According to the Environmental Protection Agency, environmentally preferable means “products or services that have a lesser or reduced effect on human health and the environment when compared with competing products or services that serve the same purpose,” and this applies to “raw materials, manufacturing, packaging, distribution, use, reuse, operation, maintenance, and disposal.” Halthcare can practice environmentally preferred purchasing (EPP) in many ways. Examples include purchasing paper with postconsumer recycled content, Energy Star appliances, or intravenous (IV) bags and tubing that are manufactured without the plasticizer di(2-Ethylhexyl) phthalate (DEHP).
Hazardous chemical reduction, especially in the manufacture of consumer products, is a topic of conversation in many industries. Chemicals in healthcare play an important role in safe patient care and are beneficial in many ways. However, healthcare must also understand the negative impacts of hazardous materials and commit to phase out their use wherever possible. For example, one concern in healthcare is the use of the plasticizer DEHP in medical products. In 2002, the Food and Drug Administration completed a safety assessment of DEHP and found that “some individuals can be exposed to high levels of DEHP through certain medical procedures.” The FDA findings are summarized in the table below.
|Medical devices that may contain DEHP-plasticized PVC include:
|Procedures identified by the FDA as posing the highest risk of exposure to DEHP are:
|Source: FDA Public Health Notification:PVC/DEHP, July 2002
|Intravenous (IV) bags and tubing
|Exchange transfusion in neonates
|Umbilical artery catheters
|ECMO in neonates
|Blood bags and infusion tubing
|Total Parenteral Nutrition (TPN) in neonates (with lipids in PVC bag)
|Enteral nutrition feeding bags
|Multiple procedures in sick neonates (high cumulative exposure)
|Hemodialysis in peripubertal males
|Peritoneal dialysis bags and tubing
|Hemodialysis in pregnant or lactating women
|Tubing used in cardiopulmonary bypass (CPB) procedures
|Enteral nutrition in neonates and adults
|Tubing used in extracorporeal membrane oxygenation (ECMO)
|Heart transplantation or coronary artery bypass graft surgery (aggregate dose)
Healthcare can help mitigate the impacts of these chemicals on patients by phasing out the use of items that contain them. According to Health Care Without Harm, thousands of U.S. hospitals have eliminated mercury-containing medical devices. Many healthcare facilities are using integrated pest management techniques to reduce the use of pesticides. In addition, hospitals are choosing to use less hazardous building materials in construction and renovation projects. Two healthcare sustainability leaders, Kaiser Permanente and Dignity Health (formerly Catholic Healthcare West), have committed to purchasing products that are PVC/DEHP-free (common phthalates used in IV bags), formaldehyde-free (found in carpeting and other building finishes), free of halogenated flame retardants (applied to many products such as linens and baby blankets), and free of latex and mercury. Modern Healthcare magazine recently discussed Kaiser Permanente’s commitment to purchasing furniture free of flame retardants. Healthcare can reduce patient and worker exposure by making these types of choices.
To learn more about how businesses and healthcare are addressing chemical reduction in products, visit the BizNGO page for Corporate Chemical Policies.
There are many ways to incorporate EPP practices when making purchasing decisions. Practice Greenhealth has free tools on their website, including information to get started, general contract language, specifications and resource guides, and more. Practice Greenhealth also has a Greening the Supply Chain Initiative that brings together healthcare organizations, group purchasing organizations, manufacturers, and others to help solve some of the more difficult issues in healthcare EPP programs. This program is free for anyone to join (you do not need to be a member of Practice Greenhealth). In addition, Practice Greenhealth has published free EPP case studies that cover topics such as packaging, carpeting, cleaners, computers, medical equipment, and office supplies.
The Healthier Hospitals Initiative is another free program that hospitals can join in order to make commitments to sustainability. In their smarter purchasing goal, the program asks hospitals to set a baseline where they pledge to “support Group Purchasing Organization (GPO) in contracting for, and to start purchasing applicable products based on, the environmentally preferred attributes in the Standardized Environmental Questions for Medical Products.” With this goal, each participating hospital is asked to commit to between one and three goals: a surgical kit review, single use device processing, and electronic products environmental assessment tool (EPEAT) purchasing goals. The program also has a safer chemicals goal in which hospitals set a baseline to “achieve mercury-free status or develop and implement mercury elimination plan.” With this goal, participating hospitals are asked to commit to between one and three goals: green cleaning, DEHP/PVC reduction, and healthy interiors.
The Minnesota Pollution Control Agency (MPCA) also has a focus on EPP, especially as it relates to government contracts and procurement goals. The MPCA is a founder of the Sustainable Purchasing Leadership Council, and topics covered on their Environmentally Preferable Purchasing page include EPP requirements for public entities in Minnesota, access to state EPP contracts, resources and links to national programs, case studies, and guidance on how to build EPP policies.
Finally, the University of Minnesota, through its Purchasing Services division, offers guidance to facilities looking to engage in EPP work, including standards to consider when determining whether a product is environmentally preferable.
- The Environmental Protection Agency has numerous resources available at their website: EPA Greener Products.
- Health Care Without Harm provides ideas for integrating EPP, sample EPP policy language for hospitals, and other tools and resources for sustainable purchasing.
- The State of California is a leader in EPP initiatives and has tools and resources on topics such as guidance for buying or selling products, sample purchasing policies, and more.