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Going Green and Saving Green Environmental Purchasing for Healthcare

Going Green and Saving Green Environmental Purchasing for Healthcare. Janet Bowen New England Healthcare Coordinator September 15, 2006. What’s the Problem?. Healthcare creates large amounts of waste Mercury and Dioxin, other PBTs

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Going Green and Saving Green Environmental Purchasing for Healthcare

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  1. Going Green and Saving GreenEnvironmental Purchasing for Healthcare Janet Bowen New England Healthcare Coordinator September 15, 2006 Adapted from H2E presentation

  2. What’s the Problem? • Healthcare creates large amounts of waste • Mercury and Dioxin, other PBTs • An array of hazardous chemicals and special kinds of wastes • Huge energy and water consumption

  3. Excess Waste = Wasted $$ • Treating solid wastes as hazardous or infectious • Disposing of products that could be reused • Using more product than necessary • Worker exposure and health damages • Liability for environmental harm

  4. What is Environmentally Preferable Purchasing (EPP)? EPP is the process of selecting products and services whose environmental impacts have been considered and found to be preferable to those of comparable alternatives.

  5. Some EPP Options • Less Toxic (mercury-free) • Fewer Allergens (latex-free) • Less Packaging (buy in bulk) • Recycled content (paper supplies) • Reusable (bedpans, mattresses) • Energy Efficient (appliances, building design) • Water use reductions (low flush toilets)

  6. Benefits of EPP • Improved impact on the environment from hospital operations • Cost savings • Healthier environment for patients and employees • Positive publicity

  7. Obstacles to EPP • Product Availability/Performance • Accounting Practices hide EPP financial benefits • Purchasing is limited to GPO contract • Users are resistant to change • No Time, No Money

  8. EPP is a tool to help address your needs and priorities • Waste reduction • Hazardous exposure reduction • Worker training/protection costs • Hazardous waste cost savings • Environmental Compliance • Continuing environmental progress

  9. Prioritizing EPP Activities • Review mission of organization • Review recent problems with: • Occupational health • Environmental compliance • Patient safety • Review environmental costs • Review waste audit data & costs

  10. Work with (or create!) a Green Team • Waste Managers • Facilities Managers • Laboratory Managers • Nursing • Housekeeping • Infection Control • Clinical staff EPP initiatives will proceed smoothly, be more accepted by end users if you involve them throughout, plus you need their information!

  11. Total Cost • Purchase Price (x frequency of purchase) • Disposal Cost • Occupational Health Costs • Liability • Environmental Costs • Total Cost

  12. Don’t Forget Verification! • When specifying environmental attributes, (or asking GPO to do so) consider what evidence you need: • 3rd party verification • MSDS • Signature of chemist • Right to audit manufacturing/processing facility • Do not take vendors’ word on product attributes (they’re trying to sell products!)

  13. GPO Buying Power • GPOs have huge contracting advantages: • Buying power that makes vendors care • Dedicated contracting staff to vet claims • Communicate with your GPO: • Request general EPP contracting • Request custom EPP contracts • Serve on product review committees H2E Champion GPOs Amerinet, APS, Broadlane, Consorta, MedAssets, Novation, Premier H2E teleconference with GPOs

  14. Tracking Purchasing Progress • Tracking validates your EPP effort: • Total cost comparison with less preferable products • Volume of toxic materials, waste avoided • Require reporting by Vendors: • Specify information you want reported • Require annual or quarterly reporting • Publicize results to upper management

  15. Hospital’s should develop a comprehensive EPP program • Reviewing all contracts allows you to capture easy improvements • Comprehensive program balances higher costs with savings • Integrate EPP with other enviro initiatives: • Green Building • Waste reduction • Reuse programs (Materials Exchange)

  16. Specific EPP Targets • Mercury – Clinical, Lab, Building • Waste reduction – solid and hazardous • Resource Efficiency • Paper • Electronics • Cleaning • Pest Control

  17. Mercury in Healthcare • Thermometers • Sphygmomanometers • Bougies, dilators, cantor tubes • Batteries, electronics • Barometers Fluorescent bulbs • Switches/thermostats • Laboratory chemicals, fixatives • Pharmaceuticals

  18. Clinical Mercury Devices Alternatives widely available, at equivalent performance, cost

  19. Mercury in Building Supplies • Thermostats,Thermometers, Switches, Relays contain mercury • Gas and Water Flow Meters, Float Switches can contain gallons of mercury • Strategy: • Specify or request Hg-free alternatives for all new and replacement parts (available for most applications) • Label and require proper EOL handling of Hg- containing equipment currently in use

  20. Mercury in Lighting • ALL fluorescent and HID lamps contain mercury • Est. 620 million discarded per year in US = 2-4 tons of mercury • “Green tip” – still have Hg

  21. Mercury Lighting Strategy • Use fluorescents to reduce power consumption - reduces Hg emissions • Require disclosure of mercury content and choose lower mercury lamps where available • Recycle ALL fluorescents and HID lamps

  22. Mercury in the Laboratory • Histology Fixatives • Histology Stains • Antibodies • Parasitology Fixatives • Automated testing equipment reagents • Bleach (contaminant)

  23. Lab Mercury Strategy • Eliminate B5, Zenkers and others with readily available alternatives • Require vendor mercury disclosure for all products • Identify high mercury or easily replaced products • Prioritize list and develop schedule • to replace as you can

  24. Hidden mercury • Tilt switches • Pressure regulators • Flat panel screens • Preservatives in pharmaceuticals • Fire detection devices • Neon lights Strategy: Require ALL vendors to certify products mercury free or disclose mercury content, and establish a mercury free preference

  25. Mercury Resources H2E’s 10-step Guide to Reducing Mercury http://www.h2e-online.org/hazmat/mercguide.html H2E’s 10-Step Guide to Fluorescent Lamp Recycling www.h2e-online.org/pubs/tensteps/fluor10steps.pdf

  26. Hospital Waste US Hospitals generate approximately 3 million tons of solid waste per year...

  27. Purchasing for Waste Reduction Almost everything that leaves a facility as waste came in as a purchase – contracting for waste prevention is key Strategies: • Leasing – carpet, copiers, electronics • Switch from disposable to reusable – gowns, drapes, pads, dishware • Single use device reprocessing • Custom surgical procedure carts • Reduced weight paper (double side, reuse) • Require packaging reduction or takeback

  28. Waste Reduction $ucce$$ Foote Health System, Jackson, MI: • $56,000 savings in one year from SUD reprocessing Catholic Healthcare West facility • Eliminated newspaper delivery to patients at a savings of $18,000 and 9,100 tons of waste per year Bronson Methodist, Kalamazoo, MI: • $36,000 saved in one year from switching to reusable gowns and towels Facility • Saved $25,000 in acquisition of reusable wash basins and admission kits, eliminating disposables Alta Bates Medical Center, Oakland, CA: • Equipment reuse reduced purchasing and waste disposal costs by over $53,000

  29. Hazardous Materials • Glutaraldehyde • Ethylene Oxide (EtO) • Solvents: alcohols, xylene, formalin • Pesticides • Fleet maintenance solvents/degreasers

  30. Purchasing for Hazardous Waste Reduction • Alternatives substitution (total cost) • As-needed purchasing for all chemicals • Solvent recovery – alcohol, xylene • Review sterilization vs. high level disinfection • Least toxic pest control • Mercury-free lab chemicals

  31. Hazardous Waste Reduction $ucce$$ Sparrow Health System, Lansing, MI: • EtO alternative system reduces per cycle cost from $25 to $0.40 Facility • Recycled 520 gallons of formalin with disposal and purchase savings of $5,700 Facility • Recovered 260 gallons of xylene with $5,800 net savings per year Strong Memorial, Rochester, NY • IPM program saved

  32. Energy and Water Usage • Hospitals often the largest water and energy user in town • Highly lit operations 24/7, water-intensive laundries, cooling towers, food preparation • Costs of energy and water use are huge • Many consultants will work on a “Shared Savings” basis

  33. Energy Savings Pay Off • Huge cost savings, short payback • Energy Star: • Contract specifications, • Appliance standards, • Facility benchmarking Catholic Healthcare West, with 40 facilities, identified $48 million in energy savings upgrades. Fully implemented, these will save $12 million per year, for a 4 year payback, with savings continuing indefinitely

  34. Energy StarPurchasing and Procurement • Buy Energy Star Products Product information Cost saving information, saving calculators Procurement information, sample language http://www.energystar.gov/index.cfm?c=bulk_purchasing.bus_purchasing • Take free on-line procurement training, 9/22/06 http://energystar.netspoke.com/attendee/default.asp

  35. Energy Star Saving CalculatorSample - Exit Signs • Exit signs that have earned the ENERGY STAR operate on 5 watts or less per sign compared to as much as 40 watts • Exit Sign Saving Calculator, sample Based on 50 LED with battery backup, initial cost difference $4,500, with net life cycle savings of $15,570; simple payback of 1.8 years; life cycle energy saved 153,300kWh http://www.energystar.gov/ia/business/bulk_purchasing/bpsavings_calc/Calc_Exit_Signs.xls

  36. Energy Star Programwww.energystar.gov/healthcare • Evaluate hospitals energy performance July 2006 ASHE commitment to improve energy efficiency in hospitals by 10% Press Release, July 11, 2006 http://yosemite.epa.gov/opa/admpress.nsf/a8f952395381d3968525701c005e65b5/6f9442fca05a1e95852571a8004aeacb!OpenDocument • Benchmarking Tool for Acute Care and Children’s hospital and tool for medical offices http://www.energystar.gov/index.cfm?c=healthcare.bus_healthcare_benchmark • Take on-line benchmarking training energystar.webex.com

  37. Water Use Reductions • Implement as you build or renovate • Use consultants paid from “Shared Savings” • FEMP: BMPs, procurement specs • New! Use Energy Star Benchmarking tool to track water consumption http://www.energystar.gov/index.cfm?c=business.bus_water

  38. Water Reduction $ucce$$ • One hospital saved $280 per sink per year by installing $12 flow reduction device • Another facility saved $20,000 per year by recirculating heating/AC water • One hospital saved $42,000 per year by installing ultra low flush toilets

  39. Paper Impacts • U.S. and Canada paper industry releases 220+ million pounds of toxic pollution per year • Virgin wood used for office paper in the US annually is equivalent to building 900,000 homes • Americans discard 4 million tons of office paper per year = 12 ft high wall of paper from NY to CA • Paper use reduction can save tons of paper, thousands of dollars

  40. Paper Purchasing Strategy • Reduce paper use/costs • Negotiate aggressively, use GPO • Copy paper: spec at least 30% post-consumer content • “Processed Chlorine Free” • Janitorial paper: 50-100% post, unbleached • Recycle all office paper to ‘close the loop’ • HIPPA precautions - source reduction first!

  41. Paper Recycling Resources H2E HIPPA page www.h2e-online.org/regsandstandards/hipaa.html H2E HIPPA guidance www.h2e-online.org/pubs/paper/hipaa.pdf Paper Recycling HERC website www.h2e-online.org/wastereduction/paper.html

  42. Electronic Waste Fastest growing waste stream in the world • 3.96 billion lbs. of consumer electronic waste in 2000 • ~ 100 million cell phones discarded -50,000 tons per year - as of 2005 • ~ 315 to 680 million computers obsolete in US in the next decade Those computers contain: • 1 billion pounds of lead • 1.9 billion pounds of cadmium • 400,000 pounds of mercury

  43. Electronics Assessment Tool(EPEAT) • Developed by EPA and others to meet demand for greener electronic products • Green performance standards for computers • Over 60 desktops, computers , notebooks and monitors offered by 3 manufacturers • Searchable database www.epeat.net

  44. EPP Strategy for IT • Consider leasing, with proof of EOL handling • If purchasing, require OEM or retailer takeback and proof of responsible recycling • Recyclers - due diligence on their operations and overseas shipping • Require demonstrated compliance with EU’s RoHS (Reduction of Hazardous Substances) Directive • Procurement criteria systems

  45. Strategy for IT staff Energy Star Power Management • Save $10 to $50 per desktop annually • Places inactive monitors and computers into sleep mode with free software from EPA http://www.energystar.gov/index.cfm?c=power_mgt.pr_pm_faq • Free teleconference, 9/19/06 http://www.energystar.netspoke.com/attendee/default.asp

  46. “Greener” Janitorial Chemicals Why be concerned about Cleaners? • Asthma risk • Occupational skin/eye injuries • Indoor Air quality • Training/Worker protection costs • Patient and staff comfort • 35% of cleaning chemicals can cause blindness, severe skin damage or damage to organs through skin. • 6% are linked to cancer, ozone depletion or global warming

  47. Green Cleaning Strategy • Involve all interested parties: • Infection Control, Nursing, Purchasing, Housekeeping/Environmental Services, staff with occupational health issues • Look for certification • Green Seal or equivalent -- require verification! • Address routine cleaning first • Disinfection issues are more complex, may take more work

  48. Green Cleaning Resources • INFORM, Cleaning for Health http://www.informinc.org/cfh_00.php • Janitorial Products Pollution Prevention Project http://www.wrppn.org/janitorial/jp4.cfm • H2E Green Cleaning call, August 2005 http://www.h2e-online.org/teleconferences/molydesc.cfm?Date=2005-08-12&teleconfid=64

  49. Pesticide Health Effects Acute:nausea, dizziness, headaches, aching joints, mental disorientation, vomiting, convulsions, skin irritation, flu-like symptoms and breathing problems. Chronic:cancer, birth defects, genetic damage, neurological, psychological and behavioral effects, blood disorders, chemical sensitivities, reproductive effects, and abnormalities in liver,kidney, and immune system function. Numerous environmental impacts

  50. IPM – A Proven Alternative • Scouting and treatment thresholds • No routine treatment • Nonchemical methods • Good sanitation practices • Structural maintenance • Least toxic controls • Minerals, soaps, boric acid • Enclosed baits, crack and crevice treatments • No treatment while spaces are inhabited Detailed plan and specifications are essential

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