Nursing and the Environment: New Dimensions for Clinical Practice

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Nursing and the Environment New Dimensions for
Clinical Practice

• By
• Hollie Shaner RN, MSA, FAAN
• Nightingale Institute for Health and the
  Environment

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Mercury waste management DIOXIN latex Pers
istent bioaccumulative toxic substances Glutarald
ehyde hazardous pharmaceuticals PVC purchasing
decisions energy use Water conservation indoor
air quality Patient safety worker
safety
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Nurses Roles Past, Present, Future We wont
have a society if we destroy the
environment. -Margaret Mead
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No amount of medical knowledge will lessen the
accountability for nurses to do what nurses do,
that is, manage the environment to promote
positive life processes -Florence
Nightingale
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DEVER MODEL Health Status of Populations
Human Biology
Environment
Health Status
Lifestyle
Health Care System
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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

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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 Health
• American Academy of Pediatrics 1999

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Human Health the Environment

• Dr. Sandra Steingraber
• Living Downstream
• Exploration of cancer the environment
• Having Faith
• The ecology of childbirth breastfeeding

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Human Health and the Environment

• Bioscience October 98
• David Pimentel, Cornell University
• 40 of deaths worldwide due to environmental
  pollution and degradation

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Healthcare Industry Special Obligations

• Promote health well being of community
• Treat the sick

• Act as responsible corporate citizen
• Provide employment

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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

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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

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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

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Health Care Industry Footprint

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

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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

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Waste Streams
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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
Solid Waste

Biohazard Waste Sharps Blood/blood
products Pathological Trace Chemo Animal
carcasses
Hazardous Waste chemical hazards solvents U P
listed pharmaceuticals cytotoxics lead silver merc
ury ether
Universal Wastes Batteries Fluorescent light
tubes Mercury switches Pesticides
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Hospital Solid Waste

• Paper waste
• Plastic waste
• Glass waste
• Metal waste
• Food waste
• Wood waste
• Other waste

glass
wood
other
paper
metal
food
plastic
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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

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Hazardous Wastes Commonly Found in Hospitals

• Solvents
• Mercury
• Waste anesthetic gases
• Cleaning and Maintenance chemicals
• Other corrosives

• Chemotherapy and anti-neoplastic chemicals
• Formaldehyde
• Radio nuclides

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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

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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 , otherMedical Waste Incinerators
  sources of mercury dioxin pollution by US EPA

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PBTs Persistent Bioaccumulative Toxic Substances

• Problem pollutants from healthcare
• American Hospital Association MOU with US EPA
  calls on hospitals to address minimize PBTs
• To virtually eliminate mercury from healthcare
  wastes by 2005
• To reduce healthcare waste by 50 by 2010
• See www.h2e-online.org

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

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Health Effects of Dioxin

• Immune System
• Ah receptor
• Cancer Promoter
• WHO IARC Committee a proven human carcinogen
• Reproductive Toxin
• birth defects
• endometriosis
• Endocrine Disruptor

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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 animals lifetime
  bioaccumlative dose of dioxin

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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.

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What is PVC plastic??

• Polyvinyl Chloride Plastic

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PVC DEHP

• HCWH blue folder
• FDA alert
• www.fda.gov click on alerts, click on
  July11DEHP in medical products
• www.noharm.org

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Mercurymercury in fish
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Mercury Sources

• Mercury containing healthcare products including
• thermometers
• sphygmomanometers
• esophageal dilators
• laboratory chemicals
• fluorescent light tubes
• batteries

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Mercury Sources

• Mercury containing healthcare products including
• Boiler Switches
• fluorescent light tubes
• batteries

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Mercury Sources

• Mercury containing healthcare products including

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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

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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

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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

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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?

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Bowling Green University VideoWhat really
happens during a mercury spill
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Key Actions Nurses Can Do To Reduce Mercury
Pollution

• Mercury
• phase out use of mercury products

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Key Actions Nurses Can Do To Reduce Mercury
Pollution

• Mercury
• establish policies to eliminate purchase of
  mercury products in hospitals and clinics

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Key Actions Nurses Can Do To Reduce Mercury
Pollution

• Mercury
• properly manage and dispose of mercury
• batteries
• thermometers

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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

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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.

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Make it Personal!

• Nurses as Environmental Consumers of Health Care
• www.nihe.org

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For more information visit The Nightingale
Institute for Health and the Environment
www.nihe.org