First do no harm identifying and eliminating healthcare toxics
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First do no harm – identifying and eliminating healthcare toxics. Nancy Larson Pollution Prevention Institute Hospitals for a Healthy Environment Champion December 6, 2007. Mission of Healthcare.

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First do no harm identifying and eliminating healthcare toxics

First do no harm – identifying and eliminating healthcare toxics

Nancy Larson

Pollution Prevention Institute

Hospitals for a Healthy Environment Champion

December 6, 2007


Mission of healthcare

Mission of Healthcare

  • Prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical, nursing, and allied health professions.

First, do no harm.


The environmental footprint of a hospital

Inputs

Outputs

Healthcare Organization

The Environmental Footprint of a Hospital

The impact of an organization in environmental terms

  • Resource use

  • Waste generation

  • Physical environmental changes


Work with or create a green team

Work with (or create!) a Green Team

  • Waste Managers

  • Facilities Managers

  • Laboratory Managers

  • Nursing

  • Housekeeping

  • Infection Control

  • Clinical staff

    Initiatives will proceed smoothly, be more accepted by end users if you involve them throughout, plus you need their information!


Identifying toxics

Identifying toxics

  • Mercury

  • Cleaners and disinfectants

  • Gludaraldehyde

  • ETO

  • Xylene

  • Formaldehyde

  • Flame retardants

  • PVC and DEPH

  • Other environmental hot buttons


Mercury health concerns

Mercury Health Concerns

  • Mercury is a known and ubiquitous hazard

  • Persistent, Bioaccumulative & Toxic

  • CDC: 1 in 12 women of childbearing age risk giving birth to infants with neurological disorders due to mercury exposure in-utero.

1 | Mercury


Mercury circulation in the environment

Mercury circulation in the environment


Fda advisories

FDA Advisories

1 | Mercury


Hg in hospitals

Obvious

Less Apparent

  • Thermometers

  • Sphygs

  • Cantor, Miller-Abbott tubes

  • Esophageal bougies

  • Laboratory chemicals

  • Thermostats

  • Fluorescent lamps

  • Batteries

  • Dental amalgams

  • Caustic soda

  • Laundry chemicals-bleach

  • Antibacterial soaps

  • Boiler & air conditioning chemicals

  • Reagents

  • Plastics

Hg in Hospitals

  • Know where it is:

    • Clinical, facility, and laboratory sources

1 | Mercury


Roadblocks

Roadblocks

  • Mercury is viewed as the “gold standard”

  • Multi-discipline effort

  • Cost

  • Not a regulatory requirement

1 | Mercury


Mercury in building supplies

Mercury in Building Supplies

  • Thermostats,Thermometers, Switches, Relays contain mercury

  • Gas and Water Flow Meters, Float Switches can contain gallons of mercury

  • Strategy:

  • Specify or request Hg-free alternatives for all new and replacement parts (available for most applications)

  • Label and require proper handling of Hg-containing equipment currently in use


Mercury in lighting

Mercury in Lighting

  • ALL fluorescent and HID lamps contain mercury

  • Est. 620 million discarded per year in US =

    2-4 tons of mercury

  • “Green tip” – can have same Hg content as a standard lamp


Mercury lighting strategy

Mercury Lighting Strategy

  • Use fluorescents to reduce power consumption - reduces Hg emissions

  • Require disclosure of mercury content and choose lower mercury lamps wherever possible

  • Recycle ALL fluorescents and HID lamps


Mercury in the laboratory

Mercury in the Laboratory

  • Histology Fixatives

  • Histology Stains

  • Antibodies

  • Parasitology Fixatives

  • Automated testing equipment reagents

  • Bleach (contaminant)


Lab mercury strategy

Lab Mercury Strategy

  • Eliminate B5, Zenkers and others with readily available alternatives

  • Require vendor mercury disclosure for all products

  • Identify high mercury or easily replaced products

  • Prioritize list and develop schedule

  • to replace as you can


Hidden mercury

Hidden mercury

  • Tilt switches

  • Pressure regulators

  • Flat panel screens

  • Preservatives in pharmaceuticals

  • Fire detection devices

  • Neon lights

    Strategy:

    Require ALL vendors to certify products mercury free or disclose mercury content, and establish a mercury free preference


Greener janitorial chemicals

“Greener” Janitorial Chemicals

Why be concerned about Cleaners?

  • Asthma risk

  • Occupational skin/eye injuries

  • Indoor Air quality

  • Training/Worker protection costs

  • Patient and staff comfort

  • 35% of cleaning chemicals can cause blindness, severe skin damage or damage to organs through skin. 6%

  • are linked to cancer, ozone depletion

  • or global warming


Green cleaning strategy

Green Cleaning Strategy

  • Involve all interested parties:

    • Infection Control, Nursing, Purchasing, Housekeeping/Environmental Services, staff with occupational health issues

  • Look for certification

    • Green Seal or equivalent -- require verification!

  • Address routine cleaning first

    • Disinfection issues are more complex, may take more work


Glutaraldehyde

Glutaraldehyde

  • Who still uses this?

  • Bonus question:

    • What carcinogenic disinfectant did it replace in the 1960’s?

  • 10 reasons to eliminate


First do no harm identifying and eliminating healthcare toxics

ETO

  • How many still use?

  • Air permitting concerns

    Sparrow Health System, Lansing, MI:

  • ETO alternative system reduces per cycle cost from $25 to $0.40

  • Alternative available including:

    • Sterrad

    • Steris


Xylene

Xylene

  • Xylene and alcohols used in tissue processing

    • Many go to the drain now?

    • RCRA hazardous waste – listed and ignitable

      H2E Award Winner

  • Recycled 520 gallons of formalin with disposal and purchase savings of $5,700

    H2E Award Winner

  • Recovered 260 gallons of xylene with $5,800 net savings per year


Formalin

Formalin

  • Used in tissue preservation

  • Is it going to the drain?

  • Problems with aquatic life in our streams?

  • Minimize use, recycle and look for alternatives


Flame retardants

Flame retardants

  • What are they and which ones are a problem?

    • Chlorinated or brominated FR

    • Polyurethane foam, textiles, and electronics

  • Request materials that do not contain the halogenated flame retardants


First do no harm identifying and eliminating healthcare toxics

  • Poly-vinyl chlorides and Di-ethylhexyl phthalate medical devices

  • DEHP is a reproductive toxicant.

  • Some DEHP-containing medical devices expose patients to DEHP.

  • FDA says neonatal males, fetuses, and peripubertal males with prolonged DEHP exposure may be at highest risk for adverse effects.


Dehp free alternatives

DEHP-Free Alternatives

  • Blood bags

  • Catheters and PICC Lines

  • Peritoneal & urinary catheters

  • Enteral & TPN feeding sets

  • Epidural vessel catheters

  • IV Bags and tubing

  • Infusion tubing

  • Respiratory therapy products


Work with or create a green team1

Work with (or create!) a Green Team

  • Waste Managers

  • Facilities Managers

  • Laboratory Managers

  • Nursing

  • Housekeeping

  • Infection Control

  • Clinical staff

    Initiatives will proceed smoothly, be more accepted by end users if you involve them throughout, plus you need their information!


Preparing for epp action

Preparing for EPP Action

  • Start with a product that is already causing environmental/health/cost problems

  • Include users when researching alternatives

  • Set specific performance and environmental criteria, with verification measures for each

  • Investigate availability and price of alternatives

  • Pilot alternative in willing department—find a champion


Tracking purchasing progress

Tracking Purchasing Progress

  • Tracking validates your EPP effort:

    • Total cost comparison with less preferable products

    • Volume of toxic materials, waste avoided

    • Ask GPO for EPP tracking

  • Require reporting by Vendors:

    • Specify information you want reported

    • Require annual or quarterly reporting

    • Publicize results to upper management


Pollution prevention institute ks h2e contact information

Pollution Prevention Institute KS H2E Contact Information

Nancy Larson

800-578-8898

316-722-7721

[email protected]

www.sbeap.org

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