Description
LPH is a 731-bed hospital that incinerates its medical waste onsite. The facility has an Environmental Stewardship Committee, which includes representatives from the purchasing department. The facility promotes waste reduction and recycling through training, a newsletter, and employee discounts. The use of mercury-containing thermometers has been drastically reduced, mercury-containing gastrointestinal equipment has been eliminated, and mercuric oxide batteries have been eliminated.

Purchasing Practices
LPH uses a Group Purchasing Organization (GPO) to purchase its products. Department directors and standardization committees are responsible for product selection decisions. An Environmental Committee also has influence on this decision.

HCEPT Implementation
The facility selected six products to analyze using the tool (see Table 1). One GPO was selected for three products and three suppliers were selected for one product apiece. A total of six product inquiries were made from four suppliers. Although two products (formalin and media powder) were selected for substances of concern that were not addressed by the Product section of the HCEPT questionnaire, the tool questionnaire was not modified to reflect these concerns.

Product	Substance of Concern
Chest drainage unit	PVC
Formalin	Formaldehyde
Media powder	Sodium azide
Oral thermometer	Mercury
SCD sleeves	PVC
Tri-chrome stain	Chromium

Table 1: Selected products for LPH in HCEPT study.

Supplier Response
Three of the suppliers responded to LPH’s inquiries. The Environmental Scores for formalin, media powder, and sequential compression device (SCD) sleeves ranged from 0.5 to 9. The supplier of SCD sleeves noted on its Alternative Product List that they offered SCD sleeves with lower PVC content.

LPH received a response from the manufacturer of tri-chrome stain they selected for the study. The manufacturer examined all of the products that LPH had ordered from the manufacturer through their GPO and noted that one of the products, PVA fixative, "meets the criteria of this questionnaire … This product is a mercuric chloride heavy metal fixative, and is exactly the type of product that the AHA/EPA – MOU document is targeting." The manufacturer informed the GPO that they offer a fixative that does not contain heavy metals and encouraged the GPO to relay this information to LPH, "advising them on issuing another survey for the PVA fixative."

LPH also received complaints from their suppliers about time requirements and a lack of firm answers (since products are always changing content). Suppliers said that responding to the hospital’s request was "a lot of work," and that they had to refer to other people and "scramble to get answers."

Impact of HCEPT on Facility
The HCEPT information was relayed to the Environmental Stewardship Committee, and to Nursing. LPH continues to evaluate the use of SCD sleeves with lower PVC content. The HCEPT project may affect the PVC content of 180 SCD sleeves per month, at a site that incinerates its medical waste. They have also eliminated mercury thermometers. Their average usage rate is about 20 thermometers per month. Assuming each thermometer contains 0.7 grams of mercury, a reduction of 14 grams per month will be realized.