AJN Article-Sept 1999: Health Care Waste and the Environment

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The American Journal of Nursing

September, 1999

Health Care Waste and the Environmen
Hollie Shaner, MSA, RN


Q. I’ve just learned from someone in my facility’s environmental services department that the hospital has its medical waste incinerated. I’m concerned that this produces environmental toxins. What should I do?

A. Different types of waste should be treated differently, and health care has one of the most complex waste streams of any industry: solid waste (trash), biohazards (sharps, red bag wastes), hazardous waste (chemicals, solvents, mercury), recyclables (paper, cardboard, metal, glass, plastic), compostable waste (food and organic wastes), and radioactive waste. Mercury and dioxin, two toxic pollutants, are commonly emitted during the processing of some of these waste products. Mercury pollution can originate in the mercury found in such products as thermometers, Miller-Abbott tubes, fluorescent-light tubes, esophageal dilators, certain batteries, and in hundreds of other products and chemicals. Mercury can be released into the air when wastes are burned or into the water when they’re discarded down the drain. Mercury poses health risks because it bioaccumulates in living tissues and is a neurotoxin and nephrotoxin.

Dioxin has been linked to endometriosis, learning disabilities, endocrine disorders, and cancer; it’s created when PVC (polyvinyl chloride) plastic is manufactured and incinerated. According to the Health Industry Manufacturers Association, PVC is found in 25% of all health care products, including iv bags, iv tubing, blood bags, fluid collection containers, feeding tubes, endotracheal tubes, oxygen tubing, and patient identification bands.

As health professionals working under the edict “First, do no harm,” we should learn as much as possible about these two toxins and their risks. Some ways you can take action include:

  • Find out what happens to your facility’s wastes. Where and how are the wastes treated? Are they incinerated or landfilled? The only types of waste that need to be incinerated to protect public health are pathologic wastes (body parts) and chemotherapy wastes. These usually amount to 1% to 2% of a health care facility’s total waste output.

    Determine the type of waste segregation programs your facility maintains. Ideally, every facility should have separate, convenient containers for collecting wastes that should be kept apart from the general trash or biohazard waste stream, such as batteries, mercury, and recyclables.

    Get an ANA Nurses Pollution Prevention Kit, with dozens of tools and resources to help all nurses, regardless of workplace, to make a difference in the community. The cost is $55.95 to state nurses association members and $79.95 to nonmembers. Call (800) 637-0323 to order.

  • Read the American Hospital Association/Environmental Protection Agency Memorandum of Understanding (AHA/EPA MOU), designed to help facilities prevent the pollution generated by hospital waste disposal (available online at www.aha.org/MemOfUnder.html . If administrators at your workplace aren’t aware of it, you may be doing them a big favor by informing them of this agreement and encouraging them to initiate a program to meet its goals.

    Contact Health Care Without Harm (703) 237-2249), a coalition of more than 180 organizations, including the American Nurses Association, that work collaboratively to advocate “environmentally responsible health care.” The coalition’s predominant goal is to eliminate pollution caused by health care practices without compromising safety or quality of care.

    Share your concerns about toxic pollution with your facility manager, risk manager, ethicist, director of nursing, chief executive officer, and chief financial officer. And read your organization’s mission statement; it’s very likely that contributing to toxic pollution is in opposition to your organization’s mission.

  • Visit the Web site at www.nihe.org, for the Nightingale Institute for Health and the Environment, an organization dedicated to furthering “a greater understanding that human and environmental health are inextricably linked.” The site offers various products, including videos, articles, and books.

We’d all do well to remember the words of Florence Nightingale: “No amount of medical knowledge will lessen the accountability for nurses to do what nurses do, that is, manage the environment to promote positive life processes.”

For information on the ANA’s involvement in issues regarding harm to patients, health care workers, and the public arising from health care practices, visit the “RNnoharm” page.

Hollie Shaner, a member of the Vermont Nurses Association, is president of the Nightingale Institute for Health and the Environment. She works part-time for Fletcher Allen Health Care in Burlington, VT, as the environmental health coordinator in the Department of Community Health Improvement.

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