Numerous initiatives and government, industry, labor, and community-based partnerships have recently been established to foster pollution prevention in hospitals and other healthcare facilities. A major focus is to replace medical products, materials and work practices that generate pollution with those that are more environmentally-sound. Thus far, many of these pollution prevention initiatives are applied without considering their impact on workers, even though it is well-known that changes in materials and work practices can have significant effects on occupational safety and health (OSH). Traditionally, occupational and environmental health and safety hazard assessments and interventions have been conducted separately. The purpose of this work was to develop an integrated approach to assess occupational and environmental health and safety in hospitals and use the approach to: 1) identify and implement effective intervention strategies to replace the use of conventional materials and products with more environmentally-sound, healthy and safe alternatives; and 2) to evaluate the impact of the alternatives on worker health and safety. An integrated approach was developed by worksite Observation and by adapting elements of existing pollution prevention and OSH survey methods including production process mapping, process hazard analysis, and job-task hazard analysis. The survey consists of multiple, nested questionnaires that begin at the level of the entire health care facility and progress to more specific levels of work organization, concluding with a detailed analysis of the tasks associated with the use of a hazardous material or product targeted for the intervention. The survey assesses OSH risks in five categories: safety, chemical, biological, physical, and ergonomic. The survey also includes environmental impact and cost analyses of the conventional material and its alternative. The survey is conducted pre- and post-intervention and the results compared. Twelve interventions were implemented and evaluated in 7 hospitals, including: replacement of formaldehyde from an anatomical pathology laboratory, xylene from histology laboratories, glutaraldehyde from endoscopy, wet film processing to digital imaging in radiology, and mercury containing equipment and reagents from clinical laboratories. This project showed that occupational health and safety and environmental protection are closely linked because the hazards share a common source in the production process. This intervention study was aimed at replacing hazard sources with safer and more environmentally sound alternatives. When these changes were implemented, whether for pollution prevention or technological improvements, there were impacts on worker health and safety. It is concluded that the methods developed here can be used to analyze future changes in materials and work practices in hospitals and to evaluate OSH impacts so they can be managed effectively.
Dept. of Work Environment, University of Massachuesetts Lowell, Lowell, MA 01854