Chemicals
This section of the Sustainability Roadmap for Hospitals addresses chemicals policy, purchasing, and use. For information about safe handling and disposal of chemical waste, see the Roadmap Topic section on Waste.
Overview
While chemicals play an important role in health care facilities as sterilants, disinfectants, solvents, chemotherapeutics and other pharmaceuticals, preservatives, paints, sealants, and so on, they also can pose a threat to human health and the environment. According to Health Care Without Harm (HCWH), an international nonprofit membership organization that campaigns for a health care sector that "promotes the health of people and the environment," industrial societies are experiencing an increase in diseases and conditions linked to daily environmental exposure to hundreds of hazardous chemicals. HCWH views current laws as inadequate to protect the public from these exposures and testing of chemicals with unknown health effects as slow and incomplete. These factors contribute to the likelihood of potentially dangerous chemicals being widely dispersed throughout the environment and compel health care facilities, as institutions invested in public health, to respond with proactive measures that lead to the development of safer practices and products. For more information, see the HCWH report Guide to Choosing Safer Products and Chemicals: Implementing Chemicals Policy in Health Care. Of particular interest in the guide is the document Rationale for a Comprehensive Chemicals Policy in Health Care.
Compliance Considerations
Chemicals can be found throughout a hospital, including chemical reagents, solvents and a variety of chemicals in the lab; cleaners in EVS and elsewhere; paints, solvents, acids, oil, and other chemicals in the facility department; waste anesthetic gases in the OR;and pharmaceuticals, just to name a few.
To manage these substances safely, hospitals are required to enact policies for handling chemicals, training and educating staff, and providing strict oversight. Policies should dictate standard best operating procedures and may include a lab safety manual, OSHA's hazard communication policy, a hazardous materials management plan, spill policies, EPP policies, and others specific to a particular chemical (e.g., EtO, glutaraldehyde, mercury, solvents, etc.).
For more information about regulatory agencies and the chemical-related issues they oversee, visit the Roadmap Waste Topics section. In addition, the Healthcare Environmental Resource Center (HERC) is a great resource for hazardous materials management in hospitals.
Regulations are slowly being introduced that will directly or indirectly affect chemicals management in health care facilities. For example, in California, Proposition 65: The Safe Drinking Water and Toxic Enforcement Act requires, at least annually, publication of a list of chemicals known to the state to cause cancer or reproductive toxicity. Several states ban the use of fluorescent bulb crushers. And, while not yet regulated, several chemicals are of particular concern, including mercury, Biphenyl A, flame retardants, and di (2-ethylhexyl) phthalates.
Chemical use has hidden costs beyond purchase and disposal costs (e.g., poor indoor air quality, compliance costs, hidden costs of worker chemical exposures). A chemicals purchasing and management policy can help minimize the risks of having chemicals on-site.
The objectives of a safer chemicals policy are to
- Seek the least hazardous (or least toxic) chemical to get the job done.
- Use the smallest amount of the chemical necessary to get the job done.
- Use the chemical safely by properly training staff (following all regulatory guidelines of OSHA's hazard communication policy and all U.S. Environmental Protection Agency (EPA) regulations related to use and disposal of hazardous chemicals).
- Employ, to the fullest extent necessary and reasonable, personal protective equipment and engineering controls.
Organizations can anticipate future chemicals regulation by putting in place policies of their own, such as a broad chemicals policy and internal chemicals management policies.
A broad chemicals policy addresses a health care organization's commitment to and support of changes in national (and potentially international) chemicals policies. In the United States, many credible groups are working together to support policies that protect public health. To this end, the Centers for Disease Control and Prevention (CDC), the Agency for Toxic Substances and Disease Registry (ATSDR), the EPA, and others have created the National Conversation on Public Health and Chemical Exposures. The National Conversation is a collaborative initiative intended to strengthen the nation's approach to protecting the public from harmful chemical exposures.
Managing chemicals according to strict regulatory compliance is the first step in a facility's internal chemicals management policy. However, managing beyond compliance should be the goal. Examples of stepping beyond what is required include these:
- Recycling mercury-containing fluorescent bulbs. Although this action is required in some states, some facilities still choose to landfill their mercury bulbs—not a best practice as it does not protect public health.
- Recycling solvents like alcohol, xylene, or formalin. Recycling these materials saves about 80 percent on both purchase of new chemicals and on hazardous waste disposal. Likewise, although some municipalities permit disposal of formalin in drains, this is not a best practice.
The bottom line is there are many compliance issues to consider when buying, using, and disposing of hazardous materials and waste. If, after undertaking the process of looking for less hazardous or non-hazardous alternative products or services, it is found that use of a chemical is necessary, the EPA suggests using this sustainable chemistry hierarchy to select products and processes, with the goal of purchasing products and using processes that represent the highest level possible of these green actions:
- Practice green chemistry (source reduction/prevention of chemical hazards).
- Design chemical products to be less hazardous to human health and the environment.*
- Use feedstocks and reagents that are less hazardous to human health and the environment.*
- Design syntheses and other processes to use less energy and fewer materials (high-atom economy, low-E-factor).
- Use feedstocks derived from annually renewable resources or from abundant waste.
- Design chemical products for increased, more facile reuse or recycling.
- Reuse or recycle chemicals.
- Treat chemicals to render them less hazardous.
- Dispose of chemicals properly.
*Chemicals that are less hazardous to human health and the environment are:- Less toxic to organisms and ecosystems.
- Not persistent or bioaccumulative in organisms or the environment.
- Inherently safer with respect to handling and use.
Achieving an understanding of the chemical components of products and/or the hazards of using a particular chemical is best begun during the product evaluation process. As a first step, require vendors to disclose hazardous chemical components of products and to provide an MSDS (material safety data sheet) for each item.
Opportunities and Benefits
The public is becoming increasingly concerned about and aware of hazardous and potentially hazardous chemicals. Health care organizations are well-positioned to call attention to the connection between public health and the health of the environment as well as to anticipate the regulation of hazardous chemicals by taking proactive measures in chemicals purchasing, use, and policy that will minimize risk to the greatest extent possible.
Eliminating known and likely hazards and switching to safer alternatives can have many benefits, including bottom-line improvements such as reduced disposal costs, less exposure in terms of potential liability, and improved staff and patient health.
Further, because the health care sector purchases products in significant quantities from virtually every industry sector, it has the potential to drive green innovation throughout the economy. Health care can use its significant purchasing power to transform the design and manufacture of products to promote greater sustainability. All institutions can make a difference. Small institutions may be more flexible, while large institutions have greater purchasing power, but all can be leaders in innovation and models for other industry sectors.
Using the Roadmap for Chemicals Management
The Roadmap is designed to help facilities design a customized short- and/or long-term management strategies to achieve their sustainability goals. The Roadmap identifies opportunities for sustainability performance and explains the strategies involved to achieve those reductions. The Roadmap allows you to customize your plan based on your facility's current progress on sustainability and how aggressively your facility wants to pursue your goals.
Chemicals reduction/elimination and policies are being built out—please contact us if you have materials or stories to share. Click on the sections below to learn more:
- Information on drivers and barriers for sustainability efforts
- Strategies for building sustainability teams
- Strategies for getting leadership support
- Strategies for financing sustainability initiatives