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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.

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First do no harm – identifying and eliminating healthcare toxics

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  1. First do no harm – identifying and eliminating healthcare toxics Nancy Larson Pollution Prevention Institute Hospitals for a Healthy Environment Champion December 6, 2007

  2. 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.

  3. 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

  4. 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!

  5. Identifying toxics • Mercury • Cleaners and disinfectants • Gludaraldehyde • ETO • Xylene • Formaldehyde • Flame retardants • PVC and DEPH • Other environmental hot buttons

  6. 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

  7. Mercury circulation in the environment

  8. FDA Advisories 1 | Mercury

  9. 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

  10. Roadblocks • Mercury is viewed as the “gold standard” • Multi-discipline effort • Cost • Not a regulatory requirement 1 | Mercury

  11. 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

  12. 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

  13. 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

  14. Mercury in the Laboratory • Histology Fixatives • Histology Stains • Antibodies • Parasitology Fixatives • Automated testing equipment reagents • Bleach (contaminant)

  15. 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

  16. 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

  17. “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

  18. 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

  19. Glutaraldehyde • Who still uses this? • Bonus question: • What carcinogenic disinfectant did it replace in the 1960’s? • 10 reasons to eliminate

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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.

  25. 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

  26. 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!

  27. 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

  28. 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

  29. 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

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