Green Cleaning in Hospitals Cleaning to Protect Health Without Harming the Environment

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Green Cleaning in HospitalsCleaning to Protect
Health Without Harming the Environment

• Stephen P. Ashkin
• 812 / 332-7950
• SteveAshkin_at_AshkinGroup.com
• www.ashkingroup.com

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The Ashkin Group

• Mission Green the cleaning industry
• We do NOT see ourselves at advocates. Rather, we
  aspire to be transformers.
• Our clients include building owners managers,
  contract cleaning services, product manufacturers
  distributors, policy makers, environmental
  organizations, and others.

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Commitment
Never doubt that a small group of thoughtful
committed citizens can change the world. In
fact, its the only thing that ever
has. Margaret Mead
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Discussion Overview

• The Process of Change
• Defining Green and Green Cleaning
• The Cleaning Plan
• Green Cleaning Opportunities and Examples

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Process for Change - Administrative Support

• Essential to have top management support for
  implementing green cleaning
• Recommend having a team to come together to make
  changes in cleaning products and practice
• Administrator, president, marketing, community
  relations
• Environmental services, purchasing, infection
  control, GPO, others
• What is the business case?

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Process for Change - Differing Agendas

• Infection Control - cleaning, disinfection
• Environmental Services cost containment, ease
  of use, efficiencies
• Purchasing group contracts, cost containment
• Risk Management optimize environment, reduce
  risks, protect patients
• Employee Health protect healthcare workers
• Administration overall performance, community
  relations
• Recognize the competition for resources.

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Process for Change - Create a Baseline

• Who performs the services
• What products are being used what are costs
• When are services performed
• Where are they being used (are the same products
  used everywhere?)
• How are products used
• Frequency of services provided
• Training and communications how often, issues
• Are there other opportunities for improvement?

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Process for Change - Who Performs Services?

• In-house Services
• GPOs
• Contract issues
• Out-sourced Services
• Contract language
• How are supplies purchased
• Unions
• Different structures have different challenges
• Consider small, low-risk pilots

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Defining Green Cleaning Products

• Green Products Products that reduce impacts on
  health and the environment when compared to
  similar products used for the same purpose. E.O.
  13101
• Green Cleaning Cleaning to protect health
  (patients/occupants, staff, administrators, and
  visitors) without harming the environment. AG

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Defining Green Its Not JUST Products

• Cleaning chemicals
• Disposable janitorial products (e.g. paper)
• Equipment
• Procedures
• Source reduction and pollution prevention
• Encourage sustainability

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Defining Green Its Not JUST Products

• Safe for patients
• Safe for staff (especially product users)
• Safe for environment (creates minimal amount of
  pollution, especially PBTs)
• Encourage sustainability

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The Impact of Cleaning the Environment

• 5.0 Billion pounds of cleaning chemicals
• 4.5 Billion pounds of janitorial paper
• 0.5 Billion pounds of equipment
• 35.0 Billion plastic liners

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The Impact of Cleaning - Product Users

• 6 of workers injured on the job
• Occupational asthma on the increase
• 20 are eye and skin burns (chemical exposures)
• Muscular/skeletal injuries (ergonomics)

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The Impact of Cleaning - Patients Staff

• Nursing homes and assisted living
• 3,350,000 residents
• 2,000,000 staff (full and part time)
• Hospitals
• 660,000 patients (per day)
• 4,535,000 staff (full time equivalents)
• 100,000 hospital trainees
• Visitors???
• Many are exposed 24 hours per day

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A Perspective on Patient Impact

• Every Year
• 50,000 people die in automobile accidents
• 7,000 people drown
• 5,000 people die of burns
• Every Year
• 70,000 patients die of nosocomial infections
• Nine People Die Every Hour

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Nosocomial Infections

• 2,000,000 (About 5.7) of all Patients Admitted
  to U.S. Hospitals Acquire These Infections.
• 3.8 of Nosocomial Infections are Fatal
• 70,000 People Die Every Year From Nosocomial
  Infections
• Approximately one-third are preventable

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Nosocomial Infections

• This is NOT an indictment of the cleaning
  industry.
• We know how to clean.
• We just need the budget, time and tools to do the
  job right.

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Cleaning Plans Matter

• Evaluate how the facility is defined for
  cleaning
• Single or multiple levels?
• Different standards for different areas?
• (ASTM E1971-89 Standard Guide for Stewardship for
  Cleaning Commercial and Institutional Buildings)

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Divide Hospital by Risk Areas

• Typically in a hospital..
• 45 to 65 are Non-critical (low risk) areas
• 25 to 45 are Semi-critical (medium risk) areas
• 10 are Critical (high risk) areas
• An important first step is to evaluate how the
  risk areas are defined and identified.
• You can probably reclassify many areas as low
  risk areas, which in turn can reduce resources,
  impacts and costs.

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Divide Hospital by Risk Areas

• Non-critical (low risk)
• Exterior maintenance
• Administration, accounting, records, HR, etc.
• Patient registration and waiting areas
• Shops, carpentry, mail, printing, materials
• Hallways common areas

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Divide Hospital by Risk Areas

• Semi-critical (medium risk)
• Restrooms (public)
• Nursery
• Clinics, outpatients, diabetes, respiratory
• Rehabilitation, physical therapy, cardiac rehab
• Critical (high risk)
• Emergency Surgery
• Labor and Delivery
• Morgue

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Exterior Keep the Contaminants Out

• Monitor pests and weeds
• Use local plants adapted for the site
• Use mulches and replenish as necessary
• Train weed-eater operators not to damage trees
• Use ice melt compounds before the precipitation
  begins - use to break bonds for removal by
  shoveling and plowing (not intended to melt the
  ice or snow)

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Exterior Keep the Contaminants Out

• Consider closing redundant entrances in inclement
  weather
• Switch from sodium and calcium chloride to
  potassium and magnesium chloride ice melt do
  not over apply
• Use environmentally preferable exterior cleaning
  chemicals and dispose of them properly

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Entryways Capture the Contaminants

• Design all entrances with permanent entry systems
  or mats
• Can be used inside and out
• Should be appropriate for climate
• Class 1 fire retardant material
• Size approximately 12 feet in length
• Develop a plan to track cleaning

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Cleaning Chemicals Storage Mixing Areas

• Provide adequate and secure storage areas with
  appropriate plumbing and chemical dispensing
  equipment
• Have a dispenser maintenance plan
• Provide chemical storage training

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Choosing Cleaning Chemicals

• Use Green Seal Certified products
  www.greenseal.org
• Use low VOC products when possible
• Keep MSDS file up to date available

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Choosing Cleaning Chemicals

• Use concentrates with dispensing equipment
• Increase the life of finishes
• Use metal-free floor finishes when feasible
• Maintain a log of all cleaning activities
• Train personnel to use cleaning chemicals properly

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What About Disinfectants?

• All microorganisms are not bad and we do not
  want to sterilize the world!
• Some antimicrobial products may increase
  resistance
• Good physical cleaning of environmental surfaces
  often is enough

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What About Disinfectants?

• All antimicrobials are not bad and they are an
  important tool in the toolbox
• Use disinfectants only where they are necessary
  and select the appropriate products.
• One size does NOT fit all needs. Cleaning
  personnel are smart enough to use multiple
  products.

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Chlorine, Phenols, Quats Peroxide

• Chlorine / Sodium Hypochlorite
• Very effective antimicrobial
• Corrosive to eyes and skin
• Damage floor finishes, carpets, clothing, etc.
• Respiratory irritant
• Concerns regarding production, contaminants
  by-products
• 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 effective against TB or HBV
• Less toxic than phenols eye, skin and surface
  corrosive
• Toxic to aquatic life
• Peroxide
• EPA Sanitizer - not a disinfectant.

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Blood Borne Pathogen Body Fluids

• Fluids covered by OSHA
• Blood, semen, cervical solutions, other
• Excluded fluids include
• Urine, stool, saliva, sputum (unless blood is
  visible)
• Must be cleaned with tuberculocidal or hepacidal
  disinfectant
• 29CFR 1910.1030

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EPA Approved Cleaning Solutions Blood and Body
Fluids

• Must be hepacidal or tuberculocidal
• Purpose of product is to kill hepatitis B, but
  there was no EPA approved testing methodology, so
• Surrogate test is killing of M. tuberculosis - if
  solution can kill M. TB, it will kill hepatitis B
• Chlorine / Sodium Hypochlorite may be used

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Janitorial Equipment

• Vacuums meet CRIs Green Label Program
  www.carpet-rug.com
• Extraction equipment remove sufficient moisture
  to dry carpet in 24 hours
• Buffers burnishers with vacuum attachments
• Propane equipment have high-efficiency, low
  emission engines

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Janitorial Equipment

• Auto scrubbers equipped with variable-speed pumps
• Battery-powered equipment environmentally
  preferable batteries (gel batteries)
• Ergonomic equipment
• Maintain an equipment log

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Janitorial Paper - Other Disposable Products

• Comprehensive Procurement Guidelines
• www.epa.gov/cpg/products.htm
• Toilet tissue 20 minimum PC content
• Paper hand towels 40 minimum PC content
• Industrial wipes 40 minimum PC content
• Facial tissues 10 minimum PC content
• Plastic trash liners 10 minimum PC content
• Processed chlorine free
• Large rolls
• Hands-free dispensers that limit paper
• Micro-fiber cloths, mops and bonnets
• Recycled buckets, carts, mats, etc.

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Integrated Pest Management

• Landscape to eliminate safe havens
• Prevent pests from entering the building
• Monitor before pests become a problem
• Eliminate food, moisture, clutter
• Use the least toxic pesticide possible
• Universal notification

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Integrated Pest Management
Pesticides are relatively unique toxic
contaminants in that they are intentionally put
into the environment to accomplish their deadly
purpose. Therefore, all pest control programs
have a special responsibility to be fully
knowledgeable on the impact of these chemicals
and through a hierarchy of practice, prioritize
the use of preventive, nontoxic or least toxic
alternatives. IPM is the process by which this
is accomplished. It is also the law Public
Law 92-516, as amended, The Federal Insecticide,
Fungicide and Rodenticide Act (FIFRA). The
requirements for the management of hazardous
materials and the release of chemicals,
particularly pesticides, are becoming more
comprehensive. These expanding requirements and
increasing costs, are creating incentives to
reduce the amount of hazardous materials used and
wastes generated.     Excerpted from Integrated
Pest Management, by Wayne Warren American Society
for Healthcare Environmental Services Professional
Development Series
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Integrated Pest Management
Public concerns, chiefly centering around the
inappropriate use of pesticides and the
generation of harmful or toxic by-products from
waste treatment and disposal processes, clearly
indicate the need for a more comprehensive
environmental management technique known as
Pollution Prevention. A well managed facility
Pollution Prevention Program should incorporate
IPM, as well as other proactive opportunities, to
address the potential for risk before the
accident results in adverse environmental
impact, cost and/or liability. The facility
Pollution Program should seek to minimize the
generation of wastes or environmental releases
and provide conscious management of all
environmental media (i.e., air, water, and
land). Excerpted from Integrated Pest
Management, by Wayne Warren American Society for
Healthcare Environmental Services Professional
Development Series
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Occupant Participation in Recycling

• Establish a waste reduction and recycling program
  that addresses the separation, collection and
  storage of materials for recycling including (at
  a minimum) paper, glass, plastics, and metals
• Encourage a high level of recycling by building
  occupants
• The success of recycling programs is dependant
  upon ongoing educations

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Importance of Change
Insanity has been defined as doing the same
thing over and over and expecting a different
outcome. Negligence is defined as doing the
same thing over and over even though you know it
is dangerous, stupid or wrong. Now that we
know, its time for a change. Negligence starts
tomorrow. William McDonough Cradle to Cradle
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Green Cleaning in HospitalsCleaning to Protect
Health Without Harming the Environment
Thank You!

• Stephen P. Ashkin
• 812 / 332-7950
• SteveAshkin_at_AshkinGroup.com
• www.ashkingroup.com