Recently in Green Healthcare Category

Daniel Goldman sums up many of the key aspects of green consumer behaviors in this overview of his book, "Ecological Intelligence".

Incremental improvements in our product choices, and product design will add up to a generational "world view" shift that leaves a healthier system in place for our old age...and our children.

Goldman explains the choices we can make to improve the health of our business system, and our environment on which we depend for life support.

Writing about complex scientific stories isn't easy, and takes years of both study and research.  These two investigative reporters have been honored for their dedication.

Susanne Rust & Meg Kissinger

Chemical Fallout
The Milwaukee Journal Sentinel

Thirty years ago, a carcinogenic flame-retardant material was taken out of children's pajamas.  In 2008 it was being used with frequency in products such as baby carriers and bassinetts.  This was just one of several discoveries made by Susanne Rust and Meg Kissinger of the Milwaukee Journal Sentinel in their series, "Chemical Fallout."

The team exposed government programs that favored chemical makers over the public and conflicts of interests among regulators.  Rust and Kissinger reported that there was no such thing as "microwave-safe" plastics. An outside laboratory tested containers labeled as such and found toxic levels of chemicals leached from every item.

The Journal Sentinel team did their homework: They reviewed hundreds of scientific journal articles and worked with scientists to determine that the federal government's assurances that bisphenol A (a chemical compound found in many plastics) is safe are based on outdated U.S. government studies and research heavily funded by the chemical industry. PBS broadcaster Bill Moyers compared the reporting to the legendary Upton Sinclair. David Kessler, former commissioner of the Food and Drug Administration, said that the Sentinel was doing the work that the agency should have been doing all along to protect the public.

Susanne Rust

Senior Reporter, Milwaukee Journal Sentinel

Susanne Rust was part of a reporting team that won the 2008 Sigma Delta Chi award and the Society of American Business Writers and Editors award for detailing chemical dangers and lax regulations in Washington, D.C. The team also won the 2008 John B. Oakes Award.  Rust has continued to break new ground throughout 2008 with more stories exposing the failures of the Environmental Protection Agency and Food and Drug Administration.  In her five years at the Sentinel, Rust has also trekked through the hills of Rwanda to cover stories on civil engineering and AIDS; hacked through the dense foliage of a Ugandan rain forest in search of mountain gorillas; poked around Scotland's Roslin Institute looking for clones; and written about eco-friendly agriculture in Costa Rica.  Before joining the Sentinel, Rust pursued a doctorate in biological anthropology at the University of Wisconsin-Madison.

Meg Kissinger

Investigative Reporter, Milwaukee Journal Sentinel

Meg Kissinger is the Milwaukee Journal Sentinel's investigative reporter focusing on health and welfare.  She and two of her colleagues won the 2008 Sigma Delta Chi award and the Society of American Business Writers and Editors Award for a series of articles on the government's failure to screen for dangerous chemicals in household products.  The series also won the 2008 John B. Oakes Award.  Kissinger has spent the last year breaking new ground on the failures of the Environmental Protection Agency and Food and Drug Administration to regulate toxic chemicals.  She was a finalist for the 2007 Selden Ring and Investigative Reporters and Editors awards for her reports on the filthy and dangerous housing conditions in Milwaukee County for people with mental illness. That series won the Mental Health America Award for best news repoting.  In her 25 years in the newsroom, Kissinger has written about abuses in the nursing home industry, the scam of the door-to-door magazine sales industry and the travails of an oncologist who unwittingly discovered his own end-stage cancer.  

CHEMICALS CAN TURN GENES ON AND OFF; NEW TESTS NEEDED, SCIENTISTS SAY

"A National Academies workshop examined the evidence of epigenetic
effects and considered whether the thousands of chemicals in use today
should be tested for them. Some pollutants and chemicals don't kill
cells or mutate DNA. Instead, they may be more subtle, muting genes or
turning them on at the wrong time, which can lead to diseases that are
passed on for generations. Asthma in New York City children exposed to
traffic exhaust is an example, experts say." Bette Hileman reports for
Environmental Health News August 3, 2009.

http://www.environmentalhealthnews.org/ehs/news/epigenetics-workshop

The meaning of greening

The term green chemistry was first coined in 1998 by Yale professor Paul Anastas and John Warner of the Warner Babcock Institute in their book "Green Chemistry: Theory and Practice." They defined it as "the utilization of a set of principles that reduces or eliminates the use or generation of hazardous substances in the design, manufacture and application of chemical products."

The green chemistry movement is beginning to take hold at UC Berkeley. An important recent step was a 2008 report commissioned by the California EPA entitled "Green Chemistry: Cornerstone to a Sustainable California," which includes among the authors Drs. Michael Wilson and Megan Schwarzman, research scientists in the UC Berkeley School of Public Health. The wide-ranging report outlines some of the major environmental, health, and economic impacts of California's current approach to regulating chemicals.

Over 100 synthetic chemicals and pollutants have been found in umbilical cord blood, breast milk, and adult tissues, and, according to the report, many of these chemicals are "known or probable human carcinogens, reproductive or neurological toxicants, or all three."

Thousands of new chemicals are introduced to the marketplace each year and global chemical production is doubling every 25 years.

The report highlights the need for comprehensive policy solutions to avoid the potentially disastrous consequences of releasing these chemicals into the environment.

Read more at the Berkeley Science Review

SOURCE:
Green Chemistry
Chemists clean up their act (view PDF)
by Lee Bishop and Mitch Anstey

The USPS' Domestic Mail Manual, C023, as well as Department of Transportation (D.O.T.)  have certain requirements and restrictions for mailing or shipping hazardous pharmaceuticals to patients (i.e. consumer commodities that are hazardous). 

USPS also has regulations pertaining to mailing sharps, biological specimens, and other healthcare related materials.

Visit the USPS web site and reference the Domestic Mail Manual at (http://pe.usps.gov/) for more information.

Editor's Note:  Maybe the solution is to use less toxic substances in our everyday life! 

The HHS provides information on laws and regulations pertaining to healthcare from a variety of organizations including the

• Food and Drug Administration,
• Centers for Medicare and Medicaid Services,
• Health Resources and Services Administration,
• Substance Abuse and Mental Health Services Administration,
• Indian Health Services

Visit the HHS web site (www.hhs.gov) for more information.

OSHA provides regulatory standards to protect workers from injury.

OSHA requirements that apply to healthcare facilities include the

• Bloodborne Pathogens Standard (1910.1030),
• Hazardous Waste Operations and Emergency Response (HAZWOPER) Standard (1910.120),
• Asbestos Standards (1910.1001) for any renovation work.

Visit the OSHA web site (http://www.osha.gov/) for more information.

OSHA also has a Hospital eTool (http://www.osha.gov/SLTC/etools/hospital/mainpage.html) that addresses the following areas:

• administration,
  
• central supply,
  
• clinical services,
  
• dietary,
  
• emergency,
  
• engineering,
  
• heliport,
  
• housekeeping,
  
• ICU,
  
• laboratories,
  
• laundry,
  
• pharmacy,
  
• surgical suite,
  
• healthcare wide hazards,
  

and other healthcare wide hazards.

Waste management is big business in today's green job world. The Resource Conservation and Recovery Act is central to jobs that help green our communities by properly disposing of wastes that can cause environmental pollution and contamination. If you want a job that makes a tremendous difference -- you might look into waste management, and hazardous waste management in the healthcare field.

Hospitals, doctors offices, clinics, and residential facilities all need waste management -- and especially waste management that will create a new level of green stratgies that save energy, save our air, land and water resources.

Here is a breakdown of healthcare Recource Conservation and Recovery Act (RCRA) components to get you started thinking about how you can green your job if you're already in healthcare or waste management...and how you can help organizations green their upstream impact by reducing the original use of toxic materials that end up in the waste stream.

Entities that generate hazardous waste are subject to Federal standards applicable to generators of hazardous waste (e.g., hazardous waste manifest, pre-transportation, recordkeeping and reporting, etc). RCRA contains unit-specific standards for all units used to store, treat, or dispose of hazardous waste.

Most RCRA requirements are not industry-specific but apply to any company that generates, transports, treats, stores, or disposes of hazardous waste. Below are some important RCRA regulatory requirements that apply to healthcare facilities: Identification of Solid and Hazardous Wastes (40 CFR Part 261) establishes the standard to determine whether the material in question is considered a solid waste and, if so, whether it is a hazardous waste or is exempted from regulation.

Standards for Generators of Hazardous Waste establishes the responsibilities of hazardous waste generators including obtaining an EPA identification number, preparing a manifest, ensuring proper packaging and labeling, meeting standards for waste accumulation units, and recordkeeping and reporting requirements. Generators can accumulate hazardous waste on site for up to 90 days (or 180 days depending on the amount of waste generated) without obtaining a permit. If the waste must be transported more than 200 miles away for recovery, treatment, or disposal, the generator may accumulate the waste for up to 270 days.

Standards for Transporters of Hazardous Waste apply to persons transporting manifested shipments of hazardous waste within the United States. Transport requires an EPA identification number, a hazardous waste manifest, compliance with Department of Transportation (DOT) requirements, and proper recordkeeping.

Land Disposal Restrictions (LDRs) are regulations prohibiting the disposal of hazardous waste on land without prior treatment. Under the LDRs program, materials must meet treatment standards prior to placement in a RCRA land disposal unit (landfill, land treatment unit, waste pile, or surface impoundment). Generators of waste subject to the LDRs must provide notification of such to the designated TSD facility to ensure proper treatment prior to disposal.

Used Oil Management Standards impose management requirements affecting the storage, transportation, burning, processing, and re-refining of used oil. For parties that merely generate used oil, regulations establish storage standards. A party considered a used oil processor, re-refiner, burner, or marketer (one who generates and sells off- specification used oil directly to a used oil burner), must meet additional tracking and paperwork requirements.

Typical Physical Features to Inspect under RCRA

Inspection and auditing is an important part of a green job because "green" carries with it the need to document and report levels of use, cleanup, and compliance with laws and regulations.  Think about these locations that need to be audited, and how green jobs can be shaped to manage these facilities and resources for lower impact on our environment... and patients... and healthcare workers.

• Universal waste storage area;
• Used oil storage areas;
• Vehicle maintenance facilities;
• Battery storage areas;
• Building maintenance and repair shops;
• Laboratories;
• Bulk storage tank farms;
• Transfer terminals;
• Secondary containment structures;
• Tank peripheral piping, manifolds, filling and dispensing areas;
• Dispenser pumps and check valves;
• Tank sumps, manway areas;
• Leak detection equipment;
• Overflow alarms or other audible and visual alarms, sight gauges;
• Fill ports, catchment basins;
• Oil/water separators;
• Cleanup equipment (e.g. absorbent materials, fuel recovery pumps, personal protective gear);
• Hazardous waste generation sites (x-ray, chemotherapy, morgue, pathology);
• Waste storage areas;
• Satellite accumulation points;
• Vehicles used for transport;
• Container storage areas; and
• Shop activities.

SOURCE: EPA has an extensive directory of information and resources by industry sector at: www.hercenter.org/links

One of the basic knowledge areas for a green job is "compliance" with regulations that shape all responsibilities and activities.  This is especially true when the employer handles toxic substances such as healthcare facilities often do. The Clean Water Act is one of the basic compliance regulations that a green job seeker should familiarize themselves with.  Closely connected are:

Safe Drinking Water Act
The Safe Drinking Water Act (SDWA) mandates that EPA establish regulations
to protect human health from contaminants in drinking water.  The law authorizes EPA to
develop national drinking water standards and to create a joint federal-state (or federal-tribal)
system to ensure compliance with these standards.  The SDWA also directs EPA to protect
underground sources of drinking water by controlling underground injection of fluid wastes. Visit the web site at www.epa.gov/ogwdw for additional information.

Resource Conservation and Recovery Act
The Resource Conservation and Recovery Act (RCRA) aims to manage the
disposal of waste from municipalities and industries.  It regulates facilities that generate,
transport, treat, store, or dispose of hazardous waste. Under RCRA, most healthcare facilities
are hazardous waste generators. RCRA hazardous waste regulations are in the Code of Federal Regulations (CFR), Title 40, Parts 260 to 280. A series of hazardous waste evaluation
flowcharts are available on EPA Region 2's web site at http://www.epa.gov/region02/healthcare/.



Clean Water Act

The primary objective of the Federal Water Pollution Control Act, commonly referred to as the Clean Water Act (CWA), is to restore and maintain the chemical, physical, and biological integrity of the nation's surface waters.

Pollutants regulated under the CWA are classified as either "toxic" pollutants (priority pollutants); "conventional" pollutants, such as biochemical oxygen demand (BOD), total suspended solids (TSS), fecal coliform, oil and grease, and pH; or "nonconventional" pollutants, including any pollutant not identified as either conventional or priority.

The CWA regulates both direct (those that discharge directly to waters of the United States) and indirect dischargers (those who discharge to POTWs). The National Pollutant Discharge Elimination System (NPDES) permitting program (CWA Section 402) controls direct discharges into navigable waters. NPDES permits, issued by either EPA or an authorized state (EPA has authorized 45 states, one territory, and no tribes to administer the NPDES program), contain industry-specific, technology-based and water-quality-based limits and establish pollutant monitoring and reporting requirements. A facility that proposes to discharge into the nation's waters must obtain a permit prior to initiating a discharge. A permit applicant must provide quantitative analytical data identifying the types of pollutants present in the facility's effluent. The permit will then set forth the conditions and effluent limitations under which the facility may discharge.

The healthcare industry is subject to various provisions of the CWA including:

• Wastewater Discharges - NPDES Effluent Limitations and Guidelines for Direct Dischargers (guidelines for direct discharging hospitals with more than 1,000 occupied beds) and General Pretreatment Standards.
• Stormwater Permits: Municipal separate storm sewer systems (MS4), such as those from hospitals, and construction activities are subject to stormwater permitting requirements.
• Oil Pollution Prevention Requirements: Hospitals that have a total aboveground oil storage capacity exceeding 1,320 gallons or an underground storage capacity exceeding 42,000 gallons are subject to spill prevention control and countermeasure (SPCC) plan requirements.

EPA's NPDES web site http://cfpub.epa.gov/npdes provides technical and regulatory information about the NPDES permit program that controls water pollution by regulating point sources (e.g., pipe, ditch) that discharge pollutants into waters of the United States.

For detailed information on numeric limitations, contact your EPA Regional pretreatment coordinator. Contact information can be found at the following web site. http://cfpub.epa.gov/npdes/contacts.cfm?program_id=0&type=NPDES

The stormwater program is part of the NPDES program and is designed to prevent the discharge of contaminated stormwater into navigable waters. See the web site at: http://cfpub.epa.gov/npdes/home.cfm?program_id=6

EPA's oil spill program web site, http://www.epa.gov/oilspill/, provides information about EPA's program for preventing, preparing for, and responding to oil spills that occur in and around inland waters of the United States. If a hospital uses or stores oil it may be subject to the Spill Prevention Control Countermeasure (SPCC) rule.

Typical Records an EPA Inspector May Ask to Review under the Clean Water Act

• Industrial User permit (IU permit) for discharges to the local municipality (indirect discharge). Most hospitals are indirect dischargers.
• Spill Prevention, Control, and Countermeasure (SPCC) Plan. The plan is to prevent any discharge of oil into or upon navigable waters of the United States or adjoining shorelines.
• Phase II stormwater permits under the NPDES program for public hospitals located in an urbanized area.
• NPDES construction stormwater permits (Phase I and Phase II) are also required for any construction activity greater than 1 acre for any hospital located in urban or rural areas.
• NPDES general permit for discharging directly to a water body (direct discharge).

EPA's Office of Water operates a Water Resource Center with a 24-hour voice mail system for publication orders or reference questions at (202) 566-1729, or the Wetlands Helpline ((800) 832-7828). Visit the Office of Water web site (http://www.epa.gov/water/) and the NPDES web site (http://cfpub.epa.gov/npdes/) for additional material.

Practice Greenhealth is the nation's leading membership and networking organization for institutions in the healthcare community that have made a commitment to sustainable, eco-friendly practices. Members include hospitals, healthcare systems, businesses and other stakeholders engaged in the greening of healthcare to improve the health of patients, staff and the environment.

Learn the easy way, with Webinars from Greenhealth

Some samples of Greenhealth webinars for healthcare professional development include:

• Getting Started with Practice Greenhealth
• Design & Construction Series: Innovations in Energy Demand Reduction
• Greening Operations Series - Blue Wrap Recycling: From Dream to Reality in Less Than a Year

Teleosis also offers the "Leadership in Green Health Care Program"

This Interactive Course trains health professionals for the Green Economy. "Leadership in Green Health Care" is an online training program for health professionals who want to promote sustainability and protect our limited environmental resources. Course materials provide strategies that inspire environmental action in communities and workplaces. Register online at www.teleosis.org

Additional resources includ:

Energy Impact Calculator

This tool calculates the health impacts of a facility's energy use.

Greenhealth Tracker™ 

The environmental data tracking tool that helps you manage your waste.

Practice Greenhealth Forums

A place to ask questions, post articles, network with other members, and expand your knowledge.