Protecting
the Planet |
Protecting
the Planet |
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By
Megan Flaherty Despite the commitment to "First, do no harm," hospitals are responsible for some serious—and often preventable—environmental damage. In caring for patients, they generate mercury, dioxin, and other toxic pollutants that endanger human health and the planet. They also produce 2 million tons of waste a year, which makes up 1 percent of all municipal solid waste. Much of the toxic pollution can be prevented by substituting safe products and procedures for harmful ones, experts say. And waste volume can be decreased by making efforts to reuse, recycle, and reduce. "In a world of unsolvable problems, here’s one we can actually fix," said Charlotte Brody, RN, co-coordinator of Falls Church, Va.,-based Health Care Without Harm, a coalition of 140 organizations working to eliminate pollution in healthcare practices. "We have demonstrated alternatives that are affordable." By cleaning up and greening up their practices, hospitals will become safer for workers, and communities will become healthier for everyone, say scientists, health professionals, and waste experts. "We have to realize that unless you have a healthy planet, you can’t have a healthy human being," said Sister Mary Ellen Leciejewski, coordinator of the ecology program for Catholic Healthcare West, a 47-hospital system based in San Francisco that’s taking strides in reducing waste and finding alternatives to toxic chemicals. No more mercury Many hospitals are already phasing out mercury, a bioaccumulative neurotoxin linked to damage to the brain, kidneys, and fetuses. Mercury is commonly found in batteries, blood-pressure monitoring devices, thermometers, solvents, and other medical products. The risks of mercury spills and exposures to health workers are now widely recognized, so hospitals are turning to alternatives, said Hollie Shaner, MS, RN, environmental health coordinator at Fletcher Allen Health Care in Burlington, Vt., and president of the Nightingale Institute for Health and the Environment. "The occupational risk of having it around is not worth it," she said. Mercury also poses well-documented risks to the Earth and its inhabitants. If disposed of improperly—down the drain or into the incinerator—mercury can be transported across continents before it settles into the sediment and eventually contaminates water and the food supply. In 37 states including Texas health officials advise women of childbearing age not to eat certain kinds of fish from particular bodies of water because of the mercury level present. "The bottom line is that health workers need to advocate for a mercury-free environment," Shaner said. The message is getting across. The American Hospital Association signed an agreement with the Environmental Protection Agency (EPA) last summer calling for the elimination of mercury from hospital waste by 2005. Although the arrangement is voluntary, pollution prevention is a high priority to AHA members, said Katherine Svedman, executive director of the American Society for Healthcare Environmental Services, an AHA member group. "The organization’s vision is of healthy communities. We see this as an opportunity to achieve that goal," Svedman said.
Hospitals are at different stages of mercury elimination. For example, Butterworth Hospital in Grand Rapids, Mich., has eliminated 280 pounds of mercury from its waste in the past four years, becoming 99 percent mercury free. Catholic Healthcare West is using its purchasing clout with vendors in eliminating mercury products systemwide, Leciejewski said. At Dartmouth-Hitchcock Medical Center in Lebanon, N.H., which already has a mercury segregation and recycling program, administrators are considering going mercury free, said waste minimization coordinator Laura Brannen. Don’t burn it Hospitals aren’t as far along in reducing dioxin emissions, although some are taking steps in that direction, according to a "Greening Hospitals" report released by Health Care Without Harm in June 1998. Dioxin is a byproduct of several processes, including the incineration of wastes containing polyvinyl chloride (PVC), a plastic used in making disposable medical products such as intravenous tubing and blood bags, according to a report from the Sustainable Hospitals Project, an initiative at the University of Massachusetts Lowell. The average dioxin level in Americans is now "at or approaching" levels that cause health effects, including cancer, birth defects, and damage to the immune, neurological, and hormonal systems, according to a 1994 EPA report. Hospitals can reduce toxic pollution by replacing PVC plastic with other materials and avoiding unnecessary incineration—which is expensive, as well as harmful to the environment. Far more materials are incinerated in the average medical waste incinerator than necessary to protect the public from disease, according to the Sustainable Hospitals report. In fact, only 15 percent of hospital waste is considered infectious waste that requires special treatment. Less than 2 percent of a hospital’s total waste absolutely must be incinerated, including pathological wastes—like tissue and organs—and chemotherapeutic residuals, Shaner said. Nonpathological waste can be treated in other ways, such as autoclaving and microwaving. Items such as equipment, "get well" cards, and pizza boxes don’t belong in red (biohazard) bags, Shaner said. But that’s where some materials end up if health workers aren’t educated about waste segregation, or if there aren’t other means of disposal, she said. After universal precautions were instituted in the late ’80s, the use of red bags skyrocketed in some healthcare settings, Brody added. It took a while to realize the implications. "We felt the more we burned, the safer it was for everybody," she said. "We had no idea that we were contaminating the air and water." Many of the oldest, dirtiest medical waste incinerators have been shut down because they couldn’t comply with more stringent regulations the EPA enacted in August 1997. In some states, health professionals and community members have played a role in stopping medical waste incinerators or enforcing tougher standards on them. For example, nurses and other hospital workers at an Oregon facility were suffering from a series of mysterious illnesses, said Susan Wilburn, MPH, RN, specialist for occupational safety and health at the American Nurses Association. It turned out that the hospital incinerator’s smokestack exhaust was wafting into the intensive care unit, said Wilburn, who heard about the situation at a 1997 meeting. "They tested the nurses and the smoke from the incinerator. Nurses were being exposed to toxic chemicals." The operations of the incinerator were changed, she said. In another instance, Charleston Area Medical Center in W. Va. scaled back operations of a new incinerator after the community expressed concern about the amount of waste being incinerated, said Lillian Morris, director of safety. "We conducted a waste audit and found opportunities for overall waste reduction. We responded to the community’s concerns about minimizing the amount of waste being incinerated," Morris said. Waste not, want not Hospitals generate approximately 2 million tons of nonhazardous solid waste a year, an amount that has more than doubled since 1955, according to the "Greening Hospitals" report. The public pays for this waste through the loss of landfill space and pollution associated with production and disposal of products that become trash. Hospitals pay in the form of ever-higher disposal costs, according to the report. "There is going to be waste no matter what we do, but we can reduce the quantity and toxicity of that waste," Shaner said. Purchasing reusable products and packaging rather than disposable products is one giant step forward. For example, items like bed pans and respiratory therapy equipment don’t have to be disposable. Proper waste segregation is another important component in waste reduction. The majority of waste—paper, cardboard, glass, cans, and plastics—can be recycled, Shaner said. Hazardous waste such as batteries, chemicals, and solvents must be segregated separately, she said. Generally, health workers aren’t educated enough about waste minimization and segregation, Shaner believes. The agreement by the AHA and the EPA addresses solid waste as well as mercury. The agreement calls for reducing the total volume of all types of waste generated in hospitals and health systems by one-third by 2005 and ultimately by half by 2010. "Not only will this be good for the environment, but it’s good for the bottom line," said Jonathon T. Lord, MD, AHA chief operating officer. While it takes some initial investment, hospitals that have already undertaken aggressive waste minimization have realized long-term savings, Lord said. For example, aggressive waste reduction efforts at Catholic Healthcare West’s facilities have already paid off. One CHW facility reduced its solid waste by 40 percent, saving $33,000 in 1997. Another has saved $90,000 since 1996 by diverting more than 200,000 pounds out of the red bag waste disposal stream. Dartmouth-Hitchcock Medical Center, which began a recycling program in 1993, now recycles 32 tons of paper products every month, Brannen said. The hospital has gotten creative with other waste reduction strategies. It has an "online trading post" where departments advertise old binders, files, and other supplies for recycling. The program has been "very successful" in saving money on supplies and landfill costs. In addition, the facility avoids further waste by sending medical supplies—leftover sutures and linens with small tears—to needy parts of the world, Brannen said. Different approaches to pollution prevention and waste reduction work for different hospitals, she said. The important thing is to get started, but sometimes hospitals need a nudge, experts say. "These issues aren’t on the radar screen in a lot of places," Shaner said. "We need to give a higher priority to the ecological footprint a hospital has on a community." |
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