National Pesticide Practice Skills Guidelines for Medical & Nursing Practice Bonnie Rogers, DrPH,...

National Pesticide Practice National Pesticide Practice Skills Guidelines for Skills Guidelines for Medical & Nursing PracticeMedical & Nursing Practice

Bonnie Rogers, DrPH, COHN-S, LNCC, FAANBonnie Rogers, DrPH, COHN-S, LNCC, FAANDirector, North Carolina Occupational Safety and Health Director, North Carolina Occupational Safety and Health Education and Research Center and Occupational Health Nursing Education and Research Center and Occupational Health Nursing ProgramProgram

School of Public Health, University of North Carolina at Chapel School of Public Health, University of North Carolina at Chapel HillHill

NEETFNEETFChildren’s Environmental HealthChildren’s Environmental Health

Faculty Champions InitiativeFaculty Champions Initiative

Six Practice SkillsSix Practice Skills

Practice Skill I: Taking and Environmental Practice Skill I: Taking and Environmental HistoryHistory

Practice Skill II: Awareness of Community Practice Skill II: Awareness of Community and Individual Pesticide Risk Factorsand Individual Pesticide Risk Factors

Practice Skill III: Knowledge of Key Practice Skill III: Knowledge of Key PrinciplesPrinciples

Practice Skill IV: Clinical Management of Practice Skill IV: Clinical Management of Pesticide ExposurePesticide Exposure

Practice Skill V: Reporting Pesticide Practice Skill V: Reporting Pesticide Exposure and Supporting Surveillance Exposure and Supporting Surveillance EffortsEfforts

Practice Skill VI: Providing Prevention Practice Skill VI: Providing Prevention Guidance and Education to PatientsGuidance and Education to Patients

Practice Skill I:Practice Skill I:Taking an Environmental Taking an Environmental HistoryHistory

General Environmental General Environmental Screening QuestionsScreening Questions

Adults:Adults: Type of work including, how long on the Type of work including, how long on the

job, kinds of work-exposures, any specific job, kinds of work-exposures, any specific pesticide or work exposure, sorting of pesticide or work exposure, sorting of contaminated clothing, use of PPE, contaminated clothing, use of PPE, hygiene practices of applicators, co-worker hygiene practices of applicators, co-worker symptomssymptoms

Has your workplace been treated recently Has your workplace been treated recently for insects, weeds, or other pest for insects, weeds, or other pest problems?problems?

Adults:Adults: Home environment (age of home, Home environment (age of home,

characteristics of heating and ventilation characteristics of heating and ventilation system), use of pesticides in gardening or system), use of pesticides in gardening or as an insecticide in the home, well water as an insecticide in the home, well water or source of drinking water, storage of or source of drinking water, storage of chemicals, type of food bought/eaten, chemicals, type of food bought/eaten, anyone else in family sick, hobbies (e.g., anyone else in family sick, hobbies (e.g., pottery, photography, painting, furniture pottery, photography, painting, furniture stripping)stripping)

General Environmental General Environmental Screening QuestionsScreening Questions cont.cont.

Adults:Adults: Any community exposures including home Any community exposures including home

location near industry, businesses (e.g. location near industry, businesses (e.g. auto repair shops, dry cleaners), landfills, auto repair shops, dry cleaners), landfills, hazardous substance spills?hazardous substance spills?

Any problems noticed from any exposures Any problems noticed from any exposures while you are at work, at home, or in the while you are at work, at home, or in the communitycommunity

What causes symptoms to come and go?What causes symptoms to come and go? Have you recently used pesticides, Have you recently used pesticides,

solvents, insecticides, weed killers?solvents, insecticides, weed killers? What kinds of hobbies do you have?What kinds of hobbies do you have?



ChildrenChildren Environment of school, daycare, Environment of school, daycare,

playgroundsplaygrounds Have any of these places been treated Have any of these places been treated

recently (e.g., sprayed) for insects, weeds, recently (e.g., sprayed) for insects, weeds, or other pest problems?or other pest problems?

Does your child help with gardening Does your child help with gardening activities? Hobbies?activities? Hobbies?

Food, water (e.g., well water) sources, Food, water (e.g., well water) sources,

infant breast feedinginfant breast feeding

ChildrenChildren Parent’s occupational exposure Parent’s occupational exposure Any developmental issues Any developmental issues If parents have occupational exposure, If parents have occupational exposure,

is the clothing worn during application, is the clothing worn during application, stored, and washed separately from stored, and washed separately from

family clothing?family clothing?


National Pesticide Information National Pesticide Information Center: Center: Technical Pesticide Information, Technical Pesticide Information, http://npic.orst.edu/tech.htmhttp://npic.orst.edu/tech.htm

Pesticide manufacturer: Pesticide manufacturer: Contact Contact information should be on the label, or go information should be on the label, or go to: to: http://npic.orst.edu/manuf.htmhttp://npic.orst.edu/manuf.htm

Agency for Toxic Substances and Agency for Toxic Substances and Disease Registry: Disease Registry: “Case Studies in “Case Studies in Environmental Medicine, No. 26: Taking Environmental Medicine, No. 26: Taking an Exposure History”. an Exposure History”. www.atsdr.cdc.govwww.atsdr.cdc.gov

ResourcesResources

University of Maryland Pesticide Education and University of Maryland Pesticide Education and Assessment Program: Assessment Program: “Developing a Pesticide “Developing a Pesticide Exposure History”, Pesticide Information Leaflet No. Exposure History”, Pesticide Information Leaflet No. 25. May 1998. 25. May 1998. http://pest.umd.edu/spatc/Leaflets/LeafletList.htmlhttp://pest.umd.edu/spatc/Leaflets/LeafletList.html

County Cooperative Extension Service: County Cooperative Extension Service: County County Extension personnel can help determine which Extension personnel can help determine which pesticides may have been applied to a particular pesticides may have been applied to a particular crop, and what activities might have taken place crop, and what activities might have taken place through which workers or others may have been through which workers or others may have been exposed. exposed. http://npic.orst.edu/countyext.htmhttp://npic.orst.edu/countyext.htm

USDA Crop Profiles: USDA Crop Profiles: Provides information about Provides information about pesticides used on a particular crop in a specific state pesticides used on a particular crop in a specific state in the United States. in the United States. http://pestdata.ncsu.edu/CropProfileshttp://pestdata.ncsu.edu/CropProfiles//

Resources Resources contcont

Resources Resources contcont

U.S. EPA Pesticide Management Resource U.S. EPA Pesticide Management Resource Guide: Guide: Contains directories and lists of pesticide Contains directories and lists of pesticide information contacts: information contacts: www.epa.gov/oppfead1/pmreg/index.htmlwww.epa.gov/oppfead1/pmreg/index.html

Material Safety Data Sheet (MSDS) as a Material Safety Data Sheet (MSDS) as a Resource: Resource: Commercial establishments using Commercial establishments using pesticides and other products are required to keep pesticides and other products are required to keep MSDS and make them available to workers or others MSDS and make them available to workers or others potentially exposed to the substance, its diluted end potentially exposed to the substance, its diluted end product, or its residuesproduct, or its residues

Pesticide Label as a Resource: Pesticide Label as a Resource: The pesticide label The pesticide label is a legal document, and it is a violation of the law to is a legal document, and it is a violation of the law to use a pesticide in any manner inconsistent with the use a pesticide in any manner inconsistent with the label. Every pesticide is required to bear a label that label. Every pesticide is required to bear a label that conforms to EPA standardsconforms to EPA standards

Practice Skill II: Practice Skill II: Awareness of Community and Awareness of Community and Individual Pesticide Risk Individual Pesticide Risk Factors Factors

Community Assessment DataCommunity Assessment Data

High risk locales (farms, landfills, industries, High risk locales (farms, landfills, industries, urban crowding) urban crowding)

Air and water quality Air and water quality Demographics of community members Demographics of community members Populations at greatest risk (elderly, children, Populations at greatest risk (elderly, children,

workers, pregnant and lactating women, other)workers, pregnant and lactating women, other) Cultural issues that may be predisposing to Cultural issues that may be predisposing to

certain exposures certain exposures Children play areasChildren play areas Community resources availableCommunity resources available Seasonal industries of the greatest risk of Seasonal industries of the greatest risk of

exposureexposure Population groups highly mobile or transientPopulation groups highly mobile or transient Common problems related to pest infestation Common problems related to pest infestation

(rodents, mosquitoes, ants, cockroaches)(rodents, mosquitoes, ants, cockroaches)

Recreational areas and fieldsRecreational areas and fields Yards Yards Golf courses Golf courses Schools and daycare facilities Schools and daycare facilities

Potential Environmental Potential Environmental Sources of ExposureSources of Exposure

High Risk Occupations for High Risk Occupations for Pesticide Exposure Pesticide Exposure

Farming, agriculture, migrant Farming, agriculture, migrant work, structural application work, structural application

Groundskeeping, schools, Groundskeeping, schools, gardening (pesticide gardening (pesticide application), greenhouses, application), greenhouses, nurseries, golf courses, nurseries, golf courses, freeways, forestryfreeways, forestry

Extermination services Extermination services

Accident or Intentional ingestion/suicide Accident or Intentional ingestion/suicide attempt attempt

Food residues Food residues Hazardous waste sites Hazardous waste sites Industrial spills Industrial spills Laundering of clothing worn in pesticide Laundering of clothing worn in pesticide

applicationapplication Residues from treated structures Residues from treated structures

(houses, schools, office buildings); in (houses, schools, office buildings); in carpets and on domestic pets; on carpets and on domestic pets; on treated lawns and landscapestreated lawns and landscapes

Termite controlTermite control Water residuesWater residues

Non-Occupational Sources of Non-Occupational Sources of Pesticide Exposure Pesticide Exposure

Practice Skill III: Practice Skill III: Knowledge of Key Health Knowledge of Key Health Principles Principles

Key Principles of Key Principles of Environmental/Occupational Health, Environmental/Occupational Health, Epidemiology, and Population-based Epidemiology, and Population-based Health Health Understand determinants of persons, location, Understand determinants of persons, location,

and time related to exposures:and time related to exposures:

Humans differ markedly in their Humans differ markedly in their responses dependent on genetics, responses dependent on genetics, metabolism, age, gender, size, co-metabolism, age, gender, size, co-exposure, behavior factors, routes of exposure, behavior factors, routes of exposure (dermal, inhalation, ingestion)exposure (dermal, inhalation, ingestion)

Location of exposure includes workplace, Location of exposure includes workplace, home, community, and recreational sites home, community, and recreational sites

Sources of exposure, routes of exposure, Sources of exposure, routes of exposure, clusters of cases, rate, type, clusters of cases, rate, type, concentration, and frequency of concentration, and frequency of exposureexposure

Relationship of time, duration, and Relationship of time, duration, and frequency of exposure to health outcomes, frequency of exposure to health outcomes, change in symptoms during the workday, change in symptoms during the workday, week, weekends, vacation, etc. week, weekends, vacation, etc.

Impact of hazardous substances on Impact of hazardous substances on reproductive events (pre-conception, fetal), reproductive events (pre-conception, fetal), lactation, and developmental milestones in lactation, and developmental milestones in children (newborn, infant/toddler, and children (newborn, infant/toddler, and school age), and family membersschool age), and family members

Key Principles of Key Principles of Environmental/Occupational Health, Environmental/Occupational Health, Epidemiology, and Population-basedEpidemiology, and Population-basedHealth Health cont cont

Sentinel Health EventsSentinel Health Events

Unusual patterns of illnesses Unusual patterns of illnesses occurring in persons or occurring in persons or community groups that can also community groups that can also act as a "red flag" for wider act as a "red flag" for wider environmental health problems, environmental health problems, such as pesticide poisoningsuch as pesticide poisoning

Environmental Diseases and Environmental Diseases and InteractionsInteractions

Understand the type and nature of Understand the type and nature of exposureexposure

Acquire information about possible Acquire information about possible interactions including tobacco and interactions including tobacco and alcoholalcohol

Consider other health conditions that Consider other health conditions that could be aggravated, such as asthmacould be aggravated, such as asthma

Exposure Hazards: Biological, Exposure Hazards: Biological, Chemical, Enviromechanical, Chemical, Enviromechanical, Physical, PsychosocialPhysical, Psychosocial

Biological/infectious hazardsBiological/infectious hazards are caused are caused by infectious/biological agents, such as by infectious/biological agents, such as bacteria, viruses, fungi, or parasites that bacteria, viruses, fungi, or parasites that may be transmitted via contact with may be transmitted via contact with infected patients or contaminated body infected patients or contaminated body secretions/fluids, contamination of drinking secretions/fluids, contamination of drinking water supplies (improper sewage treatment water supplies (improper sewage treatment and solid waste disposal), and through the and solid waste disposal), and through the air (enhanced by improperly cleaned air (enhanced by improperly cleaned heating and cooling systems)heating and cooling systems)

Chemical hazards Chemical hazards are various forms of are various forms of chemicals that are potentially toxic or chemicals that are potentially toxic or irritating to the body system, including irritating to the body system, including medications, solutions, and gases. They medications, solutions, and gases. They include pesticides, (herbicides, fungicides, include pesticides, (herbicides, fungicides, insecticides, etc.) and other household and insecticides, etc.) and other household and industrial chemicals. Insecticides and industrial chemicals. Insecticides and herbicides used in large scale agriculture as herbicides used in large scale agriculture as well as in households, yards, and gardens, well as in households, yards, and gardens, bring about numerous health effects bring about numerous health effects ranging from nausea to long term ranging from nausea to long term neurological problems. Not only are many neurological problems. Not only are many insecticides and herbicides acutely toxic, insecticides and herbicides acutely toxic, but some are highly suspect carcinogensbut some are highly suspect carcinogens

Exposure Hazards: Biological, Exposure Hazards: Biological, Chemical, Enviromechanical, Chemical, Enviromechanical, Physical, Psychosocial Physical, Psychosocial contcont


Enviromechanical hazardsEnviromechanical hazards are factors are factors encountered in the work environment that encountered in the work environment that cause or potentiate accidents, injuries, cause or potentiate accidents, injuries, strain, or discomfort (e.g., poor equipment strain, or discomfort (e.g., poor equipment or lifting devices, slippery floors)or lifting devices, slippery floors)

Physical hazards Physical hazards are agents within the work are agents within the work environment, such as radiation, electricity, environment, such as radiation, electricity, extreme temperatures, and noise that can extreme temperatures, and noise that can cause tissue trauma through energy cause tissue trauma through energy transfertransfer


Psychosocial hazards Psychosocial hazards are factors and are factors and situations encountered or associated with situations encountered or associated with one’s job or work environment and personal one’s job or work environment and personal life experiences that create or potentiate life experiences that create or potentiate stress, emotional stress, and /or stress, emotional stress, and /or interpersonal problemsinterpersonal problems

Dose-response Relationship Dose-response Relationship

Dose-response relationshipDose-response relationship: as the dose : as the dose increases, the severity of effect increases increases, the severity of effect increases and could be fatal with pesticides and could be fatal with pesticides

High dose exposuresHigh dose exposures: may manifest signs : may manifest signs and symptoms almost immediately, making and symptoms almost immediately, making causal relationships more easily identified causal relationships more easily identified

Low dose exposuresLow dose exposures: over a period of time : over a period of time may manifest effects over a long latency may manifest effects over a long latency period, often months or years (e.g., cancer, period, often months or years (e.g., cancer, chemical sensitivity, neuropathy)chemical sensitivity, neuropathy)

Measures of Measures of Morbidity/Mortality of Morbidity/Mortality of Exposure Exposure

Incidence rates (i.e., number of new cases Incidence rates (i.e., number of new cases of illness/injury in the at-risk population of illness/injury in the at-risk population during a defined period) during a defined period)

Prevalence rates (i.e., all cases of Prevalence rates (i.e., all cases of illness/injury in the population at a point in illness/injury in the population at a point in time) time)

Be alert to possible clustering of pesticide Be alert to possible clustering of pesticide exposure cases through case identification,exposure cases through case identification,examination of dose-response examination of dose-response relationships, and population disease rate relationships, and population disease rate increases increases

Practice Skill IV:Practice Skill IV:Clinical Management of Clinical Management of Pesticide Exposure Pesticide Exposure

Basic Management Basic Management Techniques Techniques

Basic management of acute Basic management of acute pesticide poisoning includes skin, pesticide poisoning includes skin, eye, and gastrointestinal eye, and gastrointestinal decontamination, airway decontamination, airway protection, and control of seizuresprotection, and control of seizures

Basic Clinical Management Basic Clinical Management Techniques Techniques

Skin and Eye DecontaminationSkin and Eye Decontamination Shower patient, hair to toe with soap and Shower patient, hair to toe with soap and

water to remove chemical water to remove chemical Rubber gloves should be worn during Rubber gloves should be worn during

decontamination decontamination Remember to clean skin folds and under Remember to clean skin folds and under

fingernails fingernails Flush eyes with lots of clean water, 10 to 15 Flush eyes with lots of clean water, 10 to 15

minutes minutes Contaminated clothing should be removed Contaminated clothing should be removed

promptly and bagged promptly and bagged Avoid contact with contaminated clothing and Avoid contact with contaminated clothing and

body fluids body fluids

Basic Clinical Management Basic Clinical Management Techniques Techniques contcont

Gastrointestinal Decontamination Gastrointestinal Decontamination Techniques in management in Techniques in management in

pesticide poisoningspesticide poisonings– Gastric lavage Gastric lavage – CatharsisCatharsis– Activated charcoalActivated charcoal– Syrup of IpecacSyrup of Ipecac

Gastric LavageGastric Lavage Use only with ingestion of potentially Use only with ingestion of potentially

life-threatening amount of poison life-threatening amount of poison and if it can be done and if it can be done within 60 within 60 minutes of ingestion minutes of ingestion

Contraindicated Contraindicated in hydrocarbon in hydrocarbon ingestion ingestion



CatharsisCatharsis Use as a single dose to reduce harmful effects Use as a single dose to reduce harmful effects Sorbitol: 1-2 g/kg one time dose orSorbitol: 1-2 g/kg one time dose or

AdultsAdults: 70% sorbitol, 1-2 mL/kg : 70% sorbitol, 1-2 mL/kg ChildrenChildren: 35% sorbitol, 1.5-2.3 mL/kg: 35% sorbitol, 1.5-2.3 mL/kg

Contraindications: Contraindications: absent bowel sounds, absent bowel sounds, abdominal trauma or surgery, intestinal perforation abdominal trauma or surgery, intestinal perforation or obstruction, volume depletion, hypotension, or obstruction, volume depletion, hypotension, electrolyte imbalance, and ingestion of a corrosive electrolyte imbalance, and ingestion of a corrosive substance substance

Sorbitol is Sorbitol is not recommendednot recommended for poisoning with for poisoning with organophosphate, carbamates, arsenical diquat, or organophosphate, carbamates, arsenical diquat, or paraquat paraquat


Activated Charcoal Activated Charcoal Most effective if used within 60 minutes of Most effective if used within 60 minutes of

ingestion ingestion Dosage: Dosage:

Adults 12 years and olderAdults 12 years and older: : 25-100 g in 300-800 25-100 g in 300-800 mL of water mL of water Children under 12 yearsChildren under 12 years : 25-50 g : 25-50 g Infants under 20 kgInfants under 20 kg : 1g/kg: 1g/kg

Contraindications: Contraindications: unprotected airway, non-unprotected airway, non-intact gastrointestinal tract, increased risk for intact gastrointestinal tract, increased risk for aspiration of a hydrocarbon pesticide aspiration of a hydrocarbon pesticide


Syrup of Ipecac Syrup of Ipecac Check pesticide label to determine if induced Check pesticide label to determine if induced

vomiting is contraindicated vomiting is contraindicated Dosage: Dosage:

Adolescents and adultsAdolescents and adults: 15-30 mL followed : 15-30 mL followed immediately with 240 mL of water immediately with 240 mL of water Children 1-12 yearsChildren 1-12 years: : 15 mL preceded or followed by 15 mL preceded or followed by 120-240 mL of water 120-240 mL of water Infants 6 months to 12 monthsInfants 6 months to 12 months: : 5-10 mL preceded or 5-10 mL preceded or followed by 120 to 240 mL of water followed by 120 to 240 mL of water

Dose may be repeated if no emesis in 20 to 30 Dose may be repeated if no emesis in 20 to 30 minutes minutes

Contraindications: Contraindications: diminished airway protective diminished airway protective reflexes, ingestion of a corrosive material, ingestion reflexes, ingestion of a corrosive material, ingestion of a substance likely requiring life support within of a substance likely requiring life support within next hournext hour


Airway Protection Airway Protection Ensure clear airway Ensure clear airway Suction oral secretions Suction oral secretions Administer oxygen unless not Administer oxygen unless not

recommended (i.e., in paraquat recommended (i.e., in paraquat and diquat poisoning) and diquat poisoning)


Control of Seizures Control of Seizures Most patients respond to benzodiazepinesMost patients respond to benzodiazepines Lorazepam Lorazepam for status epilepticus: for status epilepticus:

AdultsAdults: : 2-4 mg/dose given IV over 2-5 2-4 mg/dose given IV over 2-5 minutes. Repeat as necessary to 8 mg in 12 minutes. Repeat as necessary to 8 mg in 12 hours hours AdolescentsAdolescents: : Same as adult with 4 mg Same as adult with 4 mg maximum maximum Children under 12 yearsChildren under 12 years: : 0.05-0.10 mg/kg IV 0.05-0.10 mg/kg IV over 2-5 minutes. Repeat as necessary 0.05 over 2-5 minutes. Repeat as necessary 0.05 mg/kg 10-15 minutes after first dose. mg/kg 10-15 minutes after first dose. Maximum of 4 mg Maximum of 4 mg


Control of Seizures Control of Seizures Diazepam Diazepam is often used for organochlorine is often used for organochlorine

poisonings poisonings AdultsAdults: : 5-10 mg IV, repeat every 5-10 minutes to 5-10 mg IV, repeat every 5-10 minutes to maximum of 30 mg maximum of 30 mg ChildrenChildren: : 0.2-0.5 mg/kg IV every 5 minutes to 0.2-0.5 mg/kg IV every 5 minutes to maximum of 10 mg in children over 5 years and maximum of 10 mg in children over 5 years and 5 mg in children under 5 years 5 mg in children under 5 years

Phenobarbital Phenobarbital may also be used may also be used Adults, children and infantsAdults, children and infants: : 15-20 mg/kg IV 15-20 mg/kg IV loading; 5 mg/kg IV every 15-30 minutes for a loading; 5 mg/kg IV every 15-30 minutes for a maximum of 30 mg/kg. Do not push drug faster maximum of 30 mg/kg. Do not push drug faster than 1 mg/kg per minutethan 1 mg/kg per minute

(cont)

Evaluation

Chlorophenoxy compound urine levels

Carcinogenic and Carcinogenic and Reproductive Effects of Reproductive Effects of PesticidesPesticides

Group A: Carcinogenic to Humans. All uses Group A: Carcinogenic to Humans. All uses of these pesticides have been cancelled of these pesticides have been cancelled except coal tar and chromium as a wood except coal tar and chromium as a wood preservative and ethylene oxide as a preservative and ethylene oxide as a fumigant fumigant

Group B: Probable human carcinogen. This Group B: Probable human carcinogen. This group is divided into subgroups B1 and B2: group is divided into subgroups B1 and B2: – B1: Positive in animal studies but limited B1: Positive in animal studies but limited

epidemiologic data. All uses of these pesticides epidemiologic data. All uses of these pesticides have been cancelled except creosote as a wood have been cancelled except creosote as a wood preservative and formaldehyde preservative and formaldehyde

– B2: Positive animal studies but inadequate or no B2: Positive animal studies but inadequate or no evidence from epidemiologic studies. All or most evidence from epidemiologic studies. All or most of the uses from this class have been cancelled of the uses from this class have been cancelled or were never approved; others have various or were never approved; others have various food and other uses food and other uses

Carcinogenic and Carcinogenic and Reproductive Effects of Reproductive Effects of Pesticides Pesticides contcont

Group C: Possible human carcinogen Group C: Possible human carcinogen in animals datain animals data

Group D: Not classifiable as to human Group D: Not classifiable as to human carcinogenicity carcinogenicity

Group E: Evidence of non-Group E: Evidence of non-carcinogenicity for humanscarcinogenicity for humans

(EPA) cont

(cont)

(cont)

(cont)

Practice Skill V: Practice Skill V: Reporting Pesticide Exposure Reporting Pesticide Exposure and Supporting Surveillance and Supporting Surveillance Efforts Efforts

Roles Of Selected Federal and Roles Of Selected Federal and State Agencies with regard to State Agencies with regard to Pesticide Exposure ControlPesticide Exposure Control

The Environmental Protection Agency (EPA) The Environmental Protection Agency (EPA) is the lead federal agency for regulation of is the lead federal agency for regulation of pesticide use under the Federal Insecticide, pesticide use under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA). Fungicide, and Rodenticide Act (FIFRA).

The Federal Food, Drug, and Cosmetic Act The Federal Food, Drug, and Cosmetic Act (FFDCA) is the basic food and drug law in (FFDCA) is the basic food and drug law in the U.S. and is administered by the Food the U.S. and is administered by the Food and Drug Agency (FDA). It establishes the and Drug Agency (FDA). It establishes the concept of a tolerance (the maximum concept of a tolerance (the maximum legally permissible level of residue at legally permissible level of residue at harvest) for pesticide residues in or on harvest) for pesticide residues in or on human food and animal feed. human food and animal feed.

Roles Of Selected Federal and Roles Of Selected Federal and State Agencies with Regard to State Agencies with Regard to Pesticide Exposure Control Pesticide Exposure Control contcont

EPA’s Worker Protection Standard is the EPA’s Worker Protection Standard is the regulation that applies to agricultural regulation that applies to agricultural pesticide handlers and field workers. It pesticide handlers and field workers. It includes requirements for warnings about includes requirements for warnings about pesticide applications, use of personal pesticide applications, use of personal protection equipment, restrictions on re-protection equipment, restrictions on re-entry into treated areas, decontamination, entry into treated areas, decontamination, emergency medical assistance, and emergency medical assistance, and pesticide safety training. pesticide safety training.

Report Pesticide Exposures as Report Pesticide Exposures as RequiredRequired

Know the mandatory reporting Know the mandatory reporting requirements in the state in which the requirements in the state in which the provider is practicingprovider is practicing

Report pesticide-related illness to the Report pesticide-related illness to the appropriate authorities, such as local appropriate authorities, such as local and state health departments and state health departments

Report and validate Workers’ Report and validate Workers’ Compensation claims as indicated in Compensation claims as indicated in each stateeach state

Practice Skill VI: Practice Skill VI: Providing Prevention Providing Prevention Guidance and Education to Guidance and Education to Patients Patients

Primary Prevention Strategies to Primary Prevention Strategies to Promote Health and Prevent Promote Health and Prevent Disease Among PatientsDisease Among Patients

For Individuals and Families: For Individuals and Families: Provide anticipatory guidance about signs, Provide anticipatory guidance about signs,

symptoms, and recognition of pesticide symptoms, and recognition of pesticide exposure, and safe use of pesticides exposure, and safe use of pesticides including hygiene practices, and protective including hygiene practices, and protective clothing (pamphlets, slides, etc.)clothing (pamphlets, slides, etc.)

Advise patients to read and follow label Advise patients to read and follow label directions on protective garb needed when directions on protective garb needed when applying pesticides around the home, applying pesticides around the home, garden, or yard. Long pants, a long-sleeved garden, or yard. Long pants, a long-sleeved shirt, and chemical-resistant gloves are shirt, and chemical-resistant gloves are generally recommendedgenerally recommended

Primary Prevention Strategies to Primary Prevention Strategies to Promote Health and Prevent Promote Health and Prevent Disease Among Patients Disease Among Patients contcont

For Individuals and Families:For Individuals and Families: Assess lifestyle factors and medications Assess lifestyle factors and medications

taken for interactions taken for interactions Counsel patients about minimizing Counsel patients about minimizing

unnecessary use of pesticides. Contact unnecessary use of pesticides. Contact local county cooperative extension local county cooperative extension services for informationservices for information

Discuss potential reproductive toxicity Discuss potential reproductive toxicity (e.g., teratogenic) effects related to (e.g., teratogenic) effects related to pesticide exposures pesticide exposures

Caution nursing mothers that pesticides Caution nursing mothers that pesticides may be excreted into mother’s milkmay be excreted into mother’s milk


For Workers: For Workers: Assess occupational exposure risk knowledgeAssess occupational exposure risk knowledge Provide anticipatory guidance about Provide anticipatory guidance about

pesticides to prevent exposures pesticides to prevent exposures Educate about signs/symptoms of pesticide Educate about signs/symptoms of pesticide

exposure exposure Discuss and demonstrate use of personal Discuss and demonstrate use of personal

protective equipment and clothing, (gloves, protective equipment and clothing, (gloves, face shields, aprons, boots) face shields, aprons, boots)

Teach patients to pay attention to specific Teach patients to pay attention to specific components of a pesticide label, including components of a pesticide label, including precautionary statements and "signal words" precautionary statements and "signal words" that indicate level of toxicitythat indicate level of toxicity


For Workers: For Workers: Teach patients about treating emergencies and Teach patients about treating emergencies and

first aidfirst aid Assess lifestyle factors/medications for Assess lifestyle factors/medications for

interactions interactions Discuss use of substitute pesticide formulations Discuss use of substitute pesticide formulations

that are less toxic that are less toxic Discuss need for washing facilities for Discuss need for washing facilities for

decontamination and removal of residues decontamination and removal of residues before eating or bathroom use before eating or bathroom use

Discuss avoidance of mixing/spraying during Discuss avoidance of mixing/spraying during windy conditions windy conditions

Discuss changing contaminated clothing at Discuss changing contaminated clothing at work, placing in separate bag, and washing work, placing in separate bag, and washing separatelyseparately

Individuals/Families: Individuals/Families: Provide information about emergency Provide information about emergency

procedures to be used if contamination procedures to be used if contamination occurs occurs

Discuss how to report exposures to Discuss how to report exposures to appropriate authoritiesappropriate authorities

Conduct screening tests to detect Conduct screening tests to detect pesticide-related exposure/illness (e.g., pesticide-related exposure/illness (e.g., cholinesterase, spirometry), including cholinesterase, spirometry), including baseline screening and after exposure baseline screening and after exposure

Prevent Exposure, Ensure Early Prevent Exposure, Ensure Early Detection, and Limit Effects of Detection, and Limit Effects of Illness Illness

Workers: Workers: Conduct worker screening tests (e.g., Conduct worker screening tests (e.g.,

cholinesterase, spirometry) to detect cholinesterase, spirometry) to detect pesticide-related exposure/illness. pesticide-related exposure/illness. Remove worker from exposure if Remove worker from exposure if neededneeded

Advise workers to carry water Advise workers to carry water attached to tractors and know attached to tractors and know emergency procedures for emergency procedures for decontamination decontamination

Prevent Exposure, Ensure Early Prevent Exposure, Ensure Early Detection, and Limit Effects of Detection, and Limit Effects of IllnessIllness contcont

Population-Based: Population-Based: Work with local agricultural extension office, Work with local agricultural extension office,

agro-universities, local grain/pesticide agro-universities, local grain/pesticide sellers, health care practitioners, farm sellers, health care practitioners, farm bureaus, garden shops, plant nurseries, bureaus, garden shops, plant nurseries, manufacturers, distributors, etc. in manufacturers, distributors, etc. in prevention strategy development prevention strategy development

Develop network for new work opportunities Develop network for new work opportunities Work with community groups (e.g., schools, Work with community groups (e.g., schools,

PTA, churches, migrant groups, farm PTA, churches, migrant groups, farm associations, etc.) to identify environmental associations, etc.) to identify environmental justice issues, and to discuss and advocate justice issues, and to discuss and advocate for prevention strategiesfor prevention strategies

Prevent Exposure, Ensure Early Prevent Exposure, Ensure Early Detection, and Limit Effects of Detection, and Limit Effects of IllnessIllness contcont

Contact InformationContact Information

Leyla Erk McCurdyLeyla Erk McCurdySenior Director, Health & EnvironmentSenior Director, Health & EnvironmentNational Environmental Education & Training National Environmental Education & Training

Foundation (NEETF)Foundation (NEETF)Email: [email protected]: [email protected]: 202.261.6488Phone: 202.261.6488

NEETF is tracking pediatric environmental healthNEETF is tracking pediatric environmental healtheducation activities for health care providers and education activities for health care providers and

requests your feedbackrequests your feedback

http://www.neetf.org/healthhttp://www.neetf.org/health

National Pesticide Practice Skills Guidelines for Medical & Nursing Practice Bonnie Rogers, DrPH,...

Documents

Transcript of National Pesticide Practice Skills Guidelines for Medical & Nursing Practice Bonnie Rogers, DrPH,...