Eco-Friendly Hospitals

Healthcare facilities that adopt more environmentally-friendly products and practices can save money, help the environment, and minimize health risks posed by toxic substances. Here is some practical advice on how to make your workplace greener, collected from Health Care Without Harm and other sources.

Waste Management

American hospitals generate more than two million tons of waste each year. Reducing waste benefits the budget as well as the environment. Simple measures can often have dramatic effects. For example, it's calculated that a 1,000-bed hospital that uses reusable sharps containers rather than disposable ones could save $175,000 per year and reduce waste by 34,000 pounds (15,422 kg). One Sacramento hospital switched to reusable, liquid-proof surgical gowns and towels from disposable ones, which resulted in a savings of $60,000 per year and cut waste by 50,000 pounds (22,680 kg). Paper makes up more than half of the waste generated by hospitals, and is an easy target for waste reduction. An Oregon hospital asked staff not to print hard copies of reports when online viewing was sufficient, and this practice saved the hospital $9,222 and 3,504 pounds (1,589 kg) of waste per year. When waste cannot be prevented, recycling is the next step. Three Oregon hospitals collectively recycled more than one million pounds (453,592 kg) of paper, plastic, glass, and other materials, and saved $45,000 in disposal costs. How do multiple waste-reduction measures add up? A New York City hospital saved $600,000 per year by minimizing the volume and toxicity of their waste material.

Segregating medical and nonmedical waste is another important way to reduce cost and environmental impact. About 85% of hospital waste is noninfectious, but this material is often mixed with medical waste, which requires more expensive, and often more environmentally harmful disposal methods, such as incineration.

As of 1997, more than 90% of medical waste in the United States was incinerated. Incineration not only releases greenhouse gases, but also cancer-causing dioxin (incinerated medical waste is the third-largest source of environmental dioxin in the United States), mercury, heavy metals, furans, acid gases, and other pollutants. A few states require certain types of medical materials to be incinerated but most do not. When possible, investigate alternative methods of medical waste disposal, including autoclaving, chemical treatment, and irradiation.

A number of strategies can be used to reduce the amount of medical waste. In general, hospitals should review practices to see where improvement can be made, and follow the principles of "prevent, reduce, reuse, and recycle."

Reducing Toxicity

Mercury: Mercury can damage the brain, spinal cord, liver, and kidneys, and fetuses are especially vulnerable to mercury-induced neurological damage. Many products used in healthcare contain mercury, including thermometers, blood pressure devices, laboratory chemicals, and cleaners. Non-mercury alternatives exist for almost every product, and Hospitals for a Healthy Environment offers a step-by-step guide on how to eliminate mercury from healthcare settings.

PVC and DEHP: PVC plastic is commonly used in medical devices, building products, everyday items such as shower curtains and bedding. Dioxin, a known human carcinogen, can be released during the manufacture of PVC and the incineration of PVC products. The compound DEHP is a probable human carcinogen, and is used to soften PVC plastic. Animal tests link DEHP to cancer, liver damage, reproductive birth defects, and other illnesses, and DEHP may leach from PVC medical devices and enter the body or the environment. When possible, choose PVC-free alternatives when purchasing products.

Brominated Flame Retardants (BFRs): Healthcare facilities use many products that contain flame retardants, such as IV pumps, bedding, privacy curtains, televisions, and computers. BFRs are a subset of flame retardants, and have been linked to disrupted memory and learning, thyroid problems, and reproductive problems in animal studies. Some BFRs may also cause cancer, immune suppression, and endocrine disruption. BFRs may leach out of products and make their way into food, water, and the human body. To minimize health risks, reduce the use of products containing BFRs, and purchase new items that do not contain BFRs. If you suspect that a product contains BFRs, ask the manufacturer to disclose the name and CAS number (chemical abstracts service registry number) of all flame retardants used in the product.

Cleaning Products, Pesticides, & Scents: The cleaners, disinfectants, pesticides, and scented products used in hospitals often contain toxic chemicals and volatile organic compounds. Their use worsens indoor air quality, and is associated with adverse health effects ranging from allergies, irritation, and headaches to cancer, birth defects, and neurological and reproductive disorders. Some patients have respiratory problems and other health conditions that are especially vulnerable to these substances, and respiratory problems also seem to be on the rise among healthcare workers. To combat these problems, hospitals can select safer cleaning products, and limit the use of disinfectants and toxic chemicals. Pests can be controlled without pesticides, and scented products should be eliminated whenever possible.

Purchasing Power

Environmentally preferable purchasing means choosing products and services that are less harmful to human health and the environment. In general, such products are nontoxic or less toxic, minimally polluting, and more energy efficient. Also look for products that are fragrance-free, have less packaging, and a higher percentage of recycled content.

Choose reusable products rather than disposable ones whenever possible. A more controversial practice involves reusing "disposable" products after they have been cleaned, sterilized, and tested. The reprocessing of single-use products must comply with FDA guidelines, and may be carried out in the hospital or at special reprocessing facilities. Reusing devices can cut costs by 40% to 60% and eliminate thousands of tons of waste. A 2008 report from the Government Accountability Office found that reusing disposable devices does not cause elevated health risks for patients.

Purchase food with reduced levels of antibiotics.

Encourage manufacturers to create safer products and adopt more environmentally friendly business practices. Lobby policymakers to create incentives for adopting environmentally sound practices and stricter guidelines to protect human and environmental health.

Visit these websites for additional information on how to make your hospital more environmentally friendly: • Practice Greenhealth • Teleosis Institute: Health Professionals in Service of the Global Environment • The Canadian Coalition for Green Health Care Also see: Hospitals, Health, & Architecture.

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