What Goes Around Comes Around

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What Goes Around Comes Around
Being in the business of making people healthy, hospitals take action to reduce waste, pollution, costs

By Michelle Gardner

Hospitals for a Healthy Environment (H2E) is a voluntary program designed to help hospitals enhance workplace safety, reduce waste and waste disposal costs and become better environmental stewards and neighbors. But with mounting paperwork, the possibility of new regulations and existing compliance requirements, why bother thinking about healthcare waste?

According to the H2E Web site (www.h2e-online.org), the answer is simple: How you handle waste is critical to the health of your patients and co-workers, the community around your facility, your hospital's financial health and to your own peace of mind.

Following a competitive selection process, H2E announced award winners in environmental leadership, champions for change, partners for change and making medicine mercury free.

Why Worry About Mercury?

Mercury is a reproductive toxin and a potent neurotoxin. When you throw away mercury-containing devices such as fever thermometers and blood pressure cuffs, mercury can leach into water supplies and be released into the air via landfill gas emissions. Experts estimate that medical and municipal waste incinerators are responsible for 30 percent of total mercury emissions into air.

Why Worry About Waste?

When healthcare workers (HCWs) throw non-contaminated waste into the regulated medical waste stream (red bags), your facility is needlessly paying for specialized disposal. Healthcare institutions that reduced the volume of regulated waste have saved 40 percent to 70 percent on waste disposal. Reducing solid waste also results in cost saving.

Federal and State Regulations

Federal and state governments are reshaping regulations as they relate to hospitals. Many medical waste incinerators are being closed. State governments are banning the purchase of mercury-containing products and setting more strict wastewater treatment discharge limits for mercury. Helping your facility become mercury-free and environmentally prepared can help you comply with various federal, state and local regulations.1

Already on Track

It turns out that most facilities participating in the H2E program implemented recycling and reduction programs years ago. In essence, they are now being rewarded and recognized for work already done.

Tom Groves, network director of biomedical engineering for the Lutheran Health Network in Fort Wayne, Ind., didn't even know awards like this existed.

"We started down the mercury-free road independent of the award, but it was nice recognition for the work we did," he says. "What instigated the efforts was responding to regulatory agencies such as the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) that asked what we were doing as far as mercury reduction. The Indiana State Department of Health was inquiring about what steps we were taking to reduce mercury in our facilities. We thought we would be proactive."

The Lutheran Health Network started the process by identifying key personnel that were impacted by the mercury reduction program.

"When people think mercury they think thermometers and blood pressure equipment, but it is a lot more than that," says Groves. "We formulated a list, did a lot of Web-based investigation and researched the professional and regulatory groups to compile a list of items that contain mercury."

Next came evaluation and selection of product alternatives. "We gave ourselves about two years to do this," shares Groves. "We set a deadline of Dec. 31, 2001. We had to budget capital money to replace about 250 mercury blood pressure units in Lutheran hospital alone. Esophageal dilators were another capital investment."

After reviewing purchasing, handling and disposal practices and clarifying special handling issues for mercury, the implementation schedule was put in motion in order to purchase equipment.

"This process doesn't really have a beginning and end; it is an ongoing process," says Groves. "We watch for alternative products to become available and we have replaced lighting, pharmaceuticals and lab chemicals."

Lean, Green Recycling Machine

Mike Walter, purchasing manager for Kaiser Northwest's laboratory and dental areas, has been chair of the "Green Team" for two years. "The Green Team (has existed) for about 12 years and focuses on recycling, reusing and reducing," he says. "We have an extensive office paper and cardboard (recycling) program. Last year we eliminated 651 tons of paper and cardboard from the landfill. That was up 3 percent from 2000 and up 5 percent from 1999. We realized a cost avoidance of about 30 percent for our solid waste."

The Pacific Northwest is fortunate to have a population that wants to recycle. Kaiser does find, however, that the difficulty is in how to do it.

"There are a lack of financial and staffing resources when collecting the bulky material," states Walter. "But people are so motivated, it is easy for us to overcome the challenges in terms of recycling."

With a goal of 50 percent reduction in solid waste, Walter estimates Kaiser is at 40 percent. "We hope to get there in about three years. Our biggest focus is to sustain what we are doing and identify opportunities to get us to 50 percent."

Last quarter, Kaiser implemented shrink-wrap and blue sterile wrap recycling. "We recycled two tons of shrink wrap from October to December and I predict we will recycle six million tons this year," says Walter. "We estimate we will recycle 60 tons of the blue sterile wrap this year, which will push us over 40 percent waste reduction."

Other recycling programs at Kaiser Permanente include: excess amalgam, a material used in dental fillings; alcohol and xylene used in its histology department; alkaline batteries; depressurized aerosol cans for the metal recycler; silver recover from X-ray processors; empty toner cartridges; and techno trash like CDs, diskettes and videotapes.

As part of its request for quote (RFQ) process, Kaiser's policy is to grade vendors on their environmental missions. "We tell them what we are trying to eliminate, so whatever they bid on, we have them identify the materials," says Walter. "We are getting the message out to our vendors that the environment is important and we believe there is a direct impact between a healthy environment and healthcare services."

It Applies to Everyone

Debbie Augustine, environmental affairs coordinator for the New Hampshire Hospital Association (NHHA), has provided information to her hospitals to help reduce volume and toxicity of their waste even before the development of the H2E national program.

"We started in 1996 with our STAT Green newsletter," she says. "It goes to about 450 people, including the CEO, CFO, environmental services and infection control, and has articles about waste reduction, pollution prevention and energy efficiency. If readers want to learn more about a topic, they can visit our Web site4 where we provide links to mercury reduction, PVC reduction and medical waste management and reduction. We provide a link to the H2E national program, which provides good technical information for hospitals."

NHHA educational programs include Greening New Hampshire Hospitals, which covered waste reduction and pollution prevention, and other programs focus on mercury reduction.

"All of our workshops are well attended," says Augustine. "This month we are doing a program called Reducing Our Environmental Footprint to help hospitals understand the environmental and health concerns of the products they use and help them make better purchasing decisions. Mercury is one concern and hospitals use a lot of PVC medical devices like plastic bags and tubing. Sometimes there are problems when PVC materials are incinerated. It will produce dioxin which, even in tiny amounts, are detrimental to human health and wildlife."

Well-Rounded Efforts

Catholic Healthcare West (CHW) in San Francisco has been working on reducing its environmental footprint since 1996. "In that regard, we are somewhat of a leader among health systems in the United States," says Susan Vickers, director of advocacy. "We endorse the Coalition for Environmentally Responsible Economies (CEREs)2 principles for environmental responsibility, which commits us to do internal audits and an annual public report."3

Vickers describes CEREs as a coalition of unions, environmental organizations, investors and advocates that endorse a set of principles and commit to improving their environmental performance. "While we are the only healthcare organization, it ranges from small companies to big ones like Baxter International, Ford and General Motors," she says.

After committing to CEREs principles in 1996, CHW was introduced to the Healthcare Without Harm campaign, of which it has been a member since 1997. "We worked with the campaign and the American Hospital Association to encourage the development of the H2E program," says Vickers. "It is wonderful to have more healthcare organizations joining in that effort. There are great opportunities for networking and hopefully some benchmarking."

Consisting of 42 hospitals in California, Arizona and Nevada, CHW's initiatives focus on waste management and waste minimization. "Each hospital has an environmental action committee. It is their job to set goals for waste reduction and to monitor progress toward that," says Vickers. "The primary thing is good segregation of waste so we are sure only medical waste is put in the red bag."

CHW facilities conduct educational programs with clinicians addressing the importance of waste management and waste minimization and to get their commitment to the effort. "Dominican Hospital has recycled 11,000 pounds of blue sterile wrap," shares Vickers. "It is used to create products siding for houses to medical carts. As the recycling company expands it pickup routes, we hope to have more hospitals involved."

H2E recognized CHW for eliminating mercury in its hospitals. "We hope to be completely mercury free by the end of this year," says Vickers. "Mercury is in places you wouldn't realize, so it takes diligent efforts and planning. You can't do everything at once, but you replace as there are alternative items available. We have to work on suppliers and encourage research and development of new products."

Taking Work Home

Jane Matlaw, community relations director for Beth Israel Deaconess Medical Center, describes the center's 4-year-old Healthy Work/Healthy Home event for its employees highlighting mercury reduction, recycling and environmental initiatives.

"We had a mercury thermometer exchange, information and graphs about our paper recycling program, the progress we have made and how much money we saved over the past year," she says "We saved $10,000 in the first year. The tonnage we are recycling went from 5 tons per month to 23 tons per month in less than one year."

The point of the one-day event is to encourage employees to take environmental activities from work and apply them at home. "What you do at work is something you should practice all the time," emphasizes Matlaw. "We talked about household products, what has mercury in it, what to avoid, batteries, what can you put in a landfill and what can be put in an incinerator."

To encourage recycling and product reuse, the medical center provided erasable memo boards for employees as an alternative to note pads and wasted paper. "Our food service company donated coffee mugs and offer employees a 25-percent discount when they fill it up (in lieu of Styrofoam cups)," says Matlaw. "One vendor, Office Depot, talked about its recycling efforts, we had an artist who showed us how she used recycled items for artwork and musicians played for the attendees."

The best part of the planning committee, says Matlaw, is that anyone from the medical center who is interested can be involved. "We pull in people from the Environmental Protection Agency New England, our waste management system company, the state Department of Environmental Protection, and the Medical Area Service Community Organization. This year we partnered with the Boston Public Health Commission, which received a grant to do a mercury thermometer exchange with local drug stores and our pharmacy."

The first year of the mercury thermometer exchanged resulted in more than 1,000 being turned in. This year, 30 were collected. "This is the one time that lower numbers mean success," says Matlaw.

Do It Because You Like It

Kathy Smith-Bernier, director of environmental services at St. John's Riverside Hospital, started the facility's recycling and mercury reduction programs because she likes recycling. "I am really in to it" she says. "We recycle everything, we get rid of metal and beds and I sell old furniture to somebody who can use it. I sold 12 beds that were taking up space in my corridors and 11 stretchers."

In addition to opening up space, recycling saves the hospital money when it doesn't have to pay for what goes into the dumpsters. "The more you recycle the more you save because it comes out of your regular trash," shares Smith-Bernier.

St. John's Riverside Hospital received two H2E awards -- Making Medicine Mercury Free and H2E Partners for Change. "It signifies our commitment to reduce waste and recycle," says Smith-Bernier.

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