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KAISER PERMANENTE
INTEGRATED PEST MANAGEMENT PROGRAM
1.0 POLICY
1.1
The Precautionary Principle states that:
When an activity raises threats of harm to the environment or human health, precautionary
measures should be taken even if some cause and effect relationships are not full established
scientifically. (From definition created at the Wingspread Conference on the Precautionary
Principle, January, 1998.)
1.2
Kaiser Permanente recognizes that the use of pesticides may be potentially hazardous to human
health and the health of the environment. In keeping with the Precautionary Principle and to
reduce or eliminate the threat of human or environmental harm caused by pesticides, Kaiser
Permanente is adopting and implementing Integrated Pest Management (IPM), which focuses on
prevention of pests both inside and outside hospitals. If corrective action becomes necessary, the
least toxic and non-pesticide practices and products are given preference with appropriate
notification.
1.3
The main components of Kaiser Permanente’s IPM program are as follows:
1.3.1
Prevention. Non-chemical prevention is the primary means of pest management in the
IPM program. Proper sanitation and housekeeping, pest-proofing waste disposal, and
structural maintenance are key ingredients. Reduce or eliminate pests’ sources of food,
water and shelter.
1.3.2 Monitoring. IPM requires regular site inspections and trapping to determine the types
and infestation levels of pests at each site and monitoring to provide accurate, timely
information on pest activity – to establish whether there is in fact a pest problem and to
identify its causes. Implementing a schedule and a plan for monitoring pest populations
ensures the success of pest control efforts. The best way to monitor for many pests, like
cockroaches, is with sticky traps.
1.3.3 Determining Action Levels. An action level is the population size that requires remedial
action for human or environmental health reasons.
1.3.4 Record-Keeping. A record-keeping system is essential to establish trends and patterns in
pest outbreaks. Information recorded at every inspection or treatment should include pest
identification, population size, distribution, recommendations for future prevention, and
complete information on the treatment action. Regular evaluation of the program will
help determine acceptable pest population levels, effective reduction measures, and
breach of the action threshold.
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Preference for least-toxic approaches. Improved sanitation and structural repair,
physical and mechanical controls such as screens, traps and weeders should be used first
to control a pest outbreak. Choose the least toxic chemical control strategy only when a
mix of other strategies is shown to be inadequate.
Least-toxic materials to consider include: boric acid and disodium octobrate
tetrahydrate; silica gels; diatomaceous earth; nonvolatile insect and rodent baits in tamper
resistant containers or for crack and crevice treatment only; microbe-based insecticides;
botanical insecticides that do not contain synthetic pyrethroids or toxic synergists;
biological, living control agents, such as parasites and predators; soap based products; use
of liquid nitrogen for cold treatments; and exempt natural pesticides listed under section
25(b) of the Federal Insecticide, Fungicide and Rodenticide Act
[www.epa.gov/pesticides/biopesticides/otherdocs/25blist.htm.htm], like corn gluten meal.
It is critical to weigh the risks associated with the use of a pesticide against the problems
caused by the pest. Options must be considered carefully, keeping in mind that a
chemical solution may have short term or long term health and environmental risks.
1.3.6
Prohibition of the most toxic products and practices, as follows:
a)Pesticides classified as acute toxicity Category I and II by the U.S. EPA;
b)Pesticides linked to cancer - U.S. EPA Class A, B, C carcinogens
(www.epa.gov/pesticides/carlist/index.html) and chemicals known to the state of
California to cause cancer under Proposition 65
(http://www.oehha.org/prop65/prop65_list/Newlist.html);
c) Pesticides that interfere with human hormones, cause birth defects, reproductive or
developmental harm - i.e. those identified as reproductive or developmental toxins
(www.pesticideinfo.org) or chemicals known to California to be reproductive toxins
under Proposition 65 (http://www.oehha.org/prop65/prop65_list/Newlist.html);
d) Pesticides in the carbamate (carbaryl, bendiocarb, etc.), organophosphate (diazinon,
acephate, etc.) or pyrethroid (cyfluthrin, permethrin, etc.) chemical family or phenoxy
herbicides (2,4-D, mecoprop, etc.);
e) Pesticide products that contain inert ingredients categorized by the U.S. EPA as "List
1: Inerts of Toxicological Concern" (dioctyl phthalate, formaldehyde, hydroquinone,
isophorone, nonylphenol, phenol, and rhodamine B);
f) Pesticides applied by fogging, bombs, or tenting or by space, broadcast or baseboard
sprays;
g) Pest management decisions based on aesthetics alone;
h) Application of pesticides on a routine basis, regardless of the presence of pests;
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i) Application of pesticides while the area is occupied or may become occupied during
the 24 hours following the application.
1.3.7
Providing notice if pesticide application becomes necessary.
With the exception of clear emergencies, hospitals should provide notification to staff
and patients at least 72 hours in advance of a pesticide application. Notification may
contain the following information: time/date of application; application site, name of
pesticide product and active ingredient; and phone number of IPM Coordinator or other
person to contact for additional information.
2.0
1.4
The person responsible for the IPM program (IPM Coordinator) may allow trained staff or the
pest control contractor to apply a pesticide listed in 1.3.6(a)-(e) or administer a product by
spraying if the Coordinator determines that a pest poses a threat to human health and other least
toxic alternatives have been considered but determined to be ineffective. This exemption from
prohibition shall be granted on a case-by-case basis only and shall apply to a specific pest
problem for a limited time.
1.5
IPM Communication. IPM personnel will meet as needed to communicate any discrepancies/
deficiencies identified by the pest control provider, address all discrepancies/deficiencies noted
in written reports in a timely manner. This committee will be chaired by the IPM Coordinator
and will enlist the support of Facilities Management, Housekeeping, Nurse personnel and other
appropriate departments. Quality assurance, request for exemptions, etc. will be agenda items to
be discussed during IPM meetings. The IPM personnel will work closely with the Pest Control
contractor or provider, if any, in support of an aggressive and effective Integrated Pest
Management Program throughout Kaiser Permanente indoor and outdoor property. Request for
corrective actions will be forwarded to the appropriate support service/department for
expeditious corrective action.
PERSONNEL RESPONSIBILITIES
Responsibilities are assigned to personnel with Integrated Pest Management responsibilities.
2.1
Integrated Pest Management (IPM) Coordinators
An IPM Coordinator will be designated for each Kaiser Permanente facility or site and shall be
responsible for development and oversight of the IPM program as follows:
2.1.1 Act as the facility contact person when pest problems arise
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2.1.2
Receive annual IPM training.
2.1.3
Disseminate information to Kaiser Permanente staff, patients, and the community
regarding Kaiser Permanente’s IPM policy and least toxic approach to pest control.
2.1.4
Every six months, facilitate IPM training for all environmental services/housekeeping
and facilities staff and any other staff who are involved in pest control at a Kaiser
Permanente site. Facilitate training for all other staff at least once/year.
2.1.5
Meet with pest control service providers to discuss the expectations of the program for
communication, application, monitoring and appropriate documentation.
2.1.6
Enlist the support of facilities management personnel for timely repairs, pest exclusion
projects, etc.
2.1.7
Maintain an Approved Pesticides list* along with their labels and MSDS. These
documents will be made available for review by staff, employee representative or the
public. (*List to be created, identified or adopted by appropriate staff.)
2.1.8
Be responsible for ensuring that the pest control contractor reports all pesticide use as
required by law to the Department of the Agriculture Commissioner Office.
2.1.9
It is the responsibility of IPM Coordinator/Designee to make timely arrangements of
appointments for any applications and for timely notification to staff and patients of
pesticide application in compliance with sec. 1.3.7, and of the level or extent of
evacuation if needed.
2.1.10 Ensure that all indoor and outdoor pesticide notification signs are posted at each site in
appropriate and visible locations.
2.1.11 Review inspection and Quality Assurance forms submitted by the pest control service
provider.
2.1.12 Work with appropriate personnel to select the Pest Control Contractor.
2.1.13 Review and/or revise the IPM plan at least every two years.
2.1.14 Consult with the IPM committee when considering any emergency application.
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2.1.15 Maintain a site-specific notebook in a central location that will contain copies of all
quality assurance forms or service record forms submitted by the pest control contractor
at each visit. The notebook will also contain a pest sighting log and reporting forms that
all appropriate personnel will be trained on filling out. The Pest Sighting Log shall be
made available to the pest control contractor at each visit.
2.1.16 Maintain direct contact with the pest control service provider and communicate any
discrepancies/deficiencies identified by the pest control provider to the appropriate
support services department to ensure appropriate follow-up.
2.2
Pest Control Provider
Pest Control Providers, both structural and landscape, are selected to safely and appropriately
implement the Kaiser Permanente IPM Policy. As a condition of hire, they must demonstrate
sufficient knowledge and experience with the least toxic IPM approach to pest management.
They are responsible for the following:
2.4
2.2.1
Adhere to the requirements of Kaiser Permanente’s IPM Policy. The contractor shall
notify the IPM Coordinator immediately if any part of the pest management program is
out of compliance with the IPM Policy.
2.2.2
Work directly with facility IPM Coordinator or his/her Designee to ensure an effective
IPM program is implemented at the site.
2.2.3
Communicate any discrepancies/deficiencies noted during site visits; this information
must be provided in writing.
2.2.4
Submit documentation of pesticide usage as required to the Department of Agriculture
Commissioner. IPM coordinators may request a copy for site usage records.
2.2.5
Make recommendations regarding prevention and remediation in keeping with IPM’s
preference for least toxic methods.
Facility Support Services (Plant Services, Building and Grounds, Environmental
Services/Housekeeping)
Support Services and Department Head personnel shall report pest sightings, address and
complete request for repairs and pest exclusion projects in a timely manner.
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EDUCATION, TRAINING AND COMMUNICATION
3.1
Education and Training
3.1.1
In addition to good structural maintenance, IPM is a preventive approach to pest
management that requires knowledge on the part of staff whose responsibilities include
pest management, as well as other staff not directly involved in pest control services or
practices.
3.1.2
At least one time per year, all staff shall receive information and education regarding
IPM at Kaiser Permanente facilities. At the inception of this policy and at the time of
employment, every staff person shall receive a fact sheet regarding IPM and the part that
each staff person plays in its successful implementation.
a) Pests are found in areas where they're getting something they need such as food,
moisture, or shelter.
b) The less of these things they can find, the fewer pests there will be.
c) Good sanitation (i.e. eliminating food and other pest attracters) must be observed
throughout the medical facilities.
3.1.3
4.0
Site staff will receive regular Kaiser Permanente IPM educational updates, notices of
revision, etc.
PEST SIGHTING, REPORTING, AND MONITORING
4.1 General practices for pest reporting are:
a) Every staff is responsible for reporting pest(s) sightings on the hospital
premises to his or her immediate Supervisor.
b) Supervisors and/or Managers will complete "Pest Sighting and Request for
Service Form” and forward it to the IPM Coordinator.
c) The IPM Coordinator will log the Sighting Form into the Pest Sightings &
Request for Service Log.
d) Upon the Pest Control Contractor visit to Kaiser Permanente locations (three
times a week (3x/wk)), Pest control contractor technician reviews
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sightings/request log, investigates, treats and make technical
recommendations as needed. (In writing and orally to IPM Coordinator).
e) It is the responsibility of the IPM Coordinator to contact the Pest Control
Contractor for scheduling of Pest Control Services.
4.2 Information regarding initial sightings of pests include size; number, time and frequency, and are
recorded onto a Pesticide Sighting and Request for Service Form. Housekeeping, Department
Heads and Supervisors submit these Forms to the IPM Coordinator.
4.3 The IPM Coordinator enters the information from Sighting Form into a facility log maintained by
the IPM coordinator, site manager or designee.
4.4 The Pest Control contractor will review log upon each visit to the facility.
4.5 Monitoring devices such as bait stations, sticky traps, snap traps, metal boxes, glue boards, will be
placed as needed in critical areas such as break rooms, rest rooms, nursing unit kitchens, resident
drawers, janitors closets etc.
4.6 The pest control contractor will keep the facility IPM Coordinator informed of all pest monitoring
data and provide written documentation and recommendations for abatement.
5.0
PEST MANAGEMENT OPTIONS -- Indoors
5.1
Pests
Pests inside structures commonly include German cockroaches, ants and rodents (mice and rats).
5.2
Pest Biology and Habitat
Pests will invade buildings when there is opportunity for food, water and shelter. This
opportunity can be seasonal or may be triggered by the conditions and use of the building. The
IPM coordinator in consultation with the Pest Control contractor will evaluate the pest problem
to determine the course of action, including additional monitoring.
There are a variety of options for using least toxic chemical and non-chemical measures to
reduce or eliminate pest populations at Kaiser Permanente (See 1.3.5 above re least toxic
approaches). Dependent upon the level of pest infestation, the IPM coordinator, site
manager/designee along with pest control provider will identify and prioritize such measures for
implementation of pest remediation and education of staff.
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If a pesticide is used at a facility, inside or outside, every effort is made to optimize the
chemical's effectiveness, so that less can be applied. Pesticides shall be carefully chosen and
applied according to label instructions
5.1
German Roaches
5.1.1
Sanitation: There should be no food residue in and around coffee machines, microwaves,
refrigerators, trash cans, lids on trash cans, desks, cabinets and patient beds and drawers.
5.1.2
Caulking: Pest control service provider will seal cracks and crevices on floors, behind
walls and front baseboards where cockroaches gain entrance to nest.
5.1.3
Vacuuming and Washing: Pest control service provider will vacuum cracks and
crevices areas with a HEPA filter vacuum before treating with bait, and will wash
surfaces with soap and water.
5.1.4
Sticky Traps and Monitoring Devices: Pest control provider will place traps in
locations where roaches were sighted. Inside traps will be observed by Environmental
Service personnel and departmental/unit staff for early detection to guide control efforts.
5.1.5
Baiting and Crack/Crevice Treatment: Apply baits indoors such as gels, paste and
flowable dust. Sources of competing foods should be cleaned up and enough bait stations
should be positioned close to the sources of infestation. Avoid any use of residual
pesticide spray that would contaminate bait. The pest control provider will use baits
listed on the Approved Pesticides List or submit an exemption request to the IPM
Coordinator for use of products not listed.
5.1.6
Indoor Spraying: Spray treatment will be the "last resort" pest control remediation only
after the safer alternative methods have proven ineffective and only in an emergency
situation where human health is at risk. The IPM Coordinator must approve any spraying
after consulting with the IPM Committee and the pest control contractor. The
Coordinator is responsible for ensuring proper notification and posting. (See sec. 1.3.7.)
It will be followed up with the application of sticky traps to evaluate the effectiveness of
the treatment.
Treatment materials used by the pest control contractor shall be from the Approved
Pesticides List. Proper notification and posting before and after treatment and reentry
times will be strictly enforced.
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Argentine Ants
5.2.1
Sealing Entry Points: Pest control service provider contractor inspects and identifies
nesting areas. Also check wall voids and planters for nesting ants. Seal cracks around
windows, foundation, and exterior walls.
5.2.2
Sanitation: Staff are educated and trained in the importance of the elimination of all
food residues in and around coffee machines, microwaves, refrigerators, trashcans, etc.
5.2.3
Vegetation Management: Gardeners will ensure the cutting back of trees, shrubs and
ground cover away from the building sides, roofs and walls to break up the passageways
for the ants to enter the building.
5.2.4
Baits: The pest control service provider will use baits from the Approved List of
Pesticides. The contractor's careful inspection and placement of baits close to the source
are needed for control.
5.2.5
Spraying: Spray treatment will be the "last resort" of pest control only after the safer
alternative methods have proven ineffective. The IPM Coordinator in consultation with
the IPM Committee must approve all spray applications and must approve use of
pesticides prohibited under sec. 1.3.5 above . It will be followed up with the application
of sticky traps to evaluate the effectiveness of the treatment
Treatment materials used by the pest control contractor shall be from the Least Toxic
List. Proper notification and posting before and after treatment and reentry times will be
strictly enforced
5.3
Mice
5.3.1
Sealing Entry Points: Seal or block utility entry points using caulk, wire mesh, steel
wool or aerosol foam.
5.3.2
Cleaning and Housekeeping: All food and trash should be stored in closed containers.
Food residual should be removed and piled materials should be completely eliminated.
5.3.3
Trapping: The pest control provider uses glue boards, snap traps and metal multiple
catch traps. In kitchens, Ketch-Alls traps are used because conventional traps are not
applicable.
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Rodenticides: Inside placement rodenticides should be at a minimum to prevent odor
problems from dying mice. Bait must be placed in inaccessible locations away from
people and pets and in tamper-proof bait stations.
Rats
5.4.1
Sealing Entry Points: Seal or block utility entry points using caulk, wire mesh, steel
wool or aerosol foam.
5.4.2
Cleaning and Housekeeping: All food and trash should be stored in closed containers.
Food residual should be removed and piled materials should be completely eliminated.
5.4.3
Trapping. The pest control provider uses snap traps and metal multiple catch traps. In
kitchens, Ketch-Alls traps are used because conventional traps are not applicable.
5.4.4
Rodenticides: The pest control service provider will use bait in preference to seed,
pelletized, tracking powder and extruded bait blocks. Inside placement rodenticides
should be at a minimum to prevent odor problems from dying rats. The baits can be
placed throughout outside areas in tamper proof bait stations where constant influx of rats
were previously observed. Bait must be placed in inaccessible locations away from
people and pets and in tamper-proof bait stations.
5.4.4
Action or treatment
The remedial actions or treatment are dependent upon the frequency of pest sightings, the
number of pests trapped and/or the over infestation. Kaiser Permanente takes a zero
tolerance outlook upon pest infestation, especially in patient care environments.
6.0
PEST MANAGEMENT --outdoors
Kaiser Permanente properties (owned, leased, and rented) include grass, trees, shrubs, trails and ground
covers. Gardeners and groundskeepers employ non-chemical and least toxic measures to maintain the
integrity of grass, plants, and shrubs.
Trapping is the preferred method of gopher and mole management. If baiting must occur, only baits
listed on the approved pesticide list shall be used.
6.1
Pests. The target pests in general are weeds. The specific types of weeds being controlled are:
wild mustard, bermuda grass, dandelion, oxalis, wild berries and other perennials.
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6.2
Pest Biology and Habitat. Grassy weeds and other perennials in landscaping tend to proliferate
after conditions of hot weather followed by a rain. Over-watering and under-watering practices
can lead to a variety of specific weed population problems. Low fertility in lawn areas can also
lead to significant proliferation of weeds.
6.3
Pest Monitoring. Informal monitoring and scouting of weeds is conducted occasionally. It is
preferably done a few days after a rainy or stormy weather on the turf. Low maintenance trees
and shrubs are monitored regularly.
6.4
Action or Treatment. Gardeners, groundskeepers weed heavy growth around shrub areas as an
immediate treatment. Preferred treatment includes combinations of hand weeding, mulching,
pruning-thinning.
6.5
Pest Management Options
Pest of established grass/turf and shrub areas are maintained by using preventive and nonpesticidal approach as follows:
(a)
Mulching - wood chip mulching underneath trees and shrubbery area. This reduces the
need for herbicide treatment.
(b)
Controlled Watering - Elimination of irrigation and hose watering of bushes, shrubs and
trees. This reduces germination of weeds.
(c)
Organic Compost application - Increased application of yard waste compost as soil
amendment, fertilizer acts as a weed proliferation suppressant on grass/turf areas.
(d)
Fertilizer Application - When applying fertilizer, the program is to apply light and
frequent applications that stimulate microbial activity, but not excessive top growth.
(e)
Pruning and Thinning - Proper pruning and thinning of trees and shrubs ensures better air
movement and solar radiation.
(f)
Green Flaming - Green flaming requires a short exposure of growing weeds to an intense
propane flame at the curb and sidewalk cracks. Green plants are not set on fire using this
technique. The heat appears to boil the water inside weed cells causing the cell wall to
burst, wilt, decline, and die. This method will reduce significantly the use of chemical
herbicides.
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7.0 Notification and Posting
7.1
7.2
The purpose of the Kaiser Permanente IPM notification policy is to:
7.1.1
Maintain a safe and healthful environment for staff, patients and visitors when
pesticides are used;
7.1.2
Give clear guidelines for requesting and notification of pest control services at
Kaiser Permanente sites;
7.1.3
Provide information by providing written notification and posting notification
signs on Kaiser Permanente property. (see sec.1.3.5)
Posting Notification
7.2.1
In the case of any indoor or outdoor application of pesticides, there should be
notification and posting at the area where applied:
Posted signs may contain:
(1) Name and active ingredient of the pesticide product,
(2) Date and time of pesticide use,
(3) Location of application,
(4) Name and contact number of the IPM Coordinator and/or Site
Manager/Designee or whom to contact for information,
7.2.2
Kaiser Permanente sites that use pesticides shall:

Post only authorized standardized signage that is easily recognized by the
public, workers, and patients.

Post signage at least three (3) days before pesticide application and remain
posted for at least three (3) days after application.

A pesticide may be applied without providing a three-day advance notification
only in the event of a demonstrable public health or worker safety emergency
and only after least and less toxic methods have been considered and
determined to be ineffective. Signage must be posted as soon as possible and
shall remain posted for three (3) days following the application.
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APPENDIX A
List of Integrated Pest Management Personnel by Location
IPM Program Coordinators
Kaiser Permanente Medical Centers
Name and phone number:
Integrated Pest Management Coordinator:
Site Managers:
Environmental Services (EVS)
Food and Nutritional Services
Gardening and Landscape
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