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

2009CDD 13700 lbs.

4.9%EWS 2280 lbs.

1.2%

RMW 46843 lbs.

16.9 %

RMW Chemo/Path

21861 lbs.

7.9%

Recycle 23800 lbs

8.6%

MSW

164500 lbs.

59.5%

Hazardous Waste

3245 lbs.

1.1%

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 anti-neoplastic 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

Benefits

• Building occupant sensitivity

• Improved indoor air quality

• Reduced packaging

• Fewer 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

Daily Use 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

2007Compost

2008Compost

2009Compost

Increase Recycling

Waste Stream Volume

58% 57%

29% 31%

65%

22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 2008 2009

Pe

rce

nta

ge

of

To

tal

Solid Waste

Recycling

1506 T

ons

332 T

ons

14

45

To

ns

710 T

ons

1400 T

ons

746 T

ons

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

34000000

35000000

36000000

37000000

38000000

39000000

40000000

41000000

42000000

2005 2006 2007 2008 2009

Ele

ctr

ic C

on

su

mp

tio

n (

kW

h)

14000

14500

15000

15500

16000

16500

17000

Metr

ic T

on

s o

f C

02

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

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

Anxiety, post-traumatic stress,

depression, despair

Forced migration, civil conflict

Malnutrition, diarrhea, harmful algal blooms

• Weather

extremes

• Sea level

rise

• Ecosystem

changes

• Floods

• Droughts

Ecological Overshoot:

We’re drawing down natural capital

Source: The Ecological Footprint Atlas 2008. Oakland: Global Footprint Network.

DHMC’s Ecological Footprint

More than 1,000 times our

physical footprint of 70 acres

Global

MTCO2e Acres %

TOTAL 190,288 75,096 100%

Products 85,346 29,949 40%

Energy 44,085 15,470 21%

Waste 498 175 0.2%

Transportation 46,885 24,679 33%

Food 12,095 4,329 6%

Water 332 119 0.2%

Built Land 1,047 375 0.5% -

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Acres

Total Ecological Footprint

Products

Energy

Waste

Transportation

Food

Water

Built Land

Here’s a Popular Place to Start

But excelling in

hospital waste

management

involves a lot more

than beverage

container recycling

2009 ASHES Annual

Conference

September 20-24, 2009

A Hospital’s Many Waste Streams

DHMC Waste Streams By Percentage, 2008

Ordinary

Trash,

53%

Recycling,

35%

Sharps, 1.5%

Infectious, 8.4%

Trace Chemotherapy &

Anatomical Pathology, 0.9%

Hazardous, 1%

DHMC Tons of Waste Generated, '08

Sharps

43

Trash

1531

Recycling

1020

Tan

Bag

243

Red

Bag

25

Haz.

300

500

1000

1500

2000

Hospitals Should Strive to Measure All of

Their Waste Streams Annually, By Weight

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

September 20-24, 2009

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

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

ExcellentGoodFairPoor

Performance / MaturityHospital 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

ExcellentGoodFairPoor

Performance / MaturityHospital B