Greening of Healthcare - Slide 1 by liuqingyan

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									Greening of Healthcare

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



        Adapted from EPA Region 9 P2 for
        healthcare and H2E presentations
    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
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
      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)
       Benefits

• Improved impact on the environment
  from hospital/healthcare operations

• Cost savings

• Healthier environment for patients and
  employees

• Positive publicity
Specific Pollution Prevention Targets
 • Waste reduction – solid and
   hazardous
 • Pharmaceuticals
 • Mercury – Clinical, Lab, Building
 • Paper
 • Electronics
 • Cleaning
 • Energy/Water/Green Buildings
    Hospital Waste




US Hospitals generate approximately
6,600 tons of waste per day...
      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
             Getting Started
• Form a Team
    Make it part of everyone’s job
• Conduct an Baseline Assessment
• Data Collection
• Education and Training
                Waste Strategies
• Waste Characterization

• Waste Segregation Best Practices

• Minimization of Infectious Waste

• Recycling

• EPP for Waste Minimization
 Characterization – Understand your
               waste!
      GREEN MEMORIAL HOSPITAL                         BROWN MEDICAL CENTER
  Total Waste Disposal Costs=$245,000          Total Waste Disposal Costs= $596,000

                                                           1%    0%



38%                                           33%




                              That’s a difference of
                                      51%




                              $351,000 every year!                             66%

      1%
           10%
                                               Solid Waste: ~ 1550 tons = $93,000
 Solid Waste: ~ 1200 tons = $72,000
                                               RMW: ~ 775 tons = $465,000
 RMW: ~ 225 tons = $135,000
                                               Hazardous Chemical Waste: ~19 tons =
 Hazardous Chemical Waste: ~19 tons =
                                               $38,000
 $38,000
 Recycling: Assumes breakeven costs.
                                               Recycling: No recycling Program
 Avoided landfill cost of $54,000!
                       Benchmarking…

            Waste Stream              Avg. Disposal Cost    Avg. Disposal    Percent of
                                           per ton         Cost per pound   total Waste

BIOHAZARD
            Municipal solid waste         $40-$120          $0.02-0.06        45%
            (MSW)
            Regulated medical waste     $450-$1,000         $0.24-0.40       6-12%
            (RMW)
            Hazardous chemical        $1,000 or more         $0.50-$10        <1%
            waste
            Recycling (average for                breakeven                 Up to 50%
            all recyclables")
   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
  Reducing Regulated Medical Waste
• Switch to reusable items: suction canisters,
  sterilization containers, drapes, gowns, etc.

• Ensure proper segregation
          Source Reduction
    Purchasing 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)
       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.html


Practice Greenhealth Donations website
http://cms.h2e-online.org/ee/waste-reduction/waste-
   minimization/donation-surplus-programs
                   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
                      Recycling
• Diverts waste from landfill
• Reduces waste disposal costs
• Reduce Greenhouse gas emissions: Waste
  Reduction Model Calculator
http://www.epa.gov/climatechange/wycd/waste/calculators/Wa
   rm_home.htm


Practice Greenhealth recycling page
http://cms.h2e-online.org/ee/waste-reduction/recycling/
    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
                        EPA’s 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
       Environmentally Preferable
              Purchasing

• Opportunities in all areas – medical, surgical
  and office supplies, maintenance, etc.

• Group Purchasing Organizations provide
  leverage, efficiency for EPP
                 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-factsheet.pdf
• Practice Greenhealth EPP website
www.h2e-online.org/wastereduction/epp/overview.html
         Hazardous Materials




•   Glutaraldehyde
•   Ethylene Oxide (EtO)
•   Solvents: alcohols, xylene, formalin
•   Pesticides
•   Fleet maintenance solvents/degreasers
        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
               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
      Pharmaceuticals (cont.)
Current waste management

– Disposed via sewer
– Solid waste—landfill or incineration
– Hazardous waste – often incineration
– Medical waste – often incineration
– Returned for credit – usually incineration
Pharmacueticals: Resources
• Practice Greenhealth
http://cms.h2e-online.org/ee/waste-reduction/waste-
   minimization/pharma/
* Practice Greenhealth 10 Step Guide, updated
   August 2008
http://www.hercenter.org/hazmat/tenstepblueprint.pdf
• 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/
    Mercury in Healthcare
• Thermometers
• Sphygmomanometers,
• Barometers
• Bougies, dilators, cantor tubes
• Batteries, electronics
• Fluorescent tubes and compact
  fluorescent lights
• Switches/thermostats
  Clinical Mercury Devices
Alternatives widely available, at equivalent performance, cost




Gastrointestinal tubes Tungsten or Water
Sphygmomanometers Aneroid or Electronic
Thermometers                   Electronic or Alcohol
Calibrating                    Electronic
Manometers
       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
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
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
      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
                   Mercury Resources
HERC mercury page
http://www.hercenter.org/hazmat/mercury.cfm


Eliminating Mercury in Hospitals
www.epa.gov/region09/waste/p2/projects/hospital/mercury.pdf

Sustainable Hospitals Project
http://www.sustainablehospitals.org/HTMLSrc/IP_factsheet_contents.html#mercury

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
           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
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!
                      Paper Reduction
• Office paper

   –   Copy & print double-sided
   –   Paperless office – electronic records
   –   Reduce number of copies
   –   Reuse once used—as scratch pads
   –   Recycle office paper separately, keeping this stream as
       clean as possible
        • Provides product to “close the loop” & increases value
        • Maintain patient confidentiality
         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
       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
    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
  EU’s RoHS (Reduction of Hazardous
  Substances) Directive
• Procurement criteria systems
             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
               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?c=power_mgt.pr_power_
   management


• Free teleconference, 10/21/08        1:30-2:30pm
energystar.webex.com
         Electronics Resources
• HERC Electronics website
www.hercenter.org/wastereduction/electronics.cfm


• EPA’s eCycling website
http://www.epa.gov/ecycling/

• Healthcare Without Harm Resource page
www.noharm.org/us/electronics/resources
      “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
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
         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/greencleaning/

• 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
Energy Savings Pay Off
• Huge cost savings, short payback
• Energy Star:
    Contract specifications,
    Appliance standards,
    Facility benchmarking

  www.energystar.gov/healthcare
              EnergyStar Resources
Benchmarking Tool for Acute Care and Children’s
  hospital and tool for medical offices
www.energystar.gov/index.cfm?c=healthcare.bus_healthcare_benchmark

Take on-line benchmarking training, 11/13/08 at 12:00
energystar.webex.com

Building Upgrade Manual
http://www.energystar.gov/index.cfm?c=business.bus_upgrade_manual

New Building Guidance
www.energystar.gov/index.cfm?c=new_bldg_design.new_bldg_design_guidance

Target Finder
http://www.energystar.gov/index.cfm?c=new_bldg_design.bus_target_finder
               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?c=evaluate_performance.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/e2cquickref.pdf
E2C Recognition application
http://www.ashe.org/ashe/facilities/e2c/rec/pdfs/recapplication.pdf
                      Energy Star
              Purchasing and Procurement
• Buy Energy Star Products
Product information
 Cost saving information, saving calculators
 Procurement information, sample language
http://www.energystar.gov/index.cfm?c=bulk_purchasing.bus_purchasing


• Take free on-line procurement training, 10/23/08 2:00-3:00pm
Energystar.webex.com
            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
                     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/
          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
              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/
          Water Use Reductions
 Implement as you build or renovate
 Use consultants paid from “Shared Savings”
 EPA’s WaterSense
   http://epa.gov/watersense/
 Check out HERC water conservation
www.hercenter.org/facilitiesandgrounds/waterconserve.cfm

New! Use Energy Star Benchmarking
 tool to track water consumption
  http://www.energystar.gov/index.cfm?c=business.bus_water
             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
           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
             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/technology.cfm
University of New Hampshire Stormwater Center
www.unh.edu/erg/cstev/
                   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 organization’s bottom-line and the
  environment.

http://www.epa.gov/region1/topics/waste/greenscapes.html
                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
     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
  More Green Building Resources
• Practice Greenhealth Green Buildings page
  http://cms.h2e-online.org/ee/facilities/greenbuilding
• Healthcare Without Harm Healthy Buildings
  http://www.noharm.org/us/healthyBuilding/issue
• HERC Green Buildings
  www.hercenter.org/facilitiesandgrounds/greenbuilding.cfm
• Global Health and Safety Initiative
  http://www.globalhealthsafety.org/
• US Green Building Council (LEED Healthcare under
  development) http://www.usgbc.org/
    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
                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@epa.gov
Phone: 617-918-1795

								
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