. romoiing a^onmentally I Responsible Health Care E nvironmentally responsible health care is gaining momen- tum in today's society (Health Care Without Harm, 2002). The international coalition Health Care Without Harm (2004) is focusing attention on the three main toxins that are polluting the air at high levels and are poisonous to people: dioxin, polyvinyl chloride (PVC) and di(2-ethylhexyll phthalate (DEHP). The purpose of this feature article is to discuss these toxins and their destructive role in the environment and propose ways in which nurses can advocate for, and protect, society. Our interest in environmentally responsible health care grew from our daily experience of witnessing the disposal of tV bags and tubing, gloves, packaging materials and containers. We questioned why so much was being wasted, so little was being reused and nothing was being recycled. As we exam- ined the issue, we discovered that there are many disposal options available and that toxins and incineration are important environmental topics in health care. In October 2004, leading international health-care profes- sionals met in Vienna, Austria, to agree on a far-reaching plat- form for environmentally responsible health care. At this conference, Manfred Muhlberger, president of the Institute for Sustainable Healthcare of Vienna, made reference to the future of health-care facilities as being PVC-free. Suggestions included replacing harmful equipment made from PVC and DEHP, reducing incineration practices in order to reduce dioxin emissions and reducing the consumption of materials, products, energy and water. From his statement, the Vienna Declaration of Environmental Standards for Healthcare was developed, paving the way for countries to implement legisla- tion regarding environmentally responsible health care. This declaration is crucial in developing compulsory international environmental health standards for the health-care sector (Health Care Without Harm, 2004). 22 CANADIAN nufse
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. romoiing a^onmentally
I Responsible Health CareEnvironmentally responsible health care is gaining momen-
tum in today's society (Health Care Without Harm, 2002).
The international coalition Health Care Without Harm (2004) is
focusing attention on the three main toxins that are polluting
the air at high levels and are poisonous to people: dioxin,
polyvinyl chloride (PVC) and di(2-ethylhexyll phthalate (DEHP).
The purpose of this feature article is to discuss these toxins
and their destructive role in the environment and propose
ways in which nurses can advocate for, and protect, society.
Our interest in environmentally responsible health care grew
from our daily experience of witnessing the disposal of tV
bags and tubing, gloves, packaging materials and containers.
We questioned why so much was being wasted, so little was
being reused and nothing was being recycled. As we exam-
ined the issue, we discovered that there are many disposal
options available and that toxins and incineration are important
environmental topics in health care.
In October 2004, leading international health-care profes-
sionals met in Vienna, Austria, to agree on a far-reaching plat-
form for environmentally responsible health care. At this
conference, Manfred Muhlberger, president of the Institute
for Sustainable Healthcare of Vienna, made reference to the
future of health-care facilities as being PVC-free. Suggestions
included replacing harmful equipment made from PVC
and DEHP, reducing incineration practices in order to reduce
dioxin emissions and reducing the consumption of materials,
products, energy and water. From his statement, the Vienna
Declaration of Environmental Standards for Healthcare was
developed, paving the way for countries to implement legisla-
tion regarding environmentally responsible health care. This
declaration is crucial in developing compulsory international
environmental health standards for the health-care sector
(Health Care Without Harm, 2004).
22 C A N A D I A N nufse
Amanda Best
Amanda Best
Amanda Best
Nurses can play an active role through
education, advocacy and the implementation
of measures to reduce medical wastage and
exposure to chemical toxins.
PEER-REVIEWED FEATURE
JACQUELINEGAUDRY,
RN, BScN
KIMBERLYSKIEHAR,RN, BScN
1
Poiyvinyi chioride and dii2'etfT/ihexyi) phthaiate. PVC is a plas-
tic widely used to make 25 per cent of hospital equipment (The
Nightingale Institute for Health and the Environment |NIHE|, 2002).
It is used in synthetic medical devices, including blood, intra-
venous, and total parenterai nutrition bags and tubing, nasogastric,
hemodialysis and endotracheal tubing, as well as respiratory
masks, examination gloves and plastic food wrap (Green, Hauser,
Calafat, Weuve, Ringer, Huttner, & Hu, 2005).
PVC is firm and fragile. To make it pliable, DEHP is added
(Gilmore Hall, 2006). PVC plastics contain between 17 and 41 per
cent of DEHP by weight (Women's Health & Environmental Net-
work [WHENL 2006) Because DEHP does not bond to the PVC, it
can leach into fluids inside bags and tubing and also into the sur-
rounding environment (WHEN, 2006).
Research on animals has shown that DEHP exposure can lead
to a number of adverse effects. These include decreased fertility
and sperm production, ovarian dysfunction and damage to the liver,
kidneys and lungs (Gilmore Hall, 2006; Rais-Bahrami, Nunez,
Revenis, Luban, & Short, 2004).
Children are more susceptible to DEHP toxicity due to their
increased metabolic demands, which heightens their absorption of
the chemical (Health Care Without Harm, 2005). In 1998, a Health
Canada advisory called for the disposal of small, soft vinyl teething
rings and rattles (Health Canada, 1998). The advisory warned par-
ents and caregivers that children sucking or chewing on toys con-
taining PVC for extended periods — three or more hours per day,
every day — could result in potential risks to young children. Health
Canada is now partnering with toy retailers and manufacturers to
provide PVC-free alternatives.
Dioxin. Dioxins are byproducts of incineration, industrial
processes and uncontrolled burning (Chlorine Chemistry Council,
2006). In lab animals, a correlation has been found between dioxin
and toxicity, cancer, reproductive disorders, decreased immunity
and altered developmental function. The results have been linked
to humans, with heart disease and diabetes being major risks
of dioxin exposure (National Institute of Environmental Health
Sciences [NIEHSI, 2006).
Dioxin is introduced into the body when PVC is incinerated
(NIHE, 2002). Upon incineration, dioxins are released into the envi-
ronment, rained back down into the ground, drained into water
sources and absorbed by plants. Animals and ultimately people
become the consumers of these altered plants (WHEN, 2006).
According to the Chlorine Chemistry Council, fish, meat and dairy
products contain the highest levels of dioxin (2002).
Dioxin accumulates in human fat tissue. This is because the
body is slow to excrete this harmful substance (NIEHS, 2006).
Breast milk, which has a very high fat content, is responsible for
passing large amounts of dioxin to infants (WHEN, 2006).
ABSTRACT
Dioxins, polyvinyl chloride and di(2-ethylhexyl) phthalate are the
three main toxins interfering with the goal to maintain a healthy
environment, according to the international organization Health
Care Without Harm (2004). Exposure to these chemicals has been
linked to cancer, as well as reproductive, cardiac, hepatic and devel-