The presence of harmful chemicals in both indoor and outdoor environments poses risks for human health and the environment. Control of chemicals in a hospital setting is important to minimize risks to patients and employees, as well as to prevent harm to the surrounding community. For this Sustainability Roadmap, we consider chemicals in terms of indoor air quality management, environmental services and chemical waste management.
Indoor air quality management ensures a comfortable and healthy indoor environment for building occupants through the management of environmental tobacco smoke, ventilation, occupant comfort, and contaminants. As with energy and water management, many of these features and practices can be incorporated into the facility during building design and construction, but facilities of all ages and designs can make improvements through commissioning, retrofitting, staff training and minimization of products that contribute to indoor contaminants.
For environmental services departments, some cleaning chemicals can present a variety of human health and ecological concerns, contributing to poor indoor air quality and containing chemicals linked to cancer, reproductive disorders, respiratory ailments, eye and skin irritation, central nervous system impairment, and other human health effects and have been shown to be a primary cause of work-related asthma, particularly in nurses and cleaning staff. These conditions may be eliminated through the use of environmentally and health-sensitive cleaning products, equipment, and methods that are proven to be effective at infection control.
Finally, chemical waste management addresses the harmful impacts of chemicals on exterior surroundings by reducing or eliminating their emission and ensuring their proper disposal.
Why is it Important?
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 and Policy Considerations
To manage chemicals 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, IAQ management plan, and others specific to having a particular chemical in the facility (e.g., EtO, glutaraldehyde, mercury, solvents, etc.). Once the chemical is deemed a “waste”, it is regulated by several U.S. Environmental Protection Agency (EPA) regulations that dictate the disposal of all hazardous chemicals.
Organizations can anticipate future chemicals regulation by putting in place policies of their own, and watching what regulations are slowly being introduced around the country 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.
Managing chemicals according to strict regulatory compliance is the first step in a facility's internal chemicals management policy. However, managing beyond compliance should also be the goal. Chemicals purchasing and management policy can help minimize the risks of having chemicals on-site. The objectives of a chemicals management policy are to
- Seek the least hazardous (or least toxic) chemical to get the job done. Understanding chemical components of products and/or the hazards of using a particular chemical is best begun during the product evaluation process.
- 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).
- 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.
- Employ, to the fullest extent necessary and reasonable, personal protective equipment and engineering controls.
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.
Lab Chemical Management
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.
The EPA and DOE’s Labs 21 program focus typical laboratories because in addition to chemicals, they use far more energy and water per square foot than the typical office building. Explore the resources and links on this site to learn more about sustainable laboratories.
Chemical Use and Disposal: Reduce and/or eliminate the use of hazardous products, ensure proper disposal of chemical hazards and toxic materials within the health care facility to safeguard the health of building occupants. Use targeted strategies for: hand hygiene products, sterilization and high level disinfection; laboratories; and radiology.
Pharmaceutical Management and Disposal: Safeguard human and ecological health through compliant management and disposal of pharmaceuticals and associated wastes.
Polychlorinated Biphenyl (PCB) Removal and Asbestos-Containing Materials (ACM) Management: Implement a PCB and ACM removal and abatement program. Prevention of associated harmful effects of these hazardous materials in new and existing buildings.
Leaks and Spills: Mitigate of leaks, spills and waterborne effluents to prevent releasing waterborne environmental, health and safety burdens to the site neighbors and surrounding community.
Sanitary Sewer: Eliminate wherever possible, the drain disposal of chemicals, pharmaceuticals and toxic materials within the health care facility to safeguard the health of the local waterways and communities.
INDOOR AIR QUALITY (IAQ) MANAGEMENT:
IAQ Performance: Develop an IAQ management plan that addresses ongoing operations and maintenance, as well as planned future upgrades related to smoking, IAQ performance, systems maintenance, and systems monitoring.
Systems Maintenance: Support for appropriate training, monitoring, operations and maintenance for buildings and building systems to ensure they deliver target building performance goals over the life of the building.
Systems Monitoring: Ensure ventilation system monitoring to help sustain long-term occupant comfort and well-being.\
Products and Materials: Minimize exposure of building occupants and cleaning personnel to potentially hazardous chemical, biological and particulate contaminants from cleaning chemicals, equipment and procedures, while ensuring effective infection control processes.
Entryway Systems: Use and maintenance of entryway grills, grates, mats, etc. to reduce the amount of dirt, dust, pollen, and other particles entering the building.
Indoor Integrated Pest Management: Emphasize non-chemical strategies for pest prevention that protect people from unnecessary exposure to pests and pesticides.
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
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