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In keeping with its commitment to the overall health and well-being of the communities it serves, San Francisco-based Catholic Healthcare West (CHW) recently converted all 42 of its hospital campuses to DEHP- and PVC-free infusion products, ensuring a greater degree of patient and environmental safety in the delivery of hospital care.

Founded in 1986, CHW is today the eighth largest hospital system in the United States, and the largest not-for-profit hospital provider in California. Recognizing the health of its patients and communities is intrinsically tied to the health of the environment, the organization began taking actions to reduce its environmental footprint more than 10 years ago.

CHW joined the Coalition for Environmentally Responsible Economies (CERES) in 1996 and has since made its ecological activities public through audits and reports. CHW has worked to reduce red-bag waste, eliminate mercury and require food vendor policies on Bovine Growth Hormone and antibiotics for livestock. The organization is one of the first healthcare systems in the nation to track its greenhouse gas emissions from all its facilities.

DEHP, or Di (2-ethylhexyl) phthalate, is a chemical plasticizer used in many medical products made of polyvinyl chloride (PVC), such as IV bags and tubing, blood bags, catheters and other soft plastic materials. Widespread research by government groups, such as the National Toxicology Program of the U.S. Department of Health & Human Services’ National Institutes of Health (NIH) indicates potential problems when these chemicals leach into IV fluids – and then patient bloodstreams – during use. The destruction of PVC during waste disposal results in the release of dioxin, a potent carcinogen, into the environment. Additionally, some studies, including a 2005 study in Environmental Health Perspectives, suggest that DEHP can have harmful effects on the reproductive development of infant and young boys, as well as cause potential liver, kidney and lung damage.

While there has been controversy about the severity of these effects, CHW decided to take a stand against unnecessary additives that may cause harm. It began endorsing DEHP- and PVC-free products in 1997, and in 2003, renewed its commitment to patient and environmental safety by actively seeking alternative products free of these chemicals.

CHW realized it could make the greatest impact by converting IV containers and tubing to DEHP- and PVC-free products. These products, into which DEHP most easily leaches, deliver medication directly into patient bloodstreams. Along with its efforts to eliminate DEHP and PVC-free products, CHW converted to "smart" pump technology to reduce the potential for medication administration errors.

For a hospital system as large as CHW’s, extensive planning is the most important part of any conversion process. When making a decision affecting patient/community/environmental health, CHW adheres to an "Ethical Decision Process," which involves seeking input from various hospital leaders – in this case, representatives from supply, nursing and pharmacy, due to their regular contact with the new infusion products. The team spent almost four months gathering research on vendors and reviewing environmental impact studies and patient safety data before arriving at a contract decision.

Finding the right vendor and forming a close partnership with a mutual commitment to success is crucial to the successful implementation of new technology. B. Braun, CHW’s vendor for IV containers and tubing products, began offering DEHP-/PVC-free options decades before any other medical device manufacturer. Of equal importance to both entities is supporting a cleaner environment, protecting patient safety and improving clinician education through best practices.

Ultimately, CHW chose B. Braun’s infusion system, with a Dose Error Reduction System (DERS), which protects against manual programming errors, providing thorough data collection for later analysis. The benefits of the new system and the alternative tubing and sets were important to the ethical values of CHW, but staff buy-in was the key to the success of the change.

Once CHW adopted the new safety products, administrators focused on training the staff to properly use the equipment and enforce best practices. For example, CHW’s vendor worked to create seminars and Webinars about the importance of routine hand-washing and proper disinfection of needle-free valves. With these proven procedures in place, there have been no infections associated with the use of the new products.

CHW and the vendor team worked closely to realize clinical improvements and financial savings, and that collaboration later helped prepare each of the hospitals for conversion. To keep internal audiences informed, CHW undertook a targeted education campaign about its role in environmental safety including memos, research and posters.

In addition, Clinical Nurse Educators from B. Braun regularly met with CHW’s nursing leadership to create a training curriculum tailored to the network’s unique needs. Perhaps most important was the "Super User" program, which trained some nurses to become facility "go to" experts. Having these specially trained nurses on site provided a sense of order in the weeks following the conversion, and left a highly positive impression with staff.

Educating 15,300 nurses across the facilities in 192 days was a massive undertaking. The vendor was accessible and supportive even after the initial conversion, conducting retraining when requested to ensure staff was comfortable with the new technology, and in turn, met their concerns about patient safety.

By informing the staff of the reasons for the change, implementing early, and providing thorough training, CHW generally experienced a smooth transition to the new system.

The prospect of converting an entire 42-hospital system to new infusion products was a huge activity. However, with efficient planning and a dedicated team of both internal and external experts, the process resulted in a successful conversion with lasting impact for cost-cutting and improving of patient care.

CHW is hoping to set an example for other large healthcare systems in the United States. By implementing new DEHP-/PVC-free IV bags, over the next five years CHW will remove 1,896,509 pounds of PVC material from IV containers – resulting in a reduction of 557,434 pounds of landfill waste and eliminating the 477,989 pounds of HCI that would have entered the environment, had that material been incinerated.

Healthcare in the United States is under great pressure to control and moderate costs. Through due diligence and ethical decision-making, CHW found it was possible to achieve cost savings while enhancing patient and environmental safety. After an initial expenditure for training and education, CHW lowered costs associated with purchasing the new system.

As healthcare providers, organizations such as CHW are accountable for the health and safety of their patients. Equally, as citizens of the community in which they function, healthcare organizations are accountable for the health, safety and impact of their decisions on the environment. While CHW has made great progress in implementing DEHP-/PVC-free IV bags, the organization knows there is much more to do and continues to seek out other sustainable approaches to minimize its impact on the earth while caring for its patients.