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Sustainable Healthcare

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Presentation on theme: "Sustainable Healthcare"— Presentation transcript:

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

37 The End Wendi Shafir USEPA Region 9

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