Sustainable Healthcare

1. Sustainable Healthcare Wendi Shafir US EPA Region 9 June 2010

2. Outline Outline • Why Healthcare? • Environmental Concerns • Opportunities and Priorities • Resources Sustainability – definition

3. Sustainability – what does it mean? “Meeting the needs of the present without compromising the ability of future generations to meet their needs”

4. Sustainability – 3 Aspects Economic Equity Environmental

5. Why Healthcare ? • Large environmental footprint • Many opportunities – waste, toxics, energy, water • Purpose – First do no harm - Provide healing environment

6. Health Care Footprint • 1 of every 7 dollars spent • Energy ~ $6.5 billion each year • Medical Incinerators • 3rd largest source of dioxin • 4th source of mercury emissions • 50X more mercury in medical waste • Water – often largest users in community • Over 2 million pounds of waste per year

7. Reduces costs Improves efficiency Reduces environmental impacts Improves human health Reduces liabilities Benefits

8. Environmental Concerns • Air Pollution • Trash • Water Pollution • Water Shortage • Energy Usage • Toxic Chemicals

9. Waste in Healthcare

10. Toxics in Healthcare ?

11. Toxics in Healthcare • Sterilants and Disinfectants • Mercury and other PBTs • Pesticides • Cleaning Chemicals • Laboratory Chemicals • Radiologicals • Pthalates

12. PVC, DEHP, Pthalates • In many medical products for flexibility, ex. IV bag, tubing • DEHP: Developmental toxicant • Dioxins– from production and incineration • DEHP leaches from the PVC • FDA recommends use of alternatives to DEHP when exposures may be excessive (esp. neonates)

13. Mercury in Healthcare • Medical Devices • Thermometers • Sphygmomanometers • Dental Amalgam • Cantor, Miller Abbot, Dennis tubes • Building Products • Thermostats • Many switches • Boiler Guage controls • Fluorescent Bulbs

14. Mercury • Toxic effects- Long term exposure can permanently damage brain, kidneys and developing fetus • Health care industry a major consumer • Persistent, Bioaccumulative, Toxic = PBT

15. Mercury Toxicity – Fish Connection

16. Pharmaceuticals • Emerging Issue • Water Quality Impacts – • Human - Reuse • Aquatic species • Many pharmaceuticals in lakes & rivers

17. Now we know why - What can we do ?

18. Waste Reduction Improved Pharmaceuticals Management Mercury / Toxics Reduction Recycling Energy / Water Efficiency Healthy Food Opportunities

19. Waste Reduction Strategies • Waste Characterization • Waste Segregation Best Practices • Minimization of Infectious/Biohazard Waste • Paper Management • Recycling • EPP for Waste Minimization

20. Pharmaceuticals • Pharmaceutical Waste Management & Minimization Plan • EPA, State guidance • Swedish model – change prescribing patterns

21. Mercury and Toxics Reduction • Mercury: Inventory and eliminate • Less toxic cleaning products • Less toxic sterilants + disinfectants • Distill and reuse lab solvents & fixatives

22. Mercury Eliminationa Primary Goal • 100s of hospitals virtually eliminated it • Many state/local programs • Dental opportunities as well • Eliminate through: • Substitution • Elimination • Environmentally Preferable Purchasing

23. Mercury Reduction – How to • Mercury Reduction 10-step guide • http://cms.h2e-online.org/ee/hazmat/hazmatconcern/mercury/10step/ • Reducing Mercury Use in Health CarePlan • http://www.sustainablehospitals.org/HTMLSrc/IP_Mercury.html • Mercury Assessment Tool • http://www.cdph.ca.gov/certlic/medicalwaste/Pages/HospitalPollutionPrevention.aspx

24. Alternatives to DEHP • There now are effective alternatives • PVC-free/ Non-PVC • DEHP-free / Non-DEHP • Assessment tools and alternatives lists • http://www.hcwh.org/us_canada/issues/toxins/pvc_phthalates/ • http://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi?px=M

25. Why? Sustainable Food in Healthcare • Support patient, staff and visitor health • Educate patients, community • Provide healthier food (Farmer’s Markets) to community • Combat Antibiotic Resistance • Reduce food production’s environmental footprint • Energy, water, pesticides, soil conservation, fishery depletion

26. Healthy Food in Healthcare Pledge • From Healthcare Without Harm (www.noharm.org) • Sample Language provided • Over 250 hospitals have signed up • Healthcare without Harm – provides resources • American Medical Association (AMA) approved a policy resolution in support of sustainable food health care systems

27. HOW? Food Policies • Locally sourced foods • Hormone/antibiotic free animal products,rBGH Free Dairy • Sustainably harvested foods, fair trade • Organic and other certified food

28. What else can you do? • Healthier vending machines • Serve meals lower on the food chain - less meat, vegetarian options • Healthy Cooking Classes and demonstrations • Sustainable Food service – energy, water, waste • Farmers Markets • Onsite Gardens

29. Paper Reduction • Copy & print double-sided • Go Paperless - electronic records • Fewer Copies • Recycle office paper separately • Recycling can still be HIPPA compliant!

30. More Recycling ! Reduce costs, generate revenue Cardboard, paper, glass, plastic Sterile Blue Wrap – new pilot in N. CA

31. Electronics • FEC, EPEAT, Energy Star • Both purchasing and disposal important • UNIVERSAL Waste • Reduced disposal costs • Reduced energy costs

32. Environmentally Preferable Purchasing or EPP • Selecting products or services that have a lesser or reduced effect on human health and the environment • All Areas – medical, surgical, office supplies, maintenance, etc. • Group Purchasing Organizations (GPOs) provide leverage, efficiency for EPP

33. Other Opportunities • Water Conservation • Energy Conservation • Renewable Energy • Green Building • Dental

34. Purchasing Housekeeping Nursing Food Service Facilities Administrative Pharmacy A Role for Everyone

35. What Can You Do at Your Hospital? • Listen and learn today • Identify some things to work on • Make a commitment to just one! • Get support – co-workers, mgmt. • Imagine, if we all do this…

36. From sustainablematerials2020.com

37. The End Wendi Shafir USEPA Region 9 Shafir.wendi@epa.gov 415-972-3422