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

2. 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.

3. 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”

6. 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.

7. 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”.

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

9. 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: dB(A)
Ventilator alarm: dB(A)
Telephone: dB(A)
Television: 79 dB(A)
Monitor Alarm: 79 dB(A)
IV infusion alarm: dB(A)
Train horn: 120 dB(A)
Pneumatic drill: 100 dB(A)
Motorcycle: 90 dB(A)
Noise on busy urban street: dB(A)
Vacuum cleaner: 70 dB(A)
Washing machine: 65 dB(A)

10. 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.

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

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

14. 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.

15. 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

16. 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.

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

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

21. 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

23. Questions?