Greening the NICU: An Expert Interview With Kathi Randall, RNC, MSN, CNS, NNP-BC

Barbara Boughton

October 16, 2009

October 16, 2009 — Editor's note: Making healthcare settings, such as hospitals, more environmentally friendly is a fairly new concept, but one that's been attracting increasing interest. A presentation highlighting ways of greening the neonatal intensive care unit (NICU) was featured at the National Association of Neonatal Nurses 25th Annual Educational Conference (NANN), held September 23 to 26 in Austin, Texas.

Medscape Nurses talked to presenter Kathi Randall, RNC, MSN, CNS, NNP-BS, to find out more about the environmental health movement, and how it applies to neonatal healthcare settings. Ms. Randall is a neonatal nurse practitioner who has been a clinician for 14 years and has worked as a consultant to medical companies and hospitals for the past 10 years. Her research on methods to make the NICU more environmentally safe led her to launch the business, gRN NICU Consulting, which provides online education and networking opportunities for NICU nurses concerned about the environment.

Medscape: How did you get interested in the concept of "greening the NICU?"

Ms. Randall: I was watching Oprah on Earth Day 2008, and I really had a paradigm shift. I started thinking that I'm doing all these things at home to benefit the environment, but very little at work. The most we do in many hospitals is to sort bottles and paper for recycling. I realized there was a void about environmental issues in the NICU, and I started educating myself through long-standing nursing organizations concerned with environmental health, such as Health Care Without Harm. At a local NANN chapter meeting, I gave my first presentation and, although many of the nurses in the room were very experienced, I found that I was telling them things they hadn't heard before.

Medscape: What is involved in making NICUs more environmentally safe?

Ms. Randall: One important issue is the use of di(2-ethylhexyl) phthalate (DEHP), polyvinyl chloride (PVC), and other chemicals. We're all exposed everyday to a cocktail of chemicals, and the accumulated effects of these chemicals can be damaging. Our tiny developing patients are even more vulnerable. It's important for nurses to be aware of these chemicals and ways we can minimize exposure.

Medscape: What kind of chemicals do neonatal nurses use in their work, and what are the alternatives?

Ms. Randall: We use a lot of cleansing soaps and lotions with chemicals, including baby shampoos and soaps that have formaldehyde-releasing preservatives. Some have fragrances to mask other chemicals, and these contain phthalates, which are known endocrine disruptors. DEHP is also used in intravenous (IV) bags and IV tubing to make them flexible. To find alternatives that are less toxic, nurses can visit the Health Care Without Harm Web site. It's possible to find IV bags and tubing without DEHP, for instance. And there are benefits to using these alternatives. A recent study from Germany showed that infants who were fed using tubing without DEHP had a lower rate of cholestasis than those fed with tubing containing DEHP (Pediatrics. 2009;1242:710-716).

Using products like tubing without DEHP is really about the precautionary principle. The evidence about it can be argued, but it's better to be safe than sorry. In other words, it's better to assume that all chemicals are unsafe until proven safe. If we know there are issues with IV tubing with DEHP in animal models, for instance, why wouldn't we switch to a version without the chemical? It's still IV tubing, it's just a better version.

Medscape: What are other steps nurses can take to protect the environment in the NICU?

Ms. Randall: I think it's important to be aware of the potential risks. Another step is to consider using organic foods. A lot of fruits and vegetables have very high pesticide loads. It's especially important to go organic with fruits and vegetables that have peels that we consume. Hormone- and antibiotic-free milk can also contribute to health. These measures are not only important for our patients, but also for the families who eat in our hospital cafeterias. We should be providing them with the highest quality foods while they're guests at our hospitals.

Recycling is also crucial. At home we separate things that can be recycled from our trash, but in our units it's often thought to be okay to throw everything in the trash. But we need to go beyond recycling paper and plastics and think about composting, creating organic hospital gardens, and recycling electronic waste.

Medscape: When you give presentations on greening the NICU, what kind of reactions do you get from nurses?

Ms. Randall: Their first reaction is to feel a little bit overwhelmed because there's so much information they didn't know before. And then there's a little bit of fear, which I think is natural. But once you get past that, I think many nurses start to feel invigorated and empowered.

As neonatal nurses, we spend hours and hours in classes learning to take care of infants. But we sacrifice the kind of ongoing learning that affects our infants' and our own health. Being around chemicals has an effect on us too. So if we can make changes that benefit the environment, we all benefit. Most nurses want to make a big difference, so I think, at our core, all nurses are environmental health nurses.

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