September 2010
Premier Safety Institute - GreenLink Newsletter

Medical ErrorsHealthcare sustainability news from the Premier Safety Institute. Visit our Greenhealthy® website for tools and resources.

Gina Pugliese, editor


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Powerful Web tools improve waste management

Powerful Web ToolsHospitals 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 subscription-based "Greenhealth 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 reporting tool, 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 each year.

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 streams.

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 Breakthroughs Conference.


Chemicals in healthcare come under heightened scrutiny and proposed laws

Chemicals in healthcarePatient 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 women.

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 law."



Premier's SPHERE® energy program saves hospitals $10 million

SPHERE Energy save $10 millionPremier 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 partnership with Practice Greenhealth's 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  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 million. 

Chicago-based 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 Institute®.

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 Premier's Environmentally Preferable Purchasingng™ (EPP) program and internal corporate-wide Yes to Green program.


"Greening the OR" program hopes to reign in waste costs, improve quality

Greening the ORFor 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 recycle.

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 safety.

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 interventions:

  • 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; and
  • 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 GreenCorner® website.)

Fairview's program was recently profiled in a New York Times 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, AZ.

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

Energy EfficiencyU.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 Northwest.

"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

e-Stewards LogoPremier 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.

The "e-Stewards" 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, implemented an 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 environmentally responsible.

The 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 sustainability.

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 website.


GreenCorner - 90 "green" cases studies

Ninety "green" case studies from hospitals on computers/electronics, construction, donations, energy efficiency, food, recycling, water conservation, and purchasing.

Editorial team 
  • Gina Pugliese, RN, MS, editor
  • Judene Bartley, MS, MPH, CIC, associate editor
  • Cathie Gosnell, RN, MS, MBA, contributor
  • John Hall, BSJ, contributor
  • David Huntley, BA, Web master

Greenlink 2010 Premier healthcare alliance is a service of the Premier Safety Institute. Please forward this bulletin to interested colleagues. If you would like to reprint it, please cite "Greenlink newsletter, Premier healthcare alliance" as your source and send an email to and alert us. Thank you.

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