First Do No Harm Hospital vs.. Environment Noe Copley-Woods, MD Assistant Professor Department of Obstetrics and Gynecology University of Pittsburgh School of Medicine
Magee Women’s Hospital • • • • • •
10,000 babies born per year 30,000,000kWh electricity 166,000 decatherms of gas 161,500,000 ft2 space 494 tons of Red Bag Waste/yr 927 tons of Municipal Waste/yr
#7 US News Report Best Gynecology Hospitals • NICU DEHP and PVC free • Mercury Free Hospital • Environmental Education Classes for expectant parents • green roof, edible gardens used in hospital food, non-toxic cleaning products, environmentally preferred purchasing
My Job As An ObGyn
Laparoscopic Assisted Vaginal Hysterectomy
Dilation and Curettage
Magee Waste Comparison by Weight (lbs)- August 2009 EWS 2280 lbs. 1.2%
CDD 13700 lbs. 4.9%
Hazardous Waste 3245 lbs. 1.1%
RMW 46843 lbs. 16.9 %
RMW Chemo/Path 21861 lbs. 7.9% MSW 164500 lbs. 59.5% Recycle 23800 lbs 8.6%
Red Bag Waste (Regulated Medical Waste) • Regulated by individual states and OSHA • Defined as medical waste capable of producing an infectious disease. • Sharps • Cultures/stocks • Blood and blood products • Isolation Waste – (from patients with a known communicable disease)
• Dialysis unit waste
PVC (polyvinyl chloride) 1/4 of disposable medical devices are made of PVC Dioxin released in production and incineration of PVC.
Dioxin 2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) Class I Carcinogen (WHO)
• • The primary toxic component of Agent Orange • Unintentional bi-product of many industrial processes (pesticide manufacturing, pulp and paper bleaching, burn barrels, PVC) • 2 largest sources include garbage and medical waste incinerators. • Lipophilic and accumulates in fat.
Incinerator Emissions • Dioxin • Acid Gases (hydrochloric acid) • Particulates • heavy metals – Lead, cadmium, mercury
Hazardous Wastes Commonly Found in Hospitals
• Chemotherapy and antineoplastic chemicals • Formaldehyde (Hazardous waste incinerator) • Radio nuclides (allowed to decay and then sent to landfill)
• Solvents • Mercury (reclamation) • Waste anesthetic gases • Cleaning and Maintenance chemicals
Environmental Measures at Fletcher Allen Healthcare
Louis Dinneen Director of Facilities Management Fletcher Allen Healthcare
Toxicity Reduction Daily Use Chemicals Green
Non-Green
Total
2005
0
11
11
2006
1
10
11
2007
4
3
7
2008
5
2
7
2009
5
1
6
Benefits • • • •
Building occupant sensitivity Improved indoor air quality Reduced packaging Fewer Chemicals
Let’s Talk Trash…
The Hierarchy of Waste Stream Stream
Impact
Infectious Waste Trash
Recycling Composting
Reuse By moving the material down the hierarchy we reduce the environmental impact.
Trash to Compost 2007
Compost
2008
Compost
2009
Compost
Increase Recycling Waste Stream Volume 100% 90%
Percentage of Total
80% 70%
65%
58%
60%
57% Solid Waste
50%
Recycling
40%
31%
29% 30%
746 Tons
2008
1400 Tons
2007
710 Tons
0%
1445 Tons
332 Tons
10%
1506 Tons
20%
22%
2009
Energy Conservation $ $
$
$ $
$
Energy Reduction Measures Measure
Electric Consumption (kWh)
Gas Consumption (MMBtu)
Carbon Footprint (Tons)
Capital Project Lighting, Insulation, HVAC, Chilled Water (2007-8)
2,380,000
6,355
1,738
Turned off Transformers (2009)
1,200,000
N/A
492
AHU Re-commissioning (2009)
920,000
In Progress
377
Total Reduction
4,500,000
6,355
2,607
Historical Energy Usage Annual Electrical Consumption and Carbon Footprint
42000000
17000 16500
40000000 16000
39000000 38000000
15500
37000000
15000
36000000 14500
35000000 34000000
14000 2005
2006
2007
2008
2009
Metric Tons of C02
Electric Consumption (kWh)
41000000
QUESTIONS
Sustainability & Waste Management at University Hospitals
John Leigh
Healthcare’s Footprint • 24/7 Operations • 3 million tons of waste per year and growing - increase in disposables, packaging, chemicals • Hospitals are the second most energy-intensive commercial buildings in the U.S. • Medical waste incinerators have been a major source of dioxin emissions
Why are hospitals more focused on greening their operations? • • • • • • •
Public Health Benefits Cost Savings Reg. Compliance/Liability Indoor Air Quality Community Pressure Healing Environments Recognition of Our Large Environmental Footprint • Mission & Ethic • Precautionary Principle
4
Could these trends be connected? ↑ Rise in chemical production & prevalence of chemicals in the products we use ↑ Rise in our toxic chemical body burden ↑ Rise in the incidence of cancer, asthma, diabetes, autism...
“Overall...the health effects of a rapidly changing climate are likely to be overwhelmingly negative.” – World Health Organization
• Weather extremes • Sea level rise • Ecosystem changes • Floods • Droughts
HEAT SEVERE WEATHER AIR POLLUTION ALLERGIES VECTOR-BORNE DISEASES WATER-BORNE DISEASES WATER & FOOD SUPPLY ENVIRONMENTAL REFUGEES MENTAL HEALTH
Heat stress, cardiovascular failure Injuries, fatalities Asthma, cardiovascular disease Respiratory allergies, poison ivy Malaria, dengue, hantavirus, encephalitis, Rift Valley fever Cholera, cryptosporidiosis, campylobacter, leptospirosis Malnutrition, diarrhea, harmful
algal blooms Forced migration, civil conflict Anxiety, post-traumatic stress,
depression, despair
Ecological Overshoot: We’re drawing down natural capital
Source: The Ecological Footprint Atlas 2008. Oakland: Global Footprint Network.
DHMC’s Ecological Footprint Total Ecological Footprint
MTCO2e
TOTAL Products Energy Waste Transportation Food Water Built Land
190,288 85,346 44,085 498 46,885 12,095 332 1,047
Global Acres 75,096 29,949 15,470 175 24,679 4,329 119 375
% 100% 40% 21% 0.2% 33% 6% 0.2% 0.5%
Acres
80,000 70,000
Products
60,000
Energy
50,000
Waste
40,000
Transportation
30,000
Food
20,000
Water
10,000
Built Land
-
More than 1,000 times our physical footprint of 70 acres
Here’s a Popular Place to Start But excelling in hospital waste management involves a lot more than beverage container recycling
A Hospital’s Many Waste Streams
2009 ASHES Annual Conference
DHMC Waste Streams By Percentage, 2008 Hazardous, 1% Sharps, 1.5% Infectious, 8.4%
Recycling, 35%
Trace Chemotherapy & Anatomical Pathology, 0.9%
Ordinary Trash, 53%
Hospitals Should Strive to Measure All of Their Waste Streams Annually, By Weight DHMC Tons of Waste Generated, '08
2000 1500 1000 500 0
Trash 1531 Recycling 1020 Tan Bag 243
Sharps 43
Haz. 30
Red Bag 25
What One Can Do With Waste Data • • • • •
Track changes (generation, costs, composition) Generate ideas, prioritize actions Measure progress, see what needs attention Win environmental leadership awards Better manage your: – Haulers – Processors – Equipment – Budget
Whom I Gather Waste Data From • Vendors (a dozen or so) • Other departments (Pathology, Engineering, Med School, Safety, Radiology, Inventory & Logistics) • My staff (Excel spreadsheets)
2009 ASHES Annual Conference
Volume Reduction Programs • Single-Use Device reprocessing • Reusable sharps containers
• Red bag waste minimization • Fluid management systems • Donations of surplus supplies • Office supply reuse center • Online waste exchange (esp. good for furniture & office equipment) • Waste prevention education and Environmentally Preferable Purchasing
Hospital A Environmental Stewardship Structure Education and Communication Environmentally Preferable Purchasing Waste Management and Reduction Mercury Elimination Energy, Water and Climate Environmental Services Food Services Sustainable Sites Management Transportation Operations Chemical Management
Poor
Performance / Maturity Fair Good Excellent
Hospital B Environmental Stewardship Structure Education and Communication Environmentally Preferable Purchasing Waste Management and Reduction Mercury Elimination Energy, Water and Climate Environmental Services Food Services Sustainable Sites Management Transportation Operations Chemical Management
Poor
Performance / Maturity Fair Good Excellent