Transcript HOSPITALS FOR HEALTHY ENVIRONMENT Naga Veena Raman Akhil Kadiyala Department of Civil Engineering University of Toledo Air Pollution Research Group.

HOSPITALS
FOR
HEALTHY ENVIRONMENT
Naga Veena Raman
Akhil Kadiyala
Department of Civil Engineering
University of Toledo
Air Pollution Research Group
Why: Greening of Hospitals is
Necessary?
• Hospitals play a pivotal role in protecting USA's
health.
• They may have a surprising unhealthy side
inadvertently contributing to illness & pollution by
exposing patients & staff to a witch's brew of
toxins from building materials, medical waste,
hospital supplies & cleaning products.
Goals for H2E
•
Virtual elimination of Hg.
•
Reduction of quantity & toxicity of health care waste-from
manufacturing, purchase & use of products & materials, to
improved end-of-life management.
•
Minimization of use & exposure to hazardous chemicals,
including persistent, bio-accumulative & toxic (PBT)
substances.
•
Reducing health care’s environmental footprint through
resource conservation & other measurable environmental
improvements.
•
Integrating sustainable design & building techniques with
environmentally sound operational practices to create true
healing environments.
Mercury
• Hg is both a precious metal & a neurotoxin.
• Extremely toxic substance.
• In the past, Hg was used for everything from thermometers to
paint to hair bleach.
• It has been well documented that elemental Hg is persistent in
the environment & bio-accumulates in food chain.
• Presence of elemental Hg in environment always raises a
concern.
• Hg is still used in a variety of products today although in many
cases there are Hg-free alternatives.
• When it is necessary to use Hg or is already present in a
product, it must be handled properly.
Medical & Non-Medical Uses of Hg
Medical Uses
Non-Medical Uses
• Thermometers.
• Sphygmomanometers.
(blood pressure monitors)
• Esophageal dilators.
(bougie tubes)
• Cantor tubes & Miller
tubes.
• Feeding tubes.
• Dental amalgam.
• Laboratory chemicals.
(fixatives, stains,
reagents, preservatives)
• Medical batteries.
• Cleaning solutions with caustic
soda/chlorine
that
were
contaminated with Hg during
production process.
• Batteries.
• Fluorescent lamps & high-intensity
lamps.
• Non-electric thermostats.
• Pressure gauges.
• Some electrical switches for lights
& appliances.
Facts on Hg Exposure & effects
• Exposure to Hg occurs from
breathing contaminated air,
ingesting contaminated water &
food, & having dental & medical
treatments.
• If a thermometer breaks or a
Hg-containing solvent spills &
Hg vapor is inhaled, as much as
80% of the inhaled Hg may be
absorbed into the bloodstream.
• Biological half-life of Hg is 60
days. Thus, even though
exposure is reduced, the body
burden will remain for at least a
few months.
• Hg, at high levels, may
damage the brain, kidneys, &
developing fetus.
• Very high exposures to Hg
vapor in air can cause acute
poisoning.
• Symptoms usually begin with
cough,
chest
tightness,
trouble breathing & upset
stomach. This may go to
pneumonia, which can be
fatal.
• If inorganic Hg compounds
are
swallowed,
nausea,
vomiting, diarrhea, & severe
kidney damage may occur.
Contd...
•
Hg affects development of prenatal
life & infants.
•
Skin allergies may develop.
•
Exposure to Hg vapors can cause
the lens of the eye to discolor.
•
Some of the inorganic Hg
compounds (ionic Hg) can cause
burns or severe irritation of the skin
& eyes on contact.
•
Gingivitis: The gums become soft
& spongy, the teeth get loose, sores
may develop, & increased
salivation.
•
Exposure to any form of Hg on a
repeated basis, or even from a
single, very high exposure can lead
to the disease of chronic Hg
poisoning.
•
Chronic effects include central nervous
system effects, kidney damage, & birth
defects.
•
Mood & mental changes: People with
chronic Hg poisoning often have wide
swings of mood, becoming irritable,
frightened, depressed or excited very
quickly for no apparent reason. Such
people may become extremely upset
at any criticism, lose all selfconfidence, & become apathetic.
Hallucinations, memory loss & inability
to concentrate can occur.
•
Nerve damage from Hg - which in
rare historical cases has caused
paralysis & death - may start with a
fine tremor (shaking) of hand, loss of
sensitivity in hands & feet, difficulty in
walking/slurred speech. Tremors may
also occur in the tongue & eyelids.
Eventually this can progress to trouble
balancing & walking.
Exposure Pathways
Mercury
Elemental Mercury
Inorganic Mercury
Air
Organic Mercury
Water
Skin Contact
No Harm
Lungs
•Skin
•Skin
•Lungs
•Stomach
•Eyes
•Mucus Membranes
Phased Elimination of Hg
Get support
from the top
Evaluate current handling
& disposal techniques
Identify &
Involve the staff
Evaluate current policies
Identify Mercury
Sources
Evaluate Hg
product alternatives
Establish realistic goals
& implementation policies
Implement best
management practices
Identify Hg sources
Eliminate Hg
containing products
Evaluate current handling
& disposal techniques
Make Hg pollution
prevention easy
Establish purchasing
policies
Measure success
Educate staff
Advertise success
Evaluate current policies
Document reductions
Regulated Medical Waste Reduction
• Understand RMW definitions: Check with state regulatory authorities
to understand state specific regulations. Waste Segregation & mode of
their disposal are 2 important considerations that need to be in
compliance with state regulations.
• Define problem & Develop a Cost/Benefit analysis: Determine % of
total waste being disposed as RMW. Assess amount of waste inclusive
of RMW, cost of disposal & potential savings through RMW
segregation. (Excel Spreadsheet available for estimating potential
savings on H2E’s website.)
• Create a team to develop goals & an action plan: After calculating
RMW waste generation & working out cost-benefit analysis, create a
team with diversity & develop reduction goals & an action plan i.e.
practicable which includes health & safety, cost reduction & pollution
abatement considerations. (H2E Self-Assessment Guide & Worksheets
available online.)
Contd…
• Planning for Waste Segregation: Determine type & quantity of
waste produced by each department to estimate container needs.
• Container Placement & Signage: By proper labeled container
placement & signage, waste segregation can be done effectively.
• Training of Personnel: Train staff of necessity of segregating
waste properly.
• Sharps Management: Reduce sharp container usage.
• Problem Identification & Resolution plan: Identify waste disposal
issues & develop a resolution plan that solves problem.
• Waste Treatment & Hauling: Review hauling & treatment of waste
& if possible supervise.
• Track Your Progress, Report Successes & Reward Staff!
Green Procurement & Benefits
•
One of the keys to sustainability is the Green Procurement.
•
Purchase environmentally preferable “green” products & services in accordance with
one/more of the established Federal procurement preference program.
•
Environmental Preferable Purchasing (EPP) is the act of purchasing products/services
whose environmental impacts have been considered & found to be less damaging to
environment & human health when compared to competing products/services.
•
EPP = Environment + Price + Performance
•
Environmental benefits: By carefully selecting goods & services, hospitals can
-
Significantly improve their impact on the overall quality of the environment.
Reduce costs due to lower overhead, avoided waste disposal, liability costs/ occupational
health costs.
Provide a healthier environment for patients, workers & employees through reduced
exposures to cleaners, solvents & other hazardous materials.
Leverages positive publicity & promotion potential.
-
Contd…
•
Sustainability : Sustainable Hospitals Program (SHP) provides technical support to the
healthcare industry for selecting products & work practices that eliminate/reduce
occupational & environmental hazards, maintain quality patient care & contain costs.
•
Compliance: H2E conducts a compliance screen on all its applicants for compliance
violations.
•
Use EPA /USDA designated items.
•
Affirmative Procurement Program (APP) : Healthy Hospitals APP plan helps to reduce
the adverse environmental impact of our purchasing decisions by buying goods & services
from manufacturers & vendors who share the commitment to protect human health & the
environment.
•
APP ensures that items composed of recovered material will be purchased to the
maximum extent practicable, & are consistent with EPA's CPG & Recovered Materials
Advisory Notices.
•
Preference Program: Preference must be given to manufacturers who offer take-back
programs when purchasing equipment.
•
Promotion Program: Reusable plastic hot & cold mugs are sold by Food & Nutrition Dept
which serve as an alternative to disposable paper or foam cups. Employees receive
discount on beverages each time they use these mugs.
Facilitate
• Include green products in your contract specifications & purchase
requests
• Remove all restrictions to purchase green products in contract
purchase requests.
• Check labeling
attributes.
&
product
descriptions
for
• Incorporate appropriate FAR clauses into contracts.
environmental
References
•
Hospitals for healthy Environment, http://cms.h2e-online.org/about/ accessed
September 2007.
•
Mercury Waste Virtual Elimination Model Plan, http://www.h2eonline.org/pubs/mercurywaste.pdf accessed September 2007.
•
RMW Reduction – http://h2e-online.org/docs/h2e10steprmw20103.pdf
accessed September 2007.