Maine Hospitals for a Healthy Environment
Maine Department of Environmental Protection
and
Maine Hospital Association
Pollution Prevention Agreement
The Maine Department of Environmental Protection (ME DEP) agrees to the following:
To provide technical assistance at a multi media (air, land and water) level to assist Maine Hospital Association (MHA) members in achieving the virtual elimination of mercury and the continuous reduction of other toxic materials, including but not limited to, Chlorinated compounds including Dioxin and Furan precursors, and Persistent Bioaccumulative Toxins (PBT's), from all sources within their facilities in a comprehensive program to reduce both the toxicity and volume of wastes generated by their operations.
The MHA agrees to the following:
To solicit commitments from the member hospitals to: (1) survey their facility to identify the sources and location of toxic materials, including the ones described above, that are found within their facilities; (2) develop a 'statement of conditions' that will plan for and begin the replacement, removal and/or substitution of environmentally safe alternatives as part of a comprehensive program, mutually agreed upon by all parties, to reduce both the toxicity and volume of wastes generated by their operations; and, (3) organize a statewide mercury thermometer exchange program. The 'statement of conditions' is a document that establishes baseline conditions, constitutes a pollution prevention plan and sets a timetable for meeting pollution prevention goals and objectives and correcting any problems including funding and other resources needed for that correction.
The Member Hospitals of the MHA agree to the following:
To, within three months of the date of this document, sign the attached Maine Hospitals for a Healthy Environment Pollution Prevention Agreement.
The organization Health Care Without Harm agrees to the following:
To provide technical assistance including participation, information and resource contacts to help hospitals meet their commitments to replace, remove and/or substitute environmentally safe alternative equipment and supplies as part of a comprehensive program to reduce both the toxicity and volume of wastes generated by their operations. The organization Natural Resources Council of Maine has been authorized to represent the interests of Health Care Without Harm through this agreement.
Plan Development and Implementation
Environmentally Preferable Purchasing (EPP)
The member hospitals of the MHA agree to the following:
To survey their facility to identify products and materials used within their facility, with initial emphasis on mercury, chlorine containing compounds including dioxin compounds and their precursors and Persistent Bioaccumulative Toxins (PBT's) that can be safely replaced with another product or material that is more environmentally preferable by a date specified in the Hospital's Pollution Prevention Plan;
To design and begin implementation of a purchasing program that favors the purchase of Environmentally Preferred Products used within the facility by a date specified in the Hospital's Pollution Prevention Plan;
To document and track the substitution of products or materials purchased through the implemented environmentally preferred by a date specified in the Hospital's Pollution Prevention Plan;
Solid Waste Volume and/or Toxicity Reduction
The member hospitals of the MHA agree to the following:
To survey their facility to identify major or significant sources and activities that result in the generation of solid wastes and address those sources or activities that could be altered or changed in such a way as to reduce the volume and/or toxicity of that waste or to design a program that will allow the separation and recycling of those materials as part of the Site Assessment phase outlined in the Pollution Prevention Agreement.
To begin implementation of actions, including the expansion of recycling efforts, that will lead to the reduction in the volume and/or toxicity of solid wastes generated within the facility by a date specified in the Hospital's Pollution Prevention Plan;
Mercury
Definitions:
Mercury added products are those products, like fluorescent light bulbs, to which mercury is added for its physical or chemical properties. Mercury-added products should be recycled when removed from service or inventory and some are prohibited from disposal into solid waste intended for a solid waste facility. These requirements are further delineated in 38 MRSA § 1662 et al.
Mercury formulated products are those products, like certain chemical reagents, which contain mercury as part of the chemical formulation of the product, whether the mercury is purposefully added or is introduced inadvertently as a contaminant of another ingredient.
The member hospitals of the MHA agree to the following:
To survey their facility to identify potential sources of mercury in their facilities including, but not limited to: medical devices; reagents and chemicals; light bulbs; electrical switches; batteries; and other possible mercury added and mercury formulated products within six months of signing the Pollution Prevention Agreement. {A list of mercury added and mercury formulated products is attached in Appendix 1}
To design and begin implementation of a purchasing program that eliminates the use of mercury added and mercury formulated products, including but not limited to laboratory reagents and pharmaceuticals, wherever possible by substituting mercury free products, by a date specified in the Hospital's Pollution Prevention Plan;
To ensure that where a hospital provides fever thermometers to discharged patients, that all those thermometers are mercury free; replace mercury thermometers used within the hospital with mercury free alternatives; collectively organize and participate in mercury fever thermometer exchange programs; and, recycle the collected mercury thermometers;
To replace mercury added and mercury formulated diagnostic and treatment equipment, such as sphygmomanometers and gastrointestinal tubes, with mercury free alternatives by a date specified in the Hospital's Pollution Prevention Plan;
To recycle fluorescent lighting and to use low mercury added bulbs as existing inventories are replaced;
To replace mercury added and mercury formulated batteries with mercury free alternatives by a date specified in the Hospital's Pollution Prevention Plan,
and recycle the mercury added and mercury formulated batteries that are collected;
To replace mercury added switches, thermostats, and industrial thermometers with mercury free alternatives as soon as reasonable and at any the time that they fail or are included in a remodeling project, and recycle the devices collected;
To institute a staff training program aimed at enabling all affected staff to identify all mercury added and mercury formulated materials and products to facilitate the segregation of all mercury added and mercury formulated wastes such that all other waste streams, including wastewater, emanating from the hospital, are mercury free by a date specified in the Hospital's Pollution Prevention Plan;
To replace mercury added and mercury formulated cleaners and degreasers with mercury free alternatives by a date specified in the Hospital's Pollution Prevention Plan;
To be sure that contingency plans are in place to abate any mercury spills that may occur at the facility by a date specified in the Hospital's Pollution Prevention Plan;
To clean laboratory drains of accumulated mercury waste materials. This action should begin after mercury free reagents have replaced mercury added and mercury formulated products, such as reagents, by a date specified in the Hospital's Pollution Prevention Plan;
Chlorinated Compounds including precursors to Dioxins and Furans
Chlorine and compounds containing chlorine (including hypochlorite {bleach} and hypochlorous acid are often used in cleaning agents because of their disinfecting qualities. Chlorine and chlorinated compounds are toxic to many organisms and, at certain levels, to humans. Chlorine and its compounds may also react chemically with other materials to create new compounds that are carcinogenic or mutagenic.
Dioxins and furans ("Dioxin compounds") are a class of persistent, bioaccumulative and highly toxic chemicals (PBTs) that are formed as byproducts when chlorine-containing materials are subject to accidental fires, waste incineration or other reactive environments. Chlorine-containing materials that are precursors to dioxin formation include polyvinyl chloride plastic (PVC or vinyl), chlorinated solvents, sodium hypochlorite (bleach) or other chlorine-containing chemicals or materials.
The member hospitals of the MHA agree to the following:
A goal is established to continuously reduce the use and disposal of PVC plastic in hospitals.
Steps to be taken toward achievement of this goal will include:
-
Establish a written hospital-wide PVC reduction policy.
-
Assess the current use of PVC-containing materials and products, including purchasing, inventory, existing use and disposal in medical and solid waste. As appropriate, request that vendors and suppliers disclose the PVC content and DEHP content of products.
-
Place highest priority on reducing PVC use in disposable healthcare products and office products. Departments that are the highest priority include maternity, NICUs (neonatal intensive care units) and pediatrics.
-
Consider longer term replacement of PVC in durable medical products, construction materials and furniture when opportunities present themselves.
-
Hold meetings with current Group Purchasing Organizations (GPOs) and manufacturers to evaluate the efficacy and availability of PVC-free alternative products under existing contracts.
-
When current GPO contracts expire, negotiate for reduced purchase of PVC-based products.
-
Report annually to the Maine Hospitals for a Healthy Environment partnership on progress achieved in reducing the use and disposal of PVC-based products
Steps to be take to reduce the use of other chlorinated compounds will include:
-
Phase out the use and purchase of chlorinated solvents or products containing chlorinated solvents by a date specified in the Hospital's Pollution Prevention Plan;
-
Establish goals to reduce the use of sodium hypochlorite bleach in favor of non-chlorinated bleaches with effective cleaning and disinfection properties by a date specified in the Hospital's Pollution Prevention Plan;
-
Annually increase the proportion of paper products purchased that were processed chlorine free (PCF) or were made totally chlorine free (TCF) or are unbleached by a date specified in the Hospital's Pollution Prevention Plan;
-
Inventory the use and purchase of other materials and products that contain chlorine and to develop plans, goals and timetables to reduce reliance on such products and materials
Persistent Bioaccumulative Toxins (PBTs)
Definitions:
Persistent Chemicals: do not readily break down in the environment. Depending on the properties of these chemicals, they may be transferred among air, water, soils, and sediments.
Bioaccumulative Chemicals: concentrate in animal and plant tissues as a result of uptake from the surrounding environment (e.g. from water, air), or as a result of one organism consuming another that's lower on the food chain (i.e. gets passed from one organism to another)
Toxic Chemicals: are hazardous to human health and the environment. In certain forms, PBT chemicals may cause adverse effects, such as cancer, birth defects, and declines in specie populations.
The member hospitals of the MHA agree to the following:
To recognize that Persistent Bioaccumulative Toxins (PBTs) {see list in Appendix 2} are present in materials used in their facilities in items including but not limited to: medical devices; reagents and chemicals; light bulbs; batteries; and other products;
To recognize that the United States Environmental Protection Agency is continually updating and adding to the list of Persistent Bioaccumulative Toxins; and,
To recognize that reduction or elimination of the use of products containing Persistent Bioaccumulative Toxins may be required in the future.
Approved By:
_________________________________
Steven R. Michaud, President
Maine Hospitals Association
|
____________________________
Date of Approval |
|
|
_________________________________
Martha Kirkpatrick , Commissioner
Department of Environmental Protection |
____________________________
Date of Approval |
|
|
_________________________________
Everett B. Carson, Executive Director
Natural Resources Council of Maine for
Health Care Without Harm |
____________________________
Date of Approval |
Appendix 1 - Instruments, Products, and Laboratory Chemicals, Used in Hospitals, That May Contain Mercury
Instruments and Products that may contain mercury
(This list should not be assumed to be complete.)
Thermometers
Body temperature thermometers
Clerget sugar test thermometers
Heating and cooling system thermometers
Incubator/water bath thermometers
Minimum/maximum thermometers
National Institute of Standards and Technology calibration thermometers
Tapered bulb (armored) thermometers
Sphygmomanometers
Gastrointestinal tubes
Cantor tubes
Esophageal dilators (bougie tubes)
Feeding tubes
Miller Abbott tubes
Dental amalgam
Pharmaceutical supplies
Contact lens solutions and other ophthalmic products containing thimerosal, phenylmercuric nitrate
Diuretics with mersalyl and mercury salts
Early pregnancy test kits with mercury-containing preservative
Merbromin/water solution
Nasal spray with thimerosal, phenylmercuric acetate or phenylmercuric nitrate
Vaccines with thimerosal (primarily in hemophilus, hepatitis, rabies, tetanus, influenza, diphtheria and pertussis vaccines)
Cleaners and degreasers with mercury-contaminated caustic soda or chlorine
Batteries (medical use)
Alarms
Blood analyzers
Defibrillators
Hearing aids
Meters
Monitors
Pacemakers
Pumps
Scales
Telemetry transmitters
Ultrasound
Ventilators
Batteries (non-medical uses)
Lamps
Fluorescent
Germicidal
High-intensity discharge (high pressure sodium, mercury vapor, metal halide)
Ultraviolet
Electrical equipment
Tilt switches
Air flow/fan limit control
Building security systems
Chest freezer lids
Fire alarm box switches
Lap-top computer screen shut-off
Pressure control (mounted on bourdon tube or diaphragm)
Silent light switches (single-pole and three-way)
Temperature control (mounted on bimetal coil or attached to bulb device)
Washing machine (power shut off)
Float control
Septic tanks
Sump pumps
Thermostats (non-digital)
Thermostat probes in electrical equipment
Reed relays (low voltage, high precision analytical equipment)
Plunger or displacement relays (high current/high voltage applications)
Thermostat probes in gas appliances (flame sensors, gas safety valves)
Pressure gauges
Barometers
Manometers
Vacuum gauges
Other
Devices, such as personal computers, that utilize a printed wire board
Blood gas analyzer reference electrode (Radiometer brand)
Cathode-ray oscilloscope
DC watt hour meters (Duncan)
Electron microscope (mercury may be used as a damper)
Flow meters
Generators
Hitachi Chem Analyzer reagent
Lead analyzer electrode (ESA model 3010B)
Sequential Multi-Channel Autoanalyzer (SMCA) AU 2000
Vibration meters
Laboratory Chemicals That May Contain Mercury (Compiled in 1997)
This list is intended to demonstrate the wide variety of laboratory chemicals that may contain mercury. It was derived from examining the Massachusetts Water Resources Authority Mercury Source Identification Program Database.
Some of the chemicals may contain added mercury and others may contain mercury as a contaminant in a feedstock. If the mercury is a contaminant, its presence or absence may vary from lot to lot. In the case of kits, it is necessary to consider separately each of the reagents that make up the kit.
This list should not be assumed to be complete. Request that vendors disclose mercury concentration on a Certificate of Analysis for all chemicals ordered.
Acetic acid
Ammonium reagent/Stone analysis kit
Antibody test kits
Antigens
Antiserums
Buffers
Calibration kits
Calibrators
Chloride
Diluents
Enzyme Immunoassay test kits
Enzyme tracers
Ethanol
Extraction enzymes
Fixatives
Hematology reagents
Hormones
Immunoelectrophoresis reagents
Immunofixationphoresis reagents
|
Immu-sal
Liquid substrate con
Negative control kits
Phenobarbital reagent
Phenytoin reagent
Positive control kits
Potassium hydroxide
Pregnancy test kits
Rabbit serum
Shigella bacteria
Sodium hypochlorite
Stains
Standards
Sulfuric acid
Thimerosal
Tracer kits
Urine analysis reagents
Wash solutions |
Appendix 2 - Persistent Bioaccumulative Toxins (PBTs)
The U.S. Environmental Protection Agency currently lists the following as Persistent Bioaccumulative Toxins.
DIOXINs and FURANs *
PCBs
Chlorinated Solvents:
Chloroform
1,1-Dichloroethane
1,1,1-Trichloroethane
Chlorobenzenes:
1,2-Dichlorobenzene
1,3-Dichlorobenzene
1,4-Dichlorobenzene
1,2,4-Trichlorobenzene
1,2,4,5-Tetrachlorobenzene
Pentachlorobenzene
HEXACHLOROBENZENE *
Other Halogenated Organics:
4-Bromophenyl phenyl ether
Hexachlorobutadiene
OCTACHLOROSTYRENE *
Pesticides:
alpha-Endosulfan
beta-Endosulfan
ALDRIN / DIELDRIN
CHLORDANE
DDT / DDP / DDE
Heptachlor
Heptachlor epoxide
gamma-Hexachlorocyclohexane
Methoxychlor
MIREX
Pentachloronitrobenzene
Pentachlorophenol
TOXAPHENE
2,4,5-Trichlorophenol
Organonitrogens:
Nitrobenzene
|
Nonhalogenated Phenolics:
Phenol
2,4,6-tris-(1,1-Dimethylethyl) phenol
Phthalate esters:
Bis(2-ethylhexyl) phthalate (DEHP)
Butylbenzyl phthlate
Dibutyl phthlate
Polycyclic aromatic hydrocarbons:
Acenaphthene
Acenapthylene
Anthracene
BENZO(A)PYRENE
Benzo(g,h,l)perylene
Fluoranthene
2-Methylnaphthalene
Naphthalene
Other polycyclic aromatic hydrocarbons
Phananthrene
Pyrene
Metals:
Antimony
Arsenic
Beryllium
Cadmium
Chromium
Copper
Lead (ALKYL-LEAD) *
MERCURY (AND ITS COMPOUNDS) *
Nickel
Selenium
Zinc
Cyanide
|
Capitalized, boldface chemicals are priority PBTs identified in EPA's Agency-wide Multimedia Strategy for Priority Persistent, Bioaccumulative, and Toxic (PBT) Pollutants (PBT Strategy), November 16, 1998. The other chemicals are from the US EPA's draft list of RCRA PBT chemicals proposed in the Federal Register Notice dated November 9, 1998. Chemicals on both lists indicated with an asterisk (*). More information is available at http://www.epa.gov/pbt/
