Hospitals for a Healthy Environment G etting Started Using the H2E Ten Step Guides

1. Hospitals for a Healthy EnvironmentGetting Started Using the H2E Ten Step Guides University of Kansas Hospital www.h2e-online.org December 6, 2007

2. What is H2E? H2E was jointly founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association. To achieve our vision, mission and goals, H2E is educating health care professionals about pollution prevention opportunities and providing a wealth of practical tools and resources to facilitate the industry’s movement toward environmental sustainability.

3. What we know:Toxicity: The Pervasive Impacts of Mercury • 2004 EPA Mercury Advisory data (most recent released) • 35% of lakes, 24% of rivers in US under advisory (some for non-mercury reasons) • 13,183,748 lake acres and 765,399 river miles under mercury advisory • 21 states have statewide advisories against fish consumption from all waters • 12 states have coastal or marine fish advisories

4. Warming of the Climate is Unequivocal • The Intergovernmental Panel on Climate Change (IPCC) has just completed its fourth assessment of the science of climate change, its impacts and possible solutions. The panel of 2,500 scientists and other experts declared manmade warming "unequivocal" and wrote that it could lead to climate changes that are "abrupt and irreversible.“ • International CONSENSUS document Listen to H2E Climate Change Webinar with Bill McKibben And Dr. Katherine Shea at www.h2e.org

5. Body Burden • The current chemical burden of individuals is unprecedented in human history. There are approximately 100,000 chemicals now used in energy production, manufacturing, and consumer products. Almost all are manmade with 15,000 of them produced annually in quantities greater than 10,000 pounds and 2,800 in quantities greater than 1 million pounds a year. Of the 2,800, only 7% have been tested for developmental effects and only 43% have been tested for human health effects. (Louisville Charter for Safer Chemicals)

6. What We Know • Every one of us is carrying a body burden of toxic chemicals • Children are more susceptible to environmental exposures than adults • The fetus may be harmed by amounts of chemicals that do not effect adults • Already sick patients or the elderly may be less able to deal with environmental exposures

7. Toxicity: What Is The Concern? • In the U.S. the prevalence of asthma doubled between 1982 (34.8) and 2003 (69.4). • Autism increased from less than 3 per 10,000 in the 1970s to more than 30 per 10,000 in the 1990s. • 1 in 6 children now have a learning or developmental disability. • In 1940, a women’s lifetime risk from breast cancer in was 1 in 22, today the risk is 1 in 7. • The incidence of hypospadius has doubled over the last two decades. • The Center for Disease Control biomonitoring studies show that 1 in 10 women have mercury blood levels that poses a threat of neurological damage to their fetus. • In 2005, EWG study of neonatal cord blood detected 287 chemicals: 180 known to cause cancer in humans or animals; 217 known or suspected of being toxic to the brain or nervous system.

8. Our material is speaking to us….are you listening?

9. What we know… • Regulated Medical Waste is 5 -20 times more expensive to manage than solid waste. • Paper and in particular cardboard makes up 15-40% of total waste. • Cardboard recycling should, at the very least pay for itself. • Paper recycling should beat the cost of solid waste disposal. (HIPAA considerations). • Hazardous waste, while a small portion of the waste stream, is 200 times more expensive than solid waste. • A comprehensive waste management program saves money

10. Show us the Green! • Sirota Survey Intelligence, a research firm in Purchase, N.Y., underlined the relationship between companies' environmental practices and employees' attitudes. • The survey findings, released in September 2007, show 82% of employees who were satisfied with their employers' environmental practices also felt proud to be working for their company. By comparison, just 55 per cent of those dissatisfied with their employers' environmental practices said they were proud of where they worked. • "If employees take pride in working for their company, then that unleashes unbelievable creative energy and ideas that will help the company be successful," Mr. Willard says.

11. Three goals of “healing environments” Reduce stress of the building’s occupants “A better building is one that facilitates physical, mental, and social well-being and productive behavior in its occupants” • Connection to nature (daylight/ views) • Choice & Control (light and ventilation) • Social Support (program areas) • Positive Distractions (views/ program) • Elimination of Environmental Stressors (noise) Improve Safety • Improved Indoor Air Quality • Supportive Lighting Design/ Reduced Glare Contribute to Ecological Health • Healthier Materials • Reduce Energy and Water Use http://www.healthdesign.org

12. Why a commitment to the environment? • Safety • Liability • Community Relations • Cost Savings • Indoor Air Quality • Environmental Impact • Regulatory Compliance • Mission Statement • Healing Environment • Commitment to Health

13. Where do we start? • There’s so much to do • How do we get started? • Who is in charge? • What to do first? • No Space! • No Time! • No Money!

14. 1998 American Hospital Association & U.S. EPA Memorandum of Understanding • 1 Virtual elimination of mercury-containing waste from healthcare facilities waste streams; • 2 Reduce total waste volume; • 3 Identify hazardous substances for pollution prevention and waste reduction opportunities, including hazardous chemicals & persistent, bioaccumulative, and toxic pollutants. • H2E: www.h2e-online.org

15. http://cms.h2e-online.org/partner/10steppartner/ Ten Step Guide to Getting Started • Step 1: Form a Team • STEP 2: Subscribe to H2E Program • Step 3: Assess Your Facility • Step 4: Establish Baseline Data • Set Waste and Mercury Reduction Goals • Step 6: Develop an Action Plan • Step 7: Kick off the Program • Step 8: Educate Employees • Step 9: Track, Measure, and Record Progress • Step 10: Celebrate Your Achievements

16. Greening Your Facility – Data • Materials and Waste • Occupational Exposure • Regulatory Infractions • Air Quality Reports • Environment of Care Rounds • Patient Satisfaction Surveys • Worker Suggestions • Lost Work Days

17. Risk Management – Lost work days, employee accidents Regulatory Infractions – Worker “morale” issues Air Quality Reports/complaints Respect Issues (sanitary break space, day lighting, places of respite, cleanliness) Board of Directors/Funding Opportunities Patient Satisfaction Surveys Facility Audit – What are common suggestions, complaints, concerns… Learn from front-line workers – get into shops, waste areas, sterilization, disinfection, O.R., food Services, radiology, sub basement, break rooms, endoscopy, outpatient treatment care areas – listen! Waste Data – what else?

18. Inventories: On the ground • There’s no easy way around it. Walking floor to floor, unit by unit and seeing is believing. • So even if the unit/area insists they “have no mercury”…. Mind if I take a look around?

19. Introduce the Front door to the Back Door • Evaluate what and from whom we purchase medical supplies and equipment for its impact: on: • the environment (air, water, electric, gasoline, etc.) during its use and upon disposal • staff and patients health (chemical exposure, allergens, etc.) • cost of use and disposal • Group Purchasing Organization contracting and research support of environmentally preferred purchasing

20. Environmental Structure • JCAHO Environment of Care • Quality Improvement • Mission or Ethics Committee • Green Team • Infection Control Consortium • Multi-disciplinary councils representing each hospital site (i.e., EVS, surgical services, radiology, materials management, etc.)

22. http://cms.h2e-online.org/partners/toolbox/ Partner Toolbox • Intro to H2E Fact Sheet • Intro to H2E PowerPoint Presentation • 10 Steps to Getting Started as an H2E Health Care Facility Partner • 10 Steps to Getting Started as an H2E Organizational Partner • Getting Started as an H2E State Partner • Sample Partner Goals • Sample Facility Newsletter for New Partners • Sample Kick-Off Memo • Press Release for Joining H2E • Sample Environmental Commitment Statements • H2E’s Self Assessment Guide • Tips on Getting Press • H2E Logo and Logo Guidelines • H2E Webinars • Awards Fact Sheet • Sample Results of H2E Award Media Outreach • Sample Boulder Community Hospital Recycling Flyer • Sample Environmental Stewardship Brochure

23. H2E Ten Step Guides: • Mercury Reduction • Regulated Medical Waste Reduction • Composting • Environmentally Preferable Purchasing • Fluorescent Light Bulb Recycling • Integrated Pest Management • Transition to Cidex OPA • Green Cleaning http://cms.h2e-online.org/partners/toolbox/

24. Specific Partner tools include • Getting Started – An H2E Partner Assessment Tool • Intro to H2E and data collection Webinar • Immediate access to industry-wide Listserv for all departments • H2E Partner Hotline for answers to your questions • StatGreen newsletter • Greener Operations Now! Newsletter • “Making Medicine Mercury-Free” Teleconference • Online Tool Kits addressing key operations areas • eWelcomepacket • Certificate of participation • Eligibility for annual awards program • Listing on H2E Community Page • 50% Discount on annual subscription to bi-monthly teleconference series (link) and the Waste Data Tracking Tool (link) • Discounted rates on customized technical and consulting services

25. H2E Environmental Excellence Awards and Pharmaceutical Waste Workshop Stats –May 14-15, 2007, Minneapolis, MN • 193 in attendance • 500 Printed Copies of Pharmaceutical Blueprint paid by Kendall given our or sent after event. • Clancy, Mercury sniffing dog • Over 120 awards given • Keynote by Pete Myers • Sessions on: DEHP, Data Collection, Pharmaceutical Waste, case studies on pharm waste management.

26. H2E Environmental Excellence Awards SAVE THE DATE May 20, 2008 www.cleanmed.org Pittsburgh

27. h2e web stats

28. h2e webinar series Top 5 attended calls in 2007

29. Janet brown 413/253-0254 Janet.brown@h2e-online.org h2e staff Mark Tecca, Bus. Alliance Lin Hill, Awards Coordinator Bill Craig, Now Asst Prof in NH College Cecilia DeLoach Laura Brannen Julie Taylor! Janet Brown I’m Sarah, but I now work for EPEAT!