We carefully selected this list of chemical classes for inclusion in our reference. Some are hazardous and unnecessary in some instances. Some are hazardous and safer alternatives are available. Dioxin and mercury are on the list because health care institutions were once major contributors to environmental releases and pollution but there's still more to do. The chemicals classes listed here are good examples of how changes in health care practices helped address the problem and made a difference.

How to purchase safer products

From medical products like IV tubes and pulse oximeters to flooring, carpets, and building materials, safer toxic chemical-free alternatives are available. Learn how to purchase safer products, reusable products, and other alternatives.

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Learn more about chemicals of concern

Our standardized environmental criteria and additional Health Care Without Harm criteria offer additional details about priority chemicals of concern.

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Antimicrobials

With rare exceptions, very few studies support the use of antimicrobials in hospital furnishings as a means of reducing health care-associated infections. Sometimes antimicrobials are added to products, with the hope that they will reduce infection risk but may actually create a false sense of security, reduce adherence to proven methods of infection prevention, expose health care workers to toxic chemicals and contribute to antimicrobial resistance.

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Priority product categories

Bisphenol A (BPA)

Bisphenol A (4,4-dihydroxy-2,2-diphenylpropane or BPA) is a chemical substance used as a
monomer in the production of polymers such as polycarbonate, epoxy resins, polysulfone,
and some polyacrylates. BPA has applications in medical devices that have both direct and indirect contact with patients including those made of polycarbonate, polysulfone, and PVC such as medical tubing, catheters, haemodialysers, newborn incubators, syringes, and blood oxygenators. BPA has been shown to leach from medical devices into liquids administered to patients.

Exposures to BPA are associated with many health effects in humans, including reproductive effects (erectile dysfunction, miscarriage, infertility), cardiovascular diseases, thyroid, immune and metabolic diseases (diabetes), childhood obesity as well as general/abdominal obesity and hypertension, neurodevelopment impairments, respiratory conditions and behavior alterations (anxiousness, hyperactivity, depression).

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Priority product categories

  • Medical devices
  • Operating Room
  • Respiratory
  • Nursing supplies / patient care
  • Food packaging

Cleaners and disinfectants

Many traditional cleaning products, floor strippers, and disinfectants present a variety of human health and environmental concerns. They often contribute to poor indoor air quality and may contain chemicals that cause cancer, reproductive disorders, respiratory ailments (including occupational asthma), eye and skin irritation, central nervous system impairment, and other human health effects.

In addition, some of these products contain persistent, bioaccumulative, and toxic chemicals (PBTs), are classified as hazardous waste, and/or otherwise contribute to environmental pollution during their manufacture, use, or disposal.

Hospitals also use a variety of methods to disinfect and sterilize surfaces and equipment. Some of the most commonly used products, however, such as glutaraldehyde and ethylene oxide, have been shown to cause serious health effects. Alternatives to these products offer effective disinfection while protecting health care workers and the environment.

Definitions

Sterilization and disinfection chemicals are categorized by their potency and achieve different aims:

Sterilization is the complete removal or destruction of all forms of microbial life (including fungi and bacterial spores). Items must first be cleaned before sterilization to be effective. Sterilization is used for critical items like surgical equipment, central line catheters, urinary catheters, and IV fluids.

Disinfection eliminates most microorganisms, with the exception of bacterial endospores. Items must be clean for effective disinfection. Disinfection is further categorized into high, intermediate, and low-level disinfection

Cleaning is the removal of visible soil (organic and inorganic material) from objects and surfaces and is accomplished manually or mechanically using water with detergents or enzymatic products. Thorough cleaning is essential before high-level disinfection and sterilization because inorganic and organic materials that remain on surfaces interfere with the effectiveness of these processes.

Decontamination removes pathogenic microorganisms from objects so they are safe to handle, use, or discard.

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Priority product categories

Dioxin

Dioxin is a highly toxic and persistent substance that is the unintentional by-product of medical waste incineration and PVC plastic production. Other sources of dioxin include paper and pulp mills, municipal incinerators, cement kilns that burn chemical waste, and the manufacturing of some chlorinated pesticides.

Dioxin is a known human carcinogen. According to the U.S. Environmental Protection Agency, the general population exposure to dioxin may cause a lifetime cancer risk that is 1,000 times higher than the EPA's "acceptable" risk level. Other health problems associated with dioxin exposure include birth defects, learning disabilities, endometriosis, infertility, suppressed immune function, reduced IQ, and hyperactive behaviour in children.

In 1994, EPA estimated that medical waste incinerators were the leading source of dioxin air pollution. While no longer a leading source of dioxin pollution — thanks to the closure of thousands of medical waste incinerators due to grassroots activism and federal pollution standards — medical waste incineration is still a source of dioxin pollution, due in part to the large amount of disposable PVC plastic products used by hospitals.

Health Care Without Harm continues to work toward eliminating the health care sector's contribution to dioxin pollution by advocating for the closure of medical waste incinerators and the phase out of PVC plastic products.

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Priority product categories

Flame retardants

Flame retardant chemicals are designed to inhibit, suppress, or delay the production of flames to prevent the spread of fire. While sometimes necessary to meet specific fire safety standards, this is not always the case, and flame retardants can be avoided.

Chemicals that act as flame retardants are commonly added to a wide range of products such as IV pumps, televisions, computers, hospital beds, waiting-room chairs, and hospital privacy curtains. Flame retardants can be persistent and have a variety of toxic properties depending on the specific flame retardant. Non-polymeric flame retardants can migrate out of products into the environment resulting in human exposure.

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Priority product categories

Fragrances

Fragrance chemicals are organic compounds that volatilize or vaporize into the air, which is why we can smell them. They are added to products to give them a scent or to mask the odor of other ingredients. The volatile organic chemicals (VOCs) emitted by fragrance-containing products can contribute to poor indoor air quality (IAQ) and are associated with a variety of adverse health effects.

Exposure to fragrance chemicals can cause headaches; eye, nose, and throat irritation; nausea; forgetfulness; loss of coordination; and other respiratory and/or neurotoxic symptoms. Many fragrance ingredients are respiratory irritants and sensitizers, which can trigger asthma attacks and aggravate sinus conditions. Fragrances are typically dissolved in a solvent, sometimes a phthalate, before being added to the scented product, and there is generally no regulatory requirement to disclose the identity of the fragrance or its solvent on product labels.

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Priority product categories

  • Cleaning products
  • Fragrance-emitting devices and sprays
  • Laundry detergents, fabric softeners, or dryer sheets
  • Lotions and other skin products

Mercury no more

On August 16, 2017, the Minamata Convention on Mercury, a global treaty that aimed to phase out mercury-based medical devices by 2020, entered into force.

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Mercury

Mercury is a potent toxicant that can harm the brain, spinal cord, kidneys, liver, and immune system. The developing brain is particularly susceptible to long-lasting damage after low-level exposures. Mercury is used throughout health care in a variety of products, including thermometers; sphygmomanometers; dental amalgam; laboratory chemicals; preservatives such as thimerosal; cleaning agents; and various electronic devices such as fluorescent lamps and computer equipment. In recent years, a few of these uses have been sharply reduced as a result of widespread advocacy and the availability of safer alternatives. Nonetheless, the health care sector continues to contribute to mercury pollution in the environment by continued use, spills, breakages, and disposal of mercury-containing products. 

Fortunately, it is relatively easy to phase out the use of mercury because of the many safe, cost-effective non-mercury alternatives that exist for nearly all uses of mercury in health care. As part of a global initiative to reduce the use and spread of mercury in all aspects of society, Health Care Without Harm is leading the effort to eliminate mercury from the health care sector. 

Practice Greenhealth offers step-by-step resources that will make it simpler for any hospital with a mercury elimination goal to design, implement, and measure the success of their efforts.

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Priority product categories

Pesticides

In addition to being harmful to pests, pesticides can cause acute symptoms in humans, including nausea, headaches, rashes, and dizziness. Many are also linked to chronic diseases and conditions such as cancer, birth defects, neurological and reproductive disorders, and the development of chemical sensitivities.

Most people have no idea that the majority of health care institutions use chemical pesticides on a regular basis, both inside and outside of their facilities. Many patients, staff and visitors at health care facilities have underlying health conditions, such as compromised immune, neurological, or respiratory systems, that put them at increased risk of suffering harmful effects from pesticide exposure.

Integrated pest management (IPM) eliminates or greatly reduces the use of hazardous pesticide products. IPM prevents pest problems by reducing or eliminating sources of pest food, water, and shelter; blocking pest entry into buildings; and maintaining healthy soil and plants. Chemical pesticides are used only as a last resort and preference is given to the least-toxic pesticide that will accomplish the job. On the rare occasion that a toxic pesticide is used, ample notification is given to staff, patients, and the public.

Learn more about this strategy and how to implement it at your facility

Per- and polyfluoroalkyl substances (PFAS)

PFAS are widely used chemicals that make everyday products stain, water, and grease resistant. Unfortunately, they are long lasting chemicals, components of which break down very slowly over time. Some PFAS bioaccumulate, their concentrations building up in blood and tissues over time. Because of their widespread use and their persistence in the environment, many PFAS are found in the blood of people and animals all over the world and are present at low levels in a variety of food products and in the environment. Scientific studies show that exposure to some PFAS in the environment is linked to harmful health effects including: some kinds of cancer; decreased fertility; developmental effects or delays in children, including low birth weight, accelerated puberty, or behavioral changes; reduced immune system vaccine response; and increased cholesterol and risk of obesity. Since there are thousands of PFAS chemicals and they are found in many different consumer, commercial, and industrial products, they are exceedingly challenging to study and assess the full scope of their potential human health and environmental risks.

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Priority product categories

  • Flooring and carpeting
  • Reusable food service ware
  • Furnishings

Phthalates / (including diethyl-hexyl-phthalate (DEHP))

Ortho-phthalates, (hereafter ”phthalates”) , are a family of industrial chemicals with structural similarities used to soften polyvinyl chloride (PVC) plastic and as solvents in cosmetics and other consumer products. Extensive studies in laboratory animals and human populations show that exposure to various phthalates can damage the liver, kidneys, lungs, reproductive system, and developing brain.

For example, recent studies in human populations confirm some of the adverse impacts of diethyl-hexyl-phthalate (DEHP) on male reproductive tract development first identified in many experimental animal studies. A systematic review also finds that higher exposures to DEHP are associated with sperm abnormalities and lower testosterone levels.

Recent studies show that prenatal exposure to various phthalates is associated with adverse impacts on neurodevelopment, including lower IQ, and problems with attention and hyperactivity, and poorer social communication.

Medical devices made of flexible PVC, such as IV bags and tubing, can leach the phthalate DEHP into patients, resulting in some of the highest exposures to this toxic chemical. Several government agencies have concluded that some patients are likely to be exposed to potentially unsafe amounts of DEHP while receiving medical care. Researchers at the Harvard School of Public Health have found that sick infants treated in neonatal intensive care units can have high exposure levels to this reproductive and development toxicant.

Health Care Without Harm and Practice Greenhealth recommend health care facilities avoid PVC and DEHP and replace them with safer alternatives without compromising patient safety or care.

Hospitals in the Practice Greenhealth network have made eliminating PVC and DEHP a top priority. Practice Greenhealth offers step-by-step resources that will make it easier for any hospital to restrict the use of PVC and DEHP.

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Priority product categories

Polyvinyl chloride, PVC

Polyvinyl chloride (PVC) is a problematic plastic because it requires toxic additives, often including plasticizers like diethylhexyl phthalate (DEHP), and generates chemicals of concern, including dioxin, at various stages of its life cycle – from manufacture, through use and disposal – resulting in potentially hazardous exposures to those chemicals in the workplace, in communities, and in some patients.

Chemicals of concern include, but are not limited to carcinogens, reproductive toxicants, and endocrine disruptors. Recycling PVC is challenging without strict separation and segregation from other kinds of plastic. Even then, the complex mix of additives in various PVC products makes recycling difficult. And even small amounts of PVC can hinder recycling other kinds of plastic.

Health Care Without Harm’s analysis “Polyvinyl chloride in health care: A rationale for choosing alternatives” distills current research to reveal the human and environmental impacts of PVC from production to end-of-life. It details the human health risks posed by chemicals of concern associated with the production of PVC and toxic additives such as DEHP. It also explores the pollution associated with traditional methods of disposal and recycling. The report also offers a summary of recent research about alternatives.

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Priority product categories