Incorporating Environmental Health into Nursing Practice Denise Choiniere, RN, BSN University of Maryland School of Nursing January 13, 2009

Is it the dolphins? I am here to talk to you about environmental health, and hopefully, by the time I am done, you will have some new insight into how environmental health fits into health care.

So when you think of the “environment” what comes to mind So when you think of the “environment” what comes to mind? Is it, “save the rainforest”

Identified those effected to discuss change: CCU staff and Physicians Respiratory Therapy Pharmacy Materials Management Housekeeping Cath/EP Lab, ECHO, Nuclear Medicine Rehabilitation Services Case Management Social Work This is the sign that is placed on the pts doors, lights are dimmed, etc. Not only have we received positive feedback from the pts, but also from the staff. They report that they enjoy the one hour to catch up with decreased stimulation.

Florence Nightingale, Notes on Nursing, 1860 “Unnecessary noise is the most cruel absence of care which can be inflicted either on sick or well”. Notes on Nursing: Defined noise as an extraneous environmental variable for quality of care. “Unnecessary noise is the most cruel absence of care which can be inflicted either on sick or well”.

Common Noise Volumes Train horn: 120 dB(A) Pneumatic drill: 100 dB(A) Motorcycle: 90 dB(A) Noise on busy urban street: 80- 90 dB(A) Vacuum cleaner: 70 dB(A) Washing machine: 65 dB(A)

Noise Volumes Common Noises Common ICU Noises Items falling onto the floor: 92 dB(A) Equipment movement: 90 dB(A) Pager: 84 dB(A) Talking: 75- 85 dB(A) Ventilator alarm: 70- 85 dB(A) Telephone: 70- 80 dB(A) Television: 79 dB(A) Monitor Alarm: 79 dB(A) IV infusion alarm: 65- 77 dB(A) Train horn: 120 dB(A) Pneumatic drill: 100 dB(A) Motorcycle: 90 dB(A) Noise on busy urban street: 80- 90 dB(A) Vacuum cleaner: 70 dB(A) Washing machine: 65 dB(A)

Increased noise levels include adverse effects such as sleep deprivation, increase stress, elevated blood pressure, heart rate and reported pain levels, Increased errors due to miscommunication between caregivers In the CCU, there could be up to 30 staff in the unit at one time.

Total of almost 500 pounds of used alkaline batteries have been recycled so far (almost 2 years)

UMMC Green Team Patient Care Services Green Team Recruited through current committee structure. Over 50 members, representing over 30 patient care areas.

Waste reduction strategies Reusable pillows, new initiative, taking 100,000 pounds out of our waste stream per year 3432 cubic feet of medical supplies & equipment was donated to Project Cure. Locally, donations of surplus beds & medical equipment, medical supplies, and furniture went to HealthCare for the Homeless, Shepperd Clinic and the Baltimore City Code Blue Shelter.

Reusable Sharps Containers 32,500 total pounds collected in the 12 months of the program.   Of that 32,500 pounds, only 23,600 pounds were actual sharps that were burned.   8,900 pounds was the weight of the needle boxes that we spared from burning. 300 sharps containers are in the pilot Save roughly 46,000 in container cost, Save a little over 11,000 in disposal cost, Remove 63,000 lbs. of plastic out of our waste stream Reduce annual pounds of incinerated plastic

Recycling Initiatives 380,000 pounds of cardboard was recycled in 2008. 43,000 pounds of mixed paper was recycled in 2008. Paper, Doubled what we did in 2007 Cardboard, tripled what we did in 2007.

The MD H2E Team includes Technical Assistance, Nursing, and Sustainable Foods programs

Nursing Outreach Coordinator Educate nurses throughout the state Engage nurses on all MD H2E initiatives Guide nurses on where to begin

The Power of Nurses Highest percentage of employees in facility Nurses understand the connection between environmental issues and health Precautionary Principle Nurses are patient advocates Nurses bridge the gap between administrative executives and floor staff End user of most products 21

Questions?