Making health care healthier: a prescription for change - Focus

Environmental Health Perspectives, August, 2001 by Bob Weinhold

When people are sick, all they want is to feel better, so they go to a doctor, clinic, or hospital for help. But sick people may get more than they bargain for when seeking treatment. "[T]hreats to patients' health often can be found within the health care setting itself," writes registered nurse Ann Melamed in the November/December 2000 issue of Nursing World. Problems can be triggered by exposure to indoor air pollutants, mercury, latex, polyvinyl chloride (PVC), disinfectants, laboratory chemicals, and hundreds of other substances integral to medical care. Exposure to agents such as these is enough to make both vulnerable patients, who often have weakened immune systems, and health care employees, who are continually exposed, quite literally sick.

A treatment--if not a cure--may be in sight. Pollution linked to health care facilities has drawn both interest and subsequent regulation in the past few years. Medical waste has been in the public eye for more than a decade, spurred in part by sightings of discarded syringes washing up on beaches. Federal and state regulations now apply to medical waste incineration, and numerous programs target reductions in medical waste. Latex allergies, which affect many patients and health care industry employees, are being addressed through a variety of alternatives and changes to medical procedures. Many health care organizations are moving to reduce problems associated with mercury contamination. And around the United States, a number of projects are being undertaken to improve the environmental quality of health care facilities as well as minimize the risk of adverse exposures inside them.

Faulty Facilities

According to the U.S. Environmental Protection Agency (EPA) Office of Radiation and Indoor Air, indoor air pollution in buildings of all types ranks among the top five environmental health risks to public health. The EPA's list of potential culprits includes tightly sealed buildings, reduced ventilation rates, mold contamination, synthetic building materials and furnishings, and chemically formulated personal care products, pesticides, and cleaning supplies. Many, if not all, of these problems exist in health care facilities as well. For some people, exposure to contaminated indoor air can lead to short-term health problems such as headaches, dizziness, difficulty thinking, fatigue, and irritation of the eyes, nose, and throat. Long-term problems may include respiratory disease, heart disease, and potentially even cancer.

While the evidence of indoor air quality problems in buildings of all types is accumulating, the Joint Commission on Accreditation. of Healthcare Organizations (JCAHO) addresses only a few of these issues in its review of thousands of hospitals that voluntarily participate in the accreditation process. JCAHO accredits about 5,000 hospitals and another 14,000 facilities including laboratories, ambulatory care centers, and long-term care facilities, ratings by JCAHO can be important in issues such as Medicare certification, state licensure, liability insurance premiums, managed care contracts, and bond ratings. Of about 500 criteria for a hospital, just a handful at most deal directly with indoor air quality. For instance, JCAHO generally checks the design and management of utilities so that they function in accordance with standard industry guidelines for such factors as air exchange rates, filtration efficiency, and other standards.

A few organizations involved in the construction of new medical facilities are voluntarily attempting to build hospitals, clinics, and other facilities incorporating safeguards against indoor air pollution and other environmental hazards. Nationally, the health care industry builds about 70-75 million [ft.sup.2] of space each year, according to Gall Vittori, a project consultant and codirector of the Austin, Texas-based Center for Maximum Potential Building Systems, a nonprofit design firm that focuses on sustainable design and building practices.

Plans are on the drawing board for such a new building at the University of Texas Health Science Center at Houston. The goal is to design a nursing school and student community center that will be healthy inside and out. The new $40 million 194,000 [ft.sup.2] building, though dominated by educational and office facilities, will also have a few medical spaces tucked into its eight stories.

Having experienced environmental problems such as poor indoor air quality with some of their other buildings, officials at the University of Texas Health Science Center are trying to be proactive this time. "Among other things, we are a health science center," says campus architect Rives Taylor. "We wanted to walk the walk." Center officials are also watching their wallets, because the new building is expected to be in use for decades, if not centuries. "It's much more [cost-]effective to be smart up front," Taylor says, and build with materials that won't later cause harm. Campus officials are planning to take the lessons from construction of this new center and apply them to two other buildings in the next few years.