Environmental accountability in perioperative settings

AORN Journal,  June, 2003  by Ann Melamed

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For many years, a critical factor in caring for the sick and injured was control of the environment. Control of temperature, fresh air, cleanliness, good food and water, and clean rooms and bedding were the basis of good nursing care. In 1860, Florence Nightingale wrote

   In watching diseases, both in private houses
   and in public hospitals, the thing which strikes
   the experienced observer most forcibly is this,
   that the symptoms or the sufferings generally
   considered to be inevitable and incident to the
   disease are very often not symptoms of the disease
   at all, but of something quite different--of
   the want of fresh air, or of light, or of warmth,
   or of quiet, or of cleanliness, or of punctuality
   and care in the administration of diet, of each
   or of all of these. (1)

As nursing developed into a profession, nurses continued to control environmental factors as much as possible, but as hospitals assumed greater control over the direction of health care, nurses focused more on individual patients and immediate needs rather than environment and community factors. (2)

What role do nurses play in promoting cleaner, healthier environments for patients, staff members, and communities today? How does the health care industry affect the environment, and what steps can nurses take to promote the very foundation of nursing care (eg, control and promotion of a healthy environment)? At a groundbreaking conference in 2000 titled Setting Healthcare's Environmental Agenda, Michael Lerner, PhD, founder of the health and environmental research institute Commonweal, said,

   The question is whether healthcare professionals
   can begin to recognize the environmental
   consequences of our operations and set our
   own house in order. This is no trivial question.
   The fact that it plays out with little issues, like
   eliminating mercury thermometers and medical
   waste incineration, and all the technical aspects
   of transforming one of the greatest industrial
   centers in the world. The fact that it plays out in
   that detail shouldn't blind us to what it is that
   we're actually doing ... in this concrete work ...
   setting in order the house of healthcare. (3)

This issue encompasses both ecology (ie, the science of preservation of natural resources) and environmental health (ie, the study of health outcomes that may be associated with exposure to environmental hazards). (4) Every nurse today is aware of the problems of global warming; contamination of air, soil, and water; loss of habitat; and species extinctions. These are ecological issues. Every nurse surely understands the effects of contaminated air, water, and soil on the food chain, water supply, and human health and reproduction. Nurses can be the link between the science of ecology and the art and science of environmental health.

During the past 30 years, the health care industry has undergone tremendous changes in the types of products it uses and its waste practices. Not only has the industry embraced disposable products, many of them plastic, but it also has redefined infectious versus noninfectious waste. Waste disposal methods have come under continued and increasing attack for human health and environmental reasons. Perioperative nurses are leaders in examining these complex issues and finding solutions. This article examines some of the history of pollution prevention and environmental movements in health care and nursing, explains basic concepts about the hospital waste stream, and examines some of the toxic products used in health care settings and by-products of health care waste. It also provides concrete examples for nursing actions that promote environmental leadership at all levels and discusses two organizational efforts at "greening" the health care industry--Hospitals for a Healthy Environment (H2E) and the Health Care Without Harm (HCWH) coalition, of which AORN is a member organization. Through collaboration with HCWH and the H2E project, there are many opportunities for AORN members and chapters to continue to take the lead in identifying the scope and direction of environmentally preferable and healthier practices in the health care industry.

MEDICAL WASTE, AORN, AND THE ENVIRONMENT

Historically, there was little guidance for dealing with medical waste separately from other waste because most hospitals had on-site incinerators and incinerated everything. In addition, the quantities of waste were much smaller, and there were fewer plastic items. The increasing rise of bloodborne disease, such as HIV and hepatitis B virus, in the early 1980s along with concurrent televised scenes of medical waste washing up on US beaches resulted in a movement to regulate medical waste and protect the public and health care and waste workers from bloodborne infections.

Universal precautions standards, which were introduced in 1987, and the Medical Waste Tracking Act, which was signed into law in 1988, (5) set in motion a movement to treat most medical waste, even clean hospital waste, as infectious. This resulted in increased amounts of waste being identified as "red bag" (ie, infectious) waste, including the now ubiquitous polyvinyl chloride (PVC) plastics and other disposable items. Most of this waste was incinerated.