Nursing and the Environment: New Dimensions for Clinical Practice By Hollie Shaner RN, MSA, FAAN Nightingale Institute for Health and the Environment.

Nursing and the Environment: New Dimensions for Clinical

Practice

By

Hollie Shaner RN, MSA, FAAN

Nightingale Institute for Health and the Environment

Mercury waste management

DIOXIN latex

Persistent bioaccumulative toxic substances

Glutaraldehyde hazardous pharmaceuticals

PVC purchasing decisions energy use

Water conservation indoor air quality

Patient safety worker safety

Nurses Roles

Past, Present, Future

“We won’t have a society if we destroy the environment.”

-Margaret Mead

““No amount of medical knowledge will lessen No amount of medical knowledge will lessen the accountability for nurses to do what the accountability for nurses to do what nurses do, that is, manage the environment nurses do, that is, manage the environment to promote positive life processes” to promote positive life processes”

-Florence Nightingale-Florence Nightingale

DEVER MODEL: Health Status of Populations

Health Status

HumanBiology

Lifestyle

Health Care

System

Environment

What are the most important things for human life?

• Air – we can live about 4 minutes without it

• Water– we can live about 4 days without it

• Food– we can live about 3 weeks without it

Human Health & the Environment

– Critical Condition: Human Health and the Environment MIT Press 1993

– Generations at Risk: Reproductive Health and the Environment MIT Press 1999

– Pediatric Environmental HealthAmerican Academy of Pediatrics 1999

Human Health & the Environment

– Dr. Sandra Steingraber

• Living Downstream– Exploration of cancer & the

environment

• Having Faith–The ecology of childbirth &

breastfeeding

Human Health and the Environment

– Bioscience October ‘98

• David Pimentel, Cornell University

–40% of deaths worldwide due to environmental pollution and degradation

Healthcare Industry Special Obligations

• Promote health & well being of community

• Treat the sick

• Act as responsible corporate citizen

• Provide employment

Ecological Footprint “Industrial metabolism”

• Resources: energy, water, materials

• Waste Outputs: solid waste, hazardous waste, biohazardous waste, radioactive waste, air emissions, waste water

• Resource Book: Our Ecological Footprint by Wackernagel and Rees

Environmental Implications of the Health Care Service Sector

Terry Davies and Adam I. Lowe October 1999

• http://www.rff.org/disc_papers/PDF_files/0001.pdf

Health Care Industry Footprint

• Energy: 365 days & 24 hours

• Water: sinks, toilets, showers, food service, landscape, equipment

• Materials: plastics, paper, glass, metals, mixed materials, equipment, bandages pharmaceuticals, foodstuffs

Health Care Industry Footprint

• Among the leading sources of MERCURY and DIOXIN pollution in the USA

By-products of Healthcare

• Understand the wastes generate

• Understand the relationship between the products we use and the toxicity and volume of wastes we create

• Understand helpful interventions we can make in our role as nurses

Waste StreamsHospital Waste Composition

85%

10% 5%

Solid

Biohazard

Hazardous

Biohazard

Waste

Sharps

Blood/blood

products

Pathological

Trace Chemo

Animal carcasses

Hazardous

Waste

chemical hazards

solvents

U & P listed pharmaceuticals

cytotoxics

lead

silver

mercury

ether

Solid

Waste

Recyclable

Waste

cardboard

paper

confidential paper

metal

aluminum

plastic

pvc, hdpe, pet, ldpe, pp, ps,other

glass

medical, sodalime

wood

construction & demo

food

kitchen grease

Universal Wastes

Batteries

Fluorescent light tubes

Mercury switches

Pesticides

Hospital Solid Waste• Paper waste

• Plastic waste

• Glass waste

• Metal waste

• Food waste

• Wood waste

• Other waste paper

plastic

metal

food

other

woodglass

Hospital Biohazard Waste

• Blood and blood products• Sharps used and unused• Cultures and stocks • Pathological waste• Blood contaminated items• Wastes from patients in

isolation from a known communicable disease

Hazardous Wastes Commonly Found in Hospitals

• Chemotherapy and anti-neoplastic chemicals

• Formaldehyde• Radio nuclides

• Solvents• Mercury• Waste anesthetic gases• Cleaning and

Maintenance chemicals

• Other corrosives

Hazardous Wastes

• Not the same as biohazardous wastes

• Hazardous wastes are regulated federally in USA under the Resource Conservation and Recovery Act (RCRA)

• Require hospitals to characterize wastes prior to disposal

• Hospitals must determine their waste generator status – SQG, LQG

What Happens to all that waste?????

• Hazardous waste: requires special treatment depending on material type

• Universal wastesome is recycled, recovered

• Solid waste: landfill, recycle, compost, incinerate

• Biohazard wastes: incinerate, autoclave, microwave , other

*Medical Waste Incinerators sources of mercury & dioxin pollution by US EPA

PBT’s: Persistent Bioaccumulative Toxic Substances

• Problem pollutants from healthcare

• American Hospital Association MOU with US EPA calls on hospitals to address minimize PBT’s– To virtually eliminate mercury from healthcare

wastes by 2005– To reduce healthcare waste by 50% by 2010– See www.h2e-online.org

Dioxin2, 3, 7, 8- tetrachlorodibenzo-p-dioxin

or TCDD

Dioxin: Sources• Medical Waste Incineration

– 25% of all healthcare products made from PVC• iv bags, blood bags, tubing,

endotracheal tubes

• Municipal Waste Incineration– PVC plastics

• Copper smelters

Health Effects of Dioxin

• Immune System– Ah receptor

• Cancer Promoter– WHO IARC Committee: a proven human carcinogen

• Reproductive Toxin– birth defects– endometriosis

• Endocrine Disruptor

Dioxin travels

• Emissions from incinerators

• Land on terrestrial landscape, plants

• Consumed by animals

• Dioxin is lipo-philic & accumulates in fatty tissue of animals

• Humans eating animals get animal’s lifetime bioaccumlative dose of dioxin

Consumer Reports

• Article reports that a 2 oz. Jar of beef based baby food ( Heinz, Beechnut, Gerber) has up to 100x the safe exposure limit of dioxin

• Mothers milk is largest source of dioxin to infants. Despite this finding, breastfeeding is still recommended.

What is PVC plastic??• Polyvinyl Chloride Plastic

PVC & DEHP

• HCWH blue folder

• FDA alert– www.fda.gov click on alerts, click on July11

DEHP in medical products

• www.noharm.org

Mercurymercury in fish

Mercury: Sources• Mercury containing healthcare products including

– thermometers

– sphygmomanometers

– esophageal dilators

– laboratory chemicals

– fluorescent light tubes

– batteries

Mercury: Sources• Mercury containing healthcare products including

– Boiler Switches

– fluorescent light tubes

– batteries

Mercury: Sources• Mercury containing healthcare products including

Mercury Health Effects

• Depend on form of Hg, dose, route of exposure, stage of development– organic mercury

• impaired vision, hearing, taste, smell, speech

• low level fetal exposures interfere with normal brain development

• includes impaired memory, attention, and learning

Mercury Travels

• A single fever thermometer

contains one gram of mercury

• 4 grams of mercury are sufficient to contaminate a small to medium sized lake rendering the fish in that lake unfit for consumption by women of child bearing age

Mercury Travels

• Improper disposal, either via incineration or down the drain, spreads mercury into the environment

• In ponds and streams, mercury is converted to organic mercury that is absorbed by fish and continues to bioaccumulate up the food chain

• Humans are exposed through diet

Mercury Spills

• Have you ever broken a mercury thermometer?– Sphygmomanometer?– Esophageal dilator?

• Have you ever cleaned up a mercury spill?

• Where did you discard the spilled materials?

Bowling Green University Video

What really happens during a mercury spill

Key Actions Nurses Can Do To Reduce Mercury Pollution

• Mercury– phase out use of

mercury products

Key Actions Nurses Can Do To Reduce Mercury Pollution

• Mercury– establish policies to

eliminate purchase of mercury products in hospitals and clinics

Key Actions Nurses Can Do To Reduce Mercury Pollution

• Mercury– properly manage and

dispose of mercury• batteries

• thermometers

Key Actions Nurses Can Do To Reduce Mercury Pollution

• Mercury– Find out who is in

charge of cleaning up mercury spills when they happen

– How is the mercury disposed of?

• Mercury should NEVER be discarded in a sharps container or biohazard waste container, or the trash, or down the drain

Key Actions Nurses Can Do To Reduce Mercury Pollution

• Mercury– Does your hospital have mercury spill kits?

– Have you been trained in how to use them?

– Where is the cleaned up mercury discarded? It should be discarded as a HAZARDOUS waste, not biohazardous.

Make it Personal!

• Nurses as Environmental Consumers of Health Care

• www.nihe.org

For more information visit

The Nightingale Institute for Health and the Environment www.nihe.org