In no other vertical facilities market is Kermit’s refrain — it’s not easy being green — truer than in health care. The 24/7, energy-intensive, highly specialized nature of health care facilities seems, on the surface, to be a huge hindrance to any sort of meaningful, cost-effective and comprehensive green plan.
But while green may be tough for health care facilities, it can also be argued that in no other type of facility is green more critical. That’s because environmentally responsible strategies don’t just focus on the health of the environment. They also can positively affect the health of people — both patients and staff.
Evidence-based design has shown that design and operational strategies can influence everything from the amount of medication patients need to nursing turnover rate. And facility executives are starting to understand that evidence-based design strategies and green strategies complement each other quite nicely.
“Environmental responsibility should be viewed as a key parameter within evidence-based design,” says John McCarthy, a member of the steering committee for the Green Guide for Health Care and president of Environmental Health & Engineering. “This will impact any number of areas, such as energy, materials used as part of the building process and packaging of products that may be used in various hospital settings.”
Though some hallmarks of evidence-based design, like providing daylight and views of nature, are new-construction strategies, operational ideas in existing buildings may have just as much impact.
For instance, several facets of a green cleaning program can have both environmental and patient-health impacts. A common green cleaning practice is to reduce aerosolized cleaning application in favor of pour and wipe. This reduces exposure to toxins that may make patients sicker.
Facility executives can also improve IAQ and reduce health issues by using disinfectants, which are toxic by design, only in high-touch and critical care areas, says Janet Brown, director, sustainable operations for Practice Greenhealth.
“Among nursing professionals, workplace exposures to cleaning products and disinfectants increase the risk of new-onset asthma,” says Brown.
It is up to facility executives to ensure that health care organizations focus as much on green operations as on more visible elements of new construction. “You can see daylighting and meditative spaces,” says Brown. “Operational changes are not as visual, but we still want to make sure other things like toxicity, health of workers and waste should be just as important a part of the model.”
To make sure this happens, designate a department, or at least a person, whose only job is focusing on sustainable strategies, says Edward Rubenstein, manager, energy and environment for Toronto General Hospital, a 4.5 million-square-foot, three-facility organization. “This office should oversee the whole process of instituting environmental policies, which means managing different groups and streamlining the whole process.”
The environmental office should be a one-stop-shop for suggestions from those who work at and visit the facility — and a place where people know their suggestions will be taken seriously.
Whether the environmental office is a part of the facilities department or not, it has to have the ear of upper management as well as the authority to work with other departments, like procurement, waste management and human resources, to set policy and evaluate suggestions.
“Products are brought down to me all the time,” says John Ebers, sustainable business officer for Metro Health Hospital in Grand Rapids, Mich. “I’m always being asked to find out what’s in it and if it can be recycled.”
In a standard “bucketed” arrangement, procurement and waste management might have little contact. A sustainability office can help bridge that gap and work with product procurement folks to make sure that standards for products entering the facility contain no chemicals on a facility’s black list. Many items that might be covered by green procurement standards are not facility-related, but many are (like flooring, furniture and paint), so having a central office that can handle both is critical to creating an organizationwide policy.
This also helps make the connection to waste management, because the end-of-life of products is considered in procurement standards.
According to the Green Guide for Health Care, U.S. hospitals generate about 6,600 tons of waste per day, so facility executives should work closely with the environmental department to create a waste reduction plan, a major tenet of which is recycling. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) imposed strict requirements for how health care facilities could dispose of waste. Regulated medical waste — or “red bag” waste — must be disposed of separately from non-medical waste per a specific protocol.
Brown says that, even today, HIPAA isn’t well understood. Instead of examining how to separate waste streams, the policy at some hospitals is to toss just about any type of waste into the red bags. This increases waste management spending by hundreds of thousands of dollars in some hospitals and is not very environmentally responsible.
“By carefully separating waste streams, dramatic reductions can be found in the amount of required regulated waste disposal,” says McCarthy. Some medical waste haulers now provide cleaned and reusable containers for red bag waste.
Ebers says he uses reusable “sharps” containers and recyclable “blue wrap” plastic. Blue wrap is used in operating rooms to sterilize instruments, and represents as much as 23 percent of solid waste in some health care facilities.
According to the Green Guide for Health Care, about 80 percent of all waste is actually non-medical. Concentrating on ways to reduce and recycle paper, packaging and other waste may have the most impact on green operations.
A common misconception is that HIPAA requires paper to be shredded before it is recycled. Recycled paper is destroyed by the recycler, which meets the intent of the law. “If a recycling bin is publicly accessible, just make sure it’s closed and locked,” Brown says.
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