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Sowing the Seeds of SustainabiltyMarch 1, 2012
Sowing the Seeds of Sustainabilty
Hospital green teams work to ensure a healthier future
By Samantha Friedman
A hospital should be the first place that comes to mind when considering establishments promoting healthy living and a healthful environment. But with their critical need to sterilize medical equipment, eliminate germs and properly dispose of toxic or disease-spreading medical waste, combined with the enormous energy and water usage in a 24/7 facility, hospitals have only recently begun to adopt environmentally sustainable practices.
Medical centers are becoming increasingly diligent in their efforts to operate in greener, environmentally sensitive ways that in the long term actually save money and further improve patient health and well-being. Until now, groups of dedicated hospital staff members with a personal interest in making their workplace more sustainable most often have led the push for change. Called “green teams,” they are comprised of representatives from various hospital departments such as facilities and building management, medical supply purchasing, food services, transportation, housekeeping and janitorial services and community outreach. These groups lean on and learn from each other, forming a network through Maryland Hospitals for a Healthy Environment.
“We have to go so far in changing the culture,” says Suzanne Jacobson, an emergency room nurse who coordinates the green team at Frederick Memorial Hospital in Frederick. “We can educate the hospital community, but sustainable initiatives go beyond the hospital. That’s what our goal is, to keep putting out there what the hospital is doing.”
In Montgomery County, Shady Grove Adventist, Holy Cross, Montgomery General and Adventist Rehabilitation hospitals have green teams.
Green team leaders say it has not been hard to convince hospital leadership of the significance of paying attention to things like energy efficiency, reusable supplies, lower-chemical cleaning supplies and paints and waste stream management. The backing of hospital administrators is essential—they control the money needed for the research behind and initiation into energy- and cost-saving efforts. Today, more than three-quarters of Maryland hospitals have greening programs, and three—the University of Maryland Medical Center in Baltimore, Anne Arundel Medical Center in Annapolis and Mercy Medical Center in Baltimore—have full-time “sustainability managers.”
A compelling force behind growing sustainable operations in hospitals is the concept that the whole is greater than the sum of its parts. In other words, one person or a single department can introduce recycling bins, but when the whole hospital or the entire health-care provider industry makes sustainable practices customary, the results will be considerable, not only for the hospital, but the larger community beyond its walls as well. Nationally, for instance, Kaiser Permanente, one of the largest providers in the country, has used its huge purchasing power to lead the way in requiring suppliers to share information on chemical content in products, and in January, Kaiser announced the six-month roll-out of a conversion to intravenous equipment free of PVC and DEHP, chemicals known to have negative effects on people and the environment.
Maryland green team leaders share ideas and resources through Maryland Hospitals for a Healthy Environment (MD H2E), a grant-funded initiative of the University of Maryland School of Nursing established in 2005 to promote environmental sustainability in health care. According to the organization’s technical director, Joan Plisko, who visits facilities to advise them on best practices and organizes meetings to facilitate collaboration among green team leadership, “We are leading the nation. There are other states that are trying to pursue this, but what you really need is funding, and we have had that consistently over six years.”
Practice Greenhealth is a national membership organization that keeps hospitals tuned in to sustainable initiatives across the country; hospitals pay to belong. Plisko, on the other hand, consults at no charge. “For six years, [MD H2E] has been the go-to organization for sustainability and health care. What our organization wants is for the hospitals to own this.”
Boasting successes and figuring out new ways to be environmentally sound has become a “friendly competition” among green team leaders, says Denise Choiniere, a public health nurse who is a sustainability manager at the University of Maryland Medical Center.
Plisko is certain the health care industry’s attention to green efforts in Maryland will only grow – as well as set a model for other industries. “The intersection of health care reform and environmental sustainability is huge,” she says. “Doing the right thing for the environment because we are health-care providers is essential. Energy consumption saves money. Reducing your use of toxic pesticides and switching to less toxic, green cleaners have a positive impact on the health of employees, staff and patients.”
She attributes an explosion in interest over the past two years to “a little bit of good timing.” “You hear about global climate change, air pollution, pollution in our water, so going green is now more mainstream,” she says. “And when we can tie it to cost savings and health outcomes, it’s a no-brainer.”
Waste Not, Want Not
One of the most significant and widespread ways hospitals are saving money is reducing medical waste. In the past, all waste coming out of medical facilities, whether it was infectious medical waste (known as red-bag waste) or what would elsewhere be considered standard municipal trash (clear bag waste) was tossed out together and sent to be burned in an incinerator. A dangerous side effect was the release of dioxins, mercury, lead and other pollutants into the air.
“I’ve been a nurse for 32 years,” says Carol Chandler, chair of the green team at Shady Grove Adventist Hospital and the hospital’s director of the nursing education department, “and back then, it seemed like most of the equipment we used was reusable. Thirty-two years later, it’s all disposable as we got into infection control and single-use devices and began using more plastic rather than sending down equipment to be sterilized and reused again. We have a huge impact on the environment because of all of the disposables. Health care is the second largest producer of waste after the food services industry. We use a lot of resources, and we dispose of a lot of resources.”
According to Health Care Without Harm, an international network of hospitals, health care systems and environmental and community groups interested in promoting medical industry standards that do not harm the health of people and the environment, improving waste stream management focuses on three strategies: separating wastes so only those that require incineration are burned, reducing the amount of waste generated and improving recycling of materials such as paper and reuse of instruments and medical products when safe to do so. Significant progress has been made nationally. The organization reports that while more than 5,000 medical waste incinerators were in operation in the 1990s, there are fewer than 100 today.
Chandler has led efforts at Shady Grove to analyze waste stream management to effectively reduce the hospital’s footprint by examining consumption at the front end as well as improving waste separation. If a hospital pays by the pound for trash removal, recycling reduces costs. A group of nurses spearheaded a successful initiative to explore whether packaging containing sterile surgical equipment could be recycled. They collected the plastic wrap, and the environmental services department showed it to recycling companies to find out. The nurses were right, and today, a greater proportion of the packaging is recycled than thrown out. Nurses also have turned the blue wrap that contains sterilized equipment into bags for patient belongings, further diverting the level of trash headed for the landfill.
Cutting the Paper Trail
One way to reduce paper use is to move toward electronic data storage. At Holy Cross Hospital, says green team leader and service coordinator for plant operations Claudia Schreiber, lab data and other medical files and even W-2 forms are now digital.
As far as energy conservation, incorporating low energy consumption LED lighting to reduce carbon dioxide emissions is becoming increasingly common. Adventist HealthCare for instance, now purchases nearly 15 percent of its electricity in what is known as green energy, making it the largest purchaser of green energy of the health-care systems participating in the U.S. Environmental Protection Agency’s Green Power Partnership. Holy Cross is installing movement sensors in storage rooms and other non-patient rooms to replace what used to be 24/7 lighting with lights that automatically turn on and off as staff enters and leaves.
Product purchasing provides significant opportunities for incorporating products that have less of a negative impact on the environment, as well as cleaning products with less harmful chemicals. Shady Grove, for instance, now uses biodegradable washcloths, and Frederick Memorial Hospital has reusable needle boxes to cut down on plastic waste. At Holy Cross, disposable leg warmers, used to prevent blood clots for bedridden patients, and pulse oximeters are sterilized and reused, saving the hospital money.
Many of the efforts are simple but have monumental impact when incorporated on a large scale. Suburban Hospital encourages recycling in mixed bins throughout the hospital, has eschewed foam cartons and plastic covers from the cafeteria and is replacing paper towel dispensers with hand dryers in restrooms, says Leslie Weber, senior vice president for government and community relations.
Along the way, green team coordinators and sustainability managers are focusing on educating fellow staff members on why sustainability across the board is important and how they can better incorporate it into their day-to-day lives, both at work and at home. Earth Day provides a yearly opportunity to engage staff and update them on green initiatives.
When Shady Grove was in the process of building its tower expansion, which opened in 2007, the green team conducted a cost/benefit analysis on investing in water-saving technology that would recycle water as well as reduce the amount of water needed for sterilizing equipment. It successfully convinced the executive team to buy the equipment, reducing water consumption by 70 percent.
LEEDing the Way
The architectural industry’s green building standard is known as LEED, Leadership in Energy and Environmental Design, a certification system developed by the U.S. Green Building Council to acknowledge facilities that incorporate sustainable design elements. Last year, Anne Arundel Medical Center opened the first LEED-certified hospital tower in the state.
“The tower has between 18-20 percent energy conservation due to a combination of our 17,000-square-foot green roof, which helps with cooling and maintaining the temperature in the building, very high-efficiency HVAC systems, and eight LED lights in operating rooms, with 90 percent energy conservation,” says Charlotte Wallace, a pediatric nurse turned sustainability manager at Anne Arundel Medical Center in Annapolis. Surgeons appreciate the high-tech lighting because the lights do not heat up like traditional overhead lights, maintaining room temperature at a comfortable level and eliminating the need for blowing air conditioning.
In Montgomery County, Suburban Hospital, now a member of Johns Hopkins Medicine, which is known for its sustainable initiatives, plans to build a 300,000-square-foot addition that will double the size of the current building. The engineering and architectural team has designed the structure with the goal of achieving LEED Silver certification. Not only is Holy Cross in the process of building a LEED Silver tower, but it also has been incorporating LEED standards as it has renovated parts of the older building. A new hospital Holy Cross is building in Germantown, slated to open in 2014, will have a completely green roof, like its new tower in Silver Spring.
Transit is another area ripe for sustainability initiatives. In Frederick, many staffers live outside of the city proper and must commute to work, says Jacobson, which has motivated her green team to develop a carpool system. The team’s transportation committee educates staff on safe bicycling and is working to install more bike racks and generally make the campus more bicycle-friendly. Holy Cross uses diesel-fueled buses to shuttle employees from off-site parking lots. The parking lots have been retrofitted to collect storm water in underground vaults so as to not run off into the adjacent Sligo Creek Subwatershed and are lit by high-efficiency LED bulbs. Certain spots are reserved for carpoolers.
Green team leaders agree that building good environmental practices into the hospital environment is most effective when it can impact the larger community. Frederick Memorial, for instance, is considering sharing the service provided by a confidential paper shredding company with which it contracts by inviting the public to dispose of personal papers in need of shredding.
Many hospitals now source produce from local farmers and host farmers markets on their campuses. Shady Grove’s cafeteria features an all-local vegetable stand popular among employees and composts just about all food waste. Composting, in fact, has become fairly standard in hospital kitchens. Suburban offered a community supported agriculture program, known as a CSA, to its employees last summer. Holy Cross hosts a local farmer who brings in produce and freshly baked pies to sell to employees in the cafeteria.
Adding components like an in-house farmer’s market and elements that beautify the hospital environment can ease busy physicians’ and other staff members’ lives while adding peace and tranquility to patient experiences. When the green team initially gathered at Holy Cross, one of the first things its members did was plant trees and install birdhouses in the hospital’s healing garden.
Perhaps the next step is going green in ways that can help others beyond the hospital. Good Samaritan Hospital in Baltimore has been recognized for its Grown for Good Garden, an employee-managed garden that generated its first harvest last fall. Most of the crops were donated to a local charity, Our Daily Bread, and the rest shared among the employees who “put their sweat equity into the garden,” says the mastermind behind the garden, Chris DeRocco, green team member and the hospital’s director of food and nutrition. The garden educates people on where their food comes from, encourages the community to donate seeds or spend time working in the garden, and if DeRocco achieves his next goal, will also become a means of patient occupational therapy. “You start seeing the possibilities of how a small piece of ground can turn into a whole host of things,” he says.
Samantha Friedman is a writer who grew up in Rockville and now lives in Washington, D.C.