Healthcare Environmental Resource Center (HERC)

Profile of the Healthcare Industry:
EPA Office of Compliance Sector Notebook Project
(Click here to access entire document in PDF format)

This is a primer for those in the industry, government or the general public who want to familiarize themselves with environmental issues associated with healthcare and for those seeking a starting point for additional research. It contains chapters on the various services provided by healthcare facilities and the pollutants and environmental regulations associated with each.

Printed copies of this document are available free of charge from EPA's document warehouse, the National Service Center for Environmental Publications. Be sure to search by the EXACT title or EPA publication number (EPA/310-R-05-002). Once documents are out of stock they will not appear in the data system and cannot be back ordered.

For details about the Sector Notebook Project and a complete list of all the industries and governments profiles, visit the Sector Notebook Web page.

This table lists all links contained in the document so that they can be repaired as web pages/URL's change.

Page	Title	Link
i	Electronic versions of all Sector Notebooks	http://www.epa.gov/compliance/resources/publications /sectors/notebooks/index.html
i	EPA’s National Service Center for Environmental Publications	http://www.epa.gov/ncepihom
ii	Electronic versions of all Sector Notebooks	http://www.epa.gov/compliance/resources/publications /sectors/notebooks/index.html
2	Electronic versions of all Sector Notebooks	http://www.epa.gov/compliance/resources/publications /sectors/notebooks/index.html
6	American Hospital Association’s (AHA) criteria for registration as a hospital facility	http://www.hospitalconnect.com/ aha/ resource_center/
19	Environmental Management Guide for Small Laboratories	http://www.epa.gov/sbo/labguide.htm
25	A Guide for Dentists: How to Manage Waste From Your Dental Practice University of Wisconsin—Extension	http://www.uwex.edu/shwec/Pubs/ pdf/guidefordentists.pdf
25	Guidelines for New Mexico Dental Facilities Waste-Management, Education and Research Consortium	http://www.cabq.gov/p2/pdfs/dental booklet.pdf
25	Characteristics and Treatment of the Dental Wastewater Stream, University of Illinois, Chicago	http://www.wmrc.uiuc.edu/main_sections/ info_services/library_docs/rr/RR-97.pdf
25	Options for Dental Mercury Reduction Programs: Information for State/Provincial and Local Governments, U.S. EPA and Environment Canada	http://www.epa.gov/region5/air/mercury/ dentaloptions3.pdf
25	Northeast Waste Management Officials' Association (NEWMOA) has both a Dental Mercury Topic Hub	http://www.newmoa.org/Newmoa/htdocs/ prevention/topichub/toc.cfm?hub=103& subsec=7&nav=7
25	NEWMOA list of links to articles , fact sheets, and case studies	http://www.newmoa.org/Newmoa/htdocs/ prevention/topichub/bibliography.cfm?hub =103&subsec=7&nav=100
27	Practice Greenhealth	http://www.Practice Greenhealth-online.org
29	Flowchart that outlines the major steps in the hazardous waste identification process	http://www.fedcenter.gov/resources/ facilitytour/hazardous/whatis/flowchart/
30	Healthcare Environmental Resource Center	http://www.hercenter.org
33	Identification and Management of Regulated Hazardous Waste, A Workshop Geared Toward Healthcare Facilities”	http://www.Practice Greenhealth-online.org/pubs/ chemmin/master.pdf
38	Pharmaceutical wastes resources	http://www.Practice Greenhealth-online.org/tools/ chem-pharm.htm
39	Returns Industry Association	http://www.returnsindustry.com
41	Requirements for labeling, storage, and manifesting.	http://www.epa.gov/epaoswer/ hazwaste/id/univwast.htm
41	Information on management of universal wastes at hospitals	http://www.Practice Greenhealth-online.org/tools/ univwast.htm
49	Environmentally Preferable Purchasing (EPP).	http://www.epa.gov/opptintr/epp/
57	Facilities currently operating incinerators	http://www.epa.gov/ttn/atw/129/hmiwi/ 2004hmiwi_inventory.xls
58	Information regarding EPA's HAP regulations for industrial, commercial and institutional boilers and process heaters.	http://www.epa.gov/ttn/atw/boiler/ boilerpg.html
59	Healthcare Guide to Pollution Prevention Implementation through Environmental Management Systems	http://www.epa.gov/region02/healthcare/
59	Practice Greenhealth	http://www.Practice Greenhealth-online.org
59	Sustainable Hospitals project	http://www.sustainablehospitals.org
61	Return program	http://www.returnsindustry.com
63	Examples of products containing recycled materials	http://www.epa.gov/cpg
65	EPA WasteWi$e program	http://www.epa.gov/wastewise
68	Sustainable Hospital Project	http://www.sustainablehospitals.org
72	Electronic Code of Federal Regulations (e-CFR)	http://www.gpoaccess.gov/ecfr/
72	Federal Register	http://www.gpoaccess.gov/fr/index.html
76	EPA's NPDES web site	http://cfpub.epa.gov/npdes
76	EPA Regional pretreatment coordinator contact information	http://cfpub.epa.gov/npdes/contacts.cfm? program_id=0&type=NPDES
77	General Stormwater Information	http://cfpub.epa.gov/npdes/home.cfm? program_id=6
77	Stormwater Phase II Compliance Assistance Guide	http://www.epa.gov/npdes/pubs/ comguide.pdf
77	EPA's oil spill program	http://www.epa.gov/oilspill/
78	EPA's Office of Water	http://www.epa.gov/water/
78	EPA's NPDES site	http://cfpub.epa.gov/npdes/
79	EPA’s Safe Drinking Water website	http://www.epa.gov/ogwdw
79	Hazardous waste evaluation flowcharts	http://www.epa.gov/region02/healthcare/
84	RCRA hazardous waste rules. Some states may nothave adopted this policy. See also:	http://www.epa.gov/epaoswer/ hotline/94report/12_94.txt
86	EPA's Office of Solid Waste	http://www.epa.gov/osw
86	Site-specific information on RCRA facilities within their states.	http://www.epa.gov/epaoswer/osw/ comments.htm
86	RCRA OnLine database	http://www.epa.gov/rcraonline
86	More information on RCRA Subtitle C	http://www.epa.gov/epaoswer/osw/ hazwaste.htm
86	Healthcare Environmental Resource Center	http://www.hercenter.org
89	More information on EPCRA	http://yosemite.epa.gov/oswer/ceppoweb. nsf/content/EPCRA.htm
89	More information on Hazardous Waste	http://www.epa.gov/ceppo/
89	EPA's TRI site	http://www.epa.gov/tri/
90	EPA Title 3	http://www.epa.gov/ceppo/pubs/title3.pdf
91	Information on Boilers	http://www.epa.gov/ttn/atw/boiler/ boilerpg.html
91	Hospital and/or medical/infectious wastes incinerators (HMIWI).	http://www.epa.gov/ttn/atw/129/hmiwi/ rihmiwi.html
92	Industrial, Commercial and Institutional Boilers and Process Heaters	http://www.epa.gov/ttn/atw/boiler/ boilerpg.html
92	Refrigerant Recycling Rule	http://www.epa.gov/region02/cfc/
92	EPA's Clean Air Technology Center	http://www.epa.gov/ttn/catc
92	Stratospheric Ozone Information Hotline	http://www.epa.gov/ozone
92	The RCRA OnLine database	http://www.epa.gov/rcraonline
93	On-line order form for RCRA publications	http://www.epa.gov/epaoswer/osw/ publicat.htm
93	Unified Air Toxics site	http://www.epa.gov/ttn/atw/
93	Office of Air and Radiation (OAR)	http://www.epa.gov/air/
95	A list of suspected asbestos-containing materials	http://www.epa.gov/Region06/6pd/ asbestos/asbmatl.htm
95	TSCA programs for lead	http://www.epa.gov/lead/regulation.htm
95	Approved PCB waste handlers	http://www.epa.gov/pcb/
95	EPA Asbestos Management & Regulatory Requirements	http://www.epa.gov/asbestos/help.html
97	MMWR Recommendation and Report on Dental Infection Control Guidelines	http://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5217a1.htm
97	Guidelines for Environmental Infection Control in Health-Care Facilities	http://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5210a1.htm
98	EPA’s Pesticide Program	http://www.epa.gov/pesticides
98	EPA’s Office of Compliance, Pesticide Compliance Assistance	http://www.epa.gov/pesticides/ enforcement/assistance.htm
98	EPA’s Office of Compliance Agriculture and Ecosystem Division	http://www.epa.gov/compliance/ assistance/sectors/agriculture.html
98	The National Agriculture Compliance Assistance Center	http://www.epa.gov/agriculture/
98	National Pesticide Information Center	http://npic.orst.edu/
98	EPA’s Antimicrobial hotline	http://www.epa.gov/oppad001/
99	EPA’s Effluent Guidelines Program	http://www.epa.gov/guide/
99	Area Source Category NESHAP regulations.	http://www.epa.gov/ttn/atw/urban/ arearules.html
99	Waste management requirements of universal wastes	http:www.epa.gov/epaoswer/hazwa ste/id/univwast/regs.htm
101	National Response Team's Integrated Contingency Plan Guidance	http://yosemite.epa.gov/oswer/ceppo web.nsf/content/sta-loc.htm
101	HAZMAT web site	http://hazmat.dot.gov/hazhome.htm
101	Nuclear Regulatory Commission (NRC)	http://www.nrc.gov
101	Occupational Safety and Health Administration (OSHA)	http://www.osha.gov
101	OSHA also has a Hospital eTool	http://www.osha.gov/SLTC/etools/ hospital/mainpage.html
102	USPS web site and reference the Domestic Mail Manual	http://pe.usps.gov/
102	National Institutes of Health, Centers for Disease Control (CDC)	http://www.cdc.gov
102	Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings	http://www.cdc.gov/niosh/docs/ 2004-165/
102	U.S. Department of Health and Human Services (HHS)	http://www.hhs.gov
104	The ECHO database	http://www.epa.gov/echo/index.html
105	Sector Notebook data refresh web page	http://epa.gov/compliance/resources/ publications/assistance/sectors/notebooks /data_refresh.html
112	Protect Your Family from Lead in Your Home	http://www.epa.gov/opptintr/lead/leadpdfe.pdf
119	More information about the healthcare initiative	http://www.epa.gov/Region2/healthcare/ index.html
119	Hazardous waste regulation in general	http://www.epa.gov/epaoswer/osw/index.htm
121	More information about hazardous waste regulations	http://www.epa.gov/epaoswer/osw/index.htm
124	Yale-New Haven Hospital and EPA say they have reached an agreement ...	http://pubs.bna.com/ip/BNA/den.nsf/is/ a0b0d4k1d7
126	Resource Conservation Challenge (RCC)	http://www.epa.gov/epaoswer/osw/conserve/
126	Performance Track Hotline	http://www.epa.gov/performancetrack/
126	EPA’s Audit Policy	http://www.epa.gov/compliance/incentives/ auditing/index.html
126	See voluntary audit policy at:	http://www.epa.gov/region02/healthcare/
127	Office of Solid Waste and Emergency Response (OSWER) Innovations Pilot	http://www.epa.gov/oswer/iwg
128	EPA Pesticide Initiative web site	http://www.epa.gov/oppfead1/safety/ healthcare/healthcare.htm
128	EPA and Veterans Health Administration (VHA) Cooperative Environmental Partnership	http://www.epa.gov/compliance/federalfacilities/ compliance/epavha.html
129	WasteWi$e Program	http://www.epa.gov/wastewise
129	Energy Star®	http://www.energystar.gov/healthcare
129	Small Business Compliance Policy	http://www.epa.gov/smallbusiness/
130	Healthy Building Network (HBN)	http://www.healthybuilding.net/healthcare /index.html
130	Health Care Without Harm (HCWH)	http://www.noharm.org/
130	The Sustainable Hospitals Project (SHP)	http://www.sustainablehospitals.org
131	Nightingale Institute for Health and the Environment (NIHE)	http://www.nihe.org/
131	Canadian Centre for Pollution Prevention (Healthcare EnviroNet)	http://www.c2p2online.com/main.php3? section=83&doc_id=169
131	Recovered Medical Equipment for the Developing World (REMEDY)	http://www.remedyinc.org/about_us.cfm
131	Public Entity Environmental Resource (PEER) Center	http://www.peercenter.net/
132	ISO 14000	http://www.iso.ch/iso/en/ISOOnline. openerpage
132	Joint Commission on Accreditation of Healthcare Organizations (JCAHO)	http://www.jcaho.org/
132	American Hospital Association (AHA)	http://www.aha.org/
133	American Medical Association (AMA)	http://www.ama-assn.org/
133	American Dental Association (ADA)	http://www.ada.org/
133	American Nurses Association (ANA)	http://www.ana.org/
134	American Veterinary Medical Association (AVMA)	http://www.avma.org/
134	American Health Care Association (AHCA)	http://www.ahca.org/
134	American Society for Healthcare Environmental Services (ASHES)	http://www.ashes.org/
134	American Society for Healthcare Engineers (ASHE)	http://www.ashe.org/
135	College of American Pathologists (CAP)	http://www.cap.org/
135	National Indian Health Board (NIHB)	http://www.nihb.org
138	American Hospital Association	http://www.hospitalconnect.com/aha/ resource_center/fastfacts/fast_facts_ US_hospitals.html
138	The Centers for Medicare & Medicaid Services (CMS)	http://www.cms.hhs.gov/
138	The MedPAC reports	http://www.medpac.gov/
138	U.S. Census Bureau	http://www.census.gov/prod/ec97/97 s62-sz.pdf
138	Webster’s Medical Dictionary	http://www.abms.org/Downloads/ Which%20Med%20Spec.pdf
138	The American Veterinary Medical Association	http://www.avma.org/membshp/ marketstats/usvets.asp
139	The TrendWatch report by the Lewin Group	http://www.hospitalconnect.com/aha/ press_room-info/specialstudies.html
139	Centers for Disease Control and Prevention	http://www.cdc.gov/ncidod/hip/sterile /sterilgp.htm
139	Practice Greenhealth	http://www.Practice Greenhealth-online.org/pubs/ chemmin/master.pdf http://www.Practice Greenhealth-online.org/pubs/ wrguide/wappe.pdf
139	Occupational Health and Safety Administration (OSHA)	http://www.osha.gov/SLTC/etools/ hospital/index.html
139	PROACT	http://www.afcee.brooks.af.mil/pro- act/pro-acthome.asp
139	U.S. EPA Region 3	http://www.epa.gov/reg3artd/airregulations/ ap22/incin2.htm
139	World Healthcare Organization	http://www.who.int/water_sanitation_health/ medicalwaste/en/guide2.pdf
139	Non-Incineration Medical Waste Treatment Technologies	http://www.noharm.org/nonincineration
140	Identifying and Managing Hazardous Pharmaceutical Waste	http://www.Practice Greenhealth-online.org/tools/chem- pharm.htm
140	University of Iowa Virtual Hospital Site	http://www.vh.org/welcome/aboutus/ index.html
140	U.S. Department of Labor Program Highlights Fact Sheet No. OSHA 91-38. Waste Anesthetic Gases	http://www.osha.gov/pls/oshaweb/owadisp. show_document?p_table=FACT_SHEETS&p _id=128
140	EPA’s Hospital/Medical/Infectious Waste Incinerators	http://www.epa.gov/ttn/atw/129/hmiwi/ rihmiwi.html
140	Health Care Without Harm	http://www.noharm.org/library/docs /SHEA_Proceedings_Waste_Management_ White_Paper.pdf http://www.noharm.org/library/docs/ Going_Green_4-1_Waste_Minimization_ Segregation.pdf http://www.noharm.org/nonincineration http://www.noharm.org/details.cfm?type= document&id=599 http://www.noharm.org/library/docs/ Going_Green_The_Mercury_Problem _-_Fast_Facts.pdf.
140	Practice Greenhealth	http://www.Practice Greenhealth-online.org/tools/chemplan.htm
140	U.S. EPA FRN 40 CFR Part 60 Standards	http://www.epa.gov/ttn/atw/129/hmiwi/ fr91597.pdf
140	Western Regional Pollution Prevention Network	http://www.wrppn.org/hospital/azhospitalp2.cfm
140	World Health Organization	http://www.who.int/inf-fs/en/fact253.html
140	Environmentally Conscious Manufacturing Strategic Initiative Group. Hospitals and Health Care Impacts, Risks and Regulations	http://ecm.ncms.org/eri/new/IRRhosp.htm
141	Kentucky Cancer Registry Online Abstractor Manual, Appendix H	http://www.kcr.uky.edu/manuals/abstractor /appendix_h.pdf
141	Sustainable Hospitals Project Fact Sheets	http://www.sustainablehospitals.org
141	Minnesota Pollution Control Agency Health Care Fact Sheets	http://www.pca.state.mn.us/industry/ healthcare.html
141	U.S. Army Center for Health Promotion and Preventive Medicine. Management of Unused Pharmaceutical Nitroglycerin	http://chppm-www.apgea.army.mil/ documents/FACT/37-019-702.pdf
141	U.S. EPA Monthly Hotline Report December 1994 RCRA/UST, Superfund, and EPCRA. Notification Requirements for Exported Wastes	http://www.epa.gov/epaoswer/hotline /94report/12_94.txt
142	Kentucky Pollution Prevention Center. Healthcare Guide to Pollution Prevention Implementation through Environmental Management Systems	http://www.kppc.org/Publications/Print%20Materials/ Healthcare%20Guide/hospital%20manual%20disclaimer.doc
142	Electronic Code of Federal Regulations (e-CFR) BETA TEST SITE for 40 CFR	http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?&c=ecfr&tpl=/ecfrbrowse/Title40/ 40tab_02.tpl
142	The Office of Wastewater Management, NPDES Stormwater Program	http://www.epa.gov/npdes/stormwater
142	EPA’s Office of Solid Waste and Emergency Response	http://www.epa.gov/epaoswer/osw /laws-reg.htm
142	EPA’s Oil Program	http://www.epa.gov/oilspill/
142	EPA’s Polychlorinated Biphenyl (PCB)	http://www.epa.gov/pcb/
142	EPA’s Air Program Mobile Sources	http://www.epa.gov/ebtpages/air mobilesources.html
142	EPA’s Asbestos Management and Regulatory Requirements	http://www.epa.gov/asbestos/asbreg.html

Title

Electronic versions of all Sector Notebooks

EPA’s National Service Center for Environmental Publications

Electronic versions of all Sector Notebooks

Electronic versions of all Sector Notebooks

American Hospital Association’s (AHA) criteria for registration as a hospital facility

Environmental Management Guide for Small Laboratories

A Guide for Dentists: How to Manage Waste From Your Dental Practice University of Wisconsin—Extension

Guidelines for New Mexico Dental Facilities Waste-Management, Education and Research Consortium

Characteristics and Treatment of the Dental Wastewater Stream, University of Illinois, Chicago

Options for Dental Mercury Reduction Programs: Information for State/Provincial and Local Governments, U.S. EPA and Environment Canada

Northeast Waste Management Officials' Association (NEWMOA) has both a Dental Mercury Topic Hub

NEWMOA list of links to articles , fact sheets, and case studies

Practice Greenhealth

Flowchart that outlines the major steps in the hazardous waste identification process

Healthcare Environmental Resource Center

Identification and Management of Regulated Hazardous Waste, A Workshop Geared Toward Healthcare Facilities”

Pharmaceutical wastes resources

Returns Industry Association

Requirements for labeling, storage, and manifesting.

Information on management of universal wastes at hospitals

Environmentally Preferable Purchasing (EPP).

Facilities currently operating incinerators

Information regarding EPA's HAP regulations for industrial, commercial and institutional boilers and process heaters.

Healthcare Guide to Pollution Prevention Implementation through Environmental Management Systems

Practice Greenhealth

Sustainable Hospitals project

Return program

Examples of products containing recycled materials

EPA WasteWi$e program

Sustainable Hospital Project

Electronic Code of Federal Regulations (e-CFR)

Federal Register

EPA's NPDES web site

EPA Regional pretreatment coordinator contact information

General Stormwater Information

Stormwater Phase II Compliance Assistance Guide

EPA's oil spill program

EPA's Office of Water

EPA's NPDES site

EPA’s Safe Drinking Water website

Hazardous waste evaluation flowcharts

RCRA hazardous waste rules. Some states may nothave adopted this policy. See also:

EPA's Office of Solid Waste

Site-specific information on RCRA facilities within their states.

RCRA OnLine database

More information on RCRA Subtitle C

Healthcare Environmental Resource Center

More information on EPCRA

More information on Hazardous Waste

EPA's TRI site

EPA Title 3

Information on Boilers

Hospital and/or medical/infectious wastes incinerators (HMIWI).

Industrial, Commercial and Institutional Boilers and Process Heaters

Refrigerant Recycling Rule

EPA's Clean Air Technology Center

Stratospheric Ozone Information Hotline

The RCRA OnLine database

On-line order form for RCRA publications

Unified Air Toxics site

Office of Air and Radiation (OAR)

A list of suspected asbestos-containing materials

TSCA programs for lead

Approved PCB waste handlers

EPA Asbestos Management & Regulatory Requirements

MMWR Recommendation and Report on Dental Infection Control Guidelines

Guidelines for Environmental Infection Control in Health-Care Facilities

EPA’s Pesticide Program

EPA’s Office of Compliance, Pesticide Compliance Assistance

EPA’s Office of Compliance Agriculture and Ecosystem Division

The National Agriculture Compliance Assistance Center

National Pesticide Information Center

EPA’s Antimicrobial hotline

EPA’s Effluent Guidelines Program

Area Source Category NESHAP regulations.

Waste management requirements of universal wastes

National Response Team's Integrated Contingency Plan Guidance

HAZMAT web site

Nuclear Regulatory Commission (NRC)

Options for Dental Mercury Reduction Programs: Information for State/Provincial and Local Governments, U.S. EPA and Environment
Canada

Flowchart that outlines the major steps in the
hazardous waste identification process

Identification and Management of Regulated
Hazardous Waste, A Workshop Geared Toward Healthcare Facilities”

Healthcare Guide to Pollution Prevention
Implementation through Environmental Management Systems

EPA’s Office of Compliance
Agriculture and Ecosystem Division

U.S. Army Center for Health Promotion and Preventive Medicine. Management of Unused
Pharmaceutical Nitroglycerin