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 toxics

  • 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 toxics

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 toxicsGreen 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 toxics

  • Mercury

  • Cleaners and disinfectants

  • Gludaraldehyde

  • ETO

  • Xylene

  • Formaldehyde

  • Flame retardants

  • PVC and DEPH

  • Other environmental hot buttons


Mercury health concerns
Mercury Health Concerns toxics

  • 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



Fda advisories
FDA Advisories toxics

1 | Mercury


Hg in hospitals

Obvious toxics

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 toxics

  • 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 toxics

  • 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 toxics

  • 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 toxics

  • 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 toxics

  • Histology Fixatives

  • Histology Stains

  • Antibodies

  • Parasitology Fixatives

  • Automated testing equipment reagents

  • Bleach (contaminant)


Lab mercury strategy
Lab Mercury Strategy toxics

  • 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 toxics

  • 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 toxics

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 toxics

  • 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 toxics

  • Who still uses this?

  • Bonus question:

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

  • 10 reasons to eliminate


ETO toxics

  • 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 toxics

  • 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 toxics

  • 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 toxics

  • 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


  • 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 devices

  • 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 devicesGreen 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 devices

  • 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 devices

  • 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 devicesKS H2E Contact Information

Nancy Larson

800-578-8898

316-722-7721

[email protected]

www.sbeap.org

H2E and circuit rider intern program, sign up today


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