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Improving Air Quality in Your Community

Indoor Air: Hospitals - Additional Information

Information provided for informational purposes onlyNote: EPA no longer updates this information, but it may be useful as a reference or resource.

This information will help you gain a better understanding of questions hospital administers may have about the reduction of hazardous air pollutant (HAP) emissions from hospitals. The sections below provide more information on this topic.

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What are hospitals and why should they reduce air pollution?

  • Medical hospitals are facilities that engage in providing general medical, surgical, and specialty services.
  • Equipment breakage and waste incineration may release pollutants into the air and may contribute to health concerns in hospitals and in the community.
  • Hospitals for a Healthy Environment Exit EPA Disclaimer is an organization that strives to educate healthcare professionals about the potential of pollution prevention throughout hospitals and healthcare systems in general.
  • Health Care Without Harm Exit EPA Disclaimer works to reduce pollution without compromising healthcare safety and benefits.

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What are the health effects of air pollutants that come from hospitals?

Hospitals can emit HAPs such as mercury and dioxin. These pollutants can contribute to health problems that may affect employees, patients, their families, and the community. While Federal, state, local, and Tribal regulations limit the amount of emissions from hospitals, dangerous releases of HAPs can occur if a hospital does not operate in compliance with regulations.

  • Mercury
    • Mercury can be used in thermometers, blood pressure cuffs, thermostats, fluorescent lights, and other products found in hospitals.
    • At room temperature, mercury is a liquid and emits toxic vapors, which can be inhaled into the lungs and absorbed into the bloodstream.
    • Mercury is very toxic to humans. It impacts the kidneys, liver, respiratory system, and central nervous system.
    • EPA's Health Effects Notebook has additional information related to the health effects of exposure to mercury.
    • Learn more about Indoor Air Mercury (PDF). (8 pp, 26 KB) Exit EPA Disclaimer
  • Polyvinyl Chloride (PVC)
    • PVC is used in plastic products such as IV bags, surgical tubing, other medical supplies, and construction materials.
    • PVC is a source of HAPs. Some hospitals incinerate their waste onsite.
    • Burning medical waste can produce dioxin, a potent carcinogen and that interferes with normal reproduction and development at low doses. EPA's Health Effects Notebook has more information related to the health effects of dioxin.
  • National air pollution standards exist for hydrogen chloride (HCL), carbon monoxide (CO), lead (Pb), cadmium (Cd), particulate matter (PM), dioxin/furans, nitrogen oxides (NOx), and sulfur dioxide (SO2)
  • EPA has developed regulations for medical waste incinerators and for ethylene oxide emitted from commercial sterilizers.

For more information on the toxicity of these pollutants, check out information on the Integrated Risk Information System (IRIS). EPA also has more information available at its Air Toxics Web site.

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How can hospitals reduce air pollution?

Making changes in hospital operations can stop pollutants at the source and increase efficiency. By evaluating and improving work practices, hospitals can decrease emissions, reduce operational costs, and protect employee and public health. Examples of changes in work practices that help reduce air pollution include:

  • Mercury
    • Replacing Sources of Mercury
      • Alternatives to mercury thermometers include electronic, infrared, chemical strip, and gallium, indium, and tin thermometers.
      • Mercury blood pressure cuffs can be replaced by aneroid and electronic blood pressure cuffs.
      • Use gastrointestinal tubes weighted with tungsten or water instead of mercury.
      • Replace mercury pharmaceutical products with mercury-free preservatives.
      • Identify why mercury is present as an active ingredient in laboratory chemicals. It may be possible to substitute a mercury-free alternative.
      • Insist on mercury disclosures of all incoming products to the hospital.
      • Insist on using recovered and recycled mercury in all products that do not yet have mercury-free alternatives.
      • By reducing the amount of mercury used, it is possible to minimize the costs associated with mercury collection, storage, recycling, or disposal; paperwork for tracking hazardous waste disposal; and training for hospital employees who handle mercury-containing products or respond to drills. Reducing sources of mercury will also help avoid increased regulation in the future.
    • Locating Sources of Mercury
      • Conduct a regular mercury audit to determine where mercury may be used.
      • When forming a mercury audit team, use employees from all parts of the hospital. They have the best knowledge regarding where sources of mercury pollution may occur.
      • Formulate a plan based on the results of the audit to reduce sources of mercury.
    • Communicating Mercury Dangers
      • Develop a training and communication program aimed at increasing the general awareness of mercury health impacts.
      • Train employees to look for ways to reduce mercury pollution.
      • Develop and implement a protocol to prevent hospital employees from any improper disposal of mercury.
    • Developing a Mercury Housekeeping Program
      • Ensure that equipment and operating procedures meet all standards for handling mercury. This helps avoid inadvertent mercury air emissions.
      • Monitor and maintain the working condition of mercury-containing equipment. Label equipment.
      • Establish procedures on how and where mercury may be used and disposed.
      • Create and implement spill cleanup procedures for the recovery and cleanup of mercury.
      • Recycle mercury whenever reducing the amount of mercury used is not feasible.
    • Learn more about the need to reduce mercury usage in hospitals. Exit EPA Disclaimer
    • Health Care Without Harm has developed extensive information about mercury and ways to reduce its use Exit EPA Disclaimer in hospitals and healthcare systems.
    • Sustainable Hospitals Project Exit EPA Disclaimer has developed extensive information about the need to reduce mercury in hospitals.
    • EPA Region 5 presents a fact sheet on the importance of keeping mercury out of medical waste.
    • EPA Region 5 discusses using alternative products to mercury.
    • The Wisconsin Department of Natural Resources has developed Mercury Use: Hospitals and Clinics (draft, PDF) (38 pp, 253, KB) Exit EPA Disclaimer that discusses mercury reduction in hospitals.
  • PVC
    • Developing a PVC Use Reduction Plan
      • Conduct an audit to determine sources of PVC. Use employees from all parts of the hospital. They have the best knowledge regarding where PVC usage may occur.
      • Learn more about the need to reduce PVC in hospitals. Exit EPA Disclaimer
      • Sustainable Hospitals Project Exit EPA Disclaimer has additional information about the need to reduce PVC in hospitals.
    • Reducing Usage
      • Look for PVC-free products to replace PVC.
      • Use PVC-free construction and furnishing products whenever possible.
      • Learn about PVC-free alternatives. Exit EPA Disclaimer

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What is a mercury "turn-in" program and how can it benefit hospitals?

  • A mercury "turn-in" program is an event sponsored by hospitals to receive mercury products that citizens may have in their homes such as mercury thermometers and batteries. The hospital then disposes of the mercury in a safe manner.
  • You can use this type of event as a community health initiative to inform your community of the dangers of mercury in the home.
  • Also, mercury "turn-ins" can promote hospitals as environmentally friendly hospitals and cooperative partners within the community.

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What are environmentally preferable purchasing programs and how can they reduce mercury and PVC usage?

  • Environmentally preferred purchasing (also known as "green" purchasing) involves buying products that have a reduced environmental impact while maintaining the same quality and performance. See the Web page related to green procurement for more information.
  • Products that are environmentally friendly have some of the following attributes:
    • Mercury free.
    • Non-toxic (or less toxic).
    • Minimal disposal impacts (recyclable product and packaging, no hazardous material disposal.
    • Recycled content (post-consumer).
    • Minimal packaging.
    • Energy efficient.
    • Can be reprocessed or reused.
    • More durable.
    • Safer for patients, workers, and the environment.
  • Using environmentally preferred purchasing reduces mercury and PVC usage by eliminating the entry of products containing mercury and PVC into the hospital.

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