardous. For example, seven hospitals pose their own risks. chemicals, including piperonyl butoxide, that are often formulated with toxic “synergistic” 159 pesticide products surveyed hospitals 159 pesticide products surveyed Regulation’s Pesticide Product Database on the of PesticideCalifornia Department celled pesticide products, a search through the Although EPA does not maintain a list of can- stocks are depleted. they have already purchased until existing time, allowing individuals to use the products Cancelled products are often phased-out over ● ● ● cellations occur for various reasons, such as: the manufacturer. According to EPA, these can- “cancelled” by EPA or withdrawn from use by uses of the product arecide or certain From time to time, the registration of a pesti- and Active IngredientsProducts Use of Cancelled PesticideHospital changes in the way pesticide is used. cancellation of selected uses or tary reduced by other actions such as volun- able risk existed that could not be Cancellation by EPA because unaccept- fees were not paid; or Cancellation by EPA because required Voluntary cancellation by the registrant; 96 Also, pyrethrins 97 Healthy Hospitals 17 Controlling Pests Without Harmful Pesticides While the use of While 99 98 products containing these active ingredients is ingredients containing these active products phase outs take place, the risk legal while the these pesticides should raise associated with their use. that reported concerns for hospitals (18%) of the surveyedhospitals reported Four that contain bendiocarb, using eight products chlorpyrifos or diazinon. non-agricultural uses because they pose unac- they pose uses because non-agricultural health risks. ceptable n-octyl dicarbozimide, bicycloheptene, refined petroleum oil n-octyl dicarbozimide, bicycloheptene, refined petroleum oil FIGURE 16. While these cancellations are for the pesticide are cancellations While these ingre- active product’s and not for the product bendiocarb, ingredients dient, the active diazinon, all of which are chlorpyrifos, and are hospitals, responding the used by reportedly and these cases, EPA In also being cancelled. to phase agreed have the pesticide registrants ingredi- active out and cancel the use of these for many ents in pesticide products Date cancelled EPA U.S. CANCELLED PESTICIDE PRODUCTS USED AT SURVEYED HOSPITALS PRODUCTS USED AT CANCELLED PESTICIDE Product NameProduct Borid Turbo Dust Ficam W Ficam Microcare 11/92 5G Pennant (month/year) Liquid HerbicidePennant Spray1421-49 Malathion Premium 8/94 2000Precor Active Ingredient 4/01PT 1500 A Knox Out 7/01 ortho-benzyl-para-chlorophenol 7/97PT 265 A Knox Out 4/01PT 3-6-10 Aerocide 6/96 7/01 boric acidPT 565 11/01 7/01 bendiocarb metachlor 7/01 malathionDiazinon Spray bendiocarb Pellets G Rodenticide Talon # Registration metachlor Bait G Weatherblok Talon diazinon Bait Rodenticide Vengeance 5/87 diazinon methoprene, permethrin 5/87 piperonyl butoxide, pyrethrins, 7/99 7/01 9/01 9444-133 45639-3 / 432-933 brodifacoum 100-691 499-221 904-153 / 10404-72 brodifacoum 45639-1 / 432-931 pyrethrins, piperonyl butoxide, bromethalin 2724-455 diazinon 100-665 499-234 499-228 499-182 10182-44 0182-43 432-748 802-444 BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM reported using shows that some hospitals use hospitals that some shows using reported hospi- cancelled. Eight been that have products using at least one cancelled tals (36%) reported sixteen cancelled A total of pesticide product. as being used reported were pesticide products products The dates these hospitals. the eight by 1987 to May range from cancelled were hospitals, one these eight Of 2001. November using four cancelled products. reported Healthy Hospitals 18 Controlling Pests Without Harmful Pesticides individuals could be at risk of serious health who are chemically sensitive. Some of these the elderly, those who already ill, and people harmful effects of pesticides, such as children, for people who are most vulnerable to the pesticide application, is especially important ticides. Notification before, during, and after a precautions to avoid exposure to hazardous pes- cide application allows them to take Providing notice to individuals prior a pesti- care facilities and their adverse effects. informed about the use of pesticides at health Patients, staff, and the public have a right to be PesticideHospital Use Notification of pesticides already in use. status and staying up-to-date on the regulatory tion on the proposed pesticide before it is used responsible for gathering appropriate informa- in-house or contracted out, is performed hospital pest management program, whether other hand, the individual that oversees the cellations or restrictions. On the hospitals regarding pesticide can- improve communication with regulate pesticides need to federal and state agencies that What is clear, however, is that because it is a “favorite tool.” using a cancelled product pesticide applicator is knowingly stocks are depleted, and/or 4) the they are using until existing stockpiles of the product that 3) the hospital or contractor have record keeping of pesticide use, product, 2) there is inadequate cancellation of the pesticide or contractor is unaware of EPA’s products because: 1) the hospital Hospitals may be using cancelled Pesticide - 5% Do Not Use Yes - 27% PESTICIDE NOTIFICATION SIGNS HOSPITALS POSTING INDOOR other forms of pesticide notification to those in Some of the responding hospitals do provide pesticide applications. notification signs for both indoor and outdoor those hospitals, only three hospitals (14%) post because pesticides are not used. Excluding not post signs for outdoor pest management are not used and two other hospitals (9%) do for indoor pest management because pesticides hospital (5%) reported it does not post signs and traps are the only products they use. One because baits cation is considered unnecessary some hospital’s notification program or notifi- suggest that pesticide baits are exempted from ticides. Comments provided hospitals by a few (36%) post notification signs for outdoor pes- used inside the hospital and eight hospitals they post notification signs when pesticides are Six responding hospitals (27%) reported that cides. into a hospital that has been treated with pesti- effects just by walking on hospital grounds or EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND FIGURE 17. No - 68% email or other form of distribution. notice, or providing written notice through notice on a bulletin board, providing verbal in the treatment area,supervisor posting a notice include informing the contact person or notice for outdoor applications. Other types of six hospitals (27%) provide other forms of of notice for indoor pesticide applications and tors. Eight hospitals (37%) provide other forms the hospital staff and not patients or visi- the hospital, although they usually only inform PESTICIDE NOTIFICATION SIGNS HOSPITALS POSTING OUTDOOR No - 46% FIGURE 18. Yes - 36% Pesticides - 9% Do Not Use Answer - 9% Did Not Healthy Hospitals 19 Controlling Pests Without Harmful Pesticides for an outpatient-only facility to $150,000 for facility to $150,000 for an outpatient-only pest facility’s The 898-bed facility. an 898-bed times the than three is more management cost pest manage- most expensive second and third $36,761 for a which are ment programs, and $35,000 for an 850-bed 998-bed hospital the thirteen by costs provided The hospital. annually $26,703 hospitals average responding per hospital per hospital (or $16,429 annually the 898-bed facility is by if the cost reported data, the average the available Using excluded). for the annual cost of pest management hospitals is $55 per bed annually responding by cost reported (or $37 per bed annually if the the 898-bed facility is excluded). Number of Beds FIGURE 19. 101 0 100 155 300 333 420 500 540 550 670 850 898 998 COST OF HOSPITAL PEST MANAGEMENT COST OF HOSPITAL $0 $80,000 $60,000 $40,000 $20,000 $160,000 $140,000 $120,000 $100,000 Cost of Hospital Management Pest Cost is an important factor for hospitals when A pest man- choosing a pest management strategy. the IPM approach that utilizes agement program pesti- than a conventional cost-effective is more management program. pest cide-intensive hospitals’ The annual costs for the responding pest management services $4,800 range from results show that only six hospitals (27%) pro- only six hospitals that show results effects on the health to their staff vide training some cases only a subset of the of pesticides. In the to trained, according are hospital staff surveys.returned 100 BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Staff Training on Pesticide Health Effects Health on Pesticide Staff Training staff on the health effects of hospital Training of pesticides is essential so staff can recognize pesticide-poisoning symptoms and make The survey informed choices about exposure. Record Keeping Record part is an essential keeping any pest of Record documenting Records management program. strategy pest, and treatment the location, date, the effec- can be used to determine employed of potential sources of pest treatments, tiveness for improving and techniques pest problems, on efforts. Information and prevention control understanding pesticides used can be helpful in in providing possible pesticide poisoning and hospital occupants with information interested pesticide applications. on previous to the The majority of hospitals responding of the pesticides used at survey keep records hos- of the responding Seventeen their facility. of structural pesticide pitals (77%) keep records hospitals applications and fourteen responding of outdoor pesticide appli- (64%) keep records often kept in the most are cations. Records Services Department. Environmental copies hospitals (91%) have responding Twenty on file of the MSDS for the pesticides it uses A to hospital staff. and make these available on some of the information MSDS provides (usually only the active the product of hazards as makes suggestions for safe- as well ingredient) should be taken when that ty precautions applying, handling or storing the pesticide. and Health Safety Although the Occupational man- product requires (OSHA) Administration MSDSs on their pesticide to provide ufacturers the fact the information is limited by products, completes them. that the manufacturer Healthy Hospitals 20 Controlling Pests Without Harmful Pesticides cieIgein eet fet ertxnDmg Irritant Damage Neurotoxin Effects Defects Insecticide Active Ingredient Herbicide etmtrnX C Sulfluramid X Silica Gel X Pyrethrins Likely Propoxur B2 Suggestive C Potassium Laurate (soap) C D Piperonyl Butoxide (synergist) Permethrin D dicarboximide (synergist) bicycloheptene n-octyl X Malathion X Lambda-Cyhalothrin C Hydroprene Hydramethylnon C Fipronil C Diazinon X Deltamethrin Cypermethrin Cyfluthrin X Boric Acid* Bifenthrin C Bendiocarb Abamectin Acephate C lpoaeX X D 2B Glyphosate Dicamba 2,4-D Bentazon C Carbaryl FIGURE 20. HEALTH EFFECTS OF 37 PESTICIDE ACTIVE INGREDIENTS MOST COMMONLY USED AT SURVEYED HOSPITALS (1 OF 2) acrBrhRpoutv Kidney/Liver Sensitizer/ Birth Reproductive Cancer 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 X X X X X X 3 7 4 2 6 3 7 3 3 2 ELHCR IHU HARM WITHOUT CARE HEALTH X X X X X X X X 10 7 7 9 7 2 5 2 2 9 4 2 2 X X X X X X X X X X X X X X X X X X 12 2 2 2 2 2 2 5 2 2 2 2 2 2 2 2 2 8 X X X X X X X X X X X X 2 2 2 2 5 2 2 5 2 5 2 2 X X X X X X X X X X X X X X X X X X X X X 11 4 2 2 2 5 5 2 5 5 2 5 2 2 2 2 2 4 2 2 2 Healthy Hospitals 21 Controlling Pests Without Harmful Pesticides 2 2 8 8 2 8 2 X X X X X X X 8 8 2 2 2 8 X X X X X X 8 8 8 8 X X 8 14 List of Reproductive Toxicants. . . 101(5): 378-384. . 2." Journal of Part Chemical News (Aug 17): 9 as cited in Cox, C. 1997. "Subterranean Termites, Toxic 17(2): 21. Reform Pesticide "possibly . IARC lists chlorophenoxy herbicides as carcinogenic to humans (Group 2B)." . . Council. of Endocrine Disruption: Introduction. Science Policy Economic Valuation . X X 7. Frazier, L., et al. (eds.) 1998. Reproductive Hazards of the Workplace. Wiley Europe. Table 10: Partial 7. Europe. Table Wiley L., Hazards of the Workplace. et al. (eds.) 1998. Reproductive Frazier, 8. Hazardous Substances Database. National Library of Medicine. TOXNET. 9. Effects of Endocrine-Disrupting "Developmental Chemicals et al. 1993. Our Stolen Future. Colborn, T. and Bait, SC Johnson and Sons, Inc." Pesticide Issues SSURG for Roach 10.CRC Inc. 1994. "EPA Press, 11.International of Carcinogenicity to Humans. on Cancer (IARC). Overall Evaluations Agency for Research Website. Network. Air Toxics Transfer Technology 2003. 2,4-D. EPA. 12.U.S. 13.MSMA contains arsenic. IARC lists arsenic and arsenic compounds as known carcinogens. Appendix C Case Studies, 2002. Handbook for Non-Cancer Health Effects Valuation, EPA 14.U.S. 2 4 8 X X 1 11 1 1 1 13 Cancer Birth Reproductive Sensitizer/ Kidney/Liver or possible) MOST COMMONLY USED AT SURVEYED HOSPITALS (2 OF 2) SURVEYED HOSPITALS AT USED MOST COMMONLY FIGURE 20. HEALTH EFFECTS OF 37 PESTICIDE ACTIVE INGREDIENTS INGREDIENTS PESTICIDE ACTIVE EFFECTS OF 37 HEALTH FIGURE 20. . . . Inventory (TRI) Program. Release Toxic . of Environmental Health Assessment. . MetolachlorMSMAPicloram ProdiamineTriclopyr C X Bromadiolone Diphacinone X C D X Brodifacoum X Brodifacoum Mancozeb B2 Mecoprop 2B Rodenticide Fungicide TOTAL probable 16 (likely, 13 15 22 18 28 Active Ingredient Defects Effects Neurotoxin Damage Irritant X = Adverse effect demonstrated, see footnote. "probable human carcinogen, sufficient evidence in animals category, evidence weight-of EPA B2 = U.S. and inadequate or no evidence in humans." Health Organization (IARC), the agent World on Cancer category, 2B = International Agency for Research (mixture) is possibly carcinogenic to humans. "possible human carcinogen" rating. weight-of-evidence category, EPA C = U.S. usually due to "not classifiable as to human carcinogenicity," weight-of-evidence category, EPA D = U.S. inadequate data. Likely = "Likely to be a human carcinogen." potential. Suggestive = Suggestive evidence of carcinogenicity but not sufficient to assess human carcinogenic this table, boric acid includes borax, disodium octobrate tetrahydrate, and orthoboric acid. the purposes of * For Notes 1. Programs. of Pesticide Office 2002. List of Chemicals Evaluated for Carcinogenic Potential. EPA. U.S. 2. EPA. and U.S. Oregon State University Information Profiles. Network. Pesticide Extension Toxicology Data by Category for Chemicals Listed Under EPCRA Section 313. 3. 1: Toxicity 2000. Table EPA. U.S. 4. Program. sheets. Office of Pesticide Eligibility Decision (RED) Fact Reregistration EPA. U.S. 5. Sheets. Oregon State University. Fact Pesticide Information Center. National Pesticide 6. Office Toxicity. 2003. Chemicals Known to the State to Cause Cancer or Reproductive California EPA. BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals 22 Controlling Pests Without Harmful Pesticides Herbicide cieIgein rudae ece oBrsAutcOgnssto Bees Aquatic Organisms to Birds Leacher Groundwater Insecticide Active Ingredient eorpX X X X X X Mecoprop X Glyphosate Dicamba X 2,4-D Bentazon Sulfluramid Silica Gel Pyrethrins Propoxur X X Potassium Laurate (soap) Piperonyl Butoxide (synergist) Permethrin bicycloheptene dicarboximide (synergist) n-octyl Malathion Lambda-Cyhalothrin Hydroprene Hydramethylnon Fipronil Diazinon X Deltamethrin Cypermethrin Cyfluthrin Carbaryl Boric Acid* Bifenthrin Bendiocarb Abamectin Acephate FIGURE 21. ECOLOGICAL EFFECTS OF 37 PESTICIDE ACTIVE INGREDIENTS MOST COMMONLY USED AT SURVEYED HOSPITALS (1OF 2) eetdi oeta oi Txct ih Toxic Toxic to Fish/ Toxic Potential Detected in EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND 1 1 1 1 1 1 1 X X X X X X 1 1 2 1 1 2 1 2 X X X X X X X X X 1 1 1 1 1 2 1 1 1 1 X X X X X X X X X X X X X X X X X X X X X X 1 1 1 4 1 1 2 2 1 4 1 1 2 1 2 1 1 1 1 1 1 1 1 X X X X X X X X X X X X X X X X 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 Healthy Hospitals 23 Controlling Pests Without Harmful Pesticides 5 1 5 5 5 5 1 X X X X X X X 5 5 5 1 X ngton, DC cited in Orne, S., et al. 2002. Pesticide Action Network Pesticide Database. Action Network Pesticide et al. 2002. Pesticide ngton, DC cited in Orne, S., o/extoxnet/pips/ghindex.html>. ct.htm>. s/reregistration/status.htm>. 5 6 1 1 X X 5 1 Detected in Potential Toxic to Fish/ Toxic Toxic MOST COMMONLY USED AT SURVEYED HOSPITALS (2 OF 2) SURVEYED HOSPITALS AT USED MOST COMMONLY FIGURE 21. ECOLOGICAL EFFECTS OF 37 PESTICIDE ACTIVE INGREDIENTS INGREDIENTS ACTIVE EFFECTS OF 37 PESTICIDE ECOLOGICAL FIGURE 21. Pesticide Action Network North America. San Francisco, CA. . Action Network North America. San Francisco, Pesticide Metolachlor X MSMAPicloramProdiamine TriclopyrX Bromadiolone Diphacinone X X X X Brodifacoum X Brodifacoum Mancozeb X = Adverse effect demonstrated, see footnote. of this table, boric acid includes borax, disodium octobrate tetrahydrate, and orthoboric acid. the purposes * For Notes . 2. 2003. ToxFAQs. (ATSDR). Substances and Disease Registry Agency for Toxic . National Library of Medicine. TOXNET. Active Ingredient Groundwater Leacher to Birds Aquatic Organisms to Bees Rodenticide Fungicide TOTAL 9 12 14 30 16 BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals 24 Controlling Pests Without Harmful Pesticides docks, storage areas, bathrooms, waste disposal infestations include hospital cafeterias, loading gifts, and water sources. Frequent sites of pest improperly stored food, waste scraps, food nance, and soil health. Pests are attracted by with a health care facility’s sanitation, mainte- Pest problems usually signal larger problems damage. structural with allergies, contaminating food, or causing stings which can be life-threatening to those allergies or asthma attacks, causing painful cause harm by spreading disease, triggering rodents, and termites have the potential to pests like flies, cockroaches, yellowjackets, Although many pests are only nuisances, some weeds and other insects on hospital grounds. mice, ants, flies, and spiders inside facilities to ence their share of pest problems ranging from Like other public buildings, hospitals experi- patient.” … maintained to ensure the safety of Health and Human “hospital must be Services, Medicaid of (CMS) of the Department Services As required by the Centers for Medicare and problems using the least hazardous approach. gram that effectively prevents and controls pest the hospital employ a pest management pro- such an environment. Therefore, it is vital that able to pesticides yet pests are unacceptable in Many hospital occupants are especially vulner- Practices Management 111. Safer Pest 102 nonchemical alternative.” and to use the least toxic chemical pesticide or pesticides exposures to themselves and others, homeowners, farmers, and workers to limit for Considering these data gaps, it is prudent pesticide usage or pesticide-related illnesses. potential exposure problems related either to lance systems are inadequate to characterize low dose pesticide exposure. Current surveil- exists regarding the long-term health effects of Scientific Affairs states, “Particular uncertainty American Medical Association’s Council on associated with a variety of health risks. The not harmful. Most pesticides however, are mon house spiders may be a nuisance but are pesticide. For example, many pests like com- of the pest and underestimate the risk of grams it is not unusual to overestimate the risk meant to solve. In typical pesticide spray pro- more harmful than the pest problem it is But the solution to a pest problem must not be ter weed growth and insect infestations. and landscape and/or poor soil conditions fos- repair. On hospital grounds, unhealthy lawns dried up floor drains, and water traps that need which often results from broken lines, sewer in Massachusetts is the American cockroach a major pest problem for hospitals Alpert, Gary among other things. According to IPM expert in cardboard boxes, suitcases, and flowers, can also enter a hospital by hitchhiking a ride and other pipes that enter the building. They and floor cracks, gaps around plumbing of hospital facilities), windows, wall, ceiling, bated by typically heavy foot traffic in and out a hospital through open or leaky doors (exacer- term care facilities. Pests most frequently enter areas, and patient rooms, especially in long- called IPM that can control pests without the Fortunately there is a method of pest control EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND 103 outdoor IPM program since the early 1980’s. National Park and has had a structural Service IPM program since 1989 and the structural General Administration Services has had a increasingly adopting IPM programs. The ment agencies, and schools nationwide are use of toxic pesticides. Cities, counties, govern- some U.S. hospitals. shows, IPM is also being practiced in tal survey a conventional pest program. And as the hospi- problems, and have kept costs at or lower than pesticides used, decreased the number of pest that have significantly reduced the amount of are successfully implementing IPM programs School District, and Chicago Public Schools, New York Public Schools, Los Angeles Unified largest school districts in the continental U.S., able occupants from toxic exposures. The three have a special obligation to protect their vulner- is occurring in schools, which like hospitals Perhaps the greatest increase in IPM programs meetings be open to the public. from each agency and require the Committee Committee consisting of an IPM representative lish an Interagency IPM Coordinating agency to be trained in IPM. These laws estab- son responsible for pest management in each Oregon statutes are similar, per- requiring every facilities under their control. Washington and state agencies to adopt an IPM program at the Connecticut have all passed laws that require Washington, Oregon, Michigan, and completely eliminated its use of toxic pesticides. ed an IPM ordinance in 2001 and has almost ordinance in 1996. The City of Santa Fe adopt- The City of San Francisco adopted an IPM 105 104 Healthy Hospitals 25 Controlling Pests Without Harmful Pesticides 109 , Gary Alpert, who has a doctorate in , Gary Alpert, who has a doctorate 110 of the American Hospital Association, EPA, Health Care Without Hospital Association, EPA, of the American The goal of H2E is American Nurses Association. Harm, and the about pollution prevention to educate health care professionals health care systems. This includes opportunities in hospitals and website states that “Health care the adoption of IPM. The H2E but many pesticides can facilities must control pest problems, visitors, and the community to hazardous expose patients, staff, allergic reactions, irritation, neuro- chemicals that might cause a combination IPM uses and cancer. toxic effects, hypersensitivity, while minimizing the potential of methods to control pests adverse health effects.” Hospital IPM Expert entomology, is an environmental biologist at Harvard is an environmental entomology, University’s For Environmental Health and Safety Department. in 20 years he was responsible for ten major hospital facilities the Boston area. Although he never used an organophosphate and or carbamate pesticide, he achieved 100% pest control that client satisfaction with his program. It is critical, says Alpert, the hospital’s policy be put in the pest control bid specifications. agrees This becomes a tool for getting a good contract. Alpert but is that IPM is not just a safer approach to pest management in also more effective. Once preventive measures are firmly place, IPM uses less time to manage pests than conventional pest control. 108 FIGURE 22. FIGURE 22. , a divi- Integrated 106 (ASHE) of AHA (H2E) is a joint project HEALTH CARE COMMUNITY SUPPORTS IPM COMMUNITY SUPPORTS CARE HEALTH for their Professional Development Series, for their Professional 107 American Society for Healthcare Environmental Services American Society for Healthcare a document entitled, (ASHES) of AHA, has published American Society for Healthcare Engineering has developed a Sustainable Design Award. As part of the hospi- recognition program, ASHE has developed guidelines for tals, which include the recommendation to use IPM practices. Hospitals for a Healthy Environment Pest Management, Pest on IPM for health care facili- which provides general information tradi- ties. The document addresses issues regarding IPM versus and tional pest control, client expectations, IPM implementation, pesticide use and storage, while emphasizing “a hierarchical last approach, with actual pesticide application[s] being the accommodation.” sion of the American Hospital Association (AHA), has developed Hospital Association sion of the American Healthcare Environmental a certification program for Certified The examination includes sanitation issues Services Professionals. to possess an understanding of and requires the candidate “… an integrated pest manage- pest control, develop and administer a process for monitoring and ment program, … [and] develop for … pest control …” evaluating contracted services American Hospital Association Certification Center Association Certification American Hospital BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Healthy Hospitals 26 Controlling Pests Without Harmful Pesticides ● threat to health): (except when a pest problem poses an urgent A model IPM program prohibits the following biopesticides/regtools/25b_list.html> Act Federal Insecticide, Fungicide and Rodenticide meal, that are listed under section 25(b) of the and exempt natural pesticides, like corn gluten ucts; use of liquid nitrogen for cold treatments; prod- as parasites and predators; soap-based toxic synergists; biological control agents, such cides that do not contain synthetic pyrethroids or insecticides; botanical insecti- microbe-based tainers or for crack and crevice treatment only; insect and rodent baits in tamper-resistant con- tetrahydrate; diatomaceous earth; nonvolatile include boric acid and disodium octoborate Least hazardous pest management materials least hazardous pesticide be used. been tried or have no chance of working, may a practices. Only after non-toxic options have cal and biological controls, cultural tion practices, structural maintenance, mechani- through non-toxic methods such as good sanita- lems both inside and outside a hospital facility focuses on preventing and managing pest prob- IPM is an approach to pest management that b Pesticides linked to cancer — U.S. EPA (b) Pesticides in U.S. EPA Categories I and II (a) The use of the most dangerous pesticides: (FIFRA). Class A, B, C carcinogens (i.e., those with highest acute toxicity); FIGURE 23. INTEGRATED PEST MANAGEMENT (IPM) DEFINED ● ● ● ● EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND e Pesticide products that contain inert ingre- (e) Pesticides in the carbamate (carbaryl, (d) Pesticides that interfere with human hor- (c) baseboard spraying. bombs, or tenting by space, broadcast, The application of pesticides by fogging, the 24 hours following application. occupied or may become during The application of pesticides while the area is basis, whether pests are present or not. The application of pesticides on a routine thetics alone. Pest management decisions based on aes- nol, and rhodamine B) quinone, isophorone, nonylphenol, phe- (dioctyl phthalate, formaldehyde, hydro- 1: Inerts of Toxicological Concern” dients categorized by the U.S. EPA as “List mecoprop, etc.); and, family and phenoxy herbicides (2,4-D, (cyfluthrin, permethrin, etc.) chemical (diazinon, acephate, etc.) or pyrethroid bendiocarb, etc.), organophosphate Newlist.html>; or chemicals endocrine disruptors developmental toxins or suspected e.g., those identified as reproductive or reproductive or developmental harm, mones and/or cause birth defects or prop65/prop65_list/Newlist.html>; Proposition 65 Ethion, Sulfur, Disulfoton Carbaryl, Malathion, Dimethoate, 2,4-D, Dicamba, Mecoprop, Anticoagulant dusts or baits Propoxur Bendiocarb, Chlorpyrifos, Diazinon, Cyfluthrin and other Pyrethroids, Hydroprene, Acephate, Propoxur Chlorpyrifos, Bendiocarb, Diazinon, Cyfluthrin and other Pyrethroids, Hydroprene, Acephate, Propoxur Chlorpyrifos, Bendiocarb, Diazinon, Cyfluthrin and other Pyrethroids, Diazinon, Propoxur, Chlorpyrifos Permethrin and other Pyrethroids, Diazinon, Propoxur, Chlorpyrifos Permethrin and other Pyrethroids, PESTICIDES COMMONLY USED natural enemy organisms. soapy water, use beneficial, predatory, or with hard stream of water, spray plants with physically remove insect pests or knock off mulch planting beds to suppress weeds, apply corn gluten meal to lawns and/or Maintain lawn health, pull or cut weeds, pepper at entry points; snap traps. from exterior walls); sprinkle ground cayenne age areas (including keeping plantings away cracks/crevices), eliminate clutter/ harbor- copper mesh or stainless steel wool in (install door sweeps, pack openings with waste compactors and mechanical barriers self-contained moisture; use well-sealed Sanitation, eliminate access to food and soapy water, use baits specific for ant type. sweeps; vacuum, spray or wipe trail with sources, seal cracks/crevices, install door Sanitation, eliminate food and moisture necessary. volatile baits and gels (such as boric acid) if use glueboards, or least hazardous least- Locate/eliminate nest, eliminate moisture; necessary. volatile baits and gels (such as boric acid) if pheromone traps, or least-hazardous least- block entry points; vacuum, use glueboards, entry into facility; eliminate moisture sources; by removing supplies from boxes prior to containers, eliminate corrugated cardboard Sanitation, food stored in pest-proof airtight service to minimize fruit storage. frequently, UV light traps, work with food Sanitation, including cleaning floor drains attractants outdoors. UV light traps indoors, with non-toxic Sanitation, exclusion, flypaper, fly swatters, SAFER ALTERNATIVE esources. lacewing, and ladybird beetles. insects include predatory mites, green only when turf starts to lose turgor. Beneficial mowing height to 3½ 4 inches, water the best weed and pest prevention. Raise Healthy soil, lawn, and landscape plants are engage staff in rectifying source problems. relations issue, communicate with and most difficult to address. Sensitive public prevent access to interior where infestation is Rats are likewise managed. It is critical to mice infestations in their delivered goods. have IPM programs to reduce chance of warehouses (especially of office supplies) to control method(s) used. Encourage supplier large buildings, regardless of the type Mice are managed, but rarely eliminated in effective control measures. Identify specific ant type to determine most turbed. are less visible until environment/nest is dis- American roaches stay in defined area and rectifying source problems. issue, communicate with staff and engage in vating lighting. Sensitive public relations roaches are very visible, especially after acti- cracks, and eliminate clutter. German cock- source. Fix leaks, install door sweeps, caulk Most important is to remove food and water tainers and empty frequently. flies. Put food waste in tightly sealed con- sumption. Mitigate by frequent vacuuming of Common problem around fruit storage/con- per types, which explode flies. from floor near entryways. Do not use zap- dow screens. Place UV light traps 3 to 6 feet in tightly wrapped plastic bags. Secure win- source removal is essential. Secure garbage Fly problems often caused by rotting food, COMMENTS 111 Healthy Hospitals 29 Controlling Pests Without Harmful Pesticides 113 (B.t.) is a natu- (B.t.) Insecticidal and herbici- 114 Bacillus thuringiensis FIGURE 26. FIGURE 26. Boric acid is a naturally occurring non-volatile Boric acid is a naturally HAZARDOUS PESTICIDES HAZARDOUS OVERVIEW OF SELECT LEAST OVERVIEW rally occurring soil bacterium. It is a spore-forming rod and an insect pathogen. There are nearly 400 registered B.t. providing effective control of such products in this country, major insect pests as gypsy moths, mosquitoes, black flies, must be ingested to be effective, and many others. Since B.t. it only works against insects in their larval feeding stages. is ingested, insect larva soon stop feeding Once enough B.t. is completely and die within a few days to weeks. B.t. biodegradable, has a short half-life, and does not persist in the digestive systems of birds or mammals. While the health are generally minimal, one recent study suggests risks of B.t. may lead to allergic skin the possibility that exposure to B.t. sensitization in some farmworkers. Bacillus thuringiensis. Boric Acid. mineral with insecticidal, fungicidal, and herbicidal proper- fungicidal, and herbicidal mineral with insecticidal, including baits, ties. It comes in different formulations is an effective ant and sprays, gels, and dusts. Boric acid long been embraced as a cockroach stomach poison. It has and more toxic synthetic safer alternative to highly volatile to boric acid can cause chemical pesticides. While exposure can be avoided by adverse health effects, these problems acid baits, dusts, or gels using boric acid bait stations. Boric where they will not come in should only be applied in areas in cracks and crevices, behind contact with people, e.g. boric acid is somewhat counters, and in wall voids. While pesticides, it is more slower acting than more hazardous effective in the long run. Insecticidal and Herbicidal Soaps. dal soaps contain sodium or potassium hydroxides of fatty acids, which are usually combined with vegetable oil. (Be aware that some soaps are combined with petroleum prod- ucts and/or other toxic active ingredients or synergists and soaps are virtually non-toxic to should be avoided.) Fatty-acid humans or mammals unless they are ingested. When fatty- or cuticle, of an insect or acid soap touches the outer body, plant tissue it leads to dehydration and eventual death of the pest. These soaps rapidly biodegrade in soil. Because fatty- acid insecticidal soaps can kill beneficial as well as pest insects, outdoor use should be limited to spot treatments. (FIFRA). facts. Information about the about facts. Information can be of a pesticide toxicity and material found on its label (MSDS), in safety data sheet scientific articles, and fact gov- various by sheets prepared non-profit ernment and Resources organizations (See List in Appendix). pest manage- Least hazardous ment materials include boric acid and disodium octoborate diatomaceous tetrahydrate; earth; insect and nonvolatile baits in tamper-resistant rodent containers or for crack and only; treatment crevice insecticides; microbe-based botanical insecticides that do not contain synthetic synergists; or toxic pyrethroids agents, such biological control as parasites and predators; use of liq- soap-based products; for cold uid nitrogen gels; and silica treatments; natural pesticides, like exempt list- corn gluten meal, that are ed under section 25(b) of the Fungicide Insecticide, Federal Act and Rodenticide are materials While the above than conven- less hazardous tional pesticides, they still have the potential to cause harm to human health and the environ- ment, especially to chemically asthmatic, or allergic sensitive, individuals. They are, however, than con- generally less volatile 112 FIGURE 25. FIGURE 25. control options include using a high-pres- control options BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Least Hazardous Approach to Pests to Pests Approach Hazardous Least a pest out- to controlling The first approach make sanitation, improve should be to break and use physical and structural repairs, traps, vac- such as screens, mechanical controls The least weeders. uuming and motorized strategy should be control chemical hazardous of other strategies chosen only when a mixture The risks associated to be inadequate. is shown with the use of a pesticide need to be weighed the pest. Control caused by against the problem being carefully, options should be considered mindful not to blindly jump at a solution that risks - without first collecting the may have control options include both natural and intro- control options include using weed-free topsoil control options include using weed-free GROUNDS MANAGEMENT GROUNDS NON-TOXIC LANDSCAPE AND LANDSCAPE NON-TOXIC Non-chemical from plants, a hot water sure water system to remove insects manual/physical weed control system, flame weeders, mechanical cultivation, removal of insects and weeds, vegetation to out- mulches to suppress weeds, competitive to increase the num- grow weeds, and landscape renovation species and arrange ber of native and/or pest-resistant plantings to maximize their health. Cultural weed resistant varieties of and soil amendments, pest and appropriate soil pH and plant materials, soil tests to guide and mowing techniques nutrient content, proper pruning blade set as high as mowing dry grass with sharpened (e.g. possible), proper water drainage and irrigation, proper plant selection for the proposed location, and tolerance of weeds. Biological duced pest predators and parasites, microbe-based insecti- cides, botanical insecticides that do not contain synthetic pyrethroids or toxic synergists, and enzymes. Healthy Hospitals 30 Controlling Pests Without Harmful Pesticides pesticide applications before, during, and after have a right to be informed. Notification of they are used, patients, staff, and the public IPM program. Buta true in those cases where Hazardous pesticides are rarely, if ever, used in Pesticide Use Notification or dust applications. when used in bait stations rather than as spray als, like other pesticides, are the least hazardous vaporize or volatize into the air. These materi- ventional pesticides, so have less ability to and be out of the reach children. treatments or placed in other inaccessible locations, resistant containers, only used for crack and crevice however, extremely important that baits be in tamper- tize little or no pesticide ingredients into the air. It is, pest populations, use much less pesticides, and vola- than spraying pesticides because they target specific In general, baits are a better choice for pest control pose a risk to human health and the environment. ardous if used in baits rather than as sprays, but still carbamates, and organophosphates, are less haz- human exposure. Other chemicals, like pyrethroids, ing toxic pesticides, and does not pose the high risk for in controlling these types of pest populations as spray- pesticide like boric acid, is just as, if not more, effective and the queen. colony and share with the others including larvae attractants that the pest will take back to hive or insect or rodent poisons mixed with food other like ants, termites, wasps, and bees. Baits contain Baits are most successful at controlling social insects BAITS: THE BETTER OPTION BAITS: 115 A bait containing a non-volatizing FIGURE 27. ly if they are weather dependent and only recur trends and patterns in pest outbreaks, especial- A record keeping system can help establish for a minimum of 7 years and longer if feasible. of any pesticides) and outcomes should be kept Records of pests, treatments (including the use Record Keeping laws for the specific requirements. to check state and local state, it is important cation are changing with variations in each EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND laws on pesticide use and notifi- upon request. health care facility be available regarding an application in a Delaware require information those states. California and made in health care facilities in types of pesticide applications tion be provided for certain require pesticide use notifica- New Jersey, and Texas, already Illinois, Maine, Massachusetts, As of September 2003, laws in els of pesticides. from low exposures lev- to very they can become extremely ill sensitive to chemicals because ments, for people who are even for spot treat-important, Notification is especially minimize exposure to them. take precautions to avoid or to public with the opportunity tal staff, patients, and the the application provides hospi- (see Figure 29). Because state pesticides are applied to lawns. to post notification signs when require commercial applicators 116 Twenty states ● ● ● ● ● ● ● ● ● ● ● emergency situations, hospitals should: When pesticides are used, with the exception of clear cide use, including past and proposed applications. vide additional information about the hospital’s pesti- coordinator, who is able to answer questions and pro- email address of a contact person, ideally the IPM Hospitals should also provide the phone number and should contain the following information: Written notification and posted signs remain posted for 72 hours afterwards. the commencement of pesticide application and In the case of emergencies, signs should be posted at additional information. Name and phone number of whom to contact for Applicator name and company; and, Target pest and reason for the pesticide application; Application method; uct label or Material Safety Data Sheet (MSDS); Possible health effects listed on the pesticide prod- EPA registration number; Name of pesticide product, active ingredient and Application site; Time/date of application; after the application. application and leave them in place for 72 hours pesticide application 72 hours in advance of the immediately adjacent to the site of an expected Post notification signs at the entrance to and landscape; and, application will be made on the hospital’s lawn or Pre-notify abutting property owners, if a pesticide 72 hours in advance of a pesticide application; Provide written notification to all staff and patients MODEL NOTIFICATION PROGRAM FIGURE 28. Healthy Hospitals 31 Controlling Pests Without Harmful Pesticides 121 122 120 The General ServicesThe General Administration an (GSA) has successfully implemented a decade in its 30- over for IPM program feet of office space million square 7,000 federal buildings). (approximately on portable vacuums relies The program rather than pesticide sprays for initial pest cleanouts and uses trapping devices rather than pesticide sprays for indoor fly con- Albert appropriate. Greene, wherever trol GSA, IPM Coordinator National Ph.D., be pragmatic, eco- states that IPM “can on a massive nomical, and effective scale.” at the an IPM program Similarly, in a 50 resulted of Rochester University in material costs and a reduction percent in personnel costs. substantial reduction California, Monica, The City of Santa 30 costs by control its pest has reduced control while achieving excellent percent, and ants in of rats, mice, cockroaches, structures. city-owned and around County Schools in Monroe Before implemented an Indiana Bloomington, in 1995, it was spending IPM program about $34,000 on pest management. the hiring of an IPM Coordinator With Activities that can be absorbed into a hospital’s can be absorbed that Activities mainte- training of budget include existing and food servicenance, cleaning, and staff and visitors to modify patients educating staff, some hospital addition, In their behavior. funds may structuralmaintenance and repair such as be budgeted for activities already water-damaged materials, landscap- replacing constructinging, waste management, and physical barriers. of IPM: cost effectiveness of the Examples ● ● ● ● 118 Ohio Rhode Island Vermont Washington Wisconsin 119 The EPA agrees, “IPM can reduce the use of “IPM can reduce agrees, The EPA and effective economical chemicals and provide pest suppression.” an IPM program, the savings from decreased the savings from an IPM program, often add up to time maintenance costs over methods, a savings. Chemical-intensive overall to managing pest prob- symptomatic approach in the to be less expensive lems, may only prove short-term. General’s Attorney York to the New According Pest Hospital State York on New report pesticide expo- reduce IPM “will Management, and to hospital staffers and to patients sures adoption of health. Additionally, thus protect not are Pesticides money. [IPM] will save that sensibly reduce Any approaches cheap. their use will help to contain hospital costs.” Massachusetts Michigan New Hampshire New Jersey New York Indiana Iowa Kentucky Maine Maryland 117 BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM periodically. Information recorded at every recorded Information periodically. should include the inspection or treatment dis- identification of the pest, population size, for future tribution, recommendations and complete information on the prevention, of the evaluation Regular action. treatment will help determine acceptable IPM program reduction and effective pest population levels measures. IPM is Cost Effective to pest manage- approach an IPM Adopting as, if not more ment is just as cost-effective pro- pesticide intensive than, a conventional of IPM focuses on prevention gram. Because to deter- monitoring and proper pest problems, IPM mine the extent of pest problems, the amount of money can decrease programs While in the long-term. spent on pest control often some additional startup costs for are there FIGURE 29. STATES WITH LAWN NOTIFICATION REQUIREMENTS NOTIFICATION WITH LAWN STATES FIGURE 29. Colorado Connecticut Florida Georgia Illinois Concerns over potential human exposure to pesticides have led some states to pass laws that warn to pesticides have led some potential human exposure Concerns over registries or providing posting notification signs, establishing pesticide application by people of a lawn state where, when, and State notification laws usually to abutting property owners. prior notification states require be applied and by whom. As of September 2003, twenty what pesticide has been or will Most states notification signs when a pesticide is applied to a lawn. commercial applicators to post property and be posted in a conspicuous point of access to the treated require that notification signs Care Application: signs vary in language but usually state, “Lawn left in place for 24 hours. Warning off the Grass.” Keep Healthy Hospitals 32 Controlling Pests Without Harmful Pesticides these methods have failed should the least toxic exclusion, etc.) is the first choice, and only after methods (environmental sanitation, trapping, pests. The “control of pests through alternative non-chemical methods to prevent and manage tive measure, promoting instead the use of periodic application of pesticides as a preven- plan for each facility. Its policy discourages the when needed. VA requires a pest management tion, and use of the least hazardous pesticide identification of sensitive areas and the selec- methods where appropriate alternatives exist, environmental sanitation, no chemical control cific IPM tasks in detail including inspections, to pest control.” efficient, environmentally preferable approach concept of IPM has become the economically- lations and hazards to human health, the resulting adverse effects on some wildlife popu- mulation of pesticides in the environment and due to “the rising public concern over the accu- Affairs (VA) has an IPM policy that says veterans of hospitals, the Department Veterans report, As highlighted in the 1995 Beyond Pesticides Veterans Hospitals use of pesticides. their unnecessary IPM policies that have significantly decreased The following hospital facilities have instituted IPM Programs of Hospital Examples discontinued. aerosol and liquid pesticides have been percent with the IPM program, and all cide use has dropped by approximately 90 management costs. saving around $13,600 annually in pest per year on products, the school district is in 1997, and spending less than $1,000 A Failure to Protect 125 124 The VA policy describes spe- 123 Conventional pesti- , which surveyed six , which surveyed necessary for effective control.” necessary pesticide be employed and only to the extent the state run hospital. the state run 120-acre campus in Portland, which includes has nine staff to maintain their Department office of the Groundsand Construction programs. service The Facilities Management research institutes and centers, community care and specialty clinics, dozens of primary (OHSU) includes four schools, two hospitals, The Oregon Health and Science University Oregon Health and Science University the facility. removing pests, and can be used anywhere in no health hazard to the operator, are effective in their pest management program as they pose of tals should be using vacuum cleaners as part thing to do.” Warren suggests that more hospi- Administration. “That’s not always the best for the Veteransgram services Health Wayne Warren, director of environmental pro- some pesticide and just kill the critters,” says “Everybody’s knee-jerk reaction is to haul out four-option system for making pest manage- be used.” The policy contains a prioritized control of the pest will will obtain the necessary be determined. The least toxic alternative that surpassed, treatment and control options will The policy states, “Once the threshold has been mentation of the campus-wide IPM program. Coordinator as being responsible for the imple- The policy establishes the Grounds and evaluating the effect of IPM program.” ing through inspections and record keeping, environment, providing for effective monitor- ing minimal environmental hazard upon the materials, minimizing the health risks, inflict- ing minimal human exposure to hazardous an acceptable level of pest control while insur- IPM policy states that its intent “is to provide EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND 127 128 The OHSU outdoor 126 tractors to follow the policy as well. provision in the policy requiring outside con- implement the facility’s IPM policy, there is a annually. Although in-house staff currently pesticide use. The IPM program is evaluated detailed records and of pests, interventions, for all applicators and the requirement to keep OHSU policy include pesticide safety training application area. Other provisions in the traffic flaggers are them from used to divert the present during the application, barriers and on the public. If pedestrians or vehicles will be applications be scheduled at times of least effect treatment area.” The policy recommends that anyone with open windows of the immediate ing air intakes can be secured and alerting PublicConstruction Safety Dispatch, so build- include Facilities Management and action to be taken. This notification will accompanied by proper notification of the ments in the immediate area should be that may have an impact on persons or depart- use of any control option nent that states, “The OHSU’s policy also has a notification compo- likely be unusual.” hensive treatment, the use of which would spot treatment is to be used before “a compre- the listing of this last option is prioritized – the campus patients, visitors, and staff.” Even as well as the least toxic to the applicator and should be “the least toxic to the environment, be considered is chemical controls, which ment decisions. or last, option to The fourth, Healthy Hospitals 33 Controlling Pests Without Harmful Pesticides 130 (For more information, see Figure 31 information, see Figure more (For Hackensack University Medical Center UniversityHackensack Medical Center Medical University Hackensack (HUMC) is a 683-bed tertiary teaching care covering Jersey hospital in New and research The buildings range in feet. 2.2 million square The hospital old. to 106 years 3 years age from in the late 1990’s initiated its IPM program was Staff contractor. using a local pest control and educated in new policies and re-trained examined and repair were practices. Buildings to those According addressed. were problems the use of pesticides the program, that oversee are measures discouraged. Preventive is strongly monitoring such as weekly always the first step, medical waste and solid (food, of specific areas the use of mechanical traps. and waste areas) to environ- immediately reported are Sightings mental services dealt with in the most and are This includes way. humane and least hazardous the type of infestation, the efficacy evaluating and alternatives, of the available and toxicity applied. are the manner in which products that it has not observedHUMC reports any to IPM. infestations since its conversion visions in the policy include the requirement in the policy include visions the pest between communication for weekly servicecontrol and the Director; contractor signs for lawn pesticide posting of notification storing or mix- of prohibition applications; and Baits the hospital facility. ing pesticides within from excluded are and hospital disinfectants the policy. on page 36.) Brigham and Women’s Hospital and Women’s Brigham is a 700-bed Hospital Women’s and Brigham tertiarythat hospital in an urban setting care of Area Longwood Medical anchors the inpatient and outpatient Boston. Combined of nearly 3.5 mil- to a facility correlates volume Services Environmental The feet. lion square Hospital Women’s and Department of Brigham pest management for the facility’s is responsible was adopted in Their IPM policy program. updated been regularly 1989 and has January the purpose since then. As written in the policy, and attractive sanitary, a healthy, ensure is, “To and visitors patients, staff, for environment of integrated pest man- the application through management services agement principles.” Pest con- an outside by to be provided required are but the contactor must meet the tractor, The policy states, qualifications. vendor policy’s “The dis- pesticides is strongly use of chemical the Director by couraged and only authorized exhaustion of basis. Upon on a case-by-case the ven- non-pesticide treatments alternative, limited use of the least dor may recommend The chemical pesticide. effective hazardous such recommendation will review Director will submit the relevant and, if in concurrence, to the Sheets Data Safety Material Department Safety and Health Environmental the prior to and recommendations for review authorization of limited pesticide use. A record of the chemical application … will be possi- Wherever reference. for future entered… ble, application of chemical pesticides will be to mechanical spaces, etc. limited to wall voids, the potential for human exposure. minimize pesticides will not be used in areas Aerosolized potential exists. Any human exposure where limited use of pesticides will be implemented of the and approval only with the awareness being serviced.”manager of the area pro- Other (For more information, more (For 129 BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Massachusetts General Hospital General Massachusetts is pest management program The hospital’s pre- based on IPM principles that emphasize and physical exclusion through vention attention to sanitation. MGH “strongly oppose[s] the use of pesticides in the work- likely to be more and traps are place.” Baits pesticide if Yet, than pesticide sprays. employed not to be applied in an are used, they sprays are The hospital uses triangular occupied room. wall sconces that emit a blue light to attract fly- ing insects, which then stick to an adhesive These traps bottom of the trap. on the board in keeping flying insects from effective are into sensitive entering the facility and moving areas. San Francisco General Hospital General San Francisco a passed Francisco San 1996, October In use of pes- the to reduce policy groundbreaking city departments,propertyticides on city by contractors, including San agencies, and land- The (SFGH). Hospital General Francisco of bans pesticides suspected ordinance mark harm and causing cancer and reproductive also It most acutely toxic. those that are to pest management, an IPM approach requires applications posting notices of most pesticide and after an application, and 72 hours before The pesticides. use of approved the exclusive empha- pest management program resulting less-harmful and developing education sizes chemicals, such as toxic to alternatives using flamers and mulching, hand weeding, also recom- The program natural predators. mends planting foliage that is suitable to San natu- more climate and, therefore, Francisco’s to pests. rally resistant 30 on page 34.) see Figure Healthy Hospitals 34 Controlling Pests Without Harmful Pesticides considerable energy into changing our paradigm of long-term weed control strategy. We have invested weed-whacked, or have weed fabric and mulch as a nology. Other landscaped areas are hand-weeded, and we receive annual training in the use of this tech- propane flamers to control weeds in hardscaped areas, pesticides on patients’ health. In the past we have used unknown combined effects of pharmaceuticals and patients and because of the immune-compromised 99% of the time. This is out concern for our We avoid spraying pesticides or herbicides more than vent and manage weeds? What are some of the techniques you use to pre- trash collection areas. entering the building especially in loading dock and also installed door sweeps to prevent rodents from mulch to reduce or eliminate weed growth. We have amounts of fruit. Several areas have weed fabric and producing plants, and species reduced few known pest problems, less allergenic and pollen- grows. We also choose landscape plant varieties with zone next to all building structures, especially where ivy scaping design requires a 12” to 18” vegetation-free outdoor pests such as rodents from entering, our land- areas and facilitate monitoring control. To keep centralized our garbage to minimize pest aggregation from landing on windowsills and ledges. We have also ants, and installing wires spikes to prevent birds includes installing window screens, caulking to exclude we continually try to modify the existing structure. This before “designing for pest control” was a paradigm, Because the buildings are very old and were built to prevent pest problems? What have you done in landscape/building design health hazards. dowsill defecation creates objectionable smells and (SFGH) are ants, rodents, and pigeons whose win- The main problems at San Francisco General Hospital solve? What are the main pest problems you needed to Interview with Deanna Simon, Toxics Reduction Specialist, San Francisco Department of the Environment (Part 1 of 2) FIGURE 30. A CLOSER LOOK AT SAN FRANCISCO GENERAL HOSPITAL’S IPM PROGRAM EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND remove and destroy it, then seal caulk the area to On the rare occasion we find a nest, physically the renegade indoor bee or wasp, we vacuum it up. We do not have frequent stinging insect problems. For How do you manage stinging insects? for quick reference by our PCC. where a pest-sighting logbook is continually updated pest information from the entire facility into one office we use lots of sticky traps, and have centralized all the our Pest Control Contractor (PCC). To accomplish this look for and report the first signs of pest problems to working. We have trained nursing and custodial staff to lation in order to evaluate whether our methods are pest problems and also helps track the size of a popu- Monitoring and trapping helps with early detection of soaps are used rarely and only for extreme problems. plants by spraying them off with water; insecticidal inside buildings. Aphids are removed from landscape pests, especially flying insects such as bees and wasps ing access for rodents. Vacuums are used to remove from buildings at least 12 inches to remove easy build- areas where ants enter buildings. All ivy is cut back sweeps, and an air blower in the kitchen; caulking installing pigeon wires, bird spikes and screening, door are also very important in our plan. Exclusion includes accumulated food particles under kitchen equipment Regularly cleaning floor and sink drains removing flies, and not keep food in their lockers or desks. out trash containers, rinse drink cans to prevent fruit Sanitation – hospital staff have been trained to wash vent and manage pests? What are some of the techniques you use to pre- and promotes a healthy, vigorous lawn. leaving grass clippings in place further enriches the soil areas where weeds are hand-pulled. Aeration and which crowds out broadleaf weeds, and top dress the lawns regularly promoting vigorous grass growth diversity of vegetation in our lawns. We also fertilize what a tolerable plant is, and we now have greater spray, our only pesticide use is in baits used for rodents, notices of all pesticide applications. Because we do not The City of San Francisco IPM Ordinance requires posting How do you notify the public? be adding extra work to already busy schedules. thin and we can run into resistance when appear to pest prevention. Hospital custodians are often stretched our entire custodial staff to check traps and clean for proactive. Also, it is difficult to enlist the participation of pest control, often make it difficult to be non-emergency for pest entrance, combined with a limited budget Our aging buildings with few screens and ample gaps What have been your biggest challenges? team of professional pest management consultants. Citywide IPM Technical Advisory Committee, and a the Department of Environment, members network of advisors for support and advice, including develop to our PCC. Also, staff have access a toring, and communicating pest problems as they key role by helping with sanitation, prevention, moni- ed buy-in and cooperation from our staff, who play a toxics reduction and continual trainings have generat- commitment to tion of our hospital staff. A top-down However, he could not do his job without the coopera- finding and using least toxic control measures. success. The first is to have a PCC who committed There are three factors that stand out as critical to our What is the key to your success? measures and alternative controls. ensure that everyone is on board with prevention succeed. Our staff has received extensive training to other methods are tried first, and they almost always “allowed” for use under the Citywide IPM program, only. Although certain, reduced risk, pesticides are Pesticides are reserved for last resort or emergency use How do you decide when and if to use pesticides? to destroy ground nests. prevent future infestations. We use a vacuum or steam Healthy Hospitals 35 Controlling Pests Without Harmful Pesticides tated our transition. At this point two things would tated our transition. ren- to implement: extensive building make IPM easier labor with ovations, and replacement of temporary Continually training new temporary permanent labor. us from planning workers is inefficient and prevents ahead. you used? What external resources have use information and training from technical con- We Extension, sultants, local experts, Cooperative control contractor, University researchers and our pest and find innova- who have all helped us troubleshoot tive solutions. for a health care What suggestions do you have facility that is just starting to make the transition? The first and most important step is to designate a committed person who can effectively communicate the importance of IPM and provide leadership and over- ensure your pest control sight during the transition. To contractor is committed to IPM, re-write your contract and carefully evaluate each service proposal. In-house, a plan must be developed to promote a top-down phi- and through trainings losophy and bottom-up buy-in incentives. Understand that changing behavior can be give up. a long and frustrating process, and don’t It is also critical to provide new tools and technologies, not just take away old ones. A great way to do this is talking to and visiting other programs, and having meetings with other city departments to coordinate tri- try to re- als and share successes among peers. Don’t invent the wheel! Specialist at the Reduction Deanna Simon is the Toxics Department of the Environment, 11 San Francisco CA 94102, 415-355- Grove Street, San Francisco 3707, [email protected]. In the calendar years 2001 and 2002, what were In the calendar pesticides and pesticide appli- your expenses for cation? contracted structural SFGH pays $1,700 per year for all site visits and pest control services. This includes traps and baits). materials used (almost exclusively inspected, with some Each month every building is fully more frequent atten- areas (i.e. the cafeteria) receiving or materials for large-tion. This does not include labor the Department scale pest exclusion jobs. In addition, General Health (of which San Francisco of Public $17,000 annually Hospital is one facility) contributes fund staffing, to the Citywide IPM program to help pest management consultant services. and training, What were your expenses for other pest control equipment)? measures (i.e. labor, Our 2001 and 2002 pest control expenses were a This includ- total $125,000 and $80,000, respectively. and contractual ed costs for facilities, personnel, labor, work above and beyond our regular structural pest control service mentioned above. This amount covered spik- landscape pest control, pigeon control (netting, and lots of cleaning to discourage roosting), win- ing, installation of door sweeps to exclude dow repair, rodents, installation of a blower in the kitchen to exclude flies, and other structural and landscape pest exclusion work. or other funds to imple- Did you obtain start-up ment the program? funds were minimal, largely because the Our start-up program and trainings were coordinated and funded by the Department of the Environment, which adminis- ters the Citywide IPM umbrella program. Our IPM and coordinator is also our Health and Safety Officer, her IPM responsibilities take up about 10% of her time. What would have made your transition easier? What types of assistance would be useful to you now in implementing IPM? leadership and thorough staff trainings facili- Persistent FIGURE 30. A CLOSER LOOK AT SAN FRANCISCO GENERAL HOSPITAL’S IPM PROGRAM GENERAL HOSPITAL’S SAN FRANCISCO AT LOOK A CLOSER FIGURE 30. BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Interview with Deanna Simon, Toxics Reduction Specialist, San Francisco Department of the Environment (Part 2 of 2) (Part of the Environment Department San Francisco Specialist, Reduction Deanna Simon, Toxics Interview with ants, and cockroaches. Notification of the ongoing use of Notification of the ongoing ants, and cockroaches. on near the building entrance and these baits is posted notices. bulletin boards or walls near other to pest control Is there a process for responding questions and complaints? and prevention, we Because of our diligent monitoring our facilities. have had few pest complaints in to the hospital’s Questions and concerns are directed and She can answer most questions IPM coordinator. visitors, staff and acts as the interface between hospital IPM Coordinator the PCC. In addition the hospital also have We maintains a list of contacts for reference. staff at the City’s Environment who Department of the and they are oversees the Citywide IPM program, always available to answers questions. What have you done to train staff? What train- ing materials or organizations have you found most useful? with the help have periodic trainings coordinated We of the City’s Department of the Environment (DOE) that cover topics such as hospital-specific IPM for our use of weed flamers for our gardeners, nursing staff, and custodial roles in IPM. The DOE also presents a wide range of pest control issues to our staff through and an Handler Trainings, workshops, annual Pesticide annual IPM conference. Continuing education credits also conduct spe- are granted whenever possible. We Nile cialty topic trainings covering such issues as West virus, Hanta virus, and the health hazards of pigeon droppings. The Department of the Environment, through monthly meetings and general distribution, makes available information such as updated lists of City-approved reduced risk pesticides, the SF IPM training manual, fact sheets on various pests, guest speaker materials from monthly meetings, and the recently created IPM General Hospital (SFGH) has Francisco San newsletter. also developed our own structural pest control training manual for use by our staff and PCC. Healthy Hospitals 36 Controlling Pests Without Harmful Pesticides healthier indoor environment. If I’ve added anything department away from pesticides and toward a director (now my VP) who had already led the Actually, I was fortunate to succeed a previous How did you manage pests in the past? and staff. environment to better serve the needs of patients tion as we constantly morph our physical rates indoor air quality into design and construc- seriously. Brigham & Women’s Hospital incorpo- care. Hospital leadership takes this responsibility could impede their ability to deliver high-quality a higher incidence of respiratory symptoms that sure to the indoor environment, might experience staff, by nature of their long-term prolonged expo- pitalization or undesirable clinical outcomes. Our ulation, this might manifest itself in extended hos- respiratory illnesses. In our acutely ill patient pop- substantial role in the development and acuity of that prolonged exposure to pesticides may play a ed to indoor air quality. Current research suggests acted on the concerns of those staff as they relat- clinical and research community we heard As a department serving the needs of an advanced with alternatives? What was the impetus to replace pesticides of life for patients, staff, and visitors alike. have a direct and measurable impact on the quality support service team we have the opportunity to excellence and pride. As a key component of the serving the healthcare needs of community with patients, consistent with the hospital’s larger goal of and attractive environment for staff as well We see our mission as one that provides a healthy building and landscape management. Describe your general approach/philosophy for Interview with Richard Bass, Director of Environmental Services, Brigham and Women's Hospital (Part 1 of 2) FIGURE 31. A CLOSER LOOK AT BRIGHAM AND WOMEN'S HOSPITAL’S IPM PROGRAM EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND fish and roaches. construction can prevent later problems with silver- Placement of boric acid powder in wall voids during the Engineering Department to assist in effort. develop which need caulking. We rely heavily on resources to later eradicate. New cracks always pest infiltration which may take considerable sweeps can go a long way in preventing that initial potential pest access points for correction. Door structure, we take an active role in identifying foundation to prevent burrowing rodents. Within the exterior ledges or installing wire mesh along the heavily in erecting barriers, whether bird-proofing structure to reduce harborage. We’ve also invested we’ve learned to keep bushes from abutting the managing grounds. This has been a benefit as Environmental Services also has responsibility for problems? What have you done outdoors to prevent pest underlying issues. absent a commitment from the hospital to resolve contractor to resolve infestations without pesticides laboratively. To be fair, unrealistic to expect any it’s nicate well with the contractor to resolve issues col- address them directly. It really is critical to commu- cals than to track the source of infestations and far easier to apply poisonous chemi- restrictions. It’s eradicating pests through trapping and mechanical rare one who will devote the time and energy to a the principles of IPM, but in my experience it’s pest control contractors state their commitment to pests without the use of dangerous pesticides. Many commitment to take an active stance in managing ice provider with one who was willing to make the step was the replacement of previous pest serv- decision-making and communication. Another key it has been the formalization of policy to clarify cide MSDSs are available on the Web). EH&S along with the relevant MSDS (quick tip: most pesti- I concur, I forward the recommendation to EH&S tor may recommend the use of a specific product. If exhaust all other options. At that point the contrac- staff and the manager of affected area. We port of our Environmental Health & Safety (EH&S) and implemented only with the approval sup- wherever it is feasible to do so. Exceptions are rare, issues without resorting to the use of pesticides Our policy clearly outlines our goal to manage pest How do you decide when and if to use pesticides? caulk or otherwise eliminate the access. removed, we work to identify the access point and tank vacuum cleaner. Once the immediate pest is those that do infiltrate, our first response is with a to avoid significant bees, wasps, and the like. For As a facility with few open windows we are fortunate How do you manage stinging insects? harborages. with elimination of potential food sources and traps are used extensively for rodents in conjunction rather than utilizing a hit-or-miss approach. Baited each allows us to address the specific problem counterparts. Understanding the characteristics of roaches behave quite differently from their American ular problem. For instance, common German cock- ensure that our response is customized to the partic- pests. Our vendor has access to an entomologist extensive use of glue monitors to identify specific strongly for appropriate food storage. We make diately after food service functions, and advocates uled cleaning of waste containers, clean up imme- Environmental Services focuses on thorough sched- manage pests inside the hospital? What techniques do you use to prevent and Healthy Hospitals 37 Controlling Pests Without Harmful Pesticides What changes did you make first? What changes and weaknesses of the Identifying the strengths a strategic plan existing program, then developing pests for accomplishing the goal of managing play a critical communica- Logbooks proactively. issues of a large tions role when managing the pest believe in hiding and complex environment. I don’t people who might ini- one’s problems. Surprisingly, available pesti- tially advocate using the strongest really do come cide to solve the immediate problem to take that to appreciate that our reluctance own health. It approach is out of respect for their the problem with- sometimes takes longer to solve out the use of pesticides, but it’s time well spent to ensure that we’ve resolved the core issues rather than addressing the symptoms alone. What suggestions do you have for a health care facility that is just starting to make the transition to IPM? Educate yourself about what Integrated Pest Management really means so that you can explain it in simple terms to others. If pest control service is outsourced, select a vendor who will support your choice and not excuse a lack of results by claiming that eliminating pesticides hampers their ability to be effective. I have a bias toward independents. They tend to take the longer view toward retaining the account rather than seeking to preserve the bot- tom line by choosing the most expeditious solution (usually pesticides). Richard Bass is the Director of Environmental Hospital, 75 Services for Brigham and Women’s Street, Boston MA 02130, 617-732-7130, Francis [email protected]. ities, it is all the more critical that we make full use more critical that we make full ities, it is all the to block pest entry into build- of mechanical means a burgeon- ings and act expeditiously in controlling ing rodent population. staff? What have you done to train Our staff’s is to report pest problems responsibility can be logged they become aware of so that they are trained to solic- for treatment. Our clerical staffs information it considerable detail from reporters, the issue quickly. that can be critical in resolving They know to ‘turf’ repeat issues or difficult situa- control is a daily topic we tions to me forthwith. Pest touch base on. In the calendar years 2000 and 2001, what were your expenses for pesticides and pesticide applications? In 2000, we spent about $23,000 on all pest management (primarily routine service visits). In October 2001 we transitioned to a small inde- pendent contractor who had serviced our smaller facility for 10 years, saving nearly $10,000 with an improved service level. Extraordinary mechani- cal expenditures this year (mesh installation for rodent control) has consumed less than half of that savings. or other funds to Did you obtain start-up implement the program? worked within our existing budget. We What types of assistance are useful to you in implementing IPM? There are a number of good resources available to learn more about IPM. I make thorough use of the to answer specific questions or research partic- Web ular pests. FIGURE 31. A CLOSER LOOK AT BRIGHAM AND WOMEN'S HOSPITAL’S IPM PROGRAM WOMEN'S HOSPITAL’S BRIGHAM AND AT LOOK A CLOSER FIGURE 31. BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Interview with Richard Bass, Director of Environmental Services, Brigham and Women's Hospital (Part 2 of 2) (Part Hospital Brigham and Women's of Environmental Services, Richard Bass, Director Interview with reviews the potential hazard of the recommended reviews the potential that it minimizes potential risk product to ensure that appropriate while being effective, and ensures off-shiftmeasures are employed (treating when area etc.) to mini- is vacant, post application ventilation, tenure we just mize risk of exposure. In my 2-year the no pesticide poli- made our second exception to bird mite infesta- cy in order to address a stubborn tion in an older building. Is there a How do you involve the public? control ques- process for responding to pest tions and complaints? is defined in Our procedure for handling complaints our pest management policy and procedures. We use a dedicated phone extension for reporting pest problems and answering questions. I have made it a personal priority to involve myself directly in man- aging significant pest issues and communicate directly and openly with all interested parties. What is the key to your success? like to be It’s really the communication. People reassured that the pest issue is a priority for our department and be kept informed of what actions have been taken. By involving the hospital staff in the process the contractor can better understand that we must work together in order to be methodi- cal and pragmatic in developing solutions. By resolving root issues we have a greater likelihood of avoiding recurrence, rather than using pesticides solution to the problem. liberally for a short-term What have been your biggest challenges? adjacent control. A mild winter coupled with Rodent construction really resulted in a very challenging year for pest control. Since we exert little or no influence over the weather and other people’s activ- Healthy Hospitals 38 Controlling Pests Without Harmful Pesticides tered for hospital use by EPA, ingredients in 1,600 pesticide products regis- tal effects. With approximately 320 active known adverse human health and environmen- the availability of pesticide products with Inadequacies in federal laws have resulted in Recommendations IV. Conclusion and ment practices. an urgent need to adopt safer pest manage- suggest that the majority of U.S. hospitals have mented IPM programs. Yet, the results also show that some hospitals have already imple- the hazards of pesticides. findings The survey pests while simultaneously protecting it from the hospital community against harm from Fortunately, an IPM program can safeguard pesticide injury. hospital occupants at an unacceptable risk for These practices put staff, patients, and other consequences associated with many pesticides. cate their staff or others on the negative health about pesticide applications; and, do not edu- not notify their staff, patients or the public problems with hazardous pesticides; often do apparent that many hospitals control their pest From results reported, it is the hospital survey as well as pests. pital occupants from the hazards of pesticides controlling pest populations must protect hos- places of health and healing. Their strategies for especially of concern. Hospitals are meant to be 131 this is no harm.” providers to live up to their code “First, do management program helps health care management. Adopting an integrated pest the way in modeling safe and effective pest obligation to protect their patients and to lead hazardous chemicals. Hospitals have a special exposure to to reduce their patients and staff’s adopt safer pest management practices in order tion and proper tools, health institutions can patients, and the public. With good informa- mount concern for the health of their staff, Harm acknowledge health institutions’ para- Beyond Pesticides and Health Care Without ● ● ● Health care facilities should: providing pesticide use notification. adopting least hazardous IPM programs and action to increase the number of hospitals can all take the pest management industry Hospitals, government entities, the public, and Recommendations and other hospital occupants when pesti- Provide notification to the staff, patients, the IPM policy. have a clear written contract that includes implemented by a commercial applicator, technical training. If pest management is provide staff with IPM education and tal staff implements pest management, been tried and found ineffective. If hospi- non-toxic methods of pest control have the least hazardous pesticides only after Implement an IPM program that selects elements outlined in this report. definition of IPM that includes the key materials that contain a strong and clear Develop an IPM policy and guidance EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND ● ● ● ● ● ● ● ● ● on the hospital’s grounds. cides are used in the hospital building or monitor, an Environment and support of to develop, Organizations (JCAHO) Accreditation for Healthcare Work with the Joint Commission on to becoming ill from pesticides. ability that makes them more susceptible who have a medical condition and/or dis- Provide pesticide-free areas for patients and state health agencies. by a pesticide used at the hospital to EPA itor or hospital staff member is made sick Report any incidents where a patient, vis- ties or those undergoing chemotherapy. asthma, allergies, and chemical sensitivi- systems, people with immune or nervous dren, the elderly, those with compromised more sensitive to pesticides, such as chil- the needs of patients and staff that are Establish additional guidelines to address ucts and methods. alternative pest management prod-new of pesticides used at the hospital and on Stay up-to-date on the registration status least seven years. Maintain pest management records for at principles of IPM. ards of pesticides and the advantages and Educate all hospital staff about the haz- ment program and its pesticide use. tion about the hospital’s pest manage- questions or provide additional informa- IPM coordinator, who is able to answer address for a contact person, ideally the Publicize the phone number and email ownersproperty or residents. used on hospital grounds to neighboring Provide prior notification of pesticides Healthy Hospitals 39 Controlling Pests Without Harmful Pesticides Become informed and acquire expertise acquire informed and Become IPM. in true least hazardous that the number of businesses Expand IPM services. these provide and pest management practices Disclose the public. pesticide use to for the adoption of industry-wide Work for training and certifica- IPM standards tion. ● ● ● ● contact Beyond information, more For or see Harm Without Care Health or Pesticides for a list of in the Appendix List the Resource and govern- organizations, IPM companies, ment contacts. The pest management industry management The pest should: Develop hospital IPM policy and guid- Develop and ance materials that contain a strong the clear definition of IPM that includes key elements outlined in this report. hospitals to to require legislation Pass pesticide adopt IPM policies and disclose and the public through use to workers and upon posting, individual notification, request. and certifica- an IPM training Develop pest control commercial for tion process operators and hospital employees. operators without certifica-Commercial tion should not be eligible for hospital contracts. pesticides at hazardous the use of Prohibit alternative hospitals when less hazardous practices exist. IPM of strong for the adoption Advocate at hospitals. programs of about the pest management Inquire in their hospital buildings and grounds communities. that promote for public policies Advocate safer pest management practices and pesti- on hazardous restrictions strengthen cides. Care Standard that requires hospitals to hospitals requires that Standard Care the that includes IPM Plan a written have in this report. key elements outlined BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM ● ● ● ● The public should: ● ● ● Federal, state, and local government entities state, and local government Federal, should: Healthy Hospitals 40 Controlling Pests Without Harmful Pesticides www.noharm.org [email protected] 202-234-0091 Washington DC 20009 1755 S Street, NW, Suite 6B Health Care Without Harm www.pesticidereform.org [email protected] 415-981-3939 San Francisco CA 94102 49 Powell Street, #530 Californians for Pesticide Reform www.birc.org [email protected] 510-524-2567 Berkeley CA 94707 PO Box 7414 Bio-Integral Resource Center www.beyondpesticides.org [email protected] 202-543-5450 Washington DC 20003 701 E Street, SE, Suite 200 Beyond Pesticides tice IPM. to find pest management companies that prac- Pesticides’ Safety Source for Pest Management ment entities, and/or consult Beyond following organizations, consultants, govern- menting a hospital IPM program, contact the For more information on pesticides and imple- Resource List V. Appendix www.panna.org [email protected] 415-981-1771 San Francisco CA 94102 49 Powell Street, Suite 500 America Pesticide North Network Action www.pesticide.org [email protected] 541-344-5044 Eugene OR 97440-1393 PO Box 1393 to Pesticides Coalition for Alternatives Northwest http://npic.orst.edu [email protected] 800-858-7378 OR 97331 Corvallis 333 Weniger Oregon State University National Pesticide Center Information www.ncehs.org [email protected] 856-429-5358 Voorhees NJ 08043 1100 Rural Avenue National Center for Environmental Health Strategies www.ipminstitute.org [email protected] 608-232-1528 53705 Madison WI 1914 Rowley Avenue America IPM Institute of North [email protected] 818-843-8304 Burbank CA 91502 275 South 3rd Street, #312 International Pest Management Institute EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND ● www.pesticideinfo.org pest problem needing to be addressed. decide what action is most appropriate for the their potential to cause adverse effects, and about the products that they use, learn about provider to talk with the service important are classified as “toxic.” As a customer, it is tions” because they may also use products that that Beyond Pesticides considers “mixed opera- operate businesses companies in the directory responses in their own words. Many of the arethe directory the companies’ survey rizes as “non-toxic” or “least-toxic.” Included in and/or materials that Beyond Pesticides catego- indicate that they use one or more practices pleted the Beyond Pesticides questionnaire and because they have com- listed in the directory companies that practice IPM. Companies are tysource provides a list of pest management Providers National Directory of Least-toxic Service The Safety Source for Pest Management: A IPM Companies Hospital www.epa.gov/pesticides 202-260-2090 Washington, DC 20460 Mail Code 3213A 1200 Pennsylvania Ave., NW Ariel Rios Building Office of Pesticide Programs U.S. Environmental Protection Agency at www.beyondpesticides.org/safe- Healthy Hospitals 41 Controlling Pests Without Harmful Pesticides grounds, the Director shall provide to each staff to provide shall the Director grounds, to be that is expected and patient member written notice to be treated, in the area residing The pesticide application. of the proposed abutting property shall pre-notify Director will be made if a pesticide application owners, Notice lawn or landscape. on the hospital’s ingredient, shall include the brand name, active Agency Protection and U.S. Environmental number of the pesticide to be used; registration the pesticide a description of the location where of the date and will be applied; a description in the case of that, time of application, except each notice outdoor pesticide applications, in chronological dates, shall include three that the outdoor pesticide applications order, date is canceled may take place if the preceding the target pest and description due to weather; effects of the pesticide of potential adverse based on the label or MSDS for the pesticide; a for the application of description of the reasons the pesticide; the application method; the company; the name and name and applicator’s telephone number of whom to contact for and any additional warning information; more to the pesticide. information related a pesticide is used at a least 72 hours before At applicator the pest control hospital facility, notice of the shall post a sign that provides application of the pesticide in a prominent place that is in or adjacent to the location to be entrance to the building or and at each treated shall contain the Signs to be treated. grounds same information as written notices and remain in place during the pesticide application and for at least 72 hours afterwards. Section 5. Pesticide Notification. Pesticide Section 5. a pesticide is less than 72 hours before Not applied in a hospital building or on hospital Section 4. Management. Pest Integrated to pest management is an approach Integrated eliminates or mitigates eco- that pest control pests, by nomic and health damage caused the use of pes- while minimizing or eliminating health and the ticides and their risk to human site or pest inspec- involves IPM environment. and the tions; pest population monitoring; The primary need for action. of the evaluation and focus on pest prevention methods control sanitation, making structur- include improving and using mechanical, physical, al repairs, A least haz- cultural, and biological controls. is only applied if non-toxic pesticide ardous not appro- or are been ineffective methods have priate. technician, whether a hospi- Each pest control is or outside contractor, tal employee problem, for documenting a pest responsible and their the problem actions taken to correct to the source outcomes, and findings relevant technician The pest control of the infestation. which shall shall fill out a Service Form, Report be kept in a logbook at the hospital’s Services Department. A log- Environmental book shall be kept in a central location and pro- shall be used to document the pest control staff and/or pest control The hospital gram. of pests in the presence technician shall report a timely manner. other appropriate administrator evaluating the evaluating administrator other appropriate pest management the integrated of progress for is also responsible The Director program. of individuals that the training coordinating IPM program. implement the not harm humans or the environment. not harm humans pesticides. that a haz- pital community in the event applied. is pesticide product ardous BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Section 2. General. of this policy apply to hospi- The requirements policy shall This tal buildings and grounds. a pesticide or apply to any person that applies a activities in engages in other pest control including a custo- building or on the grounds, applicator. or commercial dian, staff member, All individuals that apply a pesticide must be the state. licensed by Section Services. Director of Environmental 3. Services, or of Environmental The Director for staff person, is responsible other appropriate the implementation and overseeing developing of the integrated pest management (IPM) pro- shall designate a contact The Director gram. person for inquiries about the IPM program; (MSDSs) Sheets Data Safety maintain Material and labels for all pesticides which may be used inside or outside the facilities; maintain sched- uling of all pest monitoring and pesticide usage; stay up-to-date on new IPM materials and methods; obtain periodic updates and make IPM experts;training from on request pest management and pesticide the hospital’s and, to the public for review; use data available CEO, or to the Board, an annual report present Model Hospital Pest Integrated (IPM) Policy* Management Goals. Section Policy 1. (a) pests in a manner that will manage To (b) or eliminate the use of toxic reduce To (c) ample notification to the hos- provide To Healthy Hospitals 42 Controlling Pests Without Harmful Pesticides a The use of the most dangerous pesticides: (a) pest problem causes an urgent threat to health): The following are prohibited (except when a 7.Section Pesticide Hospital Use. than the time application commences. warning of the pesticide application no later requirements under Section 5 shall be posted tion takes place. A sign that meets the treated area within 72 hours after an applica- and patients expected to be residing near the and notification shall be provided to all staff is unoccupied prior to the pesticide application gency, care shall be taken to make sure the area If a hospital applies pesticide due to an emer- 6. Emergency PesticideSection Use. 4 Pesticides in the carbamate (carbaryl, (4) Pesticides that interfere with human (3) Pesticides linked to cancer — U.S. (2) Pesticides in U.S. EPA Categories I (1) bendiocarb, etc.), organophosphate Newlist.html>; or chemi- suspected endocrine disruptors ductive or developmental toxins or harm, e.g., those identified as repro- or reproductive or developmental defects hormones and/or cause birth Newlist.html>; and chemicals known to the phenol, and rhodamine B) quinone, isophorone, nonylphenol, phthalate, formaldehyde, hydro- Toxicological Concern” (dioctyl EPA as “List 1: Inerts of ingredients categorized by the U.S. and, herbicides (2,4-D, mecoprop, etc.); etc.) chemical family and phenoxy pyrethroid (cyfluthrin, permethrin, (diazinon, acephate, etc.) or cable pesticide notification laws and regulations. responsibilities, including compliance with appli- agement programs meet legal and patient care legal and medical advice to ensure that pest man- Health care providers and institutions should seek and does not constitute legal or health advice. *This document is for educational purposes only request. made available to the staff and public upon CEO, or other appropriate administrator and shall be submitted to the hospital’s Board, areas where improvement is needed. The report gram to evaluate its effectiveness and to identify The Director shall annually review its IPM pro- 9.Section Reporting. 1)name, address, and phone number (10) possible adverse health effects to (9) least hazardous and non-chemical (8) method of application and quantity (7) U.S EPA registration number; (6) name of the pesticide manufacturer; (5) brand name and active ingredients of (4) application area; (3) date and time of the application; (2) target pest and reason for the appli- (1) pesticide. of the individual who applied MSDS; and, humans as stated on the label or the proposed pesticide was chosen; the reasons why the application of accomplish the desired objectives and that were tried and/or unavailable to alternative methods or treatments of pesticide used; the pesticide product; cation(s); Healthy Hospitals 43

Controlling Pests Without Harmful Pesticides

A member of member A

We will then work with interested hospitals to hospitals interested with work then will We

Catherine Porter, Co-Chair, Health-Affected Work Group, Health Care Without Harm Without Care Health Group, Work Health-Affected Co-Chair, Porter, Catherine

Sincerely,

them as environmentally safe as possible. possible. as safe environmentally as them

Thank you for taking the time to complete this survey. We look forward to continuing our work with hospitals to make to hospitals with work our continuing to forward look We survey. this complete to time the taking for you Thank

site, www.noharm.org. site,

that complete a survey will automatically receive a copy of the report. Other hospitals can obtain a copy by visiting our web- our visiting by copy a obtain can hospitals Other report. the of copy a receive automatically will survey a complete that

except those hospitals demonstrating best-practices pest management techniques and/or model IPM programs. All hospitals All programs. IPM model and/or techniques management pest best-practices demonstrating hospitals those except

Other than an appendix listing the 171 facilities on the U.S. News list, no hospital names will be mentioned in the report the in mentioned be will names hospital no list, News U.S. the on facilities 171 the listing appendix an than Other

Aggregate data from the survey will also be used to write a report on the current state of pesticide use in U.S. hospitals. U.S. in use pesticide of state current the on report a write to used be also will survey the from data Aggregate

develop or improve safer integrated pest management (IPM) programs for their facilities. their for programs (IPM) management pest integrated safer improve or develop

HCWH will be contacting you to see if you need help with the survey. the with help need you if see to you contacting be will HCWH

2001). The purpose of this survey is to determine which pesticides are being used in the nation’s hospitals. hospitals. nation’s the in used being are pesticides which determine to is survey this of purpose The 2001).

HCWH is distributing to the top 171 hospitals in the United States (as determined by U.S. NEWS & WORLD REPORT, WORLD & NEWS U.S. by determined (as States United the in hospitals 171 top the to distributing is HCWH

ticide products are currently being used. Enclosed you will find a survey of pest control practices and pesticides use that use pesticides and practices control pest of survey a find will you Enclosed used. being currently are products ticide

Before HCWH can work with hospitals on their pest management, we must first gain a better understanding of what pes- what of understanding better a gain first must we management, pest their on hospitals with work can HCWH Before

chemical sensitivities. chemical

illnesses including cancer, asthma, birth defects, hormone disruption, learning disabilities, Parkinson’s disease and multiple and disease Parkinson’s disabilities, learning disruption, hormone defects, birth asthma, cancer, including illnesses

headache, seizures and other serious health problems. Pesticides are also increasingly being linked with a myriad of chronic of myriad a with linked being increasingly also are Pesticides problems. health serious other and seizures headache,

ings. This is desirable because exposures to many commonly used pesticides can cause wheezing, vomiting, diarrhea, vomiting, wheezing, cause can pesticides used commonly many to exposures because desirable is This ings.

our focus to help hospitals reduce their pesticide use and find less-toxic ways to manage pests within and outside their build- their outside and within pests manage to ways less-toxic find and use pesticide their reduce hospitals help to focus our

HCWH has assisted numerous medical facilities in reducing their dioxin and mercury emissions. Now we are expanding are we Now emissions. mercury and dioxin their reducing in facilities medical numerous assisted has HCWH

harm, without compromising safety or care. or safety compromising without harm,

cy groups. The mission of HCWH is to transform the health care industry so that it is no longer a source of environmental of source a longer no is it that so industry care health the transform to is HCWH of mission The groups. cy

care systems, organizations of health professionals, labor, environmental groups, religious organizations and health-advoca- and organizations religious groups, environmental labor, professionals, health of organizations systems, care

is an international coalition composed of over 340 member-organizations in 36 countries. These members include health include members These countries. 36 in member-organizations 340 over of composed coalition international an is

As you may be aware, Health Care Without Harm: The Campaign for Environmentally Responsible Health Care (HCWH) Care Health Responsible Environmentally for Campaign The Harm: Without Care Health aware, be may you As Dear Facilities Manager: Manager: Facilities Dear BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Cover Letter and Survey Letter Cover Healthy Hospitals 44 Controlling Pests Without Harmful Pesticides .D o otwrigsgswe etcdsaeue nhsia rud?YNNo pesticides used No pesticides used N N Y Y N Y N N Y Y Do you post warning signs when pesticides are used on hospital grounds? 6. Do you post warning signs when pesticides are used in the hospital? 5. Are hospital staff members given training on the health effects of pesticides? 4. Are Material Safety Data Sheets (MSDS) on file and available to hospital staff for all 3. Does your facility use chemical pesticide products on hospital grounds? 2. Does your facility use chemical pesticide products inside the hospital? 1. For each question below, circle the response that best fits the situation at your facility. I Part Hospital type: ______Direct phone: ______Job title: ______Name of person completing survey: ______Main information phone number: ______Address: ______Name of hospital: ______was completed: Date survey Please complete and return to HCWH by January 15, 2002 Pesticide Use Survey Specialty: Number of beds: ______Affiliated with a university? Y N etcdsue nyu optlo nhsia rud?YN Y pesticides used in your hospital or on grounds? ❏ General ❏ Non-profit ❏ Children’s ❏ Urban ❏ Women’s ❏ For-profit EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND ❏ Cancer ❏ Suburban ❏ Eye ❏ Rural ❏ Rehabilitation/Orthopedic ❏ Other Healthy Hospitals 45 Controlling Pests Without Harmful Pesticides are used in the hospital? used in are tents (e.g., table directed to whom they are the forms of notification and to #7, please describe “yes” If spraying): monthly roach to inform hospital staff about in hospital cafeteria ______used on hospital grounds?pesticides are directed notification and to whom they are to #8, please describe the forms of “yes” If ______Y N Y pesticides used No N pesticides used No BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM 7. when pesticides others patients, or to staff, other forms of notification provide you Do 8. patients, or others when other forms of notification to staff, provide you Do 9. of pesticides used in the hospital? keep records anyone Does 10. keeper) of record (Title/position who keeps the records? yes, If 11. copies also kept at the hospital? are a contractor, kept by are records If 12. of pesticides used on hospital grounds? keep records anyone Does 13. keeper) of record (Title/position who keeps the records? yes, If 14. copies also kept at the hospital? are a contractor, kept by are records If 15. contractors? outside pest management is handled by of your What percentage 16. Y staff/employees? pest management is handled by of your What percentage 17. Y management plan? a written pest hospital have your Does 18. N to pest management? (IPM) approach hospital use an integrated pest management your Does N 19. Y $______pest management? hospital’s for your per year cost What is the approximate pesticides used No N Y _____ % indoors ______% outdoors Y pesticides used No N _____ % indoors N ______% outdoors know Don’t Y N know Don’t Healthy Hospitals 46 Controlling Pests Without Harmful Pesticides DC 20009 or fax to 202-234-9121 by January 15, 2002. Thank you for your cooperation in completing this survey. Please return the completed form to Health Care Without Harm, 1755 “S ______In the space below (or as an attachment), please add any comments or information that you would like to share about how your ho Part III 5 Identify the frequency of application to each area (e.g., weekly, monthly, twice a year) and whether the applications were m 4 Identify the method of pesticide application (e.g., spray, granules, fog, bait). 3 Identify the indoor and outdoor area(s) where this pesticide was applied (e.g., cafeteria, patient room(s), building perimet 2 Active ingredients can be found on the product labels. 1 Please list each pesticide product applied in your hospital or on its grounds the last year. EPA #3125-380 Tempo 20 WP Example: EPA registration # Brand name & to kill or repel pests (e.g., insects, rodents, birds, weeds). Please attach additional sheets if necessary. Please use the following to list all chemical pesticide products (excluding chart disinfectants) used in your hospital or on it II Part 1 Active ingredient(s) Cyfluthrin 2 EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND Building perimeter Loading dock Cafeteria Areas treated 3 Spray Spray Spray Method of application er, lawn, shrubs). ade on a regular calendar basis or only as needed based upon pest populations. s grounds in the past year. “Pesticides” refer to products used 4 Monthly (regular) Every 3 mos. (as needed) Monthly (regular) applied regularly or as-needed Frequency of application & whether spital manages pests. ” St NW, Suite 6B, Washington, 5 ______Healthy Hospitals 47 Controlling Pests Without Harmful Pesticides Yes: 20 Yes: 1 No: 1 Answer: Not Did 17 Yes: 5 No: 20 Yes: 1 No: 1 Answer: Not Did 6 Yes: 10 No: 6 Answer: Not Did 6 Yes: 12 No: 1 Used: Pesticides No 3 Answer: Not Did 8 Yes: 10 No: 2 Used: Pesticides No 2 Answer: Not Did 1. Does your facility use chemical pesticide use chemical facility your 1. Does inside the hospital? products pesticide facility use chemical your 2. Does grounds? on hospital products on file and Sheets Data Safety Material 3. Are staff for all pesticides to hospital available or on hospital grounds? hospital used in your training hospital staff members given 4. Are on the health effects of pesticides? warning signs when pesticides post you 5. Do used in the hospital? are warning signs when pesticides post you 6. Do used on hospital grounds? are Non-profit: 17 Non-profit: 2 For-profit: 3 Answer: Not Did 10 Urban: 0 Suburban: 1 Rural: 1 and Rural: Suburban, Urban, 10 Answer: Not Did 10,015 Total: Range: 93 - 998 facility): 1 (outpatient Other 16 Yes: 3 No: 3 Answer: Not Did 13 General: 7 Children’s: 5 Women’s: Cancer: 6 3 Eye: 6 Rehabilitation/Orthopedic: teaching (1); trauma (2); research Other: (3); asthma/lung (1) 3 Answer: Not Did Type of Hospital: Type of Beds: Number Affiliated with a University: than one) (some hospitals chose more Specialty: CA: 4 IL: 3 MA: 2 AZ: 2 CO: 2 TX: 2 DC: 2 1 each OH, OR, FL, NH, PA: Services (manager or Environmental 12 director): 2 Manager: Safety Contractor: 2 Management Pest Hired 1 Department (Coordinator): Grounds 1 Hygienist: Industrial Services(manager): 1 Guest 1 Consulting Entomologist: Services: 1 Housekeeping 1 Department Trainer: BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM Survey Results survey: returned Hospitals 12 states & District 22 hospitals representing of Columbia: Contact in Hospitals: Management Pest Hospital Use Pesticide Healthy Hospitals 48 Controlling Pests Without Harmful Pesticides ● ● ● notification and to whom they are directed. If “yes” to #8, please describe the forms of used on hospital grounds? to staff, patients, or others when pesticides are 8. Do you provide other forms of notification ● ● ● ● ● ● ● notification and to whom they are directed. If “yes” to #7, please describe the forms of used in the hospital? to staff, patients, or others when pesticides are 7. Do you provide other forms of notification Direct communication to staff tickets state what used, whereService beforedepartment application Arborists, contractors informed by Did Not Respond: 1 No Pesticides Used: 5 No: 10 Yes: 6 Send email of the affected areaInform RN supervisor ed area, usually one week in advance Treatment is discussed with staff at treat- Communicate to staff directly Follow all California regulations (2) ed upon request and where pesticides will be used provid- Verbal or documented notice of when ing of pests Inform contact person in area complain- Did Not Answer: 4 No Pesticides Used: 1 No: 9 Yes: 8 used on hospital grounds? 12. Does anyone keep records of pesticides copies also kept at the hospital? 11. If records are kept by a contractor, are 10. If yes, who keeps the records? in the hospital? 9. Does anyone keep records of pesticides used ● ● Did Not Answer: 1 No Pesticides Used: 5 No: 2 Yes: 14 Did Not Answer: 5 Not Applicable: 1 No: 0 Yes: 16 Not Applicable (No Pesticides Used): 1 Did Not Answer: 3 Contractor: 1 Customer 1 Department: Service Guest 1 Services: Supervisor of Facilities: 1 Housekeeping 3 Department: Environmental 11 Services: Did Not Answer: 4 No Pesticides Used: 1 No: 0 Yes: 17 Verbal, written to maintenance staff maintenance and security are notified Nursing supervisor, infection control, EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND ment is handled by outside contractors? 15. What percentage of your pest manage- copies also kept at the hospital? 14. If records are kept by a contractor, are 13. If yes, who keeps the records? i o nwr 7 Did Not Answer: 8 100%: Outdoors: 5 Did Not Answer: 14 100%: Indoors: Did Not Answer: 5 Not Applicable: 3 No: 1 Yes: 13 Did Not Answer: 2 Not Applicable: 5 Grounds Supervisor: 1 Supervisor of Facilities: 1 Housekeeping 2 Department: Pest Control Company: 5 Environmental 6 Services: 0:1 10%: 1 25%: 1 20%: 1 98%: 1 99%: % 4 0%: 1 5%: 0 0%: Healthy Hospitals 49 Controlling Pests Without Harmful Pesticides Amdro Fire Ant Insecticide Fire Amdro Atrazine 310 Avert 1 Formula Stations Bait Cockroach Avert 2 Formula Bait Gel Cockroach Avert 3 Formula Bait Gel Cockroach Avert Dry Flowable Avert 0.15 ec Miticide/Insecticide Avid Whole Corn Avitrol Herbicide WG 65 Barricade Herbicide Barricade T/O Basagran 2% Bait Baygon Bait Baygon Bayleton Kill) Borid (Roach Borid Barrier Borid Turbo Caterpillar Attack BT Bueno AG Casaron CB-40 Extra CB-80 Extra 3336 Cleary’s Confront Concentrate Conquer Residual Conserve Blox Contrac All-weather Cake Contrac All-weather Bait Contrac Rat & Mouse Crossbow Kick Cy WSB Insecticide Cynoff 40 Deadline CS Insecticide Demand EC Demon WP Demon Diathane Spray Diazinon Blox All-weather Ditrac Powder Tracking Ditrac Ant Kill Gel Drax 80 $4,800: 1 $5,000: 1 $7,788: 1 $10,000: 1 $11,000: 1 $12,000: 1 $15,000: 3 $29,800: 1 $35,000: 1 $36,761: 1 17 $150,000: 1 159 pesticides products Did Not Answer: 7 Answer: Not Did 2 Know: Not Do $347,149.00 for 13: Total (outpatient only facility) - Range: $4,800 $150,000 (898 bed facility) 19. What is the approximate cost per year for cost per year approximate What is the 19. pest management? hospital’s your List of Pesticides that Provided Hospitals in Facility: Used Listed: Products of Pesticide Number Total 216 Products Pesticide Different of Number Listed: Ingredients: of Active Number Listed on Returned Products Pesticide Surveys: Hospital Carpenter Ant Bait Advance Choice Dual Advance Ant Bait Granular Advance 2%: 1 1%: 1 0%: 14 0%: 11 80%: 1 95%: 1 90%: 1 75%: 1 Indoors: 100%: 0 Answer: Not Did 5 Outdoors: 100%: 1 Answer: Not Did 7 14 Yes: 2 No: 2 Know: Not Do 4 Answer: Not Did 16 Yes: 2 No: 2 Know: Not Do 2 Answer: Not Did BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM 16. What percentage of your pest manage- of your What percentage 16. staff/employees? handled by ment is pest a written hospital have your 17. Does management plan? hospital use an integrated pest your 18. Does to pest manage- management (IPM) approach ment? Healthy Hospitals 50 Controlling Pests Without Harmful Pesticides Maxforce Roach Bait Stations Maxforce Roach Bait Gel (reservoir) Maxforce Roach Bait Maxforce Granular Roach Killer Maxforce Granular Insect Bait Maxforce Gel Maxforce FC Roach Killer Bait Gel Maxforce FC Ant Station Maxforce FC Ant Bait Stations Maxforce Bait Station Maxforce Ant Killer Maxforce Ant Bait Maxforce Ant & Insect Bait Manage Malathion Premium Spray Malathion E-5 Malathion 50% Grade Lesco Horticulture Oil Knox Out 2FM Kicker EC Insecticide Intruder HPX Gourmet Gel Gentrol Point Source Gentrol IGR Concentrate Gentrol IGR Fore Fly-Tek Fluorguard Ant Control Baits FLF Atochem Knox Flee Insecticide Final Blox Ficam W Ficam Dust Esbiol fogging concentrate 2289 Epoleon NnZ ElioTrol ECOPCO Jet Ecolan 2000 Ecolab ISI 30 Dursban Pro Drione Insecticide Drax Ant Kill PF Safer Insecticidal Soap Rozol TrackingPowder Rowstar GL Rout Ornamental Herbicide Round-up Pro Quintox Rat & Mouse Bait Pyrenone multi-purpose insecticide Purge SuperHydro-Sol PT 565 Plus Xlo PT 565 PT 515 Wasp Freeze PT 370 Ascent Fire Ant Stopper Bait PT 3-6-10 Aerocide PT 280 Orthene PT 265A Knox Out PT 240 Permadust PT 230 Tri-Die PT 1500 A Knox Out Pro-Control Fogger Pro-Control Dual Choice Precor 2000 Polysul Summer & Dormant Spray Concentrate Poast Permacide P-1 Pennant 5G Pennant Liquid Herbicide Pathway P.I. Outsmart Orthene Nibor Niban Granular Bait Niban Musca-cide M-Peda Moss-Kil Monobor-Chlorate Mistocide-B Microcare Merit 75 WSP Merit MCPP-4 Amine EODPSIIE & ELHCR IHU HARM WITHOUT CARE PESTICIDES & HEALTH BEYOND Bacillus thuringiensis atrazine acephate abamectin 4-aminopyridine 2-2 methyl-4-propionic acid 2,4-D Returned Hospital Surveys: Pesticide Active Ingredients Listed on Weatherblok Rodenticide Bait Wasp Freeze Vengeance Rodenticide Bait ULD BP-300 Insecticide ULD BP 100 Turflon Trimec Herbicide Tri-Die Triad Tordon K Terro Ant Killer II Tempo 20 WP Tempo 2 Tempo Ultra Tempo SC Ultra Insecticide Tanglefoot Talstar PL Granular Talstar Lawn & Tree Talstar Talon-G Rodenticide Pellets Talon-G Rodenticide Bait Packs Talon G Weatherblok Bait Suspend SC Subdue Stimukil Fly Bait Sterifab Snapshot 2.5TG Siege Gel Insecticide Sevin Scythe Healthy Hospitals 51 Controlling Pests Without Harmful Pesticides n-octyl bicycloheptene dicarboximide bicycloheptene n-octyl ortho-benzyl-para-chlorophenol oryzalin oxadiazon oxyflurfen pelargonic acid permethrin hydrocarbon petroleum phenothrin phenylethyl propionate picloram butoxide piperonyl polybutenes potassium salts of fatty acids prodiamine propoxur pyrethrin oil petroleum refined s-bioallethrin sethoxydim silica gel sodium chlorate sodium salt of bentazon spinosad sulfuramid thiophanate methyl triadimefon triclopyr trifluralin (z)-9-tricosene zinc chloride BEYOND & HEALTH PESTICIDES CARE WITHOUT HARM bendiocarb bifenthrin borax boric acid brodifacoum bromadiolone bromethalin calcium polysulfide carbaryl chlorophacinone-liphadione chlorpyrifos cholecalciferol clopyralid cyfluthrin cypermethrin deltamethrin diazinon dicamba dichlobenil diphacinone disodium octaborate tetrahydrate d-trans allethrin esfenvalerate eugenol fipronil glyphosate halosulfuron-methyl hydramethylnon hydroprene imidacloprid isoxaben lambda-cyhalothrin malathion mancozeb mecoprop mefenoxam metaldehyde methomyl methoprene metolachlor MSMA (monosodium acid methane arsonate) muscalure Healthy Hospitals 52 Controlling Pests Without Harmful Pesticides 2 Extension Toxicology Network. 1996. 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