1. HOSPITAL WASTE MANAGEMENT & MERCURY ELIMINATION Presented by Laurie Tenace Florida Department of Environmental Protection (850) 488-0300 at the Florida Pollution Prevention & Environmental Essentials Conference July 31-August 2, 2002

2. HOSPITALS FOR A HEALTHY ENVIRONMENT Working Together to Create Healthy Communities A partnership between: American Hospital Association U.S. Environmental Protection Agency American Nurses Association Health Care Without Harm

3. Hospital waste management: always swamped

4. WHY SHOULD HOSPITALS CARE ? Expands and supports mission to improve community health Promotes community trust and confidence Preserves environmental resources Prevents pollution $aves money

5. WHY ELSE? Hospitals generate 2 millions tons of solid waste annually Medical incinerators are the 4th largest known source of mercury emissions Many PBT’s found in hospitals are suspected to cause health problems Hospitals need to consider actions based on “first, do no harm”

6. H2E Program H2E goals for hospitals include: Virtually eliminate mercury waste by year 2005 Reduce total waste volume by 33% by year 2005, by 50% by 2010 Identify and reduce PBT chemicals and other hazardous substances in hospitals through pollution prevention and waste reduction The key to success is your involvement!

7. WHAT CAN MY HOSPITAL GAIN? Decreased Costs from: Increased worker health & safety Better waste segregation Environmentally preferable purchasing

9. REAL NUMBERS Average 9kg waste per patient day! Jacobi Medical Center cut annual waste management costs by 30% Working with WasteWorks, St. Barnabas Hospital reduced waste volume by 65% and costs by 50% P2 efforts by Staten Island University Hospital reduced waste management costs by $500,000 per year

10. The 10 Step Program Form a team Assess your facility Establish baseline data Set waste & mercury reduction goals Develop an action plan

11. The last five steps Kick off the program Educate employees Do the work Track, measure, record progress Celebrate your achievements

12. WHY MERCURY? What’s the big deal? I used to play with mercury when I was a kid, and I’m OK now…

13. Mad as a Hatter? Mercury is well know for its toxic effects Methyl mercury is the most toxic form Long term exposure can permanently damage brain, kidneys and developing fetus

14. Who’s affected? Methyl-Hg pose no health threat to most, but 3 groups are at high risk through ingestion: Pregnant women Nursing infants Young children

17. WHAT’S UP NATIONALLY? Retail sale ban of mercury thermometers Regional sales bans Labeling Retirement Vs Recycling Laws The U.S. Senate Public Works Committee voted June 27th to approve S 351, a bill that would phase out mercury thermometers except by prescription, and coordinate a plan to manage surplus mercury. Nine states have already banned mercury thermometers. Meanwhile, note that Connecticut recently enacted a ban on most mercury-containing products, exempting only certain lamps and pharmaceuticals - and it looks like Massachusetts is trying to follow suit with a very similar bill. Meanwhile, the courts have upheld a controversial mercury labeling law in Vermont. Details in the last two issues of State Recycling Laws Update.

18. Where is Mercury in the Hospital? Thermometers Fluorescent lamps Thermostats, batteries

19. THE BIG ONE The recent New York Times story by Gina Kolata, carried by the Duluth News Tribune, "The Risk Seen in Move to Replace Gauge of Blood Pressure" (June 16) raises the important point that sphygmomanometers, also known as blood pressure cuffs, the measuring devices used to determine blood pressure, cannot provide accurate readings unless they are properly calibrated and maintained.

23. Mercury in MY hospital? Lab ChemicalsBarometers Cleaning SolutionsElectric Switches Pharmaceutical Preservatives Esophageal Dilators Cantor Tubes Feeding Tubes Pressure Gauges

24. Where Else? Esophageal Bougies, Feeding Tubes, Miller Abbott Tubes Dental Amalgam

25. Barometers Used in Respiratory Therapy to calibrate instruments

26. TWO TOUGH ONES Laboratory Chemicals MSDS vs Certificate of Analysis Drain Traps

27. Places It Hides Cleaning Products Bleach, Cleansers Pharmaceutical Products Thimerosal Thermostat Probes Industrial Thermometers Pressure Gauges

28. Some Things to Do: Work with Purchasing Spill Clean Up Training and Awareness

29. SPILL CLEAN-UP Spill Kits What NOT to use: vacuum cleaner broom What to use: tape flashlight stiff paper eye dropper mercury vacuum GET HELP!

30. Safe Storage