Identification and Control of Hospital Effluents

There are significant environmental health concerns within health-care facilities including chemical, biological and waste effluents. Due diligence requires that these effluents be identified, evaluated and mitigated in a pro-active manner through avoidance, elimination or control. Unfortunately, few facilities appear to be demonstrating due diligence across the board for various reasons. Therefore there is an opportunity for pro-active facilities to take the lead.

In regard to the facilities themselves, both professionals and the public are increasingly aware that there are new risks involved in designing and operating successful health-care facilities. New and resurgent diseases are not the only concern; health-care facilities can be major emitters of a wide range of substances with negative health and environmental consequences. These substances of concern can be divided by major category including chemical, radiological and biological; by major pathways including surfaces, people, water, air, and food; and by operation including health services, building operations, outsourcing and procurement.

The first opportunity to mitigate these risks occurs at the point of procurement.

It is the responsibility of everyone along the supply chain to ask for evidence of environmental appropriateness. This responsibility cannot be assigned to one person. If outsourcing is involved the facility must still ensure that the same level of scrutiny is exercised. It is difficult to know what questions to ask and what standards to apply therefore tools and standards have been developed to assist with the process.

Environmental decision making tools include assessment protocols, services and labeling programs. Some of these tools such as Material Safety Data Sheets (MSDS) and EcoLogo labels are familiar while others such as American Society of Testing and Materials (ASTM) chamber tests are not. Evaluating and managing the application of these tools is complex and should be done in consultation with experts who are specialists in the field. There are substantial opportunities to improve procurement practices.

Another major opportunity to mitigate risks occurs at the point of use. Health-care facilities require various levels of environmental control related to functions ranging from office space to operating rooms. Environmental control in many spaces is substantially below where it could be given our current knowledge and experience base. Therefore there is ample room for a facility to demonstrate or prove that a pro-active or reactive stance has been taken with regard to due diligence and liability. There are many critical building and operations related problems, which may compromise human and environmental health. Many of these problems are not included in standard protocols or training and development programs and therefore staff cannot effectively apply appropriate strategies without training, direction, assistance and quality assurance.

There are many examples of issues, which are of significant concern, but are not typically on the radar screen of busy health-care professionals in most facilities. For instance there will be inadequately heated or standing water in some sections of pipe, heaters and other water system equipment, which can become contaminated and rejoin flowing water. Good examples include orphaned sections of pipe that have been capped off but are still connected to the main plumbing system and domestic hot water tanks that are on duty cycles or are not frequently flushed. This can lead to health concerns including bacterial infections when the contaminated water rejoins the domestic supply.

Concern is also triggered by the fact that few institutions are aware of the chemicals being used by cleaning and maintenance staff, or of the chemical effluent profiles of many of the operations and health-care materials they procure. For example fuels, pesticides and solvents can be found in most facilities, often in out-of-compliance quantities, containers and storage facilities. Most facilities have paints and cleaning chemicals stored in unlocked and often non-vented custodial cupboards.

Waste streams represent another major category of concern. While tools exist which can assist organizations in management of wastes, few institutions can state or certify what the environmental impacts are from their in-house and outsourced waste management programs. For instance, very few health-care facilities have engaged in third party programs such as International Standards Organization verification (ISO 14000) to ensure that environmental issues are being dealt with in an accepted and standardized approach. Planetree, the healthy hospital organization provides another avenue for addressing appropriate operations. Overall few institutions can demonstrate due diligence regarding environmental procurement, operations and waste management at a level that is commensurate with what readily available tools would allow, therefore there is significant room for improvement and therefore for significant reductions in health and environmental impacts and liability.

What can be done in a cost-effective and expeditious manner to address these issues given the financial realities of the health-care sector? It is important to understand that pro-active facilities significantly reduce both costs and liabilities while improving productivity and patient outcomes by applying appropriate environmental strategies. It is important to recognize that these issues and related responsibilities and liabilities are significant and growing, and therefore that senior responsibility must be clearly defined, empowered and directed. A facility and operations assessment should be undertaken and a strategic plan drawn up followed by implementation and quality assurance. These activities can be staged if necessary but should be integrated, cross-disciplinary, strategic and should preferably be executed under the direction of an appropriate consultant and program.