Toxins Lurking in Hospitals

I was shocked and scared to read an article in the December Time online magazine. "A doctor's principle code is, "First, do no harm," so it says.The irony is that the doctor's clinics or hospital may be making you more ill than when you first went in. The materials with which hospitals are made, like particleboard, PVC flooring and even conventional paint, that can leach poisonous substances. What's more, the chemicals used to clean hospitals — chlorine, laundry detergents and softeners, ammonia — contain toxic ingredients and can cause respiratory disease. In fact, studies suggest that nurses, who spend long hours at the hospital, have among the highest rates of environmentally induced asthma of any profession. Also, a patient staying too long in hospital does tend to get a hospital induced infection.

In is observed that in the typical hospital, while they are trying to treat or cure illness and disease...the staff and patients are exposed to irritants and carcinogens, and the treatments often contribute to the development of other diseases.

The international advocacy group Health Care Without Harm (HCWH) — whose 2006 study of 1,200 nurses suggested a link between the hospital environmental and health problems among the staff — has been a pioneer in the movement of creating green medicine- the effort to detoxify the healing environment and enhance patients and staff health while reducing costs.

It was HCWH, for example, that in the mid-1990s got U.S. hospitals to stop using thermometers containing mercury, a potent neurotoxin associated with health problems, such as respiratory, kidney and gastrointestinal disorders, as well as interruption of fetal development (which occurs when pregnant women consume too much mercury, usually through fish). Today most hospitals have swapped out their mercury-based measuring devices — including sphygmanometers, which are used to measure blood pressure and contain more mercury than thermometers — for safer alternatives.

Over the same time period, hospitals began eliminating their incinerators altogether, reducing one of the toxic byproducts of burning waste: dioxins. Says Gary Cohen: "In 1996 there were 4,200 medical incinerators in the country. Now there are 83."

Cohen says that the HCWH is now also urging hospitals to replace their PVC (vinyl) flooring with rubber floors. PVC can emit toxins such as dioxin and phthalates, particularly when wet, which studies suggest may affect reproductive health and fetal development, and may also trigger asthma. "Hospitals change to rubber flooring because of the toxic emissions," says Cohen, "As it turns out, switching to rubber actually cuts down on noise and reduces slips and falls, which are also a threat to patient and worker safety."

The investment in new flooring, says Cohen, also saves hospitals money, if one considers the costs over the entire life cycle of a product. Although PVC flooring is cheap to buy, it ends up costing more later; its tendency to become brittle requires frequent maintenance or replacement. The environmental costs are high as well. With PVC flooring, "the manufacturing process creates dioxin. In the end, it is burned, releasing additional dioxin. In between, there's the [emission] of phthalates," says Cohen, noting that PVC is found throughout the hospital, not only in flooring, but also in shower curtains, blood bags and intravenous tubing. "If you can have a safer IV system without exposing patients to toxic substances, especially pregnant women and babies in the neonatal intensive care unit, then hospitals have a responsibility to replace PVC with safer alternatives." Fortunately, safer alternatives exist and may cost as much or less as PVC products.

Hospitals have also managed to save money by greening their cleaning supplies. The Hackensack University Medical Center's pediatric oncology center in New Jersey swapped its toxic-chemical-laden cleaners for its own custom-made natural products, dropping cleaning costs by 15% — and, more important, minimizing employees' and young patients' exposure to irritants and harsh substances, such as ammonia.

The idea of greener — and cheaper — health is catching on fast among health-care CEOs. Some 150 registered health-care industry construction projects currently underway — involving about 30 million sq. ft. of new building space — have pledged to adopt the Green Guide for Health Care (GGHC), a sustainable design toolkit developed in part by HCWH, which helps the health-care sector construct healthier buildings from the start, according to Cohen. For example, the guide suggests ways to maintain indoor air quality, as indoor pollution can cause or aggravate many health conditions and threaten the well-being of patients with compromised immune systems.

But much can be done without building anew, and although support at the executive level is crucial, the impetus for change can come from any member of the staff. At the Community Hospital of the Monterey Peninsula in Calif., for instance, Joy Colangelo, an occupational therapist, helped launch the "Green Team" about six months ago. The team's first task was to do a "waste audit" in order to tally unnecessary expenditures, says Colangelo. She found that the hospital's heart department was churning out 20 pages of patient-identification labels per patient, but using only six.

Beyond cutting down waste, says Colangelo, the hospital also attempts to wield the "power of aesthetics to heal," with musical performances, a koi pond filled with 70 koi in the atrium, a "healing garden" and a nursing floor that wraps around a waterfall and patio. All patient rooms also have large windows that provide views of nature and lots of natural light — which cuts electricity costs and is associated with high staff morale and better patient outcomes. "Our green efforts are done under the premise that we have two patients, the environment and the ill patient," says Colangelo, "and the ill patient can't get well without improving our environment."

I wonder whether the planners in Malaysia think "green" when they built our new hospitals. The Sultan Ismail hospital in Pandan, Johor is one example, whereby the operation theatres were contaminated even before full commissioning of the hospital could be carried out.