What Goes Around Comes Around

August 1, 2002

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

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

By Michelle Gardner

Hospitalsfor a Healthy Environment (H2E) is a voluntary program designed to helphospitals enhance workplace safety, reduce waste and waste disposal costs andbecome better environmental stewards and neighbors. But with mounting paperwork,the possibility of new regulations and existing compliance requirements, whybother 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 yourpatients and co-workers, the community around your facility, your hospital'sfinancial health and to your own peace of mind.

Following a competitive selection process, H2E announced award winners inenvironmental leadership, champions for change, partners for change and makingmedicine mercury free.

Why Worry About Mercury?

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

Why Worry About Waste?

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

Federal and State Regulations

Federal and state governments are reshaping regulations as they relate tohospitals. Many medical waste incinerators are being closed. State governmentsare banning the purchase of mercury-containing products and setting more strictwastewater treatment discharge limits for mercury. Helping your facility becomemercury-free and environmentally prepared can help you comply with variousfederal, state and local regulations.1

Already on Track

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

Tom Groves, network director of biomedical engineering for the LutheranHealth 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 itwas nice recognition for the work we did," he says. "What instigatedthe efforts was responding to regulatory agencies such as the Joint Commissionfor Accreditation of Healthcare Organizations (JCAHO) that asked what we weredoing as far as mercury reduction. The Indiana State Department of Health wasinquiring 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 personnelthat were impacted by the mercury reduction program.

"When people think mercury they think thermometers and blood pressureequipment, but it is a lot more than that," says Groves. "Weformulated a list, did a lot of Web-based investigation and researched theprofessional and regulatory groups to compile a list of items that containmercury."

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

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

"This process doesn't really have a beginning and end; it is an ongoingprocess," says Groves. "We watch for alternative products to becomeavailable and we have replaced lighting, pharmaceuticals and labchemicals."

Lean, Green Recycling Machine

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

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

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

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

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

Other recycling programs at Kaiser Permanente include: excess amalgam, amaterial used in dental fillings; alcohol and xylene used in its histologydepartment; alkaline batteries; depressurized aerosol cans for the metalrecycler; silver recover from X-ray processors; empty toner cartridges; andtechno trash like CDs, diskettes and videotapes.

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

It Applies to Everyone

Debbie Augustine, environmental affairs coordinator for the New HampshireHospital Association (NHHA), has provided information to her hospitals to helpreduce volume and toxicity of their waste even before the development of the H2Enational program.

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

NHHA educational programs include Greening New Hampshire Hospitals, whichcovered waste reduction and pollution prevention, and other programs focus onmercury reduction.

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

Well-Rounded Efforts

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

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

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

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

CHW facilities conduct educational programs with clinicians addressing theimportance of waste management and waste minimization and to get theircommitment to the effort. "Dominican Hospital has recycled 11,000 pounds ofblue sterile wrap," shares Vickers. "It is used to create productssiding for houses to medical carts. As the recycling company expands it pickuproutes, we hope to have more hospitals involved."

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

Taking Work Home

Jane Matlaw, community relations director for Beth Israel Deaconess MedicalCenter, describes the center's 4-year-old Healthy Work/Healthy Home event forits employees highlighting mercury reduction, recycling and environmentalinitiatives.

"We had a mercury thermometer exchange, information and graphs about ourpaper recycling program, the progress we have made and how much money we savedover the past year," she says "We saved $10,000 in the first year. Thetonnage we are recycling went from 5 tons per month to 23 tons per month in lessthan one year."

The point of the one-day event is to encourage employees to takeenvironmental activities from work and apply them at home. "What you do atwork 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 anincinerator."

To encourage recycling and product reuse, the medical center providederasable memo boards for employees as an alternative to note pads and wastedpaper. "Our food service company donated coffee mugs and offer employees a25-percent discount when they fill it up (in lieu of Styrofoam cups)," saysMatlaw. "One vendor, Office Depot, talked about its recycling efforts, wehad an artist who showed us how she used recycled items for artwork andmusicians played for the attendees."

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

The first year of the mercury thermometer exchanged resulted in more than1,000 being turned in. This year, 30 were collected. "This is the one timethat lower numbers mean success," says Matlaw.

Do It Because You Like It

Kathy Smith-Bernier, director of environmental services at St. John'sRiverside Hospital, started the facility's recycling and mercury reductionprograms 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 oldfurniture to somebody who can use it. I sold 12 beds that were taking up spacein my corridors and 11 stretchers."

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

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