Greening of Healthcare

1
Greening of Healthcare

• Janet Bowen , EPA Region 1
• New England Healthcare Coordinator
• 617-918-1795
• October 9, 2008

2
What are the Opportunies?

• Healthcare creates large amounts of waste
• Mercury and Dioxin, other PBTs
• An array of hazardous chemicals and special
  kinds
• of wastes
• Huge energy and water consumption
• Healthcare Construction on the rise
• - New building design and site design

3
Waste Concerns

• Disposing of products that could be reused
• Using more product than necessary
• Treating solid wastes as hazardous or infectious
• Worker exposure and health risks
• Liability for environmental harm

4
Pollution Prevention Options

• Less Toxic (mercury-free)
• Fewer Allergens (latex-free)
• Less Packaging (buy in bulk ?)
• Recycled content (paper supplies)
• Reusable (bedpans, mattresses)
• Energy Efficient (appliances, building design)
• Water use reductions (low flush toilet, digital
• 
  imaging)

5
Benefits

• Improved impact on the environment from
  hospital/healthcare operations
• Cost savings
• Healthier environment for patients and employees
• Positive publicity

6
Specific Pollution Prevention Targets

• Waste reduction solid and hazardous
• Pharmaceuticals
• Mercury Clinical, Lab, Building
• Paper
• Electronics
• Cleaning
• Energy/Water/Green Buildings

7
Hospital Waste


US Hospitals generate approximately 6,600 tons of
waste per day...
8
Hospital Solid Waste Stream

• Paper/Cardboard (53.8)
• Food/Organics (17.5)
• Plastic (14.6)
• Diapers (3.5)
• Glass (1.8)
• Yard trimmings (1.6)
• Other
• Source HERC website
• http//www.hercenter.org/wastereduction/solidwaste
  .cfm

9
Getting Started

• Form a Team
• Make it part of everyones job
• Conduct an Baseline Assessment
• Data Collection
• Education and Training

10
Waste Strategies

• Waste Characterization
• Waste Segregation Best Practices
• Minimization of Infectious Waste
• Recycling
• EPP for Waste Minimization

11
Characterization Understand your waste!
Thats a difference of 351,000 every year!
12
Benchmarking
13
Waste Segregation Best Practices

• Implement an Infrastructure Conducive to Waste
  Minimization-
• Color coded, strategically placed and well
  labeled containers for
• Solid Waste
• Infectious Waste
• Hazardous Waste
• Recycling
• Universal Wastes
• Others

14
Reducing Regulated Medical Waste

• Switch to reusable items suction canisters,
  sterilization containers, drapes, gowns, etc.
• Ensure proper segregation

15
Source ReductionPurchasing for Waste Reduction

• Almost everything that leaves a facility as waste
  came in as a purchase contracting for waste
  prevention is key
• Strategies
• Leasing carpet, copiers, electronics
• Switch from disposable to reusable gowns,
  drapes, pads, dishware
• Single use device reprocessing
• Custom surgical procedure carts
• Reduced weight paper (double side, reuse)
• Require packaging reduction or takeback
• Purchase reusable or compostable tableware
• Digital Imaging
• Reusable Containers (sharps) and Packaging
  (specify)

16
Donation/Surplus Programs

• Reduce solid waste and costs
• Positive impact on community and the world
• EPA Region I Reuse Guide
• http//www.epa.gov/region1/assistance/reuse/index.
  html
• EPA Region I Donation Medical Devices
• http//www.epa.gov/region1/assistance/reuse/med.ht
  ml
• Practice Greenhealth Donations website
• http//cms.h2e-online.org/ee/waste-reduction/waste
  -minimization/donation-surplus-programs

17
Recycling

• GOAL A 33 to 50 (by 2010) recycling rate
  (based on 1998 EPA/AHA MOU)
• Opportunities to reduce costs, even generate
  revenue
• Cardboard, paper, organics, metal, glass, plastic

18
Recycling

• Diverts waste from landfill
• Reduces waste disposal costs
• Reduce Greenhouse gas emissions Waste Reduction
  Model Calculator
• http//www.epa.gov/climatechange/wycd/waste/calcul
  ators/Warm_home.htm
• Practice Greenhealth recycling page
• http//cms.h2e-online.org/ee/waste-reduction/recyc
  ling/

19
Resource Conservation Challenge(RCC)

• The RCC is a national effort to conserve natural
  resources and energy by managing materials more
  efficiently. The goals of the RCC are to
• Prevent pollution and promote reuse and
  recycling
• Reduce priority and toxic chemicals in products
  and waste and
• Conserve energy and materials.
• www.epa.gov/epawaste/rcc

20
EPAs WasteWise Program

• Free, voluntary, EPA program
• Eliminate costly municipal solid waste and select
  industrial wastes
• Allows partners to design their own waste
  reduction programs tailored to their needs.
• Provides free technical assistance to help you
  develop, implement, and measure your waste
  reduction activities
• EPA offers publicity and recognition
• www.epa.gov/wastewise

21
Environmentally Preferable Purchasing

• Opportunities in all areas medical, surgical
  and office supplies, maintenance, etc.
• Group Purchasing Organizations provide leverage,
  efficiency for EPP

22
EPP Key Resources

• Practice Greenhealth 10-Step Guide to EPP
• www.h2e-online.org/wastereduction/epp/10steps.html
  
• EPA EPP website
• www.epa.gov/opptintr/epp/
• Sustainable Hospital Project
• www.sustainablehospitals.org/cgi-bin/DB_Index.cgi
• Green Chemical Alternative Wizard
• http//web.mit.edu/environment/academic/purchasing
  .html
• Pharos, fact sheet April 2008
• http//www.healthybuilding.net/pdf/pharos-factshee
  t.pdf
• Practice Greenhealth EPP website
• www.h2e-online.org/wastereduction/epp/overview.htm
  l

23
Hazardous Materials

• Glutaraldehyde
• Ethylene Oxide (EtO)
• Solvents alcohols, xylene, formalin
• Pesticides
• Fleet maintenance solvents/degreasers

24
Pollution Prevention Hazardous Waste Reduction

• Alternatives substitution (total cost)
• As-needed purchasing for all chemicals
• Chemical Management
• Solvent recovery alcohol, xylene
• Review sterilization vs. high level disinfection
• Least toxic pest control
• Mercury-free lab chemicals

25
Pharmaceuticals

• Emerging Issue
• Impacts
• Water Reuse, biosolids
• Water quality for aquatic species
• USGS Survey 2002 Numerous pharmaceuticals
  personal care products (PPCPs) in lakes rivers
• New reports daily of PPCPs in water

26
Pharmaceuticals (cont.)

• Current waste management
• Disposed via sewer
• Solid wastelandfill or incineration
• Hazardous waste often incineration
• Medical waste often incineration
• Returned for credit usually incineration

27
Pharmacueticals Resources

• Practice Greenhealth
• http//cms.h2e-online.org/ee/waste-reduction/wast
  e-minimization/pharma/
• Practice Greenhealth 10 Step Guide, updated
  August 2008
• http//www.hercenter.org/hazmat/tenstepblueprint.p
  df
• Healthcare Environmental Resource Center (HERC)
• http//www.hercenter.org/hazmat/pharma.cfm
• EPA http//www.epa.gov/ppcp/
• EPA Water page
• http//www.epa.gov/waterscience/ppcp/

28
Mercury in Healthcare

• Thermometers
• Sphygmomanometers,
• Barometers
• Bougies, dilators, cantor tubes
• Batteries, electronics
• Fluorescent tubes and compact fluorescent lights
• Switches/thermostats

29
Clinical Mercury Devices
Alternatives widely available, at equivalent
performance, cost
30
Mercury in Building Supplies

• Thermostats,Thermometers, Switches, Relays
  contain mercury
• Gas and Water Flow Meters, Float Switches can
  contain gallons of mercury
• Strategy
• Specify or request Hg-free alternatives for all
  new and replacement parts (available for most
  applications)
• Label and require proper EOL handling of
  Hg- containing equipment currently in use

31
Mercury in Lighting

• ALL fluorescent and HID lamps contain mercury
• Est. 620 million discarded per year in US
• 2-4 tons of mercury
• Green tip still have Hg

32
Mercury Lighting Strategy

• Use fluorescents to reduce power consumption -
  reduces Hg emissions, assumes coal use for
  electricity
• Require disclosure of mercury content and choose
  lower mercury lamps where available
• Recycle ALL fluorescents and HID lamps

33
Hidden mercury

• Tilt switches
• Pressure regulators
• Flat panel screens
• Laboratory chemicals, fixatives
• Preservatives in pharmaceuticals
• Fire detection devices
• Neon lights
• Auto Switches (fleets)
• Strategy
• Require ALL vendors to certify products mercury
  free or disclose mercury content, and establish a
  mercury free preference

34
Mercury Resources

• HERC mercury page
• http//www.hercenter.org/hazmat/mercury.cfm
• Eliminating Mercury in Hospitals
• www.epa.gov/region09/waste/p2/projects/hospital/me
  rcury.pdf
• Sustainable Hospitals Project
• http//www.sustainablehospitals.org/HTMLSrc/IP_fac
  tsheet_contents.htmlmercury
• Replacing Mercury in Healthcare Facilities A
  Step-by-Step Approach
• http//www.h2e-online.org/hazmat/mercguide.html
• Fluorescent Lamp Recycling 10 Steps to
  implementing a program
• www.h2e-online.org/pubs/tensteps/fluor10steps.pdf

35
Paper Impacts

• U.S. Healthcare facilities generate nearly two
  billion pounds of paper and cardboard waste every
  year. 
• Largest category of waste in the annual total of
  five billion pounds of waste of all types from
  the healthcare sector.
• Paper use reduction can save tons
• of paper, thousands of dollars
• Reduce Greenhouse Gas Emissions

36
Paper Purchasing Strategy

• Reduce paper use/costs
• Use mat finish (non-glossy)
• Negotiate aggressively, use GPO
• Copy paper spec at least 30 post-consumer
  content
• Processed Chlorine Free
• Janitorial paper 50-100 post, unbleached
• Recycle all office paper to close the loop
• HIPPA precautions - source
• reduction first!

37
Paper Reduction

• Office paper
• Copy print double-sided
• Paperless office electronic records
• Reduce number of copies
• Reuse once usedas scratch pads
• Recycle office paper separately, keeping this
  stream as clean as possible
• Provides product to close the loop increases
  value
• Maintain patient confidentiality

38
Paper Recycling Resources

• EPA Paper recycling website
• www.epa.gov/paperrecycling
• Paper Recycling HERC website
• http//www.hercenter.org/wastereduction/paper.cfm
• WasteCap of Massachusetts, Recycling Paper
  website
• http//www.wastecap.org/wastecap/commodities/paper
  /paper.htm
• Practice Greenhealth HIPPA page
• www.h2e-online.org/regsandstandards/hipaa.html
• Practice Greenhealth HIPPA guidance
• www.h2e-online.org/pubs/paper/hipaa.pdf

39
Electronic Waste

• Fastest growing waste stream
• 1.9 to 2.2 million tons of used or unwanted
  electronics in 2005
• 1.5 to 1.8 million tons were primarily disposed
  in landfills
• Only 345,000 to 379,000 tons were recycled
• Electronic waste is growing 2-3 times faster than
  any other waste stream
• 315 million computers that
• became obsolete from 1997-2004
• ended up in landfills contain
• 1.2 billion pounds of lead
• 2.0 billion pounds of cadmium
• 400,000 pounds of mercury
• 1.2 million pounds hexavalent chromium

40
EPP Strategy for IT

• Consider leasing, with proof of EOL handling
• If purchasing, require OEM or retailer takeback
  and proof of responsible recycling
• Recyclers - due diligence on their operations and
  overseas shipping
• Require demonstrated compliance with EUs RoHS
  (Reduction of Hazardous Substances) Directive
• Procurement criteria systems

41
Electronics Assessment Tool(EPEAT)

• Developed by EPA and others to meet demand for
  greener electronic products
• Green performance standards for computers
• New purchasers section of website
• - Searchable database
• - Model contract language
• - Fact Sheets and Powerpoint presentations
• - Electronic Environmental Benefits
  Calculator
• www.epeat.net

42
Strategy for IT staff Energy Star Power
Management

• Save 10 to 50 per desktop annually
• Places inactive monitors and computers into sleep
  mode with free software from EPA
• http//www.energystar.gov/index.cfm?cpower_mgt.pr
  _power_management
• Free teleconference, 10/21/08 130-230pm
• energystar.webex.com

43
Electronics Resources

• HERC Electronics website
• www.hercenter.org/wastereduction/electronics.cfm
• EPAs eCycling website
• http//www.epa.gov/ecycling/
• Healthcare Without Harm Resource page
• www.noharm.org/us/electronics/resources

44
Greener Janitorial Chemicals

• Why be concerned about Cleaners?
• Asthma risk
• Occupational skin/eye injuries
• Indoor Air quality
• Training/Worker protection costs
• Patient and staff comfort
• 35 of cleaning chemicals can cause blindness,
  severe skin damage or damage to organs through
  skin.
• 6 are linked to cancer, ozone depletion or
  global warming

45
Green Cleaning Strategy

• Involve all interested parties
• Infection Control, Nursing, Purchasing,
  Housekeeping/Environmental Services, staff with
  occupational health issues
• Look for certification
• Green Seal or equivalent -- require verification!
  
• Address routine cleaning first
• Disinfection issues are more complex, may take
  more work

46
Green Cleaning Resources

• Greening Your Purchase of Cleaning Products
• http//www.epa.gov/epp/pubs/products/cleaning.htm
• Practice Greenhealth Green Cleaning page
• http//cms.h2e-online.org/ee/facilities/greenclean
  ing/
• 10 Step Guide to Green Cleaning Implementation
• http//www.h2e-online.org/docs/h2e10stepgreenclean
  -r5.pdf
• INFORM, Cleaning for Health
• http//www.informinc.org/cfh_00.php
• Janitorial Products Pollution Prevention Project
• http//www.wrppn.org/janitorial/jp4.cfm

47
Energy Savings Pay Off

• Huge cost savings, short payback
• Energy Star
• Contract specifications,
• Appliance standards,
• Facility benchmarking
• www.energystar.gov/healthcare

48
EnergyStar Resources

• Benchmarking Tool for Acute Care and Childrens
  hospital and tool for medical offices
• www.energystar.gov/index.cfm?chealthcare.bus_heal
  thcare_benchmark
• Take on-line benchmarking training, 11/13/08 at
  1200
• energystar.webex.com
• Building Upgrade Manual
• http//www.energystar.gov/index.cfm?cbusiness.bus
  _upgrade_manual
• New Building Guidance
• www.energystar.gov/index.cfm?cnew_bldg_design.new
  _bldg_design_guidance
• Target Finder
• http//www.energystar.gov/index.cfm?cnew_bldg_des
  ign.bus_target_finder

49
EnergyStar Recognition

• Join as an EnergyStar Partner
• www.energystar.gov/healthcare, scroll down to
  Join EnergyStar
• EnergyStar Label - Energy performance rating of
  75 or higher
• www.energystar.gov/index.cfm?cevaluate_performanc
  e.bus_portfoliomanager_intro
• EPA/ASHE E2C Program
• July 2006 ASHE commitment to improve energy
  efficiency in hospitals by 10 Energy
  Efficiency Commitment - E2C
• http//www.ashe.org/ashe/facilities/e2c/index.html
  
• E2C Quick reference Guide
• http//www.ashe.org/ashe/facilities/e2c/pdfs/e2cqu
  ickref.pdf
• E2C Recognition application
• http//www.ashe.org/ashe/facilities/e2c/rec/pdfs/r
  ecapplication.pdf

50
Energy StarPurchasing and Procurement

• Buy Energy Star Products
• Product information
• Cost saving information, saving calculators
• Procurement information, sample language
• http//www.energystar.gov/index.cfm?cbulk_purchas
  ing.bus_purchasing
• Take free on-line procurement training, 10/23/08
  200-300pm
• Energystar.webex.com

51
Buy Renewable Energy Green Power Partnership

• Voluntary program in which partners use green
  power to meet a portion of their electricity
  needs
• More than 900 partners purchase more than 14.3
  billion KWh of green power annually
• The Green Power Partnership helps through
• Green Power Locator List of providers
• Step-by-Step Guide to Purchasing Green Power
• Media/outreach tools

52
How Does the Help?

• Green Power Locator
• Comprehensive list of local, regional national
  green power providers
• Guide to Purchasing Green Power
• Step-by-step instructions, issues, details
• Green Power Partner logo and guidelines
• Environmental claims calculators
• Partner recognition Captures favorable media
  attention
• Clean technology
• Domestic energy supply/energy security
• http//www.epa.gov/grnpower/

53
Combined Heat and Power Partnership (CHP)

• Promotes cogeneration of electricity and thermal
  energy
• Most fossil fuel use in the United States is for
  either
• Heat/steam to drive industrial processes or
  provide space heating/cooling
• Electricity production
• Separate heat and electricity production is
  highly inefficient average efficiency of fossil
  fuel power plants is 33
• Combined heat and power systems are highly
  efficient 60-80 efficient

54
Opportunities for Hospitals

• Hospitals are excellent candidates for CHP
• High thermal and electric loads
• Thermal and electric loads rise and fall together
• Long operating hours
• Power reliability very important
• Benefits
• Reduced pollution and carbon emissions
• Improved reliability, for the user and the
  electrical grid as a whole
• Economic benefits many projects have short
  payback periods all provide hedge against
  electricity price increases
• The CHP Partnership can help you determine
  whether your facility is a good candidate for CHP
• http//www.epa.gov/chp/

55

Water Use Reductions

• Implement as you build or renovate
• Use consultants paid from Shared Savings
• EPAs WaterSense
• http//epa.gov/watersense/
• Check out HERC water conservation
• www.hercenter.org/facilitiesandgrounds/waterconse
  rve.cfm
• New! Use Energy Star Benchmarking tool to track
  water consumption http//www.energystar.gov/index.
  cfm?cbusiness.bus_water

56
Storm Water Management Low Impact Development
(LID)

• What is LID?
• An approach to land development (or
  re-development) that works with nature to manage
  stormwater as close to its source as possible.
• LID employs principles such as preserving and
  recreating natural landscape features, minimizing
  effective imperviousness to create functional and
  appealing site drainage that treat stormwater as
  a resource rather than a waste product.
• Healthcare examples of LID practices
• Green Roofs
• Permeable Pavement
• Rain Barrels

57
Storm Water Management Low Impact Development
(LID)

• Why LID?
• Water can be managed in a way that reduces the
  impact of built areas and promotes the natural
  movement of water within an ecosystem or
  watershed.
• Green roofs for example may promote a healing
  environment within a hospital
• Applying LID techniques can reduce project costs
  and improve environmental performance

58
Storm Water Management Low Impact Development
resources

• Low Impact Development (LID)
• http//www.epa.gov/nps/lid/
• New England Storm Water Page
• www.epa.gov/region1/topics/water/stormwater.html
• Stormwater Pollution Prevention Plans for
  Construction Activities
• http//cfpub.epa.gov/npdes/stormwater/swppp.cfm
• Green Infrastructure Technologies and
  Approaches
• http//cfpub.epa.gov/npdes/greeninfrastructure/tec
  hnology.cfm
• University of New Hampshire Stormwater Center
• www.unh.edu/erg/cstev/

59
GreenScapes is

• A Multi-media EPA Partnership Program designed
  to
• Promote a wide variety of environmentally
  beneficial landscaping and land management
  practices
• Preserve natural resources and prevent waste and
  pollution and to provide cost-efficient and
  environmentally friendly solutions
• Improve both an organizations bottom-line and
  the environment.
• http//www.epa.gov/region1/topics/waste/greenscape
  s.html

60
Green Guidelines for Healthcare Construction -
GGHC

• First quantifiable sustainable design toolkit
• - Integrates environment and health into
• planning, design and construction
• - Voluntary, self-certifying
• - Sign up to be a Version 2.2 registered
  projects
• Pilot program report and technical guides
• www.gghc.org

61
Building Healthy Hospitals Top 5 Green
Strategies for Decisionmakers

• 1 Energy Efficiency Integrated Design
• HVAC System Enhancements
• 2 Process Water Efficiency
• 3 Sustainable Flooring Material Selection
• 4 Material Selection To Improve Air Quality
• 5 Lighting Efficiency Optimizing Use of
  Natural
• and Artificial Lighting
• EPA publication, 2007 http//www.epa.gov/region09
  /waste/p2/greenbldg.html

62
More Green Building Resources

• Practice Greenhealth Green Buildings page
  http//cms.h2e-online.org/ee/facilities/greenbuild
  ing
• Healthcare Without Harm Healthy Buildings
  http//www.noharm.org/us/healthyBuilding/issue
• HERC Green Buildings www.hercenter.org/facilitiesa
  ndgrounds/greenbuilding.cfm
• Global Health and Safety Initiative
  http//www.globalhealthsafety.org/
• US Green Building Council (LEED Healthcare under
  development) http//www.usgbc.org/

63
Healthcare Environmental Resource Center (HERC)

• USEPA sponsored comprehensive website
• Specific to the healthcare sector
• Federal regulatory information
• State regulatory contacts
• Technical Assistance information (P2)
• Handout on back of the agenda
• www.hercenter.org

64
Questions?

• Want to be added to the EPA Region I email group
  for bi-monthly updates?
• Want additional information on any of the topics?
• Janet Bowen, EPA Region I
• Email Bowen.Janet_at_epa.gov
• Phone [phone]