1. IPM for School Nurses What’s Bugging Us... & How to Make them STOP! Lyn Garling PA IPM Program Penn State University

2. Risks of pests and pesticides How IPM reduces risks & gives better results Identify and safely resolve school pest issues – “What’s Biting Me?” – Dealing with Bed bugs in schools Q&A Overview 2

3. 7 Principles of a “Healthy Home” Keep it: Ventilated Dry Clean Safe (injuries) Maintained Contaminant-free Pest-free

4. Pests may include critters that may: “Bite”, itch or sting Trigger asthma Spread diseases Be a simple nuisance! FEAR.... NOT!! IPM to the rescue..!

5. Pesticides Chemicals that are made on purpose to be toxic – Acute and chronic health effects – Special sensitivity of children – Commonly used indoors for decades Tend to treat symptoms vs causes Tend to use as “first resort” for pests

6. PA IPM Program, PSCIP 6 What is IPM? Integrated Pest Management (IPM) is an approach to controlling pests in the safest, most effective, and longer-lasting ways. IPM Methods: understand a pest's identity and habits focus on pest PREVENTION use a combination of different tactics for best results if chemicals are needed, choose least-risky products COMMUNICATE with everyone to resolve problems

7. PA IPM Program, PSCIP 7 Find out what it is AND Understand its life cycle and needs. IPM = Proper Diagnosis Mosquito life cycle Cockroach life cycle

8. PA IPM Program, PSCIP 8 IPM = Determine Scope of Issue Find out how many and where they are. How many are too many in this spot?

9. PA IPM Program, PSCIP 9 IPM is Pest “CSI”! Decide what to do based on this knowledge.

10. 1. Keep Pests Out Check screens for rips, tears, and holes. Fill all holes like these… 10

11. 2. Remove Pests’ Food & Water 11

12. 3. Remove Pests’ Shelter Clutter provides lots of hiding spots AND covers up evidence of a growing problem. Yes, that is a roach. 12

13. 4. Monitor for Pests DON’T WAIT FOR THIS!  USE AN EARLY WARNING SYSTEM!  13

14. PA IPM Program, PSCIP 14 How do we do IPM? PREVENT 1. Keep Pests Out 2. Remove Pests’ Food & Water 3. Remove Pests’ Shelter KEEP WATCH 4. Monitor for Pests ELIMINATE 5. Take appropriate action for existing pest problems COMMUNICATE – pests move and react! Routine Monthly Spraying is NOT Part of IPM

15. Eliminate Pests with IPM Selects most effective, least-risky protocols for the situation at hand Big Toolbox! = – Design/Maintenance – Physical/Mechanical – Biological – Chemical (Pesticides)

17. 17 What is a Pesticide? “_____ - cide” means “to kill” Rodenticide (kills rodents) Insecticide(kills insects) Herbicide(kills plants) Anti-microbials(kills microorganisms) Triclosan in detergents, soaps = not needed 17

18. Types of chemical hazard Toxic Flammable Corrosive Reactive Compressed gas (explosive)

19. RISK = TOXICITY x EXPOSURE Reduce Exposure by looking at the formulation of product and how it’s used can this be used without exposure? can it be mistaken for food/drink? Reduce Toxicity by choosing less toxic ones look at signal word on the container look up the active ingredient 19

20. Formulation of Pesticides “Formulation” = what product forms & mixtures are for sale Products can vary by: - Type of chemicals mixed into product - Type of medium used (aerosol, liquid, solid) - Mix or Ready-to-use (concentrate, dilute) - Type of “packaging” (kid-proof containers) 20

21. YELLOW formulations: Enclosed baits Gels Pellets & granules for insects** ** Hazardous to children – may mistake for food item 21

22. RED formulations: Aerosols Foggers Liquid concentrates Ready to use liquids & sprays Poisons for rodents 22

23. PA IPM Program, PSCIP 23 Reduce Exposure Risk? USENOT Traps and Baits Sprays and Foggers Less Risky More Risky

24. Reduce Toxicity? Look on the container for: Signal word Active ingredient(s) Directions for use Special precautions 24

25.  Signal Word Source: PSU Pesticide Education Program Active Ingredients  25

26. Aviso Precaución Peligro Veneno del Peligro Highly hazardous DANGER POISON DANGER WARNING CAUTION Severe Eye Damage or Skin Irritation Slightly hazardous Moderately hazardous Understanding ‘Signal Words ’ Source: PSU Pesticide Education Program 26

27. Read the Label First! ONLY 1 out of 4 People read the label ! 27

28. A COMPARISON OF DETECTION FREQUENCIES OF SELECT INSECTICIDES FROM THE AHHS HOMES (2005-2006) & CHILD CARE CENTERS (2001) a Tulve NS, Jones PA, Nishioka M, Fortmann RC, Croghan CW, Zhou JY, Fraser A, Cave C, Friedman W. (2006). Pesticide Measurements from the First National Environmental Health Survey of Child Care Centers Using a Multi-Residue GC/MS Analysis Method. Environ Sci Technol 40(20):6269-74.

29. Child Care setting

30. Teacher desk drawer This is ILLEGAL

31. Treat Existing Pest Problems Safely Example: Mice Indoors – Use traps first Poison baits are more risky & “stinky” because mice die inside walls! If any used, put in tamper-proof boxes 31

32. Pest CSI: Place the mousetrap along the wall so the mouse can access the food from either direction 32

33. IPM Plan IPM Coordinator IPM Advisory Cmte Record-keeping system 72 hr notification of pesticide application No application w/in 7 hrs PA Schools, IUs, VoTechs must have:

34. IPM Coordinator AdminFacilities Custodial Staff & Faculty Nurses Students School IPM Team

35. Identify and safely resolve school pest issues : “What’s Biting Me?” Dealing with Bed bugs in schools

36. Got Mystery Itch? What Can Bite Me? Mites (chiggers, scabies) Ticks Spiders (~rare; few are medically significant) ======================================= Lice (head and pubic) Bed bugs Fleas Flies (mosquitoes, blackflies, no-see-ums) However, arthropods typically do NOT cause a biting, burning or skin-crawling sensation.

37. What Can NOT Bite Me? Don’t exist Paper mites Sand “fleas” Can’t bite people Springtails Dust Mites Cockroaches Gnats

38. What else causes Mystery Itches? Low humidity Drugs - prescription, over-the-counter, and illegal (e.g. antibiotics, aspirin, cocaine) Other medical conditions (e.g. eczema, nutritional deficiencies, shingles, MRSA) Environmental exposures (e.g. chemicals, cosmetics, disinfectants, detergents, perfumes) Stress Don’t spray pesticides, or apply skin repellants or remedies until a positive pest ID has been made!

39. “Chiggers” Trombicula spc. Outdoors on vegetation Almost microscopic Larval stage feeds on skin of many species They do not – Burrow in/under – Feed on blood – Lay eggs in skin Early summer mostly

40. Chigger having lunch Make small hole & inject an enzyme Enzyme breaks down skin and they feed on it You can’t feel it or see it Can feed for 3-5 days Itching 24-48 hr later Drop off and go away to develop into nymph As adults, eat other small critters & plants

41. Chigger bites Intensely itchy bc of enzymes..

42. Dealing with chiggers DO – Tuck pant legs into socks – Wear rubber boots – Loose fitting clothes (they bite by constrictions) – Dust shoes/socks w. sulfur dust – Treat bites with topical corticosteroids or antihistamines – Repellents on clothes may help DON’T – Spray the yard – Treat bites w. nail polish

43. Scabies mite: Sarcoptes scabiei Females burrow under the skin & lay eggs Larvae tunnel around Intense, allergic itching 1 st “Infestation” may not show up for 2 mo. Don’t survive more than 2-3 days off host Spread by prolonged skin-to-skin contact; clothing, bedding

44. Typical distribution / “bite” type SEEK MEDICAL ATTENTION

45. Ticks ~25 spcs in PA Most commonly ID’d – American dog tick (RMSF) – Blacklegged tick (Lyme) – = “deer tick” – Lone star tick – Ground hog tick Photos: Steve Jacobs PSU

46. Takes 24 hr attachment to transmit Lyme spirochete SE PA, North Central; Presque Isle

47. Prevention of Tick BItes DO Wear light colored clothing, long sleeves Tuck pant legs into socks Stick to the beaten path Keep tall vegetation down Inspect body after hike Repellents may help DON’T Spray all over outdoors Use pesticide impregnated clothing

48. Dealing with Tick Bites Remove tick w. firm upward pressure close to its head. Get positive ID of the tick. If you see this, seek medical help.

49. Got Hitchikers???   

50. The Hitchhikers Head Lice Infest the scalp, live there Cannot survive off head Eggs will not hatch off head Transmission by head-to head contact Bed Bugs Do not “infest” people Suck blood then hide away Eggs can hatch anywhere Transmission by hitchhiking on stuff or walking

51. Three Types of Human Lice Head lice – Live on head and neck, cement their eggs to hairs on scalp. Body Lice – Live mainly in clothing except when feeding. Lay eggs in cloth seams. This DOES transmit disease (Typhus). Crab Lice - Found mainly in pubic hairs or chest and armpit hairs. Eggs attached to hairs.

52. Head lice

53. Head lice are adapted to living in hair & gripping skin.

54. Nits are cemented to the hair shaft

55. Head lice bite, inject saliva w/anticoagulant; eat small amounts of blood every few hrs Their chompers up close.

56. Biology of head lice Lice feed on blood about every four hours. Lice cannot jump or fly. If a louse is injured (by combing for example), the louse usually dies. Older nymphs and adult head lice quickly transfer from head to head, through direct contact among people. Life span on the head is about 30 days after hatching. About 80 eggs laid per female.

57. Lice cycle of the head louse 

59. Prevention & Control of Headlice Don’t have close physical contact with those affected. Avoid sharing clothes, hats, combs, pillows, etc. Lice die if not in contact with humans for 1-2 days = no need for sprays or foggers. Control begins on the person, with combing. Botanical and enzyme shampoos with combing are the best tools.

60. Lice combs

61. Pediculicides Shampoos that contain pesticide ingredients (permethrin, lindane) or solvents, are applied to the scalp. Perhaps these should be a last line of defense, esp on children (?!) Combing and use of an essential oil-based product or “Cetaphil” can be very effective. Certain heat treatments..

62. Promising New Lice Therapy Hot air may represent a safe and effective way to eliminate head lice according to a study published in Pediatrics in 2010 The custom built “Lousebuster” resulted in 100% elimination of eggs and 80% mortality of hatched lice. Nearly all subjects were cured of their infestation at one week follow up. The authors conclude that a 30-minute application of hot air is a safe and effective way to o treat lice.

63. Uninvited Bed Mates???!

64. Photo: Changlu Wang Understanding Bed Bugs

65. Bed bugs pierce the skin w. beak and suck blood till full, then run off & hide. Can go up to a yr without feeding.

66. Misidentification is Common Organisms commonly mistaken for bed bugs.

67. Reactions to Bites Vary Bed bug bites on a woman’s leg. Photo from www.bedbugger.com.

68. Bites Bed bugs prefer to bite without crawling onto host 1 st bite requires 10-14 days for immune reaction, later bites react faster Rows of bites

69. Why Bites are in Rows

70. Bed bugs and head lice do not carry diseases, but do have health effects. Itchy or painful welts on the skin or scalp Secondary skin infections from scratching Bed bugs likely trigger asthma and can cause anemia

71. Bed bug bites Bite is nearly painless, like a mosquito. The saliva injected produces an inflammatory reaction, like mosquitoes. Reaction time may be delayed by 2+ days. Itchy welts are larger than mosquito and flea bites, and size may depend on size of bug that bit you. Many people have no reaction at all to bites.

72. Bed bug eggs Female lays 1-5 eggs a day Female lays 200-500 total Eggs hatch in 6 to 10 days

73. Bed bug biology A blood meal is required for each molt but nymphs may feed very frequently Under good conditions (85˚F, 75%rh) the life cycle can take 4 to 5 weeks Although cooler conditions lengthen the life cycle, some may acclimate to cold Adults can live 6 -12 months and nymphs up to 3 months without a meal

74. Fecal spots – tarry tan or dark brown/black, raised or soaked into cloth

75. Bed bug habits Active at night but if seen during the day – probably a massive infestation! Prefer living in crevices close to the host Live in loose groups, aggregations, not “nests” Have an aggregation pheromone Will travel good distances to locate a host They can run fast, but do not jump or fly Reportedly can fall from ceiling onto host

76. Methods of bed bug introduction Passive Bed bug is introduced from another infested location, by being transferred on: Furniture Mattresses Guests Employees Forms of travel Bags, coats, shoes Active Bed bug migrates by walking from an infested area. From one room to another From one apartment to another via pipes, telephone or cable wires. Down a hallway after dropping of an item being discarded.

77. Bed bugs can actively move through a building. Photo by Rick Cooper, Cooper Pest Solutions

79. Insecticides are not enough to control bed bugs Allowed insecticides are not as toxic as yrs ago Contact with the bed bug is needed for kill. Treatments must be made knowing exactly where all the bugs are hiding. Many bed bugs can survive insecticides. Other bed bug management methods are needed, in addition to chemicals.

80. Tactics for treating bed bugs – Interceptors – Mattress covers – Vacuuming – Steam cleaning – Heat /Cold Treatment Eggs are the most difficult life stage to kill with chemicals – but heat & steam will do it!

81. “Interceptors” – CLIMBUP  Insect Interceptor – Serves for monitoring and as a barrier! – Petroleum Jelly (not as good) – Other

82. Steam Cleaning Steam temperature (at the bed bug) must be 120 degrees F or greater Some say HIGHER The steam head must not be too small Steam will kill bed bugs and their eggs Steaming is slow and labor intensive Upholstery and bedding can disperse steam heat

83. Pesticides IMPORTANT: You CANNOT PREVENT bed bugs by spraying chemicals “in advance”. Sprays, liquids, aerosols have to be still wet and touch the bed bugs to kill them. Some DUSTS may have ability to damage bed bugs’ “skin”. Must be used properly & carefully - in cracks, crevices, behind wall voids, switch plates - NOT ON BEDS.

84. Don’t use foggers! “Total Release Foggers” Don’t kill bed bugs* Create toxic fog Do not penetrate well Leave residues Many bugs resistant to the chemicals in foggers *Some advertising on fogger boxes says “Kills bed bugs on contact.” They DON’T.

85. Other things that don’t work: Bed legs in kerosene or gasoline Thyme oil, other home remedies Abandoning the area for a period of time Turning up the heat (use a professional for heat) Leaving the lights on – hungry bugs will feed anyway Discarding old and buying new furniture Wrapping items in plastic and placing in the sun Vacuuming only, insecticide only

86. Areas packed with stuff are very good for bed bugs (and other pests). Photos by Rick Cooper, Cooper Pest Solutions

87. Maintenance/Repair Mechanical Physical Chemical Pyramid of IPM tactics for Bed Bugs Toxicity Increasing >>> Intervention Prevention De-clutter, caulk, wash bedding Mattress covers, climb-ups Heat, steam, vacuum Contact pesticides Diatomaceous earth (DE) dust

88. Reality is: Bed bugs are beginning to show up in K-12 schools (as well as colleges) They show up in child care facilities. Taxis, offices, hospitals, nursing homes… They probably appear in movie theaters, airplanes, and trains. Do they reproduce in these places?

89. Introductions vs Infestations Infestations not common Schools are inhospitable to bed bugs due to lack food sources at night No known established breeding populations in schools (except boarding schools) Introductions may become common Backpacks, books, clothing wheelchairs going from home to school provide harborage and transport (staff, students, faculty)

90. Finding Bed Bugs- K-9 Scouts Dogs are excellent detectors but expensive and special labor needed Can distinguish between live and dead bed bugs and single eggs We do not know if they can find “a single egg in a drop ceiling”. PMP should verify the dog’s findings Jada (Advanced K-9 Detectives) sniffs for bed bugs in Manhattan Scout in Long island

91. Homemade CO2 Monitor for BB

92. Effective Practices/Policies? Accurately identify all suspected specimens. Notify all parents of children using the room. Provide with basic info: detection in schools, resolve infestations in homes. Inspect room, careful follow up Cleaning/vacuuming of room if necessary. Reduce clutter. Isolate student belongings - in clear plastic bags? No need for residual insecticide use in schools

93. When a child arrives at school with bed bugs. Develop a protocol for this situation. Suggestions: – Once noticed, child goes to health office – Health office keeps simple change of clothes for kids (scrubs) – Place child’s belongings in the dryer on high for 30-60min – shoes, coat, clothes, book bag. – Send information home with child to parents about bed bugs and help available.

94. Engage the school community Education and awareness reduces TABOO and enables early detection at home. Educate the school community – hold an evening workshop for parents about bed bugs. Develop or adopt educational resources to be sent home with all kids.

95. IPM Coordinator AdminFacilities Custodial Staff & Faculty Nurses Students School IPM Team

96. Integrated Pest Management Ideal for both bed bugs and lice because: – Insecticides alone will not eliminate either pest. – Both pests have a social factor – those affected must be involved in their control – Education and awareness leads to early detection which makes both pests easier to control. IPM is based on education and awareness.

97. Thank you very much. More information at: http://extension.psu.edu/ipm