Nursing and the Environment:
New Dimensions for Clinical
Practice
By
Hollie Shaner RN, MSA, FAAN
Nightingale Institute for
Health and the Environment
Mercury
waste management
DIOXIN
latex
Persistent bioaccumulative toxic substances
Glutaraldehyde
PVC
hazardous pharmaceuticals
purchasing decisions
Water conservation
Patient safety
energy use
indoor air quality
worker safety
Nurses Roles
Past, Present, Future
“We won’t have a society if we destroy the
environment.”
-Margaret Mead
“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
DEVER MODEL:
Health Status of Populations
Human
Biology
Health
Status
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
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
Human Health & the
Environment
– Dr. Sandra Steingraber
• Living Downstream
– Exploration of cancer & the
environment
• Having Faith
–The ecology of childbirth &
breastfeeding
Human Health and the
Environment
– Bioscience October ‘98
• David Pimentel, Cornell University
–40% of deaths
worldwide due to
environmental pollution
and degradation
Healthcare Industry
Special Obligations
• Promote health &
well being of
community
• Act as responsible
corporate citizen
• Provide employment
• Treat the sick
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
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
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
Health Care Industry Footprint
• Among the leading
sources of MERCURY
and DIOXIN pollution in
the USA
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
Waste Streams
Hospital W
asteCom
position
10%
5%
Solid
Biohazard
Hazardous
85%
Recyclable
Biohazard
Hazardous
Waste
Waste
Sharps
Blood/blood
products
Pathological
Trace Chemo
Animal
carcasses
Solid
cardboard
Waste
chemical
hazards
solvents
U & P listed
pharmaceuticals
cytotoxics
lead
paper
confidential paper
metal
Universal
Wastes
aluminum
Batteries
pvc, hdpe, pet, ldpe,
pp, ps,other
Fluorescent
light tubes
glass
silver
Mercury
switches
mercury
Pesticides
ether
Waste
plastic
medical, sodalime
wood
construction & demo
food
kitchen grease
Hospital Solid Waste
•
•
•
•
•
•
•
Paper waste
Plastic waste
Glass waste
Metal waste
Food waste
Wood waste
Other waste
glass
wood
other
paper
metal
food
plastic
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
Hazardous Wastes Commonly
Found in Hospitals
• Chemotherapy and
anti-neoplastic
chemicals
• Formaldehyde
• Radio nuclides
•
•
•
•
Solvents
Mercury
Waste anesthetic gases
Cleaning and
Maintenance
chemicals
• Other corrosives
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
What Happens to all that
waste?????
• Solid waste: landfill,
recycle, compost,
incinerate
• Biohazard wastes:
incinerate, autoclave,
microwave , other
*Medical Waste
Incinerators
sources of
mercury &
dioxin pollution
• Hazardous waste:
requires special
treatment
depending on
material type
• Universal waste
some is recycled,
recovered
PBT’s: Persistent Bioaccumulative
Toxic Substances
• Problem pollutants from healthcare
• American Hospital Association MOU with
US EPA calls on hospitals to address
minimize PBT’s
– To virtually eliminate mercury from healthcare
wastes by 2005
– To reduce healthcare waste by 50% by 2010
– See www.h2e-online.org
Dioxin
2, 3, 7, 8- tetrachlorodibenzo-p-dioxin
or
TCDD
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
Health Effects of Dioxin
• Immune System
– Ah receptor
• Cancer Promoter
– WHO IARC Committee: a proven human
carcinogen
• Reproductive Toxin
– birth defects
– endometriosis
• Endocrine Disruptor
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 animal’s
lifetime bioaccumlative dose of dioxin
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.
What is PVC plastic??
• Polyvinyl Chloride Plastic
PVC & DEHP
• HCWH blue folder
• FDA alert
– www.fda.gov click on alerts, click on July11
DEHP in medical products
• www.noharm.org
Mercury
mercury in fish
Mercury: Sources
• Mercury containing healthcare products including
– thermometers
– sphygmomanometers
– esophageal dilators
– laboratory chemicals
– fluorescent light tubes
– batteries
Mercury: Sources
• Mercury containing healthcare products including
– Boiler Switches
– fluorescent light tubes
– batteries
Mercury: Sources
• Mercury containing healthcare products including
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
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
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
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?
Bowling Green University Video
What really happens during a
mercury spill
Key Actions Nurses Can Do To
Reduce Mercury Pollution
• Mercury
– phase out use of
mercury products
Key Actions Nurses Can Do To
Reduce Mercury Pollution
• Mercury
– establish policies to
eliminate purchase of
mercury products in
hospitals and clinics
Key Actions Nurses Can Do To
Reduce Mercury Pollution
• Mercury
– properly manage and
dispose of mercury
• batteries
• thermometers
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
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.
Make it Personal!
• Nurses as Environmental Consumers of
Health Care
• www.nihe.org
For more information visit
The Nightingale Institute for Health and the
Environment www.nihe.org