Johns Hopkins Bayview Medical Center

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Johns Hopkins Bayview Medical Center Green Team
Presentation February 19th, 2008
Joan D. Plisko, PhD Technical Director Cecilia
DeLoach Partner Program Director Louise
Mitchell Sustainable Foods Coordinator Denise
Choiniere, RN Nursing Outreach 410-706-2107
plisko_at_son.umaryland.edu
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How can YOU improve the health of staff,
patients, and the community by improving
environmental performance?
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MD H2E
Maryland Hospital Association
UMD School of Nursing Maryland Nurses Assoc.
MD H2E
Maryland Department of the Environment
National H2E Health Care Without Harm
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What Does MD H2E Do?

• Build a support network for MD
• healthcare facilities
• Reduce total waste through
• minimization, segregation, and recycling
• Eliminate generation of mercury waste
• Decrease hazardous waste through
• P2, product substitution, and recycling
• Increase awareness of the viability of
• environmental programs

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Some Regional Participants

• Anne Arundel Medical Center
• Bon Secours Hospital
• Civista Medical Center
• Doctors Community Hospital
• Franklin Square Hospital Center
• Good Samaritan Hospital
• Greater Baltimore Medical Center
• Harbor Hospital
• Harford Memorial Hospital
• Holy Cross Hospital
• The Johns Hopkins Hospital
• The Johns Hopkins Bayview Medical Center

Kernan Hospital Kennedy Krieger Institute Mercy
Medical Center Montgomery General Hospital Shady
Grove Adventist Hospital Sinai Hospital of
Baltimore St. Agnes Hospital St. Joseph Medical
Center Suburban Hospital Union Memorial
Hospital University of MD Medical Ctr Upper
Chesapeake Health Washington Adventist Hospital

 

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Why Bother?
Environmental Health
Economic
Compliance
Recognition
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Overlapping Regulatory Requirements

• State oversight of medical waste
• Department of Health (DHMH)
• Department of the Environment (MDE)
• Occupational Safety and Health Administration
  (MOSH)
• Department of Transportation (DOT)
• Joint Commission
• Nuclear Regulatory Commission (NRC)
• Drug Enforcement Administration (DEA)

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Maryland Award Winners

• Calvert Memorial Hospital
• Dorchester General Hospital
• Franklin Square Hospital Center
• Kaiser Permanente Mid Atlantic
• Malcolm Grow Medical Center
• Memorial Hospital at Easton
• Montgomery General Hospital
• National Naval Medical Center
• St. Joseph Medical Center
• Washington Adventist Hospital

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Menu of Environmental Programs

• Pharmaceutical waste management
• Recycling
• Universal waste management
• Sustainable Foods
• HIPAA/Confidential paper management
• Reusable sharps containers
• Solvent recovery
• Single-use device reprocessing
• Red bag waste minimization
• Mercury elimination
• Energy efficiency
• Environmentally preferable purchasing
• Glutaraldehyde/ EtO elimination
• Green cleaning/microfiber mops
• Green construction, renovation design
• Integrated pest management
• PVC/DEHP elimination
• Water conservation

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Green Team Development

• Administration
• Clinicians
• Engineering/Facility Management
• Environmental Services
• Food Services
• Housekeeping
• Infection Control
• Laboratory
• Marketing

• Nursing
• Pharmacy
• Purchasing
• Risk Management
• Safety

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Assess Where Are You Starting From?

• Inventory current activities
• Take credit for what is already happening
• Get the word out share information with
  employees
• Provides baseline for future efforts
• Assists with strategic prioritization

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Life Cycle Approach

• Front Door? Work Practices ? Back Door
• Everything that comes in must go out. Waste
  reduction starts with purchasing.
• Purchasing environmentally preferable products
  can positively affect worker health, patient
  health and the environment
• Contracting is key.

KAISER PERMANENTE SAYS NO TO Mercury...Latex...PV
C...Phthalates...Halogenated Flame
Retardants...Persistent, Accumulative and Toxic
Compounds...Carcinogens and Reproductive Toxins
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Environmentally Preferable Purchasing

• Materials Matter
• Mercury free
• Non-toxic (or minimize toxicity)
• PVC or DEHP free
• Recyclable
• Hazardous Waste Considerations
• Minimal Packaging
• Take Back Programs
• Recycled Content (post-consumer)
• Durable or Reusable
• Energy Efficient
• Can Be Reprocessed
• Take-Back Provisions

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H2E and Purchasing
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• Green Building
• Hospital should be place of HEALTH AND HEALING
• Nationally?Green Guide for Health Care
• Thinking about the way building design and
  construction influences (or is a barrier to)
  healing

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GREEN BUILDING can be Cost Effective!
Factors such as increased daylighting, more
environmentally friendly wall and floor
coverings, healing gardens, green roofs, break
rooms with natural light have been associated
with

• Improved patient outcomes
• Fewer medication errors
• Decreased pain medication for some patients
• Shorter patient stays/quicker recovery times
• Increased staff retention
• Improved environmental operations programs

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Solid waste/trash
Recyclable
Hazardous waste
Radioactive waste
 
Infectious waste
Chemotherapy waste
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Comprehensive Waste Management Plan
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Hazardous Waste is Costly!
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Data Collection and Benchmarking
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Regulated Medical Waste

• Biohazardous, infectious, red bag waste
• 4-6x more costly to dispose of RMW than regular
  trash
• Avoid cross-contamination of waste
• MDE and DHMH regulatory issues
• Educational materials
• Reduction and segregation strategies
• Treatment technologies

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Regulated Medical Waste Minimization

• Reusable sharps container program
• Operating room waste
• Single-use device reprocessing
• Liquid waste management

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Blue Wrap Recycling

• 20 of surgical waste is blue wrap
• Blue wrap is made of polypropylene
• MD H2E and cdm eCycling partnered on six month
  pilot project to assess economic viability
• Harbor Hospital and UMMC
• Good Samaritan is next

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Paper, Cardboard, and HIPAA

• Can comprise up to 50 or more of a facilitys
  waste stream
• Often, first (and most important) areas to
  address in recycling programs
• Combine paper recycling and confidential paper
  management (HIPAA)
• Figure out system for baling or compacting boxes
  and getting them down off of floors

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Plastics
Traditional Bottles, foam cups, egg crate foam
mattresses
Mixed Sterile Operating Room Instrument Trays,
Blister Packaging, Tyvek Suits, Saline Bottles,
Sterile Blue Wrap, IV Bags, Tubing Mixed Cleaned
Patient Care Basins, Urinals, Bed Pans, Pitchers
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Manufacturer Take Back

• Kodak
• Tyvek
• Ink jet cartridges
• Toner cartriges
• Printer cartridges
• Leasing computers and copiers

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Virtual Mercury Elimination
Thermometers
Pharmaceuticals
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Pharmaceutical Waste Management

• Environmental and Public Health Impacts
• Worker Health Issues
• Complex Waste Streams
• Regulatory Requirements/Compliance Issues
• Financial Implications

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Polyvinyl Chloride (PVC) and Di-2-ethylhexyl
pththalate (DEHP) Reduction

• When incinerated, PVC can contribute to dioxin
  formationa human carcinogen
• DEHP, a plasticizer, can leach out of contained
  fluids such as IVs, enteral feeding devices and
  total parenteral nutrition (TPN) bags
• US FDA Public Health Notification on DEHP
• Maryland Department of Environment provided grant
  support to MD H2E for audits

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Batteries Everywhere!
Lead-acid vehicles, wheelchairs,
forklifts Lithium cameras, mobile phones, PDAs,
MP3s Mercuric oxide hearing aids, cameras, smoke
detectors, fetal monitors, EKG monitors Zinc-air
hearing aids and electronic pagers Nickel-cadmium
calculators, handheld tools, alarm systems,
pagers Silver cadmium medical electronics,
require high-energy density and constant
voltage Alkaline common household batteries
contains zinc
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Fluorescent Lamps
Wrong
Right

• Fluorescent lamps contain mercury
• More energy-efficient than incandescents
• Recycle ALL lamps, even green tips
• Worker exposure risk
• Environmental risk

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Electronics
Electronics can contain copper, chromium, nickel,
lead, mercury and brominated flame retardants

• Start with purchasing least toxic and from
  company with buy back program
• Reuse/Donate
• Recycle with company that takes apart and
  reclaims

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Green Cleaning

• Greener, less toxic cleaning chemicals
• Relationship to infection control? cleaning THEN
  disinfecting where necessary
• Safer cleaning equipment that reduces impact on
  patients and staff
• Environmentally friendly bathroom paper products

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Integrated Pest Management (IPM)

• Pesticides are designed to kill pests hospitals
  are designed to heal people
• IPM uses effective, least toxic methods of pest
  control
• Think about whats attracting or supporting
  pest infestations food, moisture, shelter
• IPM Pilot Program in collaboration with the
  Maryland Pesticide Network

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Healthy Food in Health Care

• Nutritious, Whole Foods
• Environmentally Sound
• Economically Viable
• Socially Responsible

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Food Issues

• Food Miles
• Confinement
• Pesticides
• Growth Hormones rBGH
• Antibiotics
• Working Conditions Income

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Menu of Options

• Local Foods
• Organic Foods
• rBGH-free Dairy
• Meat and Poultry - without the Non-Therapeutic
  Use of Antibiotics
• Fair Trade Coffee Tea

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Improve Availability

• Farm Stand / Farmers Market
• CSA Community Supported Agriculture
• On-site Garden
• Vending Machines
• Meetings, In-services, Events

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Sustainable Practices

• Composting
• Recycling
• Fryer Grease Recycling
• Reusable or Biodegradable Dishware Utensils
• Integrated Pest Management

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One Step at a Time

• Start a Hospital Food Committee
• Work with Purchasing/Food Contractor and Food
  Nutrition Department
• Cafeteria, Food for Staff and Visitors
• Patient Meals
• Host Farmers to Speak Exhibit
• Create Fact Sheets
• Educate Patients, Staff and Community

www.healthyfoodinhealthcare.org
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The Power of Nurses

• Highest percentage of employees in facility
• Largest trash producer
• End user of most products
• Retention and Recruitment

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Getting Nurses Involved

• Provide them with educational opportunities.
• Provide them with opportunities to contribute.
• Utilize established committees to educate and
  recruit team members.
• Bridge the gap between executives and nurses.

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Nurses Exposure Survey

• Survey of over 1500 nurses on health and chemical
  exposures.
• Assessed the relationship between nurses health
  and exposures to common health care hazards.
• Results are troubling

• Disinfecting sterilizing
• chemicals
• Medications antiviral
• chemotherapy
• Radiation
• Anesthetic gases
• Latex
• Cleaning chemicals

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What They Found

• Nurses with frequent, long-term exposures to
  chemotherapeutic medications reported 42 higher
  rates of cancer.
• Nurses exposed to anesthetic gases during
  pregnancy reported rates of certain birth defects
  in their children up to 7 times higher than among
  children born to nurses not exposed during
  pregnancy.
• Nurses have highest rates of work-related asthma

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University of Maryland Medical Center

• Educating and engaging staff by attending already
  scheduled committee meetings.
• Write articles for our hospital newsletter.
• Provide educational opportunities.
• Working in collaboration with other Green Teams.

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Practice Greenhealth The Power of 3
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Webinars
March 7 Introduction to Practice Green Health
and Data Collection March 14 Design and
Construction Series Lessons Learned March 21
Making Medicine Mercury Free March 26
Operations Series Pharmaceutical Waste
Prevention April 11 How to Series Climate
Change
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Where to Begin

• Where its easy, with the fewest barriers
• Where youll save money
• Where alternatives exist
• Where its the greatest risk to health of
  patients, employees the community
• Where the law requires
• Where you can take small steps towards long term
  projects

 

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Moving Forward
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Call Us
www.mdh2e.org www.h2e-online.org
Joan D. Plisko, PhD Technical Director 410-706-210
7 plisko_at_son.umaryland.edu