HEALING WITHOUT HARM REDUCING EXPOSURE TO ENDOCRINE DISRUPTORS IN HOSPITALS - PILOT PROJECT AT PIERRE BOUCHER HOSPITAL'S NEONATAL UNIT - Canadian ...
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HEALING WITHOUT HARM
REDUCING EXPOSURE TO
ENDOCRINE DISRUPTORS
IN HOSPITALS
PILOT PROJECT AT PIERRE
BOUCHER HOSPITAL’S NEONATAL
UNIT
SYNERGIE SANTÉ ENVIRONNEMENT
– Non-profit founded in 2006 by health care professionals
– Administered by a board of directors from a health care network.
– Mission : Support health facilities in reducing their environmental impact
and improving their environmental practices by applying the principles of
environmental health and sustainable development.
Services: Status reports, development of policies and action plans, training,
pilot project implementation, implementation of participatory action plans
– Membership: 19 health institutions (CISSS, CIUSSS, CHU) members, ie 41
hospitals, 147 shelters and 98 CLSCs, 5 educational institutions and 2
associations (1 purchasing group and 1 union)
CANADIAN COALITION FOR
GREENHEALTH CARE
– Non-profit created in 2001 by health care organisations
– Administered by a board of directors from a health care network.
– Mission: The Canadian Coalition for Green Health Care enables the
health care sector to lead the integration of environmentally responsible
practices into the delivery of health care.
– Services: resources, pilot projects, webinars, workshops, training, Green
Health Digest, Research projects, onsite energy services.
– Membership: represents 40% of hospital beds across Canada
SAFER CHEMICAL
PROJECT OBJECTIVES
• Reduce toxic and hazardous waste generated by health care facility
(HCF) operations to water through:
– Identification, evaluation and implementation of innovative, safer chemical
technologies and product use strategies.
• Reduction target:
– 250 kgs of toxics and other waste per year to water
• Use of project results:
– Develop best practices to reduce chemicals in HCFs
– Share key successes and lessons learned
PROJECT ACTIVITIES • Engage HCFs willing to pilot new safer chemical systems & strategies
PROJECT ACTIVITIES
• Engage technical partners to provide information on purchasing, technological systems,
infection control and safer chemicals for health care
– Class 1 Inc
•Shared expertise on UV disinfection
– Crothall Healthcare
•Provided labour and testing for aqueous ozone pilot at Lower Mainland Health Organizations
– Coalition for Healthcare Acquired Infection Reduction (CHAIR)
•Shared expertise on health care infection reduction
– Tersano
•Provided 2 Aqueous Ozone units and training for St Martha’s Hospital pilot
•Provided information for pilot at Lower Mainland Health Organizations
PROJECT ACTIVITIES • Background research • Establish baselines – Chemical/product purchasing, use, and waste generation • Complete pilot projects with final evaluation • Share findings and recommendations
SAFER CHEMICAL PROJECT
COLLABORATORS
Lower Mainland
Health Organizations,
BC
St. Martha's Regional Hospital, NS
THIS PROJECT WAS UNDERTAKEN WITH THE FINANCIAL SUPPORT OF
10
ENDOCRINE
DISRUPTORS
Lise Parent, Ph.D.
Petya Grigorova, Ph.D.
TÉLUQ UNIVERSITYRESULTS OF THE TESTS ON THE SAMPLES Tests sanguins Poussière 1,1,1-Trichloroéthane BPC-28 p,p'-DDE 4-nonylphenol diisobutyl phthalate 1,1,2-Trichloroéthane BPC-52 p,p'-DDT nonylphenol monoethoxylate di-n-butyl phthalate 1,1-Dichloroéthène BPC-99 Para-xylène nonylphenol diethoxylate butylbenzyl phthalate 1,2,4-Triméthylbenzène Bromodichlorométhane PBB 4-octylphenol di(2-ethylhexyl) phthalate 1,2-Dichlorobenzène Cadmium PBDÉ 100 octylphenol monoethoxylate [bis(2-ethylhexyl)phthalate] 1,2-Dichloroéthane Chlorobenzène PBDÉ 153 octylphenol diethoxylate 2,2’,4,4’-tetrabromodiphenyl 1,2-Dichloropropane Chloroforme PBDÉ 47 4-tert-methylbutylphenol ether 1,3- Dichlorobenzène Cis-1,2-Dichloroéthène PBDÉ 99 α-chlordane (alpha-chlordane) 2,2’4,4’,5-pentabromodiphenyl 1,3,5- Triméthylbenzène Cis-nonachlore Phosphate de diéthyle γ-chlordane (gamma-chlordane) ether 1,4- Dichlorobenzène Cobalt Phosphate de diméthyle 2-bis(4-chlorophenyl)-1,1,1- 2,2’,4,4’,6-pentabromodiphenyl Aldrine Cuivre Plomb trichloroethane ether Argent Dibromochlorométhane Sélénium 4,4-DDT 2,2’, 4,4’, 5,5’-hexabromodiphenyl Arsenic Dichlorométhane Styrolène diazinon ether Benzène Dithiophosphate de Sulfonate de perfluorooctane dicofol + 4,4’-dichlorobenzophenone 2,2’,4,4’5,6’-hexabromodiphenyl Béryllium diéthyle Tellure (breakdown product) ether Bismuth Dithiophosphate de Tétrachloroéthane dieldrin 2,2’,3,4,4’,5’,6-heptabromodiphenyl BPC 101 diméthyle Tetrachloroéthylène methoxychlor ether BPC 128 Étain Tétrachlorure de carbone pentachloronitrobenzene decabromodiphenyl ether BPC 138 Éthylbenzène Thallium pentachlorophenol monobutyltin BPC 163 Hexachlorobenzène Thiophosphate de diéthyle cis-permethrin dibutyltin BPC 183 Lithium Thiophosphate de diméthyle trans-permethrin tributyltin BPC 187 Manganèse Toluène piperonyl butoxide tetrabutyltin BPC Aroclor 1260 Mercure Toxaphène 26 propoxur dioctyltin BPC-105 Méta-xylènes Toxaphène 50 perfl uorooctanoic acid tricyclohexyltin BPC-118 Mirex Trans-1,2-dichloroéthène perfl uorooctanyl sulfonate triphenyltin BPC-153 Molybdène Trans-nonachlore dimethyl phthalate BPC-156 MTBE Trichloroéthène diethyl phthalate BPC-170 Nickel Uranium di-n-propyl phthalate BPC-180 Oxychlordane Zinc
BODY BURDEN IS A TERM THAT REFERS TO THE TOTAL ACCUMULATION OF TOXINS IN YOUR BODY • Is it normal to have all of these substances in our bodies? • Even babies have been found to have a body burden at birth • This has been detected even in very remote geographical areas ….
WHAT IS A TOXIC SUBSTANCE? • The obvious, with immediate effects: poison, corrosive, irritant • The less obvious, with effects that can appear later on: carcinogenic, teratogenic, mutagenic ENDOCRINE DISRUPTORS?
ENDOCRINE DISRUPTOR • Exogenous substance that alters the function(s) of the endocrine system and causes adverse health effects in an individual or his progeny An ED disrupts the hormonal message and causes health problems to an individual or their children
THE ENDOCRINE SYSTEM
THE INFLUENCE OF HORMONES
IS VERY IMPORTANT FROM THE
FIRST MOMENTS OF YOUR LIFE
AND ONWARDS
– Fetus development
– Childbirth
– Lactation
– Growth
– Puberty
– ReproductionHORMONES PLAY A PART IN OUR DAILY ACTIVITIES
FEMINIZED FISH • In the St. Lawrence River and elsewhere in the world, more and more male fish also have...ovaries!
HEALTH PROBLEM TO BE LINKED TO THE ED • Infertility • Behavioral Disorders • Changes in the males / females ratio • Increased rates of other cancers • Miscarriage • Immune system alteration • Low Birth Weight • Obesity • Sexual Anomalies • Early Puberty
ENDOCRINE DISRUPTORS
DURING DEVELOPMENT
This is the latest report published by the World
Health Organization and the United Nations
Environment Program
The report states that exposure to endocrine
disruptors during development is considered to
be a significant risk factor for developing a
chronic disease
http://www.who.int/ceh/publications/endocrine/
en/index.htmlState of the science of endocrine disrupting chemicals - 2012 An assessment of the state of the science of endocrine disruptors prepared by a group of experts for the United Nations Environment Programme (UNEP) and WHO http://www.who.int/ceh/publications/ endocrine/en/index.html
TESTICULAR CANCER IN NORTHERN
EUROPEAN COUNTRIES
1989-1994 1998-2003State of the science of endocrine disrupting chemicals - 2012 An assessment of the state of the science of endocrine disruptors prepared by a group of experts for the United Nations Environment Programme (UNEP) and WHO http://www.who.int/ceh/publications/ endocrine/en/index.html
SOME CONCLUSIONS • Everyone is exposed to ED • Rapid increase in chronic diseases (and those related to ED = underestimated) • Can epidemiological studies link ED exposure to diseases • Critical periods of exposure: fetal, neonatal and puberty
CHALLENGES POSED BY ED • Effects at very low doses • The effect is not the same depending on the moment of life when the exposure occurs • Multiple exposures daily • Misunderstood interactions (cocktail effect) • Effects are not visible immediately (transgenerational effects)
CHALLENGES POSED BY ED • Effects at very low doses • The effect is not the same depending on the moment of life when the exposure occurs • Multiple exposures daily • Misunderstood interactions (cocktail effect) • Effects are not visible immediately (transgenerational effects)
DO WE NEED TO WORRY ABOUT OUR CHILDREN? • They are more vulnerable – They are more exposed than adults – Eat, drink and breathe more frequently ... – Play near the ground and dust – Carry objects and their hands to their mouths – Their skin is thinner and absorbs more • They are developing
CHALLENGES POSED BY ED • Effects at very low doses • The effect is not the same depending on the moment of life when the exposure occurs • Multiple exposures daily • Misunderstood interactions (cocktail effect) • Effects are not visible immediately (transgenerational effects)
ORIGIN OF DETECTED SUBSTANCES
Phtalates Styling products
Personal care products
dimethyl phthalate (DMP)
Indoor air fresheners
diethyl phthalate (DEP)
Scented products
diisobutyl phthalate (DiBP)
Containers and plastic wrap
di-n-butyl phthalate (DBP)
Toys
butylbenzyl phthalate (BBzP)
Biomedical products
di(2-ethylhexyl) phthalate
Perfumes and scented products
[bis(2-ethylhexyl)phthalate] (DEHP)
Composés perfluorés Non-stick frying pans
Food packaging
Fabrics and carpets
perfluorooctanoic acid Body creams
perfluorooctanyl sulfonate Dental bristles
Medical and sports equipment
Athletic wear
Electronic appliancesCHALLENGES POSED BY ED • Effects at very low doses • The effect is not the same depending on the moment of life when the exposure occurs • Multiple exposures daily • Misunderstood interactions (cocktail effect) • Effects are not visible immediately (transgenerational effects)
CHALLENGES POSED BY ED • Effects at very low doses • The effect is not the same depending on the moment of life when the exposure occurs • Multiple exposures daily • Misunderstood interactions (cocktail effect) • Effects are not visible immediately (transgenerational effects)
EPIGENETIC REPROGRAMMING Felici, MD & Sala, GL (2015) Epigenetic Reprogramming in the Mammalian Germ Line: Possible Effects by Endocrine Disruptors on Primordial Germ Cells
DOHAD
WHAT IS IT?
• What happens in utero can have
consequences throughout life!
• The months we spend in utero are the
most important of our lives!FACTS… • ED exposure is a reality • These products are everywhere in our lives Information is the first step to protect ourselves
MAKING CHOICES AS A SOCIETY • Is the onus of responsibility on the consumer? • Can we demand improved protection? • How do we stimulate the supply of a safer products?
www.sabotage-hormonal.org Réseau des femmes en environnement Téléphone : 514 -987-3000 poste 6684 Courriel : info@rqfe.org
39
HEALING WITHOUT HARM:
REDUCING EXPOSURE TO
ENDOCRINE DISRUPTORS IN
HOSPITALS
PILOT PROJECT AT PIERRE
BOUCHER HOSPITAL’S NEONATAL
UNIT
Nathalie Robitaille, Assistant Director, SSE
Dre Émilie Fréchette-Pelletier, pediatrician at
Pierre-Boucher Hospital (CISSS Montérégie-
East)PILOT PROJECT OBJECTIVES
REDUCE EXPOSURE OF
PATIENTS AND STAFF TO
SUSPECTED ENDOCRINE
DISRUPTING CHEMICALS
(EDCS).PARTICIPANTS
Pilot Hospital
✚ Pierre Boucher Hospital, Longueuil, Quebec
✚ 350 beds
✚ Supply department, care team (nurses, respiratory
therapists, doctors), technical services director
Synergie Santé Environnement
♻️ Trainee
♻️ Assisstant DirectorWHY CHOOSE THE NEONATAL UNIT?
• Newborns are more vulnerable to exposure
from chemicals
• Nouveau-nés sont plus vulnérables à
l’exposition aux substances chimiques :
– Fine skin
– Less developed systems
– Per kilogram of weight, newborns eat, breathe and
drink more than an adultPOURQUOI AVOIR CHOISI L’UNITÉ DE NÉONATALOGIE Interest Innovative project
HEALING WITHOUT HARM
REDUCING EXPOSURE TO ENDOCRINE DISRUPTORS IN HOSPITALS
Pilot project at the neonatal intermediate care unit. A first in Canada!
1. Inventory the products to which babies and mothers are exposed
2. Target substances of concern
3. Establish communication with industries (suppliers & distributors)
4. Know the composition of the products
5. Look for healthy alternatives
ØAll these steps involve a participatory approach and apply the cautionary
principle! «Better safe than sorry»HEALING WITHOUT HARM
REDUCING EXPOSURE TO ENDOCRINE
DISRUPTORS IN HOSPITALS
1. Make an inventory of
the products babies are
exposed toHEALING WITHOUT HARM
REDUCING EXPOSURE TO ENDOCRINE
DISRUPTORS IN HOSPITALS
Know the inventory … 74 products under the magnifying glass
Diachylon en tissu Electrode (pour électrocardiogramme) Cathéter d'aspiration
Thermomètre numérique clinique Saturomètre Crème pour l'irritation mineure à sévère due à l'incontinence
Seringue Cathéter IV radio-opaque Lotion nettoyante pour les mains
Lunette nasale pour CPAP Rallonge à tubulure (partie d'un set) Canule nasale avec tube à oxygène
Microbore extension set Air cushion face mask Masque standard avec crochet taille 1
Gelée lubrifiante PVC nasopharyngeal airway Isolette (incubateur)
Seringue Tubulure à oxygène Matelas
Lingette préopératoire Contenant stérile à prélèvement Matelas
Pansement transparent adhésif avec cadre de pose Tubulure à acides aminés Système du cathéter IV fermé - deux ports
Gants chirurgicaux stériles en latex poudrés Onguent de zinc Cathéter d'aspiration, contrôle du vide
Tubulure à intraveineuse Cathéter multi-action Diachylon
Tubulure pour la transfusion sanguine Tubulure d'alimentation Poire d'aspiration
Injection de sodium chloride à 0.9% Tubulure avec filtre Gel de glucose
Nettoyant bébé Ventimasque Masque à ventilation
Contenant pour lait maternel Seringue de sodium chloride pour rinçage Tubulure, circuit de respiration pédiatrique
Fortifiant de lait maternel (poudre) Eau stérile pour inhalation Injection de dextrose à 5% dextrose
Préparation pour nourrisson à base de lait enrichie de fer Gel antimicrobien pour les mains Injection d'eau stérile
Préparation de suivi à base de lait pour prématurés Thermomètre Ballon d'anesthésie avec masque
Eau stérilisée Ensemble et plateau de drain thoracique Lingette de bain désinfectante
Tétine de biberon (bébés à terme et prématurés) Cathéter à succion gradué Bracelet d'identification
Cache yeux Cathéter ombilical Bouchon de seringue
Téterelle Sonde d'alimentation Echantillon de crème pour les mamelon
Intraveineuse papillon Oral/nasal tracheal tube cuffless Onguent ophtalmique
Brassard à pression Seringue tuberculine Multi-adaptateurPILOT PROJECT AT PIERRE BOUCHER HOSPITAL’S NEONATAL UNIT 2. TARGET SUBSTANCES OF CONCERN
HEALING WITHOUT HARM REDUCING EXPOSURE TO ENDOCRINE DISRUPTORS IN HOSPITALS TARGET SUBSTANCES OF CONCERN – Phthalates (Fragrance, DEHP, DiNP, DiDP, DEP, BBP, DiDP, etc.) – Bisphenols (Bisphenol A but also its cousins, Bisphenol S and F) – Brominated flame retardants (PBDEs - polybrominated diphenyl ethers) – Triclosan and triclocarban (antibacterial and antifungal) – Parabens – Mercury – Perfluorinated compounds (perfluocarbons or PFCs) – Formaldehyde
PHTALATES
ØTheir presence in medical products has been known
since the late 1960s.
ØDetected in the air administered by oxygen therapy
ØConcentration of DEHP increased from 0.126 mg / L
to 0.588 mg / L when the solute is stirred.
ØAcceptable DEHP dose is 0.037 to 0.02mg / kg / day
according to European Union Scientific Committee and
EPA
References : « The association between phthalate exposure and asthma »PILOT PROJECT AT PIERRE BOUCHER HOSPITAL’S NEONATAL INTERMEDIATE CARE UNIT 3. ESTABLISH COMMUNICATION WITH INDUSTRY (SUPPLIERS & DISTRIBUTORS) AMDRITMED JOHNSON & JOHNSON CARDINAL MAXTREC COOK MEDELA COVIDEN- MEDIQUE MEDTRONIC PHILIPS DEB-Canada SMITHS DRAEGER TELEFLEX DUFORT & LAVIGNE TRUDEL FISHER & PAYKEL WOOD WYANT INC HOSPIRA
HEALING WITHOUT HARM REDUCING EXPOSURE TO ENDOCRINE DISRUPTORS IN HOSPITALS 4. KNOW THE COMPOSITION OF THE PRODUCTS
PRODUCT COMPOSITION
• Total number of products with Endocrine Disrupting Chemicals (EDCs) based on their labels = 74
– Products containing EDCs= 12
– EDC free products= 18
– Unknown product composition= 44
• Total number of products containing EDCs according to a survey sent to suppliers
– Products with unknown compositions = 44
– No answer= 37
– Responses= 7 (Products containing EDCs= 1 | Products without EDCs= 6
• Total number of products containing EDCs at the end of the pilot project = 74
– Products containing EDCs = 13
– EDC free products = 24
– Unknown product composition= 37HEALING WITHOUT HARM
REDUCING EXPOSURE TO ENDOCRINE
DISRUPTORS IN HOSPITALS
5. RECHERCHER DES
ALTERNATIVES SAINES
Ø EVA, silicone, polyethylene,
polyurethane, but studies are limited.
Ø Silicone seems to be the best
alternative
Ø Cyclic olefin polymers (COP / COC)
can also be used as a safe alternative
to bisphenols.% AVERAGE POURCENTAGE OF PHATALATE PER PRODUCT Sources: 2004, Health Care Without Harm, Preventing Harm from Phthalates: Avoiding PVC in Hospitals 1999, Phthalates in PVC Medical Products from 12 Countries, Greenpeace USA
COMPOSITION OF THE MATERIAL
Ball of anesthesia with mask
ØPercentage of PE weight based on total
weight of material 16.6%
Presence of DINPCOMPOSITION OF THE MATERIAL
Nasal Canule and Oxygen Tube
ØPercentage of EDC weight based
on total weight of material:
26.7%
DEHP presenceCOMPOSITION OF THE MATERIAL
IV bag
ØPercentage of EDC weight based
on total weight of material:
30.7%
PVCCOMPOSITION OF THE MATERIAL
Suction catheter
ØPercentage of EDC weight based on total
weight of material: 33.9%
DEHP PresenceCOMPOSITION DU MATÉRIEL
Oral / nasal tracheal tube cuffless
ØPercentage of EDC weight based on
total weight of material: 27.3%
DEHP presenceCOMPOSITION OF THE MATERIAL
Nasopharyngeal
Tube
ØPercentage of EDC weight based on
total weight of material : 33%
PVCGLOBAL INITIATIVES FOR ALTERNATIVES TO ENDOCRINE DISRUPTORS
STEPS TAKEN TO LIMIT EDCS IN HOSPITALS
PVC-free blood-bag project (Sweden)
• Civil Society Initiative (online petition)
• Collaboration between industry and the medical sector (4 European companies)
Hospital of Southern Jutland (Denmark)
• Started removal of material containing PVC (2005)
PVC-free NICU of the Vienna Hospitals Association (Austria)
• Withdrawal of medical equipment containing PVC for premature infants (2001-2010) (+ 15%)
Clémentville Clinic (France)
• Phthalate suppression in medical devices (2010) (+ 5%)
Karolskina University Hospital
Neonatal Unit
Stolkholm, Sweden
2014- Complete phase out of PVCCASE STUDY: KAISER PERMANENTE'S
APPROACH
– Health care and insurance - 35 hospitals and more than 400 medical
centers - 10.2 million members
– Replacement of PVC in intravenous material (2012)
Asked subcontractor to find material
without DEHP
Standardized purchases to reduce
costs: change affects 100 tons of
medical equipment
Will likely have $ 5 million in
savings each yearSIMILAR APPROACHES ELSEWHERE IN THE
UNITED STATES
« Safer Chemicals Challenge» A
Healthier Hospitals initiative ØPVC reduction in medical equipment
)
ØMaintenance products without triclosan
–Gundersen (Wisconsin) ØElimination of mercury 30% of
–Advocate Health Care (Illinois) purchases to mobilize without toxic
–Dignity Health (Californie) substances
–Innova Health System (Virginie)
–Partners Healthcare (Massa- chussetts)
–Orlando Health (Floride
–Tenet Healthcare (Texas)
–Spectrum Health (Michigan)SIMILAR STEPS IN FRANCE
THE INDUSTRY IS STARTING TO MOVE IN QUEBEC ! • Medtronic replaces DEHP with DHET in its products
PEDIATRICIAN CONCLUSION
STEPS TO REDUCE ENDOCRINE DISRUPTING CHEMICALS IN YOUR EVERYDAY LIFE! READ THE INGREDIENTS!
THANK YOU !
CONTACT INFORMATION
CANADIAN COALITION FOR GREEN HEALTH CARE
Linda Varangu | linda@greenhealthcare.ca
SYNERGIE SANTÉ ENVIRONNEMENT
Nathalie Robitaille | nrobitaille@ssequebec.org
Jérôme Ribesse | jribesse@ssequebec.orgYou can also read
