Medical Facilities: Part of the Solution to Water Pollution

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Medical Facilities Part of the Solution to
Water Pollution

• Laura Jankower, REM, CIPS

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Acknowledgements

• City of Albuquerque, New Mexico (Doug Dailey)
• Lake Charles, Louisiana (Emile Gary)

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Permitting vs. BMP

• Problems with Permitting Hospitals and Medical
  Facilities

• Expensive
• Time Consuming
• Complicated
• Confusing and Difficult
• Expensive

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Permitting vs. BMP

• Advantages of BMP for Hospitals and Clinics

• Effective

• Inexpensive

• Simple

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Best Management Practices for Hospitals and
Clinics (BMP)

• A cost effective method for hospitals or clinics
  to use measures or practices to reduce the amount
  of pollution entering the sanitary sewer system.

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Goal of BMPs

• To encourage hospitals and clinics to promote
  strategies to eliminate pollutants used in their
  facility, reduce the export and trafficking of
  pollutants, and significantly reduce pollution
  exposures at the local, state and national
  levels.

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What is the main element of a Best Management
Practice Program?

• Waste reduction

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Topics of Discussion

• Medical Facilities Waste Reduction
• Planning and Organization
• Assessment Process
• Hospital waste profile
• Waste minimization
• Sources of information

http//www.zerowastenetwork.org
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Assessment Process

• Planning and Organization
• Assessment Phase
• Feasibility Analysis Phase
• Implementation

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Planning and Organization

• Managements commitment
• Setting goals
• Task force

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Assessment Phase

• Collect data
• Select targets
• Select team
• Review and inspect
• Options
• Select options for further evaluation

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Feasibility Analysis Phase

• Technically feasible
• Economically feasible

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Final Phase

• Implementation

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Hospital Waste Profile

• Chemotherapy Antineoplastic chemicals
• Formaldehyde
• Photographic chemicals
• Radionuclides
• Solvents Organic Materials
• Cyano Complexes
• Heavy metals
• Anesthetic gases
• Toxic, Corrosive and Misc. Chemicals

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Chemotherapy Antineoplastic chemicals

• Largest volume of hazardous waste in a hospital
• Small contain chemotherapy compounds
• Contaminated PPE and gauze

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Formaldehyde

• Dialysis
• Histology
• Pathology

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Photographic Chemicals

• Radiology
• X-ray

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Radionuclides

• Nuclear Medicine

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Solvents Organic Materials

• Low flash points
• Flammable
• Immiscible in water

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Cyano Complexes

• Cell lysing solutions

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Heavy metals

• Chromium
• Copper
• Mercury
• Silver
• Zinc

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Anesthetic gases

• Nitrous oxide
• Halogenated agents

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Toxic, Corrosive and Miscellaneous Chemicals

• Ethylene Oxide
• Disinfecting Cleaning Solutions
• Utility wastes
• Maintenance wastes

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Waste Minimization

• Methods to minimize waste
• Pollution Prevention opportunities
• Less waste Less liability

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Methods to Minimize Waste

• Recommended control options
• Better operating practices
• Source reduction
• Process modification
• Primary waste streams

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Better Operating Practices

• Segregate wastes
• Minimize dilution of waste
• ID all chemicals

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Improve Management Practices

• Centralize purchasing
• Monitor material flows
• Apportion waste costs
• Improve inventory control
• Employee training
• Waste reduction program
• Recycle

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Source Reduction

• Recyclable Drums
• Proper Material handling

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Process Modification

• Material substitution

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Waste Minimization Help

• Hospitals for a Healthy Environment
• http//www.h2e-online.org

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Primary waste streams

• Chemotherapy Antineoplastic chemicals
• Formaldehyde
• Photographic chemicals
• Radionuclides
• Solvents Organic Materials
• Cyano Complexes
• Heavy metals
• Anesthetic gases
• Toxic, Corrosive and Misc. Chemicals

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Chemotherapy Antineoplastic chemicals

• Segregate
• Compounding hood
• Purchase of drugs
• Spill containment
• Training
• Outdated drugs
• Centralize

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Formaldehyde

• Pathology
• Histology
• Dialysis

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Photographic chemicals

• Store properly
• Recycle
• Expired Materials
• Extend Processing bath life
• Squeegees
• Countercurrent washing
• Recover
• Recycle

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Radionuclides

• Isolate and store
• Segregate
• Central processing

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Solvents Organic Materials

• Lab
• Pathology
• Histology
• Maintenance (engineering)
• Halogenated
• Non-halogenated

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Cyano Complexes

• Chemistry
• Hematology

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Heavy metals

• Immunology
• Chemistry
• Hematology

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Anesthetic gases

• Better operating practices
• Better anesthetist work practices
• Leak detection

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Toxic, Corrosive and Misc. Chemicals

• Standard waste minimization practices
• Replace
• Reduce
• Recycle
• Reuse

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Cleaning Supplies

• Do not over look these!

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Real Life Scenario

• Hospital was exceeding permit limits on Total
  Zinc.
• Where was it coming from?

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Best Management Practices

• Better understanding
• Standardize procedures
• Eliminate mercury
• Material substitutions
• Record keeping
• Spill control

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Implementing a BMP Program and P2 Can...

• Decrease costs
• Increase business productivity
• Increase employee safety
• Improve environmental protection
• Enhance community relations

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Summary

• Management practices
• Process management
• Spill control
• Disposal
• Purchasing and Inventory Management
• Chemistry and Hematology
• Pathology and Histology
• Microbiology
• Gross Pathology and Necropsy
• Facility Plumbing and Cleaning
• Electron Microscopy and X-ray

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Sources of Information

• EPA Guides to Pollution Prevention Selected
  Hospital Waste Streams
• EPA/635/7-90-009 June 1990

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Sources of Information

• Waste Directory Yellow Book
• Exchange materials
• What to do with your waste
• Financial assistance
• Technical compliance assistance

http//govlink.org/hazwaste/business
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Sources of Information

• http//www.zerowastenetwork.org
• http//www.h2e-online.org