Toxics Use Reduction through Chemical Policy Reform in Healthcare ENVIROPHARM ™ 2009

1. Toxics Use Reduction through Chemical Policy Reform in HealthcareENVIROPHARM™ 2009 Linda Varangu

2. Our vision… Nationally recognized as the premier, integrated green resource network, the CCGHC will positively influence the ecological impact of Canadian healthcare.

3. Our mission… We provide an active vehicle for enabling positive ecological change within the Canadian healthcare landscape.

4. Selected Activities… • Resource sharing – Listserve • Advocacy – Government relationships • Education – Green health care sessions • Partnerships – Cross sectoral • Programs – Green health care awards

5. Constellations: • Toxics Use Reduction for Health Care • - ‘Green’ cleaning products • - ’ Green’ private sector joint initiatives • Fragrance Free Policies and Implementation kits • Local Foods

6. New Initiatives… • Partnerships with businesses and suppliers interested in supporting green health care • Updated and expanded web site and resources • Development of case studies with private sector support • Actively engaging health care facilities across Canada

7. Presentation Outline • Toxic Substance ‘101’ • What are the drivers for toxics management? • Where do we find toxic substances in hospitals? • Proposed Toxics Reduction Strategy for Health Care • Resources

8. Chemicals in Commerce 400 400 million tonnes 100,000 chemicals world wide 300 Million Tonnes 200 100 7 million tonnes 1940 1960 1980 2000 2020 Year

9. MOE: Toxics the Environment and Your Health. A Toxics Reduction Strategy for Ontario. 2008

10. What Do We Know About These Chemicals? • Most of these chemicals have not been tested for health and environmental impacts • We need to know more on: • Their synergistic effects • Effects of trace quantities • Effects at different developmental phases (i.e. children and babies) • Longterm effects • Subtle effects on behaviour

11. Canadian Environmental Protection Act (CEPA) Toxic • CEPA states: "a substance is toxic if it is entering or may enter the environment in a quantity or concentration or under conditions that (a) have or may have an immediate or long-term harmful effect on the environment or its biological diversity; (b) constitute or may constitute a danger to the environment on which life depends; or (c) constitute or may constitute a danger in Canada to human life or health."

12. Chemicals of High Concern • Persistent, Bioaccumulative and Toxic (PBT), • very Persistent and very Bioaccumulative (vPvB), • very Persistent and Toxic (vPT) • very Bioaccumulative and Toxic (vBT) or • known or likely to be: • carcinogenic, • mutagenic, • reproductive or developmental toxicant, • neurotoxicant or • endocrine disrupting. Clean Production Action Red List http://www.cleanproduction.org/Spotlight.php#redlist

13. Drivers for Toxics Substance Management • Government Drivers • Health Effects: Increase of chemical related diseases • Business Initiatives • Shareholder Resolutions

14. DRIVER: Government • Global: Strategic Approach to International Chemicals Management • EU: • REACH (Registration, Evaluation, Authorisation and Restriction of CHemicals • RoHS (Restriction of the Use of Certain Hazardous Substances in Electrical and Electronic Equipment Regulations)

15. DRIVER: Government • Canada: • Chemicals Management Plan • Ontario: • Toxics Use Reduction Strategy • City of Toronto Public Health: • Environmental Reporting and Disclosure Bylaw • US: • California Green Chemistry • Proposition 65

16. DRIVER: Increase of Chemical-Related Diseases • Cancer • Asthma • Birth defects • Developmental disabilities • Autism • Endometriosis • Infertility • 1 in 4 Canadians will die from cancer • Increase in asthma and learning disabilities, which are associated with chemical exposures.  • Dozens of now common conditions like birth defects and low sperm count are strongly linked to some chemicals in the environment. Collaborative on Health and Environment Toxicant and Disease Database: http://database.healthandenvironment.org/

17. Growing Concern Over Respiratory Issues Among Health Care Workers • The US Joint Commission on the Accreditation of Health Care Organizations (JCAHO) has identified indoor chemical pollutants as a contributing factor to indoor air quality issues. • Sources include: • photocopiers, glutaraldehyde and ethylene oxide sterilents, xylene, aerosolized medication distribution systems, anesthetic gases, chemotherapeutic agents, latex, cleaners and floor finishes. Green Guide for Healthcare: www.gghc.org page 10-51

18. DRIVER: Business Initiatives • Reduction in hazardous wastes • ‘Safer Chemical’ policies • Substituting safer chemicals for toxic substances • Design for Environment (DfE) • Supply chain requirements for • safer chemicals • Increased use of bio-based materials

19. Preferred Chemical Principles: WalMartSafe Products for Mother, Child, and the Environment Chemicals Harmful to the Environment • Persistent –do not break down in the environment • Bioaccumulative –builds up in the food chain • Toxic –causes death or damage to organisms in the environment Chemicals Harmful to Human Health • Carcinogens –can cause cancer • Mutagens –can damage genetic material • Reproductive Toxicants – may affect reproduction or the unborn

20. Safer Chemical PoliciesHerman Miller: Perfect Vision • By 2020 achieve a sustainability targets such as ZER0 landfill and ZER0 hazardous waste generation. • Material Chemistry and Safety of Inputs—Chemicals in materials are the safest available. • Disassembly--Products can be taken apart at the end of their useful life to recycle their materials. • Recyclability--Materials contain recycled content, and can be recycled at the end of the product's useful life.

21. DRIVER: Shareholder Resolutions (SR) • Johnson and Johnson: • SR request for global formulation of cosmetics to EU standards (2006) • Becton Dickinson: • SR to survey suppliers of components for medical devices for flame retardants (2006 and 2008) • Catholic Healthcare West: • Made a SR to retail store Kroger in US about toxics in consumer products Investor Environmental Health Network http://www.iehn.org/resolutions.shareholder.php

22. Where do we Find Toxic Substances in Hospitals? • Cleaners and disinfectants • Phthalates in medical devices • Flame retardants in furniture • Formaldehyde in furniture and labs • Solvents in labs • Heavy metals in electronics

23. Polyvinyl Chloride (PVC) Concerns: • Incineration of wastes can result in dioxin • DEHP (Di2-ethylhexyl)phthalate is a plastizer which can leach out – probable carcinogen and endocrine disrupter Hospital Products: • blood bags, • catheters, • drip chambers, • enteral feeding devices, • hemodialysis equipment, • IV containers, • respiratory therapy products, • tubing

24. Electronics Hospital Products: • Computers • Televisions • Lab analyzers • EKG monitors • other types of electronic equipment Hazardous constituents: • Lead in cathode ray tube (CRT) monitors • Chlorinated plastics in cable wiring • Brominated flame retardants in circuit boards and plastic enclosures • Mercury in LCD displays.

25. Sterilization: Substitution of Gluteraldehyde • Use a different liquid chemical disinfectant 1. Cidex OPA (.55% ortho-phthalaldehyde) 2. Peracetic Acid and Hydrogen Peroxide mix 3. Hydrogen Peroxide solutions • Invest in new enclosed equipment technologies 1. Steris 2. Sterrad 3. Sterilox www.sustainablehospitals.org

26. Toxics Reduction Strategy for Health Care • Development of Safer Chemical Policies

27. Hospital Safer Chemicals Policies • Kaiser Permanente Comprehensive Chemicals Policy (2005) • Guide to Choosing Safer Products and Chemicals. Implementing Chemicals Policy in Health Care May 2008 Health Care Without Harm www.noharm.org • University Health Network draft policy development • CCGHC support for Toxics Reduction Strategy for Health Care

28. Hospital Safer Chemical Policy • Eliminate toxic chemicals from commerce. • Eliminate chemicals from commerce which have not been thoroughly tested. • Shift the burden for chemical safety testing from public and consumers to manufacturers and suppliers. • Shift the burden for monitoring emerging chemically related environmental problems to manufacturers. • Ensure consumers and workers have complete information about the constituents of products they use. • Drive the design of products upfront to be least toxic throughout the product life cycle.

29. Contracting Focus in Safer Chemicals Policy • Create appropriate contractual obligations with manufacturers, suppliers, and distributors to: • Avoid identified chemicals of concern; • Conduct and share results of extended toxicity testing; • Disclose processes that use chemicals of concern; • Substitute safer alternatives.

30. Sample Draft Safer Chemical Policy Encourage vendors to supply products and services that strive to lower their environmental impacts through: • use of chemicals that are inherently less hazardous and minimize the release of toxic by-products throughout their lifecycles • application of waste minimization principles, including reduce, reuse and recycling, throughout product and packaging lifecycles • efficient use of energy and water • promotion of sustainability through use of renewable materials, energy and recycled content

31. Unless required or recommended for clinical, medical, or research purposes or where there are no commercially reasonable or feasible alternatives, HOSPITAL X will not purchase products that contain the following substances: •  mercury • asbestos • alkyl phenol ethoxylates • methylene chloride

32. Unless required or recommended for clinical, medical, or research purposes or where there are no commercially reasonable or feasible alternatives, preference will be given to products that do not contain:

33. “Chemicals of High Concern”, as identified by the Clean Production Action and Healthy Building Network Red List (www.cleanproduction.org/Greenscreen.php), that have one or more of the following attributes: • Persistent, Bioaccumulative and Toxic (PBT),  • very Persistent and very Bioaccumulative (vPvB) • very Persistent and Toxic (vPT) • very Bioaccumulative and Toxic (vBT) or known or likely to be: • carcinogenic, • mutagenic, • reproductive or developmental toxicant, • neurotoxicant or • endocrine disrupting.

34. substances listed under Schedule 1 of the Canadian Environmental Protection Act • substances listed under O. Reg. 347 under the Ontario Environmental Protection Act • “subject pollutants” as described by the City of Toronto sewer-use bylaw • substances listed under the Global Ban List compiled under the Stockholm Convention

35. brominated flame retardants (BFRs) including polybrominated diphenylether (PBDE) flame retardants • formaldehyde • heavy metals, including arsenic, cadmium, hexavalent chromium, lead, and manganese • naphthalene • perchloroethylene (PERC)

36. perfluorochemicals (PFC) or perfluorinated chemicals • phthalates, including di 2-ethylhexyl phthalate (DEHP) • polyvinyl chloride (PVC) • triclosan • volatile and semi-volatile organic compounds (VOCs), including xylene, benzene and toluene

37. Benefits of Safer Chemical Policy • Safer workplaces, communities, ecosystems leading to reduced disease and health care costs • Reduced long-term costs and liabilities • Increased information for better decision making • Market pressure for more testing, the provision of better information and the design of safer products • Increased momentum at local and provincial level

38. We welcome feedback, input and participation of vendors... • Become involved with the CCGHC • Attend greening health care sessions • Consider piloting green products /processes at a hospital • Consider piloting safer chemical purchasing process with a hospital • Identify safer chemical policy case studies • Participate in developing new guidelines for greener safer products (EcoLogo for healthcare products)

39. Resources 1. Organizations that advocate for greener, healthier hospitals: • Canadian Coalition for Green Health Care www.greenhealthcare.ca • Health Care Without Harm: www.noharm.org • Practice Greenhealth: www.practicegreenhealth.org • Sustainable Hospital Project:www.sustainablehospitals.org 2. Checklist for hospitals who are going green: • Green Guide for Health Care: www.gghc.org 3. Cleaning in Healthcare Facilities: Reducing human health effects and environmental impacts. April 2009 http://sustainableproduction.org/downloads/CleaninginHealthcareFacilities.pdf 4. Safer Chemical Policies for hospitals: http://www.noharm.org/us/chemicalpolicy/issue

40. Thank you! Linda Varangu Linda@greenhealthcare.ca www. greenhealthcare.ca