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While hospitals across the country have begun embracing the complimentary missions of caring for both public health and the environment, Maryland hospitals have had the distinct advantage of local, on-the-ground support through the Maryland Hospitals for a Healthy Environment (H2E) initiative. Maryland H2E, housed at the University of Maryland School of Nursing, is the first state program with staff dedicated to assisting hospitals and health care facilities in preventing pollution; reducing the generation of solid, hazardous, and special medical waste; eliminating mercury; and promoting recycling, green building, energy conservation, integrated pest management, and sustainable food practices on site.
Through workshops, conferences, and newsletters, professionals from Maryland’s health care community regularly exchange information and share their experiences in reducing environmental impacts. To support this collaboration, the Maryland Department of the Environment (MDE) recently funded a project with Maryland H2E that involved audits at six hospitals to identify and reduce sources of mercury and certain PVC-type plastics.
As Maryland H2E Technical Director Joan Plisko, PhD. points out, “Removing mercury and certain PVC-containing devices makes sense from an economic, compliance, and environmental perspective. Using what we learned in the audits, we were able to develop case studies with practical information and specific step-by-step guidelines for hospitals to follow.”
Mercury Audit Project
Mercury is a potent neurotoxin that can affect the brain, spinal cord, kidneys, and liver. Sphygmomanometers (i.e., blood pressure devices) and gastroenterology instruments (e.g., esophageal dilators) typically account for 80 to 90 percent of the mercury in a health care facility. Mercury can also be found in thermometers, repair kits for certain devices, staining solutions and laboratory re-agents, tissue fixatives, thermostats, batteries, manometers on medical equipment, fluorescent and high intensity lamps, and cleaning solutions.
Fortunately, there are safe, cost-effective non-mercury alternatives for all of these products and the healthcare community is quickly making the switch. In fact, more than 4,000 health care facilities in the United States have pledged to become mercury free, and eight hospitals in Maryland have received national recognition for their mercury reduction efforts.
Maryland H2E, with assistance from Antos Environmental, conducted mercury audits at three Maryland hospitals. Each hospital received recommendations on next steps including a mercury management policy, purchasing policy, expansion of recycling efforts for clinical devices, fluorescent bulbs and batteries, and a budget for removal and disposal of mercury containing devices and procurement of alternatives.
As a result of the audits, the participating hospitals took the following actions:
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Switched to mercury-free esophageal dilators
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Eliminated gram iodine in the lab
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Replaced mercury thermometers
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Properly recycled mercury-containing dilators and fluorescent bulbs; and
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Committed to developing mercury management and purchasing plans.
Polyvinyl Chloride/DEHP Audit Project
Polyvinyl chloride (PVC) is the most common plastic used in hospital products. Dioxin, a potent human carcinogen and endocrine disruptor, is formed during the production of PVC-containing products and during the incineration of disposed PVC products. Di-2-ethylhexyl phthalate (DEHP) is a plasticizer used to make PVC-containing products flexible. Unfortunately, DEHP can leach out of PVC-containing devices into IV fluids and is a known developmental and reproductive toxicant. A growing number of hospitals are undertaking efforts to reduce PVC and DEHP use in their facilities, specifically in the neonatal intensive care unit (NICU) where the most vulnerable populations can be found.
Maryland H2E, in conjunction with Clean Production Action, audited NICUs at three Maryland hospitals to identify products containing DEHP and develop a plan to transition to DEHP-free products. While safe and effective alternatives are available for most DEHP-containing medical products, many medical product labels do not disclose the material content making it difficult to identify which products to target for priority replacement. As part of the audits, Maryland H2E researched the material content of dozens of products found in the NICUs in order to identify high and moderate priority products for replacement. Maryland H2E recommended that the hospitals send letters to their vendors asking for clarification of material content and work with vendors and group purchasing organizations to request DEHP-free products.
As a result of the audits, the participating hospitals took the following actions:
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Replaced almost all high priority items identified in the audits
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Removed low-use DEHP products from their inventories
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Ensured that all new equipment purchases are DEHP-free; and
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Committed to work to incorporate DEHP-free requirements into purchasing contracts.
Read more about mercury and PVC case studies on MDE’s H2E website.
MDE is partnering again with Maryland H2E in 2009, using pollution prevention grant funds to support energy efficiency audits at two Maryland hospitals. For more information on Maryland H2E, contact Joan Plisko at Maryland H2E, Laura Armstrong at MDE 410-706-2107.
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