AP-HP & ARS ÎLE-DE-FRANCE
Ecomaternities in Île-de-France: a guide to get you through!
Launched in 2021 by ARS Île-de-France and AP-HP, the eco-maternity project has helped to develop best practices in pilot establishments, culminating in the production of a charter open to all, setting out 24 concrete, accessible actions for taking the eco-responsibility step.
The 13 maternity units of theAP-HP6 non-AP-HP public maternity hospitals in the 92 and 93 regions and 3 perinatal networks are taking part in the project, which has a dual objective. "On the one hand , the aim is to raise awareness among maternity hospital staff, to encourage them to adopt more environmentally-friendly practices, and on the other, to reduce the exposure of patients and caregivers to environmental pollutants such as endocrine disruptors ", explains Dorothée Henin, representing the Direction de l'offre de soins of theARS Île-de-France. The project is based on four pillars: staff training, in-clinic diagnostics, a charter of good practice and a toolbox.
The key role of training for collective involvement
Caregivers, bio-cleaning referents, catering staff, operational hygiene teams, pharmacists, buyers, works engineers... all profiles are targeted. "It' s essential that it's a collective project ," stresses Lucie Garcia, head of the AP-HP's ecoresponsible maternity unit project. Three training formats, in addition to a toolbox (see box), have been developed: a classic formula with trainers who have been working on environmental health for some twenty years, and webconferences of 1h30 to 2h led by experts targeting certain professions " to reach profiles that are a little difficult to find in training ", explains Lucie Garcia.
For example, Dr Philippe Carenco described the implementation of bio-cleaning in the Nice and Hyères maternity units. This was followed by exchange workshops between the 19 maternity units to share best practices, such as cord care with soap and water at the Port-royal maternity unit. " Two pediatricians agreed to be filmed to explain what was easy to implement, what wasn't, and how they went about it," says Lucie Garcia.
Toolbox: when Barbie and green plants play the training game
Set up in a waiting room, "mon écologis " is a real eye-catcher. In a multi-storey showcase on wheels, you'll discover the various furnished rooms of a doll's house, with colored dots highlighting good and bad environmental health practices. A red dot tells you not to put plastic containers in the microwave oven, while a green one recommends washing with soap and water...
" The idea is to retain a few key environmental health messages even when you're just passing through a waiting room," explains Lucie Garcia. " The establishments that have equipped themselves - at a cost of around €1,000 - are very satisfied because they manage to recruit many more moms for environmental health workshops when they promote them right next to the window! "
The ecologis scale corresponds to Barbie houses, so rooms can be customized with furniture or Barbie dolls. " At Necker, they added plants and an ashtray ..." And on the bottom two floors, maternity units showcase their initiatives: a green briefcase offered to mothers, a welcome kit for new caregivers including a water bottle, an already-washed baby bodysuit promoting second-hand purchases, and so on. ■
A photo at a moment T
In order to tackle the problem of pollutants in a concrete way, eight pilot maternity units were given environmental health diagnoses. " Funded by ARS Île-de-France, these diagnoses were carried out by Dr. Isabelle Farbos, an expert in epigenetics at Habitat Santé-ENvironnement, who has already diagnosed some 50 maternity units in the Nouvelle-Aquitaine region," explains Lucie Garcia. " The aim was to get a snapshot at a given moment of where the maternity hospital stands and what the priority areas for action are. "
In each case, the auditor spent three days on site, after having asked each maternity unit player to pre-fill in the grids. " In the pharmacy, for example, she checked whether breast pump tubing contained DEHP (a phthalate), or whether the products used to remove adhesives contained CMR (carcinogenic and mutagenic) particles... She also studied the alternatives used in other maternity units ... "
The good news is that many eco-responsible practices have already been adopted at most facilities. " Work teams at Robert-Debré, for example, have chosen phthalate-free floor coverings, while catering teams at Lariboisière and GHU Sorbonne have made good progress in applying the Egalim law. We have also seen that the Montfermeil maternity hospital has limited the formaldehyde (formaldehyde) exposure of caregivers by choosing to send fresh tissue to laboratories ...".
Ecomaternity charter: follow the guide
After 3 years of operation, the maternity units in the program have expressed the wish to draw up an eco-maternity charter - drawn up by a group of multi-disciplinary players (nursing teams, support/management functions, central purchasing agencies, etc.) and scientifically validated at each stage by members of the ARS, toxicology physicians and representatives of the CPS Île-de-France.
24 priority actions (broken down into 112 measures) in 8 fields of application have been identified, which are intended to be concrete and accessible in the short term: improving the framework for patient care and working conditions for professionals, reducing waste and resource consumption, integrating regulations (such as the Egalim law), training eco-maternity referents... Several levels of involvement are proposed, and some measures are compulsory. " Most of the pilot establishments have formalized their commitment by signing this charter ", says Dorothée Henin, who is delighted to invite all maternity units in the Paris region to join the project.
Hospitals have a prescriptive role to play
" Hospitals have a real role to play as prescribers," says the head of the AP-HP's eco-responsible maternity unit project. " If tomorrow, no hospital orders a product that poses a problem, suppliers will start to think again!
At present, not all pharmacy references have an ecological counterpart. " Ultrasound gel, for example, no longer contains parabens, but methylisothiazolinone (MIT), another allergenic preservative ..." explains Lucie Garcia. " We could replace it with sterile ultrasound gel used for endocavitary examinations, but it comes in plastic single-dose form, so for one ultrasound, you'd need ten, which in terms of waste is not an option. " However, " hospitals have a real role to play as prescribers ", says the head of the AP-HP's eco-responsible maternity unit project. " If tomorrow, no hospital orders a product that poses a problem, suppliers will start to think again! ■