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WASHINGTON — A coalition of medical and environmental groups is calling for the Environmental Protection Agency to tighten rules for dioxin emissions from hospital incinerators, which they say would force health-care providers to use fewer PVC products.

The Health Care Without Harm Coalition, which includes Greenpeace, the Environmental Working Group and Physicians for Social Responsibility, called for tighter rules in a March 6 report. That followed the November resolution by Washington-based American Public Health Association, which urged hospitals to cut back on PVC products.

The medical campaign follows a Greenpeace effort last month to force toy makers to stop using PVC. The environmental group also is considering expanding its anti-PVC campaign, said Rick Hind, a campaigner in the organization's Washington office.

But plastics industry officials said the anti-PVC campaign is not the right way to eliminate dioxins, which also can be created by burning human tissue and from natural events such as forest fires. The amount of PVC and chlorine going into an incinerator is not as important as how the incinerator is operated and how much pollution-control equipment is there, said Robert Burnett, executive director of the Vinyl Institute in Morristown, N.J.

A 1996 study sponsored in part by the Vinyl Institute found no statistically significant relationship between waste feed chlorine and dioxin emissions in 80 percent of the 90 facilities examined.

If PVC is removed from the medical waste stream, ``there is still about a million times as much chlorine present in the waste stream as is needed to create dioxin,'' Burnett wrote in a March 5 letter to health-care officials.

Ann Baldwin, the director of technology and regulatory affairs for the Health Industry Manufacturers Association in Washington, said ``misinformation'' from groups like Greenpeace is gaining steam.

She said there are no alternatives to PVC for some medical products and development costs need to be considered for other alternatives. She noted that the American Medical Association has put off a recommendation on PVC until EPA completes a review of the health effects of dioxin. The International Agency for Research on Cancer last month classified dioxin as a carcinogen.

Burnett said the campaign will have little impact on PVC's use and medical industry officials said they have not yet seen large-scale moves away from PVC.

``It has not made it to the consciousness of the physicians,'' said Peter Orris, a Chicago physician who introduced the APHA resolution.

But some hospitals are looking very seriously at it, said Hollie Shaner, a Burlington, Vt., hospital waste consultant and author of several books for the American Hospital Association.

Shaner is also a member of the health-care coalition, which is in Washington.

Until recently, environmental concerns about PVC did not figure into hospital purchasing decisions, but that is starting to change, said David Rice, a regional sales manager for Irvine, Calif.-based McGaw Inc., which makes non-PVC intravenous bags and solution. McGaw has about 20 percent of the market, while PVC products have the rest, he said.

Tenet Healthcare Corp., in Santa Barbara, Calif., recently bought non-PVC IV bags from McGaw partly because of environmental concerns surrounding PVC, he said. Tenet, one of the nation's largest investor-owned health-care systems, said the non-PVC product has a "value-added benefit,'' and the decision was based on many factors.