Objectives
Funded by Environment and Climate Change Canada – EcoAction Community Funding Program, this two-year clean water initiative will reduce toxic and hazardous waste generated by health care facility operations through the identification, implementation, and evaluation of innovative, toxics-free technologies and chemical use strategies.
Working collaboratively with BC Lower Mainland GreenCare, Ontario’s Chatham-Kent Health Alliance, Synergie Santé Environnement, the Coalition for Healthcare Acquired Infection Reduction, Class 1 Inc., Aqueous Solutions, and Tersano Inc., approximately 250 kilograms of toxics and other hazardous waste will be reduced per year by replacing chemical agents with safer alternatives and implementing systems that reduce or eliminate the need for chemical use.
The results of these pilot efforts will be used to develop comprehensive best practices to strategically reduce chemicals in health care facilities. Webinars, case studies, reports and other outreach materials will be developed based on the key successes and lessons learned and distributed nation-wide to the broader health care community.
Project Activities
- 1. Engage technical partners to provide innovative technological systems and information on toxics-reduced chemicals for health care.
- 2. Develop background research on best practice strategies for toxics reduction in health care operations.
- 3. Engage partner facilities willing to implement (pilot) new systems and strategies; formalize their organisational commitments to pilot projects.
- 4. Develop implementation plans with partner facilities for introduction of new systems and strategies.
- 5. Establish baselines of chemical purchasing, chemical use, and hazardous waste generation at pilot facilities; develop a standardized evaluation procedure to compare year 2 results to initial baselines.
- 6. Oversee implementation of new systems and strategies (chemical reduction measures) at pilot health care facilities.
- 7. Conduct ongoing mid-project evaluation of toxics reduction achieved by pilot projects (reduction measures); assess findings to determine whether implementation plans can be modified to optimize results.
- 8. Develop best practices and case studies of pilot projects as well as communications strategy for introducing findings to national health care community.
- 9. Complete pilot projects with final evaluation and validation of toxics reductions achieved according to established baselines.
- 10. Perform communications/awareness activities to distribute pilot findings and recommendations to national health care community; assess level of interest in pursuing additional or expanded reductions projects at partner or other facilities.
Performance Indicators/Results
- • Reduction or diversion of kilograms of toxic or harmful waste
- • Participants in Activities
- • Volunteers participating directly in project
- • Jobs Created
Reducing Toxics
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
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.
Resources:
Pages 344-348 of this document list alternatives for many products that commonly use mercury.
Wisconsin Mercury Sourcebook: Hospitals
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
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.
Resources:
Environmental Endocrine Disruption: An Effects Assessment and Analysis
National Institute of Environmental Health Sciences: Endocrine Disruptors
Healthcare Without Harm: Endocrine Disruptors in the Health Care Sector
Chlorinated Wastewater
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.
Resources
Environment and Climate Change Canada: Chlorinated Wastewater Effluents
Centers for Disease Control and Prevention: Chlorine and Chlorine Compounds
Safer Chemicals Resources
UV Sterilization
What is it?
Surface and air disinfection using UV light
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.
Resources:
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
Copper Surfaces
What is it?
Copper or copper alloy replacements or coverings for high-touch surfaces such as toilet seats, bed rails, doorknobs
, faucets, and IV poles.
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.
Resources:
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
Ozone Cleaners
What is it?
Ozone (O3) is a very reactive gas that can oxidise bacteria, moulds, organic material and other pollutants found in water.
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.
Resources:
Class 1 Inc. SmartFLO₃ Hand Hygiene Sink
Tersano iClean, SAO Dispenser, ProScrub, Laundry System
Aqueous Solutions Lotus PRO
Coalition Project Staff
Kent Waddington, Communications Director – Project Lead
Samantha Putos, Sustainable Health Care Programs – Project Secondary
Linda Varangu, Executive Director – Project Advisor
Collaborators
BC Lower Mainland GreenCare
Chatham-Kent Health Alliance
Synergie Santé Environnement
Coalition for Healthcare Acquired Infection Reduction
Class 1 Inc.
Aqueous Solutions
Tersano Inc.
For further information, contact:
Kent Waddington
Canadian Coalition for Green Health Care
1-613-720-4889 or kent@greenhealthcare.ca
Funding
This project was undertaken with the financial support of:
Ce projet a été réalisé avec l’appui financier de:
