Northwest Guide to Pollution Prevention by the Healthcare Sector

Publication Date: June 2001
Updated: July 2004
Links Last Checked: July 2004

Introduction
How can P2 Providers Use Healthcare Waste Stream Data?
General Information on Healthcare Pollution Prevention
Case Studies
Greening Hospitals/Sustainable Medical Facilities
Audio-visual Materials on Healthcare Pollution Prevention
Mercury
      Fact Sheets & General Information
      In-depth Information
      Alternatives
PVC and Phthalate Reduction
Waste Incineration
Recycled and Reprocessed Products
Chlorine-free Product Purchasing (to eliminate dioxin)
Environmentally Preferred Purchasing (EPP)
Pharmaceutical Disposal
Food Waste

Introduction

The healthcare industry operates on the Hippocratic premise: Primum non nocere. First, do no harm. This has been the credo of every healthcare worker and institution since the beginning of modern medicine. The tenet has applied to the treatment of patients, serving as a caveat to any otherwise zealous practitioner that moderation and good judgment are crucial in providing the best care. In other words, while aggressively searching out the root cause of an illness and, subsequently, prescribing treatment, the healthcare provider — and ultimately the patient — is best served by limited use of potentially harmful remedies. Patience and moderation are valuable commodities.

Until recently, this concept has not been applied to the healthcare "industry" itself. The advent of high technology brought with it a plethora of diagnostic, therapeutic and palliative modalities and pharmaceuticals that fill clinic and hospital exam and treatment rooms. Often, the mere presence of the most recent and hi-tech materials, equipment and supplies defined a healthcare facility as being "cutting edge." And this has often been confused with good medical care. In the race to cure (as well as care and comfort), the result justified the means. Little attention has been paid to the environmental — and ultimately, human health — effects from the use of these products.

What are the healthcare activities that can damage the environment and human health? On the simplest level, any that generate toxic or hazardous materials. These would include the use — and improper disposal — of mercury-containing supplies and equipment, polyvinyl chloride-containing (PVC) supplies and equipment, and laboratory supplies and chemicals. On a more expansive level, the list includes those activities that add to the waste stream and cause environmental pollution, including wasteful overpackaging of medical instruments, supplies and materials — which take up more and more space in landfills across the country – and incineration of medical facility wastes. The more than 6000 hospitals in the U.S. also generate solid and hazardous wastes that include mattresses, cardboard, food waste, mercury, photographic chemicals, formaldehyde, batteries, and solvents.

Mercury is a persistent bioaccumulative toxin (PBT, see more information about PBTs at www.pprc.org/pubs/pbt.cfm) included on most lists of toxic chemicals that should be eliminated from use. Mercury can interfere with the development of the fetal brain and is directly toxic to the central nervous system, kidneys and liver. It is commonly described as a developmental neurotoxin. Elemental mercury —such as that found in medical instruments and solutions — is converted by biochemical processes in the environment — mainly by bacteria — to methylmercury. Mercury in this organic state, methylmercury (www.nap.edu/books/0309071402/html), is harmful to the nervous system, especially in the developing fetus and infant. Ten to twenty percent of mercury in the waste stream comes from the healthcare industry.

Polyvinylchloride (PVC) is in many plastic components of medical equipment and supplies. Scientists have found that not only are PVC products dangerous from their release of dioxin when incinerated, but PVC products often contain vinyl plasticizers (softeners) known as phthalates. As a class, phthalates have been incriminated in tumor development in experimental animals. Many citizens and scientists are concerned about the use of both PVC and phthalates in medical products. While evidence of harm to human health from phthalates is lacking, the application of the Precautionary Principle (see sidebar) may be appropriate in this controversy. Other medical products that contain chlorinated organic compounds can contribute to environmental dioxin burden when incinerated. Dioxin is a known human carcinogen and has been linked to birth defects, decreased fertility, immune system suppression and other hormonal dysfunction.

PRECAUTIONARY PRINCIPLE

"When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established. In this context the proponent of an activity rather than the public should bear the burden of proof. The process of applying the Precautionary Principle must be open, informed, and democratic and must involve potentially affected parties. The process must include a comprehensive, systematic examination of the full range of alternatives, including no action."

Taken from the Physicians for Social Responsibility "Resolution Affirming the Precautionary Principle." For complete text of the Resolution, go to: www.psr.org/documents/
psr_doc_0/program_3/eupdate0101.pdf.

Non-hazardous, non-toxic solid waste quantities of up to 2 million tons per year are produced by hospitals alone. Medical waste is estimated to be 1% of the total waste generated in the U.S., according to EPA. It has been estimated that up to 80% of this waste could be eliminated through effective waste prevention programs in healthcare facilities.

These three categories of healthcare waste are examples of the varied challenges that the industry faces in today's health- and environment-conscious market.

Beginning in the 1990's, environmental engineers began looking at pollution prevention (P2) needs in healthcare. Prior to that time, few had focused on this sector. As healthcare regulatory activity increased, and as economists entered the picture to evaluate the efficiencies of this profession-now-industry, recommendations to reduce waste began to appear. At the same time, community and environmental watchdogs began to express concern over some practices that they deemed unhealthy, such as the on-site incineration of hospital wastes. (It was no coincidence that this concern arose at the height of AIDS epidemic awareness in the U.S.) Not until 1997 did the U.S. Environmental Protection Agency (EPA) issue new standards and guidelines for hospital waste incinerators. Initially, as conservation efforts increased throughout the U.S., many state recycling laws exempted medical facilities; more recently, these exemptions have been removed.

In 1998, a Memorandum of Understanding (M.O.U.) between the U.S. Environmental Protection Agency and the American Hospital Association (AHA) brought to the forefront the importance of the mercury issue in the healthcare industry. (See the document at www.epa.gov/glnpo/toxteam/ahamou.htm.) The Memorandum establishes a partnership between these two bodies with a goal of reducing total waste volume as well as eliminating mercury waste from healthcare facilities. Furthermore, the parties agreed to hold seminars that would "be the primary vehicle by which technical information on P2 opportunities will be transferred to the healthcare professionals, and…focus upon transferring technical information related to decreasing healthcare industry waste volume, minimizing the production of PBT pollutants, improving waste stream segregation, reducing waste management costs and ensuring regulatory compliance for regulated waste streams." These seminars are being "held at various locations across the United States."

Other pollution prevention issues in the healthcare world include reduction of excess packaging, environmentally preferred purchasing (EPP), recycling, energy and water conservation, chlorine-free product purchasing, pharmaceutical disposal, and food waste.

As with all pollution prevention activities, the goals of healthcare P2 are to:

Reduce pollution
Create a safer working environment
Save money
Reduce regulatory burden
Improve public image
Lower energy costs
Lower waste disposal costs
Reduce liability for contaminated site remediation
Lower operational and maintenance costs
Lower risk for public, staff and the environment
Reduce insurance costs
Improve liability, productivity and quality
Help eliminate environmental health concerns for patients, staff and general public

The suggestions found in this topical report and links herein will give healthcare technical assistance providers the resources to accomplish those goals.

How can P2 Providers Use Healthcare Waste Stream Data?

Information contained in this report will aid those who provide technical assistance to healthcare facilities in identifying and reducing or eliminating sources of environmental pollution. Surveys completed during the past few years have revealed that only a small percentage of medical facilities in the U.S. had changed their purchasing, recycling and waste management behaviors. Many continue to add to environmental pollution and--ironically--to the disease burden of those who are ultimately contaminated by the pollutants produced by inappropriate handling of hospital and clinic wastes. A 1998 report, "Greening Hospitals," produced by the organization Health Care Without Harm (HCWH) reveals that "over 40% of hospitals surveyed continue to incinerate infectious waste that could be treated by safer methods." Furthermore, the report states, "just 20 percent have programs to reduce purchases of PVC plastic; only 4 percent use PVC-free IV bags." And while "80 percent have programs in place to reduce mercury use, ...nearly 50 percent still purchase mercury-containing thermometers and over 50 percent still purchase mercury blood pressure cuffs." Of the pollutants that derive from the healthcare industry, the two most well defined are mercury (from medical equipment and chemicals) and dioxin (largely from incineration of discarded PVC-containing medical materials). But in addition to these toxic pollutants, the healthcare industry discards tons of non-hazardous, non-toxic waste that is adding to burgeoning landfills nationwide. There is much that can be and need be done to lessen this burden.

The following are topics that are relevant to healthcare waste reduction and pollution prevention. References and links to information concerning each of these topics are included in the charts below.

General Information

Resource Listing	Description and Comments	Contact (if applicable)
www.deq.state.or.us/ wmc/solwaste/cwrc/wrstrategy/ healthcarestrategy.html	Waste Reduction Tips for Healthcare	State of Oregon Department of Environmental Quality 811 SW Sixth Avenue Portland, OR 97204-1390 General Information Phone: (503) 229-5696 Toll Free in Oregon: (800) 452-4011 TTY: (503) 229-6993 Fax: (503) 229-5850 E-mail: deq.info@deq.state.or.us
www.montana.edu/ ~wwwated/healthcare.htm	Montana Pollution Prevention Program - Health Care Providers Fact Sheet from the Montana State University's Extension Service program serving small businesses and citizens of Montana	Montana Pollution Prevention Program Montana State University Extension Service Taylor Hall Bozeman, MT 59717 Toll-free in MT: (888) 678-6872 Phone: (406) 994-3451 Fax: (406) 994-5417 Web: www.montana.edu/wwwated
www.ciwmb.ca.gov/ BIZWASTE/factsheets/hospital.htm	Waste Reduction Activities for Hospitals From the California Integrated Waste Management Board, a series of connected Fact Sheets on topics ranging from solid waste to patient supplies, complete with case examples from healthcare facilities nationwide.	California Integrated Waste Management Board 1001 I Street PO Box 4025 Sacramento, CA 95812-4025 Phone: (916) 341-6000
www.noharm.org	Health Care Without Harm The "campaign for environmentally responsible health care" is the self-descriptor for this loosely-knit coalition of organizations with environmental orientations. Originally a union generated by concern over medical waste incineration, it is now a "broad-based international campaign designed to reform the environmental practices of the health care industry."	Health Care Without Harm PO Box 6806 Falls Church, VA 22040 Phone: 703-237-2249 Fax: 703-237-8389 Email: info@hcwh.org
www.c2p2online.com/ main.php3?section=83&doc_id=169	Canadian Centre for Pollution Prevention	Canadian Centre for Pollution Prevention 100 Charlotte Street Sarnia, ON N7T 4R2 Tel: 519-337-3423 or 1-800-667-9790 Fax: 519-337-3486 E-mail: info@c2p2online.com
www.cornet.nf.ca/web/acapha/ projects/documents/hospital_book.pdf	A comprehensive report on Healthcare P2 from Western Memorial Regional Hospital in Newfoundland
www.cmaj.ca/cgi/content/ full/164/3/365	Sustainable healthcare and emerging ethical responsibilities. A report from the Canadian Medical Association Journal's Environment and Health Series on the need to consider the long-term environmental costs of providing healthcare and to reduce the material and energy consumption of the healthcare industry. This is an editorial format, although there are links in the bibliography to many of the references mentioned in the text.
wrrc.p2pays.org/ industry/hospital.htm	P2Pays' site for Hospital and Medical Waste Reduction. P2Pays is the web site for North Carolina's Waste Reduction Resource Center (WRRC). This site provides links to many helpful web sites, fact sheets, manuals, video tapes, and case studies concerning healthcare P2.	WRRC 1639 Mail Service Center Raleigh, NC 27699-1639 Telephone: (919) 715-6531 or (800) 476-8686 Fax: (919) 715-1612 E-Mail: wrrc@p2pays.org

Case Studies

Resource Listing	Description and Comments	Contact (if applicable)
www.deq.state.or.us/ wmc/solwaste/cwrc/ cstudy/healthcare.html	Healthcare Case Studies in Oregon. A variety of scenarios in which healthcare facilities have saved money while reducing their contribution to the waste stream. From the Waste Prevention and Management division of the Oregon Department of Environmental Quality.	State of Oregon Department of Environmental Quality 811 SW Sixth Avenue Portland, OR 97204-1390 Phone: (503) 229-5696 Toll Free in Oregon: (800) 452-4011 TTY: (503) 229-6993 Fax: (503) 229-5850 E-mail: deq.info@deq.state.or.us
www.ciwmb.ca.gov/ BIZWASTE/factsheets/hospital.htm	Waste Reduction Activities for Hospitals. From the California Integrated Waste Management Board, a lengthy fact sheet with many useful practical recommendations on reducing facility waste, interspersed with short case studies.	California Integrated Waste Management Board 1001 I Street PO Box 4025 Sacramento, CA 95812-4025 (916) 341-6000
wrrc.p2pays.org/ indsectinfo.asp?INDSECT=15	Waste Reduction Resource Center's (WRRC) Case Studies-scroll down to the case studies in healthcare waste reduction	WRRC 1639 Mail Service Center Raleigh, NC 27699-1639 Telephone: (919) 715-6531 or (800) 476-8686 Fax: (919) 715-1612 E-Mail: wrrc@p2pays.org

Greening Hospitals/Sustainable Medical Facilities

Resource Listing	Description and Comments	Contact (if applicable)
www.sustainablehospitals.org	Sustainable Hospitals. A comprehensive web site with fact sheets, links to healthcare technical assistance program sites, and alternative medical product suppliers. Internal link to "An Ounce of Prevention: Waste Reduction Strategies for Healthcare Facilities," an excellent reference published by the American Society for Healthcare Environmental Services of the American Hospital Association. "Sustainable Hospitals" is maintained by the Lowell Center for Sustainable Production.	Sustainable Hospitals Project Kitson 200 One University Avenue Lowell, MA 01854 Catherine Galligan phone: (978) 934-3386 e-mail: shp@uml.edu
www.ewg.org/pub/ home/reports/ greening/greenpr.html	"Greening" Hospitals, from the Environmental Working Group	Environmental Working Group 1718 Connecticut Ave NW, Suite 600 Washington, DC 20009 e-mail: info@ewg.org
inspiredliving.com/ airpurification/ a~healthcareairproblems.htm	Indoor Air Quality Problems in Healthcare Facilities. Opportunities for improving air quality problems in healthcare facilities, created by chemical hazards, ventilation systems, infectious diseases, biological hazards, carpet, and more.	Inspired Living PO Box 21287 Concord, CA 94521 Direct: 925-363-9724
www.gghc.org	Green Guidelines for Healthcare Construction. Guide to healthcare facility planning, design, construction and operation towards enhanced environmental and health performance. Similar in structure to the USGBC LEED system but addresses the particular structural, usage, and regulatory challenges of healthcare buildings and emphasizes environmental and public health issues.	Green Guidelines for Healthcare Construction, admin@gghc.org
www.healthybuilding.net/ pvc/pvc-free_carpet.html	Latest PVC-Free Carpet Lines Signal Environmental Health Considerations are Driving Markets Away from PVC. This article discusses Kaiser Permanente's PVC-Free Carpeting Challenge to develop a PVC-free carpet that meets the healthcare giant's exacting environmental and performance standards. Collins & Aikman introduced a new carpet line with an alternative plastic backing. Shaw also committed to end all production of PVC-backed carpet this year.	Contact: Healthy Building NetworkHealthy Building Network Institute for Local Self-Reliance 927 15th Street, NW, 4th Floor Washington, DC 20005 phone: (202) 898-1610 info@healthybuilding.net

Audio-visual Materials on Healthcare Pollution Prevention

Resource Listing	Description and Comments	Contact (if applicable)
www.noharm.org/ library/docs/First_Do_No_Harm _video_2.htm	"First Do No Harm" is a video resource designed to educate healthcare professionals and others about the industry's contribution of dioxins to the environment.	Health Care Without Harm PO Box 6806 Falls Church, VA 22040 Phone: 703-237-2249 Fax: 703-237-8389 Email: info@hcwh.org

Mercury

Resource Listing	Description and Comments	Contact (if applicable)
Mercury Elimination: Fact Sheets & General Information
www.atsdr.cdc.gov/ ToxProfiles/phs8916.html	ATSDR - Public Health Statement: Mercury (1990)	Agency for Toxic Substances and Disease Registry Division of Toxicology 1600 Clifton Road, E-29 Atlanta, Georgia 30333
www.atsdr.cdc.gov/tfacts46.html	ATSDR - ToxFAQs - Mercury	Agency for Toxic Substances and Disease Registry Division of Toxicology 1600 Clifton Road, E-29 Atlanta, Georgia 30333
www.dtsc.ca.gov/PollutionPrevention/ guide-to-mercury-assessment -in-healthcare-facilities.pdf	State of California Mercury Assessment and Elimination Guide	Medical Waste Management Program California Department of Health Services P.O. Box 942732 MS 396 Sacramento, CA 94234-7320 Phone: (916) 327-6904 Fax: (916) 323-9869
www.ingham.org/hd/ lepc/pamphlets/hazwaste/ mercuryfacts.html	"Mercury: A Factsheet for Health Professionals." Mercury Factsheet from Ingham County, Michigan
www.nsc.org/library/ chemical/Mercury.htm	Mercury Toxic Release Inventory (TRI) data and general information sheet from the National Safety Council	National Safety Council 1121 Spring Lake Drive Itasca, IL 60143-3201 Phone: (630) 285-1121 Fax: (630) 285-1315
www.epa.gov/mercury	U.S. EPA Mercury Web Site	U.S. Environmental Protection Agency 1200 Pennsylvania Avenue, NW Washington, DC 20460
www.epa.gov/OGWDW/ dwh/c-ioc/mercury.html	Drinking Water and Health: Contaminant Specific Fact Sheets for Consumers (Mercury)	U.S. Environmental Protection Agency 1200 Pennsylvania Avenue, NW Washington, DC 20460
www.wlssd.duluth.mn.us/ publications/mercury.htm	Mercury, Get Mad Now, Not Later! A simplified overview of the mercury issue in a handy information and fact sheet graphic format. Good content. Produced by the Western Lake Superior Sanitary District.
Mercury Reduction and Elimination: In-depth Information
www.pprc.org/hubs/ toc.cfm?hub=502& subsec=7&nav=7	Mercury - Health Care Topic Hub. This resource is an online "primer" on the subject, and is intended as a quick guide to the essential P2 information on Mercury-Health Care, as well as a compilation of pertinent on-line resources.
www.pprc.org/hubs/ toc.cfm?hub=103& subsec=7&nav=7	Mercury - Dental Topic Hub. This resource is an online "primer" on the subject, and is intended as a quick guide to the essential P2 information on Mercury-Dental, as well as a compilation of pertinent on-line resources.
www.mercurypolicy.org/ index.shtml	Mercury Policy Project of the Tides Center of Vermont. Provides information on and links to a number of mercury elimination issues.	Mercury Policy Project 1420 North Street Montpelier, VT 05602 802-223-9000 info@mercurypolicy.org
www.nap.edu/books/ 0309071402/html	National Academy Press, Toxicological Effects of Methylmercury (2000), National Academy of Sciences report on the health effects of mercury.	National Academy Press 2101 Constitution Avenue NW Lockbox 285 Washington, DC 20055 888-624-8373 or 202-334-3313
www.epa.gov/seahome/ mercury/src/title.htm	Mercury in Medical Facilities. An extremely user-friendly EPA site with information on health effects of mercury, programs for reduction and elimination of mercury from medical facilities, and mercury in the environment.	U.S. Environmental Protection Agency 1200 Pennsylvania Avenue NW Washington, DC 20460
www.newmoa.org/prevention/ topichub/22/ Mercury_Pollution_Prevention _in_Healthcare_NWF.htm	Mercury Pollution Prevention in Healthcare -- Great Lakes Field Office -- National Wildlife Federation. This site contains information on mercury and its effects on people and the environment; the importance of source reduction; the healthcare industry's role in preventing mercury pollution; the whys and hows of becoming mercury-free; and, success stories. (Note: this document has been archived and is available in its archived form.)	National Wildlife Federation 11100 Wildlife Center Drive Reston, VA 20190-5362 Phone: (703) 438-6000
www.epa.gov/grtlakes/ seahome/mercury.html	Mercury in Medical Facilities. EPA's discussion on the hazards of mercury in healthcare facilities. This HTML program teaches healthcare professionals (and anyone else) about the hazards of mercury as commonly used in medical care facilities.
www.sustainablehospitals.org/ HTMLSrc/IP_Merc_Tools_CompSphyg.html	Sustainable Hospitals - Mercury Information Package. Guide to differences between mercury and aneroid sphygmomanometers. Includes cost and other comparisons.	Sustainable Hospitals Project Kitson 200 One University Avenue Lowell, MA 01854 Catherine Galligan Phone: 978-934-3386 E-mail: shp@uml.edu
www.noharm.org/ index.cfm?page_ID=12	Health Care Without Harm. Extensive site on health and environmental effects of mercury. Includes information on ordinances and resolutions from various areas of the country.	Health Care Without Harm PO Box 6806 Falls Church, VA 22040 Phone: 703-237-2249 Fax: 703-237-8389 Email: hcwh@chej.org
Mercury Alternatives
www.deq.state.mi.us/ documents/deq-ead-p2- mercury-healthpr.doc	Mercury Alternatives in Healthcare (Michigan). List of healthcare products known to contain mercury, and alternatives. From the Michigan Department of Environmental Quality.
www.pprc.org/ hubs/toc.cfm? 101&subsec=7&nav=7	This topic hub provides background information on mercury and alternative thermometers, including collection and exchange, handling, spills, mercury reduction plans, and recommended alternatives for various applications.

MERCURY SPILLS: A LESSON

THIS IS A TRUE STORY

On March 6,2001, a large barometer fell and broke in a 60 square foot office in a Medical Center located in the Puget Sound Region. The barometer was used to calibrate instruments used in treatment of patients. No one knew when the barometer fell and broke in the office. The office has carpet installed circa 1978. Expensive computer equipment is used in the office and two occupants work in the space. The Code Yellow call came through at 9:30 a.m. Personnel arrived on the scene to evaluate, secure and cleanup the spill. Staff who worked in the area did not react to the Code Yellow call in their area. The cleanup crew did not use personal protective equipment while cleaning the spill. The vacuum used in spill cleanup does have a HEPA filter but is not a certified mercury spill cleanup vacuum.

At the conclusion of the cleanup the vacuum was placed in the bottom shelf of a metal, wheeled spill cleanup cart. The cart was returned to its storage area. In the early afternoon, a Manager in the Department overheard that the mercury spill occurred in a carpeted area. The Manager called the Safety Officer and they both arrived on the scene. Using flashlights they found that there still was mercury on the top surface of the carpet. They asked the staff working in the office to leave, secured the area and left to investigate the spill cart and spill cart storage area. Once again using flashlights, they found mercury droplets under the mercury vacuum on the shelf of the spill cart. Staff was dispatched to clean the cart shelf area. The responders did this wearing personal protective equipment: tyvek suits, nitrile gloves, disposable booties and powered air purifying respirators. The environmental cleanup company was called.

The cleanup company arrived and began the cleanup. Vapor monitoring was done in the office. Cleanup personnel entered the office wearing full personal protective equipment including full-face respirators with mercury cartridges. The portion of contaminated carpet was removed and additional mercury was found below on the substrate. This too was cleaned using mercury sponges. The office was sealed and not reopened until the following day when further air monitoring was done.

The cleanup company accompanied the Manager to the Spill Cart Storage Room. Cleanup company personnel opened the spill cart door housing the mercury vacuum. A vapor level was taken and a sample was found that was close to the Serious Health Risk Level. The spill vacuum was found to be compromised and unsafe for further use. The vacuum and contents were bagged for disposal. Additional mercury was found on the shelf in the cart and was mitigated. The suspected path of travel to the spill site was searched and air monitoring conducted. This was necessary due to the presence of mercury on the shelf and in the shelf seams of the spill cart.

On March 7, 2001, Cleanup personnel returned to the spill site and conducted further air monitoring. Air vapor levels were well within safe ranges and the office was returned to service. Cleanup personnel returned on March 8, 2001, to the Spill Cart Storage Room to decontaminate the spill cart. During cleanup, air vapor levels were higher than deemed safe. Once all visible mercury was removed, vapor levels began to diminish. The Spill Cart Storage Room was shut down for further monitoring the next day. On March 9, 2001, air vapor levels in the Room and the cart had returned to safe levels. Both were deemed operational at that time.

The following are costs associated with the mitigation of the spilled mercury in this 60 square foot office area:

Outside Vendor Cleanup Company - Time, Materials and Labor: $ 4,094.00
Replacement of Mercury Spill Vacuum: $ 3,200.00
Medical Follow up (Blood Testing) For Hospital Staff: $ 260.00
Mercury Disposal Costs: (Will Vary Per Vendor Used) $ 1,600.00
Labor Hours Cost for Hospital Personnel Involved Est.: $ 1,000.00
Total Costs for Spill Mitigation: $ 10,054.00

CONCLUSIONS

This is a true story. It could have been worse. Had the mercury not been mitigated in the office the material could have been tracked throughout the surrounding area. Personnel in the area would have been exposed to air vapor levels containing mercury necessitating medical follow-up. Contaminated carpet would have to be replaced (estimated area 2500 sq. ft.). All carpet replaced would need to be discarded as dangerous waste (extremely expensive). Because of the age of the building and the carpet, asbestos testing would need to be done before replacement. (Asbestos could be in the carpet mastic necessitating, abatement. This would substantially increase carpet replacement cost.) All for a mercury spill in a 60 square foot carpeted office.

The Medical Center was able to use this spill to make positive improvements in its Spill Response Training Program. In-house staff will no longer clean up spills of this magnitude again. The improved process was tested in early April at another mercury spill in a carpeted area and was found to be effective. And much less costly. The March 6th spill demonstrates the need for hospitals to become virtually mercury free by 2005 in accordance with the Memorandum of Understanding signed by the American Hospital Association and the Environmental Protection Agency.

PVC and Phthalate Reduction

Resource Listing	Description and Comments	Contact (if applicable)
www.rppi.org/peg2.html	Phthalates and Human Health: Demystifying the Risks of Plastic-softening Chemicals. Phthalates provide softness and flexibility in the normally rigid PVC used since the 1930's in a variety of plastic medical supplies and equipment. Increasing concerns over the possible carcinogenic potential of this chemical class has led to a call for their removal from all medical products.	Reason Public Policy Institute 3415 S. Sepulveda Blvd., Suite 400 Los Angeles, CA 90034 Phone: 310-391-2245 Mobile: 310-292-2382 Fax: 310-391-4395 E-mail: gpassantino@reason.org
www.noharm.org/ details.cfm?type=document&ID=271	Tenet Healthcare makes the decision to use non-PVC products in all their healthcare facilities.	Health Care Without Harm Gary Cohen Phone: 617-524-6018 Jackie Hunt Christensen Phone: 612-870-3424 or 612-387-3424 Medical Mission Sisters Sister Regina Rowan Phone: 617-364-5255
www.advamed.org/ publicdocs/pvcopenletter11300.htm	Advocates for "Sound Science" Support Vinyl Medical Products" A letter of refutation of concerns about the use of vinyl in medical products. The signing scientists state that there is no evidence to support the claim that patients are being exposed to or harmed by vinyl in crucial medical equipment and supplies. There is no mention of phthalates.	AdvaMed 1200 G Street NW, Suite 400 Washington, D.C. 20005-3814 Phone: 202-783-8700 Fax: 202-783-8750 Email: info@AdvaMed.org
www.baxter.com/ investors/citizenship/environmental/ issues/pvc.html	PVC use in the healthcare industry from the PVC product industry point of view. Baxter Healthcare Corporation.	Baxter Healthcare Corporation One Baxter Parkway Deerfield, IL 60015 Phone: (847) 948-2000
www.ecpi.org/index.asp?page=40	"ECPI - Phthalates in Medical Devices" Questions and answers on the European Council on Plasticizers and Intermediates' web site. This is a "pro-phthalates" organization.

Waste Incineration

Resource Listing	Description and Comments	Contact (if applicable)
www.tcwellness.com/issues/ 1998/04/14.html	Is the healthcare industry detrimental to our health? A warning in the Twin Cities Wellness journal (April 1998) from the Twin Cities, Minnesota Coalition of Healthcare Without Harm stating that the incineration of medical waste is a major source of the harm caused by healthcare.	Women’s Cancer Resource Center Carol Johnson Phone: (612) 825-3322 Kathleen Schuler Phone: (612) 926-4603 Institute for Agriculture and Trade Policy Jackie Hunt Christensen Phone: (612) 870-3424 Minnesota Center for Environmental Advocacy Bob Eleff Phone: (612) 223-5969
www.essentialaction.org/ waste/kniffen.html	"Medical Waste Incineration and the World Bank" - An article from the Environmental News Service. From the article: "When you decide to incinerate medical waste, you're turning a biological problem into a chemical problem."
www.noharm.org/nonincineration newsletter/archive/health/dioxin.html	"Non-Incineration Medical Waste Treatment Technologies: A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members. (Health Care Without Harm, Washington, DC, August 2001;" - A 2001 report from Healthcare Without Harm.	For more information about Health Care Without Harm, contact Jackie Hunt Christensen c/o Institute for Agriculture and Trade Policy 2105-1st Av S, Mpls, MN 55404 Phone: 612-870-3424 Web: www.noharm.org
www.nap.edu/books/ 030906371X/html/17.html	National Academy Press, Waste Incineration and Public Health (2000), Waste Incineration Overview. The National Academy of Sciences' no-frills report on waste incineration, including medical waste. This is an excellent overview of the incineration process, with consideration of the P2 opportunities along the way.	National Academy Press 2101 Constitution Avenue NW Lockbox 285 Washington, DC 20055 Phone: 888-624-8373 or 202-334-3313
www.ul.com/eph/ insights/ephiv3n1/clnrair.htm	EPA Guidelines Driving Innovations in Medical Waste Treatment - A report from "EPH insights" (Environmental and Public Health news from Underwriters Laboratories, Inc.)	For more information on UL's Standard-development efforts for alternative medical waste technologies, contact Tom Blewitt Phone: (631) 271-6200, ext. 22332 Fax: (631) 439-6014 E-mail: blewittt@ul.com

Recycled and Reprocessed Products

Resource Listing	Description and Comments	Contact (if applicable)
www.clearmedical.com/	ClearMedical: A Bellevue (WA) company that reprocesses "single-use" medical devices that otherwise would be added to the waste stream. Items such as anesthesia inhalation set-ups and DVT (deep venous thrombosis) sequential compression devices are pasteurized and re-sold for multiple uses.	1776 136th Pl. N.E Bellevue, WA 98005 Phone: 800-426-1042 or 425-401-1414 Fax: 425-401-1515

Chlorine-free Product Purchasing (to eliminate dioxin)

Resource Listing	Description and Comments	Contact (if applicable)
www.thecre.com/ ntp/resolution-berkeley.html	Berkeley Dioxin Resolution by the Berkeley City Council. A resolution to eliminate dioxin by reducing the purchasing and use of chlorine-containing products by, among others, healthcare facilities. As reported on the Center for Regulatory Effectiveness' web site.	The Center for Regulatory Effectiveness 11 Dupont Circle, N.W., Suite 700 Washington, D.C. 20036

Environmentally Preferred Purchasing (EPP)

Resource Listing	Description and Comments	Contact (if applicable)
www.h2e-online.org/tools/ grnpurch/epp.htm	Hospitals for a Healthy Environment - Environmentally Preferable Purchasing This is H2E's comprehensive "how-to" site for EPP, including many links to information on products and supply chains. Discussion of product life cycle analysis helps assistance providers assist facilities in determining true costs.
www.mass.gov/ota/ support/medspecs.htm	Healthcare Environmental Purchasing Specification Database - This database includes language used in Requests for Proposals (RFPs), public solicitations for contracts, or purchasing contracts to specify environmentally preferable products for healthcare organizations. Created by the Massachusetts Office of Technical Assistance for Toxics Use Reduction.	Massachusetts Office of Technical Assistance 100 Cambridge Street Suite 900 Boston, MA 02114-2524
www.nwmedicalwaste.org/topics/epp.cfm	"EPP in the Medical Industry" - Minutes from the King County (WA) Solid Waste Division's "Medical Industrial Waste Reduction Roundtable" of November 2000 on EPP in the Medical Industry.

Pharmaceutical Disposal

Resource Listing	Description and Comments	Contact (if applicable)
www.sdearthtimes.com/ et1098/et1098s5.html	"Drugs in the Water" - An enticing report on pharmaceutical drugs given to people and to domestic animals including antibiotics, hormones, strong pain killers, tranquilizers, and chemotherapy chemicals given to cancer patients being measured in surface water, in groundwater and in drinking water at the tap. From the San Diego Earth Times, 10/98, reprinted from Rachel's Environment and Health Weekly.	San Diego Earth Times PO Box 99179 San Diego, CA 92169 Phone: (858) 272-7423 Fax: (858) 272-2933 E-mail: sdet@sdearthtimes.com
books.nap.edu/books/ 0309064325/html/112.html	National Academy Press, Identifying Future Drinking Water Contaminants (1999), 6 Emerging Chemical Drinking Water Contaminants. National Academy of Sciences report on, in part, pharmaceuticals discovered in water destined to be used as drinking water.	National Academy Press 2101 Constitution Avenue NW Lockbox 285 Washington, DC 20055 Phone: 888-624-8373 or 202-334-3313
www.ngwa.org/news/drug.html	National Ground Water Association report. News item on the National Ground Water Association's report on early evidence of the emerging issue of contamination of water supplies by drugs and endocrine disrupting chemicals (EDCs).	Julie Shaw Marketing Communications Coordinator National Ground Water Association Phone: 800-551-7379 E-mail: jshaw@ngwa.org Web: www.ngwa.org

Food Waste

Resource Listing	Description and Comments	Contact (if applicable)
www.epa.gov/epaoswer/non-hw/reduce/food/food2.pdf	Success story - Fletcher Allen Healthcare - The Medical Center Hospital of Vermont (MCHV) Campus of Fletcher Allen Health Care delivers approximately 90% of its food preparation scraps and steam table leftovers to an off-site composting facility. The hospital also donates produce to a food bank and sends old grease to a rendering facility. Its food discard recovery program allows Fletcher Allen to save approximately $1,400 per year in landfill hauling and tipping fees and to support a local farm.	Environmental Health Coordinator Office of Community Health Improvement Fletcher Allen Health Care Community Health Improvement UHC Campus, Arnold 4410 Burlington, VT 05401 Phone: (802) 656-2399 Fax: (802) 656-5985 E-mail: hshaner@aol.com

Our thanks to the following people for their generous assistance:
Janice Englehart, Washington State Board of Health
Evan Kanter, Washington Physicians for Social Responsibility
Mike Smith, Swedish Hospital
David Stitzhal, Full Circle Environmental