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Greening of Healthcare

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Title: 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 617-918-1795
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