Health Care Environmental Purchasing Tool Background

In recent years, the release of persistent, bioaccumulative, toxic (PBT) materials into the environment has emerged as a significant environmental problem. The U.S. Environmental Protection Agency has classified more than 50 substances as PBTs. These substances break down very slowly in the environment, accumulate in animal tissues, and have toxic effects. PBTs can enter the environment through combustion processes, wastewater treatment facilities, or leaching from solid waste sites.

Maintaining and improving human and ecosystem health requires the minimization of PBT releases. The Health Care Environmental Purchasing Tool targets the reduction of PBTs from health care facilities, particularly mercury and toxic halogenated compounds.

Mercury
Elemental mercury, such as that from a broken thermometer, can cause damage to the nervous system, kidneys, and lungs. At high levels it can cause fatalitites.

When mercury-containing items are incinerated, the mercury is vaporized, oxidized, and widely distributed through the air in the surrounding community, depositing in small amounts on land and water surfaces. Bacteria, in the presence of sufficient water, convert the deposited oxidized mercury to methyl mercury. Zooplankton consume the methyl mercury, and fish ingest the zooplankton. The mercury compounds accumulate as the fish are eaten by larger fish. The mercury concentration increases up the food chain, resulting in the highest concentration in human tissue.

Methyl mercury is very poisonous to humans. In sufficient amounts, it can lead to neurological disorders and even death. In children and the developing fetus, the effects can be more profound since the developing brain is more vulnerable to toxic substances.

For a detailed, referenced account of the sources and health effects of mercury, click here.

Toxic Halogenated Compounds
Dioxins are a highly toxic class of halogenated compounds. While the term "dioxins" typically refers to the chlorinated species, dioxins can also contain other halogens, including bromine and fluorine. Medical waste incinerators and municipal waste incinerators, which both treat waste from health care facilities, are considered major sources of dioxins.

Dioxin formation is affected by a complex interaction of the material burned, the design of the combustion chamber, and operating conditions. Dioxin can be found in the particulate matter (fly and bottom ash) and in flue gas emissions. Even under optimum operating conditions, dioxins can be formed upon cooling of the combustion gases, particularly within the temperature range of 250-400º C. Thus the incinerator must be equipped with effective pollution control devices. The bottom and fly ash need to be properly contained to prevent further releases of dioxins.

Humans are exposed to dioxins through inhalation of dioxin-contaminated air and, more significantly, through consumption of food that contains high levels of dioxins. Dioxins are lipophilic (fat-loving) and accumulate in meat and dairy products.

In 1997, the International Agency for Research on Cancer (IARC) classified the most toxic dioxin compound as carcinogenic to humans. IARC’s evidence suggests that dioxins promote existing cancers instead of causing cancer directly. Additionally, dioxins have been linked to other adverse health effects in mammals, including immune system dysfunction and reproductive and endocrine system disorders.

For a detailed, referenced account of the sources and health effects of dioxin, click here.

Purchasing Strategies to Reduce PBTs
Purchasing agents and materials managers can adopt several strategies to reduce PBT releases from health care operations and play a role in environmental protection. Health care administrators and environmental managers can also facilitate the implementation of these strategies.

Strategy 1:
Remove as much mercury from medical facilities as possible, by purchasing mercury-free products. Health care products that may contain mercury include thermometers, blood pressure monitoring equipment, batteries, esophageal dilators, liquid reagents, and fluorescent light bulbs.

Strategy 2:
Reduce the amount of disposable products containing halogenated materials such as polyvinyl chloride (PVC) that go to incinerated waste streams. Health care products that may contain PVC include gloves, blood bags, IV bags, tubing, single-dose medication, and suction canisters.

Strategy 3:
Know where your waste goes, how it is treated, and how much this treatment costs. Seek non-burn treatment technologies for biohazardous wastes where appropriate. Eliminate all non-essential incineration of wastes.