Pollution Prevention Strategies Used by Oregon Hospitals
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AN ABSTRACT OF THE THESIS OF Neha T. Patel for the degree of Master of Science in Environmental Health Management presented on September 24, 2002. Title: Pollution Prevention Strategies Used By Oregon Hospitals. Redacted for Privacy Abstract approved: Anna K. Harding Waste generated by the health care industry has been cited as a major source of toxic pollution, including mercury and dioxins, which poses a serious threat to public health. The purpose of this study was to investigate pollution prevention activities of health care facilities in Oregon related to environmentally- preferable purchasing practices, recycling, mercury reduction efforts, and written policy. Surveys were sent to 57 hospitals in Oregon, 24 facilities responded (42.1 %). Results indicate that the following environmentally-preferable purchasing practices are being implemented: purchasing reduced hazardous material (92%); using recycled packaging (75%); and, using products made from recycled content material (83%). Other practices, such as the purchasing of cadmium-free red bags (25%), supplies shipped in reusable shipping containers (34%), and using minimal packaging (46%) are being implemented in a few hospitals. None of the hospitals are purchasing chlorine-free office paper. The majority of participating Oregon hospitals are recycling paper (96%), cardboard (96%), clear glass (67%), linens (87.5%), batteries (67%) and X-ray film (83%). Fewer hospitals are recycling plastics: #1 PET and #6 polystyrene (37.5%), #2 HDPE (42%), #5 polypropylene (33%). Fewer hospitals are also composting food (46%), computers and equipment (42%), fluorescent lamps (2 1%) and solvents/fixers (29%). Major barriers to recycling in hospitals include lack of established markets for some materials, limitedspace to collect the materials, and low employee participation. The majority of participating hospitalsare reducing the purchasing of mercury containing products, replacing mercury blood pressure units andgauges, replacing lab and housekeeping chemicals, and pharmaceuticals.Fewer than 50% of then participating hospitals are replacing switches, recyclingbatteries and conducting an inventory of mercurysources. Few hospitals are checking drains and pipes for mercury contamination (13%), recycling fluorescentlamps (21%) and requiring vendors to disclose mercury content below 1%(17%). While most hospitals no longer purchase new mercury-containing devices,the cost associated with disposal of mercury as a hazardous waste isa major barrier to elimination. Hospitals located in urban areas in Oregonare more likely to implement pollution prevention strategies than rural hospitals. Nearly allOregon hospitals lack a corporate policy on pollution prevention/sourcereduction, or written goals on waste volume reduction or waste toxicity reduction efforts. The few hospitals (8%) that have put policies in place have doneso voluntarily, and with the full support from upper-level management. Based on theses findings recommendations include the following: Establish a "Green Team" of hospital staff from diversedepartments.This group can then strategize about courses of action for the facility with input from all responsible sectors. Coflduct a waste audit. This establishesa baseline of existing hospital waste and will help determine how to shapea waste minimization program and pollution prevention plan. Pollution prevention education should bea top priority for all departments within each hospital including purchasing, nursing, housekeepingand top management. Many health care professionals are notaware of the link between the products and practices they choose and theenvironmental consequences of these choices. Rural hospitals can join pollution prevention email listserves such as the Oregon Health Care Without Harm list (HCWHoregon-health.org)or the H2E list serve (www.h2e-online.org) to share, learn and identif'practical strategies for pollution prevention and waste minimization. Approach and involve upper level management to work with hospital "green teams" to develop and implementa hospital policy on pollution prevention. ©Copyright by Neha T. Patel September 24, 2002 All Rights Reserved Pollution Prevention Strategies Used By Oregon Hospitals by Neha T. Pate! A THESIS Submitted to Oregon State University in partial fulfillment of the requirements for the degree of Master of Science Presented September 24, 2002 Commencement June 2003 Master of Science thesis of Neha Patel presented on September 24, 2002. Approved: Redacted for Privacy Major professor, representing Health Management Redacted for Privacy Chair of the Department of Public Redacted for Privacy Dean of the I understand that my thesis will become part of the permanent collection of Oregon State University libraries. My signature below authorizes release of my thesis to any reader upon request. Redacted for Privacy Neha T. Patel, Author ACKNOWLEDGMENTS The author expresses sincere appreciation to the Oregon Center for Environmental Health for helping support this study. I also thank the participants of the Oregon Health Care Without Harm Coalition for their valuable input and Professor Anna Harding for her encouragement and guidance during the various stages of this research. TABLE OF CONTENTS INTRODUCTION . I PURPOSE OF THE STUDY.......................................... 4 SJGNIFICANCE OF STUDY......................................... 5 LIMITATIONS OF STUDY.......................................... 6 DEFINITIONS.......................................................... 6 ABBREVIATIONS..................................................... 7 REVIEW OF THE LITERATURE............................................. 9 RECYCLING AND WASTE MINIMIZATION................... 9 ENVIRONMENTALLY PREFERABLE PURCHASING II EPA Environmentally preferable purchasing guidelines 12 EPP in the public and private sectors........................ 12 HCWH, H2E and EPP......................................... 14 EPP hospital case studies...................................... 15 Purchasing departments role in EPP......................... 17 ELIMINATION OF MERCURY IN HEALTHCARE............ 17 Mercury toxicity................................................ 17 Historical uses of mercury in medical industry............ 18 Making medicine mercury free.............................. 19 ENVIRONMENTAL PERFORMANCE POLICY................. 20 Regulatory standards........................................... 21 Corporate policy 21 METHODS........................................................................ 26 STUDY POPULATION................................................ 26 SURVEY INSTRUMENT............................................. 26 DATA COLLECTION................................................. 27 Phone call and meeting........................................ 28 Cover letter...................................................... 29 Mailing........................................................... 29 Follow-up phone calls and mailing........................... 29 TABLE OF CONTENTS (CONTINUED) Collection of qualitative data................................. 30 DATA ANALYSIS..................................................... 30 RESULTS AND DISCUSSION................................................ 31 GENERAL INFORMATION.......................................... 31 ENVIRONMENTAL PURCHASING PRACTICES............... 34 Cadmium-free red bags....................................... 35 Reusables vs. disposables..................................... 36 Officepaper..................................................... 37 Reduced hazardous material.................................. 40 RECYCLING PRACTICES OF OREGONHOSPITALS 41 Paper recycling.................................................. 42 Plastics recycling................................................ 43 Food Donation................................................... 44 Glass recycling.................................................. 45 Solvents and fixers............................................. 45 Fluorescent lamps............................................... 46 Computers! equipment......................................... 47 MERCURY REDUCTION PRACTICES........................... 48 Reduce purchasing ofmercury -containing products 49 Replace mercury bloodpressure units.................... 50 Replace mercury-containing cantor tubes/dialators 50 Purchase mercury-free pharmaceutical chemicals.......... 51 Require vendors to disclosemercury content below 1% 51 Inventory mercury sources.................................... 51 BARRIERS TO MAKING MEDICINEMERCURY-FREE 52 POLICY ON POLLUTION PREVENTION........................ 54 CONCLUSIONS AND RECOMMENDATIONS........................... 56 CONCLUSIONS......................................................... 56 TABLE OF CONTENTS (CONTiNUED) RECOMMENDATIONS................................................ 58 BIBLIOGRAPHY.............................................................. 63 APPENDICES...................................................................... 69 APPENDIX A Hospitals in Oregon Listed in OAHHS members 70 list2001..................................................................... APPENDIX B Hospitals for a Healthy Environment Original Survey....................................................................... 75 APPENDIX C Waste Survey used for Oregon Hospital Study 81 APPENDIX D Telephone Script.......................................... 85 APPENDIX E The Oregonian News Article........................... 87 APPENDIX F Cover Letter..............................................