Cleaning for Health

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• Cleaning for Health
• New Hampshire Hospitals for a
• Healthy Environment
• June 7, 2007
• Carol Westinghouse
• Program Manager

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• A 34-year-old, national, nonprofit environmental
  organization whose mission is to
• Facilitate Sustainable Business Practices
• Advocate for Incentives Based Public Policy
• We focus on mitigating business and industrial
  impacts on
• climate change
• water use and quality
• human health

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Cleaning for Health

• 1990 INFORM began investigating the
  environmental and human health effects of
  chemicals in commerce
• 2000 INFORM was asked by a cleaning service to
  research cleaning products because of a growing
  body of information about the health hazards to
  its employees
• 2002 INFORM published Cleaning for Health
  Products and Practices for a Safer Indoor
  Environment
• 2004 INFORM launched its New England outreach
  program
• 2004-2007 We visited over 120 facilities
  including 80 schools in 5 states

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What Are The Issues?

• Health and safety
• staff and patients
• Poor indoor air quality
• staff and patients
• Detrimental environmental effects
• climate change
• cleaning products contribute 8 of non-vehicular
  VOCs
• fish and wildlife
• hormone disruption

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Health and Safety

• A single janitorial worker uses, on average,
  between 194234 lbs. of chemicals annually,
  approximately 25 of which are hazardous
  substances
• Janitorial workers experience one of the
• highest rates of occupational asthma
• 6 out of 100 janitors are injured each year
• 20 are serious burns to the eyes
• or skin
• 12 are a result of chemical fumes

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Conventional Cleaning Products

• May contain
• Carcinogens
• Ingredients that affect
• Respiratory system
• asthmagens
• Central nervous system
• Reproduction
• Development
• Other organ systems

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Consequences of Poor IAQ

• Asthma
• 30 million people have suffered from asthma
• including 9 million children under the age of
  18
• Chronic respiratory illnesses
• Sick Building Syndrome
• Building related symptoms
• Allergies and sensitivities
• Low levels of common chemicals

National Center for Health Statistics
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Asthma In New England

• New England has one of the highest rates of
  asthma as a region
• Residents who have been diagnosed in their
  lifetimes
• 14 of children
• 15 of adults
• Current rates in the NE states
• CT 8.7 of children, 9.7 adults
• NH 8 of children, 10.3 of adults
• ME 10.7 of children, 9.6 of adults
• VT 8.1 of children, 8.5 of adults

NE Asthma Action Plan Asthma Regional Council
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Asthma/Respiratory Disease Related Ingredients

• Cleaners
• Aliphatic polyamines
• Ammonia
• Hydrochloric acid
• Monoethanolamine
• Sodium Hypochlorite
• Triethanolamine
• Fragrances
• Volatile organic compounds VOCs

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Health and Environmental Impacts

• VOCs are common ingredients in cleaning products
• Some are known or suspected to cause cancer as
  well as respiratory disease
• Propellants in aerosol containers
• butane, benzene, ethanol, isobutane, propane
• Solvents
• 2-butoxyethanol 1,4-dichlorobenzene
• formaldehyde isoproponol
• methylene chloride naphthalene
• phenol styrene
• tetrachloroethylene trichloroethylene
• toluene xylene

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Volatile Organic Compounds

• 2-Butoxyethanol VOC
• Is absorbed directly through the skin
• Can affect the developing fetus
• Is a suspected carcinogen
• Can cause liver and kidney damage
• Common in
• Surface cleaners (glass, all purpose)
• Specialty cleaners (disinfectant, carpet)

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Hormone Disrupting Chemicals

• Common ingredients in cleaning products
• Alkylphenol ethoxylates
• All-purpose cleaners
• Specialty cleaners
• Dibutyl phthalate
• Diethyl Phthalate
• Floor care products
• Fragrances

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Hormone Disruptor

• Dibutyl phthalate
• Endocrine disruptor
• Reproductive system toxin
• Mutagen
• Liver and kidney damage
• Common in
• Floor finishes
• Floor strippers

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Know Your Products

• Air-fresheners
• May cover up poor cleaning practices
• Contain VOCs and fragrances that have not been
  tested for neurotoxicity or carcinogenic effects,
  and that are recognized as triggers for
• Asthma
• Migraine headaches
• Allergy and sinus problems

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Know Your Products

• Do they contain
• 2-butoxyethanol
• alkylphenol ethoxylates
• ammonia
• chlorine bleach
• diethanolamine
• formaldehyde
• glycol ethers
• hydrochloric acid
• napthalene

nitrilotriacetic acid perchloroethylene
phosphoric acid paradichlorobenzene potassium
hydroxide pthalates sodium hydroxide triethanolami
ne zinc
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Results of Relevant Studies

• New Scientist 1999 - Air fresheners and aerosol
  sprays contribute to increased headaches and
  depression in mothers and ear infections and
  diarrhea in infants
• European Respiratory Journal 2000 - Acute
  short-term exposure to common cleaning chemicals
  causes a severe asthmatic attack in asthmatic
  subjects
• Scandinavian Journal of Workers Environmental
  Health 2001 - Asthma prevalence in workers who
  clean private homes is 1.7 times higher than
  control group

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Results of Relevant Studies

• Journal of Occupational and Environmental
  Medicine 2003 - Of asthma cases associated with
  cleaning chemicals, 80 were new onset cases
• Thorax 2005 - Pre-natal exposure to common
  cleaning products, paints, pesticides, etc.,
  increased the risk of persistent wheezing, a
  precursor to asthma, in young children
• Occupational and Environmental Medicine 2005-
  Asthma symptoms in domestic cleaning women are
  associated with exposure to bleach and possibly
  other irritant agents.

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Results of Relevant Studies

• Environmental Health Perspectives 2005
• 85 mothers and sons were tested for phthalates
  in their urine. The mothers with the highest
  levels of phthalates in their urine late in their
  pregnancies produced babies with genital
  abnormalities. This same effect has been seen in
  rats, but this is the first evidence that
  phthalates are causing a similar effect in
  humans. In rats, phthalate syndrome causes a
  decrease in testosterone levels, lower sperm
  counts, infertility, and testicular abnormalities
  in the mature animal.

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Cleaning for Health

• Cleaning that protects public health, without
  affecting the health of staff, building occupants
  and the environment.
• Health first!

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What Is Cleaning for Health?

• A program that includes
• Environmentally preferable chemicals
• Safer, less-toxic, with third-party verification
  for environmentally preferable qualities
• State-of-the-art cleaning methods (commonly
  called best practices)
• Identify areas that need disinfecting as opposed
  to areas that just need cleaning
• Vacuum rather than dust mop

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Disinfectants Sanitizers

• Chlorine / Sodium Hypochlorite
• Very effective antimicrobial
• Corrosive to eyes and skin
• Damages floor finishes, carpets, clothing, etc.
• Respiratory irritant
• Environmental concerns from production,
  contaminants, byproducts
• Mixing can create poisonous gas
• Phenols
• Effective against TB HBV assumed
• Corrosive to eyes and skin
• Damage floor finishes and other surfaces
• Strong pungent odor respiratory irritant
• Environmental concerns. Possible estrogen mimic.
• Quats
• Typically not proven effective against spores
• Less toxic then Phenols eye, skin and surface
  corrosivity
• Toxic to aquatic life
• Peroxide
• EPA Sanitizer

Source CDCNY-Apic-Albany-2006 Lynn Sehulster
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What Is Cleaning for Health?

• The use of advanced technology cleaning equipment
  and processes
• Microfiber mops and cloths
• High-filtration vacuums and vacuum attachments
• Dry carpet cleaning methods
• Steam cleaning
• Recycled content paper and plastic products
• Paper towels, tissue and toilet paper
• Trash bags

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Environmentally Preferable Cleaning Chemicals

• Less-toxic chemicals are readily available
  through most manufacturers and distributors
• Third-party certification of institutional
  cleaning products is important to ensure quality
• Common third-party programs are
• Design for the Environment EPA
• Green Seal (GS) US
• Environmental Choice (EC) Canada

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Standards Criteria

• Overall toxicity
• Carcinogenic/ reproductive toxicity
• Skin/eye irritant
• Sensitization
• Combustability
• Photochemical smog/ozone/IAQ
• Aquatic toxicity

Aquatic biodegradability Eutrophication Packaging
Concentrates Fragrances Prohibited
Ingredients Training Animal testing
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Greenwashing

• Manufacturers may claim their products
• Are nontoxic to humans
• Will not harm the environment
• Pose no threat to health
• Products need third-party certification to show
  they meet standardized green criteria
• Material safety data sheets do not fully disclose
  all the ingredients and are hard to understand

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Advanced Technology Equipment

• Reduce particulates in the air by
• Installing dirt-grabbing walk-off mats inside and
  outside entrances, recommended 15
• Using microfiber cloths and mops that pick up
  dirt while using a reduced amount of chemicals
• Employing high-filtration vacuums or microfiber
  mops instead of conventional dust mops
• Installing high-filtration vacuum attachments on
  other floor-care equipment

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LEED Existing Buildings

• Awards points for
• Walk-off mats (1 pt)
• Chemical storage mixing areas (1 pt)
• Isolate, exhaust copy rooms (1 pt)
• Low-impact cleaning fluid and housekeeping(1 pt)
• Sustainable cleaning and hard flooring coating
  systems
• Green Seal GS 37 or CA CR low voc
• Utilization of concentrated cleaning products
• Low impact disposable products (1 pt)
• Min. 30 PCW, 100 recycled paper products
• Manufactured without the use of chlorine
• Plastic trash bags
• Integrated indoor pest management (1 pt)
• Outdoor storage facility (1 pt)

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H2Es Ten Key Steps to Successful Implementation

• 1. Form a team
• Environmental Health and Safety Committee
• 2. Review current products and practices
• Cleaning Product Evaluation
• 3. Evaluate and categorize facility areas
• Divide areas by risk critical care,
  semi-critical, non- critical, patient rooms
• 4. Determine evaluation criteria for products
• Third-party certification
• 5. Select products
• Work with your vendors

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H2Es Ten Key Steps to Successful Implementation

• 6. Develop a pilot plan
• Choose a campus, building or wing
• Determine evaluation criteria
• 7. Execute the pilot plan
• Work with your vendors
• Provide training
• 8. Evaluate the pilot plan
• Survey participants for feedback
• 9. Celebrate success
• Educate your building occupants and the public
• Reward participating staff
• 10. Expand the program
• Identify other areas for environmentally
  preferable purchasing

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Case Study

• Vermont hospital with 3 campuses
• EHS Team researched the issue
• Evaluated current products and practices
• Identified the largest campus as the pilot
  project
• Worked with vendors to select products
• Tried EP products from current manufacturers
  green line for all-purpose, bathroom, glass,
  carpet and neutral floor
• used with current command stations

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Case Study

• Effectiveness sells staff- it really works!
• New generation of equipment
• high-filtration vacuums and vacuum attachments
• microfiber mops and mop systems
• microfiber cloths
• Conducting trials for floor strippers and
  finishes
• Are safer disinfectants in the future?

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Cleaning for HealthJoin the Revolution

• Make human health a priority
• Use healthier cleaning products
• Adopt state-of-the-art cleaning methods
• Incorporate better cleaning equipment

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Resources

• INFORMs Resources www.informinc.org
• Approved Products
• Design for the Environment www.epa.gov/dfe
• Green Seal www.greenseal.org
• Environmental Choice- www.environmentalchoice.net
• Additional Information
• H2E www.h2e-online.org
• Healthcare Without Harm - www.noharm.org