The List of Toxic Substances in Schedule 1 of the Canadian Environmental Protection Act, 1999 (CEPA 1999) includes substances that are considered to be toxic as defined in Section 64 of the Act. Each of the substances, or groups of substances, below has been used (and may continue to be used) in health care settings.
Mercury is a bioaccumulative, persistent, toxic substance that threatens the health of humans and wildlife throughout North America. The USEPA, Environment Canada, the International Joint Commission, the Commission for Environmental Cooperation and many state and provincial governments have identified mercury as one of the most critical pollutants for significant elimination and/or reduction. Exposure to elemental mercury vapours can cause acute respiratory problems, which are followed by neurologic disturbances and general systemic effects. Acute exposure to inorganic mercury by ingestion may also cause gastrointestinal disturbances and may effect the kidneys.
In hospitals, the main uses of mercury are in dental amalgam (cavity fillings), sphygmomanometers (blood pressure cuffs), thermometers, batteries, electrical and electronic switches, and fluorescent lamps. Mercury is released from hospitals by: incineration of medical waste; land filling of mercury-containing solid waste; and releases of mercury containing chemicals into wastewater.
Pages 344-348 of this document list alternatives for many products that commonly use mercury.
Environment and Climate Change Canada: About Mercury, Mercury and the Environment, Notice Regarding Pollution Prevention Planning in Respect of Mercury Releases from Dental Amalgam Waste
Health Care without Harm: Instruments, Products, and Laboratory Chemicals Used in Hospitals That May Contain Mercury
Endocrine Disrupting Chemicals (EDCs) are chemicals that can disrupt any systems of the body regulated by hormones. Hormonal disruptions can cause cancerous tumors, birth defects, and other developmental disorders.
EDCs in Health Care
Phthalates are a group of chemical substances, primarily used as plasticisers (softeners) in plastics. They are abundant in polyvinyl-chloride (PVC) based medical devices such as blood bags, nutrition pockets, tubing, umbilical venous catheters or disposable gloves, where they can account for up to 40% of the final product. Phthalates are also commonly used as medicine excipients to make coatings for oral medications and in flooring, among many other uses. Phthalates can easily be released, transferred or leached into the air, water or body fluids during their production, use and disposal. Numerous phthalates are documented or suspected EDCs, which act by inhibiting the production of testosterone in the testes, and are classified as toxic to reproduction according to European legislation.
Bisphenol A (BPA) is a chemical substance that can be polymerised to produce polycarbonate plastic and other plastic products, or used as an additive in PVC plastic. Applications in the health care sector include, among others, medical tubing, hemodialysers, newborn incubators, syringes and nebulizers. BPA is a strong endocrine disrupting chemical able to interfere with the action of estrogen and the estradiol hormone. BPA has been show to leach from devices containing PVC (similarly to phthalates) or other polymerized plastics and from dental sealants.
Di(2-ethylhexyl) phthalate (DEHP) is a high production volume chemical used in the manufacture of a wide variety of consumer food packaging, some children’s products, and some polyvinyl chloride (PVC) medical devices. In 2006, the NTP found that DEHP may pose a risk to human development, especially critically ill male infants.
National Institute of Environmental Health Sciences: Endocrine Disruptors
Healthcare Without Harm: Endocrine Disruptors in the Health Care Sector
Chlorine and chlorine compounds have long been used as cleaning agents in health care settings due to their antimicrobial activity. The most commonly used chlorine product is sodium hypochlorite (bleach). Alternative compounds that release chlorine and are used in health-care settings include demand-release chlorine dioxide, sodium dichloroisocyanurate, and chloramine-T. Inorganic chlorine solution is used for disinfecting tonometer heads and for spot-disinfection of countertops and floors. Other uses in health care include as an irrigating agent in endodontic treatment and as a disinfectant for manikins, laundry, dental appliances, hydrotherapy tanks, regulated medical waste before disposal, and the water distribution system in hemodialysis centres and hemodialysis machines.
Effluent wastewaters are disinfected to protect downstream municipal water supplies, recreational waters and shellfish-growing areas from bacterial contamination and other agents causing waterborne disease. Studies have demonstrated that certain levels of chlorinated wastewater effluents from wastewater treatment plants have caused acute lethality to fish and invertebrate species. Chlorinated wastewater effluents were added to the List of Toxic Substances in Schedule 1 of the Canadian Environmental Protection Act in November of 1999.
Environment and Climate Change Canada: Chlorinated Wastewater Effluents
Centers for Disease Control and Prevention: Chlorine and Chlorine Compounds
Safer Chemicals Resources
How does it work?
High-energy UV light sterilizes bacteria by disrupting DNA. When patient rooms are vacant, switching on UV lights for just five minutes can sterilize the entire room.
Benefits of using UV Sterilization:
Studies indicated that using UV as a surface disinfectant gives you a 53 to 56% reduction in Methicillin-resistant Staphylococcus aureus (MRSA) and C. Diff Hospital Acquired Infections (HAIs) when supplementing terminal cleans with UV room disinfection. UV light reaches tight cracks and corners, and leaves no harsh residues, prolonging the life of health care equipment. It is also fast: the twin tower system can sanitize a room in just five minutes.
Hospital News: Ultraviolet and HVAC: Keys to Reducing Hospital-Acquired Infections
Class 1 Inc. ASEPT.1X Fixed, Fully Automatic
Class 1 Inc. ASEPT.2X Twin-tower Mobile
Class 1 Inc. ASEPT.3X Patient Activated Room Disinfector
How does it work?
Copper has natural antimicrobial properties due to metal ions’ oligodynamic effect on cells. Copper has been shown to control a wide range of moulds, fungi, algae and harmful microbes, which can reduce the spread of Hospital Acquired Infections (HAIs).
Benefits of using copper:
On February 29, 2008, the United States Environmental Protection Agency (EPA) approved the registrations of five different groups of copper alloys (mixtures with copper as the principle component) as "antimicrobial materials" with public health benefits. Research has shown that after switching touch surface material found in hospitals from stainless steel to copper, there was a 97% reduction in surface pathogens. Additionally, there is a 56% reduction in ICU HAIs if the copper surfaces remain throughout the patient’s stay. Copper is highly durable and its antimicrobial qualities do not diminish over time. Copper also has a halo effect on surrounding non-copper materials. Research shows that non-copper surfaces up to 50 centimeters from the antimicrobial copper surfaces exhibited a microbial reduction of 70% compared to surfaces not in such close proximity.
Class-1 Inc. Aereus™ BioFree Copper-coated Toilet Seat
Copper Development Association Inc.: Antimicrobial Copper Touch Surfaces: A new tool for Infection Control and Prevention
How does it work?
Because the additional oxygen atom in O3 is held by a weak bond, it is readily released to oxidize and kill microorganisms.
Benefits of using ozonated water:
Ozonated water is 2x more effective than bleach, 50x faster than bleach, non-toxic and eco-friendly. The wastewater needs to be in contact with ozone for just a short time (approximately 10 to 30 minutes). Ozone decomposes rapidly, leaves no harmful residual that would need to be removed from the wastewater after treatment, and helps destroy bad odours. There is no regrowth of microorganisms after ozonation. Ozone is generated onsite, and thus, there are fewer safety problems associated with shipping and handling. Ozonation increases the dissolved oxygen (DO) concentration of the discharged wastewater. The increase in DO can improve the oxygen content of the receiving body of water.
Contamination of Sinks and Drains with Gram-Negative Bacteria: A Call for Solutions
CCHFM Core Competency: PDC, M&O
Growing evidence that hospital sinks and drains may be reservoirs for gram-negative bacteria, which can be transmitted to patients, has led to a number of interventions aimed at addressing this challenge. During this panel discussion you will hear from Infection Control professionals from acute care facilities in the Greater Toronto Area about solutions that have been put in place to protect patients. Topics covered will include: how sink and drain design affects contamination rates, remediation techniques once a drain is contaminated, preventative maintenance of plumbing and novel patient care ideas to combat this issue. The objective of the presentation is to increase knowledge of the risk to patients posed by hospital plumbing contaminated by gram-negative bacteria in order to stimulate thought/discussion around solutions that can be incorporated into design to prevent contamination of sinks.
Heather Candon, Infection Control Manager, Mackenzie Health, Richmond Hill ON
Natasha Salt, Director of IPAC, Sunnybrook Health Sciences Centre, Toronto ON
Lorraine Maze, Infection Control Practitioner, Mount Sinai Hospital, Toronto ON
Engineering Infection Reduction at Vancouver General Hospital
Dr. Elizabeth Bryce, Regional Medical Director, IPAC, Vancouver Coastal Health, Vancouver, BC
CCHFM Core Competency: PDC
This presentation will describe the results of a pilot project that followed the microbiome of patients undergoing bone marrow transplantation, their healthcare workers and their environment. Patients were randomized to receive care in a regular isolation room or a room that had been re-engineered with self-disinfecting material on high-touch surfaces and with ultraviolet C light in the bathroom.
1) To discuss basic principles of engineering for infection reduction and summarize key studies to date on self-disinfecting surfaces
2) To describe the results from the first phase of the pilot project and the practicalities of operationalizing this type of study
3) To identify existing gaps in our knowledge regarding self-disinfecting surfaces and potential ways of further clarifying their role in healthcare.
Coalition Project Staff
Kent Waddington, Communications Director – Project Lead
Dan Ritchie, Sustainable Health Care Programs - Project Secondary
Linda Varangu, Executive Director – Project Advisor
For further information, contact:
Canadian Coalition for Green Health Care
1-613-720-4889 or email@example.com
This project was undertaken with the financial support of:
Ce projet a été réalisé avec l'appui financier de: