nursing and the environment: new dimensions for clinical practice by hollie shaner rn, msa, faan...
TRANSCRIPT
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 hazardous pharmaceuticals
PVC purchasing decisions energy use
Water conservation indoor air quality
Patient safety 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 No amount of medical knowledge will lessen the accountability for nurses to do what the accountability for nurses to do what nurses do, that is, manage the environment nurses do, that is, manage the environment to promote positive life processes” to promote positive life processes”
-Florence Nightingale-Florence Nightingale
DEVER MODEL: Health Status of Populations
Health Status
HumanBiology
Lifestyle
Health Care
System
Environment
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 HealthAmerican 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
• Treat the sick
• Act as responsible corporate citizen
• Provide employment
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
Biohazard
Waste
Sharps
Blood/blood
products
Pathological
Trace Chemo
Animal carcasses
Hazardous
Waste
chemical hazards
solvents
U & P listed pharmaceuticals
cytotoxics
lead
silver
mercury
ether
Solid
Waste
Recyclable
Waste
cardboard
paper
confidential paper
metal
aluminum
plastic
pvc, hdpe, pet, ldpe, pp, ps,other
glass
medical, sodalime
wood
construction & demo
food
kitchen grease
Universal Wastes
Batteries
Fluorescent light tubes
Mercury switches
Pesticides
Hospital Solid Waste• Paper waste
• Plastic waste
• Glass waste
• Metal waste
• Food waste
• Wood waste
• Other waste paper
plastic
metal
food
other
woodglass
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?????
• Hazardous waste: requires special treatment depending on material type
• Universal wastesome is recycled, recovered
• Solid waste: landfill, recycle, compost, incinerate
• Biohazard wastes: incinerate, autoclave, microwave , other
*Medical Waste Incinerators sources of mercury & dioxin pollution by US EPA
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: 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.
PVC & DEHP
• HCWH blue folder
• FDA alert– www.fda.gov click on alerts, click on July11
DEHP in medical products
• www.noharm.org
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 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?
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