April 2007

Dear Colleague:

This April 2007 edition of Premier's Green Link newsletter brings you the latest news, resources, and cost-saving success stories in green purchasing and healthcare practices.

A special feature is a newly developed Web site, Green Corner, housing success stories from healthcare facilities and suppliers and organized by topic. A listing of Green Corner topics follows the news headlines below. We welcome your success stories for future issues – send an email to epp_program@premierinc.com.

Visit Premier's Safety Institute Web site for more resources on green purchasing at www.premierinc.com/epp.

Please share this free newsletter with your colleagues and encourage them to subscribe. You can unsubscribe at any time.

Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute

News

 

Green Guide for Healthcare toolkit stimulates environmentally friendly building projects

The healthcare industry represents $16 billion and more than 100 million square feet of construction per year. As with medical products, there are concerns among hospitals about the health effects of construction building materials on patients, staff, and the environment.

Recent research has found that chronic diseases linked to hazardous chemicals are on the rise—including certain cancers, birth defects, fertility problems and asthma. Total annual costs of environmentally attributable diseases in U.S. children alone are estimated at $55 billion. Many of these potentially hazardous chemicals are contained in materials used for healthcare facility construction and furnishings and include, for example, mercury, lead, dioxin, cadmium, phthalates, PVC, and halogenated flame retardants.

Green Guide for Health Care (GGHC) is the primary guide for the healthcare industry as a transformational new tool for building hospitals that are healthy for people and the environment. It is being cited as an important catalyst in the recent watershed for healthcare green construction that emphasizes human health outcomes when designing healthcare environments.

Major healthcare facilities around the world are using the GGHC to design, build, and operate the next generation of high performance healing and green environments. The Green Guide is a voluntary, self certifying system modeled after the U.S. Green Building Council's LEEDŽ rating system with more than 170 design, construction and operations points that offers specific health policy reasons for each point. A toolkit of best practices, the guide incorporates design elements that can be used by designers, owners, and operators of healthcare facilities to guide and evaluate their progress toward what is being called "high performance healing environments." (See related story on Healing Environments.)

Unique features of Green Guide Some of the unique features of the new version of Green Guide (Ver. 2.2) released in January 2007:

  • Tailoring to assist with regulatory challenges in healthcare
  • Incorporating design elements that enhance patient healing and staff well-being
  • Using innovative technologies to reduce energy and water use
  • Reducing hazardous chemicals
  • Implementing green operations ranging from organic food to landscaping and housekeeping protocols

Green construction at its highest level The number of green building projects among U.S. hospitals reached its highest level in 2006, with no signs of slowing down. At the close of 2006, a total of 112 projects (mostly new construction) were underway among hospitals participating in GGHC pilots, representing a 45 percent increase from 2005. The trends in green construction have spawned a proliferation of environmentally friendly building materials that do not contain or produce persistent, bioaccumulative, toxic chemicals such as PVC-free furniture, non-toxic flooring and insulation. By choosing building materials that are free of hazardous chemicals, healthcare facilities are finding they can significantly improve the quality of their air and water, and ultimately protect the health of their patients and staff.

Resources from Premier's Safety Institute
Visit Premier's Safety Institute Web site on Construction for resources on safer, greener design; research on safety advantages of single room occupancy; construction guidelines and toolkits from national organizations (AIA, APIC, CDC, The Joint Commission); and a tool for conducting an infection control risk assessment (ICRA) prior to construction.

Downloads and links

Green Guide for Healthcare Web site: http://gghc.org

The Safety Institute's Construction Web site

Back to News

 

Hospitals expand green building efforts to create healing environments

In addition to using environmentally friendly building materials, hospitals are designing healing spaces that incorporate all that is good about nature, including calming indoor gardens and waterfalls, outdoor walking spaces, public areas bathed in natural light, and noise reducing ceilings and flooring.

Most importantly, healing environments have been found to have a direct correlation with improved patient outcomes. One study found, for example, that patients with views of nature went home almost a day sooner, had a $500 lower cost per case, used fewer medications and exhibited better emotional well-being. Private rooms have been associated with shorter length of stay and reduction in both medication errors and nosocomial infections—according to a study by the Coalition of Healthcare Environment Research (CHER) on the single versus multiple occupancy rooms in acute care.

Examples of healing environments

Many hospitals have recently undertaken green construction projects designed to create holistic healing environments. A few highlights:

Hackensack (NJ) University Medical Center's Women and Children's Pavilion, opened in December 2005, has earned a distinction as one of the nation's top 10 green hospitals by the Green Guide Institute. Its Deirdre Imus Environmental Center for Pediatric Oncology has garnered worldwide acclaim as one of the first hospital-based programs whose specific mission is to identify, control and ultimately prevent environmental factors that may cause adult and pediatric cancer and other health problems. The hospital took exhaustive measures to procure and use materials with little or no persistent bioaccumulative and toxic chemicals as well as creating special healing features. Among these healing features are interactive lobby lighting to welcome and engage children, meditation rooms that feature a wall of natural sounds and visuals to quiet the spirit, organic food selections, a rooftop garden, patient gowns made from 25 percent organic cotton/75 percent "green" cotton (processed without toxic chemicals), and PVC-free plastic and formaldehyde-free wooden toys.

Banner Health – a large non-profit healthcare system with 17 hospitals in seven states has embraced a "healing environment" in many of its hospitals. Two examples:

  • Banner Estrella Medical Center, Phoenix, AZ - Sunbathed lobbies, waterfalls and soothing music describe the ambience of this desert hospital that was featured in a special 2006 Newsweek report, "Fixing America's Hospitals."
  • Banner Gateway Medical Center, Gilbert, AZ - Opening in early fall 2007, Banner Gateway was designed with a canyon theme to bring the peacefulness of nature indoors and create a warm and welcoming environment. The hospital was built using "evidence-based design," that is, research that supports healing environments and patient care. Some examples include 167 large private rooms with space up to 240 square feet, sliding doors to the bathrooms to prevent falls, patient controlled lighting and temperature, a spa tub for women in labor, and measures to control noise such as sound absorbing flooring, acoustical tiles, and hands-free communication system for staff.

Green Guide for Health Care address "healing environment"
The Green Guide for Health Care (GGHC) is a voluntary self-certifying metric toolkit of best practices that address both green and "healing environments" in healthcare. Among the best practices for construction and operations are those that evaluate progress towards a healing environment such as connection to the natural world with exterior access for patients; reducing noise levels, use of natural ventilation, and use of daylight. See related story on Green Guide.

Resources from Premier's Safety Institute
Visit the Safety Institute 's Web site on Construction for resources on safer-greener design, research on safety advantages of single room occupancy, construction guidelines and toolkits from national organizations (AIA, APIC, CDC, The Joint Commission) and a tool for conducting an infection control risk assessment (ICRA) prior to construction.

Downloads and links

Download the executive summary: Single versus multiple occupancy room (CHER) (.pdf) (271 KB)

The Safety Institute's Construction Web site

Back to News

 

Healthy food movement spreads to healthcare

Increasing scrutiny has been leveled at foods high in pesticides, antibiotics and other chemicals, and hospitals are implementing solutions such as purchasing locally grown foods, organic foods, and produce, milk and meats that are free of potentially damaging chemicals.

Recent trends

  • Close to 20 million pounds of antibiotics are used as feed additives for animals to promote growth, about 10 times the total antibiotics used in human medicine.
  • Genetically engineered drugs such as recombinant bovine growth hormone (rBGH), which is given to dairy cows to boost milk production, has been singled out as a major health concern in humans.
  • The vast majority of the nearly 9 billion broiler chickens are fed arsenic to promote growth and better skin color.
  • Nearly 40 percent of U.S. hospitals host a fast-food establishment on their campus - according to recent studies by the University of Michigan Health System and Ann Arbor VA Medical Center.

The healthy food movement in U.S. hospitals is growing, and food suppliers and distributors are beginning to respond by offering healthy alternatives.

Positive steps
To the 80 percent of U.S. hospitals that operate their own food service – each of which serves up more than 1 million meals a year – implementing healthy food initiatives can be daunting. But scores of hospitals are doing just that today through various initiatives, including:

  • Seeking out arrangements with local farmers' markets to provide produce free of pesticides and other chemicals. More than 100 U.S. hospitals now host farmers' markets, and dozens more are reportedly planned.
  • Developing on-site organic gardens.
  • Purchasing antibiotic - and hormone-free dairy products, poultry and other meats.
  • Offering healthier alternative snacks in vending machines.
  • Removing fast food chain restaurants from their premises.

One of the broadest such approaches is illustrated by the work of Catholic Healthcare West (CHW), a 41-hospital system that developed its own "Food and Nutrition Vision Statement" in the late 1990s shortly after becoming a signatory to the Coalition for Environmentally Responsible Economies (CERES), a national network of investors, environmental organizations and other public interest groups working with companies and investors to address sustainability challenges such as global climate change. The statement is CHW's effort to be proactive and to advocate for healthy foods in its facilities that are produced in more sustainable ways. (For related story, see Green Corner article, "CHW hospitals take healthy food goals to high levels.")

"Our food vision statement began as a list of things we wanted to commit to, and we started with ensuring milk had no rGBH and poultry were antibiotic-free," said Sister Mary Ellen Leciejewski, CHW Ecology program coordinator. "We also looked at other things like organic vegetables and getting away from pesticides and genetically modified produce."

  • CHW's Dominican Hospital in Santa Cruz, CA, for example, has adopted sustainable food programs that include on-site gardens and buying locally grown organic produce.
  • White Memorial Hospital in Los Angeles also has a successful on-site organic garden, which not only provides food to the hospital but also to residents of the surrounding community.

Health Care Without Harm's
"Healthy Food in Health Care Pledge"
Scores of hospitals have committed to Health Care Without Harm's (HCWH) Healthy Food in Health Care Pledge, which was unveiled at the CleanMed 2006 conference in Seattle. The pledge commits signatories to such things as sourcing locally grown produce, encouraging vendors to provide healthy, chemical-free food alternatives, healthy food procurement policies, and minimizing food waste. Pledge authors hope the document will send an important signal to the marketplace and policy makers about their interest in local, nutritious, sustainable food and importantly, beginning to model healthy food practices in a ongoing stepwise fashion.

Downloads and links

Catholic Healthcare West commits to healthy foods

Health Care Without Harm – Healthy Food Resources: http://www.noharm.org/us/food/issue

Back to News

 

Hospitals becoming more energy efficient

Getting a handle on energy cost, use
In a typical hospital, water heating, space heating, and lighting account for nearly 80 percent of total energy use. According to the EPA, healthcare organizations spend more than $6 billion on energy each year to meet patient needs and the energy demand continues to increase, in part, due to an upsurge in the use of technology. The increased demand along with an aging energy infrastructure and energy deregulation has made energy costs soar, prompting hospitals to invest in energy efficient equipment and practices.

In addition to such measures as retrofitting heating and air conditioning systems and installing energy efficient lighting, hospitals have found ways to better manage increasing energy requirements. These include using alternative power sources, such as electricity generated from renewable sources such as wind or solar energy; using biodiesel fuel made from renewable resources like soybean oil in diesel generators; and outsourcing energy management.

Energy tax credits available from the federal government
Hospitals that have buildings classified as "commercial" may benefit from the energy efficiency tax credits that were signed into law in August 2005 as part of the first comprehensive energy legislation in over a decade and apply to services in place from January 2006 to December 2008. A tax deduction from the federal government of up to $1.80 per square foot is available to owners or designers of new or existing commercial buildings that save at least 50 percent of the heating and cooling energy of a building that meets ASHRAE Standard 90.1-2001. For more information, go to Energy tax credits.

Energy Star program provides tools and awards efficiency
Superior energy efficiency — identified by the Energy Star program — is a critical element of green buildings. Energy Star is a joint program of the U.S. Environmental Protection Agency and the U.S. Department of Energy that helps in measuring current energy performance, setting goals, tracking savings, and rewarding improvements. Top performing hospitals are recognized with the Energy Star label, with 54 hospitals currently in the program. For highlights of a few Energy Star hospitals, visit Premier's new Green Corner Web site of environmental success stories.

The Energy Star Web site offers no-cost online Energy Star training and presentations on demand, including self-guided presentations, live Web conferences and pre-recorded training programs. For more, go to the Energy Star Web site.

ASHE's 'E2C' campaign
The American Society of Healthcare Engineers (ASHE) recently launched a two-year campaign, Energy Efficient Commitment (E2C) to educate hospitals about the environmental and economic benefits of pursuing energy efficiency improvements. Among the campaign's resources, provided at no cost, are a Web site that offers tools, best practices and case studies on energy management and a forum for peer networking. You can also download a copy of the 180-page ASHE Healthcare Energy Guide book that provides energy benchmarking data, assessment of energy-efficient practices, methodologies, and technologies; and features of facilities with low versus high energy usage. See the EC2 program below.

Downloads and links

Energy tax credit Go to:
www.energystar.gov/index.cfm?c=products.pr_tax_credits#s8

Commercial Energy Star brochure for commercial tax deductions (.pdf) (114 KB)

The Safety Institute's Green Corner Web site

Energy Star Web site, go to: www.energystar.gov.

EC2 program, go to: www.ashe.org/ashe/facilities/e2c

Back to News

 

Healthcare industry mobilizes on electronic waste issue

Computers, televisions, lab analyzers, EKG monitors and other types of equipment routinely used in hospitals contain many hazardous constituents – from lead in cathode ray tube monitors to chlorinated plastics in cable wiring, brominated flame retardants in circuit boards and mercury in LCD displays. When electronic products are incinerated or landfilled, they can release heavy metals and other hazardous substances that contaminate groundwater and pollute the air.

Discarded computers and other consumer electronics (so called e-waste) are the fastest growing portion of our waste stream and less than 10 percent of discarded computers and electronics are being recycled. It is estimated that 600 million desktop and laptop computers in the U.S. will soon be obsolete; many of these are from healthcare facilities.

Healthcare industry efforts Healthcare facilities are addressing the environmental impact of computers and electronics through environmentally conscious purchasing of equipment with fewer and/or less toxic components and with options for end-of-life handling. Computer manufacturers are rapidly responding to the increased demand for less toxic components and providing options and programs at the time of purchase for recycling, reuse and "take back." As hospitals are upgrading their electronics and computers systems, outdated equipment that is still functional is also being donated to schools and other non-profit organizations.

The Electronic Product Environmental Assessment tool (EPEAT) is a new tool being used to help institutional purchasers, including healthcare organizations, evaluate, compare and select desktop computers, notebooks and monitors based on their environmental attributes. EPEAT also provides a clear and consistent set of performance criteria for the design of products, and provides an opportunity for manufacturers to secure market recognition for efforts to reduce the environmental impact of its products. EPEAT was developed with a grant from the U.S. EPA and is managed by the Green Electronics Council.

Premier provides "green" computer options and
web resources
In keeping with its commitment to offering contracts for environmentally preferable products, Premier used the EPEAT tool in its sourcing process to select suppliers computers and electronics that have fewer toxic components and recycling and reuse programs In successful internal corporate efforts in the past two years, Premier recycled a total of more than 5 tons of IT equipment in its Charlotte, NC offices.

Premier also offers Web-based resources and tools, along with guidance on selection, purchasing and end of use disposal and recycling of computers and electronics on its popular "Computers and electronics in healthcare" Web site. These Web site resources include information on Premier's contracted suppliers, Dell and Gateway, and their environmentally friendly computers and recycling options. A searchable database is also provided to find a local recycling company that subscribes to the Electronics Recycler's Pledge of True Stewardship, to make sure the computers are recycled or disposed in a safe manner.

Downloads and links

The Safety Institute's Computers and electronics in healthcare Web site

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New H2E environmental guide bridges JCAHO, federal regulations

One of the greatest challenges for hospitals undertaking environmental improvement initiatives is sorting through the complex maze of regulations from myriad organizations and federal agencies.

H2E's Web-based tool, Environmental Compliance and Improvement Guide, serves as an information bridge by matching each Joint Commission (JC) "element of performance" to specific federal regulations, and in effect, helping facilities identify how to be in compliance with both. H2E stresses that the resource was created to supplement guidance provided by the JC standards.

Elements of performance are specific expectations that must be met in order to meet a JC standard, which is a statement that defines the performance expectations, structures, or processes that must be in place for an organization to provide safe and high-quality care, treatment, and services. Some of the standards refer to environmental issues; many of the environmentally relevant elements of performance fall under the JC "Environment of Care" standard, while others are included in the Human Resources and Leadership standards.

The guide also helps facilities identify JC quality improvement initiatives, as well as steps that facilities can take to encourage environmental performance improvements. A comprehensive environmental program, including waste minimization and pollution prevention initiatives, not only ensures compliance, but can also help reduce the costs of compliance.

The guide provides links, tips and tools that enumerate specific management practices, materials, regulatory requirements, and facility infrastructure relevant to a specific element of performance.

Downloads and links

H2E's Web-based tool, go to:
www.h2e-online.org/regsandstandards/jcahointro.html

Back to News

 

"Green" demands from hospitals, investors, fuel Dow Jones Sustainability Indexes

Created in 1999, the Dow Jones Sustainability Indexes (DJSI) is one of the first global indexes watching the financial performance of leading companies with an emphasis on sustainability in economic, social, and environmental capacities. The Indexes have a twist that is somewhat unique: other than auditing historical financial information, companies listed in the Dow Jones Sustainability World Index are selected globally based on their ability to integrate economic, environmental and social criteria into their strategies and operations to determine sustainability. A company can quickly be tossed from the fund if it fails to maintain certain criteria.

"Sustainability" no longer a buzz word
The Dow Jones Sustainability Indexes are simply a product of the times: Investors, many of whom are aging baby boomers with strong feelings about the environment, wanted to invest in companies that did more than just talk about saving the earth. As the Indexes notes on its Web site, the concept of corporate sustainability is attractive to investors not only because it aims to increase long-term shareholder value and can now be financially quantified, but also because sustainability leaders are increasingly expected to show superior performance and favorable risks and returns.

How hospitals have changed dynamics
While investors gave rise to the Dow Jones Sustainability Indexes, hospitals more than anything have been a major impetus behind the innovations that got companies on the DJSI list in the first place. Hospitals also have the power to shift markets.

Kaiser Permanente, for example, has required building materials for their 30 million square feet of new construction to be PVC-free. In November 2005, Catholic Healthcare West awarded a five-year, $70 million contract for IV products to B. Braun Medical for their PVC and DEHP-free products.

As the hospital industry embarks on a $200 billion construction program to replace rapidly aging buildings and to meet expansion needs from an aging population, it has become a major market force, according to Health Care Design Magazine. The publication asserts that many of the same health concerns driving change in the medical products industry are also driving change in the building materials industry, which is responding with products like PVC-free furniture and non toxic rubber flooring.

Clearinghouse of "green" healthcare products
and practices
One popular source for resources on products and practices that eliminate or reduce environmental hazards is the Sustainable Hospitals Program affiliated with the University of Massachusetts Lowell. A key feature of the program is a Web site that contains a clearinghouse of information and alternative healthcare products and practices.

Downloads and links

Dow Jones Sustainability Indexes, go to:
www.sustainability-index.com

Sustainable Hospitals Program, go to:
www.sustainablehospitals.org

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InformeDesign Web site fosters hospital, designer collaboration on "green" projects

Created by the University of Minnesota in collaboration with the American Society of Interior Designers, InformeDesign is a clearinghouse for design and human behavior research.

The project is based on a belief that the designers of the built environment must continue to enhance their knowledge and skills to continue to protect the health, safety, and welfare of the public to ever-increasing degrees of excellence.

The site enables hospital designers to apply research to their design decisions so the outcomes of design solutions can be systematically examined. Hospital lay people benefit from the body of knowledge through an understanding of key design considerations. Creators hope that practitioners, researchers, educators, code officials, clients, and industry partners are able to share ideas and information, enabling them to design environments that protect and enhance the public's health, safety, and welfare, and respect the limitations of the earth.

Navigating the Web site
The InformeDesign Web site focuses on providing reputable research sources, including research tutorials, webcasts and a monthly publication, Implications, that addresses the issues facing practitioners and researchers who focus on design and human behavior.

The major portion of the InformeDesign Web site is organized into three areas: Space, Issues and Occupants. The Issues section, for example, includes more than 1,600 research summaries organized by the categories of building materials, finishes, and systems, codes and safety, design and aesthetics, design business and process, furnishings, fixtures, and equipment, personal/individual needs and factors and social needs and factors.

Healthcare Research Topics
There is a plethora of research studies specific to healthcare – for example, one on Elder-Friendly Design Interventions: Acute Care Hospitals Can Learn from Long-Term Care Residences. This study discusses how healthcare environments should be designed to functionally restore the independence of the individual and acute care must respond to the demands of the increasing number of senior patients. Other healthcare related research summaries cover topics such as keeping patients safe during hospital construction and indoor air pollutants causing eye irritation.

Downloads and links

•InformeDesign Web site, go to:
www.informedesign.umn.edu

Back to News

 

Premier launches Web site with "Green"
Success Stories

Premier's Safety Institute launched a new Web site, Green Corner, which showcases hospital and supplier success stories in environmental or "green" initiatives that contribute to a safer and healthier environment. Topics include:

  • Environmentally preferable purchasing (EPP) program or implementation;
  • Waste reduction (solid, hazardous, medical);
  • Toxicity elimination (e.g., mercury);
  • Energy efficiency;
  • Water savings;
  • Indoor air pollution reduction;
  • Recycling;
  • Healthy foods;
  • E-waste (computers, electronics) recycling or reduction;
  • Green cleaning programs;
  • Green building initiatives; and
  • Pharmaceutical waste management.

Downloads and links

Green Corner

Information on submitting a success story

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Editorial team

  • Gina Pugliese, RN, MS, editor
  • Judene Bartley, MS, MPH, CIC, associate editor
  • John Hall, BSJ, writer, designer
  • Cathie Gosnell, RN, MS, MBA, contributor
  • Derek Kleckner, BA, CUA, Web master

About Premier, 2006 Malcolm Baldridge National Quality Award recipient

Serving 1,700 hospitals and almost 45,000 other healthcare sites, Premier Inc., is the largest healthcare alliance in the United States dedicated to improving patient outcomes while safely reducing the cost of care. Owned by not-for-profit hospitals, Premier provides an Environmentally Preferable Purchasing (EPP) program, a collaboration of its Safety Institute and group purchasing to enhance the safety and health of patients, healthcare workers and the environment. Through its EPP program, Premier provides publicly available resources and tools to assist hospitals with their environmental safety agenda. Headquartered in San Diego, Premier has offices in Charlotte, N.C. and Washington.

Green Link © 2007 Premier, Inc.

You may forward this newsletter to your colleagues. If you would like to reprint any of these stories, please cite "Green Link newsletter, Premier, Inc." as your source and send an email to safety_institute@premierinc.com and alert us. Thank you.