The real cost of toxic chemicals in healthcare

Healthcare Purchasing News, Sept, 2003 by Larry Weiss

According to the Bureau of Labor Statistics, hospitals and nursing facilities are among the most hazardous work environments. Every year, on average there are about seven occupational injuries or illnesses for every 100 employees and about half will result in lost worktime (1). Working with or exposure to toxic chemicals is the single largest contributing risk factor associated with occupational illness and injury in healthcare. In addition to the human cost, the economic cost associated with these injuries and illnesses is staggering. The majority of the toxic exposure in healthcare occurs with the use of cleaners and disinfectants by aids and housekeeping staff. Purchasing decisions for these products often involve input from a number of hospital departments and may ultimately be made by outside cleaning contractors.

Historically, indirect costs due to toxicity and corrosion have not been taken into consideration when choosing disinfectants. Consequently, purchasing decisions are often based on the lowest bid. As complicated as the financial modeling of the indirect costs of toxic chemicals may be, there is compelling evidence that reducing toxic exposure in the workplace is a good business decision that can result in a significant return on investment.

Many institutions have records that may track these costs but have yet to connect them to the underlying cause, toxic exposure. Purchasing managers are uniquely qualified to identify these costs, involve the respective departments to reduce toxic exposure and then benchmark the actual return on investment. By taking a leadership role in this effort, purchasing managers have an opportunity to significantly improve both the physical health of the workforce and the financial health of the institution.

Background

At a recent international infection control meeting, a prominent physician was asked how germicides and disinfectants were chosen at his institution. After giving it some thought, he responded that he had no idea. This is emblematic of the problem that faces healthcare purchasing when making a buying decision has direct and indirect impact throughout the institution. The purchase of disinfectants and germicides is particularly complicated because they are regulated as hazardous materials and involve input from departments beside the end-user.

Compliance with JCAHO, OSHA, EPA, and local water districts necessitates an ongoing program of training and monitoring particularly since there tends to be high turnover among the aids and housekeeping staff that make up most of the users. Input into the product specifications and requirements for germicides and disinfectants often come from infection control, risk management, environmental compliance and housekeeping. This can be further complicated if individual clinical departments insist on specific germicides. Increasingly, emerging infectious diseases and resistant organisms present ongoing challenges that may necessitate the reexamination of infection control practices and subsequent changes in purchasing. Relationships with GPOs and existing vendors may limit the alternatives or bundle desirable products with a compromise product, solving one problem and creating another. At the center of this, and tasked with finding win-win solutions within an increasingly tight budget, is hospital purchasing.

Purchasing: An opportunity to lead

To many, this complicated process may not reflect their experience when it comes to disinfectant purchasing decisions. The choice of products has remained largely unchanged in many if not most institutions, with the exception of switching between manufacturers or vendors on the basis of a lower bid or a value added service. To the departments that had input on the specifications of the product prior to the decision making process, the use of the product goes essentially unnoticed. Unless there is an outbreak or some other pressing need to reevaluate the cleaning and disinfecting practices, very little attention is paid to disinfectants that are used by the aids and housekeeping staff. Moreover, even in the event of an outbreak, the most common of which today are due to the resistant staph MRSA, enterococcus VRE, or norovirus, the most likely agent of transmission are the unwashed hands of the professional staff.

Without a pressing demand from the involved departments, it is understandable that there has been little incentive to invite the reconsideration of disinfectants. In fact, it is the complicated process and the number of involved constituencies that has served as a disincentive to open up this can of worms. The recent introduction of a new class of disinfectants which address the dual problems of toxicity and material incompatibility, based on nanotechnology, and used in combination with microfiber cleaning materials presents the first real advance in hospital infection control. It has the potential to improve practice, simplify the workload, eliminate hazmat exposure and reduce both direct and indirect costs. This represents a win-win solution for the entire institution and an opportunity for purchasing to take a leadership role.