Pollution Prevention—Occupational Safety and Health in Hospitals: Alternatives and Interventions

An integrated pollution prevention (P²) and occupational safety and health (OSH) worksite intervention and alternatives assessment strategy was developed in hospitals. It was called the Pollution Prevention-Occupational Safety and Health (P²OSH) assessment for the “Sustainable Hospitals Project.” Methods included (a) developing a participatory intervention model for introducing more environmentally sound, healthy, and safe materials and work practices for specific hospital procedures; (b) developing an integrated P²OSH survey to evaluate environmental and occupational impacts of the intervention; and (c) conducting and evaluating interventions by applying the P²OSH assessment pre- and post-intervention. Eleven interventions were performed in six hospitals: an aliphatic fixative replaced xylene in three histology laboratories; a mercury reduction plan was implemented in three clinical laboratories; digital imaging replaced wet chemical film processing in three radiology departments; a less toxic aldehyde replaced formaldehyde in one hospital histopathology laboratory; and conventional mopping was replaced by microfiber mopping in one hospital. Occupational and environmental health and safety impacts were observed for all interventions. The alternatives generally were beneficial, although each had limitations that resulted in process and task changes with potentially negative P² and/or OSH impacts. When these were identified in the pilot phase they could be addressed before full-scale implementation. The P²OSH method shifts the focus of occupational and environmental hygiene from hazard control to substitution. Because few ideal alternatives exist, the emphasis is on a continuous process to identify, implement, and evaluate alternatives, rather than on a particular alternative. Occupational and environmental health and safety professionals have an important role as agents in hospital organizational change and in the search for healthier and safer alternatives. Through these activities they can become involved in the design/redesign of products, materials, and processes, thus expanding their traditional role.

Keywords:

• alternatives assessment
• hospital pollution prevention
• occupational health in hospitals
• substitution
• worksite interventions

ACKNOWLEDGMENTS

We wish to thank the following for contributions to the field work: Howard Herman-Haase, Jamie Tessler, Mary Sabolefski, Lin Li, Ilir Agalliu, and Hany Mohammed Idreis.

We are grateful to the following for providing professional consultation related to best practices and materials management in hospitals: Janet Clark and Elizabeth Harriman, Massachusetts Toxics Use Reduction Institute (TURI); Cathy Crumbley, Lowell Center for Sustainable Production; Kay Doyle, Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell; Martin Levin, environmental lawyer; Debra Steward, Clinical Laboratory Services, Mount Auburn Hospital; Elizabeth Gross; Environmental Health and Safety, Dana-Farber Cancer Institute; and Peg McClory, Materials Management, Saints Memorial Medical Center.

This study was funded by a National Institute for Occupational Safety and Health grant 5 R01 0H03744 as part of the National Occupational Research Agenda (NORA) and by U.S. Environmental Protection Agency Region I Assistance Agreement number X9-98176701-0.

Notes

^A P2/FINANCE (Pollution Prevention Financial Analysis and Cost Evaluation system) developed for the U.S. EPA. Copyright 1996, Tellus Institute, Boston.

^A Hospital demographics: 1-urban, small, private; 2-suburban, large, public; 3-urban, medium, private teaching; 4-urban, very large, private teaching; 5-urban, large, private teaching; 6-suburban, medium, public.