ECOCARE CONFERENCE ENVIRONMENTAL REGULATIONS AFFECTING HEALTHCARE FACILITIES

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ECOCARE CONFERENCE ENVIRONMENTAL REGULATIONS
AFFECTING HEALTHCARE FACILITIES

• October 20, 2009

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WHO IS EAG?

• The Environmental Advisory Group (EAG) is a
  multidisciplinary environmental consulting firm
  with specific expertise in the healthcare field.
  EAG has assisted organizations since 1990 in
  planning and executing strategies to meet
  environmental requirements.

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Questions For You?

• Your name?
• Position?
• City / Town You Live In?
• Favourite vacation destination?
• One unfulfilled desire

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Drivers of Change

• It is incompatible with the mission of
  institutions devoted to healing to be significant
  consumers of resources and sources of
  environmental harm through air and wastewater
  emissions, hazardous and solid waste generation,
  greenhouse gas emissions and toxic chemical
  usage. Thus, being green has a symbolic and
  practical significance for any health care
  institution.
• The Canadian Coalition for Green
  Healthcare (www.greenhealthcare.ca)

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Drivers of Change

• Market Size Growing Healthy!
• Trends re aging population
• Costs are skyrocketing and budgets are tight
• Waste in the system will not be tolerated
• P2 resources are limited Time is scarce

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Industry Standards for Environmental Issues

• Increasingly stringent
• More accountability to stakeholders
• Encompasses all areas of the corporation
• Social conscience issues on the rise

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More Industry Standards

• EMS becoming the norm
• ISO 14000 is the gold standard
• Corporate Reporting and accountability is
  constantly increasing
• Industry being forced to pay
• Social conscience not an option

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CANADIAN HEALTHCARE FACILITIES

• 3000 Hospitals, Medical Facilities, and Surgery
  Centres that Require Medical Waste Treatment
  Disposal
• You Are Consumers
• You Are Waste Generators
• Your ecological footprint is enormous

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Pharmacy
Administrative Supplies
Food Services
Med-Surge Supplies
Hospitals Retirement Assisted Living
Facilities
Gift Shops On-Site Vendors
Grounds Maintenance
Laboratories
Imaging
Capital Equipment
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WASTE VOLUMES

• MEDICAL WASTE 500 MT PER DAY IN CANADA, 6600 MT
  PER DAY IN THE U.S.
• 1 MT IS ROUGHLY THE SIZE OF A SMALL VOLKSWAGON
• 1 LARGE INSTITUTION (1500) CAN GENERATE 700 MT /
  YEAR OF WASTE

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Is it Complex? You Bet!
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WASTE STREAM TYPESSurprise there are really
only 2!

• Most wastes generated by hospitals and medical
  clinics are NON-HAZARDOUS (80 - 90) (kitchen
  wastes, office materials, all types of packaging,
  workshop residuals, non-infectious patient waste
  - disposable masks, gowns -, pop cans,
  newspapers, plastic water bottles, etc.)
• Potentially hazardous wastes from hospitals and
  clinics which have a pathogenic, chemical,
  explosive, or radioactive nature are called
  medical wastes. Medical wastes include the
  following
• pathological wastes (i.e., body parts, aborted
  fetus, tissue and body fluids from surgery and
  dead infected laboratory animals)
• infectious waste (i.e., surgical dressings and
  bandages, infected laboratory beddings,
  infectious cultures and stocks from laboratories,
  and all waste from patients in isolation wards
  handling infectious diseases)
• sharps (i.e., needles, syringes, used
  instruments, broken glass)
• pharmaceutical wastes (i.e., soiled or
  out-of-date pharmaceutical products)
• chemical wastes (i.e., spent solvents,
  disinfectants, pesticides and diagnostic
  chemicals)
• aerosols (i.e., aerosol containers or gas
  canisters which may explode if incinerated or
  punctured)
• radioactive wastes (i.e., sealed sources in
  instruments, and open sources used in vitro
  diagnosis or nuclear medical therapy) and
• sludges from any on-site wastewater treatment
  facilities may be potentially hazardous.

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The Other One (10 20 but )

• Potentially HAZARDOUS WASTES from hospitals and
  clinics which have a pathogenic, chemical,
  explosive, or radioactive nature aka medical
  wastes. May include
• pathological wastes (i.e., body parts, aborted
  fetus, tissue and body fluids from surgery and
  dead infected laboratory animals)
• infectious waste (i.e., surgical dressings and
  bandages, infected laboratory beddings,
  infectious cultures and stocks from laboratories,
  and all waste from patients in isolation wards
  handling infectious diseases)
• sharps (i.e., needles, syringes, used
  instruments, broken glass)
• pharmaceutical wastes (i.e., soiled or
  out-of-date pharmaceutical products)
• chemical wastes (i.e., spent solvents,
  disinfectants, pesticides and diagnostic
  chemicals)
• aerosols (i.e., aerosol containers or gas
  canisters which may explode if incinerated or
  punctured)
• radioactive wastes (i.e., sealed sources in
  instruments, and open sources used in vitro
  diagnosis or nuclear medical therapy) and
• sludges from any on-site wastewater treatment
  facilities may be potentially hazardous.

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CONSIDERING REGULATIONS

• Federal, Provincial, Municipal
• Emissions (Air, Water, Soil)
• Hazardous or Non-hazardous
• Hazardous specific types based on
  Characteristics
• Corrosive
• Reactive
• Ignitable
• Toxic

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CCME 1992 Canadian Council of Ministers of the
Environment

• Guidelines for the Management of Biomedical Waste
  in Canada
• Definitions
• Treatment Options
• Disposal Options

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CEPA Health Canada Chemical Management
Plan(1999)

• Evaluate assess chemicals used in Canada in
  medical products including human veterinary
  drugs, natural health products, cosmetics, food
  additives and medical devices

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CEPA - NPRI National Pollutant Release
Inventory

• Established under CEPA, after Bhopal
• First report released in 1995 based on 1993
  data
• Chemicals released, disposed of and
  recycled by the ICI sector
• 10 employees, 268 listed substances, 10 mt

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TDG Federal

• Transportation of Dangerous Goods Regulations
• Safety standards and regulations overseen by
  Transport Canada
• Develops, provides oversight and gives expert
  advice on dangerous goods accidents to promote
  public safety in the transportation of dangerous
  goods by all modes of transport in Canada.

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Biomedical Waste Ontario C-4

• Regulation 347 governs handling, transport and
  disposal of subject waste, which includes all
  hazardous wastes including pathological waste
• MOE Guideline C-4, published in 1994, deals with
  The Management of Biomedical Waste in Ontario
• Proposed Revisions posted October 23, 2008
• (EBR010-3864)

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Environmental Protection Act (EPA) Ontario

• Regulates the emissions of toxic substances into
  air, soil and groundwater
• A contaminant is defined as a solid, gas, liquid,
  odour, heat, sound, vibration, radiation, or
  comboresulting from human activities which may
  cause injury to humans, flora or fauna.

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TOXICS REDUCTION ACT (Bill 167)

• Royal Assent June 3, 2009
• Key element in Ontarios toxic chemicals
  reduction strategy
• Part of overall initiative to promote a green
• economy
• Applies to the owner and the operator of a
• facility (not as yet a defined term)
• Future regulations will implement, to require
• tracking and reduction plans for targeted
• chemicals at prescribed facilities

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Extended Producer Responsibility (EPR) Across
Canada
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EPR Legislation Across Canada
full-colour symbols mean in-place or pending
legislation
white-washed symbols mean proposed legislation
see inset
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3RS REGULATIONS

• Introduced In 1994 O. Reg. 102/94 103/94 to be
  Conducted Annually
• ICI Waste Audits Reduction Workplans
• Regular (Non-Hazardous) Waste only
• Most Hospitals NOT in compliance MOE is busy
  conducting Inspections
• OHA Green Initiative

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WARNING!!!

• If you look at these forms too long
• YOU WILL GO BLIND

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BRITISH COLUMBIA

• Hazardous Waste Regulations Under Review
• Some Hazardous HHW covered under current
  regulations, not sharps
• Will become much more stringent

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OTHER PROVINCES

• NOVA SCOTIA
• QUEBEC
• SASKATCHEWAN

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PRACTICE GREENHEALTH H2ERegulated Medical
Waste Resource LocatorSelect a state by clicking
on the map
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WHERE TO FROM HERE?

• Each province is different
• Clear shift in responsibility from government to
  industry
• Programs growing in scope complexity
• Organizations / resources are scarce. Find them,
  use them!

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WHAT TO DO?

• Figure Out Where You Are
• Figure Out What Your Role Is
• Audit if Applicable
• Get Expert Advice
• Pay if you Must
• Forge Ahead Like the Rest of Us! ?

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Thank You!

• Lisa J. James
• President CEO
• The Environmental Advisory Group
• 43-2205 South Millway,
• Mississauga, Ontario L5L 3T2
• lisa.james_at_enviroadvisory.com
• www.enviroadvisory.com
• T 905-569-0620
• C 416-566-8813