first do no harm identifying and eliminating healthcare toxics n.
Download
Skip this Video
Download Presentation
First do no harm – identifying and eliminating healthcare toxics

Loading in 2 Seconds...

play fullscreen
1 / 31

First do no harm – identifying and eliminating healthcare toxics - PowerPoint PPT Presentation


  • 124 Views
  • Uploaded on

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.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'First do no harm – identifying and eliminating healthcare toxics' - curry


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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

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
slide20
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
slide24
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

NLarson@ksu.edu

www.sbeap.org

H2E and circuit rider intern program, sign up today

ad