Correction to This Article
This article incorrectly associated Stacy Malkan with H2E. She is a steering committee member of Health Care Without Harm.
Medicine Gears Up for a Code Green
Doctors, Hospitals Put Environment On Their Charts

By Lindsay Minnema
Washington Post Staff Writer
Tuesday, July 22, 2008

Tossing out everything from plastic bandages and cotton swabs to hospital robes after a single use, the U.S. medical industry generates more than 2 million tons of waste per year, environmental advocates say. Some of that waste makes its way to incinerators and, when burned, releases dioxin, mercury and other toxins.

Is it ironic that the industry we trust to protect our health is releasing substances that may be tied to cancer, diabetes and other illnesses? Many health-care professionals think so.

In recent years, some have begun to think greener. Most efforts focus on reducing toxic waste from hospitals and medical offices as well as cutting back on water and energy use. But some doctors and health workers are also considering changes in their practices that could enhance environmental and patient health.

"There is an understanding between and among health professionals that the environment is playing a really important part in our health status," said Barbara Sattler, director of the Environmental Health Education Center at the University of Maryland School of Nursing. In fact, she added, many of the industry's most wasteful habits, including those made in the name of hygiene and sterility, "may be creating avenues for disease."

Many U.S. hospitals are seeking ways to make their daily operations more environmentally friendly. More than a fourth have joined Hospitals for a Healthy Environment (or H2E, as it styles itself), a government-supported movement to minimize medicine's environmental footprint.

But getting hospitals to curb resource consumption on a large scale can be tough, given their need to operate 24 hours a day.

"There are major parts of the building that never shut down," said Cindy Kilgore, assistant vice president of materials management at Inova Fairfax Hospital. "We have to have a certain airflow, have to stay at a certain temperature, so there are unique things that make [cutting energy use] more complicated."

Still, Inova has come up with some cost-saving answers. After its five hospitals completed energy audits last month, they turned off the lights in their vending machines. Kilgore said that simple change will save about $15,000 a year. More changes will come once Inova has had a chance to analyze the audit's findings, she said.

Inova is also exploring the feasibility of a system that would shut down nonessential computers each night. And before the summer landscaping season ends, Kilgore said, Inova Fairfax hopes to use leftover oil from its cafeteria fryers to make biodiesel for its lawn mowers.

Reducing the environmental impact of medical waste is a tougher challenge. The biggest problem: limiting toxins, such as mercury, that are released into the environment during disposal.

Mercury "is leaching into the environment, and we're ingesting some of that through fish and seafood," said Ravindra Gupta, an internist at Inova Fairfax and co-chairman of the Going Green Committee for the Inova Health System.

Hospitals throughout the country have responded in the past decade by eliminating mercury from many of their supplies, including thermometers and blood pressure cuffs.

"Now it would be hard to find a hospital anywhere using mercury thermometers," Sattler said. "We were also able to get them out of retail drugstores."

Sattler said environmental health groups have also been working with medical manufacturers to limit polyvinyl chloride, a flexible plastic commonly used in IV and surgical tubing. Burning PVC releases toxic dioxins into the air.

In the mid-1990s, there were more than 5,000 medical waste incinerators in the United States, said Stacy Malkan, a steering committee member of H2E. Today, there are fewer than 100.

"But we'd like to see the end of all medical waste incineration," Malkan said.

For many hospitals, autoclaving, or steam sterilization, has proved to be a good alternative: The waste is steam-sterilized, compressed, then sent to landfills.

But to be really effective, the effort to minimize the environmental impact of medical waste has to start with smart purchasing practices, Kilgore said.

"We are looking at what we're buying and changing over [to greener products] because that sends a message to manufacturers that this is what is important to us," Kilgore said. "We make sure we're dealing only with manufacturers that are as concerned about the environment as we are."

Thanks to advances in product development and manufacturing, "there are many kinds of cleaners, pesticides, nontoxic chemicals on the market today that meet medical standards," said Anna Gilmore Hall, executive director of Health Care Without Harm, an international coalition working to reduce medical industry pollution. "Infection control, for example, is just as effective with green cleaners as it is when you use Clorox."

On the construction side, there has been progress in establishing medically appropriate green standards. The Green Guide for Healthcare, released in 2004 by a coalition of environmental and medical advocacy groups, was the first to offer hospitals guidelines for building green facilities. And sometime next year the U.S. Green Building Council, which sets green construction standards for a range of industries, plans to issue some specific to the medical profession, known as the LEED for Healthcare rating system.

Of all medical green efforts, "the greening of the built environment is what has really taken off," said Niyati Desai, associate director of the Teleosis Institute, a Berkley, Calif.-based environmental outreach group that offers classes on green practices to medical professionals. "It's a strategy that doesn't involve changing care. It involves changing light bulbs and changing paint and changing material."

But for Teleosis and a still small group of medical professionals, green medicine can be even more.

"It goes beyond what light bulb you're using to how do we make our care more sustainable?" Desai said. "Sustainable medicine is about prevention, precaution and using the most invasive procedures only when necessary."

Teleosis warns against over-prescribing medications, which Desai said presents a pollution hazard because unused pharmaceuticals often find their way back into the environment.

"If everyone who comes in gets prescribed pharmaceuticals or is admitted for surgery, that is more invasive on the environment," she said. "How do we step back and reduce that reliance?"

"Going green is not just about recycling," Gupta said. "It's more a change in the way we work. It's a change in our environment. For example, one of the big pushes in new construction is to have more daylight in the [hospital] rooms . . . to help patients feel more at peace, so they require less medication for sedation."

Some medical practitioners are catching this green spirit, promoting their practices as environmentally friendly.

Christopher Warner, a gynecologic laser surgeon and obstetrician, advertises a Georgetown office that he says is entirely free of toxins, down to the paint on the walls.

"Everything in the space is recycled," said his wife, Sharon Warner, who manages the practice, called the Washington Wellness Institute. Everything (even the carpet and wall panels) is made of natural and recycled materials.

Glass walls throughout the office allow sunlight to illuminate the space, and motion sensors in most rooms turn off the lights when people leave. The Warners use washable hemp gowns instead of disposable paper ones and are in the process of entering all patient records into an electronic, or paper-free, system.

"All the things we tell our kids to do -- turn out the lights, close the door -- our office does it for us automatically," Christopher Warner said. "Coming into the office, the air just feels that much cleaner; the environment is less toxic."

Hall expects more efforts to grab patients' attention in the months and years to come, adding that although the industry has made improvements, there is still a long way to go.

"We can do things differently -- limit exposure to toxic chemicals in hospitals, limit the things that have mercury so patients aren't exposed to them," she said. "And there are a lot of teachable moments in the hospital. It's a good opportunity to . . . make sure we are role-modeling healthy living."

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