Powerful Web tools improve waste management
Hospitals have long been able to identify and track their
own waste production using such simple methods as spreadsheets. And in recent
years, many facilities have made significant progress in recycling, waste
minimization and other sustainable practices. Many facilities, however, do not
audit or track their waste spending and may not realize how many hidden charges
or costs are in their own waste management contracts.
But thanks to sophisticated Web-based data management
tools, hospitals now have a powerful set of resources that not only help them
manage waste even more efficiently, but also help them make more well-informed
decisions based on better information.
Practice Greenhealth (PGH) The
Tracker" from PGH helps an organization quantify and manage its
environmentally sensitive waste and material streams by tracking total waste
streams and identifying opportunities to save money and manage more efficient
operations. According to PGH, the tool helps a facility understand how hundreds
of thousands of waste disposal dollars are being spent and organizes information
by each type of waste.
Greenhealth Tracker allows a facility to record and analyze
its custom waste data volumes and costs, and in turn, identify opportunities to
reduce both by seeing where to prioritize goals for waste minimization and
justify specific contracts that contribute to particular waste streams.
EPA The EPA's free Web-based data management and
WasteWise Re-TRAC System, allows WasteWise partners to collect, organize,
analyze and report their municipal solid waste information. WasteWise partners
may log into the WasteWise Re-TRAC system to view and edit organization
information, track waste reduction activities, and generate summary reports.
Users can collect, analyze and report all recycling data and waste information,
instantly generate program performance and trend reports, and calculate
greenhouse gas emissions. WasteWise partners submit baseline data within two
months of joining WasteWise and are then asked to report waste reduction data
PGH states that its Greenhealth Tracker tool is also based
on the EPA Re-TRAC system, but is customized for healthcare's more complex waste
Cleveland Clinic success with Greenhealth tracker
The Cleveland Clinic, which co-developed and tested the Greenhealth Tracker
tool, has realized dramatic reductions in waste production and disposal costs
since 2006, according to Christina Vernon Ayers, AIA, LEED AP, director of
Cleveland Clinic's Office for a Healthy Environment. On its main campus alone,
Cleveland Clinic's recycling rate jumped from 5 percent in 2007 to nearly 30
percent in 2009. During that same period, the organization's waste disposal
costs dropped by a similar percentage – from more than $600,000 to approximately
$400,000 – all while adding 2 million square feet in new office and patient care
space, she noted.
According to Ayers, the tool permits the organization to
have system-wide reporting, produce aggregate landfill diversion rates and
savings information and permits constant feedback among multiple users
throughout the organization's 22 million square feet of space. "It's a
management tool that allows us to share responsibility and accountability within
our green teams," Ayers said during a presentation at this year's Premier
Chemicals in healthcare come under heightened scrutiny and proposed laws
Patient and worker safety advocates have long known about
the dangers of chemicals in medical products; and thanks to the "green"
movement, the issue is now getting even wider scrutiny when it comes to
non-medical products and construction materials. But until recently, few outside
the healthcare industry have paid much attention.
Legislation Two pieces of legislation have
been introduced this year to overhaul the 1976 Toxic Substances Control Act (TSCA).
The "Safe Chemicals Act of 2010" and the "Toxic Chemicals Safety Act of 2010"
would require the chemical industry to demonstrate that chemicals are safe,
rather than the EPA having to prove they are unsafe, give EPA authority to take
the most dangerous chemicals out of products, and require chemicals to meet a
science-based health standard to enter or remain on the market, providing
additional protections for vulnerable populations such as children and pregnant
In addition to stemming chronic diseases linked to chemical
contamination, the legislation is also intended to give American manufacturers
and retailers the tools they need to compete in a world demanding safer
products, according to Andy Igrejas, director of Safer Chemicals, Healthy
Families, a coalition of 250 environmental and public health groups.
In an April 2, 2010, joint letter to key members of
Congress working on various pieces of chemical policy, Premier joined other
groups in voicing support for a strengthened chemical regulatory system that
protects human and environmental health.
Public education Meanwhile, public education
efforts about the issue are ramping up. In mid-summer, the EPA announced that it
would add more than 6,300 chemicals and 3,800 chemical facilities regulated
under the TSCA to a database called
Envirofacts, providing unprecedented public access about chemicals that are
manufactured in individual communities. The agency also will address the
potential health risks of benzidine dyes, hexabromocyclododecane (HBCD) and
nonylphenol (NP)/nonylphenol ethoxylates (NPEs). The chemicals are widely used
in both consumer and industrial applications, including dyes used commonly in
textiles, paints, printing inks, paper, pharmaceuticals, flame retardants, and
industrial laundry detergents. The plans identify a range of actions the agency
is considering under TSCA.
The range of actions on these chemicals include adding HBCD
and NP/NPE to EPA's new Chemicals of Concern list, issuing significant new use
rules for all three chemicals, and, for HBCD and benzidine dyes, imposing new
reporting requirements on EPA's Toxic Release Inventory and potentially banning
or limiting the manufacture or use of the chemicals.
Around the same time, the EPA, FDA and various other
federal agencies joined the "Tox21"
collaboration, an effort that merges federal agency resources (research, funding
and testing tools) to develop ways to more effectively predict how chemicals
will affect human health and the environment.
Safer Chemicals, Healthy Families, meanwhile, hopes to carry the message
about chemical contamination to a broader audience – the American public. The
group launched a public awareness campaign whose ultimate goal is reducing
chemical contamination in healthcare by overhauling the U.S. chemical management
system. In its report, "The
Health Case for Reforming the Toxic Substances Control Act," the group noted
an alarming increase in cancer, asthma, reproductive disorders, and other
conditions directly attributable to chemicals in the environment. "There is
growing agreement across the political spectrum that the Toxic Substances
Control Act of 1976 does not adequately protect Americans from toxic chemicals,"
the report stated. "In the 34 years since TSCA was enacted, the EPA has been
able to require testing on just 200 of the more than 80,000 chemicals produced
and used in the U.S., and just five chemicals have been regulated under this
Premier's SPHERE® energy program saves hospitals $10 million
Premier healthcare alliance members participating in its
SPHERE energy program have saved more than $10 million and avoided putting
15,000 tons of carbon dioxide into the atmosphere with purchase of a portion of
their energy from renewable sources. SPHERE – Securing Proven Healthcare Energy
Reduction (for the) Ecosystem – is a collaboration among Premier alliance
members to reduce the healthcare industry's carbon footprint, greenhouse gas (GHG)
emissions and related public health impacts. As part of SPHERE and through a
Healthcare Clean Energy Exchange (PGH/HCEE), Premier offered an electronic
energy procurement process to help hospitals purchase energy more wisely.
Premier's SPHERE energy program also provided education on
energy efficiency strategies to the more than 1,200 healthcare leaders who
participated in the five-part Energy Leadership Forum audioconference
series. The popular SPHERE website at
www.premierinc.com/sphere provides best practices, measurement strategies,
case studies, tools and resources. The website also contains a list of Premier
contracted suppliers for efficient energy management, equipment and solutions.
Costing more than $8 billion each year, healthcare ranks as
the country's second most energy intensive industry. Through decreases in
overall energy usage and more frequent use of renewable energy, hospitals
participating in Premier's
SPHERE program have significantly reduced their carbon footprint and a
negative impact on climate change and public health.
"The online reverse auction procurement process enabled us
to buy our electricity from renewable sources for the same price as the
traditional electricity generated from fossil fuels," said Larry Jennings,
director of purchasing and contracting at
St. Luke's Hospital & Health Network, a health system in Bethlehem, PA, that
has reduced its carbon dioxide usage by 3,000 tons and saved more than $1
Ingalls Health System also reduced its carbon footprint by 10,000 tons to
date through it purchase of 5 percent of its electricity from renewable sources
through SPHERE's reverse auctions. This 5 percent green component of Ingalls
purchase, combined with the Illinois renewable portfolio standard requiring 6
percent of power from utilities to come from renewable sources, makes Ingalls
among the first hospitals to achieve an 11 percent of green and renewable energy
purchases by 2010.
"Hospitals that are focusing on the purchase of renewable
energy and reducing energy use with increase efficiency are not only having a
positive impact on climate change but the significant dollar savings can be
considered new revenue that can be used to improve the safety and quality of
patient care," said Gina Pugliese, vice president of the Premier Safety
Currently only 7 percent of the nation's energy consumption
is from renewable energy sources, including biofuels such as ethanol, solar,
hydroelectric and wind power. Premier's contracted suppliers, and partnerships
with experts and organizations in the environmental and energy-related fields
permit members to implement and share best practices and solutions for
responsible energy management.
SPHERE is part of Premier's
GreenHealthy® environmental leadership platform, which also includes
Environmentally Preferable Purchasingng™ (EPP) program and internal
Yes to Green program.
"Greening the OR" program hopes to reign in waste costs, improve quality
For years, hospitals have grappled with managing their
various waste streams, and have been successful in minimizing some solid,
hazardous and regulated medical waste while increasing the amount of waste they
Recently, however, hospitals are turning an eye toward
managing one of their most costly, and some say "wasteful," streams – the
operating room, which is responsible for between 20 percent and 33 percent of a
facility's total waste. Much of that waste is disposed of as regulated medical
waste, which costs 10 to 15 times more in disposal fees than regular waste.
Greening the OR Initiative Practice Greenhealth (PGH)
recently launched the
Greening the OR Initiative, a sweeping program aimed at examining a range of
interventions that will not only reduce the environmental impact of the OR, but
also potentially reduce cost, increase quality and improve worker or patient
PGH acknowledges that a number of leading healthcare
institutions have begun to tackle this problem by identifying key interventions
that can reduce waste, energy, worker exposure to hazardous chemicals and save
money. The group states that Greening the OR is an attempt to collect data on
these interventions and share them as a means to encourage widespread adoption
across the healthcare sector. Greening the OR plans to explore the following
Single-use device (SUD) reprocessing;
Reusable vs. disposables: gowns, surgical drapes, basins
and other reusables;
OR kit formulation;
Waste anesthetic gas scavenging systems;
Fluid waste management systems;
Energy use/lighting and thermal comfort;
Regulated medical waste (RMW) minimization/segregation;
Substitution of reusable hard cases for blue sterile wrap;
Recycling of medical plastics;
Laser safety/smoke evacuation systems;
Green cleaning/proper disinfection in a surgical setting;
Medical equipment and supplies donation.
Over the next year, a collaborative group of selected
hospitals, healthcare industry leaders, manufacturers and vendors, and
initiative sponsors will participate in the development of a series of Greening
the OR best practices guidance documents, including case studies and
implementation recommendations addressing these and other related areas.
Fairview "greens" its OR At the University of Minnesota
Medical Center-Fairview, a general thoracic surgeon has linked community health
to the health of the environment and has made it his mission to reduce as much
waste from his procedures as possible. After eliminating needless, redundant
supplies from surgical packs, and other efforts such as minimizing surgical prep
waste, Dr. Rafael Andrade and his team are saving Fairview thousands in supply
costs and eliminating significant amounts of waste annually. (For details of
Fairview's program, see the
case study on Premier's
Fairview's program was recently profiled in a New York
article about PGH's Greening the OR initiative. Dr. Andrade also presented
his case study on the effort at the PGH Greening the OR Symposium in Scottsdale,
According to Dr. Andrade, hospitals should also focus on
resuming traditional practices of relying on equipment designed to be reusable.
Dr. Andrade told the New York Times that his OR green team's efforts have
prevented 7,792 pounds of waste and saved Fairview $104,658.
Energy efficiency is a union of ethics and smart business
U.S. healthcare facilities are among the biggest consumers
of energy and grapple with some of the biggest utility bills in the industry.
And although hospitals have made significant strides in recent years to become
more energy efficient and environmentally responsible, a more systematic,
long-term approach is needed.
This is the conclusion of a new report by
Better Bricks, the commercial building initiative of the Northwest Energy
Efficiency Alliance (NEEA). Through the Better Bricks initiative, NEEA advocates
for changes to energy-related business practices in buildings in the Pacific
"The U.S. healthcare sector is at a crossroads in resource
management," notes the report, Healthcare: A Business & Ethical Case for
Sustainability. And while the industry is embracing energy efficiency as a
viable and cost-effective path to improve margins and reduce the impacts from
their own building operations, "many healthcare organizations are acting too
slowly or falling short on execution," by failing to integrate sustainability
into their business functions or focusing too much on individual projects rather
than developing a process to change system-wide business practices, it adds.
Timing is crucial for a competitive edge
Better Bricks argues, in fact, that hospitals may be putting themselves as a
competitive disadvantage if they don't make sustainability a system-wide
goal. "For companies and healthcare organizations alike, becoming
environmentally friendly can lower costs and increase revenues," it adds. "For
any healthcare organization, a healthy planet supports its mission of providing
the highest quality care. There is no doubt that sustainability is a major force
to be reckoned with—one that will determine how healthcare systems think, act,
manage and compete. It is time for CEOs and senior executives of healthcare
systems to boldly embrace sustainability management and make effective changes
that lead to a stronger balance sheet and a healthy planet."
Accountability The report concludes that "leading
healthcare systems now recognize that to provide the highest quality care, they
have a moral and ethical responsibility to contribute to health— inside and
outside hospital walls." This includes taking concerted efforts to reduce carbon
dioxide (CO2) emissions that lead to complications in health, and CEO-led
efforts to make a strong business case for energy efficiency as a cornerstone of
their sustainability policies.
Energy efficiency is one of the primary themes of Premier's
SPHERE-Energy Leadership Forum educational audioconference series for healthcare
leaders. Al Neuner, VP of facilities at Geisinger Health System, shares
strategies for saving more than $4 million a year with changes in equipment,
design and operation, all with an eye toward energy efficiency. See related
story on Premier's SPHERE energy program.
New third party e-Steward certification program offered for electronics recycling
Premier is among a select initial group of major
organizations to be known as e-Stewards® Enterprises, committed to using
electronics recyclers that meet the world's highest standards for responsible
recycling whose goal is to push recyclers to eliminate exports of hazardous
e-wastes to developing countries and halt the e-waste dumping into municipal
landfills or incinerators.
Initiative is a project of the Basel Action Network (BAN), the group that
first documented the dumping of toxic electronic waste in China and Africa, and
is the first such program backed by environmental organizations and major
corporations alike. The accredited, third-party audited certification program
has been endorsed by the Natural Resources Defense Council, the Electronics
TakeBack Coalition and close to 70 other environmental organizations.
The e-Stewards recycler certification has also attracted
broad participation from the electronics recycling industry. Approximately 50
e-Stewards recyclers have already passed BAN's review and are now committed to
become certified in the next two years. E-Stewards certification is offered to
electronics recyclers and waste management companies that abide by the strongest
environmental and health standards.
E-waste is the fastest growing waste stream in the country,
and contains toxic substances such as mercury, lead, cadmium, arsenic, beryllium
and brominated flame retardants. In the United States alone, as little as 11-14
percent of all e-waste is currently safely recycled. The remainder is most often
dumped or burned.
Premier's more than 1,200 employees have made major strides
in Premier's environmental performance policies and practices by recycling and
disposing of more than 25 tons of outdated computer equipment from Premier's
corporate headquarters office in an environmentally safe manner. Premier's group
purchasing program includes contracts with computer and electronics
manufacturers that offer "take-back" programs for equipment targeted by
hospitals for disposal.
In addition, the Premier Safety Institute's publicly
accessible website includes a
popular section on computers and electronics to help hospitals with
responsible purchasing and end-of-life options. Premier also was among the first
companies to adopt the EPEAT tool, which helps institutions buy the greenest
computers and monitors possible.
Catholic Healthcare West, a major healthcare system and
Premier member, also is among the elite first group of e-stewards and, together
with Kaiser Permanente, have purchased 336,180 EPEAT gold or silver registered
products, and have reused 318,364 units (or 9.8 million pounds) of electronics,
while recycling another 387,198 units (6.8 million pounds).
In recent years, many Premier organizations have taken
proactive measures to minimize or eliminate the impact of hazardous e-waste on
our nation's environment. Hartford, CT-based Saint Francis Care, for example,
e-waste management program that includes safely recycling discarded
electronics. The program is saving the hospital as much as $20,000 a year in
disposal and labor costs. Beth Israel has developed a
disposal strategy for end-of-life computer equipment that safely disposes of
more than 2,600 pieces of electronic computing equipment annually.
Your help is needed to save EPA ENERGY STAR® hospital rating system
ENERGY STAR® Hospital Rating System, the most widely used
publicly available data set on energy use, is badly in need of updating to
ensure continued credibility and usability for benchmarking. The American
Society of Healthcare Engineering (ASHE) of the American Hospital Association
(AHA) has partnered with the EPA on a survey to gather and identify trends in
energy use and needs your help.
Portfolio Manager, the engine powering the
ENERGY STAR Hospital Rating System used by more than 3,000 hospitals, is based
on hospital energy data collected in 1997.Updating this information will not
only help the EPA update its rating system, but also will provide valuable
information for ASHE to use for developing resources to help hospitals reduce
energy costs, improve operating margins and protect the environment.
The survey asks for energy data from 2008, as well as
building information, space use, and operating characteristics, similar to the
information collected in Portfolio Manager online.
The ASHE Energy Survey can be downloaded from the ASHE
website. All surveys shared by ASHE to the EPA will be anonymous.
Download, complete and submit the
ASHE Energy Survey by September 17, 2010.
Green doctor office program
A group of Florida Medical Association physicians and
experts in sustainable environments have developed a unique educational resource
program aimed at helping doctor's offices reduce costs while becoming more
Green Doctor Office Program can guide any doctor's office to improve its
energy and environmental practices through building an office "Green Team" who
work together to make changes in the doctor's office, and to share ideas with
their families and patients.
Organizers say most doctor's offices will be able to save
money, have a healthier workplace, and gain personal satisfaction from the Green
Doctor Office Program. The program is intended for any healthcare office,
including those of medical physicians, dentists, pharmacists, mental health
providers, chiropractors, acupuncturists, physical therapists and others.
Sustainability guides for facility managers
The International Facility Management Association
Foundation is now offering a series of free sustainability "white paper" guides
to provide data and information on a wide range of sustainability subjects,
share examples of successfully implemented practices, and help organizations
develop a business case and return on investment analysis for facility
Currently, six of a projected series of 12 guides are now
available on the following subjects: Getting Started, EPA's Energy Star
Portfolio Manager, Food Service Guide, No Cost/Low Cost Guide, Lighting Guide
and Landscaping Guide. The guides can be downloaded on the Foundation's
GreenCorner - 90 "green" cases studies
from hospitals on computers/electronics, construction, donations, energy
efficiency, food, recycling, water conservation, and purchasing.
- Gina Pugliese, RN, MS, editor
- Judene Bartley, MS, MPH, CIC, associate
- Cathie Gosnell, RN, MS, MBA, contributor
- John Hall, BSJ, contributor
- David Huntley, BA, Web master