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‘Green’ Tide on the Rise
For many years, environmental management in health care simply meant ensuring compliance with regulations about waste disposal, wastewater discharge and toxic chemical management. Few within health care facilities stopped to consider where waste comes from, the link between toxic materials and occupational safety, and ways to avoid pollution.
Recently, many environmental and facilities professionals have begun to realize that this approach unnecessarily limits their successes. This growing trend toward bigger-picture thinking has entailed a shift in approach. The updated approach increasingly involves collaboration with maintenance and engineering departments and occupational safety staff, and it requires dialogue with clinicians, lab staff, and hospitality and housekeeping departments, among others.
Working together, this network of hospital staff can identify preventive strategies to reduce the burden of regulatory compliance, eliminate occupational hazards, and even improve the organization’s bottom line.
An increased focus on the health care sector by the U.S. Environmental Protection Agency (EPA) has created an incentive to address regulatory compliance. A recent surge in hospital inspections has resulted in fines for many hospitals for non-compliance, especially with regulations governing hazardous waste under the Resource Conservation and Recovery Act (RCRA).
Another driver for environmental compliance improvements has been the substantial body of evidence that links sustainable building design and operations to faster healing times for patients and reductions in absenteeism and increased job satisfaction among workers.
Research also indicates that many products used in health care facilities — including cleaning chemicals, furniture, computers and other electronic devices, wall coverings, vehicles, and lighting system components — contain and release toxic substances both during use and after they are discarded. Among these substances are mercury, brominated flame retardants, cadmium, and phthalate plasticizers. Clearly, managers interested in promoting a healthy indoor environment in their facilities must assess potential releases of toxic contaminants from products during their use and beyond.
Hospitals’ access to materials and training provided by organizations like Hospitals for a Healthy Environment (H2E) also has improved their environmental performance.
Resources related to pollution prevention, green purchasing and waste reduction available through H2E make it much easier for front-line workers to become comprehensive environmental stewards for their organizations.
Finally, simple economics pushes environmental and facilities managers to find ways to reduce costs by, for example, reducing energy and water use or by eliminating toxic substances and associated worker protection, recordkeeping, storage, and disposal costs. Avoiding the excess use of resources and the generation of wastes through careful purchasing and use of low-impact alternatives can mean direct cost savings for organizations operating in an ever-more competitive environment.
Reviewing innovative approaches to environmental performance in three areas — hazardous materials and waste, resource consumption, and building design and operations — can help managers develop strategies tailored to their organizations.
Hazardous materials and wastes are leading sources of problems with compliance, worker and patient safety, and cost. Managers can address all of these issues by working with materials management personnel to eliminate the purchase and use of hazardous materials in favor of less toxic alternatives where possible. Examples of these measures include:
- Replacing mercury clinical devices with non-mercury alternatives. This step eliminates the danger of a mercury spill and the resulting exposure and hazardous-waste disposal costs.
- Adopting green cleaning practices. Such practices use the least toxic chemicals available, do not require significant worker protection or special handling when disposed of, and do not contaminate wastewater that contains mercury or other contaminants.
- Eliminating or significantly reducing pesticide use. By adopting integrated pest management (IPM) practices where the focus is on pest prevention, grounds care managers can nearly eliminate costs associated with worker protection, pesticide storage and mixing regulations, and disposal of universal or hazardous waste. Even if a department contracts out its pest control services, IPM approaches are widely available and will reduce indoor air contamination, worker exposures and resulting illness or absenteeism.
- Adopting non-hazardous reagent or fixative substitutes for laboratory use. For example, substitutes such as sodium laurel sulfate for cyanide in automated hemoglobin analysis, or glacial acetic acid instead of Bouins fixative for certain biopsies might allow technicians to significantly reduce hazardous waste generation.
Addressing these types of issues will require managers to include interested parties, training, and step-by-step implementation that allows for feedback. Managers will need to consult clinicians and educate them on mercury device replacement. They also will need to ensure that infection-control personnel review plans for adopting green cleaning methods. Finally, lab managers and staff members will need to offer feedback on adopting new chemicals before full implementation.
Despite the logistical hurdles managers must clear in this process, the payoff in terms of worker exposures and waste reductions will be worth this up-front effort. And the ongoing communication might even uncover new opportunities for change.
Hospitals consume huge amounts of energy and water in their everyday operations, due to their 24-7 schedule and constant cleaning activities. By retrofitting existing buildings with water- and energy-saving devices, managers can save hundreds of thousands of dollars while reducing their environmental impact. Best of all, the payback begins immediately, and the return on investment can be complete within a few years. Here are a few examples of hospitals’ efforts and achievements:
- New York Presbyterian Hospital saved $700,000 through capital improvements and efficient operating systems strategies designed to reduce energy use.
- Covenant Health System in Milwaukee, which processes 13 million pounds of laundry per year for 34 different facilities, bought continuous-batch washers. The units cut water use radically by recycling rinse water into wash water. The organization also installed a heat-reclamation unit that heats incoming water from an average of 50 degrees to 100 degrees solely through heat stripped from outgoing wash water. Combined energy and water savings mean the new laundry system will pay for itself in less than three years.
- Bronson Methodist Hospital in Kalamazoo, Mich., curtailed water use by 480,000 gallons by adopting a microfiber mopping system.
A growing number of hospitals are adopting combined heat and power plants, which generate electricity and replace much of the central plant’s heating and cooling equipment. By using energy normally wasted in the power production process to produce chilled water, hot water and steam, these plants can achieve total energy efficiencies approaching 70 percent, compared to conventional power generation at 30 percent.
The U.S. Department of Energy’s ENERGY STAR® program works with the health care sector to provide benchmarking tools, energy-saving advice, and product specifications that are designed to help facilities reduce power use.
For more information on how to benchmark and improve the energy performance of acute-care campuses and medical offices, managers can check out Energy Star’s 90-minute web-based training, www.energystar.gov/ index .cfm?c=healthcare.bus_healthcare_workshops.
Many private consultants also work on a shared-savings approach to help managers design and implement programs to curtail water and energy use, meaning they take a percentage of the money saved. This arrangement offers managers confidence that their efforts won’t increase overall water or energy budget.
The United States is experiencing a boom in health care facility construction. At the same time, growing evidence demonstrates that patient outcomes and staff satisfaction can improve substantially — and environmental impact can drop dramatically — if health care buildings are sustainable, minimize toxic substances and exposures, and encourage environmentally beneficial operations and maintenance. This connection suggests that environmentally sound facilities also might be the best environment for healing.
The most recent and most comprehensive resource on green building design, construction, maintenance and operation is the Green Guide for Health Care, a voluntary best-practice tool developed by the U.S. Green Buildings Council and the American Society for Healthcare Engineering. Created to help facility managers and others green their hospitals’ new building projects, renovations and current operations, the guide is available at www.gghc.org.
The publication is based on points a facility earns by adopting specific building or operating methods or materials. The guide is free and voluntary, and managers can use it to make their facilities as green as they would like.
One key component of the guide’s recommendations is the use of multidisciplinary teams, which include plant operations and engineering staff, clinicians, administrators, support services and housekeeping. These individuals work together throughout each project.
Another essential element is its focus on operations and maintenance strategies that contribute to environmental sustainability in the health care. These strategies include, training staff, implementing source control for indoor air quality, maintaining and replacing air filters, reducing building water use, reducing process water use in laundry, dishwashing and lab washing operations, reducing regulated medical waste, reducing food waste and increasing composting, implementing IPM, using environmentally preferable cleaning practices, and ensuring recycled content in janitorial paper and other disposable products.
Of course, when considering green building, economic interests, as well as environmental improvements, come into in play. Several recent studies have shown that organizations can achieve green buildings at costs that are comparable to conventional construction. Studies also demonstrate that designs that take advantage of energy efficiency, water-use reduction, efficient air handling, and other technological advances tend to use far fewer resources than conventional buildings, reducing ongoing operating costs.
Similarly, up-front product and operations choices that allow facilities to avoid costly indoor air testing and remediation efforts down the road can save money over the life of a building.
Taking a broader environmental approach to maintenance and engineering management in health care requires time, careful planning, and collaboration with an array of hospital personnel, but the payoffs are worth the effort. Among the potential outcomes of an environmentally sustainable approach to facility maintenance are reduced liability, improved compliance, greater worker safety and employee satisfaction, and significant cost savings.
By identifying opportunities to eliminate toxic substances and outdated practices, managers can create a healthier working environment and more efficient operations, as well as reduce their facilities’ overall environmental impact. This change brings environmental services and facilities departments into alignment with the central mission of health care — to prevent illness and create healthy communities.
Hospitals for a Healthy Environment (H2E) is a free and voluntary program that helps health care professionals improve their facilities’ environmental and safety performance. H2E grew out of an agreement between the American Hospital Association (AHA) and the U.S. Environmental Protection Agency . H2E does this by providing a number of useful tools to help hospitals implement pollution prevention programs, including:
For more information on H2E’s efforts to help health care facilities improve their environmental impact and reap the rewards for their achievements, call (800) 727-4179 today or visit www.h2e-online.org.
— Sarah O’Brien
Sarah O’Brien is the champion coordinator for Hospitals for a Healthy Environment (H2E). She works with GPOs, state environmental departments, manufacturers, service providers, health systems and other large organizations to improve environmental performance and promote H2E’s programs.