1. Greening the Health Sector

2. Overview The objectives of this class are to: –provide information on the health system’s use of energy and toxic substances –describe the health system’s generation of waste –offer ideas about what nurses can do to decrease the environmental impact of hospitals and other health-care facilities

3. Why is greening health care an issue for nurses? “There are broad aspects of social justice that are associated with health and well-being and that ethical nursing practice addresses. These aspects relate to the need for change in systems and societal structures in order to create greater equity for all. Nurses should endeavour as much as possible, individually and collectively, to advocate for and work toward eliminating social inequities by: vi. Supporting environmental preservation and restoration and advocating for initiatives that reduce environmentally harmful practices in order to promote health and well-being.” Code of Ethics for Registered Nurses (CNA, in press)

4. Examples of nurses’ work in protecting the environment Advocating for a mercury-free environment: Jane initially joined the hospital’s green team to advocate for a mercury-free environment in the family practice department. She has raised the issue of converting to mercury-free blood pressure equipment with the hospital’s management. Gloria has advocated for a mercury-free environment at the monthly meetings of the occupational health and safety committee. Fluorescent light bulbs and mercury- based blood pressure equipment are now being replaced with mercury-free products.

5. Energy Use and Toxic Substances in the Health System

6. Energy use and toxic substances Fossil fuels: –Use of fossil fuels leads to the production of greenhouse gases (GHGs) –GHG production contributes to climate change and poor outdoor air quality –Canadian hospitals don’t fare well in international comparisons of energy use Toxic substances: –Examples are mercury, cleaning products, di(2- ethylhexyl)phthalate (DEHP) in polyvinyl chloride (PVC) products and pesticides –Patients and staff are exposed –Toxic substances contaminate the environment

7. Energy use and greenhouse gas production © Her Majesty the Queen in Right of Canada, represented by the Minister of Health (2005)

8. Credit: Getty Images Toxic substances used in hospitals: mercury

9. © Environment Canada

10. Exposure to mercury © Environment Canada: http://www.ec.gc.ca/MERCURY/EH/EN/eh-ec.cfm

11. Use of toxic products: DEHP in PVC plastics PVC is a primary component of 25% of all medical products. –DEHP is an additive that makes PVC flexible. –DEHP does not bind well with the plastic; it leaches out. –DEHP has adverse effects on the developing testes of young animals. Health Canada has recommended that exposures be reduced in high-risk populations. The cost of alternative products will come down as demand for them increases.

12. Generation of Waste in the Health System

13. Credit: Getty Images

14. Waste generation Health-care facilities produce: –recyclable and compostable waste such as paper, cardboard and food scraps –biomedical and infectious wastes that require special handling –waste destined for landfill sites, such as many plastic and polystyrene products When waste streams are not clearly separated, too much waste ends up in medical incinerators: –aging hospital incinerators are the largest contributors to dioxin and furan emissions into the air in Canada

15. Why are dioxin emissions a concern? Incineration of medical waste Dioxins Dioxin discharge into the air Deposition on pasture Ingestion by grazing animals Buildup in meat and milk Ingestion by humans

16. © Health Canada

17. What can nurses do?

18. Strategies for reducing energy use Work with green teams to: –support the use of energy-efficient light bulbs, turn off lights and equipment when not in use, promote the use of local foods and make sure doors are closed as often as possible to prevent heat exchange with the outdoors –upgrade insulation and check for condensation and water penetration –draft-proof windows and doors –apply for funding for renovations that reduce energy use, such as double- or triple-glazed windows, preferably with low-emissivity glass –install automatic doors in locations where external doors are frequently left open –increase use of public transit and bicycles

19. © Health Canada

20. Strategies for reducing waste Nurses can be very influential in: introducing recycling programs for hospital waste, 45% of which may be paper supporting the purchase of reusable linens in hospital and clinic settings and reducing the use of disposable linens asking suppliers to reduce packaging ensuring, by training staff and making waste receptacles available, that only material that needs incineration goes to the medical incinerator working with other members of the hospital staff to purchase health- care products that do not contain toxic substances so that these substances do not end up in the waste stream –Identify and reduce the number of medical products containing mercury. –Investigate the possibility of reusing single-use products and purchasing reusable products. –Select the least toxic cleansers available. –Support appropriate waste segregation and recycling.

21. © Planet Ark

22. © Environment Canada

23. Strategies for reducing the use of toxic substances Work with green teams to: conduct an audit to identify sources of toxic substances, such as mercury, and mark them with a sticker to alert staff that they require special disposal. identify alternative products and develop a plan, including a budget, to use them. Categorize toxic items as immediately or gradually replaceable. choose non-toxic cleaning and sterilizing alternatives. identify less toxic building materials and furniture.

24. Conclusions Nurses can encourage health-care facilities to minimize their environmental footprint by reducing their energy use, their use of products containing toxic substances, and their waste production. Other steps to creating sustainable hospitals include exploring the potential for major renovations that will further increase energy efficiency. Reducing the environmental footprint of health care more generally involves exploring the sustainability of the health system and identifying more effective ways to use resources across the system (Guenther & Gilmore-Hall, 2007).

26. © Canadian Nurses Association, 2008 Photos: Comstock; Corbis; Getty Images