5Why Healthcare ? Large environmental footprint Many opportunities – waste, toxics, energy, waterPurpose– First do no harm- Provide healing environment
6Health Care Footprint 1 of every 7 dollars spent Energy ~ $6.5 billion each yearMedical Incinerators3rd largest source of dioxin4th source of mercury emissions50X more mercury in medical wasteWater – often largest users in communityOver 2 million pounds of waste per year
11Toxics in Healthcare Sterilants and Disinfectants Mercury and other PBTsPesticidesCleaning ChemicalsLaboratory ChemicalsRadiologicalsPthalatesSome affect patients – pthalates in IV tubing and bags affect neonates, pesticidesSome affect staff: sterilants and disinfectants, cleaning chemicalsSome affect the general population: mercury, pesticides, dioxins in burning medical waste
12PVC, DEHP, PthalatesIn many medical products for flexibility, ex. IV bag, tubingDEHP: Developmental toxicantDioxins– from production and incinerationDEHP leaches from the PVCFDA 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.
13Mercury in Healthcare Medical Devices Building Products Thermometers SphygmomanometersDental AmalgamCantor, Miller Abbot, Dennis tubesBuilding ProductsThermostatsMany switchesBoiler Guage controlsFluorescent Bulbs
14MercuryToxic effects- Long term exposure can permanently damage brain, kidneys and developing fetusHealth care industry a major consumerPersistent, Bioaccumulative, Toxic = PBT
19Waste Reduction Strategies Waste CharacterizationWaste Segregation Best PracticesMinimization of Infectious/Biohazard WastePaper ManagementRecyclingEPP for Waste Minimization
20Pharmaceuticals Pharmaceutical Waste Management & Minimization Plan EPA, State guidanceSwedish model – change prescribing patterns
21Mercury and Toxics Reduction Mercury: Inventory and eliminateLess toxic cleaning productsLess toxic sterilants + disinfectantsDistill and reuse lab solvents & fixatives
22Mercury Elimination a Primary Goal 100s of hospitals virtually eliminated itMany state/local programsDental opportunities as wellEliminate through:SubstitutionEliminationEnvironmentally Preferable Purchasing
23Mercury Reduction – How to Mercury Reduction 10-step guideReducing Mercury Use in Health Care PlanMercury Assessment Tool
24Alternatives to DEHP There now are effective alternatives PVC-free/ Non-PVCDEHP-free / Non-DEHPAssessment tools and alternatives lists
25Why? Sustainable Food in Healthcare Support patient, staff and visitor healthEducate patients, communityProvide healthier food (Farmer’s Markets) to communityCombat Antibiotic ResistanceReduce food production’s environmental footprintEnergy, water, pesticides, soil conservation, fishery depletion
26Healthy Food in Healthcare Pledge From Healthcare Without Harm (www.noharm.org)Sample Language providedOver 250 hospitals have signed upHealthcare without Harm – provides resourcesAmerican Medical Association (AMA) approved a policy resolution in support of sustainable food health care systems
28What else can you do? Healthier vending machines Serve meals lower on the food chain - less meat, vegetarian optionsHealthy Cooking Classes and demonstrationsSustainable Food service – energy, water, wasteFarmers MarketsOnsite Gardens
29Paper Reduction Copy & print double-sided Go Paperless - electronic recordsFewer CopiesRecycle office paper separatelyRecycling can still be HIPPA compliant!
30More Recycling ! Reduce costs, generate revenue Cardboard, paper, glass, plasticSterile Blue Wrap – new pilot in N. CARecycling/Reuse – Worksheet IIIf 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?
31Electronics FEC, EPEAT, Energy Star Both purchasing and disposal importantUNIVERSAL WasteReduced disposal costsReduced energy costs
32Environmentally Preferable Purchasing or EPP Selecting products or services that have a lesser or reduced effect on human health and the environmentAll Areas – medical, surgical, office supplies, maintenance, etc.Group Purchasing Organizations (GPOs) provide leverage, efficiency for EPP
33Other Opportunities Water Conservation Energy Conservation Renewable EnergyGreen BuildingDentalReduce flow or frequency; replace with water-efficient models; reuse once-through waterMinimizing water usage can reach savings of 40%, which catches eye of CFO
34A Role for Everyone Purchasing Facilities Housekeeping Administrative NursingFood ServiceFacilitiesAdministrativePharmacy
35What Can You Do at Your Hospital? Listen and learn todayIdentify some things to work onMake a commitment to just one!Get support – co-workers, mgmt.Imagine, if we all do this…