In this final entry in our 6-part series on hospital sustainability, we will discuss food, chemicals, commuting, pest management, recycling “blue wrap” and “single stream” recycling.

Here are links to the previous five parts in the series:

1. Green Team and Mercury Elimination
2. DEHP Elimination and Green Hospital Initiative
3. Red Bag Waste Reduction
4. Environmentally Preferable Purchasing and Reprocessed Medical Devices
5. Energy Conservation and Other Conservation Techniques

Friendlier Food

Green Medical Center’s cafeteria offers sustainable food options (e.g. bovine growth hormone-free milks and meats, local organically grown produce).  They sell seasonal organic fruits and vegetables from local farms including apples, broccoli, mushrooms, peppers, radishes, green beans, hormone-free milk and fair trade coffee.  The Women’s Health & Environmental Network (WHEN) offers a free download of sustainable recipes for healthcare here.

Greener Chemicals

The hospital eliminated toxic cleaning chemicals in favor of environmentally safer alternatives.   Benefits of using “green chemicals” are safer disposal, reduced liability and improved health for employees, patients and visitors.   Many green products are less costly, too.

Environmental Commuting

Green Medical Center employs about 7,000 individuals and most commute from home to work by car.   Employers can promote a ride board to encourage carpooling or they can offer discounted bus and train passes to advance public transportation.   Another simple thing is to make bike racks available for cyclists.

Integrated Pest Control

Less toxic pesticides are used at Green Medical Center.   The hospital does not use pesticides classified as or containing:  EPA toxicity I or II requiring a danger or warning label, developmental or reproductive toxicants, known or suspected carcinogens, neurotoxin inhibitors, groundwater contaminants, nervous system toxicants, endocrine disruptors or wildlife toxicants.

Recycling Blue Wrap

Green Medical Center does not currently recycle their blue wrap, a polypropylene #5 plastic, however, that may be a future improvement at the hospital.   Blue wrap is a strong material resistant to moisture, tearing and an effective barrier to contamination.   The Operating Room (OR) generates about 50 tons of blue wrap waste per year or approximately 25% of their waste.   Prior to waste segregation, the OR disposed of blue wrap as red bag waste and paid about $20,000 per year in disposal costs.   After source separation in the OR, blue wrap is now considered municipal waste and costs only $1,250 per year for disposal.  Blue wrap is not biodegradable.  If it were diverted from the waste stream, it could be recycled and the hospital would earn a modest profit from a plastics recycler and remove it from the waste stream.

“Single-Stream” Recycling as a Future Option?

Single stream recycling is a system where all municipal “waste” is mixed together in a single collection and not sorted into paper, cardboard, plastic, and glass.  In single stream recycling, both the collection and processing systems are designed to handle a fully commingled mixture of recyclables.   The advantages include reduced sorting, fewer trucks, fleet flexibility, reduced transportation, automated collection, reduced collection costs, increased recycling and less time spent on recycling.  The disadvantages are that food waste must be separated from the other materials.  Employees, patients and visitors must be educated on the process and currently no single-stream recyclers exist in the local area.

Green Medical Center is currently reviewing the full spectrum of possibilities for improving the sustainability of the hospital.

We hope you have enjoyed this series on hospital sustainability.  Come back soon for a questionnaire to be posted on our blog, EES Essential Elements, related to sustainability practices at your institution.  And, as always, we’re looking for comments on our posts to get conversations started.

These are my links for August 23rd through August 31st:

• Supermarkets lose heart in green war on plastic carrier bags – Green Living, Environment – The Independent -
• Scientists find 10 new coral species in Hawaii – USATODAY.com -

We’re in the process of getting our blog listed by Technorati.  (Here’s our unique claim code KM3FHA7AV73Z – for Technorati’s review).

Check out Technorati when you are searching for new and interesting blogs.

Energy Conservation

Green Medical Center replaced over 3,000 incandescent lamps with LED lamps, reducing electrical usage substantially.   Occupancy sensors were installed in conference rooms.   Exit signs were replaced with LED lamps.   4-foot fluorescent tubes were changed from T12 to T8, saving additional energy.

The hospital was awarded a $3 Million matching grant from the Pennsylvania Department of Environmental Protection for a natural gas powered electrical cogeneration plant.  This cogeneration system is currently under construction and will drastically reduce expenses and reduce the hospital’s carbon footprint.

New buildings are designed with energy efficient windows to reduce winter heat loss and summer heat gain.   “Free cooling” mechanical systems use outside air for cooling when desirable.   “Green rounding” (Green Team visits to various hospital departments) and a poster campaign encourage employees to turn off lights, printers, and computers.

Other Key Conservation Initiatives at “Green Medical Center” Include:

1.  Improved boiler controls save over 100,000 gallons of water per year.   Low flow toilets and sensor-operated faucets were added to public bathrooms to further reduce water consumption.

2.  Online forms have replaced many paper forms.   Printer settings are set to default to double-sided.

3.  The number of linen changes has been cut in half to save labor, electricity, water and detergent.

4.  Printer ink cartridges, batteries and even office furniture are now recycled or reused.

5.  70 to 80 percent of all construction debris is recycled during the construction demolition process.

6.  100% of confidential paper is destroyed and recycled.

7.  Unwanted computers, printers and equipment with sensitive information are purged of data and then recycled.

8.  Food composting saves waste and kitchen oils are converted to bio-diesel fuels.

What conservation initiatives are you working on?  Let us know by commenting below, or contacting Tom Petersen or Paul Rivers at 215-881-9401, or by email at tom@eesolutions.net.

Part 6 of this Hospital Sustainability series will be posted on Friday this week.

Environmentally Preferable Purchasing

Green Medical Center (our fictitious hospital which is based on a Philadelphia-area hospital), through its Green Team, Purchasing Department and employees are encouraged by hospital administration to purchase the safest, least toxic and most environmentally friendly products and services available.   The hospital was honored in 2006 with the EPA Trailblazer Award for demonstrating leadership in reducing waste, improving indoor air quality and investing in reusable rather than disposable products.   Under the direction of the Green Team Chair, the hospital brought together manufacturers, suppliers, group purchasing organizations and Philadelphia-area hospital executives to leverage their influence and buying power.   It started a conversation among many vested parties and produced a written environmental policy for regional hospitals to follow.

The goals of this policy are to reduce the consumption of resources, reuse materials, recycle or re-sell materials and explore the use of alternative materials.   These practices are less damaging than traditional purchasing to human health and to the environment.   The Group Purchasing Organization, manufacturers and vendors were educated on the policy.   They are expected to comply with the policy or risk losing business.   Green Medical Center’s office supply partner now offers over 3,000 environmentally friendly office products, facility supplies, recycled paper, rechargeable batteries, refillable ink cartridges, remanufactured toner cartridges and Green Seal cleaning supplies.   Most corrugated shipping boxes are made from 35% to 100% recycled products.   Other vendors deliver their products in reusable totes.

Reprocessed Medical Devices

One of the most significant money-saving initiatives for healthcare purchasing is the safe reprocessing (cleaning, testing/verifying, sterilizing and packaging) and remanufacturing (disassembling, repairing) of “single-use” medical devices.   After thorough scrutiny by the Infection Control Committee, the hospital now saves approximately $500,000 per year by safely reprocessing and reusing “single use” devices.   Often the devices are reprocessed and reused many times vs. discarding the devices after a single use.   There is greater than $1,000,000 in potential in cost savings yet to be realized.   Reprocessing also saves about 7,000 pounds per year in waste.

Here are some of the devices that are currently reprocessed by Green Medical Center:

*Electrophysiology Catheters and Cables

*Pulse Oximetry Probes

*Compression Devices

*Diagnostic Catheters

*Cardiac Catheters

*Tourniquet cuffs

Do you have questions or comments about environmentally preferable purchasing or reprocessing of medical devices?  If so, please post a comment on our blog, or contact Paul Rivers or Tom Petersen at 215-881-9401.

Tune back in next week for the last two parts of our hospital sustainability series, where we will cover energy conservation, resource conservation and single-stream recycling.

Red Bag Waste (RBW)

Prior to 2005, at Green Medical Center (our fictitious hospital which is based on an actual Philadelphia-area hospital), all waste generated in every patient room was handled and treated as infectious waste.   The waste was placed in a single large infectious waste container.   Additionally, all waste generated in each bathroom was also handled and treated as infectious waste.   With the cooperation of Epidemiology, Administration, Environmental Services and Nursing, the Green Team set a goal to reduce red bag waste (RBW) to less than 25% of the total waste stream.   Eight-gallon, step-on lidded red bag waste containers were purchased for all medical/surgical patients’ rooms so staff could “source-separate” waste at the patient bedside.   Within one year, RBW was reduced from over 50% of the total hospital waste to less than 35% of the total waste stream.

RBW can cost approximately $480 a ton to process in comparison to municipal waste costing approximately $25 per ton.   One benchmark for measuring RBW is by pound per adjusted patient day (APD).   APD is a general measure of combined inpatient and outpatient days.   Best practices suggest that hospitals can reduce waste down to about one to three pounds per patient day or less than 10% of their total waste.

The Hospital Green Team wanted to reduce RBW to less than 25% of the total waste.   The team had to ensure that there were sufficient step-on receptacles in the Emergency Trauma Center (ETC), Labor and Delivery Floors to allow these departments to participate in the program.   The hospital staff was trained to dispose of items soiled with blood as RBW.   Labels were placed on top of the lidded containers informing staff of what is and what is not infectious waste.   Receptacles in bathrooms were changed to regular trash containers.   Soon, RBW decreased to less than 25% of total waste and the goal was reached.   Still, there was room for improvement…..

Critical Care Units and the Operating Rooms had not been included in the program.   These units produce significant quantities of RBW.   Prior to rollout in these units, Nurse Managers trained their staff on RBW source separation.   Step-on lidded, RBW receptacles were placed in these areas.   Staff began source separating and RBW tonnage plummeted.   “Green Rounds” were implemented as a teaching tool.   Green Team Members were assigned a floor or unit and they used a checklist to monitor compliance.   Green rounds were effective at reducing RBW even further while increasing recycling efforts.

About this time, the non-critical areas piloted a program to remove the red bag receptacles in favor of  small red bags available at the patient bedside.   Soon all medical surgical floors followed.   Now the medical surgical rooms feature one large municipal waste container with back-up small red bags, as needed.   Today, RBW stands at less than 15% of the total waste or about 2 pounds per adjusted patient day.   Green Medical Center achieved best practices and saved approximately $200,000 in cost avoidance per year.

We respond to all questions or comments posted here.  What have been your experiences with Red Bag Waste?

The next post in this series will cover environmentally preferable purchasing and reprocessed medical devices, so visit us again on Friday.

These are my links for August 11th through August 23rd:

• People in ‘active cities’ are slimmer | MNN – Mother Nature Network –
• Plain English Guide to The Clean Air Act | Air & Radiation | US EPA –
• Portugal Makes the Leap to Renewable Energy – NYTimes.com –

After attending a Clean Med Conference in 2004, the Hospital Safety Officer at Green Medical Center (our fictitious hospital which is based on an actual Philadelphia-area hospital) had learned about Di(2-ethylhexyl) phthalate (DEHP) (a vinyl plasticizer that was used to manufacture many IV bags and IV tubes).   DEHP is a toxin known to cause reproductive changes in the organs of developing animals.   The National Toxicology Program (NTP) convened an expert panel in 2000 and again in 2005, to review data pertaining to exposures and effects of DEHP.   In 2006, the NTP concluded that DEHP is a reproductive and developmental toxicant in animals.  The NTP further concluded that these animal studies are relevant to humans, and that current exposure levels are of particular concern for three distinct human populations:   critically ill infants; healthy infants and toddlers; and pregnant and lactating women.

The Patient Safety Committee at Green Medical Center, equipped with this information, agreed to phase out DEHP beginning with the neonatal intensive care unit (NICU), Pediatrics, Labor & Delivery and Maternity Units, where the potential risk to low weight developing infants and fetuses was believed greatest.

After evaluating options, the Patient Safety Committee agreed to a complete phase out of DEHP.   The decision to switch to Hospira’s new DEHP-free, VisIV containers paid off through increases in waste reduction, patient safety and staff satisfaction.   The hospital was an early adopter of the new Hospira, VisIV containers.   These containers were DEHP-free, latex-free, PVC-free and had specific design features to enhance patient and caregiver safety.   In 2010, Green Medical Center converted nearly all containers over and the entire hospital is virtually DEHP-free.

We appreciated the containers having no protective over wrap, which reduced waste by approximately 10 tons per year and increased the ease of use for the pharmacist and for the caregiver.   In the pharmacy batch processing, IV bag preparation and set up times were faster. Also, the containers were designed with a longer shelf life of up to 24 months.   The containers also featured new tamper-resistant ports.

Green Hospital Initiative:

The next leg of sustainability, evolved when the Pennsylvania Department of Environmental Protection (DEP) launched a Green Hospitals Initiative.   The program involved approximately twenty local hospitals, the Health Care Improvement Foundation and the Women’s Health & Environmental Network (WHEN).   The initiative was supported by an EPA grant and targeted best practices for regional healthcare facilities.   The initiative had a major impact in reducing wastes, toxins and pollution and got hospitals to work together, share ideas and improve practices. The hospitals were formed into four groups:

• Pharmaceutical and Toxic Waste Management
• Green Facilities
• Red Bag Waste Reduction
• Green Purchasing

Please share your experiences with similar initiatives in our comments section below.  What has worked and what hasn’t?

In Part 3 of this series, we will discuss our efforts to reduce red bag waste at Green Medical Center, so stay tuned.

This post is the first in a several part series that will focus on sustainability (green) efforts at a large hospital in the Philadelphia area, which we’ll call Green Medical Center.   In this series, I’ll discuss the economic, environmental, health and public relations benefits gained from committing to a sustainability program.   Many hospitals have been quietly, but actively, engaged in sustainability initiatives for years.   Hospitals operate around the clock caring for patients and they consume energy and material resources at high rates.   The Green Medical Center and others have realized that it makes good financial sense to protect the environment and our health through sustainability initiatives.

Green Medical Center formed a Green Team in 2006 and the team has met monthly ever since.   The Green Team grew out of the safety committee.   The Team was created and chaired by the Hospital Safety Officer.   Members on The Team represent the following disciplines:

• Safety Management
• Administration (Chief Operating Officer)
• Biomedical Engineering
• Environmental Services
• Facilities / Plant Operations
• Infection Control
• Information Technology
• Laboratory
• Nursing
• Nutrition Services
• Public Relation / Marketing / Grant Writing

There are opportunities to be “green” everywhere.   Hospitals must identify the initiatives that are easiest to implement, that cost little or nothing, and that have substantial payback, before tackling the more complicated issues.   When first launching a sustainability initiative, it is critical to pick the low-hanging fruit.  One purpose for the Green Team, is to identify and prioritize these green opportunities.

During the first several Hospital Green Team meetings, some members were skeptical about whether they could make a difference.   Many thought that the program would be costly to implement or that it would take too much time or effort.   It was important for The Team to get an early win and build upon the program from there, so they reviewed their recent history……

The EPA and the AHA (American Hospital Association) had set a goal for hospital medical devices to be mercury-free by 2005.   Green Medical Center had eliminated mercury in medical devices several years prior to 2005.   The phase out started in the late 1990’s and took approximately five years to achieve.   Since Green Medical Center had already phased out mercury, this effort was incorporated into the sustainability program and counted as a Green Team success story.

What sustainability successes have you (kind reader) had in your organizations that you’d like to share below in our comments section?  Do you have any specific knowledge related to the elimination of mercury in medical or other devices?  Do you have questions you’d like to pose about sustainability initiatives in healthcare or other sectors of the economy?  We’d love your input.

The next area of focus for sustainability initiatives at Green Medical Center was the elimination of Di(2-ethylhexyl) phthalate (DEHP), a toxic vinyl plasticizer used in making many intravenous (IV) bags and IV tubes.  We’ll discuss this initiative in the next blog post in a few days, so check back with us!

When I was a child, my uncle taught me the ancient game of chess.  Over the years, I have played sporadically and have only improved slowly.  I’ve always enjoyed chess, though, and wanted to do more with it.  With my third child showing an interest and aptitude for the game, I decided to start a chess club for his friends and schoolmates.  At first we met in my living room, but that quickly became difficult due to the noise level that just naturally accompanies 7 to 10 year olds.  Once we moved to the local community center, the crew became more manageable.

Our club members have grown and matured, and are mostly entering fourth and fifth grade.  We continually add new members and the more experienced players help the “newbies.”  Come the fall, I’ll prepare an invitation flyer for the students at the new school my son is entering, and expect to get some additional players.

Since I am not an experienced teacher, sometimes keeping order during the club is like herding cats.  One method I’ve used for keeping the focus on chess, and not on running amok, is to run chess tournaments for the group.  Our last tournament ended in a four-way tie for first, so we had to have a couple of runoffs to select the victor and award the trophy.

After a day of report writing and field work for my environmental consulting practice, an evening of playing and teaching chess is a welcome diversion.  I’ve also improved my own chess game considerably with many face-to-face and online contests under my belt in the last few years.

Anyone with interest in learning more about our Cheltenham Chess Club, please contact me.  Comments on this blog post and all other posts are always welcome.