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Pest Management in New York State Hospitals of 36

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Attorney General of New York State December 1995

Preface

Chemical pesticides have been used in the United States since the 1950's. When effectively applied, pesticides can kill and control pests including insects, fungi, bacteria and rodents. In hospitals, chemical pest control has helped to contain the smead of infection and has reduced infestations with vermin. -.-

On the negative side, pesticides have harmful side effects. Many pesticides are known or suspected to be toxic to humans. 'They can cause neurologic damage, delayed development, cancer, reproductive dysfunction, and possibly impairment of the immune and endocrine systems. Concern about these effects was first expressed in the early 1960's and now has become widespread as knowledge has grown of the toxicity of pesticides.

This balanced report from the Office of the Attorney General examines patterns of pesticide use in hospitals across the State of New York. The report recognizes the benefits that pesticides have brought to hospitals, but also it understands their potential for harm. The major finding is that pesticides are used widely in New York's hospitals. More than 30 different pesticide preparations are currently applied in hospitals across the state. They are used as fogs, sprays and powders. They are applied in virtually all areas of hospitals, including areas that contain patients. Very interestingly, the report finds that several hospitals in New York use only the least toxic pesticides. And three hospitals use no pesticides at all.

The principal recommendation of this report is that all hospitals in New York should adopt the least toxic pest management policies and practices. This is an eminently sensible finding. It transcends partisan politics. It prescribes a highly reasonable course of action that every physician and hospital administrator across the state should follow. Indeed, this recommendation deserves to be heeded widely not only in New York but across the United States. Adherence to this recommendation will reduce pesticide exposures to patients and to hospital staffers and thus protect health. Additionally, adoption of this recommendation will save money. Pesticides are not cheap. Any approaches that sensibly reduce their use will help to contain hospital costs.

The Attorney General's Office strongly recommends that hospitals adopt i

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integrated pest management (IPM) programs. IPM is a systematic and sensible approach to pest control. It takes advantage of all the available options--non- chemical as well as chemical. The essence of IPM is an orderly decision-making process that reviews all pesticide use and then determines how to reduce that use. Wherever possible non-chemical approaches are employed. Several hospitals in New York and 10 major teaching hospitals in Boston have already adopted this approach and report great success with it.

In summary, this is a landmark report. It deserves wide and careful attention. Its findings and recommendations will benefit the health of all New Yorkers.

Philip J. Landrigan, M . D . , M.Sc.

(Dr. Landrigan is Chairman and Professor in the Department of Community Medicine of the Mount Sinai School of Medicine in New York City. He was Chair of the committee of national experts, convened by the National Academy of Sciences, which prepared the landmark report "Pesticides in the Diets of Infants and Children." He is also co-author of "Raising Children Toxic Free" published in 1994.)

Contents 0 Preface

Introduction 0 Survey Methods

Results Discussion and Recommendations Hints for Hospitals Appendices

o Survey Questionnaire o Hospitals Surveyed o Summary of Survey Responses

Introduction A pesticide is "any substance or mixture of substances intended for preventing, destroying, or mitigating any pest...."' Over the last several decades, pesticide use has increased dramatically. As of 1991, Americans were using approximately one billion pounds of pesticides a yea?, twice what was used in 1964. Today, approximately 25,000 pesticide products, containing more than

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600 different active ingredients, are on the market in the United States.

An increasing body of scientific data on the potentially harmful effects of pesticide exposure on people and the environment raises environmental and public health concerns about the broad use of these toxic substances. According to the United States Environmental Protection Agency, "all pesticides are toxic to some degree, this means they can pose a risk to you, to your children and pet^..."^ As concerned citizens, we should evaluate the benefits pesticides bring to our lives and make reasoned choices about when, where and if pesticides should be used.

Hospitals, with their lutchens and cafeterias, patient rooms, public areas and offices, are regularly treated with a variety of pesticides. People may be exposed to these pesticides without the opportunity to take precautions to avoid unwanted exposure. Pesticide use in hospitals may be of particular concern because exposure to pesticides is potentially more dangerous for children, the elderly and the infirm.

Children, because of their physiology, are more sensitive than adults to many toxic chemicals, including pesticides. Some toxins will damage children's . growing and developing tissues more readily than fully established adult tissues4 Children eat more food, breathe more air, and drink more water per pound of body weight than adults; thus their exposure to and absorption of many toxic substances per pound of body weight is highe$,6. Further, "children taking medication may be at increased risk from pesticide exp~sure" .~ The elderly may have heightened sensitivity to pesticides as a result of the natural decline of various body systems which occurs with age. Patients of all ages may also be less resistent to the toxic effects of pesticides due to pre-existing disease, and the toxicity of pesticides may complicate illnesses. Pesticide exposure may cause symptoms which are not unique, such as headache, nausea, diarrhea, tingling sensations, numbness and respiratory distress. These symptoms may interfere with the diagnosis of a patient's primary illness. Conversely, symptoms of acute pesticide toxicity may be misinterpreted due to their similarity to the symptoms of pre-existing illness.

Throughout New York State, and across the nation, individuals, organizations, schools and governmental entities are adopting Integrated Pest Management (IPM) as a means of reducing or even eliminating the use of toxic chemical pesticides. IPM strategies involve careful identification of the pest, establishment of levels of tolerance and an understanding of the biology of the pest so that a variety of physical, mechanical and biological means can be employed in controlling the pest. If it is necessary to resort to chemical controls, the least toxic alternative is selected. Choosing non-chemical alternatives constitutes a form of prudent avoidance of both the known and unknown risks of exposure to pesticides. IPM has already proven effective and economical in many different settings: homes, gardens, schools, government facilities and even in hospitals. The United States General Services Administration has established a successful program for 30 million square feet of government office space in

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Washington D.C. The NYS Office of General Services has banned pesticide spraying in its more than forty office buildings and other facilities. Local governments from Nassau to Erie counties are acting as well.

The Attorney General's office hopes that this report will provide a stimulus for hospitals and hospital associations to implement IPM programs at hospitals statewide. We wish to thank all the hospital administrators and staff who took the time to compile the information we requested and used in this report.

Survey Methods

In May, 1994 questionnaires were sent to all 296 hospitals listed under "New York" in the American Hospital Association's 1993 "Guide to the Health Care Field". We requested information on each hospital's pesticide use practices and policies, and pesticide use data for the most recent twelve month period for which such data was available. Given the need for hospitals to maintain the highest sanitary standards and to disinfect special areas (eg. operating rooms), we specifically excluded those pesticides found in cleaning agents and other disinfectants from the survey. We did not inquire about pesticide use on the hospital grounds. A copy of the Questionnaire is included as Appendix 1.

A list of the hospitals we contacted, by county, is included as Appendix 2, with all responding hospitals identified. We appreciate the cooperation of these institutions and the time and effort devoted by the individuals who completed the questionnaires.

Results

Response Rate:

One hundred and ninety-two questionnaires were returned in time to be included in our analysis. (Because some hospitals we contacted had more than one independent operating unit, some of which responded independently, we actually reached 302 hospitals.) This represents a response rate of 64% of the hospitals contacted. The responses were almost equally divided between public and private hospitals. About two-thirds of the respondent hospitals offered a wide range of general services; half of the remainder were psychiatric institutions and the rest offered a variety of limited services. One hundred forty- seven had intensive care units, 124 had pediatric facilities and 96 had nursery facilities. Respondent hospitals had as few as 15 beds and as many as 1478 beds. Of the 188 respondents who characterized their location, 83 described it as urban, 62 as suburban and 43 as rural.

Some hospitals did not respond to every question, and in a few cases the answers were difficult to interpret. In such instances, we generally contacted the hospital and obtained the necessary information or clarification. Nevertheless, the number of useful responses received varies from question to question.

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In analyzing the responses, we compared the responses of public hospitals to those of private hospitals, small hospitals to large hospitals and the responses of urban, suburban, and rural hospitals. (See Appendix 3 for the responses to those questions which can be readily summarized in a quantitative manner.) There were no apparent differences between public and private institutions. Some differences were noted between smaller and larger hospitals (defined by the number of beds reported in the 1993 "AHA Guide to the Health Care Field") and between rural, suburban and urban hospitals. Size and location are often related: 64% of the rural hospitals responding to our survey are also categorized as small hospitals (140 or fewer beds).

Pesticide Use:

Three hospitals reported that they use no pesticides at all. Several others reported using only formulations of boric acid, pyrethrins and pyrethroids. Others rely primarily on such formulations but also use more toxic synthetic organic pesticides.

Pesticides are applied throughout hospital facilities. Although the most common sites reported for pesticide use are food preparation and waste disposal areas, public areas such as waiting rooms, halls and offices, patient rooms and treatment areas are also identified as sites of pesticide use.

Which Pesticides Are Used?

More than 30 different pesticide active ingredients are applied in hospitals in New York State (see Table 1). Of these, more than one third are classified as

Restricted Use Pesticides by EPA, the New York State Department of Environmental Conservation ("DEC") or by both agencies.8 Classification as a Restricted Use Pesticide is generally reserved for those pesticides which are so toxic that restrictions on their sale, use or possession are in the public interest, or present risks of adverse effects on humans or other non-target organisms because they persist in the environment or bioac~umulate.~

Responding hospitals reported using pesticides which are applied in various forms, including fogs, sprays, powders and mixed with baits. Each of these forms of pesticide application can result in human exposure, although the probability of exposure may be reduced with some baited traps, crack and crevice treatments or other methodologies. Nevertheless, exposure may occur at the site of pesticide application or elsewhere as a result of airborne movement, tracking, or routine cleaning activities. Pesticides may persist for days, weeks, months or even years after indoor application.

What Are The Potential Health Effects Of Pesticides Used at Hospitals?

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Pest Management in New York State Hospitals

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TABLE 1. Active Ingredients in Some Pesticide Products Used In Hospitals

Acephate Allethrin Ammonia Fluosilicate Avermectin Bendiocarb

Brodi facoumb

Bromadioloneb

Bromethalinb Carbaryl

Chlorpyrifos'

Cholecalciferolb C yfluthrin C yperme thrin

DDVP (Dichlorvos)b

Diazinona

Diphacinoneb Fenox ycarb Fenvalerate Hydrameth ylnon Hy droprene Methoprene Meth ylcarbamate Orthoboric Acid

Permethrin' .I

The active ingredients in the pesticides used at the responding hospitals may cause acute toxic responses such as headache, nausea, vomiting, skin and respiratory irritation, dizziness, visual disturbances and sensory, motor and behavioral disturbances. Potential chronic toxic effects attributable to exposure to the active ingredients, which may develop years after exposure, include cancer and reproductive effects. Effects attributable to the inert ingredients cannot be evaluated since these constituents are generally not identified on pesticide labels. Nor can the effects of pesticide active andor inert ingredients be adequately evaluated when exposure coincides with the administration of therapeutic drugs, although a variety of pesticide-drug interactions are known. Some such interactions are discussed in the recent National Academy of Sciences report "Pesticides in The Diets of Children."

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Organophosphates Pyrethrins Pyrethroids Boric Acid Hydramethylnon N-methyl carbamates Coumarins

Propetamphosa Propoxur Pyrethrins

Resmethrina

I Silica Gel Sulfuramid - Tetramethrin

Warfarinb

Zinc PhosDhidea3b

a Classified as a Restricted Use Pesticide by EPA.

Classified as a Restricted Use Pesticide by DEC.

Classified as a Restricted Use Pesticide by DEC

for use to control termites.

Review of the product use responses enabled us to rank pesticides according to the frequency with which they were selected for use in the respondent hospitals. Although we did not request data which would allow analysis of pesticide use by weight or volume, when ranked by chemical class, the organophosphates (eg. chlorpyrifos, acephate) were the most frequently chosen. (See Table 2) As a group, the organophosphates are known to be neurotoxic. The pyrethrins (ranked #2) and n-methyl carbamates (eg. bendiocarb, ranked #6) are also neurotoxic.

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In a recently published report", physicians from the Albert Einstein College of Medicine in New York City discussed eight individuals who developed symptoms of neurotoxic effects after exposure to exterminator applied chlorpyrifos. All eight experienced symptoms such as numbness, paresthesias (abnormal sensations) and gastrointestinal problems. Five of the patients also experienced memory loss and cognitive slowing.

One patient was a 42 year old physician who was exposed to commercially applied chlorpyrifos in her home. She suffered impaired memory and slowed thinking which persisted for at least 18 months. Neuropsychological evaluation at the time showed intellectual functioning well below her superior pre-exposure level, with particularly poor performance on recent memory tests. She also exhibited a variety of perception deficits. The spectre of such effects arising from a hospital's use of chlorpyrifos -- or other neurotoxic pesticides -- is a sufficient basis to justify critical reevaluation of pest management practices. In response to a survey question (# 13) about who applies pesticides at the hospital, 87% of the respondents selected "independent contractors." However, under the "other" option to the same question, several hospitals identified outside contractors. In response to another question (# 14), 98% of the 192 hospitals provided us with the name of a contractor used for pesticide applications. We believe that this latter question provides the more reliable total of those hospitals which have some or all pesticide applications performed by contractors. Hospitals also reported pesticide application by maintenance, housekeeping and custodial staff.

Who makes critical pesticide application decisions?

For the 98% of responding hospitals that use outside contractors, the relationship between the hospital and the contractor varies from case to case. Varying degrees of control are retained by the hospital over the key decisions about which pesticides are used as well as when and how they are applied. Of those hospitals which use independent contractors, 45% delegate pesticide selection to the contractor, 28% delegate the decision of application schedule, and 41% delegate the selection of application method. The smallest hospitals, with 140 or fewer beds, were generally more likely than larger hospitals to delegate these decisions to private contractors.

Are pesticides applied routinely or responsively?

We asked if pesticide applications were done routinely, on a schedule, or if pesticides were used only when a specific pest problem was apparent. Only 28 (15%) hospitals responded that pesticides were used only in response to a specific incident. All of the other hospitals applied at least some pesticides on a routine basis.

Is the hospital community protected from exposure to pesticides?

Most (93%) hospitals reported that they provide prior notice of pesticide




applications. Unfortunately, less than half (49%) of the hospitals that do so provide any written notice. Sixty-seven percent of the hospitals give less than 48 hours notice, and 36% provide the notice 12 or fewer hours prior to application. Fourteen (7%) responding hospitals reported that they give no prior notice. Only 60 hospitals (32%) give notice to the patients, with rural and smaller hospitals less likely to do so. Hospital non-medical staff (maintenance, custodial, food service) are the most frequently notified segment (139 hospitals, 74%) while the medical staff is notified in just 99 (52%) hospitals. Again, rural hospitals are less likely to notify than suburban and urban hospitals, while larger hospitals seem more likely to notify than smaller ones.

Only 45 (24%) hospitals post signs in and around areas treated with pesticides after the application (public hospitals more than private, larger more than smaller hospitals and urban more than suburban and rural). Such notices would serve as a reminder to anyone who might have received pre-application notification and would be the only notice to hospital staff and patients who might not get such notice or to recent admissions and visitors who could not be pre-notified.

Re-entry restrictions impose a minimum and uniform level of protection to all members of the hospital community even if they are not notified about the pesticide application. One hundred forty-four of the hospitals observe some such restriction, in the majority of cases, the restriction is determined by the pesticide applicator or the pesticide manufacturer. Only 23 (16%) hospitals reported that restrictions were determined by hospital administrators. Administrators at public hospitals, rural hospitals and the largest hospitals seemed most likely to be involved in determining these restrictions.

Are least toxic and non-chemical pest control methods used?

Pesticides are not the only way to control pests, and if pesticides are used, one can and should consider both their toxicity and their efficacy. Almost all responding hospitals (178 of 188, 95%) said that they consider least toxic alternatives when selecting pesticides for use, however only a handful appear to limit themselves to boric acid, pyrethrin, and pyrethroid formulations.

Of 183 responding hospitals, 176 (94%) said that they use at least some non- chemical methods of pest control. These methods include physical barriers (eg. sealing crevices - 17 1 hospitals), improved sanitation (166 hospitals), mechanical traps (155 hospitals), physical removal (eg. steam treatments - 86 hospitals) and biological controls (60 hospitals). The use of physical removal and biological controls increases with the size of the hospital.

Are records of pesticide applications maintained?

Adequate recordkeeping can help the hospital determine if pesticide applications are effective, help in efforts to reduce pesticide usage, and assist in the evaluation of any adverse effects which might occur. Of 187 hospitals responding, 169 (90%) reported that they maintain written records of pesticide

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applications.

Is there a written policy regarding pesticide use in the hospital?

Of the 183 responding hospitals, 74 reported that they had a written policy regarding indoor pesticide use. Of those, 57 provided us with copies for review. The documents we received were quite diverse. Some were simply copies of contracts with pesticide applicators and others were statements of the hospital's intent to control pests by regular use of pesticides. A few indicated the hospital's commitment to IPM practices and mandated the use of pesticides only as a last resort. Fewer still contained any detailed discussion of the specific non-chemical methods to be used in lieu of pesticides or addressed the coordination of responsibilities so necessary for the success of any IPM program.

Discussion and Recommendations

1. Hospitals should adopt least toxic pest management policies and practices in order to reduce or eliminate pesticide use, and should select the least toxic pesticides in situations where pesticide use is deemed to be essential.

IPM strategies involve the identification of the pest and the definition of an unacceptable level of infestation. When pest control is necessary, physical, mechanical and biological means to control pests are used before pesticide treatments. If it is necessary to resort to chemical controls, the least toxic alternative should be selected.

Many hospitals reported using at least some non-chemical pest management controls including, mechanical traps, sanitation and physical barriers. Three hospitals reported that they use no pesticides and several reported using only boric acid, pyrethrin and pyrethroid formulations, which are generally recognized as "least toxic'' pesticide alternatives.

Most hospitals appear to rely on synthetic organic pesticides as a mainstay for their pest management programs. Routine, rather than responsive treatments, are the rule. Such application practices almost certainly constitute unnecessary and excessive pesticide use. Pesticide applications, if they are to be made at all, should be targeted at a specific pest which has reached a pre-determined threshold problem level. Of those hospitals that use outside contractors, a significant number delegate critical decisions to the contractor. These decisions include which pesticides are used (46%); when they are applied (28%); and how they are applied (41%). For IPM to be successful, all members of the hospital community must participate in a coordinated effort. The hospital administration should be responsible for this coordination and should work closely with pest control personnel on these key decisions.

In Boston, 10 teaching and research hospitals associated with Harvard University have been practicing Integrated Pest Management for about 10 years. These large, urban hospitals are subject to all of the same pest problems which

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afflict New York's hospitals. Controls used include boric acid and pyrethrum formulations, sticky traps, silica gel, vacuums, caulking and other typical IPM methods. No pesticide sprays, mists or fogs are used. No rodenticides are used. And no "preventative" pesticide applications are made.

The contractor responsible for these programs has witnessed a tremendous reduction in pest problems over the years. In one hospital lutchen, thousands of roaches could be caught with sticky traps, each month, when traditional pest control methods were employed. Today, using IPM, the traps typically yield only dozens of roaches per month.

The Director of Environmental Services at Children's Hospital, a 329 bed unit of the Harvard Medical Institutions, endorses IPM wholeheartedly. He reports that pests have been better controlled by IPM than they were with pesticide treatments. Furthermore, the IPM program has proven to be no more costly for Children's Hospital than traditional pest control methods have been for comparable hospitals.

Many of the pest problems confronted by hospitals are not unique. Other large institutions have successfully implemented IPM programs. The U.S. General Services Administration has implemented IPM at federal facilities in Washington D.C. and the New York State Office of General Services has done so for facilities it manages. Many schools nationwide have also implemented IPM programs.

The experience of Harvard's hospitals, the three hospitals in New York State that do not use pesticides and the others that rely primarily on non-pesticidal and least toxic pesticide controls demonstrate that hospital pest management and pesticide use are not inextricably linked. The use of pesticides can be avoided. Hospitals and hospital associations should share information on successful IPM programs, seek to learn from the experience of other institutions that have implemented IPM, and draw from the experience of experts in the field of IPM.

2. If pesticides are used, hospitals should notify all members of the hospital community in advance. Before and after pesticides are applied, warning signs should be posted around the treated area.

In buildings such as hospitals, which are open to the public, people may be exposed to pesticides without the opportunity to protect themselves from unwanted exposures and without any knowledge that they may be or have been exposed to pesticide products. In hospitals this is of particular concern, since patients may be less resistant to the potential toxic effects of some pesticides, because the toxicity may further complicate illnesses, and because the symptoms arising from pesticide exposure may confound diagnosis of other medical problems.

As long as pesticides are used, this problem is best addressed by public information, including notification and posting and re-entry restrictions. Hospital employees, medical staff, patients or visitors have a right to know, and

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a need to know, when pesticides will be applied, which areas will be or have been treated, and what pesticides will be or have been used.

Advance notice is critical to allow for avoidance, while posting of treated areas helps to inform visitors, newly admitted patients, rotating staff and others who may not have received advance notice of a specific application.

Finally, re-entry restrictions help to reduce exposure. Such restrictions may be specified on the label and thus mandated by law. In other cases there may be no legally mandated restrictions. But, in either case, stringent re-entry restrictions might be advisable to protect the health and welfare of patients.

While most hospitals notify some sector of the hospital community, patients are the least likely to receive prior notice of a pesticide application. Medical staff are notified at only 52% of the responding hospitals statewide. These two groups, most intimately affected and involved in the healthcare process, have a need to know.

a

Written notice should be given to all members of the hospital community, including doctors, nurses, patients, administrators, kitchen staff, maintenance workers and custodians. All have a right to protect themselves, and many have responsibilities for the health and welfare of others. If individuals wish to take steps to avoid exposure, or if doctors deem it appropriate to take special precautions for their patients, adequate notice must be given.

The written notice should identify the pesticides to be used, the target pests, the locations to be treated, and should identify a place where pesticide product labels are available for inspection. Pesticide labels include information about health and environmental effects and precautionary measures. Under New York State's Environmental Conservation Law Article 33, Title 9, certified applicators must provide this information to the owner or hidher agent. The ownedagent has a legal obligation to make this information available to the hospital community upon request. Hospitals should also provide access to Material Safety Data Sheets ("MSDSs") which should include more specific information about potential health effects of exposure.

Prior to a pesticide application, the area to be treated should be identified with a warning sign. The sign should identify the pesticide to be applied, the date of application and the location where additional information can be obtained. Treated areas should be identified with posted notices that remain in place for 48 hours, or as long as a re-entry restriction is in place, whichever is longer.

3. All hospitals should maintain detailed information about what pesticides are being applied, where, how, why and by whom.

New York State law requires such records to be kept by certified applicators. We believe copies should be available on the hospital premises. Proper diagnosis and treatment of any pesticide exposure may be dependent on complete and readily available information about the history of exposure and

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what chemicals were used. These records may be useful for diagnostic and treatment purposes, and in the evaluation of long-term pest management practices.

4. Hospitals should put their pest management policies in writing and make these policies public.

At a minimum, written policies should: establish the hospital's commitment to pest management with little or no use of poisons; establish a clear and central administrative control of pest management activities; incorporate clear and unambiguous contract terms for securing needed services; and formalize appropriate record-keeping and notification practices. Some specific suggestions can be found in the next section, "Hints for Hospitals."

Hints for Hospitals"

1. Have a Clear Vision of What Constitutes Integrated Pest Management.

- IPM is based upon regular inspections and the accurate identification of the pest and the infested area(s).

- IPM requires definition of intolerable levels of infestation for each area to be managed.

- IPM seeks to reduce or eliminate infestation with long-term engineering, maintenance and sanitation methods, together with education.

- IPM responds to current infestations with short-term solutions such as mechanical, physical and biological controls, and resorts to chemical poisons only as a last resort.

- IPM requires evaluation of the toxicity and exposure potential associated

with any application of pesticides to assure that the "least toxic, least impact" alternative is chosen.

2. Make Pest Management a Central Administrative Function.

- IPM requires the coordination of many separate functions within the hospital (eg. engineering, maintenance, custodial, food services, medical and nursing) and may involve outside contractors for facility design, renovation, repair or for pesticide application.

- IPM requires staff education and cooperation.

3. If Using An Outside Contractor, Make Contract Specifications Clear and Unambiguous.




- Contract for regular inspections, pest identification and infestation evaluations. This, not regular pesticide application, is the heart of Integrated Pest Management,

- Contract for service during normal working hours, whenever possible. This will allow the pest control technician to observe typical working conditions and habits, allow free communication between the technician and those who regularly work in each area and help to discourage the use of sprays, fogs and area-wide treatments.

- Contract for service by certified applicators only. Pesticide application by uncertified individuals working under the supervision of a certified applicator, while legal, is inadequate. On-site personnel should be fully trained to help minimize the

potential for accidents and misapplications.

- Contract for minimal reliance on pesticides. Require appropriate management approval of any chemical application, based upon an evaluation of the alternatives available, their efficacy, their toxicity, and the manner in which they are applied.

- Performance standards should be based upon the elimination or control of infestations to tolerable levels, not on the completion of pesticide applications.

4. Keep Records.

- Records should include inspection reports which evaluate infestations, the existing conditions which promote them, control steps taken and their results.

- If pesticides are used, record the name of each product used, its chemical contents, the amount used and the locations treated.

- Keep a copy of the labels and MSDS for all pesticides used. The location and indwidual responsible for these files should be identified in the pest management policy.

ENDNOTES:

1. 7 U.S.C. 5 136(u). Throughout this report, the word "pesticides" is used broadly to include insecticides and rodenticides intended to kill, repel or otherwise control mice, rats, vermin, insects etc. indoors. For the purposes of this report, cleaning products, including disinfectants which might contain pesticidal ingredients, were omitted.

2. This figure does not include wood preservatives, disinfectants and sulfur, which are also pesticides. If these were included, pesticide use would more than double.

3. United States Environmental Protection Agency, "Healthy Lawn, Healthy Environment", Office of Prevention, Pesticides and Toxic Substances, June 1992.

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4. "Pesticides in the Diets of Infants and Children", National Research Council, National Academy Press, 1993, Washington D.C.

5. United States Environmental Protection Agency, "Superfund Public Health Evaluation Manual" (EPA 540/1-86/060), October 1986, p. 63.

6. Natural Resources Defense Council, "Intolerable Risk: Pesticides in Children's Food" February, 1989.

7. "Pesticides in the Diets of Infants and Children", National Research Council, National Academy Press, 1993, Washington D.C., p. 347.

8. In some cases, classification of a pesticide as "Restricted Use" is dependant upon the form or concentration of the formulation. With the available data, we are unable to determine if each hospital reporting use of an active ingredient was using a restricted formulation.

9. See New York State Environmental Conservation Law 33-OlOl(42) and 7 U.S.C. §3(d)(l) for precise State and Federal definitions of Restricted Use Pesticides.

10. Kaplan, J.G. et al., 1993. Sensory neuropathy associated with Dursban (chlorpyrifos) exposure. Neurology 43:2193 - 2196.

11. Based upon guidance in various documents prepared by the New York State Office of General Services and the United States General Services Administration.

Credits:

This report was prepared by:

Michael H. Surgan, Ph.D., Chief Scientist Gimena Sanchez, Environmental Science Aide Environmental Protection Bureau

William S. Helmer, Assistant Attorney General in Charge

APPENDIX 1: NEW YORK STATE ATTORNEY GENERAL'S SURVEY OF PESTICIDE USE IN HOSPITALS Please type or print clearly in ink.

A.G. I.D. No.:

Your name and title:

Hospital:

(Do not fill in.)

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Street Address:

CityRown:

County :

Zip Code : Phone Number:

Hospital Information: Please answer the following questions with regard to your hospital. For the purpose of this survey the term "pesticide" includes insecticides and rodenticides and specifically excludes disinfectants. Please provide information for the most recent 12 month period for which you have records. (Please specify period: from to .>

1. Is your hospital:

a. - private b. public

2. Does your hospital offer general services or does it offer a limited, specialized range of care? If limited, please specify the range of services:

3. Are pesticides of any lund used in any part of your hospital?

a. - yes b. no

c. If no, please return the survey, with only the above portion completed to our office.

4. What is the total number of people in the hospital on a typical 24 hour day?

a. staff (doctors, nurses, other health professionals)

b. administrators

C. maintenance, custodial, personnel I

d. admitted patients

e. outpatients

f. visitors

€5 laboratory/research food service staff

Pesticide Survey Hospital Name:

5. Among the admitted patients what percentage of beds are in the following categories?

a. nursery




b. pediatric

C. intensive care (pediatric, medical and surgical)

6. Is your hospital located in a(n):

a* - urban area?

b. - suburban area?

c. - rural area?

7. Who is responsible for the decision to use and the selection of pesticides in your hospital? If separate responsibilities, ,please identify the individuals responsible for each decision.

a. name:

b. title/position:

8. Is it part of your standard practice when selecting pesticides to also look at least toxic alternatives?

a. ~ yes b. no

9. Are there any local ordinances that affect pesticide use in your hospital?

a. - yes b. no c. don't know

d. If yes, please identify. Attach copy if possible.

10. After pesticides are applied, are any restrictions observed at the treated area? (e.g. on entering the applied area?)

a. - yes b. no

11. If yes, what areas are restricted and for how long after a pesticide application?

12. Who determines such restrictions? a. hospital administrator

b. - local or state government

c. - pesticide manufacturer




d. - pesticide applicator

e. - other (please specify):


Indoor Applications of Pesticides: Please answer the following questions with regard to indoor pesticide applications. For the purpose of this survey indoor pesticide applications also includes outside pesticide applications to address indoor pest problems in your hospital.

13. Who applies the pesticides? (Check all that apply.)

a. - maintenance/custodial staff

b. - independent contractors

c. - medical staff

d. other (please specify):

14. If a private contractor applies indoor pesticides, please identify:

a. name:

b. address:

c. city/town: state:

zip code: phone number :

15. If independent contractors are used, does the hospital administrator exercise control over:

a. which pesticides are used? Yes no

b. when they are applied? Yes no

c. how they are applied? Yes no

16. Prior to the application of indoor pesticides, is notice given to:

a. - administrators?

b. - medical staff? (doctors, nurses, other health professionals)

c. - maintenance, custodial, food service staff?

http://www .oag. state.ny.us/environment/hospita195. html 5/21/01

http://www


d. - patients?

e* - no prior notice given

f. - other (please specify):

17. Is such notice (check one or more):

a. - written?

b. - verbal?

c. other (please specify):


18. If notice is given, when is it given?

a. - more than 72 hours before application

b. - between 48-72 hours before application

c. - between 12 -48 hours before application

d. - less than 12 hours before application

19. After application, are notification signs posted in and around areas treated with pesticides?

a. - yes b. no

20. Does your hospital have a written policy regarding indoor pesticide use?

a. - yes b. no

If yes, please attach a copy to this survey.

21. Are pesticides applied in response to a specific incident, or routinely?

a. - responsively b. routinely c. both

22. Does your hospital maintain written records or reports regarding the application of pesticides?

a. - yes b. no

http ://w ww . oag . s tate .n y . us/environment/hospita195. html 5/21/01


23. If yes, who maintains such records?

a. name:

b. title/position:

24. Does your hospital use non-chemical methods of pest control?

a. ~ yes b. no

25. If yes, which alternatives to chemical pesticides are used? (Check all that apply.)

a. ~ physical removal (e.g. steam treatments)

b. - mechanical traps

c. - biological controls

d. ~ improved sanitation

e. - physical barriers (e.g. sealing off crevices)

f. - other (please specify):

Table of Pesticide Use

A.G. I.D. No.

Name of Hospital:

Pesticides used*

(Include brand name

and EPA registration

Active Target pest Area Size of area Frequency Total ingredients Treated of amount

( 4 treated application of (b) (d)

(sq. feet) to that area pesticide applied

in 90-91 (e) (0

number)

( 4 ex Dursban 50W

EPA registry #464-590

chlorpyrifos roaches cafeteria 5000 sq. feet every 1000 other week lbs.

kitchen area 750 sq. feet weekly

hollc wnnn cn foot




l l u l l u JU,UUU uy. L W W C

every children's 5000 sq. feet other week

ward 5000 sq. feet every

nurseries other week 10,000 sq. feet

surgical every ward other week

every other week

* Pesticides are poisons designed to kill a variety of plants and animals, such as insects (insecticides), rodents (rodenticides), weeds (herbicides), mold or fungus (fungicides) and larvicides. It is important to consider each of these variations when completing this survey. FOR THE PURPOSE OF THIS SURVEY, DO NOT INCLUDE THOSE PESTICIDES FOUND IN CLEANING AGENTS AND OTHER SURFACE DISINFECTANTS.

DIRECTIONS: In columns a through g of the attached chart, please refer to the following questions with regard to pesticide use in your hospital. Please type or print clearly in ink. Additional sheets have been attached for adequate space; please add extra sheets if necessary to include full information. To further assist you, an example has been given above.

a. List each pesticide product applied at your hospital during the reporting period. Include the brand name and the EPA registration number, both of which can be found on the product label. Please attach the full product label if possible.

b. List each of the active ingredients found in the pesticide. This information can be found on the product label.

c. Identify the target pest(s) each pesticide was intended to control at your institution.

d. Identify the area in which the pesticide was applied. (Le. patients' rooms [specify type], operating rooms, emergency rooms, cafeterias, kitchens, restrooms or other). Identify all locations for each pesticide. If other locations, please specify.

e. Give the size of the area treated. Answer in terms of square footage.

f. What was the frequency of applications to that area? (more than once a week, weekly, every other week, monthly, upon request or

other). If other, please specify.




g. What was the total amount of the pesticide applied during the reporting period. Please identify in pounds or liquid ounces where possible.

If not possible, use other standard measurement.

Please use the envelope provided to return this survey. Thank you for spending time to respond.


A.G. I.D. No.

Name of Hospital

Pesticides Used Active

(Include brand ingredients

name and (b)

EPA registration number)

26

27

28

29

30

31

Target pest Area treated Size of area Frequency Total of amount

treated application of (4 (d)

(sq. feet) to that area pesticide applied

in 92-93 ( 4 (0




32

33


A.G. I.D. No.

Name of Hospital

Pesticides Used Active Target pest Area treated Size of area

(Include brand (4 ( 4 treated ingredients

name and (b)

number) (e)

(sq. feet) EPA registration

of 36

Frequency Total

application of of amount

to that area pesticide applied

in 92-93 (0

34

35

36

37

38

39




(County1

of 36

Hospital Name

*Albany Memorial Hospital *Child's Hospital (Albany1 *Albany Medical Center Hospital JAlbanyI *St. Peter's Hospital Capital District Psychiatric Center Veterans Affairs Medical Center 1 Albanv

40

*Cuba Memorial Hospital lCuba

41

T I

-1

(Hospitals marked with one asterisk responded to the survey, and are included in this report; the hospital marked with two asterisks responded too late to be included in the report.)

"Montefiore Medical Center Moses Division 7 1 *North Central Bronx Hospital 7) *WestChester Square Medical Center 71

*Calvary Hospital [I *Veterans Affairs Medical Center (Bronx-

7 1 Bronx Municipal Hospital Center 1- St. Barnabas Hospital JBronx] Bronx Children's Psychiatric Center ~m "Binghampton Psychiatric Center ~(Binghamptonl

*Jack D. Weiler Division Of Albert Einstein Hospital

*Lincoln Medical & Mental Health Center

7 1

*Bronx Psychiatric Center *Bronx-Lebanon Hospital Center Union Hospital Of The Bronx

**Our Lady Of Mercy Medical Center




unitea Health bervices Hospital *Our Lady Of Lourdes Memorial Hospital

Olean General Hospital

"Auburn Memorial Hospital

*Tri-County Memorial Hospital

1- *Woman's Christian Association Hospital *Brooks Memorial Hospital

Lake Shore Hospital

*Arnot Ogden Medical Center *St. Joseph's Hospital *Elmira Psychiatric Center

Westfield Memorial Hospital

(ChenangoI Chenango Memorial Hospital

-1 *Champlain Valley Physicians HospitaVMedical Center

pingnampton I lBinghampton1

~n [Auburn[

JWestfield]

lPlattsburgh1 U.S. Air Force Hospital, Plattsburgh AFB

Columbia

)Coalandl -1

u "Columbia-Greene Medical Center IHudson

~*Cortland Memorial Hospital

*Mary Imogene Bassett Hospital, O'Connor Division *The Hospital Margaretville Memorial Hospital *Delaware Vallev HosPital hal ton

VI 7 1


1- *Vassar Brothers Hospital >IPoughkeepsiel *Hudson River Psychiatric Center lPoughkeepsie) *Veterans Affairs Medical Center (Castle1 Northern Dutchess Hospital pzziz-l Harlem Valley Psychiatric Center ~lWingdaleI Craig House Hospital IBeacon

"Sheehan Memorial Hospital IlBuffalo *Buffalo General Hospital 11-

1- "Roswell Park Cancer Institute IlBuffalo *Bertrand Chaffee Hospital IlSpringville "Children's Hospital of Buffalo 1 7 *Buffalo Columbus Hospital JIBuffalo

IpZGG-

*Western NY Children's Psychiatric Center

*Our Lady Of Victory Hospital



(Essexl

[Franklin

l*Buffalo Psychiatric Center IIBuffalo I "Kenmore Mercy Hospital IKenmore *Bryuin Hospitals *St. Joseph Hospital pzzG&q *Mercy Hospital [Buffalo1 Erie County Medical Hospital (Buffalo1

Gowanda Psychiatric Center VI Millard Fillmore Hospitals [Buffalo .*Elizabethtown Community Hospital p i Z Z G F l Moses Ludington Hospital lTiconderoga1 *Adirondack Medical Center p&ziq

pGGG-l

Sisters Of Charity Hospital Of Buffalo

*Alice Hyde Hospital Association

*Nathan Littauer Hospital & Nursing Home

IGenesee I "Genesee Memorial Hospital IBatavia *St. Jerome Hospital Veterans Affairs Medical Center IBatavia

I

lJeffersonI

http://www .oag.state.ny.us/environment/hospital95. html

~

*Little Falls Hospital pi izz l

*Samaritan Medic a1 Hospital -1

[Brooklyn[ *Coney Island Hospital lBrooklyn)

*E.J. Noble Samaritan

*Carthage Area Hospital

"University Hospital Of Brooklyn - S.U.N.Y.

*Community Hospital Of Brooklyn *Brooklyn Hospital Center *Kings County Hospital Center "Victory Memorial Hospital lBrooklyn) "Kingsbrook Jewish Medical Center lBrooklyn]

1s *Lutheran Medical Center r I Kingsboro Psychiatric Center lBrooklyn]

*Woodhull Medical & Mental Health Center

Wyckoff Heights Medical Center Interfaith Medical Center Veterans Affairs Medical Center Long Island College Hospital Maimonides Medical Center (Brooklyn1 Methodist Hospital lBrooklynI

I

5/21/01

http://www

* Pest Management in New York State Hospitals of 36

Brookdale Hospital Medical Center Kings Highway Hospital Center

IBrooklyn

(Brooklyn1 Lewis /]Lewis Countv General Hospital IlLowville I

\Madison I (Livingston I(*Nicholas H. Noyes Memorial Hospital I IDansville I r

*Oneida City Hospital (Oneida *Community Memorial Hospital

*Rochester Psychiatric Center IRoches ter *Rochester General Hospital IRoches ter "Lakeside Memorial Hospital lBrockport St. Mary's Hospital 7 Monroe Community Hospital 7 Park Ridge Hospital 7 Highland Hospital Of Rochester IRochester Genesee Hospital Strong Memorial Hosp./Univ. of Rochester

IRoches ter

(Montgomery]

F I

*Amsterdam Memorial Hospital IAmsterdam

*South Nassau Communities Hospital IOceanside

*St. Mary's Hospital )Amsterdam1

*Syosset Community Hospital *Hempstead General Hospital

Syosset Hemps tead

* Winthrop-University Hospital "Nassau County Medical Center *A. Holly Patterson Geriatric Center *Mid-Island Hospital *Franklin Hospital Medical Center

(Mineola

p G z G q p z z z l 1- IVallev Stream I

http://www .oag.state.ny.us/environment/hospital95 .html

*Long Beach Memorial Hospital & Nursing Home *Central General Hospital

(Long Beach

St. Francis Hospital (Roslynl Freeport Hospital lFreeportI

p z G l North Shore University Hospital At Glen Cove Massapequa General Hospital ISeaford

5/21/01

North Shore University Hospital Mercy Medical Center

Manhasset Rockville Ctr.

lNew York 1 *Memorial Sloan-Kettering Cancer Center lNew York *Columbia-Presbyterian Hospital p x z l *Goldwater Memorial Hospital (NewYorkI *Coler Memorial Hospital

I I

http://www


-1

l o n e i d a I . * F a x t o n

*Veterans Affairs Medical Center lNew York *Lenox Hill Hospital -1 *New York Downtown Hospital -1

-1 *St. Luke's-Roosevelt Hospital-10th Ave -1

-1 *Harlem Hospital Center (New1 *North General Hospital p i x z l "Cabrini Medical Center -1

p z z l -1 p x z l (New1

p x z l Regent Hospital -1

-1 Gracie Square Hospital p x z l Bellevue Hospital Center p x i l

-1 Rockefeller University Hospital p i E i l "Lockport Memorial Hospital (Lockport1

Mount St. Mary's Hospital lLewistonI

[Tonawanda]

I( *St. Elizabeth Hospital 1-

r j

*Hospital For Special Surgery *Metropolitan Hospital Center

*St. Luke's-Roosevelt Hospital Center-Amsterdam Ave "Society Of The New York Hospital

(Newyorkl

*New York University Medical Center

*Medical Arts Center Hospital *Manhattan Eye, Ear & Throat Hospital New York State Psychiatric Institute Manhattan Psychiatric Center- Ward's Island New York Eye & Ear Infirmary

Hospital For Joint Diseases Orthopedic Institute Beth Israel Medical Center

Mount Sinai Medical Center

Beth Israel Medical Medical Center-North Division St. Vincent's Hospital & Medical Center lNew York

St. Clare's Hospital & Health Center

"Niagara Falls Memorial Medical Center

*Inter-Community Memorial Hospital *De Graff Memorial Hospital North

*U.S. Air Force Hospital, Griffiss AFB

*Rome Hospital & Murphy Memorial Hospital *St. Luke's Memorial Hospital Center *Mowhawk Valley Psychiatric Center lutica

Hospital

Y

http://www .oag. state.ny.us/environment/hospita195 .html 5/2 1/0 1

http://www


lonondaga I *Community-General Hospital Of Greater Syracuse (Syracuse *Hutchings Psychiatric Center lSyracuse) *University Hospital-SUNY JSyracuse

1- Veterans Affairs Medical Center JSyracusel *Veterans Affairs Medical Center lCanandaiguaI

-1 *Geneva General Hospital 7 1

*Crouse Irving Memorial Hospital *Benjamin Rush Center St. Joseph's Hospital Health Center

*Clifton Springs Hospital & Clinic

F.F. Thompson Health System kanandaigua

(Orange I *Arden Hill Hospital IGoshen *Keller Army Community Hospital -1 "Horton Memorial Hospital Ih/IiddletownI *Cornwall Hospital lcornwall

http://www.oag. state.ny.us/environment/hospital95. html

-1

1-

-1

-1

5/2 1/0 1

*Middletown Psychiatric Center IMiddletown St. Luke's Hospital St. Anthony Community Hospital -1 Mercy Community Hospital -1 Medina Memorial Hospital 7 1 *Oswego Hospital 'I

7) "Bassett Healthcare [Cooperstown]

(Cold1 Arms Acres (CarmelI Putnam Hospital Center -1

--I *La Guardia Hospital dm

lFlushing) -1

Penninsula Hospital Center -1 Creedmore Psychiatric Center -1

Albert Lindley Lee Memorial Hospital

"Aurelia Osborn Fox Memorial Hospital

Julia L. Butterfield Memorial Hospital

*St. John's Episcopal Hospital- South Shore

*New York Hospital Medical Center Of Queens *Long Island Jewish Medical Center *Catholic Medical Center Of Brooklyn & Queens Elmhurst Hospital Center

Jamaica Hospital

Holliswood Hospital IHollisw ood

http://www.oag


Astoria General Hospital ILong Island City1 Deepdale General Hospital p i G G l Queens Children's Psychiatric Center (Bellerose Queens Hospital Center Booth Memorial Medical Center !Flushing 1

, IParkway Hospital IlFlushing

(Rensselaer I

-1

*St. Mary's Hospital Of Troy lutica

*Samaritan Hospital lTroy *Leonard Hospital lTroy *South Beach Psychiatric Center pGxiz-

pzzz- "Bayley Seton Hospital (StatenIsland Staten Island University Hospital (StatenIsland

*St. Vincent's Medical Center Of Richmond

Doctors' Hospital Of Staten Island IS taten Island

IRockland I

1- [Schenectadyl

1- (Schuylerl - -1

*Dr. R. L. Yeager Health Center/Summit Park Hospital *Rockland Psychiatric Center

IPomona

*Helen Hayes Hospital West (Haverstrawl *Good Samaritan Hospital -- *Nyack Hospital (NyackI

Saratoga Hospital 1- lSchenectady)

*Bellevue-The Woman's Hospital lSchenectady1 lSchenectady1

Conifer Park 7) *Ellis Hospital pGzzjq

p i z j z i l "Schuyler Hospital -1 *Willard Psychiatric Center [Willard-

*St. James Mercy Hospital 7 1

*Corning Hospital lComingI "Massena Memorial Hospital 1- *A. Barton Hepburn Hospital logdensburg1

Rockland Children's Psychiatric Center

*Sunnyview Hospital & Rehabilitation Center

*St. Clare's Hospital Of Schenectady

Community Hospital Of Schoharie County

*Veterans Affairs Medical Center

Ira Davenport Memorial Hospital

*St. Lawrence Psychiatric Center

*Pl;ftnn E;nn Uncnito l I C h t - T

http://www .oag.state.ny.us/environment/hospital95 .html 5/21/01

http://www


L 1 1 1 L u l l - J . lllcl lluoylLul

Edward John Noble Hospital Of Gouverneur Canton-Potsdam Hospital

r

I U C ' U UURb 1

pzEq V]

ISuffolk II*Sagamore Children's Psychiatric Center IlDix Hills I *Brunswick Hospital Center, Inc. *Huntington Hospital *Brookhaven Memorial Hospital "Pilgrim Psychiatric Center

*Veterans Affairs Medical Center *South Oaks Hospital

1 Amit yville I

lAmityville1 INorthport 1

*St. Charles Hospital & Rehabilitation Center *Kings Park Psychiatric Center *Central Islip Psychiatric Center *Eastern Long Island Hospital *John T. Mather Memorial Hospital of Port Jefferson

(Port Jefferson I -1 (CentralIslipl (Greenport1 IPort Jefferson I

*Central Suffolk Hospital *Good Samaritan Hospital *University Medical Center St. John's Episcopal Hospital

IRiverhead

r l 1-1 ISmithtown

(Tompkins IlTompkins Community Hospital (IIthaca

Smithtown Community Hospital Of West Suffolk "Southside Hospital

Smithtown Bay Shore

I I 1 " I

-([Glens Falls Hospital 1-1

(Sullivan

LWashington IlMary McClellan Hospital IlCambridge

S outhamp ton Hospital Southhampton

*Community General Hospital Harris

IUlster I *Kingston Hospital ~ IKingston Ellenville Community Hospital Benedictine Hosti tal IKinmton

http://www.oag.state.ny.us/environment/hospital95 .html

IWayne I

5/21/01

*Myers Community Hospital Sodus New ark- Wayne Community Hospital Newark

IWestchester I *St. John's Riverside Hospital IYonkers *Yonkers General Hospital *St. Joseph Medical Center r(

1- *Franklin Delano Roosevelt Veterans Affairs Hospital

*Lawrence Hospital *ATnrthnm T X l e c t r h n o t o r Unon; to l f'nntnr

r] *Phelps Memorial Hospital Center North

InAnllnt worn



1 ~ W l L l I b l I I v v b O C b l I ~ O C ~ 1 l l U O y l L u 1 L b 1 1 L b l

* Westchester County Medical Center *Rye Hospital Center *St. Agnes Hospital *Mount Vernon Hospital *St. Vincent‘s Hospital *Burke Rehabilitation Hospital *The N.Y. Hospital Cornel1 Medical, Westchester Division

*Blythedale Children‘s Hospital Hudson Valley Hospital Center Four Winds Hospital White Plains HosDital Center

A V l U U l l C 1 X I D b U I

piZi7Gl pGzGGq JHarrisonI p i a z q

-1 7 1

-1

IWhite Plains

Stony Lodge Hospital United Hospital Medical Center New Rochelle Hospital Medical Center High Point Hospital Community Hospital At Dobbs Ferry Ossining Correctional Facilities Hospital

Survey Responses: n=

IWyoming ([Wyoming County Community Hospital (IWarsaw

p-p-plp-l1621[431)46)145))45))43

IYates IlSoldiers & Sailors Memorial Hospital of Yates County IlPenn Yan

Yes no # of responses

APPENDIX 3: SUMMARY OF SURVEY RESPONSES Location I I # Beds

pi?q(97%(~1~1(100%((98%((93%1”1~ ““~1(2%)(7%(10%1(0%()0% [1921(951)971)831162””)143

I I1

http://www .oag.state.ny.us/environment/hospital95.html 5/2 1/0 1

http://www


alternatives?(#8) Yes (95%1"(191%1(100%1(93%(~1~1(96%((93% no (4%"piJ1(0%"~1)2%(15% other (2%"~1(o%IJo%1~~1)2%(12% # of responses pi--pil"~""(141

Yes ~ 1 p q ? Z l ~ 1 ~ 1 ) 0 % 1 p q ~ 1 [ 7 % ) ~ no [70%1"R1)63%"")171% don't know piq"1)18%1123%1)23%))27%1)18%))24%)~ other pZ--pq)13%(16%~)(5%)(0%"~ # of responses (iiq(192"11621(43((441(451(451142

Yes no # of responses

h ttp://w w w . oag . s tate .ny . us/environment/hospi ta195. html 5/2 1/0 1

( 8 0 % 1 ) 8 2 % ~ 1 [ 7 7 % 1 p E l ( 1 6 9 % ~ I ~ l " (-ii%qW(122%1)23%(""" (179)[9O"(Fs1)42")142pi-

hosp. admin. pzz-pEq"~""~ localhtate govt. "(116%1"((21%"" pesticide mfr. ")144%")148%)140%)142%)153%1)46% applicator (81%1p%q)184%pEiJ~1(83%"" other )38%1pzZl[40%1"()31%"1[147%1134% denominator pil""""~ # of responses ~ pq1)811)841)68)1601)341)31)13711401136

mainthust. staff indep. contractor medical staff other # of responses

T f R nrivRtp rnntrxtnr

""(lg%piZ-pq"F p z i - l ~ 1 ~ 1 ~ 1 ~ 1 ~ 1 ~ l ~ 1 ~ 1 ~ ~ 1 [ 1 % ) 1 o % ~ ~ " I ( o % ( 1 o o / o ~ (13%1(21%1(6%1(17%(115%((5%1111%)~)~11160/0 ~p-p-l1(83~1(43"1(44()43


Contractor listed (98%1(88%(196%(190%11(95%~1(93%1" ## of responses -"")(57)141(146"(136 If independent contractors are used, does the hospital

kNOTE: Total w/anv notice used to calculate percentages for #17 & #18, below)




Yes no # responding other than N/A

p%-piZl"1(17%1(17%)116%")140% (76%1(69%(182%((70%1183%1~1"~1~

)1851(89"")143"1(40

Yes no other # of responses

Does your hospital maintain written records or reports regarding the application of ~esticides?(#22)

)40%)"1(4x%""" ) 5 7 % p ? J Z E l ~ 1 1 8 2 % 1 ~ 1 1 6 x % 1 ~ 1 ~ ) ) 3 5 % "1)2%1(2%(10%"~~))2% ~))901)931)82)1391)391pG-jZ-l142))43

h ttp://w ww . oag. s tate .n y . us/environment/hospita195. h tml 5/21/01

responsively routinely both other # of responses

/15%(~1p?q(11%(12o%pzJmpz-pFq(16% [ 8 % ~ ~ ~ ) 1 3 % 1 ( 1 7 % ~ ~ ~ ~ p i q 7 i z J ~ ~ l 1 " 1 ( 7 8 % ( 1 7 7 % 1 ( 7 9 % I I " I lo. /o1(1%pzl~"pz-pi- l1)2% pq"1)82)161""W

T O/T z/s

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