Many hospitals in the US are embracing the green movement, writes Lindsay Minnema
TOSSING OUT everything from plastic bandages and cotton swabs to hospital robes after a single use, the US medical industry generates more than two million tonnes 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 which is charged with protecting health is releasing substances that may be tied to cancer, diabetes and other illnesses? Many healthcare 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," says Barbara Sattler, director of the Environmental Health Education Centre at the University of Maryland School of Nursing.
Many US hospitals are seeking ways to make their daily operations more environmentally friendly. More than one-quarter have joined Hospitals for a Healthy Environment (or H2E, as it styles itself), a government-supported movement to minimise 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," says Cindy Kilgore, assistant vice-president of materials management at Inova Fairfax Hospital in Northern Virginia.
Still Inova has come up with some cost-saving answers. After its five hospitals completed energy audits recently, they turned off the lights in their vending machines. Kilgore says that simple change will save about $15,000 a year.
More changes will come once Inova has had a chance to analyse the audit's findings, she says. Inova is also exploring the feasibility of a system that would shut down non-essential computers each night. And before the summer landscaping season ends, 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 bigger challenge. The biggest problem is limiting toxins, such as mercury, that are released to the environment during disposal. Mercury "is leaching into the environment and we're ingesting some of that through fish and seafood," says 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.
Sattler says that 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 US, says Stacy Malkan, a steering committee member of Health Care Without Harm, an international coalition working to reduce medical industry pollution. Today, there are fewer than 100.
For many hospitals, autoclaving, or steam sterilisation, has proved to be a good alternative: The waste is steam-sterilised, compressed, then sent to landfills.
But to be really effective, the effort to minimise the environmental impact of medical waste has to start with smart purchasing practices, Kilgore says.
Thanks to advances in product development and manufacturing, "there are many kinds of cleaners, pesticides, non-toxic chemicals on the market today that meet medical standards", says Anna Gilmore Hall, executive director of Health Care Without Harm.
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 US 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", says Niyati Desai, associate director of the Teleosis Institute, a California-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, Desai says.
"Sustainable medicine is about prevention, precaution and using the most invasive procedures only when necessary."