Embed Size (px)
Citation preview
11
Sustainable HealthcareSustainable Healthcare
Wendi ShafirUS EPA Region 9
June 2010
22
OutlineOutline
Why Healthcare?Why Healthcare?
Environmental ConcernsEnvironmental Concerns
Opportunities and PrioritiesOpportunities and Priorities
ResourcesResources
OutlineOutline
Sustainability – definitionSustainability – definition
33
Sustainability – what does it mean?Sustainability – what does it mean?
““Meeting the needs of the Meeting the needs of the
present without compromising present without compromising
the ability of future the ability of future
generations to meet their generations to meet their
needs”needs”
44
Sustainability – 3 AspectsSustainability – 3 Aspects
EconomicEconomicEquityEquityEnvironmentalEnvironmental
55
Why Healthcare ?Why Healthcare ?
• Large environmental Large environmental footprintfootprint
• Many Many opportunitieopportunitiess – waste, toxics, – waste, toxics, energy, waterenergy, water
• Purpose Purpose
– – First do no harmFirst do no harm
- Provide healing environment - Provide healing environment
66
Health Care FootprintHealth Care Footprint
1 of every 7 dollars spent1 of every 7 dollars spent
Energy ~ $6.5 billion each year Energy ~ $6.5 billion each year
Medical IncineratorsMedical Incinerators 3rd largest source of dioxin3rd largest source of dioxin 4th source of mercury emissions4th source of mercury emissions 50X more mercury in medical waste 50X more mercury in medical waste
Water – often largest users in communityWater – often largest users in community
Over 2 million pounds of waste per yearOver 2 million pounds of waste per year
77
BenefitsBenefits
Reduces costsReduces costs
Improves efficiencyImproves efficiency
Reduces environmental Reduces environmental impactsimpacts
Improves human healthImproves human health
Reduces liabilitiesReduces liabilities
88
Environmental Concerns
Air Pollution
Trash
Water Pollution
Water Shortage
Energy Usage
Toxic Chemicals
99
Waste in HealthcareWaste in Healthcare
1010
Toxics in Healthcare ?Toxics in Healthcare ?
1111
Toxics in HealthcareToxics in Healthcare
Sterilants and Disinfectants
Mercury and other PBTs
Pesticides
Cleaning Chemicals
Laboratory Chemicals
Radiologicals
PthalatesPthalates
1212
PVC, DEHP, PthalatesPVC, DEHP, Pthalates In many medical products for flexibility, ex. IV bag, In many medical products for flexibility, ex. IV bag,
tubingtubing
DEHP: Developmental toxicantDEHP: Developmental toxicant
Dioxins– from production and incinerationDioxins– from production and incineration
DEHP leaches from the PVC DEHP leaches from the PVC
FDA recommends use of alternatives to DEHP when exposures may be excessive (esp. neonates)
1313
Mercury in HealthcareMercury in HealthcareMedical DevicesMedical Devices ThermometersThermometers SphygmomanometersSphygmomanometers Dental AmalgamDental Amalgam Cantor, Miller Abbot, Dennis tubesCantor, Miller Abbot, Dennis tubes
Building ProductsBuilding Products ThermostatsThermostats Many switchesMany switches Boiler Guage controlsBoiler Guage controls Fluorescent BulbsFluorescent Bulbs
1414
MercuryMercury
Toxic effects-Toxic effects- Long term exposure Long term exposure can permanently damage brain, can permanently damage brain, kidneys and developing fetuskidneys and developing fetus
Health care industry a Health care industry a major consumermajor consumer
Persistent, Bioaccumulative, Toxic = Persistent, Bioaccumulative, Toxic = PBTPBT
1515
Mercury Toxicity – Fish ConnectionMercury Toxicity – Fish Connection
1616
PharmaceuticalsPharmaceuticals
Emerging IssueEmerging Issue
Water Quality Impacts – Water Quality Impacts – Human - ReuseHuman - Reuse Aquatic speciesAquatic species
Many pharmaceuticals in lakes & riversMany pharmaceuticals in lakes & rivers
1717
Now we know why -Now we know why - What can we do ? What can we do ?
1818
OpportunitiesOpportunities
Waste Reduction Waste Reduction
Improved Pharmaceuticals ManagementImproved Pharmaceuticals Management
Mercury / Toxics ReductionMercury / Toxics Reduction
Recycling Recycling
Energy / Water EfficiencyEnergy / Water Efficiency
Healthy FoodHealthy Food
1919
Waste Reduction StrategiesWaste Reduction StrategiesWaste CharacterizationWaste Characterization
Waste Segregation Best PracticesWaste Segregation Best Practices
Minimization of Infectious/Biohazard WasteMinimization of Infectious/Biohazard Waste
Paper ManagementPaper Management
RecyclingRecycling
EPP for Waste MinimizationEPP for Waste Minimization
2020
PharmaceuticalsPharmaceuticals
Pharmaceutical Waste Management Pharmaceutical Waste Management & Minimization Plan & Minimization Plan
EPA, State guidanceEPA, State guidance
Swedish model – change prescribing Swedish model – change prescribing patternspatterns
2121
Mercury and Toxics ReductionMercury and Toxics Reduction Mercury: Inventory and eliminateMercury: Inventory and eliminate
Less toxic cleaning productsLess toxic cleaning products
Less toxic sterilants + disinfectantsLess toxic sterilants + disinfectants
Distill and reuse lab solvents & fixativesDistill and reuse lab solvents & fixatives
2222
Mercury EliminationMercury Eliminationa Primary Goala Primary Goal
100s of hospitals virtually eliminated it100s of hospitals virtually eliminated it
Many state/local programs Many state/local programs
Dental opportunities as wellDental opportunities as well
Eliminate through:Eliminate through: SubstitutionSubstitution EliminationElimination Environmentally Preferable PurchasingEnvironmentally Preferable Purchasing
2323
Mercury Reduction – How toMercury Reduction – How to
Mercury Reduction 10-step guide http://cms.h2e-online.org/ee/hazmat/hazmatconcern/mercury/10step/
Reducing Mercury Use in Health Care Plan http://www.sustainablehospitals.org/HTMLSrc/IP_Mer
cury.html
Mercury Assessment Tool http://www.cdph.ca.gov/certlic/medicalwaste/Pages/H
ospitalPollutionPrevention.aspx
2424
Alternatives to DEHPAlternatives to DEHP
There now are effective alternativesThere now are effective alternatives
PVC-free/ Non-PVC PVC-free/ Non-PVC DEHP-free / Non-DEHPDEHP-free / Non-DEHP
Assessment tools and alternatives listsAssessment tools and alternatives lists
http://www.hcwh.org/us_canada/issues/toxins/pvc_phthalates/http://www.hcwh.org/us_canada/issues/toxins/pvc_phthalates/ http://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi?px=Mhttp://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi?px=M
2525
Why? Sustainable Food in Why? Sustainable Food in HealthcareHealthcare
Support patient, staff and visitor healthSupport patient, staff and visitor health
Educate patients, communityEducate patients, community
Provide healthier food (Farmer’s Markets) to communityProvide healthier food (Farmer’s Markets) to community
Combat Antibiotic ResistanceCombat Antibiotic Resistance
Reduce food production’s environmental footprintReduce food production’s environmental footprint Energy, water, pesticides, soil conservation, fishery Energy, water, pesticides, soil conservation, fishery
depletiondepletion
2626
Healthy Food in Healthcare PledgeHealthy Food in Healthcare Pledge
From Healthcare Without Harm (www.noharm.org)From Healthcare Without Harm (www.noharm.org)
Sample Language providedSample Language provided
Over 250 hospitals have signed upOver 250 hospitals have signed up
Healthcare without Harm – provides resourcesHealthcare without Harm – provides resources
American Medical Association (AMA) approved a policy American Medical Association (AMA) approved a policy resolution in support of sustainable food health care resolution in support of sustainable food health care systems systems
2727
HOW? Food PoliciesHOW? Food Policies
Locally sourced foods Locally sourced foods
Hormone/antibiotic free animal products,Hormone/antibiotic free animal products, rBGH Free DairyrBGH Free Dairy
Sustainably harvested foods, fair tradeSustainably harvested foods, fair trade
Organic and other certified foodOrganic and other certified food
2828
What else can you do?What else can you do?
Healthier vending machinesHealthier vending machines
Serve meals lower on the food chain -Serve meals lower on the food chain - less meat, less meat, vegetarian optionsvegetarian options
Healthy Cooking Classes and demonstrationsHealthy Cooking Classes and demonstrations
Sustainable Food service – energy, water, wasteSustainable Food service – energy, water, waste
Farmers MarketsFarmers Markets
Onsite GardensOnsite Gardens
2929
Paper ReductionPaper Reduction
Copy & print double-sidedCopy & print double-sided
Go Paperless - electronic recordsGo Paperless - electronic records
Fewer CopiesFewer Copies
Recycle office paper separatelyRecycle office paper separately
Recycling can still be HIPPA compliant!Recycling can still be HIPPA compliant!
3030
More Recycling !More Recycling !
Reduce costs, generate revenueReduce costs, generate revenue
Cardboard, paper, glass, plasticCardboard, paper, glass, plastic
Sterile Blue Wrap – new pilot in N. CASterile Blue Wrap – new pilot in N. CA
3131
ElectronicsElectronics
FEC, EPEAT, Energy StarFEC, EPEAT, Energy Star
Both purchasing and disposal importantBoth purchasing and disposal important
UNIVERSAL WasteUNIVERSAL Waste
Reduced disposal costsReduced disposal costs
Reduced energy costsReduced energy costs
3232
Environmentally Preferable Environmentally Preferable Purchasing or EPPPurchasing or EPP
Selecting products or services that have a lesser or reduced effect on human health and the environment
All Areas – medical, surgical, office All Areas – medical, surgical, office supplies, maintenance, etc.supplies, maintenance, etc.
Group Purchasing Organizations (GPOs) Group Purchasing Organizations (GPOs) provide leverage, efficiency for EPPprovide leverage, efficiency for EPP
3333
Other OpportunitiesOther Opportunities
Water ConservationWater Conservation
Energy ConservationEnergy Conservation
Renewable EnergyRenewable Energy
Green BuildingGreen Building
DentalDental
3434
A Role for EveryoneA Role for Everyone
PurchasingPurchasing
HousekeepingHousekeeping
Nursing Nursing
Food ServiceFood Service
FacilitiesFacilities
AdministrativeAdministrative
PharmacyPharmacy
3535
What Can What Can YouYou Do at Your Do at Your Hospital?Hospital?
Listen and learn todayListen and learn today
Identify some things to work onIdentify some things to work on
Make a commitment to just one!Make a commitment to just one!
Get support – co-workers, mgmt.Get support – co-workers, mgmt.
Imagine, if we all do this…Imagine, if we all do this…
3636 From sustainablematerials2020.com
