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"Greening" Hospitals

An analysis of pollution prevention in America's top hospitals

By Todd Hettenbach, Brian Cohen, Richard Wiles, Ken Cook, June 1998

Lack of basic environmental practices at major U.S. hospitals is resulting in serious pollution problems and contamination of major foods, including baby foods. A first of its kind environmental survey of 50 major U.S. hospitals uncovered widespread failure on the part of medical facilities to take steps to halt contamination of milk, meats and fish by dioxins and mercury, pollutants that cause a wide range of health impacts.

Federal studies have documented that incineration of millions of pounds of hospital waste each year constitutes a major source of both of these pollutants, as well as other environmental contaminants. A Consumer Reports laboratory study in June, 1998 found dioxin in processed meat baby food products at levels 100 times higher than the government's current daily limit for this extraordinarily potent carcinogen and hormone disrupting pollutant. A December, 1997 government study estimated that 1.6 million pregnant women and women of child-bearing age are potentially exposed each year to unsafe levels of neurotoxic mercury from fish alone, including canned tuna. Thirty-nine (39) state departments of health have issued fish consumption warnings due to mercury contamination.

"Greening" Hospitals finds that the health care industry has begun to change some of these practices. Many of the dirtiest and largest on-site hospital incinerators have been shut down. A growing number of hospitals has pledged to reduce toxic emissions, reduce their waste stream, and purchase products that prevent pollution from dioxins, mercury and other toxic materials. But our analysis of survey results makes clear that often the policies and goals that have been set on paper are not reflected in the actual practices of hospitals. The health care industry has a lot of work to do before it can fulfill the medical oath to "first do no harm."

This study draws on survey results obtained from 50 of the nation's top hospitals, derived from the list of the top 135 hospitals in the nation compiled by U.S. News and World Report.

Major Findings

• Just 20 percent of the survey respondents have programs to reduce purchases of PVC plastic, an important source of chlorine for the creation of dioxin in incinerators. Yet even these few PVC reduction initiatives do not seem particularly effective. Only 6 percent of the hospitals surveyed use PVC-free IV Bags and all of the hospitals that claim to have PVC reduction programs use PVC IV bags.
• Nearly 80 percent of the survey respondents say that they have mercury reduction programs, but these programs too, are not yet particularly effective. Of the hospitals that have mercury reduction programs, 37 percent of the hospitals still buy patient thermometers that contain mercury and nearly half buy mercury blood pressure devices.
• Nearly 80 percent have conducted waste audits in the past 3 years and over 90 percent have had annual trainings on how to segregate infectious waste to allow them to incinerate less. Yet, over 40 percent of survey respondents continue to incinerate medical waste that should be treated by safer methods.
• The average hospital is only recycling approximately one-third of the readily recyclable items. The most number of items recycled was 31; some hospitals recycled none.
• Almost 60 percent of the respondents report buying reusable goods over disposables where feasible, and 46 percent have packaging reduction programs.

Recommendations

There are three ways that hospitals can dramatically reduce the amount that they pollute: avoid incineration (on-site and off-site), eliminate toxic materials in the products they use, and reduce waste overall.

Waste Treatment

The most important thing that a hospital can do to reduce its impact on surrounding communities is to move away from the unnecessary incineration of waste. According to the Centers for Disease Control, only 2 percent of hospital waste needs to be incinerated to protect the public health, yet some hospitals incinerate 75 to 100 percent. This practice is quite costly for the hospital and poses serious, avoidable risks to the environment and human health. Safe and economical alternatives to incineration exist and, although they are not risk-free, they can be combined with an effective waste segregation program to both reduce pollution and cut hospital disposal costs.

Toxics Reduction

While it is important for hospitals to move away from incineration, it is also important to reduce the amount of toxic chemicals that hospitals use. Two of the pollutant sources that are the easiest to replace are mercury-containing devices and PVC plastic.

Mercury

Hospitals can reduce their impacts on surrounding communities by replacing mercury-containing instruments like thermometers and blood pressure cuffs with non-toxic alternatives. They should also educate staff on how to clean up mercury spills and check their sewer lines to ensure that existing mercury does not get into the water supply.

PVC

Polyvinyl Chloride (PVC) plastic has long been suspected as a source of toxic compounds in the environment, particularly dioxin. According to the Minnesota Hospital and Health care Partnership, PVC is thought to be responsible for 45 percent of total dioxin emissions from the health care industry.

Recognizing these dangers, a number of public health and health care organizations have recently passed resolutions calling for the elimination of PVC plastic in the health care industry. These groups include large professional organizations like the California Medical Association, the Minnesota Hospital and Health care Partnership, and the American Public Health Association.

Hospitals have begun to replace some of their PVC-based products and packaging with non-toxic alternatives like non-chlorinated plastics or metals. Ongoing research into these non-toxic alternatives will make it easier for hospitals to move away from PVC plastic. If more hospitals demand PVC alternatives, health care supply companies will respond.

Waste Reduction

The health care industry in the United States generates a huge amount of solid waste. In fact, hospitals alone produce approximately 2 million tons of waste per year, a figure that has more than doubled since 1955. The public pays for this waste through the loss of landfill space and pollution associated with production and disposal of products that become trash. Hospitals pay in the form of ever higher disposal costs.

The first step in reducing the amount of waste sent to landfills and incinerators is to conduct a waste audit to find out where the trash is being created and what types come from different areas. The second step is to reduce the amount of waste generated by developing packaging reduction programs with vendors and replacing disposable products with reusables. The third step is to design a recycling program to manage the remaining waste in an environmentally-responsible way.

The Health Care Without Harm coalition consists of a broad array of organizations concerned about the impacts of the health care industry on the environment and human health. The coalition includes major public health groups, organizations representing health care professionals, hospitals, community and environmental organizations.