Hospital pesticide use still widespread
April 1, 1996 6 minutes read
Hospital pesticide use still widespread
Alternative programs prove effective
Is your hospital still using chemical sprays, powders, and potions to fight pests? If so, you may be subjecting your staff and patients to unnecessary risks.
A recent survey of hospitals throughout New York by the state attorney general's office in Albany found that a large number of health care facilities still use pesticides. Less than 2% of the hospitals participating in the study are pesticide-free, and more than one-third of the hospitals are using pesticides classified as "restricted use" by the Washington, DC-based Environmental Protection Agency.
Pesticide exposure creates a wide range of health risks, which can be heightened in children, the elderly, and the infirm. Even if the application is contained, the report notes that ordinary movement in the hospital spreads the pesticides well beyond the area of application. Moreover, repeated exposure can cause chronic illnesses, including cancer. Long-term exposure also can have permanent effects on the reproductive system.
Not only is the use of pesticides in hospitals a health risk to patients and staff, it also can be a legal risk, risk management experts say. Pesticide exposure can be directly linked to illness in patients and staff, but it also can mask or distort other symptoms and result in possible misdiagnosis of illness.
Risk management experts say the New York attorney general's report reflects hospitals' practices throughout the country and serves as an important reminder for all hospitals to evaluate their pesticide policies. These experts urge risk managers to reduce the use of pesticides in health care facilities and to adopt the least toxic ways of responding to pests or so-called "integrated pest management" programs. (See the related story on specific strategies to include in these kinds of programs, p. 51.)
Key survey results
The New York attorney general surveyed more than 300 hospitals in New York state on their pesticide use. Nearly 200 responded, for a 64% response rate. The hospitals were asked about their pest control policies, including whether pesticides were used, the frequency of their use, and the hospitals' attempts to limit or eliminate their use.
Here are highlights of the survey's findings:
* Pesticides were used most commonly in food preparation and waste disposal areas; public areas like waiting rooms, halls and offices; patient rooms; and treatment areas.
* Nearly 98% of the respondent hospitals used outside contractors for pest control. Of those, 45% delegated selection of the pesticides used in the hospital to the contractor, 28% delegated the decision of the application schedule to the contractor, and 41% delegated the selection of application method.
* When asked whether pesticides were applied routinely or responsively, 85% of the hospitals applied pesticides routinely, whether or not a need existed. The study also noted that while 93% of the hospitals gave prior notice of pesticide applications, only 49% gave written notice. Sixty-seven percent of the hospitals gave less than 48 hours notice, and 36% provided notice 12 or fewer hours prior to the application. Only 24% posted signs in the treated areas.
* Almost all of the hospitals imposed re-entry restrictions after a pesticide application, and the majority of hospitals allowed their outside contractor or the pesticide manufacturer to determine those restrictions.
Few have policies on pesticide use
When asked whether they had policies on the indoor use of pesticides, fewer than half of the hospitals responded affirmatively. Those that did have policies spanned a broad spectrum. The report notes that some hospitals only had contracts with an extermination company, while others had statements of the hospital's intent to control pests by regular use of pesticides. Few policies contained any detailed discussion of the specific nonchemical methods to be used instead of pesticides. (See related story on the specifics your contract should contain, p. 52.)
Due to the continued and widespread use of pesticides in hospitals, the New York attorney general has urged health care facilities to adopt integrated pest management policies that limit or eliminate the use of chemical pesticides. The recommendation is one that risk management experts say is worth following, particularly in light of the recent awareness of other work- related illnesses, including latex sensitivity.
IPM is responsive, not regimented
Integrated pest management (IPM) involves responding to the problem, rather than making routine applications of pesticides to try to prevent a problem, says Leroy Tinnin, director of environmental services for Children's Hospital in Boston. Tinnin has been using IPM strategies for 13 years at Children's Hospital. The hospital now is pesticide-free.
IPM has four parts:
* identifying the pest;
* establishing tolerance for the program;
* developing an understanding of the biology of the pest;
* using the least toxic alternatives if pesticide is necessary.
To achieve this, take these six steps, Tinnin recommends:
1. Meet the pest.
To create a strategy to control pests, you must know what kind you have. IPM is based on the regular inspection of and the accurate identification of the pest and the infested areas.
The first step in implementing an IPM policy is to trap and study the pests, Tinnin says. He lays bait in the hospital in order to trap the pests.
Start with targeted areas
"Once the identification process has been determined, then you can design your program to target areas like where they are breeding and where they are entering the hospital," he says.
Because Boston Children's Hospital is affiliated with Harvard University, also in the Boston area, Tinnin works with the university's laboratories to study the trapped pests. He says by seeing what the pests eat, you may be able to determine where they breed.
2. Be aware of all possible sources.
For IPM strategies to work, the hospital must be aware of all potential sources of pests. While most hospitals exterminate or try to control pests in areas like kitchens, hallways, and patient rooms, other obvious sources often are overlooked, Tinnin says. These include shipping- and-receiving rooms and warehouses. Pests can enter the hospital in boxes and bags and he recommends monitoring and controlling these areas, as well.
3. Get used to a bug or two.
IPM requires a definition of intolerable levels of infestation for each area to be managed. Meeting this goal requires patient and staff tolerance.
"One of the things about spraying is that the smell is something that people recognize and realize that you are trying to correct the problem. With IPM, people think you are not doing anything," Tinnin says.
IPM responds to current infestations with short-term solutions, including mechanical, physical, and biological controls. Chemical poisons are used only as a last resort.
Teach staff about IPM
Because IPM strategies are largely responsive instead of prophylactic, educating staff about the goals and techniques used in IPM is crucial to the success of the program, Tinnin says. The education must include the notion that an occasional bug or rodent may be seen crawling around the hospital.
"Some of the measures that you take require the tolerance of patients and staff," he explains. "When you spray, a lot of times you get instant results. When you bait and trap, a lot of times pests come to your treatment and take it back to their nests."
Creating such an environment is a goal of IPM, because the pests unwittingly are putting controls on themselves when they return to their nests.
4. Take proactive measures.
IPM seeks to reduce or eliminate infestation through long-term engineering, maintenance, and sanitation methods, with accompanying educational programs. For example, when Children's Hospital does any construction or renovation, Tinnin uses the opportunity to treat the walls with boric acid and to seal walls to create a barrier for some types of pests.
5. Track and trend.
Tinnin requires quarterly updates from his environmental technicians in order to evaluate the success of the hospital's pest management programs. The reports should include inspection results, which evaluate infestations, the existing conditions that promote them, steps taken to control the infestation, and the results.
If pesticides are used, records should be kept of the name of each product, its chemical components, the amount used and the location of application.
Labels and material safety data sheets for all pesticides must be kept and filed with one individual responsible for safety.
In addition to periodic reports, Tinnin does an annual review of the hospital's IPM program, which helps him target any trends identified in the reports.
Tracking and trending also is useful for understanding the source of problems. Many pest trends are caused by activities in the environment surrounding the hospital, such as construction, he says. By monitoring the progress of the program, Tinnen can respond more effectively to pest problems.
6. Recognize that outside contractors can design a program.
Even if your pest control programs are managed by an outside contractor, you still can implement an IPM program. Tinnin says IPM strategies have been employed by vendors for many years throughout the country. He says the cost of implementing such a program should be comparable to a periodic application program. *
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