Achieving Healthcare Sustainability: Suggestions for Success

November 14, 2011

By Kelly M. Pyrek

While it provides the great capacity to heal, the healthcare industry is a sizable consumer of natural resources. According to Practice Greenhealth, the healthcare sector uses more than 800 trillion Btu of energy annually, costing $6.5 billion each year. Hospitals that have as many as 500-plus beds can use up to almost 300,000 gallons of water annually, and they can generate more than 6,500 tons of waste per day, costing $15 billion each year for solid waste disposal alone. There's no dispute that the healthcare sector, comprising 17 percent of the gross national product (GNP), leaves a significant environmental footprint.

In this article, we'll look at how healthcare facilities can engage in environmentally preferred purchasing, reduce chemical use, actively seek alternative sustainable products, engage in green building, reduce consumption of energy, water and raw materials, minimize waste, engage in recycling programs, transition to renewable energy sources; eliminate incineration, and improve transportation strategies. These activities, however, hinge upon whether or not a healthcare institution makes sustainability an organizational priority with support that trickles down from the C-suite level. Experts say that sustainability must be integrated into all areas of the organization and its activities, internally and externally through leadership, education, and accountability and engagement in public policy and community education. Additionally, hospital leadership must encourage and incorporate sustainability as an essential element in the culture of the organization.

"I think that the 'greening' of facilities is something that is taking hold in the healthcare sector," says Anna Gilmore Hall, executive director of Practice Greenhealth, a nonprofit membership organization founded on the principles of positive environmental stewardship and best practices by organizations in the healthcare community. "It is not a passing fad, its here to stay, and so it becomes very important for all healthcare professionals to understand the implications this has on hospital operations and medical practice. It's critical to think about the link between healthy people and the environment that is growing ever stronger. There is growing evidence that 70 percent of expenditures are related to taking care of chronic disease, which can be exacerbated by the environment. Exposure to environmental contaminants is a huge burden on the healthcare sector, so whatever we can do to reduce that burden is in the best interest of all of us in the community. One of the things we have been working on with hospitals is ensuring that nurses, physicians and other healthcare professionals understand that link."

Gilmore Hall continues, "It's about the health of people now and the health of future generations. Safer for patients, staff and leverage what's going on in healthcare better for the communities we serve. We are seeing more hospitals take up the banner of sustainability and examine their practices because of that. The healthcare sector, which is 17 percent of the GDP, is a huge employer, a huge user of resources -- water, electricity -- what we do in healthcare really impacts a lot of other people, employees and the community. So we can be role models for sustainability."

Going green requires a culture change that is embraced by everyone in the hospital's workforce, from patient-care units to the executive suite. It also requires a commitment from time-pressured healthcare professionals, and that takes education to boost awareness of environmentally friendly practices.  "When I was an operating room nurse, I was very busy and I didn't think about where the red bag waste went or how much it cost for that red bag waste," Gilmore Hall says. "When you realize that it is twice as expensive to take care of red bag waste than it is normal trash, and that hospitals need those funds for investment in patient care, you suddenly become more careful about waste disposal. Hospitals have realized by reducing the volume and toxicity of their medical waste, they can significantly reduce their carbon footprint as well as the amount of trash they are putting into landfills or sending to incinerators. And they can save money."

"Nurses and others in healthcare are not a very wasteful group of people," Gilmore Hall adds. "If we recycle at home, shouldn't we recycle at work in the hospital? If we are turning off our lights at home, why wouldn't we be doing that in the hospital? Many times we didn't do it because we didn't think about the cost implications of it and we didn't think about the environmental impact of our actions. But when we understand the impact on the environment and on people's health, we see conservation as part of our job, and we take the extra step necessary to put that pizza box or coffee cup into the normal trash receptacle and not put it in the red bag waste. It's a key change in habits. It does require a corporate culture change; people at all levels of the hospital, and particularly the C-suite, must see this as important and part of their mission for the organization. And the CEO must ensure that everyone in the organization understands this is part of their job and part of their responsibility. Together, across the organization, a significant impact can be made. That goes a long way toward a safer, healthier environment for patients and staff and the communities we serve."

Strategies for Going Green

There are a number of ways that hospitals can implement environmentally friendly activities:

Address waste. Practice Greenhealth makes the following suggestions for waste minimization, segregation, and recycling in hospitals:
- Establish a "green team" comprised of nurses, administrators, environmental services staff and others who are responsible for waste handling and occupational and environmental health and safety.
- Conduct a waste audit by examining what comes into the hospital and what (and how it) leaves. Observe red bag waste, solid waste, food waste, laboratory chemicals, and chemotherapeutic and pathological waste. Use the results of the audit to identify wasteful practices and develop a waste management strategy that incorporates waste reduction, reuse, and recycling measures. Segregating the waste at the point of generation, before treatment or disposal, is critical.
- Educate all hospital staff about the safe and appropriate segregation of waste for recycling, reuse and disposal. Cardboard, glass, office paper, cans, newspapers, magazines, and certain plastics are commonly recycled. Place signage at the point of waste disposal (trash cans, garbage bins, recycling containers, battery capturing receptacles) to reinforce the directions for proper segregation and disposal.
- Combine waste management strategies with sound purchasing practices to select reusable versus disposable products, as well as less hazardous products and products with less packaging.

Address regulated medical waste. The industry standard for optimal regulated medical waste (RMW) disposal rates is 15 percent or less of total waste, according to Practice Greenhealth, and best performers routinely hit rates less than 10 percent. For example, Practice Greenhealth suggests that the director of the hospital's environmental services, in collaboration with the infection preventionist, will spearhead the effort for better medical waste segregation, appropriate container placement and education and signage for clinical staff. The healthcare organization can then track RMW volumes over the course of the year and compare to baseline to determine percentage reduction. Other sample waste goals might include: establishing a waste baseline within six months; developing a viable, effective recycling program on patient floors within 12 months; increasing recycling to 20 percent of total waste generated within one year; implementing a reusable sharps container program within 12 months; and piloting a composting program for pre-consumer waste in the kitchen by end of the third quarter.
Hospitals are also encouraged to review their sharps disposal processes to determine if sharps are being disposed of with the RMW, and they should also consider a sharps container reuse program as part of their review of their current sharps-disposal process. Additionally, facilities should review how they handle suction canisters and whether they are rendered non-infectious and disposed with the regular solid waste. Hospitals can consider cost-effective suction canister treatment programs that render the contents non-infectious and non-toxic, does not impact the sewer system, and can be used with relatively little effort by healthcare workers.

Address misuse of red bag waste. Medical waste is typically deposited in red bags and is therefore known as red bag waste that is incinerated on- or off-site. The challenge is that if regular trash is thrown indiscriminately into these red bags, there is a significant cost involved. Practice Greenhealth encourages hospitals to observe their waste stream in operation by reviewing how and where trash is disposed of in each department, and to ensure that regular solid-waste containers are available wherever there are RMW receptacles to avoid inappropriate waste segregation. It is critical that only truly infectious waste be deposited in red bags so that the vast majority of hospital waste can be recycled appropriately instead of being incinerated or sent to the landfill. The process of incinerating hospital waste creates pollution, with two particularly worrisome pollutants--dioxin and mercury. Dioxin, a known carcinogen, poses a host of health problems as it is bio-accumulated in the environment and eventually consumed by people. Mercury has already sufficiently accumulated in our waters that it has made some fish dangerous to eat in even modest quantities. Careful waste segregation provides an opportunity to select the most environmentally safe disposal for each category of waste.

Engage in appropriate incineration. The burning of medical waste, whether on- or off-site, presents an enormous challenge due to the creation of toxic air pollution and toxic ash. The incineration of regulated medical and general hospital waste results in air and water emissions of dioxin, mercury, other toxic metals, particulates, and sulfur dioxide. The EPA has identified medical waste incineration as a significant source of dioxin air emissions and as the contributor of about 10 percent of the mercury from human activity. Plastics comprise approximately 15 percent to 30 percent of the medical waste stream, roughly twice as much as is found in municipal waste streams. There are a variety of alternatives to incineration for the treatment of waste. Although each of them has advantages and disadvantages, none creates the same level of environmentally unhealthy consequences as incineration. The alternatives include autoclave/steam sterilization, microwave, and chemical disinfection. When any of these methods are chosen, the treated waste is then placed in a landfill.

Participate in a recycling program. Practice Greenhealth encourages healthcare facilities to "prevent, reduce, reuse and recycle" with the following suggestions:
- Continue to monitor, and educate staff, and reduce wastes.
- Talk to procurement administrators, contractors, and vendors and require less packaging and take back policies for deliveries that include components such as shrink wrap, strapping, and pallets, or use reusable crates for all shipments instead of corrugated boxes.
- Learn from other source/waste/toxics reduction programs run by hospitals, industry, and government. What works for them ma work for your facility.
- Whenever possible, phase in re-useables and buy recycled products.
- Start in-house material and chemical exchange programs.
- Start recycling programs for corrugated paper, computer and mixed paper, metal cans, and glass bottles.
- Institute food composting and make food donations to food banks.
- Tie waste contracts to market prices for recyclable commodities, as print

Address environmental health hazards. For a number of years now, hospitals have been eliminating patient-care products that contain mercury, especially mercury thermometers. Another toxic substance is the chemical compound Di(2-ethylhexyl)phthalate, or DEHP, which is contained in common plastic products used in the healthcare setting. It is in a category of toxic chemicals known as pthalates, which are added to polyvinyl chloride (PVC) plastic to make the plastic product flexible and strong. It is frequently used in the manufacture of IV tubing, IV bags and feeding tubes. Because DEHP does not bind with plastic, it can leak out of PVC medical products during medical procedures, or it can off-gas from vinyl products. Another toxic chemical is dioxin, which is primarily a product of waste incineration of plastics.

Consider adopting chemical products that are less hazardous. Although there is still debate as to whether healthcare facilities can ever be truly "green" in their use of detergents and sterilants, some efforts can be made to ensure that environmentally healthier and safer chemicals for cleaning, disinfecting and sterilizing devices and surfaces are selected and used.

"Practice Greenhealth has done some work with a few groups around the topic of green cleaners," Gilmore Hall says. "We know that exposure for staff is less when they use green cleaners, and that there are fewer issues relating to asthma and allergies when using green cleaners.  We have learned that when a hospital has a green team in place, they tend to look at green cleaners as a solution. We know that housekeepers and environmental services personnel are part of the infection control team and that their job is more than mopping the floor, their job is providing an environment so we can better manage infections in hospitals because of better cleaning processes. As part of the discussion about green cleaners, there has been increased discussion about infection prevention and we have seen significant evidence of increased communication between environmental services staff and nurses around the importance of cleaning. As an example, one hospital was surveyed by the Joint Commission and performed terribly on environmental cleaning. After we conducted a program around green cleaning, at the next site visit by the Joint Commission, they were blown away by the improvement. We are not saying it was because of the use of green cleaners, we are saying that the green cleaning conversations led to better cleaning and reduced exposure to employees. It was the green team approach that increased the entire performance of their cleaning process."

Gilmore Hall acknowledges the current debate about whether green cleaning can fully achieve sufficient pathogen kill rates. "Healthcare-associated infections (HAIs) are a serious problem for hospitals that must be addressed, but do you do that at the risk of other unintended consequences or overuse of chemicals," Gilmore Hall says. "We don't want to use bleach on everything but there may be a time you have to -- knowing when to use it and how to use it and to balance it -- a lot of integrated pest management programs in hospitals -- do you want to spray the hospital kitchen with a pesticide or do you just want to put the food away in the fridge so it doesn't lure ants and other pests? Some things just make good common sense that we need to do in the hospital.

Engage in environmentally preferable purchasing. Environmentally preferable purchasing is the process of purchasing products and services whose environmental impacts are less damaging to the environment and human health when compared to competing products and services. Reducing waste can begin before a medical supply is even used, thus address environmental responsibility on the front end. Essentially, healthcare facilities can learn to reduce the number of medical supplies or office supplies by being mindful about consumption habits; they can select reusable products instead of disposables when appropriate; they can recycle products when reuse is not feasible; and they can optimize disposal methods. By understanding how the products are made, including the occupational and environmental health risks posed by their production processes, as well as the impacts of their final disposal, healthcare professionals can understand the full "life cycle" of the products and  their potential impacts. According to Practice Greenhealth, environmentally preferable products are generally less toxic; minimally polluting; more energy efficient; safer and healthier for patients, workers and the environment; higher in recycled content; packed in less packaging material; and fragrance-free.

"It's great to take care of the waste at the end of the life of the product, but the more we can get involved in the purchasing decisions of hospitals and systems to buy environmentally preferable products in the first place, the less we don't have to worry as much about the end of life issues or how much is going into the landfill or how much volume in waste because smart purchasing in the first place can reduce packaging, the toxic chemicals in products, do a lot at the front end of the process," Gilmore Hall says.

"Practice Greenhealth is very involved in leveraging the purchasing power of our member healthcare facilities to work with manufacturers to change products," Gilmore Hall adds. "We realized that DEHP, which is a chemical additive to plastics to make them more flexible and easier to use, and PVC, which is a known source of dioxin in the environment, were two chemicals that should be reduced or eliminated in the healthcare environment. But it's a challenge to do so. In order to make IV tubing and IV bags more flexible, manufacturers add DEHP; over time it leaches out and into the IV solutions and into the patients. NICUs are a site where there are lots of plastics and IV and endotracheal tubes are used; scientists have told us that baby boys are particularly susceptible to DEHP and they have pointed to some of the adverse outcomes from exposure to DEHP. So we have been able to work with companies that manufacture IV products to demonstrate that the healthcare sector would be very interested in purchasing IV supplies that don't have DEHP in them if they would produce them. Over the last two years we have seen hospitals stand behind their commitment by demanding that kind of change from IV-product manufacturers. Now, Hospira and several other manufacturers are first out of the gate to offer DEHP-free products, and that is a growing segment of their business. One of the things we try to do with industry is help them understand where the healthcare sector wants to go with sustainability practices and why it's in their best interest as a business to be involved in conversations with the healthcare sector."

As another example, Gilmore Hall adds, "Practice Greenhealth was working with Kaiser Permanente as they were getting ready to do a significant refurbishing project. They wanted to purchase carpeting that didnt have PVC backing but their supplier didnt have it. Kaiser said they would award a contract to manufacturers who would come forward with this new product. Three manufacturers responded and as a result of that situation, you and I can go to the store today and we can buy a carpet that doesn't have PVC backing. Think of the implications for all of the kinds of purchases that the healthcare sector makes -- furniture, food, medical commodities -- so as we signal the market about where we want to go, I think we can be very influential."

Practice Greenhealth is also helping foster new dialogue in the environmentally preferable purchasing arena. "At a recent CleanMed conference we brought together hospitals and group purchasing organizations (GPOs) and agreed we'd come up with a standardized set of questions that we'd like to ask manufacturers and suppliers to respond to," Gilmore Hall says. "We would signal the marketplace about where we were going with future products that we wanted to become more environmentally preferable. That conversation has continued to escalate; a scorecard has been developed by Kaiser Permanente that we are going to be using as a foundation document. We hope that many hospitals and GPOs will agree to these standardized questions and that we will be able to leverage the purchasing power of healthcare to move toward safer, less toxic medical products."

Examine waste management in the operating room. As hospitals across the country look for ways to reduce environmental impact, it makes sense to start with the departments that have the largest environmental footprints. The operating room (OR) is the epicenter of todays hospital with a recent study by the McKesson Group estimating that the OR generates 42 percent of the hospitals revenue. A primary source of hospital admissions, the OR also drives significant costs related to equipment, supplies and personnel the OR is the leader in medical supply usage for the entire hospital. A recent study estimated supply costs at 56 percent of the total budget of the OR dwarfing salary costs at 35 percent. The OR also is one of the largest users of supplies within the hospital as well as one of the largest producers of waste. Case studies have estimated that between 20 percent and 30 percent of the total waste generated by the hospital comes from the OR. A number of leading healthcare institutions have begun to tackle this problem by identifying a set of best practices that can reduce costs while also reducing waste, energy and worker and patient exposure to hazardous chemicals. The Greening the OR Initiative is a collaborative effort to envision what the green operating room of the future might look like, and what kinds of products, programs and best management practices hospitals can focus on as a means of getting there. Practice Greenhealth is committed to working with its partners and endorsing hospitals to provide the data, tools and resources necessary to substantiate these best practices as a critical step to widespread adoption across the sector.

"We have 125 hospitals who have enrolled in Practice Greenhealth's Greening the OR Initiative since the launch less than a year ago and we are thrilled with what these hospitals are doing to reduce their environmental footprint," says Gilmore Hall  "For example, Fletcher Allen Medical Center achieved a 38 percent recycling rate in 2010. The nurses in the OR who were the initiators of the OR recycling program were able to collect about 50 tons of recycling materials and they saved $6,000. Another example is Spectrum Health, which initiated a medical plastics recycling program in its 45 ORs in 2007 and by 2010, they were recycling 42,500 pounds of blue wrap -- in just one department they saved $1,300 and avoided a significant amount of waste. Since then, they have expanded their program and have saved about $200,000 and reduced waste that would have normally gone into the landfill by 2,900 tons." 

The Greening the OR Initiative is looking at interventions in the OR that reduce environmental impact, reduce cost, increase efficiency, and improve worker or patient safetyor some combination of these. There are a range of interventions that have been looked at by the initiative, and participating hospitals will continue to define additional interventions as they are piloted and implemented at different institutions. Initial interventions include:
- Regulated medical waste reduction and segregation
- Fluid management systems
- Single-use device reprocessing
- OR kit reformulation
- Reusable surgical gowns and basins
- LED lighting and power booms
- Displacement ventilation
- Waste anesthetic gas (WAG) capture and reclamation
- Medical plastics recycling
- Reusable hard cases for surgical instruments

Putting It All Together and Making the Business Case for Sustainability
It may seem daunting to hospitals to embark upon an ambitious sustainability program, but Gilmore Hall emphasizes that it's easy to create change by taking small, manageable steps. "The first step is the first step -- you don't have to redesign your whole hospital," Gilmore Hall says. " Maybe you implement a recycling program, or maybe you consider low-flow toilets or more efficient water use. The first steps can be small and simple efforts. Put a little sign by the light switch saying 'when you leave the room, turn the light off.' If you are not using your computer at the end of the day, turn it off. There are so many things that are low-hanging fruit, and they can significant savings. We tell people to start with something small, be successful, and then go to the next step and try something bigger, and that gets people excited along the journey to greater sustainability."

Gilmore Hall continues, "We have seen many hospitals across the country take part in different programs with diverse goals around recycling or energy and water conservation. We have seen many organizations focus on different parts of sustainability in their organization by first making it a pilot program in one OR or in one nursing unit and it dominoes across the hospital and eventually we see the entire hospital system embrace this work. Kaiser Permanente is a good example of a system very visibly and very vocally embracing sustainability as a core component of the work that it is doing. Catholic Healthcare West is another long-term member of Practice Greenhealth who has been a leader in making sustainability a part of the practice of hospitals in that system. VHA also is very interested in meeting the executive order from the president to reduce the volume and toxicity of its waste stream, to start leveraging purchasing power, to demand changes in the marketplace, and demand more environmentally preferable products."

Before embarking upon a sustainability program, hospital leadership must determine the return on investment for their efforts and engage in wise decision-making.

"We must demonstrate a business case for most everything we do because hospitals are very short on disposable income like many other businesses are," Gilmore Hall says. "For instance, you must look at the life cycle of a product. It isn't just what it costs you today to buy it, it's what it costs the day you buy it, what it costs while you are using that product, and what it costs when you dispose of that product. Life-cycle assessment of the cost of a product is very important, particularly in a hospital. One dollar of savings in operations is equivalent of having to go out and finding five new dollars of revenue, so you want to make purchasing as efficient as possible up front. Products currently being used in the hospital should also be scrutinized. Hospitals realized the impact that mercury in thermometers was having and Practice Greenhealth decided that getting mercury out of healthcare was a good place to start. People were initially concerned about the cost of mercury thermometers being replaced with digital products. We reminded hospitals that even though non-mercury alternatives cost more money, we asked them how much it costs to clean up a mercury spill, and what were the implications of mercury getting into the water supply or the exposure of employees and patients to a thermometer being broken and breathing in fumes. When you look at all of that it was far less expensive to go with non-mercury thermometers. That's the education process that is always necessary."

Another smart strategy is the formation of a team of hospital stakeholders that can tackle the day-to-day issues relating to a sustainability program and provide leadership to the rest of the facility.

"We strongly encourage hospitals to establish institution-wide green teams where members identify a couple of projects, establish goals and metrics so that efforts can be measured and cost savings can be demonstrated to management. That gets people excited and motivated about taking the next steps. Speaking as a former nurse, the involvement of nurses in these green teams is critical because they can make or break a program like this -- if they won't want to participate, it won't be successful, but if they do, it will be. In many instances I see nurses become the environmental champions in a facility and they have the ability to engage, educate and inspire other employees."


Practice Greenhealth

Health Care Without Harm

Healthcare Sustainability Case Studies

To help illustrate the kinds of sustainability efforts that can be undertaken by hospitals and health systems, ICT presents two case studies from members of VHA Inc.

Providence Health & Services
Providence Health & Services has aligned going green with its core values and vision, making sustainability a high priority for its senior leadership team as well as for its employees.  Providence, a system that employs more than 52,000 people and serves 42 communities throughout five Northwestern states,  continuously explores and implements processes and policies that conserve energy, reduce waste and pollution, and provide its patients and employees with more healthful food options. This case study looks at sustainability work by Providence in Oregon, a region with eight hospitals, medical clinics, health plans, long-term care facilities and home health services, and more than 16,000 employees.
We know how important sustainability is to our patients and our communities, said Mike Geller, manager for regional sustainability at Providence Health & Services in Oregon. Our sustainability program is closely aligned with our mission, vision and core values. It is an important part of the way we do business in our communities. Being good stewards of the environment is integral to providing efficient and effective health care to our patients.
The following details describe one of Providences best-in-class initiatives, its measurement efforts and its employee engagement tactics.
Best in Class Initiative: Providences single-use devices (SUD) remanufacturing program is a best-in-class collaborative effort with a remanufacturing vendor, to reprocess devices and divert them from landfills. In the programs three years, it has saved Providence in Oregon $989,000 and kept 54,230 pounds of regulated medical waste from ending up in landfills. Through this program Providence decreases its environmental impact and reaps savings that can be devoted to providing consistently high-quality healthcare.
Measurement: Providence knows that a central part of any successful sustainability program is measurement. Each month, Providence tracks all waste streams, energy use and purchasing scrutinizing those areas for opportunities to reduce environmental impact. Providence includes this data in its annual measurement report that lets stakeholders know how they are doing and what goals they have met during the year.  
Employee engagement: To maintain direct staff involvement, feedback and interest in its sustainability programs, Providence developed an Oregon Sustainability intranet site, as well as an internally produced sustainability video for its Oregon hospitals and care programs. Shown at conferences nationwide and for internal sustainability forums, its best practices are considered a model for other healthcare facilities.

New York-Presbyterian Hospital
Acknowledged as one of the countrys best hospitals on the U.S. News & World Report Honor Roll of Hospitals for the last decade, New York -Presbyterian Hospital (NYP) understands the importance of doing business in a sustainable manner, both because it makes good business sense and because its the right thing to do for its patients, employees and community. The nations largest not-for-profit hospital, NYP has 2,409 beds and serves more than 1.5 million inpatients and outpatients annually, including nearly 200,000 emergency room visits. NYP saw an opportunity to engage in more sustainable practices in order to better live out its own values and also promote sustainability in healthcare across the nation.
In recent years, NYP has adopted a comprehensive sustainability program led by a Sustainability Executive Steering Committee to create a healthier environment for patients and their families, the staff and the communities they serve.   At its Going Green:  An Emerging Mission in Healthcare Conference in October 2010, NYP defined its sustainability cornerstone programs that are devoted to energy conservation, waste reduction, resource management, and staff engagement and operate under the hospitals NYP green umbrella.  
A few examples of NYPs sustainability initiatives include:
Energy management: NYP has implemented a comprehensive energy management program.  In recognition of its efforts, NYP received its first Energy Star Partner of the Year award in 2004.  In 2011, agencies awarded NYP with the EPA Energy Star Partner of the Year Award for Sustained Excellence in Energy Management, the programs highest honor. 
Single-stream recycling: NYP established a single-stream recycling program to make recycling easier and more intuitive for its employees.  The program diverts plastic and aluminum products and non-confidential papers from conventional trash to recycling bins.  As a result, it has realized annualized savings of $100,000 from its recycling program. Working closely with the environmental services department (EVS), the hospitals campus Green Teams educate their colleagues on proper recycling practices. NYP is also collaborating with 1199 SEIU to deliver intensive training to front line housekeepers on a range of sustainability topics, empowering them with knowledge that helps prepare them for possible career advancement opportunities.
Staff engagement: Employee engagement and leadership support are important to foster and maintain an effective sustainability program.  NYP has five Green Teams, one for each campus, that work closely with the NYP Sustainability Officer and the Sustainability Executive Steering Committee.  The green teams work to provide staff volunteers, called Green Champions, with the information and tools that will help them improve awareness and adoption of sustainability initiatives.
Awareness events:  Communicating about sustainability initiatives in creative and engaging ways is essential for ensuring the success of the program.  Since 2008, NYP has hosted annual Earth Week events to raise awareness about the impact and importance of sensible sustainability practices and help empower staff and visitors to adopt these practices at work, at home and in their communities.  On a monthly basis NYP hosts un power hours where, during one designated hour of the day, staff is encouraged to take the stairs instead of the elevators as well as turn off non-essential lights, computer monitors, and electrical appliances not critical to patient care.
Desktop printer recycling program: NYP implemented a collection and recycling program that enabled staff to dispose of used toner cartridges at a central location.
Paper usage reduction program: NYP set a default standard that all photocopy machines be set to automatically print duplex (two-sided) copies. All hospital owned and operated copying machines, in both clinical and administrative spaces on and off campus, were converted to this standard.  NYP has realized annualized savings of over $100,000 through this program.
Clinical device reprocessing: By identifying specific devices for reprocessing, NYP reduced the amount of waste it generates and in 2010 realized over $1 million in cost savings through the reduced purchase of new products.
Measurement: NYP maintains data for all these programs to review and seek continual improvement.
NYP continues to set aggressive new goals to increase recycling, waste reduction and energy conservation.  Additional efforts include participation in several city-wide sustainability initiatives, including the New York City Hospital Challenge, a pledge to reduce greenhouse gas emissions by 30 percent by 2018, and a plan to reduce direct and indirect carbon emissions by 20,000 tons.


Sustainability Industry Roundtable

ICT asked members of industry to describe how they are supporting hospitals efforts to improve sustainability stewardship. Here are their responses:

Advanced Vapor Technologies
A water-only, non-toxic alternative technology for delivering rapid disinfection in the healthcare venue extends beyond the required priority for the safety of patients, staff and service personnel. The benefits of using this renewable technology, provides a reduction in costly consumables such as disinfectants, their associated packaging, transportation and handling costs. The management required for chemical storage, dilution issues, appropriate use and depletion concerns, to include the regulatory management of numerous MSDS forms is reduced. Using fewer chemicals -- coupled with the speed of disinfection and simplified disinfection protocols -- increases staff compliance while consuming and disposing of less water. When compared to chemical use, studies show reduced energy consumption and pollution between 97 percent and 100 percent across seven key indicators of sustainability.  Introducing fewer chemicals to the building envelope directly supports and benefits the quality of the healing environment expected from healthcare facilities while supporting both physical and fiscal sustainability.

The connections between human health and a healthy environment are inseparable and for that reason, BD is committed to reducing our environmental impacts and to supporting our customers and suppliers in focusing on those same goals. As part of that effort, we're working to help hospitals reduce their waste and to achieve their own sustainability goals. Most recently, BD has been exploring new approaches to managing the life cycle of our single-use medical device products. One such approach entails recycling medical sharps waste and using those materials to manufacture new products, rather than permanently disposing of them in landfills. BD launched this new approach -- the BD ecoFinity Life Cycle Solution in the U.S. in April this year. Its an innovative program to recycle sharps, and it includes an alliance with Waste Management Healthcare Solutions. BD ecoFinity was developed as a life cycle solution for our single-use devices -- hypodermic syringes, IV catheters and prefilled flush syringes all of which are widely used in hospitals.  The ultimate goal of BD ecoFinity is to help hospitals reduce waste and minimize their environmental footprint.

EnCompass While Ecolab has committed to waste, water, and greenhouse gas reductions within our own facilities, we have long recognized that we can have a more positive total impact through our customers by providing products and programs that help them conserve resources and run their businesses more efficiently. Our EnCompass Environmental Hygiene Program drives product and process standardization to maximize efficiency and minimize water and chemical use. In pilot studies, hospitals that implemented the full Encompass program reduced water usage by 86 percent and chemical usage by 74 percent. In addition to the water and chemical savings, Ecolabs personally delivered training for staff on standardized procedures helped reduce patient room turnover time by 15 percent.
*Average water, chemical and time reductions based on studies of four pilot sites. Hospitals were using string mops and changing solution every three rooms prior to implementing the full EnCompass program. Data on file with Ecolab.

Georgia-Pacific Professional
Georgia-Pacific Professional constantly strives to deliver innovative products and solutions to help hospitals achieve sustainability goals by reducing their environmental impact, as well as achieving a more hygienic environment. Many of Georgia-Pacific Professionals products connect with the Environmental Protection Agencys (EPA) Reduce, Reuse, Recycle program. For example, enMotion® touchless towel dispensers can reduce waste by up to 30 percent compared with standard folded towels. When paired with enMotion® high-capacity towels which received EcoLogo certification and meet EPA standards for recycled content enMotion touchless towel dispensers help to provide an even greater environmental benefit to healthcare facilities. Additionally, Compact® coreless bath tissue, which also received EcoLogo certification, helps minimize a hospitals environmental impact by using recycled fiber and reducing packaging waste by up to 95 percent when compared to standard bath tissue.

InPro Corporation
The one continual theme we hear from our customers in both the design community and facilities management is they want choices in materials, and especially sustainable alternatives. For more than 10 years, weve experimented with new polymers. Back in 2006, we attempted to make interior protection products out of pure PETG, a polyester derivative, but those were extremely brittle. We stepped away from pure PETG, and continued searching for new formulas. Last year, we announced a new blend combining biopolymer, recycled content and PETG.  This resulted in a durable, resilient product that fits our customers needs for impact resistance.

Kimberly-Clark Health Care
Kimberly-Clark Health Care strives to maintain the balance of protecting healthcare workers and protecting the environment by focusing on manufacturing practices, packaging efficiency, recycling programs and community support.  As part of this commitment, the Company is a member of Practice Green Health, a membership and networking organization for institutions in the healthcare community that have made a commitment to sustainable, eco-friendly practices to improve the health of patients, staff and the environment. Additionally, Kimberly-Clark Health Care recently partnered with Rhode Island School of Design (RISD)'s Industrial Design Department to develop sustainable design solutions for repurposing used hospital sterilization wrap. The partnership was initially sparked by the desire to consider a clever, well-designed solution with a direct re-use for KIMGUARD* rather than re-pelletizing it. The wrap is not hazardous and incinerates cleanly, but the volume of wrap waste generated makes the handling and disposal of used sterilization wrap a challenge for many hospitals. Undergraduate students were tasked with developing sustainable new concepts and scalable designs for repurposing KIMGUARD* Sterilization Wrap.

Glove the Planet is Sempermed USA Inc.s commitment to reducing their environmental impact. Thinking ahead and consuming less, Sempermed is able to do more to minimize their global footprint. Driving sustainability begins with innovative production, distribution and packaging design. By packaging 200 gloves instead of the usual 100 gloves per box of Sempermeds most popular nitrile gloves, they help their customers save time and money that would have been spent on restocking, storage and ordering. That, in addition to using recycled materials to create their product packaging, is the reason Sempermed is able to save 2,660 trees a year. Sempermed also reduces its carbon footprint (equivalent to removing 200,000 cars off the road annually) due to its choice of ocean shipping vessels.

Stryker Sustainability Solutions
Reprocessing single-use devices is one of the best ways for hospitals to run a smarter, more sustainable business.  Third-party reprocessing is a proven solution to address hospitals economic and environmental responsibilities without compromising safety or efficacy.  Stryker Sustainability Solutions, formerly Ascent, is a leading third-party medical device reprocessing organizations, and partners with more than 1800 hospitals across the country to provide a fiscally- and environmentally-sustainable solution.  Its reprocessing programs help hospitals divert thousands of pounds of medical waste from landfills and redirect hundreds of millions of dollars to the delivery of quality patient-care initiatives, such as equipment purchases or investing in staff resources. If just 1 percent or 2 percent of all medical devices labeled by the manufacturer as single-use were reprocessed, the healthcare industry would save nearly $2 billion every year.