Product Safety
According to Health Care Without Harm (HCWH), a safety coalition in Arlington, Va., manufacturers are not required to disclose their use of PVC, DEHP and mercury. One exception, it says, is latex, but vendors express “latex-free” in many different ways, including “nonlatex” and “LTX-FR,” making it difficult to search for them in an electronic database.
This problem is being addressed by Premier, the San Diego-based group purchasing organization and Cardinal Health, Dublin, Ohio, the distributor. Scouring their huge databases over the past few months, the two organizations have pulled together a list of safe alternatives for the four harmful substances and given them a standard identification.
The format is the name of the unwanted substance is in capital letters followed by “-FREE,” as in “LATEX-FREE.” The four identifications, thought to be the first in the industry, are available on Supply Chain Advisor, Premier’s electronic product catalog, and SupplyLine, Cardinal Health’s purchasing database. This approach makes for “a much easier search,” Callahan says. “It takes a great deal of time off the front end when you have to source the alternative products.”
“By using the same nomenclature each time, we allow the user to perform keyword searches on a consistent string of words,” says Sandy Schwartz, product director at Cardinal Health. “The user doesn’t have to search five different terms that all refer to the same product attribute.”
In most categories where the substances are used, Schwarz adds, products can be found that use alternative ingredients.
Joseph M. Pleasant Jr., chief information officer at Premier, says the new terminology represents one step in the quest for standardized identification for all products, which will allow users to identify functionally equivalent products.
He says Premier’s Supply Chain Advisor already attempts to identify functional equivalents, and the Food and Drug Administration has been assessing possible use of a unique device identification system, but he adds, “health care is still far behind other industries.”
Premier officials say that anyone is welcome to adopt the standard, but for it to be useful, they will still need to locate alternative identifications and translate them.
“Our customers have been telling us that they wanted to search our electronic product catalog to easily identify and select safer products,” says Gina Pugliese, vice president of Premier’s Safety Institute. With the new standardized indicators, “we’re taking a giant step in that direction.”
Pugliese reports that the four targeted substances are on many purchasing departments’ hit lists. Allergic reactions from latex are well known and mercury is an obvious poison.
PVC, or polyvinyl chloride, is a plastic that produces dioxin, a carcinogen, when it is manufactured or incinerated. DEHP, or di-2-ethylhexyl phthalate, is used to soften PVC in products such as intravenous bags, but it can leach out of IV bags and cause birth defects and harm infants.
Previously, purchasers looking for products without these harmful substances could consult lists on the Web sites of HCWH and the Sustainable Hospitals Project, Lowell, Mass., an affiliate of the University of Massachusetts at Lowell.
HCWH’s list of PVC- and DEHP-free products is “extensive but not exhaustive” and is updated yearly, says Mark Rossi, who helps compile the lists as research director for Clean Production Action, Medford, Mass., an HCWH affiliate. The HCWH list is consulted by Eney Gaines Wrinkle, equipment material coordinator for women’s and children’s services at 230-bed Evergreen Hospital Medical Center, Kirkland, Wash.
Wrinkle, who began removing products with DEHP in 2002, says some vendors still don’t identify which products are DEHP-free, although more are doing so now.
She welcomes the new standard nomenclature, noting that Evergreen, a Premier member, will be able to locate products eligible for Premier discounts.
Premier and Cardinal Health officials declined to name other harmful substances that might also be identified by the new standard identifications. The Sustainable Hospitals Project Web site (www.sustain ablehospitals.org), however, lists products that are free of a variety of other substances, such as accelerators in rubber, cadmium, cleaning agents, formaldehyde, glutaraldehyde, lead and xylene. The Web site also lists manufacturers of sharps safety products.
Rossi listed a few other harmful ingredients that might be identified in products. Polybrominated diphenyl ether (PBDE) is a flame retardant used in fabrics, such as surgical drapes, and in plastic casings for electronic equipment, such as the electronics for IV pumps. NPE, or nonylphenol ethoxylate, is a cleaning agent that is considered toxic. And nickel and lead are used in some electronic items.
“It’s nice to have the standard identifiers because it’s important that everyone knows about the alternative products,” Rossi says.
Leigh Page is a freelance writer based in Chicago.
Harmful materials that can be replaced with alternative ingredients
Standard terminology developed by Premier and Cardinal Health identifies safe
alternatives for products with the following harmful ingredients:
Latex: This rubber product in gloves and other items can cause allergic reactions.
PVC: Polyvinyl chloride produces a carcinogen when manufactured or incinerated.
DEHP: Di-2-ethylhexyl phthalate is used to soften PVC plastic, but it can leach out.
Mercury: It can be toxic to breathe the fumes in a small space.
Source: Health Care Without Harm, Arlington, Va., 2007
This article first appeared in the June 2007 issue of Materials Management in Health Care.
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