Are your safer’ solutions also green ones?
Environment linked to worker, patient safety
Vinyl exam gloves allow hospitals to avoid latex allergies among workers and patients, but when incinerated, they create a toxic by-product. Some new safety syringes provide a shield to cover the needle but fill disposal containers more quickly. When your employee health choices solve one problem, do they create another, environmental one? That question is increasingly coming to the forefront as hospitals face pressures to improve not only patient safety, but also worker safety and environmental stewardship.
By considering the possible impact of product choices, hospitals can avoid unnecessary costs and risks, says Kathy Gerwig, HEM, CPEA, director of national resource conservation and national environmental, health and safety operations for Kaiser Permanente in Oakland, CA. "There are clear linkages between worker safety, patient safety, and environmental safety," says Gerwig, who spoke at the recent American Occupational Health Conference in San Francisco. "As a good business practice, we ought to be pursuing the activities that have multiple benefits."
Kaiser Permanente, which has 31 hospitals and 360 medical clinics, made a commitment to environmental stewardship. It has linked that to patient and staff safety as well, says Gerwig. So when a Kaiser team began to look into latex alternatives, it contacted Gerwig for input. Vinyl, she notes, involves a "release of dioxin pollution when it’s manufactured and when it’s incinerated."
That was one factor that influenced Kaiser to choose nitrile gloves, she says. In other cases, worker or patient safety may outweigh disposal issues. For example, although safer needle devices often involve more bulk, Kaiser placed its priority on the need to reduce needlesticks. "What we ought to be doing is working with manufacturers to encourage them to build products that are safe for workers and don’t increase the waste stream," she says.
There are 15 subject areas that have environmental, patient safety, and employee safety connections, says Gerwig. (See list, below.) At Kaiser, "We have a process for ensuring that environmental considerations are part of product decisions," she says. Every request for proposal related to new products includes language about Kaiser’s environmental goals. For example, Kaiser seeks to reduce packaging and buy only mercury-free products.
Connecting Worker and Environmental Safety |
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| These items have linkages to patient safety, worker safety and environmental safety: | |
| • | Cleaning chemicals |
| • | Energy conservation |
| • | Green buildings |
| • | Infectious waste |
| • | Mercury devices |
| • | Nonlatex exam gloves |
| • | Paper (recycled content and source reduction) |
| • | Pesticides |
| • | Pharmaceutical waste |
| • | PVC/DEHP plastics |
| • | Reprocessing single-use devices |
| • | Sharps generated from patient-administered treatment in the home |
| • | Solid waste minimization |
| • | Vernacare |
| • | Electronic/dry imaging (radiology) |
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Source: Kathy Gerwig, Kaiser Permanente, Oakland, CA. |
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Gerwig reviews that portion of proposals and evaluates opportunities to integrate the environmental and safety aspects. Because of that, "we make a better decision for the organization, for the patients and for the community," she says.
The Sustainable Hospitals Project at the University of Massachusetts in Lowell is developing an assessment tool that would help hospitals evaluate environmental and safety issues. "If you look at the process, you can make it a cleaner process as you go along. You use a safer chemical and use less of it," says research associate Tom Fuller, MSPH, MBA, describing the general concept. "There’s less pollution and less environmental impact . . . and it saves money in the long run."
For example, some hospitals have changed disinfectants and cleaners to less toxic substances that are safer for the environment and for workers. (For more on glutaraldehyde, see Hospital Employee Health, February 2001, pp. 13-18.)
Yet while the changes are made, someone needs to evaluate how the product is used and what training the staff may need. The assessment form will include an exposure assessment based on observation. "We watch the process before the change and watch the process after the change," he says. "We’re reporting what the exposure-level difference is. One of the things I saw was a worker who thought that [because] the chemical is safer, he could stick his hands in it."
Fuller also looks for ergonomic issues that may occur with products that require twisting or lifting. The Sustainable Hospitals Project maintains a list of alternative products and also considers risk shifting in its evaluations.
"When we look at selecting alternatives, we look at the broader implications," says Catherine Galligan, MS, the project’s clearinghouse manager. If you like a new product, such as a needle safety device, but are concerned about excessive packaging and waste, you should contact the manufacturer, she says. "If they get the feedback, they’re often willing to make improvements," she says. "They often don’t change a product because they hear nothing from a customer and they’re afraid a change would get negative feedback."
You’ll have even more clout in that effort if you gain the support of your group purchasing organization, adds Gerwig. "That’s where [hospitals] can have a tremendous amount of impact," she says.
(Editor’s note: For more information on environmentally sound alternative products, see the Sustainable Hospitals Project web site: www.sustainablehospitals.org.)
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