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

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

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

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
Some affect patients – pthalates in IV tubing and bags affect neonates, pesticides
Some affect staff: sterilants and disinfectants, cleaning chemicals
Some affect the general population: mercury, pesticides, dioxins in burning medical waste

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)
Catholic Healthcare West announced in Nov that it has awarded a 5-year, $70 million contract to B. Braun to supply its 40 hospitals with PVC-free and DEHP-free intravenous systems.
In addition, Microsoft, Kaiser Permanente, Crabtree & Evelyn, Firestone Building Products, Hewlett-Packard, Wal-Mart, Shaw Industries, J&J, and others have announced elimination or phase-out of use of PVC in packaging, commercial roofing, & carpet backing.
They are all choosing to use alternatives to PVC that are safer to consumers & the environment.
PVC is dangerous throughout its entire life cycle of production, use, and disposal, releasing chemicals such as mercury, dioxins, & phthalates.

13. Mercury in Healthcare Medical Devices Building Products 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. Opportunities Waste Reduction Improved Pharmaceuticals Management
Mercury / Toxics Reduction
Recycling
Energy / Water Efficiency
Healthy Food

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 Elimination a 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
Reducing Mercury Use in Health Care Plan
Mercury Assessment Tool

24. Alternatives to DEHP There now are effective alternatives
PVC-free/ Non-PVC
DEHP-free / Non-DEHP
Assessment tools and alternatives lists

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 (
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
Recycling/Reuse – Worksheet II
If you are not recycling paper or cardboard, paper is about 25% of your total waste stream and will often generate revenue in rebates. Start there.
Are you generating revenue for any of the recyclables? If not, particularly for cardboard and white paper, now that you know your weights, negotiate a rebate.
Does the data provide information to help determine operational changes, new equipment needs, additional items to add to the list of recyclables? (For example can you estimate cardboard revenues and avoided disposal costs that justify purchase of a compactor?)
Ask your current vendor what other materials they collect. Can you add another material?
Are you using net benefit to help describe the benefits of your recycling program?

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
Reduce flow or frequency; replace with water-efficient models; reuse once-through water
Minimizing water usage can reach savings of 40%, which catches eye of CFO

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

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