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Presentations May 23 – 25, 2005

Presentations May 23 – 25, 2005 Portland, Maine For related information visit: http://www.newmoa.org/prevention/mercury/conferences. Making Medicine Mercury Free.

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Presentations May 23 – 25, 2005

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  1. Presentations May 23 – 25, 2005 Portland, Maine For related information visit: http://www.newmoa.org/prevention/mercury/conferences

  2. Making Medicine Mercury Free Status and Barriers to Implementing a Mercury-Elimination Plan in Healthcare

  3. www.h2e-online.org

  4. Why Bother? • AHA/EPA Goal to Eliminate Mercury in health care • Medical waste incinerators are major source of mercury • New York Academy of Sciences Report • National Resource Council (NRC) Report • AMA, ANA, APHA resolutions • Ethical responsibility/Mission Statement • Patient/Employee satisfaction • FDA and state fish consumption advisories • State and local regulations • Community Relations -Press coverage and awards

  5. What’s Working - Implementation Strategy Environmental Health AHA ANA Legislation Board of Directors Community Senior Leadership Champions Clinical Leadership Nurses NGOs Health Systems Public Affairs Partners Patients HCWH EPA Facility Managers State Organizations Safety Housekeeping Regulatory Compliance GPO’s Stewardship Cost

  6. Successes – YES!!! • Moving markets • thermometers • Education – both institutional education AND in the community • Incinerator Closures

  7. Obstacles to Mercury Elimination • Mercury is still considered the Gold Standard • Clinicians are still trained on mercury devices • Cost of replacements • Mercury in Chemicals • Purchasing Obstacles • Old habits

  8. Clinical Sources • Sphygmomanometers • Thermometers • Barometers • Bougies, cantor tubes • Pharmaceutical Preservatives

  9. Facilities Management • Light Bulbs • Switches Thermostats • Batteries, electronics

  10. Chemicals • Laboratory chemicals • Pharmaceuticals • Cleaning chemicals

  11. Providing resources for proper management… Priority Is Elimination! • Education • Segregation • Labeling • Spill Response • Monitoring • Removal • Record keeping

  12. Mercury – Data Collection

  13. Assess Mercury in the Facility

  14. www.h2e-online.org/mercury

  15. Tracks Hg Removed and What Remains

  16. H2E National Awards • Making Medicine Mercury Free • Award Application Check List • Mercury Elimination Policies • Mercury Management Policy • Clinical • Facilities • Chemical – pharmaceuticals, lab and cleaning chemicals • Environmentally Preferable Purchasing Policies

  17. Next Steps??? Environmental Health AHA ANA Legislation Board of Directors Community Senior Leadership Champions Clinical Leadership Nurses NGOs Health Systems Public Affairs Partners Patients HCWH EPA Facility Managers State Organizations Safety Regulatory Compliance Housekeeping GPO’s Stewardship Cost

  18. H2E Resources/Guidance Awards Process: www.h2e-online.org/programs/award/index2004.htm Mercury Recyclers– www.h2e-online.org/tools/hg-recy.htm Consultants – www.h2e-online.org/tools/consult.cfm Vendors – www.h2e-online.org/tools/vendors.cfm Mercury Backgrounder – www.h2e-online.org/tools/mercury.htm List serve: www.h2e-online.org/programs/list.htm Universal Waste Guidelines – www.h2e-online.org/tools/univwaste.htm 10 steps to bulb recycling – www.h2e-online.org/tools/univwaste.htm#flu Mercury Elimination Plan – www.h2e-online.org/pubs/mercurywaste.pdf Fish Advisories – www.h2e-online.org/tools/merc-oth.htm#fish

  19. Other Mercury Resources • Massachusetts Academic & Scientific Community Organization – www.masco.org • U.S. Food & Drug Administration - www.cfsan.fda.gov • Health Care Without Harm’s Fast Facts - http://www.noharm.org/library/docs/Going_Green_The_Mercury_Problem_-_Fast_Facts.pdf • Making Medicine Mercury Free Resource Guide - http://www.noharm.org/library/docs/Going_Green_Making_Medicine_Mercury_Free.pdf • Measuring Blood Pressure Accurately – http://www.noharm.org/mercury/sphygmo • American Medical Association – www.ama-assn.org

  20. Need Help? • Hospitals for a Healthy Environment www.h2e-online.org 800/727-4179 • Partner Coordinator Janet.brown@h2e-online.org 718/636-1168 • Champion Coordinator Sarah.obrien@h2e-online.org 802/479-0317 • State Program Coordinator Cecilia.deloach@h2e-online.org 800/727-4179 • Director Laura.brannen@h2e-online.org 603/795-9966

  21. Presentations May 23 – 25, 2005 Portland, Maine

  22. Mercury Elimination at Healthcare Facilities Are we there yet? Sara Johnson, M.S. NH Pollution Prevention Program May 2005

  23. P2 in Healthcare Projects • Acute Care and Specialty Hospitals • Home Health Care Agencies – Visiting Nurses Associations • Nursing Homes – Long Term Care Facilities and Mental Health Clinics • Eye Physicians and Surgeons

  24. Hospitals • Mercury Survey • 1999 and 2001 • Anecdotal information 2005 • 26 acute care and specialty hospitals • Policies – reduction, purchasing, elimination, etc. • Medical devices • Disposal

  25. Survey Results • Mercury Purchasing Policy • 1999 – 73% • 2001 – 83% • 2005 – 100% • Mercury Device Phase Out by 2003 • 1999 – 23% • 2001 – 80% • 2005 – almost 100%

  26. Survey Results • Medical Devices – fever thermometers • 1999 – 73% • 2001 – 92% • 2005 – 100% • Mercury Disposal/Recycle • 1999 – 58% • 2001 – 85% • 2005 – 100%

  27. 100% - HOW? • Partnership • New Hampshire Hospital Association Foundation for Healthy Communities • Healthcare Without Harm • EPA Region 1 – Mercury Challenge • Hospitals for Healthy a Environment • New Hampshire Hospitals for a Healthy Environment • Long-term project • In house support

  28. The Real Work to Get to 100% • Consistent supply of easy to read/comprehend guidance documents. • Frequent open discussions in person and via email. • Increase confidence levels. • New Hampshire Hospitals are reaching out to us!!!

  29. Recognition • H2E Champion for Change - NHPPP • EPA Region 1 Environmental Merit Award - NHPPP • H2E Champion for Change – Foundation for Healthy Communities

  30. Home Health Care/Visiting Nurses • New Hampshire Home Care Association • Survey 2003 • Approximately 100 facilities • Facility – universal waste • Clinical Staff • 25% response rate • No follow-up survey planned

  31. Survey Results • Issues discovered – no surprise • Bulbs, batteries not recycled properly. • Clean-up spills procedures not consistent • Non-issues – big surprise • Blood pressure cuffs have been phased out. • 0% are in use. • Thermometers eliminated. • 1% in use – only used at the request of a medical provider.

  32. Focus changed from what we wanted to what they wanted • Fish advisory pamphlets • Thermometer spill clean-up at home • Household generated wastes • Pharmaceuticals • Chemotherapy • Sharps

  33. Mental Health Clinics andNursing Homes • Mental Health clinics • 10 State supported facilities • Blood pressure cuffs • Universal Wastes • Nursing Homes a.k.a. Long-Term Care Facilities • Definition is broad • New Hampshire Health Care Association

  34. Outreach Focused • Guidance Documents • Mercury Management • Environmentally Preferable Purchasing • Universal Waste • Time and desire was missing.

  35. Eye Physicians and Surgeons • New for 2005 • New Hampshire Eye Physicians and Surgeons Society • Survey • Medical devices • Intraocular pressure reducer • Universal wastes

  36. Progress on Project • Partnership created. • Survey drafted. • New documents outlined. • Behind schedule. • Time • Hospitals

  37. Yes/Probably Hospitals Home Health Care Nursing Homes Mental Health Clinics No/Almost Healthcare Laboratories Dental Offices Eye Physicians Are we there yet?

  38. Resources • Hospitals for a Healthy Environment • http://www.h2e-online.org • Sustainable Hospitals • http://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi • NH Pollution Prevention Program • http://www.des.nh.gov/nhppp/Healthcare_P2/default.asp

  39. Contact Information • New Hampshire Department of Environmental Services • Pollution Prevention Program • Sara Johnson, M.S. • sjohnson@des.state.nh.us • 603-271-6460 • www.des.nh.gov/nhppp

  40. Presentations May 23 – 25, 2005 Portland, Maine

  41. Washington State Department of Ecology Hospital Project Camille Martin (509) 329-3551 cafr461@ecy.wa.gov

  42. Washington State Department of Ecology (Ecology) Hospital Project Initiatives- • Environmental compliance concerns in Hospitals • Hospital Project Team- scoping • H2E Champion • A Guide- Best Management Practices in Hospitals • Workshops • Hospital Technical Assistance Visits • Sponsor a Medical Industries Network- a series of discussions • Developing a website for hospital information

  43. Environmental Concerns in Hospitals • Health concerns for humans and the environment with the use of Mercury and other toxic substances. • Pollution prevention options not being used in hospitals. • Large and medium size hospitals should report as medium quantity generators of Dangerous Waste. • Wastes (solid, biomedical, dangerous, air pollutants and waste water) being improperly disposed. • Protection of groundwater and drinking water sources. • Significant wastewater generators may need discharge permits.

  44. Hospital Project Scoping Team Project Goals- • Ecology becomes a Hospitals for a Healthy Environment (H2E) champion • Eliminate Mercury use in hospitals • Reduce the use of hazardous substances • Reduce the generation of wastes • Get hospitals into regulatory compliance with environmental regulations through technical assistance • Get hospitals to implement pollution prevention

  45. BMP Guide Design • The guide needs to address the environmental concerns and give solutions • Must provide pollution prevention options • It must be an all inclusive reference • Plain talk, simple and quick to use • Gives the information without much research • Notebook style, tabbed sections

  46. A Guide: Best Management Practices in Hospitals-Contents • Proper waste management • Self-Audit form • BMP’s for specific hospital departments • Waste management fact sheets • Vendors list • Website resources • List of dangerous waste and air pollutants • Biomedical waste regulations

  47. Future Hospital Project Initiatives • Becoming a H2E champion • Technical assistance visits to all hospitals in the state of Washington • Two or three hospital workshops • Medical industry network series- eastside and west side of the state • Develop a website/Vendor list updates • Follow-up visits to address environmental concerns • Performance track reporting • Developing methods for quantifying successes

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