The American Heritage Dictionary defines “pest” as, “An annoying person or thing, a nuisance,” and also as, “An injurious plant or animal, especially one harmful to humans.” This column will focus on the latter. I’m afraid I can’t help much with the pest that pokes his head into your office ten times a day, or the one that sends you junk mail! But I can certainly help with the critters.

There’s something about insects that brings out the girly-girl in a lot of us. And even the most macho of medical men isn’t too thrilled with finding cockroaches, ants, flies or other buzzing, creeping, scuttling, squirming things in his place of work. Pests spread infection, lay eggs and increase in number over a short period of time. A fly in the soup may be bad enough, but a fly in the treatment room? That’s definitely not going to put patients at ease.

When we see a bug, many of us immediately call pest control or grab the bug spray. That’s a short-term, short-sighted solution. It might kill that particular pest, but how do we prevent its hundreds of siblings from visiting the next day? More importantly, we have to consider the impact of pesticides on ourselves, our patients, and our staff. Instead of treatment, let’s think about pest prevention.

Chemical pesticides have been used in the U.S. since the 1950s. According to the New York State Attorney General’s Office, there are about 25,000 pesticide products containing 600 different active ingredients in common use. But, just because something is useful and effective doesn’t mean it’s the right choice.

Effects of pesticide exposure include nausea, vomiting, headaches, rashes, dizziness, aching joints, flu-like symptoms and asthma. Long-term effects include increased risk of cancer, birth defects, genetic damage, neurological problems and chemical sensitivities. Most vulnerable are pregnant women, infants, children, the elderly and those with compromised immune systems. Before you reach for the Raid or call an exterminator, consider how many of your patients fall into one or more of these categories.

Integrated Pest Management (IPM) is about creating long-term programs to inspect, prevent, monitor and educate to reduce the need for pesticides. Here are my Top Ten steps for implementing an Integrated Pest Management Program:

1. Stop Using Pesticides Without Any Sign of Pests: Periodic spraying or placing of poison with no evidence of pests is unnecessary. Stop! As in your clinical practice, don’t over-treat!
2. Keep Pests Out: Seal any openings to the outside to prevent pests from entering. Repair broken equipment, seal cracks or holes in barriers, make sure waste containers are impenetrable, and shut those windows!
3. Clean Up! Remind staff to clean up after themselves, to wipe off counter surfaces, put food away in a designated food refrigerator (not in the medication fridge puleez!) and store food in closed containers. Cover waste receptacles and wipe down work surfaces. Inspect trash receptacles, transport containers and storage bins and ensure that reusable containers are washed and rinsed regularly. Eliminate moisture, where possible. Vacuuming is the best method for removing insect eggs and small particles of food that attract pests.
4. Create and Maintain a Log Book: Walk through pest-friendly areas, including food service areas, kitchens, bathrooms, waste storage areas, supply storage area (especially with corrugated boxes) and areas with built-up water. Take note any time there is pest problem, where it occurred, and if there was a reason (i.e., open window, food left out, garbage not covered).
5. Learn from Past Pest Experiences: Frequent monitoring will help you determine problem areas. Once identified, inspect them regularly.
6. Respond: If you are in a large group practice or hospital setting, designate an IPM Coordinator so any abundance of pests can be reported, logged and handled quickly. Establish a threshold level of response. Seeing one ant, for example, does not warrant an exterminator. If the problem is minor, use nontoxic methods such as fly paper and mechanical traps. Use non-pesticide methods whenever possible. Only use pesticides as a last resort.
7. Notify Staff of Pesticide Use: Should a pesticide be required, use the least toxic option to get the job done. Notify all staff in the area, log information into your IPM book, and post material safety data sheets.
8. Educate: Inform staff of the importance of cleanliness, and limiting pest access to the clinic. Talk to housekeeping, maintenance, building management and all health care staff about the program, and help employees understand the goal of providing a healthy work environment.
9. Create a Policy: Write up your IPM methodology, share with staff and file with other policies. Post information and educate others at staff meetings.
10. Seek Help if Necessary: Contact an Integrated Pest Management Vendor to guide your practice.

Last summer, Hospitals for a Healthy Environment hosted a teleconference on Integrated Pest Management. The speakers were Dr. Ann McCampbell, of the Health Care Without Harm Campaign (www.noharm.org) and Peter Castronovo, Senior Sanitarian for University of Rochester Strong Memorial Hospital, whose informative presentations were the sources for much of this article. Download their talks at www.h2e-online.org/events/teleconf/index.cfm. Please consider joining the Hospitals for a Healthy Environment Program—it’s free, and we offer a wealth of information on environmentally responsible health care. Register online at www.h2e-online.org.

Other valuable resources related to the topic of pest management and pesticides include: www.beyondpesticides.org—”Controlling Pests without Harmful Pesticides” by Kagan Owens. Also at this site is a Directory of Least Toxic Service Providers that practice Integrated Pest Management. www.NPIC.orst.edu—National Pesticides Information Center—Pest Elimination Guides and Information for a variety of pests including mosquitoes, flies, cockroaches, lice, fleas, termites and guidance in selecting a pest control firm. 1-800-858-7378 for the EPA-sponsored NPIC.

Janet Brown is the Partner Coordinator for Hospitals for a Healthy Environment Program, New York, New York. Their goals are to reduce the toxicity and volume of health care waste and to eliminate mercury from health care practice. Learn more about the organization at: www.h2e-online.org.