Getting chemicals out of health care settings, with a little help
The Hippocratic Oath declares that disease should be prevented whenever possible because prevention is preferable to cure.
Furthering this oath, the Healthier Hospitals Initiative (HHI), a program involving more than 1,300 hospitals and health care centers in the United States and Canada, has developed a safer chemicals program as part of its broader sustainability mission.
U.S. health care spending accounted for nearly 18 percent of GDP in 2014. The health care sector’s immense purchasing power is effectively tipping the marketplace in favor of suppliers adopting safer chemicals policies and practices.
The Healthier Hospitals Initiative, launched in 2012, gives each hospital the tools it needs to meet a series of six challenges. The program has created a platform to help health care organizations bring about widespread, meaningful change — and measure their impact.
Hospitals and health care systems enroll in the program and then make commitments that can drive the institution towards being a safer, healthier setting for patients to recuperate from illness or surgery.
Collaboration is one of the keys to the success of HHI. Once enrolled, participants have access to a suite of tools as well to other stakeholders and thought partners to help them establish targets, gather metrics and ultimately show progress.
Once they join the initiative, hospitals choose from among six challenges:
1. Engaged leadership
2. Healthier food
3. Leaner energy
4. Less waste
5. Safer chemicals
6. Smarter purchasing
Each challenge has two to four areas of focus and HHI provides resources, tips, tools and infographics to help enrolled members as they respond to the challenges.
The Safer Chemicals Challenge
More chemicals are used in health care than in any other sector. Many chemicals used in the health care industry can have a lasting negative effect on individual health, public health and the environment. Harmful chemicals used in some health care products have been linked to a range of health problems.
The Safer Chemicals Challenge asks hospitals to consider four focus areas and four levels of commitment. Level 1 requires commitment to one focus area whereas Level 4 requires commitment to all four focus areas. They are:
1. Green cleaning
Participants agree that at least 90 percent of their cleaning products purchases will be from two specific third party-certified labels, Green Seal or UL Ecologo. The cleaning categories are carpet, window, all purpose, bathroom and general floor care.
2. Bis(2-ethylhexyl) phthalate (DEHP) and polyvinyl chloride (PVC) reduction
DEHP is often added to plastics to make them flexible. PVC is a plastic used in a variety of end products, but both have been identified as potentially toxic if they leach out of plastics.
The challenge is for hospitals or health care systems to eliminate DEHP and PVC from at least two of the following categories: Breast pumps; enteral nutrition products; parenteral infusion devices and sets; general urological instruments; exam gloves; vascular catheters; and nasogastric tubes.
3. Healthy interiors
The challenge is to ensure that 30 percent of a participant's annual volume of purchased furniture does not contain formaldehyde, perfluorinated compounds, polyvinyl chloride, antimicrobials and flame-retardants (where code permits). It applies to all furniture in a hospital room including seating, beds, storage, dressers and drawers.
HHI provides guidance, standards, validation requirements, fact sheets and a list of approved furniture manufacturers that have met these goals.
4. Mercury elimination
The challenge is to achieve mercury-free status, or at least develop and implement a mercury elimination plan.
How are data and information collected and tracked?
Data collection obviously is a critical need in order to affirm that participants are adhering to their commitments. Participants upload self-reported data, not subjected to third-party validation, to the Institute for Healthcare Improvement's extranet. HHI staff review the data to identify any discrepancies or outliers. There is no incentive to falsify data as they are analyzed and presented in aggregate.
Since the start of the HHI, the initiative has grown quickly and provided case studies, best practices, webinars and other ways to communicate to its members. Here are some examples of successes in the Safer Chemicals Challenge.
Dignity Health, the fifth largest health system in the nation and the largest hospital provider in California over a five-year period, successfully removed nearly 1.9 million pounds of PVC material from IV containers.
Spectrum Health, which provides permanent, civilian-contracted medical professionals to U.S. Military Treatment Facilities, Veteran Affairs clinics and other federal government agencies transitioned to environmentally preferred cleaners. The outcome was a healthier work environment for staff, a healthier recovery environment for patients and reduced overall cleaning costs.
Beaumont Health System, a regional healthcare provider that currently operates three facilities with a combined 1,728 beds, met the Healthy Interiors challenge by avoiding the chemicals of concern in 26 percent of its annual furnishings spend, thus meeting the HHI challenge. Through a rigorous evaluation of its purchasing patterns, Beaumont was able to identify desk chairs as what it purchased in the largest volume. Beaumont identified a chair that did not contain halogenated flame-retardants, perfluorinated chemicals and PVC and therefore met the challenge requirements with a nominal cost increase.
Suppliers to the health care industry who rise to the challenge of meeting HHI’s precautionary approach to disease prevention are positioned to take advantage of related markets for safer chemicals in other sectors. Suppliers of chemically safer products can benefit from surging interest in real estate, hospitality and additional such markets.