Green Cleaning, Waste Reduction is Embraced by Healthcare Facilities

By Michelle Beaver

Ambulatory surgery centers (ASCs) and surgical hospitals already have long to-do-lists, but some are beginning to take on new responsibilities by making their cleaning and disinfecting processes more environmentally friendly, and by conserving resources.

The trend is finding fertile ground in the healthcare industry from the largest facilities down to the smallest, says Sarah O’Brien, environmental purchasing specialist for Hospitals for a Healthy Environment (H2E). “Unlike many industries where dealing with environmental issues may come as a low priority item, with healthcare it moved very quickly to a prominent position because it was about public health,” O’Brien says. “It wasn’t just about trees and water and skies; it was about health in the communities that (medical professionals) served, and the global community.”

H2E was launched in 1998 and is the collaboration of Health Care Without Harm, the American Nursing Association, the Environmental Protection Agency (EPA), and the American Hospital Association (AHA). H2E boasts 1,288 partners that represent a total of 3,302 clinics, 1,478 hospitals, 679 nursing homes, and 883 other types of facilities.¹

The non-profit organization educates healthcare employees about how to choose environmentally friendly products and practices. Specific goals are to eliminate mercury, support eco-preferable design of new healthcare buildings, and to reduce the use of dangerous chemicals, particularly persistent bioaccumulative toxins (PBT’s).

Moving more substantially toward green products would be a good move for ASCs and surgical hospitals, according to Molly Gutierrez, executive director of Physician Hospitals of America (PHA). “Absolutely,” Gutierrez says. “If patients get the same type of protection from an environmentally sound product that they would get from another type of cleaner, then there’s no reason not to use it.”

It doesn’t take long for healthcare professionals to realize that making more environmentally friendly choices is not about “cleaning with baking soda,” O’Brien says. “Some of the largest cleaning-chemical manufacturers in the country and the world have developed green cleaners that are certified by reputable organizations. It’s not about home remedies or untried or untested products … It’s really just a question of weeding through the very many options that are out there and finding the ones that work best in your particular circumstances.”

Many standard cleaners and disinfectants are a “major contributor to indoor air quality issues,” according to H2E’s 10-Step Guide to Green Cleaning Implementation. “Many contain high levels of volatile organic compounds which can give rise to respiratory irritation, headaches and other symptoms in workers and building occupants,” the document states.

In order to create healthy indoor air, it is necessary to regulate the use of cleaning and disinfecting agents, to have proper temperature and humidity control, sufficient air circulation and exchange, and a handle on airborne contaminants, dust, and odor.⁴

Green Cleaning and Disinfecting

Many cleaners and disinfectants cause eye, nose and throat irritation, headaches and nausea, but whether these ailments turn into chronic illnesses depends mostly on the length and magnitude of exposure, O’Brien says. Most facility administrators who switch to green products do so to ensure occupational safety, according to Lara Sutherland, an environmentally preferable purchasing researcher at Health Care Without Harm. “It’s not a tricky thing to address,” Sutherland says. “…If you want to switch to green cleaners, there are a lot of other people who have done it, there are a lot of resources out there, and it’s easy to do.”

The facilities that have worked with H2E have not seen infection rates go up after they implemented green products, O’Brien says. In fact, some centers have realized that they were treating entire buildings as though they were critical areas, and decided that such a strategy was not necessary.

It’s important to meet with fellow staff members to discuss the situation, O’Brien says. “It can be a really useful process and can uncover some instances where maybe you’re being overly aggressive just because it’s accepted practice and has been done in the facility for 30 years and no one ever really revisited it,” she adds.

H2E representatives do not pretend to be infection control practitioners in any capacity, but they do insist that cleaning and disinfection changes in critical areas be handled with utmost care. “When it comes to disinfection, clearly patient and staff health is paramount,” O’Brien says.

Still though, in almost all healthcare centers, about 60 percent of the cleaning needs are similar to any hotel, school, or other public institutions, according to Sutherland.

“(Medical facilities) have to clean mirrors just like everybody else,” she says. “With institutional cleaners, purchasers have been asking about (green products) for a long time, so companies see the advantage and they’ve developed the products.”

Employees at the Stanislaus Surgery Center in Modesto, Calif., will probably start using a breadth of green products, says Don Ward, the facility’s environmental services supervisor in charge of biohazards. In October he started researching green initiatives on the Internet and getting information at conferences. He purchases for the housekeeping department and says he is going to meet with his colleagues to discuss a strategy.

“I’ve been getting information but I have not checked out pricing,” Ward says. “I do think going green is important. Eventually I think the government will make us do it anyway. I see where things are headed and I think it’s good. It’s in part for safety reasons too because I don’t want anything to ever happen to anyone I work for or with.” Ward adds that after proper research, he will experiment with a whole line of cleaners and disinfectants.

Some general first steps that ASCs and surgical hospitals can take to be more environmentally friendly include:

• Using fragrance-free products 
• Microfiber mopping (which reduces water needs)²
• Vacuuming or damp-mopping instead of sweeping 
• Buffing on medium speed, which will generate fewer chemical particles than a high-speed buffer²
• Avoiding aerosol products 
• Considering the replacement of carpet with other surfaces, as carpet retains many undesired germs and often requires harsh cleaning agents 

And, of course, top cleansing priority should go to all medical instruments and machines, as well as surfaces most touched such as sinks, toilets and doorknobs.⁵

Bug-busting Details

The EPA classifies all microbials as pesticides, and therefore, none are considered truly “green.” There is, however, a wide range in this grey area and some products are therefore better than others in terms of indoor air quality, occupant safety and the environment.⁴

A limited amount of antimicrobials are present in sterilizers, sanitizers and disinfectants, all of which are more effective on surfaces that have been cleaned of soils. According to the EPA’s, Janitorial Products Pollution Prevention Project, “Some products, primarily those containing quaternary ammonium chlorides, may be used for both cleaning and disinfecting. These products work best upon surfaces that are already fairly clean, or when they are used twice in a row — once to clean, then to disinfect.”

The following are the most common antimicrobials, all of which have some negative health impacts:⁴

Waste Not, Want Not

The amount and content of healthcare industry waste is significant and includes:

• Solid waste (trash) 
• Biohazards (sharps, red bag wastes) 
• Hazardous waste (chemicals, solvents, mercury) 
• Pharmaceuticals (chemotherapy drugs, narcotics, controlled substances) 
• Universal wastes (computers, batteries, fluorescent bulbs) 
• Recyclables (paper, cardboard, metal, glass, plastic), 
• Food and organic waste
• Radioactive waste¹

According to the H2E Web site, “When staff throw away non-contaminated waste into the regulated medical waste stream (red bags), your facility is needlessly paying for specialized disinfection and disposal.”

Many healthcare facilities don’t realize the extent to which they waste and pollute, O’Brien says. “(Environmental consciousness) is not about doing something philanthropic if you happen to have a lot of spare time on your hands. It’s really about operation of healthcare facilities at the highest level of efficiency so that you don’t generate unnecessary costs.”

Facilities that cut down on regulated waste have saved 40 percent to 70 percent on waste disposal. 1 New York’s Beth Israel Medical Center, for instance, has reduced its regulated medical waste and now saves $600,000 annually.

Most ASCs and surgical hospitals can cut down on use of non-recyclable chlorine paper, energy inefficient bulbs, and electronics.

When ASCs and surgical centers do buy new products they can choose vendors who limit excess packaging and who recycle as much as possible.

“Often, people don’t realize that their loading dock is overwhelmed with huge amounts of Styrofoam from electronics (and other products),” O’Brien says. It is imperative to ask vendors questions about their packaging, and to write tight contacts with them.

It’s difficult for ASC or surgical hospital employees to conserve more until they have investigated their facility’s waste streams. This communication requires employees from every department.

“People are very departmentally focused in healthcare and often there’s not a lot of communication between the safety officer, the environmental services person and the purchasing person,” O’Brien says. She thinks that people should, “get together across those boundaries to really communicate about their processes or products so they can pool their information … It will tell you a lot about your purchasing habits and what’s going on in your facility.”

Each ASC and surgical hospital is “an entity onto itself” and will therefore have specific needs.

Since infection is such a serious issue in healthcare facilities, healthcare practitioners are often anxious when it comes to changing cleaning products, even though some cleaning practices are the result of perceived risks, as opposed to actual risks.²

Still though, a lot of changes are happening throughout the industry to cut down on pollution indoors, and out.

“It (started with) the recognition, which was something of a shock, that healthcare, while it was doing a really wonderful job healing people’s illnesses, was also a source of a lot of waste and toxic pollutants that can contribute to ill health,” O’Brien says.

The Bottom Line

Purchasing green cleaners and disinfectants and reducing waste should ultimately add to the profits of ASCs and surgical hospitals, O’Brien says.

“I believe the healthcare folks we speak with are facing financial pressures, staffing pressures, a multitude of issues coming at them from all directions,” she says. “That’s one of the reasons why we try to be clear about making the business case for environmental sustainability in healthcare. “But often if someone is in a situation where they’re very pressured and they have a lot of financial issues, they might look at environmental issues and say, ‘Well that would be nice in a perfect world but I just don’t have time for that.’ In fact, a lot of the processes that we can help them embrace really increase operational efficiencies, reduce waste and the need for compliance measures and worker protection.”

Health Care Without Harm and other organizations work with group purchasing organizations and individual purchasers to get them to research, ask for and purchase green products. Some, so far, are more interested than others, Sutherland says.

“There are certainly some leaders who have been doing a lot and then there others who still have a lot to do. In every category (of health facilities) there are leaders,” she says.

One helpful source is Green Seal, a non-profit organization that educates the public and certifies environmentally-preferable products. Green Seal offers information about hundreds, if not thousands, of green cleaners and disinfectants. Their standards include the following restrictions:

• The undiluted product should not contain any carcinogens or products that cause reproductive toxicity 
• The product should not be toxic to aquatic life 
• The undiluted product should not be combustible 
• The packaging should be recyclable 
• The product should not contribute to tropospheric ozone, photochemical smog or poor indoor air quality

Where to Start?

The most important step is to start a green team that can evaluate the uses and effects of the cleaners and disinfectants that are being used. It’s a good idea to go for the “low hanging fruit first” by tackling the issues that are easy to solve, Sutherland says. “People can take steps almost immediately to make improvements,” she adds.

It may also be wise to measure indoor air contaminants through an industrial hygienist or environmental scientist before any changes are made.4 That way, employees will be able to better target their problems.

“When you’re thinking about taking first steps, look at a place where there’s a problem that already needs to be solved, whether it’s compliance or occupational exposure problems,” O’Brien says. “You want people within a facility to see environmental initiatives as helping them do their jobs, not adding to them.”

There is still, however, a ways to go before the average facility will be wanting and able to get on board with green products. Part of the problem is that not enough empirical data is reaching healthcare professionals, says Patti Costello, executive director of the American Society for Healthcare Environmental Services (ASHES). “ASHES focus group data tells us healthcare cleaning professionals are tired of hearing about green cleaning from all angles without information needed to speak intelligently with their infection control colleagues,” Costello says. “Additionally, there needs to be consistency in messaging between regulatory and guidance agencies and the entities promoting seals of approval for green cleaning products.”

Some ASCs and surgical centers may want to communicate with facilities of similar scope that have implemented new products and practices.1 For that reason, H2E and other organizations put peers in contact with each other, and with a large amount of free resources.

The conversion was very successful for the North Bronx Healthcare Network and could likely be implemented in any ASC or surgical hospital. The network serves a population with high asthma rates, which was one more reason for using safer products, says Peter Lucey, senior associate director of support services.

“In conversation with our occupational health services department, they have indicated that they have seen a significant drop in incidents reported but we still want to do a formal review,” Lucey says. “In terms of dollars — because there are some who believe that implementing a Green program will cost more — I tell you that is just not true.”

The keys, Lucey says, are to use a good dispensing system, find a product supplier that can help train you, and to properly educate staff members about why the switch is being made.

“… Once the staff was given a true understanding of why we wanted to go in this direction — and that they saw that the products were just as effective — most came on board right away,” he says. “I do recommend though that when you make the change you must be vigilant in getting all of the old products out. If not, they are sure to appear at the time you least want to see them.

“For the staff that works with me to keep our building safe, clean, and sanitary I sleep better knowing that we are using products that should have no long term health effects,” he adds. “Personally, I would rather be ahead of the regulatory curve than trying to catch up, but when you boil it down though, it’s just the right thing to do.” 

3. Green Seal environmental standard for general purpose bathroom, glass and carpet cleaners used for industrial and Institutional purposes. Third edition, Feb. 27, 2006.

4. Culver A, et al. INFORM, Strategies for a Better Environment, Cleaning for Health: Products and Practices for a Safer Indoor Environment. 2002.

5. Barron T, Berg C, and Bookman L. Environmental Protection Agency. Janitorial products pollution prevention project. June 1999.