Nurses No Harm

Faye V. FerrerCoordinator, Global Green and Healthy Hospitals

Health Care Without Harm – Asia

PHICNA Convention, 17 May 2017

• Nurses have long appreciated that a healthy environment impacts upon the health of individuals, families, communities and populations

• This understanding is an essential underpinning of nursing practice

“No amount of medical knowledge will lessen the accountability for nurses to do what nurses do, that is, manage the environment to promote positive life processes.”

• Published 1995: Pope, Snyder, Mood.

• General environmental health competencies for nurses

– Basic knowledge & concepts

– Assess and refer

– Advocacy, ethics, and risk

– Legislation & regulation

Definition of Environmental Health

Freedom from illness on injury related to exposure to toxic agents and other environmental conditions that are detrimental to human health

Source: Institute of Medicine (1995): Nursing, Health and the Environment

The Environmental Crisis is Global

Environmental Factors = ¼ of global burden of disease (GBD) – WHO, 2006

Pruess-Ustun et al.

Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease

www.who.int/quantifying_ehimpacts/publications/preventingdisease/en/

Environmental factors cause over 25% of global burden of disease– important determinants for the largest diseases

Communicable

Diseases

Noncommunicable

Diseases & Injuries

Share of burden of disease

Lead-caused MMR

Cancers

Road traffic injuries

Chronic respiratory diseases (COPD, asthma etc)

Cardiovascular diseases (IHD, CVD etc)

Other unintentional injuries (excl. road traffic)

HIV/AIDS

Childhood cluster

Perinatal conditions

Malaria

Respiratory infections

Diarrhoea

Source: WHO Burden of Disease statistics

Environmental Fraction Total

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%

Share of burden of disease

Lead-caused MMR

Cancers

Road traffic injuries

Chronic respiratory diseases (COPD, asthma etc)

Cardiovascular diseases (IHD, CVD etc)

Other unintentional injuries (excl. road traffic)

HIV/AIDS

Childhood cluster

Perinatal conditions

Malaria

Respiratory infections

Diarrhoea

Source: WHO Burden of Disease statistics

Environmental Fraction Total

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%

GBD Air Pollution: WHO reported that in 2012 around 7 million people died - one in eight of total global deaths – as a result of air pollution exposure.• 3.3 million deaths

linked to indoor air pollution

• 2.6 million deaths related to outdoor air pollution

who.int/mediacentre/news/releases/2014/air-pollution/en/

Outdoor air pollution-caused deaths – breakdown by disease:

• 40% – ischaemic heart disease;

• 40% – stroke;

• 11% – chronic obstructive pulmonary disease (COPD);

• 6% - lung cancer; and

• 3% – acute lower respiratory infections in children.

• And linked to Dementia

• An international environmental and health organization and a global coalition of more than 500 organizations in 52 countries

• Working to transform the health care sector worldwide to be ecologically sustainable

• Health sector as a leading advocate for environmental health and justice

• Two core principles:

– The right to health

– The right to a healthy environment

Extent of the problem of medical waste

“Over half of the world’s population are now at risk from occupational, environmental or public health threats from improperly treated medical waste.“

Harhay et al. (2009) Tropical Medicine and International Health 14(11): 1414-1417

International guidance on waste treatment technologies

World Health Organisation• 2004 policy: scale up steam-based treatment

• Blue Book Second edition, 2014: priority for non-incineration

Stockholm Convention: • waste incinerators are specifically identified as potential sources of highly toxic

dioxins and furans.

• guidelines on medical waste states that “priority consideration should be given to alternative processes” that do not generate dioxins and furans

Basel Convention: • 2003 Guidance: prefer steam based treatment

Human Rights Council 2011• Substitution of incineration with alternatives wherever practicable

Examples of Non-Incineration Technologies Demonstrated by the GEF/UNDP Project in Different Countries

Vietnam: large autoclave

Lebanon:

hybrid autoclave

Latvia: microwave

Latvia: rotating autoclave

Biomass fired autoclave

• Gasket-less aluminium autoclave set into a high efficiency biomass cook-stove

• Potential for disinfecting waste in remote areas and post-disaster situations

• Being tested in Kathmandu May/June 2014

• Effective with wood, and various biomass briquettes

• 60 litres of waste can be disinfected with as little as 800g of fuel.

Biodigestion• Breaks down organic waste to

produce methane- a renewable fuel

• Bir hospital uses biodigestion for food waste

• Potentially able to dispose of pathological waste

• Pilot in development for Kathmandu Maternity Hospital

• -2 chamber design to maximise reaction time

• Will monitor pathogens, temp pressure, pH etc, to prove how effective the technology can be and optimise conditions

Mercury

Hospital Uses Health and Environmental Concerns

Disinfectants & Sterilants

• Glutaraldehyde is a potent occupational skin irritant and causes asthma.

• Ethylene oxide is flammable and explosive, a probable human carcinogen, a toxic air contaminant, and an ozone depleter.

• Chemicals designed to kill biological organisms like pesticidal cleaners can be very toxic to humans and ecosytems.

Hazardous Chemicals in HeaIth Care

Hospital Uses Health and Environmental Concerns

Cleaning Agents

• Chlorine bleach (sodium hypochlorite), can in some circumstances liberate chlorine gas, a respiratory irritant and sensitizer.

• Surfactants such as alkylphenol ethoxylates degrade into nonylphenol, which is toxic to aquatic wildlife; ethanolamines can cause asthma.

• Some cleaners may contain chemicals that cause cancer, reproductive disorders, respiratory ailments, eye and skin irritation, central nervous system impairment, etc.

Hospital Uses Health and Environmental Concerns

Laboratory Chemicals

• Toluene is neurodevelopmental toxicant.• Formaldehyde is a carcinogen.• Laryngitis, bronchitis or bronchial pneumonia, conjunctivitis may be

developed through chronic exposure to laboratory chemicals.

Hospital Uses Health and Environmental Concerns

Medical Devices

• PVC manufacture and incineration generate dioxins, chlorinated organochlorines.

• DEHP, an additive to PVC, can damage the liver, kidneys, lungs and reproductive system, particularly developing testes, according to animal studies.

• In animal studies, BPA is associated with alteration in breast, prostate, and brain development, changes in behavior, and susceptibility to breast and prostate cancer. Human studies find a direct association with risk of diabetes and heart disease.

Global Green and Healthy Hospitals 10 Agenda Goals

Leadership Chemicals Waste Energy Water

Transportation Food Pharmaceuticals Buildings Purchasing

10 GGHH Goals

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GGHH Objectives1. To serve as a vibrant virtual community for hospitals and

health systems seeking to reduce their environmental footprint.

2. To chart progress in achieving measurable outputs, while sharing best practices, finding solutions to common challenges, and raising the bar.

3. To mobilize health care around the world to work together toward and advocate for greater environmental health, locally and globally.

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Hospital Members

Health System Members

Health, Professional and Academic Organizations Members

Categories of Membership

Partners and Relationships

Latin America 405 Hospitals , 46 Health Care Facilities, 35 Health Systems and 15 Organizations, representing the interest of 1637 Hospitals and Health Centers.

Africa22 Hospitals, 10 Health Care Facilities, 5 Health Systems and 2 Organization, representing the interest of 1455 Hospitals and Health Centers.

Asia94 Hospitals, 3 Health Care Facilities, 7 Health Systems and 24 Organizations, representing the interest of 8229 Hospitals and Health Centers.

Pacific6 Hospitals, 20 Health Systems and 6 Organizations, representing the interest of 582 Hospitals and Health Centers.

Europe21 Hospitals, 1 Health Care Facility, 19 Health Systems and 9 Organizations, representing the interest of 7213 Hospitals and Health Centers.

USA and CanadaHCWH’s implementation arm, Practice Greenhealth has 1,401 Hospital members in the U.S. In Canada, GGHH members include 5 Health Systems and 2 Organizations representing the interest of 1080 Hospitals and Health Centers.

Totals: As of March 2017, GGHH has 797 members from 47

countries representing the interest of 25,600 Hospitals and Health

Centers.

Global1 Health System and 3 Organizations representing the interest of 1040 Hospitals.

HCWH Regional Offices

Strategic Partners

Membership

Asia

• Bahrain, Bhutan, China, India, Indonesia, Kuwait, Nepal, Philippines, Singapore, Saudi Arabia, South Korea, Thailand, Taiwan

• Membership breakdown -73 Hospitals and Health Care Facilities, 6 Health Systems and 9 Organizations, representing the interest of 8206 Hospitals and Health Centers

Programs and Benefits

Programs and Benefits

the 2020 HCCC Challenge

The Challenge is based on three pillars:

• Mitigation – Reducing health care’s own

carbon footprint.

• Resilience – Preparing for the impacts of extreme weather and the shifting burden of disease.

• Leadership – Educating staff and the

public while promoting policies to protect public health from climate change.

Forms | Report and track

Graphs | Benchmark and Compare

Case Studies

• Examples of successful project implementation from GGHH members

• Process, Implementation, Challenges

• Connect with membersto learn more

Webinars

• Water: Methods and Tools for Sustainable Management and Conservation in the Health Sector

• Buildings : Green Design and Construction of Hospitals

• Ebola and Health Care Waste: Lessons from West Africa

• Combating Climate Change: Health Care Leadership and the #2020Challenge

• Sustainable Health Care Waste Management: Strategies and Experiences

• Health and Climate Change: The Lancet Commission Report

• Health Impacts of Energy Choices: Opportunities for Health Sector Leadership

GGHH Exchange

Nurse No HarmTrain the Trainors

Training Module

• Describe environmental risk factors in the home, school, workplace and community.

• Demonstrate new skills in community environmental health assessment and exposure assessment (using the pneumonic IPREPARE).

• Demonstrate knowledge of hazardous materials and their toxic effects on individuals and subpopulations, including children.

• Discuss the goals of Global Green and Healthy Hospitals and benefits of membership in the network of 20,000 hospitals and health facilities.

• Identify the health hazards from climate change/instability and describe the role of nurses as environmental health advocates.

• Discuss environmental health resources and the “right to know” points of access to information.

• Develop an individual and collective plan of action to apply environmental knowledge.

Faye Ferrer

faye@no-harm.org

HCWH Asia - noharm-asia.org

GGHH - greenhospitals.net