1. Presentations May 23 – 25, 2005 Portland, Maine For related information visit: http://www.newmoa.org/prevention/mercury/conferences

2. Status and Barriers to Implementing a Mercury- Elimination Plan in Healthcare Making Medicine Mercury Free

3. www.h2e-online.org

4. Why Bother? AHA/EPA Goal to Eliminate Mercury in health care Medical waste incinerators are major source of mercury New York Academy of Sciences Report National Resource Council (NRC) Report AMA, ANA, APHA resolutions Ethical responsibility/Mission Statement Patient/Employee satisfaction FDA and state fish consumption advisories State and local regulations Community Relations -Press coverage and awards

5. What’s Working - Implementation Strategy GPO’s Board of Directors Facility Managers Clinical Leadership Community Legislation Environmental Health Regulatory Compliance Housekeeping Safety Nurses Public Affairs Senior Leadership Patients Health Systems HCWH Partners EPA ANA Champions AHA State Organizations NGOs StewardshipCost

6. Successes – YES!!! Moving markets thermometers Education – both institutional education AND in the community Incinerator Closures

7. Obstacles to Mercury Elimination Mercury is still considered the Gold Standard Clinicians are still trained on mercury devices Cost of replacements Mercury in Chemicals Purchasing Obstacles Old habits

8. Clinical Sources Sphygmomanometers Thermometers Barometers Bougies, cantor tubes Pharmaceutical Preservatives

9. Facilities Management Light Bulbs Switches Thermostats Batteries, electronics

10. Chemicals Laboratory chemicals Pharmaceuticals Cleaning chemicals

11. Providing resources for proper management… Priority Is Elimination! Education Segregation Labeling Spill Response Monitoring Removal Record keeping

12. Mercury – Data Collection

13. Assess Mercury in the Facility

14. www.h2e-online.org/mercury

15. Tracks Hg Removed and What Remains

16. H2E National Awards Making Medicine Mercury Free Award Application Check List 1. Mercury Elimination Policies 2. Mercury Management Policy Clinical Facilities Chemical – pharmaceuticals, lab and cleaning chemicals 3. Environmentally Preferable Purchasing Policies

17. Next Steps??? GPO’s Board of Directors Facility Managers Clinical Leadership Community Legislation Environmental Health Regulatory Compliance Housekeeping Safety Nurses Public Affairs Senior Leadership Patients Health Systems HCWH Partners EPA ANA Champions AHA State Organizations NGOs StewardshipCost

18. H2E Resources/Guidance Awards Process: www.h2e-online.org/programs/award/index2004.htm Mercury Recyclers – www.h2e-online.org/tools/hg-recy.htm Consultants – www.h2e-online.org/tools/consult.cfm Vendors – www.h2e-online.org/tools/vendors.cfm Mercury Backgrounder – www.h2e-online.org/tools/mercury.htm List serve: www.h2e-online.org/programs/list.htm Universal Waste Guidelines – www.h2e-online.org/tools/univwaste.htm 10 steps to bulb recycling – www.h2e-online.org/tools/univwaste.htm#flu Mercury Elimination Plan – www.h2e-online.org/pubs/mercurywaste.pdf Fish Advisories – www.h2e-online.org/tools/merc-oth.htm#fish

19. Other Mercury Resources Massachusetts Academic & Scientific Community Organization – www.masco.orgwww.masco.org U.S. Food & Drug Administration - www.cfsan.fda.gov Health Care Without Harm’s Fast Facts - http://www.noharm.org/library/docs/Going_Green_ The_Mercury_Problem_-_Fast_Facts.pdf Making Medicine Mercury Free Resource Guide - http://www.noharm.org/library/docs/Going_http://www.noharm.org/library/docs/Going_Green_ Making_Medicine_Mercury_Free.pdf Measuring Blood Pressure Accurately – http://www.noharm.org/mercury/sphygmo American Medical Association – www.ama- assn.org

20. Need Help? Hospitals for a Healthy Environment www.h2e-online.org 800/727-4179 Partner Coordinator Janet.brown@h2e-online.org 718/636-1168 Janet.brown@h2e-online.org Champion Coordinator Sarah.obrien@h2e-online.org 802/479-0317 State Program Coordinator Cecilia.deloach@h2e-online.org 800/727-4179 Director Laura.brannen@h2e-online.org 603/795-9966

21. Presentations May 23 – 25, 2005 Portland, Maine

22. Mercury Elimination at Healthcare Facilities Are we there yet? Sara Johnson, M.S. NH Pollution Prevention Program May 2005

23. P2 in Healthcare Projects Acute Care and Specialty Hospitals Home Health Care Agencies – Visiting Nurses Associations Nursing Homes – Long Term Care Facilities and Mental Health Clinics Eye Physicians and Surgeons

24. Hospitals Mercury Survey 1999 and 2001 Anecdotal information 2005 26 acute care and specialty hospitals Policies – reduction, purchasing, elimination, etc. Medical devices Disposal

25. Survey Results Mercury Purchasing Policy 1999 – 73% 2001 – 83% 2005 – 100% Mercury Device Phase Out by 2003 1999 – 23% 2001 – 80% 2005 – almost 100%

26. Survey Results Medical Devices – fever thermometers 1999 – 73% 2001 – 92% 2005 – 100% Mercury Disposal/Recycle 1999 – 58% 2001 – 85% 2005 – 100%

27. 100% - HOW? Partnership New Hampshire Hospital Association Foundation for Healthy Communities Healthcare Without Harm EPA Region 1 – Mercury Challenge Hospitals for Healthy a Environment New Hampshire Hospitals for a Healthy Environment Long-term project In house support

28. The Real Work to Get to 100% Consistent supply of easy to read/comprehend guidance documents. Frequent open discussions in person and via email. Increase confidence levels. New Hampshire Hospitals are reaching out to us!!!

29. Recognition H2E Champion for Change - NHPPP EPA Region 1 Environmental Merit Award - NHPPP H2E Champion for Change – Foundation for Healthy Communities

30. Home Health Care/Visiting Nurses New Hampshire Home Care Association Survey 2003 Approximately 100 facilities Facility – universal waste Clinical Staff 25% response rate No follow-up survey planned

31. Survey Results Issues discovered – no surprise Bulbs, batteries not recycled properly. Clean-up spills procedures not consistent Non-issues – big surprise Blood pressure cuffs have been phased out. 0% are in use. Thermometers eliminated. 1% in use – only used at the request of a medical provider.

32. Focus changed from what we wanted to what they wanted Fish advisory pamphlets Thermometer spill clean-up at home Household generated wastes Pharmaceuticals Chemotherapy Sharps

33. Mental Health Clinics and Nursing Homes Mental Health clinics 10 State supported facilities Blood pressure cuffs Universal Wastes Nursing Homes a.k.a. Long-Term Care Facilities Definition is broad New Hampshire Health Care Association

34. Outreach Focused Guidance Documents Mercury Management Environmentally Preferable Purchasing Universal Waste Time and desire was missing.

35. Eye Physicians and Surgeons New for 2005 New Hampshire Eye Physicians and Surgeons Society Survey Medical devices Intraocular pressure reducer Universal wastes

36. Progress on Project Partnership created. Survey drafted. New documents outlined. Behind schedule. Time Hospitals

37. Are we there yet? Yes/Probably Hospitals Home Health Care Nursing Homes Mental Health Clinics No/Almost Healthcare Laboratories Dental Offices Eye Physicians

38. Resources Hospitals for a Healthy Environment http://www.h2e-online.org Sustainable Hospitals http://www.sustainablehospitals.org/cgi- bin/DB_Index.cgi NH Pollution Prevention Program http://www.des.nh.gov/nhppp/Healthcare_ P2/default.asp

39. Contact Information New Hampshire Department of Environmental Services Pollution Prevention Program Sara Johnson, M.S. sjohnson@des.state.nh.us 603-271-6460 www.des.nh.gov/nhppp

40. Presentations May 23 – 25, 2005 Portland, Maine

41. Washington State Department of Ecology Hospital Project Camille Martin (509) 329-3551 cafr461@ecy.wa.gov

42. Washington State Department of Ecology (Ecology) Hospital Project Initiatives- Environmental compliance concerns in Hospitals Environmental compliance concerns in Hospitals Hospital Project Team- scoping Hospital Project Team- scoping H2E Champion H2E Champion A Guide- Best Management Practices in Hospitals A Guide- Best Management Practices in Hospitals Workshops Workshops Hospital Technical Assistance Visits Hospital Technical Assistance Visits Sponsor a Medical Industries Network- a series of discussions Sponsor a Medical Industries Network- a series of discussions Developing a website for hospital information Developing a website for hospital information

43. Environmental Concerns in Hospitals Health concerns for humans and the environment with the use of Mercury and other toxic substances. Health concerns for humans and the environment with the use of Mercury and other toxic substances. Pollution prevention options not being used in hospitals. Pollution prevention options not being used in hospitals. Large and medium size hospitals should report as medium quantity generators of Dangerous Waste. Large and medium size hospitals should report as medium quantity generators of Dangerous Waste. Wastes (solid, biomedical, dangerous, air pollutants and waste water) being improperly disposed. Wastes (solid, biomedical, dangerous, air pollutants and waste water) being improperly disposed. Protection of groundwater and drinking water sources. Protection of groundwater and drinking water sources. Significant wastewater generators may need discharge permits. Significant wastewater generators may need discharge permits.

44. Hospital Project Scoping Team Project Goals- Ecology becomes a Hospitals for a Healthy Environment (H2E) champion Ecology becomes a Hospitals for a Healthy Environment (H2E) champion Eliminate Mercury use in hospitals Eliminate Mercury use in hospitals Reduce the use of hazardous substances Reduce the use of hazardous substances Reduce the generation of wastes Reduce the generation of wastes Get hospitals into regulatory compliance with environmental regulations through technical assistance Get hospitals into regulatory compliance with environmental regulations through technical assistance Get hospitals to implement pollution prevention Get hospitals to implement pollution prevention

45. BMP Guide Design The guide needs to address the environmental concerns and give solutions The guide needs to address the environmental concerns and give solutions Must provide pollution prevention options Must provide pollution prevention options It must be an all inclusive reference It must be an all inclusive reference Plain talk, simple and quick to use Plain talk, simple and quick to use Gives the information without much research Gives the information without much research Notebook style, tabbed sections Notebook style, tabbed sections

46. A Guide: Best Management Practices in Hospitals-Contents Proper waste management Proper waste management Self-Audit form Self-Audit form BMP’s for specific hospital departments BMP’s for specific hospital departments Waste management fact sheets Waste management fact sheets Vendors list Vendors list Website resources Website resources List of dangerous waste and air pollutants List of dangerous waste and air pollutants Biomedical waste regulations Biomedical waste regulations

47. Future Hospital Project Initiatives Becoming a H2E champion Becoming a H2E champion Technical assistance visits to all hospitals in the state of Washington Technical assistance visits to all hospitals in the state of Washington Two or three hospital workshops Two or three hospital workshops Medical industry network series- eastside and west side of the state Medical industry network series- eastside and west side of the state Develop a website/Vendor list updates Develop a website/Vendor list updates Follow-up visits to address environmental concerns Follow-up visits to address environmental concerns Performance track reporting Performance track reporting Developing methods for quantifying successes Developing methods for quantifying successes