12/20/2011. Going Green in the NICU. Neonatal Touch & Massage Certification By Creative Therapy Consultants. Kathi Randall

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1 Going Green in the NICU Kathi Salley Randall RN, MSN, CNS,NNP The Problem Silent Dangers in Baby Products 1

2 Objectives Name two functions of the skin Describe two differences between adult skin and infant skin List two potential adverse health effects of fragrances or preservatives found in body care products My company Initiatives and Education for a green-centered NICU 2

3 10 Ways to Go Green Now Get a Team Together Organic Food choices Green Building Construction Recycle and use recycled products Eliminate PVC & DEHP Eliminate Mercury New chemical policies/cleaning agents No parabens, phthalates, chlorine Opt for green purchasing Waste reduction Why Go Green Now? Health Care without Harm: To transform the health care sector worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment. Corporate Strategy 75% of CEOs surveyed globally recently rated sustainability as an important part of corporate strategy 3

4 And first, Do No Harm. The chemical world we live in today. Chemicals are unavoidable, but exposures can be minimized. 4

5 This is a new reality. > 82,000 synthetic chemicals on EPA inventory of chemicals manufactured in U.S. today Most first synthesized in the past 50 years ~ 700 new chemicals introduced each year Few chemicals tested for basic toxicity GAO Our American body burden The total amount of chemicals present in the human body at any given point in time Each human s unique chemical load GRN NICU Consulting (C)2008 5

6 Neonatal Touch & Massage Certification 6

7 How common is the problem? CDC: 4 th Report on human exposure chemicals in each person State of the Evidence Even fetuses are contaminated before birth. 7

8 A pregnant woman will pass chemicals in her body to her developing fetus through the placenta. Body Burden in the Fetus An average of 287 chemicals were found in newborn cord blood 180 linked to cancer 217 neurotoxins 208 birth defects Environmental Working Group 2004 Ten leading causes of infant mortality An infant death occurs within the first year of life. SIDS is Sudden Infant Death Syndrome. RDS is Respiratory Distress Syndrome. Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved September 21, 2010, from 8

9 BioMonitoring Study Oct 2009 PSR/ANA 12 MDs & 8 RNs from 10 states were tested for the presence of chemicals used in the health care setting that are associated with health problems. BioMonitoring Study Oct 2009 Results: Each participant had at least 24 individual chemicals present All participants had four high priority chemicals present in their samples including bisphenol A and phthalates These are on the EPA/FDA list of priority chemicals for regulation All associated with chronic illness Chemicals and Chronic Disease Infertility Low birth weight Asthma Leukemia Diabetes Autism Parkinson s disease Source: Safer Chemicals, Healthy Families., Jan

10 What s the Problem? Most Americans believe their government is making sure that chemicals used in the market place are safe. Unfortunately, that simply isn t true." Senator Frank Lautenberg June 2005 TSCA of 1976 is Broken TSCA of 1976 is Broken Toxic Substances Control Act of 1976 Number of Chemicals 62,000 Existing chemicals ~200 EPA-required testing 5 Restricted under TSCA 0 Restricted since ,000 New chemicals added U.S. GAO,

11 Safe Chemicals Act of 2011 April 14, The Safe Cosmetics Act (H.R. 2359) June 24, 2011 Will gives FDA the authority to ensure that personal care products are free of harmful ingredients and that ingredients are fully disclosed. Under the existing law, which has not been updated in 70 years, the FDA can't require cosmetics companies to conduct safety assessments, and can t even require product recalls. The Problem Silent Dangers in Baby Products 11

12 Skin Care = Developmental Care The Model s Focus The model focused the caregiver s attention to the interface linking the body/organism and the environment, specifically referred to as the shared care surface. This shared care surface was conceptualized as the place where body and environment meet. 12

13 Five Core Measures Protected sleep, Pain and stress assessment and management, Developmental activities of daily living, Family-centered care, and The healing environment. COUGHLIN M., GIBBINS S. & HOATH S. (2009) Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Journal of Advanced Nursing 65(10), doi: /j x Core measure 3: Developmental activities of daily living Positioning Feeding Skin Care Infant skin integrity is assessed, protected and care is documented The Top Silent Dangers Fragrance Phthalates Preservatives Parabens Quaternium 15 (Q15) 13

14 AWHONN Skin Guidelines 2007 Use skin cleansers with the least irritating formulation Mild cleaners with neutral ph Preference should be given to preservative-free products; or products that have demonstrated safety/tolerance profile Acid Mantle Both detergents and soap alter skin ph, soap increases ph more than detergents Weight the risks and benefits of all products AWHONN Skin Care Guidelines Three main principles related to skin cleansers: - No preservatives - ph Neutral - Non-irritating 14

15 Pathways for skin penetration Image Source: Skin Care Forum Stratum Corneum Hydration increases penetration Image source: 15

16 Functions of the Skin Barrier between external and internal Thermoregulation Sensory Organ AWHONN Skin Guidelines 2007 Goal of Neonatal Skin Care Prevent injury Avoid potential toxins for topic agents Reduce exposure to sensitizing agents Promote normal skin development Silent Dangers in Body Care Products 16

17 Watch out for the following: Fragrance Phthalates Preservatives Parabens Quaternium 15 (Q15) The Olfactory System One of the earliest emerging systems in fetal development Early fetal experience through the amniotic fluid provide for a continuous sensory environment from fetal to newborn life. The Olfactory System Attention to all sensory aspects of the infant's odor environment, including timing, duration and strength, and pairing with other salient cues, will go a long way to a void effects on the organization of the olfactory bulb as well as on the learned behavior of the infant. 17

18 Preference to Mom Both term and preterm infants detect and discriminate odor and taste and prefer their own mother's familiar odor and taste. Bonding Frangrance, Scents, Etc. Strong, ill-timed, and nonfamiliar odors can interfere with infant physiologic stability and behavioral organization 18

19 Fragrance The 2007 Allergen of the Year. American Contact Dermatitis Society 2010 Fragrance, perfume & cologne what s the difference? Under U.S. law, the term fragrance is defined as a combination of chemicals that gives a product its distinct scent. Fragrance ingredients may be produced by chemical synthesis or derived from petroleum or natural raw materials. These additives are frequently, but not always, listed on product labels and are protected as trade secrets and described on the label only as fragrance. 19

20 Exposure to Phthalates in Neonatal Intensive Care Unit Infants: Urinary Concentrations of Monoesters and Oxidative Metabolites, Jennifer Weuve, 1 et al Environ Health Perspectives, 2006 September; 114(9): Infant exposure to lotion, powder, and shampoo were significantly associated with increased urinary concentrations of phthalates Associations increased with the number of products used and infant age. Sathyanarayana, Feb 2008, Pediatrics Phthalates IV tubings Plastic toys Fragrance Nail Polish 20

21 Endocrine Disrupting Compounds A concern in perinatology is that EDCs might be interfering with normal development of reproductive organs, especially in males. male genital development is dependent on specific hormones being present at critical times during fetal development. Source: Two Endocrine Disruptors Phthalates IV tubings Plastic toys Fragrance BPA Polycarbonate plastic bottles Cans Source: Breast Cancer Fund, State of the Evidence 2010 BPA 21

22 And vendors are responding to the pressure from consumers Watch out for the following: Fragrance Phthalates Preservatives Parabens Quaternium 15 (Q15) Environmental Working Group, No More Toxic Tub Report 2009 Parabens Preservatives added to producnts to minimize microorganism growth 22

23 Parabens methylparaben ethylparaben propylparaben butylparaben isobutylparaben, isopropylparaben, benzylparaben Parabens Mimics estrogen in the body Found in breast tumors Courtesy of The Breast Cancer Fund, State of the Evidence 2010 Rising Breast Cancer Rates Change of incidence of breast cancer over time in in in in 8 Courtesy of The Breast Cancer Fund, State of the Evidence

24 The Campaign for Safe Cosmetics No More Toxic Tub Report (March 2009) The lab found that: Many popular products contain, or are contaminated with, harmful chemicals that are not listed on the label Quaternium 15 (Q15) Inexpensive compounds added to products to inhibit the growth of microorganisms by slowly releasing formaldehyde FRPs: formaldehydereleasing preservatives Many people develop allergies to formaldehyde and the FRPs Formaldehyde-Releasing Preservative in Baby and Cosmetic Products: Health Risks Related to Exposure During Infancy, Jessica N. Moennich, et al. Journal of the Dermatology Nurses' Association, May/June 2009 Double Standards Exposed New Report Released November

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26 GRN NICU Consulting (C)

27 Chemicals are unavoidable, but exposures can be minimized. What do we know?? There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don't know. But there are also unknown unknowns. There are things we don't know we don't know. Donald Rumsfeld 27

28 Precautionary Principle Better safe than sorry 28

29 Precautionary Principle When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context, the proponent of an activity, rather than the public, should bear the burden of proof. -- Wingspread Statement, 1998 Precautionary Principle Better safe than sorry Assume all chemicals are potentially harmful until proven safe Wondering, what to do next? 29

30 Inventory your Products 30

31 The Alliance of Nurses for Healthy Environments Healthcare Without Harm Visit my website 10 Ways to Go Green Now (at work and at home) 31

32 My company Initiatives and Education for a green-centered NICU Process for Getting Started 1. Pick a target issue 2. Educate yourself 3. Educate others (create a team) 4. Strategize on possible solutions 5. Investigate feasibility of alternatives (with help) 6. Present options to committees 7. Champion the cause! 8. Get recognition for your facility s work From Anna Gilmore Hall, HCWH 32