Presentations May 23 25 2005 Portland Maine For

Presentations May 23 – 25, 2005 Portland, Maine For related information visit: http: //www. newmoa. org/prevention/mercury/conferences

Making Medicine Mercury Free Status and Barriers to Implementing a Mercury. Elimination Plan in Healthcare

www. h 2 e-online. org

Why Bother? n AHA/EPA Goal to Eliminate Mercury in health care Medical waste incinerators are major source of mercury New York Academy of Sciences Report National Resource Council (NRC) Report AMA, ANA, APHA resolutions n Ethical responsibility/Mission Statement Patient/Employee satisfaction FDA and state fish consumption advisories n State and local regulations n Community Relations -Press coverage awards and

What’s Working - Implementation Strategy AHA Legislation Clinical Leadership Champions Environmental Health ANA Board of Directors Senior Leadership Nurses Health Systems HCWH Public Affairs State Organizations Community NGOs Patients Partners Facility Managers EPA Safety Housekeeping GPO’s Stewardship Cost Regulatory Compliance

Successes – YES!!! n Moving markets thermometers n Education – both institutional education AND in the community n Incinerator Closures

Obstacles to Mercury Elimination n Mercury is still considered the Gold Standard n Clinicians are still trained on mercury devices n Cost of replacements n Mercury in Chemicals n Purchasing Obstacles n Old habits

Clinical Sources n Sphygmomanometers n Thermometers n Barometers n Bougies, cantor tubes n Pharmaceutical Preservatives

n Light Bulbs. Management Facilities n Switches Thermostats n Batteries, electronics

Chemicals n Laboratory chemicals n Pharmaceuticals n Cleaning chemicals

Providing resources for proper management… Priority Is Elimination! n Education n Segregation n Labeling n Spill Response n Monitoring n Removal n Record keeping

Mercury – Data Collection

Assess Mercury in the Facility

www. h 2 e-online. org/mercury

Tracks Hg Removed and What Remains

H 2 E National Awards n Making Medicine Mercury Free n Award Application Check List 1. Mercury Elimination Policies 2. Mercury Management Policy Clinical Facilities Chemical – pharmaceuticals, lab and cleaning chemicals 3. Environmentally Preferable Purchasing Policies

Next Steps? ? ? AHA Legislation Clinical Leadership Champions Environmental Health ANA Board of Directors Senior Leadership Nurses Health Systems HCWH Public Affairs State Organizations Community NGOs Patients Partners Facility Managers EPA Safety Housekeeping GPO’s Stewardship Cost Regulatory Compliance

H 2 E Resources/Guidance Awards Process: www. h 2 e-online. org/programs/award/index 2004. htm Mercury Recyclers – www. h 2 e-online. org/tools/hg-recy. htm Consultants – www. h 2 e-online. org/tools/consult. cfm Vendors – www. h 2 e-online. org/tools/vendors. cfm Mercury Backgrounder – www. h 2 e-online. org/tools/mercury. htm List serve: www. h 2 e-online. org/programs/list. htm Universal Waste Guidelines – www. h 2 e-online. org/tools/univwaste. htm 10 steps to bulb recycling – www. h 2 e-online. org/tools/univwaste. htm#flu Mercury Elimination Plan – www. h 2 e-online. org/pubs/mercurywaste. pdf Fish Advisories – www. h 2 e-online. org/tools/merc-oth. htm#fish

Other Mercury Resources n Massachusetts Academic & Scientific Community n n n Organization – www. masco. org U. S. Food & Drug Administration www. cfsan. fda. gov Health Care Without Harm’s Fast Facts http: //www. noharm. org/library/docs/Going_Green_ The_Mercury_Problem_-_Fast_Facts. pdf Making Medicine Mercury Free Resource Guide http: //www. noharm. org/library/docs/Going_Green_ Making_Medicine_Mercury_Free. pdf Measuring Blood Pressure Accurately – http: //www. noharm. org/mercury/sphygmo American Medical Association – www. amaassn. org

Need Help? n Hospitals for a Healthy n n Environment www. h 2 e-online. org 800/727 -4179 Partner Coordinator Janet. brown@h 2 e-online. org 718/636 -1168 Champion Coordinator Sarah. obrien@h 2 e-online. org 802/479 -0317 State Program Coordinator Cecilia. deloach@h 2 e-online. org 800/727 -4179 Director Laura. brannen@h 2 e-online. org 603/795 -9966

Presentations May 23 – 25, 2005 Portland, Maine

Mercury Elimination at Healthcare Facilities Are we there yet? Sara Johnson, M. S. NH Pollution Prevention Program May 2005

P 2 in Healthcare Projects Acute Care and Specialty Hospitals Home Health Care Agencies – Visiting Nurses Associations Nursing Homes – Long Term Care Facilities and Mental Health Clinics Eye Physicians and Surgeons

Hospitals Mercury Survey 1999 and 2001 Anecdotal information 2005 26 acute care and specialty hospitals Policies – reduction, purchasing, elimination, etc. Medical devices Disposal

Survey Results Mercury Purchasing Policy 1999 – 73% 2001 – 83% 2005 – 100% Mercury Device Phase Out by 2003 1999 – 23% 2001 – 80% 2005 – almost 100%

Survey Results Medical Devices – fever thermometers 1999 – 73% 2001 – 92% 2005 – 100% Mercury Disposal/Recycle 1999 – 58% 2001 – 85% 2005 – 100%

100% - HOW? Partnership New Hampshire Hospital Association Foundation for Healthy Communities Healthcare Without Harm EPA Region 1 – Mercury Challenge Hospitals for Healthy a Environment New Hampshire Hospitals for a Healthy Environment Long-term project In house support

The Real Work to Get to 100% Consistent supply of easy to read/comprehend guidance documents. Frequent open discussions in person and via email. Increase confidence levels. New Hampshire Hospitals are reaching out to us!!!

Recognition H 2 E Champion for Change - NHPPP EPA Region 1 Environmental Merit Award - NHPPP H 2 E Champion for Change – Foundation for Healthy Communities

Home Health Care/Visiting Nurses New Hampshire Home Care Association Survey 2003 Approximately 100 facilities Facility – universal waste Clinical Staff 25% response rate No follow-up survey planned

Survey Results Issues discovered – no surprise Bulbs, batteries not recycled properly. Clean-up spills procedures not consistent Non-issues – big surprise Blood pressure cuffs have been phased out. 0% are in use. Thermometers eliminated. 1% in use – only used at the request of a medical provider.

Focus changed from what we wanted to what they wanted Fish advisory pamphlets Thermometer spill clean-up at home Household generated wastes Pharmaceuticals Chemotherapy Sharps

Mental Health Clinics and Nursing Homes Mental Health clinics 10 State supported facilities Blood pressure cuffs Universal Wastes Nursing Homes a. k. a. Long-Term Care Facilities Definition is broad New Hampshire Health Care Association

Outreach Focused Guidance Documents Mercury Management Environmentally Preferable Purchasing Universal Waste Time and desire was missing.

Eye Physicians and Surgeons New for 2005 New Hampshire Eye Physicians and Surgeons Society Survey Medical devices Intraocular pressure reducer Universal wastes

Progress on Project Partnership created. Survey drafted. New documents outlined. Behind schedule. Time Hospitals

Are we there yet? Yes/Probably Hospitals Home Health Care Nursing Homes Mental Health Clinics No/Almost Healthcare Laboratories Dental Offices Eye Physicians

Resources Hospitals for a Healthy Environment http: //www. h 2 e-online. org Sustainable Hospitals http: //www. sustainablehospitals. org/cgibin/DB_Index. cgi NH Pollution Prevention Program http: //www. des. nh. gov/nhppp/Healthcare_ P 2/default. asp

Contact Information New Hampshire Department of Environmental Services Pollution Prevention Program Sara Johnson, M. S. sjohnson@des. state. nh. us 603 -271 -6460 www. des. nh. gov/nhppp

Presentations May 23 – 25, 2005 Portland, Maine

Washington State Department of Ecology Hospital Project Camille Martin (509) 329 -3551 cafr 461@ecy. wa. gov

Washington State Department of Ecology (Ecology) Hospital Project Initiatives- • Environmental compliance concerns in Hospitals • Hospital Project Team- scoping • H 2 E Champion • A Guide- Best Management Practices in • • Hospitals Workshops Hospital Technical Assistance Visits Sponsor a Medical Industries Network- a series of discussions Developing a website for hospital information

Environmental Concerns in Hospitals • Health concerns for humans and the environment • • • with the use of Mercury and other toxic substances. Pollution prevention options not being used in hospitals. Large and medium size hospitals should report as medium quantity generators of Dangerous Wastes (solid, biomedical, dangerous, air pollutants and waste water) being improperly disposed. Protection of groundwater and drinking water sources. Significant wastewater generators may need

Hospital Project Scoping Team Project Goals • Ecology becomes a Hospitals for a Healthy • • • Environment (H 2 E) champion Eliminate Mercury use in hospitals Reduce the use of hazardous substances Reduce the generation of wastes Get hospitals into regulatory compliance with environmental regulations through technical assistance Get hospitals to implement pollution prevention

BMP Guide Design • The guide needs to address the • • • environmental concerns and give solutions Must provide pollution prevention options It must be an all inclusive reference Plain talk, simple and quick to use Gives the information without much research Notebook style, tabbed sections

A Guide: Best Management Practices in Hospitals-Contents • Proper waste management • Self-Audit form • BMP’s for specific hospital departments • Waste management fact sheets • Vendors list • Website resources • List of dangerous waste and air pollutants • Biomedical waste regulations

Future Hospital Project Initiatives • Becoming a H 2 E champion • Technical assistance visits to all hospitals in the • • • state of Washington Two or three hospital workshops Medical industry network series- eastside and west side of the state Develop a website/Vendor list updates Follow-up visits to address environmental concerns Performance track reporting Developing methods for quantifying successes