Environmentally Preferable Purchasing

1. 1 Environmentally Preferable Purchasing Saving Money and Improving Performance Janet Brown, Director, Facility Engagement Practice Greenhealth

2. 2 Today Goals Recognize the role purchasing plays in health care environmental management programs. Identify at least three areas that can be improved through purchasing. Understand the value of assessing environmental impact and associated costs at supply chain or new product evaluation committee meetings. Today, I will share with you Environmental purchasing can help achieve reductions in GHG Understand the major env concerns facing health care (click). �Green� has become the latest buzz word. It�s on the cover of most magazines and in the news. So l�ll help you unravel some of the confusing and conflicting green claims, and I�ll show you how to better understand them. Today, I will share with you Environmental purchasing can help achieve reductions in GHG Understand the major env concerns facing health care (click). �Green� has become the latest buzz word. It�s on the cover of most magazines and in the news. So l�ll help you unravel some of the confusing and conflicting green claims, and I�ll show you how to better understand them.

3. 3 Environmentally Preferable Purchasing (EPP) EPP is the practice of purchasing products and services that have a lesser or reduced effect on human health and the environment when compared with competing products or services that serve the same purpose.� - -Federal Executive Order #13101 In fact, the federal government has been implementing what is commonly referred to as EPP since the 1990�s and doing so successfully. (click) According to the federal government, EPP is (define). This comparison may consider the life-cycle of a product or service: including raw materials acquisition, production, manufacturing, packaging, distribution, reuse, operation, maintenance, or disposal of the product or service. In fact, the federal government has been implementing what is commonly referred to as EPP since the 1990�s and doing so successfully. (click) According to the federal government, EPP is (define). This comparison may consider the life-cycle of a product or service: including raw materials acquisition, production, manufacturing, packaging, distribution, reuse, operation, maintenance, or disposal of the product or service.

4. 4 The real question for you might be why is this important? It is important to focus on purchasing because nearly every waste that leaves a hospital came in through purchasing. Everything that goes out the back door came in the front. Purchasing departments are the central standard setting point for nearly every product or service used in a hospital. So if purchasing began focusing on environmental issues up front, this could reduce liability and reduce costs in the long run. I�ll demonstrate this in this presentation. How many here would say they have been involved in some way with environmental purchasing? Respond with one or the other: -Good to see so much support -So let�s explore why EPP is important The real question for you might be why is this important? It is important to focus on purchasing because nearly every waste that leaves a hospital came in through purchasing. Everything that goes out the back door came in the front. Purchasing departments are the central standard setting point for nearly every product or service used in a hospital. So if purchasing began focusing on environmental issues up front, this could reduce liability and reduce costs in the long run. I�ll demonstrate this in this presentation. How many here would say they have been involved in some way with environmental purchasing? Respond with one or the other: -Good to see so much support -So let�s explore why EPP is important

5. Environmentally Preferable PurchasingProducts = Waste & Emissions Almost everything going out as waste or emission can be attributed to a product or service that was purchased. Facilitator Instructions: IF this topic has been covered by audience participation on previous slide, skip it. If not: How can something purchased contribute to waste creation? If no one volunteers, ask more specifically: - What is in the trash? <Then point out that most of these items have origin in products�packaging, products, wraps, etc.> - What do you do with a disposable product once you use it? - Where does it go? <Remind them there is no such place as �away.� - What is going down the sink in a hospital? - Where does it go once it�s down the sink? (Remind them that water treatment centers discharge to water bodies and that the treatment is not designed to eliminate toxic chemicals such as mercury, etc. Find out ahead of time where their local POTW discharges, mention that.> Etc. Thus, addressing these things up front, when we purchase them rather than when we throw them away or use them, then we could prevent some waste, emissions, and energy use.Facilitator Instructions: IF this topic has been covered by audience participation on previous slide, skip it. If not: How can something purchased contribute to waste creation? If no one volunteers, ask more specifically: - What is in the trash? <Then point out that most of these items have origin in products�packaging, products, wraps, etc.> - What do you do with a disposable product once you use it? - Where does it go? <Remind them there is no such place as �away.� - What is going down the sink in a hospital? - Where does it go once it�s down the sink? (Remind them that water treatment centers discharge to water bodies and that the treatment is not designed to eliminate toxic chemicals such as mercury, etc. Find out ahead of time where their local POTW discharges, mention that.> Etc. Thus, addressing these things up front, when we purchase them rather than when we throw them away or use them, then we could prevent some waste, emissions, and energy use.

6. 6 Benefits of EPP So some of you are already aware of the benefits from environmental purchasing. By taking into consideration one or more of environmental attributes, a number of benefits to health care facilities can result � #1 Reduced costs Buying less toxic products -can reduce solid or hazardous waste costs, -can reduce occupational health costs #2 -can benefit patient and staff health #3 Buying energy efficient products --generate energy or water savings. #4 Any Environmental improvement can be used to enhance public relations, particularly if the project you choose is related to local environmental concerns. #5-Employees are often happy to know the company is thinking about the environment where they live and work and showing concern about toxic chemical exposure. Implementing an employee suggestion program, if new, can also enhance employee satisfaction. #6 Most noteworthy is the significant impact to the environment when using more environmentally preferable products and services So some of you are already aware of the benefits from environmental purchasing. By taking into consideration one or more of environmental attributes, a number of benefits to health care facilities can result � #1 Reduced costs Buying less toxic products -can reduce solid or hazardous waste costs, -can reduce occupational health costs #2 -can benefit patient and staff health #3 Buying energy efficient products --generate energy or water savings. #4 Any Environmental improvement can be used to enhance public relations, particularly if the project you choose is related to local environmental concerns. #5-Employees are often happy to know the company is thinking about the environment where they live and work and showing concern about toxic chemical exposure. Implementing an employee suggestion program, if new, can also enhance employee satisfaction. #6 Most noteworthy is the significant impact to the environment when using more environmentally preferable products and services

7. 7 What goes into the total cost of purchasing supplies? Well, the answer is that its important to look at more than just the up-front product costs. There are�. CLICK --Product disposal costs which would include red bag, haz waste or solid waste. Linking hazwaste and disposal budgets with department or purchasing budgets can help you identify potential money-saving EPP opportunities. CLICK -Reduced packaging can be crucial to reducing solid waste and associated costs. CLICK-Utility costs are an important consideration (ESP now with such high fuel prices). These may already be factored into building supplies � but there are costs are associated with medical and office supplies too CLICK -There may be other operating costs involved in certain products such as maintenance and service expenses, or labor. CLICK - Occupational costs - One study found that every year, 6 out of every 100 professional janitors were injured due to chemicals they use. CLICK Environmental Risk - such clean up costs from hazardous waste spills CLICK By not factoring into purchasing decisions, its like money down the drain.. Remember: not all EPP will save you money. Must decide what your goals are and are you willing to pay more. EX: Ben and Jerry�s created unbleached ice cream container=>because bleaching paper creates dioxin (a toxin) was a big problem for them. The State of CA recently bid office furniture incorporating some of the most stringent air emission requirements on office furnishings � and no other option was available to the supplier so whether there was a cost impact was not an issue. What goes into the total cost of purchasing supplies? Well, the answer is that its important to look at more than just the up-front product costs. There are�. CLICK --Product disposal costs which would include red bag, haz waste or solid waste. Linking hazwaste and disposal budgets with department or purchasing budgets can help you identify potential money-saving EPP opportunities. CLICK -Reduced packaging can be crucial to reducing solid waste and associated costs. CLICK-Utility costs are an important consideration (ESP now with such high fuel prices). These may already be factored into building supplies � but there are costs are associated with medical and office supplies too CLICK -There may be other operating costs involved in certain products such as maintenance and service expenses, or labor. CLICK - Occupational costs - One study found that every year, 6 out of every 100 professional janitors were injured due to chemicals they use. CLICK Environmental Risk - such clean up costs from hazardous waste spills CLICK By not factoring into purchasing decisions, its like money down the drain.. Remember: not all EPP will save you money. Must decide what your goals are and are you willing to pay more. EX: Ben and Jerry�s created unbleached ice cream container=>because bleaching paper creates dioxin (a toxin) was a big problem for them. The State of CA recently bid office furniture incorporating some of the most stringent air emission requirements on office furnishings � and no other option was available to the supplier so whether there was a cost impact was not an issue.

8. 8 Group Purchasing Organizations and Environmentally Preferable Purchasing � 

9. Where is your institution? Just getting Started�..

10. 10 the healthcare sector�s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities. This Guide provides the healthcare sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments.the healthcare sector�s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities. This Guide provides the healthcare sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments.

11. The section names in the Operations section are not based on LEED, but many of the credits in this section were modeled on LEED for Existing Buildings. In addition, the Operations section includes many pollution prevention, waste management, and environmentally preferable purchasing strategies taken from health-care specific environmental non-profits such as Hospitals for a Healthy Environment and Health Care Without Harm. There are a total of 72 credits in the Operations section. The total number of credits in both the Construction and Operations sections are 166 credits and 21 Prerequisites.The section names in the Operations section are not based on LEED, but many of the credits in this section were modeled on LEED for Existing Buildings. In addition, the Operations section includes many pollution prevention, waste management, and environmentally preferable purchasing strategies taken from health-care specific environmental non-profits such as Hospitals for a Healthy Environment and Health Care Without Harm. There are a total of 72 credits in the Operations section. The total number of credits in both the Construction and Operations sections are 166 credits and 21 Prerequisites.

13. Environmentally Preferable Purchasing EP Prerequisite 1 � Mercury Elimination EP Prerequisite 2 � Electronic Assets Mgmt. Plan EP Credit 1 � Waste Prevention EP Credit 2 � Toxicity Prevention EP Credit 3.1-3.5 � Toxic Chemical Reduction � Maintenance, Alterations & Additions EP Credit 3.6 � Toxic Chemical Reduction - Furniture & Medical Furnishings EP Credit 4.1-4.5 � Sustainably Sourced 13

14. Healthy Food GGHC Credits FS Credit 1.1 Sustainable Food Policy & Plan FS 1.2 Food Nutrition FS 2 - Sustainable Food Education & Promotion FS 3.1-3.3 � Local, Sustainably Produced Food Purchasing FS 4.1-4.2 � Reusable & Non Reusable Products � Food Service Ware FS Credit 4.3 Reusable & Non Reusable Products: Non Food Service Ware items FS Credit 4.4 � Bottled Water Elimination & Public Drinking Water Access FS Credit 5 � Hospital Supported Agriculture: Food & Farm Linkages FS Credit 6.1 � Food Waste Reduction, Donation & Composting FS Credit 6.2 � Food Services Recycling FS 7.1-7.2 � Food Vendors FS 8.1-8.2 � Chemical Management for Food Services 14

15. These are attributes that affect the product directly and often the hospital directly-reducing the presence of toxic chemicals in the building, saving energy, reducing waste.These are attributes that affect the product directly and often the hospital directly-reducing the presence of toxic chemicals in the building, saving energy, reducing waste.

16. 16 There are many environmental attributes one can consider in terms of purchasing products and services EPP looks at less toxic products and services - janitorial cleaners, using integrated pest management to reduce pesticides Products that have reduced air emissions, don�t offgas � such as furniture and paints Product reuse � such as reprocessing medical devices Conserve Energy and water � such as fluorescent lights, low-flow toilets Products made from vegetable-based ingredients, not petroleum, such as soy based printing inks There are many environmental attributes one can consider in terms of purchasing products and services EPP looks at less toxic products and services - janitorial cleaners, using integrated pest management to reduce pesticides Products that have reduced air emissions, don�t offgas � such as furniture and paints Product reuse � such as reprocessing medical devices Conserve Energy and water � such as fluorescent lights, low-flow toilets Products made from vegetable-based ingredients, not petroleum, such as soy based printing inks

17. EPP: Sample Criteria Energy Efficiency � Energy Star standard baseline requirement Where no Energy Star standard, request KwH per use/month/year Water efficiency � disclosure of water usage (ask for gallons per minute- gpm) Recycled content � minimum % for certain product categories Recyclable � must be local program

18. 18 Purchasing for Waste Reduction Packaging Take-Backs Product Take-Backs Reusable Containers Recyclable Packaging Reuse and Reprocess Does it make sense that manufacturer�s produce a product, sell it and then are void of any additional responsibility, even if the product is toxic, unless they are sued. Work with suppliers to have them address waste reductionDoes it make sense that manufacturer�s produce a product, sell it and then are void of any additional responsibility, even if the product is toxic, unless they are sued. Work with suppliers to have them address waste reduction

19. Recycled Content Incorporates materials that otherwise would be disposed Post-Consumer content: Materials collected from consumers Post-Industrial content: factory floor clippings, etc. Prefer post-consumer content to post-industrial with comparable products.

20. 20 Many facilities have --a mercury policy that prohibits purchase of new mercury-containing items and tags all existing mercury items so that when they reach the end of their life they are disposed of properly and replaced with mercury-free items. Many facilities have --a mercury policy that prohibits purchase of new mercury-containing items and tags all existing mercury items so that when they reach the end of their life they are disposed of properly and replaced with mercury-free items.

21. 21 Where is Mercury in Medical Devices? The Obvious Thermometers Thermostats Sphygmomanometers Esophageal dilators Lab chemicals Fluorescent lamps Medical Batteries Dental amalgam Feeding tubes The Not So Obvious Cleaners w/caustic soda or chlorine Laundry chemicals � bleach Antibacterial soaps Boiler & air conditioning chemicals Electrical equipment Computers (printed wire board) Pressure gauges Mercury is persistent, bioaccumulative toxin (PBT) and is found in some medical devices So where is mercury in medical devices? The obvious � thermometers, fluorescent lamps, dental amalgam, lab reagents� Some lab reagents (ex:stains, sodium hypchlorite, pregnancy test kits, enzyme tracers, urinalysis reagents) contain mercury-based preservatives such as thimersal. Depending on the product, mercury-free reagents may be available. The not so obvious � cleaners, antibacterial soaps, pressure gauges. Ten years ago, EPA and the American Hospital Association committed to voluntarily eliminate all mercury waste in hospitals so many of your hospitals may have already addressed this.. How many of you have addressed mercury? So to ensure proper handling of mercury containing products� Set up purchasing contracts to require disclosure of all mercury containing devices and reagents. This will help your facility avoid the need to increase its investment in pollution controls and waste disposal. Mercury is persistent, bioaccumulative toxin (PBT) and is found in some medical devices So where is mercury in medical devices? The obvious � thermometers, fluorescent lamps, dental amalgam, lab reagents� Some lab reagents (ex:stains, sodium hypchlorite, pregnancy test kits, enzyme tracers, urinalysis reagents) contain mercury-based preservatives such as thimersal. Depending on the product, mercury-free reagents may be available. The not so obvious � cleaners, antibacterial soaps, pressure gauges. Ten years ago, EPA and the American Hospital Association committed to voluntarily eliminate all mercury waste in hospitals so many of your hospitals may have already addressed this.. How many of you have addressed mercury? So to ensure proper handling of mercury containing products� Set up purchasing contracts to require disclosure of all mercury containing devices and reagents. This will help your facility avoid the need to increase its investment in pollution controls and waste disposal.

22. 22 Establishing EPP Program Goals Time-dependent Measurable Examples: Reduce mercury use in labs by 50% in 6 months Increase use of recycled copy paper by 90% by next Board meeting Reduce mercury waste in labs by 5 pounds by 2010. In implementing EPP, it is important to quantify your goal and establish a deadline. For example, If you want to reduce mercury, set a target date and measurement goal --Reduce mercury use in labs by 50% in 6 months If your goal is eliminate PVC in NICU --Eliminate PVC and DEHP containing devices by 100% by the end of 2009 When doing so, make sure your goals are achievable and start with some of the easiest steps first. There are many resources to assist you� In implementing EPP, it is important to quantify your goal and establish a deadline. For example, If you want to reduce mercury, set a target date and measurement goal --Reduce mercury use in labs by 50% in 6 months If your goal is eliminate PVC in NICU --Eliminate PVC and DEHP containing devices by 100% by the end of 2009 When doing so, make sure your goals are achievable and start with some of the easiest steps first. There are many resources to assist you�

23. 23 Partnering With Suppliers to Increase EPP Used Electronic Pledge of True Stewardship Discontinued mercury-containing thermometers and sphygmomanometers Identified EPP products in catalogs Restricted non-EPP products Provided lists of EPP products to customers Provided quantitative reports on EPP purchases Consider in your solutions to reducing costs and providing high quality care the need to work with suppliers, to partner with them, to move environmental purchasing forward. Years ago, EPA worked with their current office supplier to identify the environmental attributes of 100s of products, and today, that supplier now promotes this to other organizations as a selling point. So suppliers may be willing to work together Consider in your solutions to reducing costs and providing high quality care the need to work with suppliers, to partner with them, to move environmental purchasing forward. Years ago, EPA worked with their current office supplier to identify the environmental attributes of 100s of products, and today, that supplier now promotes this to other organizations as a selling point. So suppliers may be willing to work together

24. EPA�s SmartWay Transport Partnership Partners with their own fleets commit to goals related to fuel-efficiency and emissions reduction. Partners using freight carriers commit to using SmartWay carriers. Ask the supplier for their SmartWay score. Ask your suppliers to report greenhouse gas emissions progress as part of your climate program. Freight vehicles emit over 350 million metric tons of the greenhouse gas carbon dioxide every year. Emissions from shipping and delivery vehicles also contribute to smog and contain chemicals and particulates that cause cancer and respiratory disease. Because health care facilities use so many products that must be shipped to them every day, there is a great opportunity to contribute to the reduction of this type of pollution. US EPA, �Mobile Source Emissions - Past, Present, and Future: Pollutants,� http://www.epa.gov/otaq/invntory/overview/pollutants/index.htm; and US EPA, �Global Warming � Actions: Transportation,� http://yosemite.epa.gov/oar/globalwarming.nsf/content/ActionsTransportation.html. IE Home Depot requires their shippers to participate and to submit more information to them than is required for SmartWay so they can track their shipping impact. Partner get a score�you can evaluate based on score.Freight vehicles emit over 350 million metric tons of the greenhouse gas carbon dioxide every year. Emissions from shipping and delivery vehicles also contribute to smog and contain chemicals and particulates that cause cancer and respiratory disease. Because health care facilities use so many products that must be shipped to them every day, there is a great opportunity to contribute to the reduction of this type of pollution. US EPA, �Mobile Source Emissions - Past, Present, and Future: Pollutants,� http://www.epa.gov/otaq/invntory/overview/pollutants/index.htm; and US EPA, �Global Warming � Actions: Transportation,� http://yosemite.epa.gov/oar/globalwarming.nsf/content/ActionsTransportation.html. IE Home Depot requires their shippers to participate and to submit more information to them than is required for SmartWay so they can track their shipping impact. Partner get a score�you can evaluate based on score.

25. Energy Use What percentage of the energy used by your company facilities over the last twelve months for which records are available is Green-e Certified (http://www.green-e.org)? Energy use during manufacturing is difficult to use as a way to evaluate different suppliers of the same product. However, you can ask about percentages for company-owned facilities. This could go further and ask about their suppliers. Green-e offers certification and verification of renewable energy. PGH has partnered with them on our HCEE. They certify: solar electric, wind, geothermal, biomass, and small and low-impact hydro We have this in the pipeline but no examples of entities asking this question yet. (note UHC may be using it)Energy use during manufacturing is difficult to use as a way to evaluate different suppliers of the same product. However, you can ask about percentages for company-owned facilities. This could go further and ask about their suppliers. Green-e offers certification and verification of renewable energy. PGH has partnered with them on our HCEE. They certify: solar electric, wind, geothermal, biomass, and small and low-impact hydro We have this in the pipeline but no examples of entities asking this question yet. (note UHC may be using it)

26. 26 Federal EPP Actions & Resources EPP: Required to purchase EPP and biobased products in all federal agencies. www.epa.gov/epp Recycled Products : EPA is required to designate products that are or can be made with recovered materials and to recommend practices for buying. Over 50 products listed. www.epa.gov/cpg The federal government has required through executive orders that environmental purchasing be implemented in all federal agencies and many resources are available at the listed EPA website. EPA is also required to designate products that are or can be made recovered materials and to recommend practices for buying. Recovered materials means both pre and postconsumer. Preconsumer means completed products that did not reach the consumer Postconsumer means finished products that were used by the consumer and were recycled. The federal government has required through executive orders that environmental purchasing be implemented in all federal agencies and many resources are available at the listed EPA website. EPA is also required to designate products that are or can be made recovered materials and to recommend practices for buying. Recovered materials means both pre and postconsumer. Preconsumer means completed products that did not reach the consumer Postconsumer means finished products that were used by the consumer and were recycled.

27. 27 EPP Labels: Electronics Energy Star is U.S. EPA program Sets energy consumption ratings for wide variety of products (computers, appliances, equipment) 100 Energy Star computers and monitors can save over $10,000 over 5 years. Ask for products or services that are certified or approved by a credible source. Energy Star is one that applies to electronics. CLICK 4x Energy Star is a US EPA program to help the US reduce its energy use. Set guidelines for energy consumption for a variety of products. This label tells you the product is one of the most energy efficient and can save money in utility costs. ENERGY STAR products do not cost more. In fact, by purchasing 100 ENERGY STAR computers and monitors can save over $10K over 5 years (test question on energy efficient being more expensive and do not save money) Ask for products or services that are certified or approved by a credible source. Energy Star is one that applies to electronics. CLICK 4x Energy Star is a US EPA program to help the US reduce its energy use. Set guidelines for energy consumption for a variety of products. This label tells you the product is one of the most energy efficient and can save money in utility costs. ENERGY STAR products do not cost more. In fact, by purchasing 100 ENERGY STAR computers and monitors can save over $10K over 5 years (test question on energy efficient being more expensive and do not save money)

28. 28 EPP Labels: Green Cleaners Certified by Green Seal or EcoLogo (Canadian). Applies to Institutional cleaners, floor care products and more Price consistent with products of similar quality. There are certifications for �green cleaners� now so when you want an �environmental safe� or �green� cleaner, ask for Green Seal or even Eco Logo. Green seal standards cover many requirements that are developed in a consensus based process which includes industry representatives, non-profits, trade associations and others to prepare: Performance Health and environmental requirements, such as toxic compounds, carcinogens and reproductive toxins, skin and eye irritations, fragrance, and Packaging, to name a few Green cleaning products is an area that has grown immensely in the last 5-6 years. NOW, hundreds of products are now certified under GS-37 most users reporting no additional costs from switching. In fact, building managers report they receive fewer complaints. These products can reduce liability to health care organizations by eliminating products that carry fragrances harmful to patients and workers. One third of cleaning chemicals used today contain chemicals that can harm you. Green Seal also has lists of certified products for paint, floor finish and strippers and food service packaging. Purchasers need only to request Green Seal certified products. There are certifications for �green cleaners� now so when you want an �environmental safe� or �green� cleaner, ask for Green Seal or even Eco Logo. Green seal standards cover many requirements that are developed in a consensus based process which includes industry representatives, non-profits, trade associations and others to prepare: Performance Health and environmental requirements, such as toxic compounds, carcinogens and reproductive toxins, skin and eye irritations, fragrance, and Packaging, to name a few Green cleaning products is an area that has grown immensely in the last 5-6 years. NOW, hundreds of products are now certified under GS-37 most users reporting no additional costs from switching. In fact, building managers report they receive fewer complaints. These products can reduce liability to health care organizations by eliminating products that carry fragrances harmful to patients and workers. One third of cleaning chemicals used today contain chemicals that can harm you. Green Seal also has lists of certified products for paint, floor finish and strippers and food service packaging. Purchasers need only to request Green Seal certified products.

29. 29 EPP Labels: Computers, Laptops & Monitors  EPEAT Environmental Label - computers meet 23 different environmental criteria. Over 600 products registered from 23 manufacturers No cost increase Savings in energy costs www.epeat.net Electronic Products Environ Assessment Tool CLICK 5x EPEAT is a self declaration program that spot checks manufacturers to ensure they meet the established environmental criteria. EPEAT Computers offer reduced cadmium, lead and mercury, more energy efficient so reduces emissions, easier to upgrade and recycle and manufacturers must offer safe recycling options. Over 600 products are now listed and most organizations I talk with have found their computers, laptops and monitors were already EPEAT registered. The Federal govt requires 95% of all its products that fall under this to be EPEAT registered. A recent EPEAT report outlines the enormous environmental benefits of EPEAT computers purchased in 2007 alone. With over 109 million units sold�some of the impact was Reduced toxic ingredients by 3,226 metric tons � equiv to 1.6 million bricks Avoided the disposal of 124,000 metric tons of hazardous waste Eliminated 174 million metric tons of air emissions None of this was at a cost increase � in fact purchasers will actually save money from energy cost reductions. Electronic Products Environ Assessment Tool CLICK 5x EPEAT is a self declaration program that spot checks manufacturers to ensure they meet the established environmental criteria. EPEAT Computers offer reduced cadmium, lead and mercury, more energy efficient so reduces emissions, easier to upgrade and recycle and manufacturers must offer safe recycling options. Over 600 products are now listed and most organizations I talk with have found their computers, laptops and monitors were already EPEAT registered. The Federal govt requires 95% of all its products that fall under this to be EPEAT registered. A recent EPEAT report outlines the enormous environmental benefits of EPEAT computers purchased in 2007 alone. With over 109 million units sold�some of the impact was Reduced toxic ingredients by 3,226 metric tons � equiv to 1.6 million bricks Avoided the disposal of 124,000 metric tons of hazardous waste Eliminated 174 million metric tons of air emissions None of this was at a cost increase � in fact purchasers will actually save money from energy cost reductions.

30. 30 Reduce Liability from Electronics Large Health System partnered with existing electronics recycler to assist recycler in meeting strict disposal and environmental requirements of the Electronic Recyclers� Pledge of True Stewardship. Results: Reduced liability Positive publicity To share what�s being done by health care facilities or has been done� One health system worked together with their electronic recycler to sign the �Electronic Pledge of True Stewardship� to reduce liability and improve public image. This ensures that electronics are handled in the most environmentally and socially just way. The pledge means they are -not using prison labor, -not exporting to developing countries, -requires tracking to show the final disposition of all e-waste. Recyclers who have signed a pledge are called E-Stewards and are listed on the Basil Action Network website. To share what�s being done by health care facilities or has been done� One health system worked together with their electronic recycler to sign the �Electronic Pledge of True Stewardship� to reduce liability and improve public image. This ensures that electronics are handled in the most environmentally and socially just way. The pledge means they are -not using prison labor, -not exporting to developing countries, -requires tracking to show the final disposition of all e-waste. Recyclers who have signed a pledge are called E-Stewards and are listed on the Basil Action Network website.

31. Environmental Compliance How many incidences of noncompliance with state, federal, or local environmental, health or safety laws and regulations that have taken place during the past 5 years, including those that were satisfactorily settled, those that resulted in no fines or legal action, and any other noncompliance incidences? You can check compliance in the federal ECHO database. http://www.epa.gov/echo/ State of Massachusetts has used this to evaluate suppliers. PGH uses this for award applications. This is numeric, can be compared.You can check compliance in the federal ECHO database. http://www.epa.gov/echo/ State of Massachusetts has used this to evaluate suppliers. PGH uses this for award applications. This is numeric, can be compared.

32. Corporate Environmental Policy & Report List URL of Corporate Environmental Policy List URL of most recent publicly-available corporate environmental report. Does your environmental report meet the Global Reporting Initiatives Sustainability Reporting Guidelines? This is really a yes/no question asking if they have a report or policy and whether it is publicly available. Like EMS, nothing specific about an environmental impact, just that they care enough to do these.This is really a yes/no question asking if they have a report or policy and whether it is publicly available. Like EMS, nothing specific about an environmental impact, just that they care enough to do these.

33. 33 PVC/DEHP in Medical Devices PVC - polyvinyl chloride (�vinyl�) Most widely used plastic in medical products (27% in 1996). Plasticizers � phthalates Used to make PVC plastic flexible. One phthalate is Di-ethylhexyl phthalate (DEHP) used in medical devices. Another concern of health care facilities that want to provide quality care involves plastics -PVC or poly vinyl chloride is the most widely used plastic in medical products � 27% in 1996 To make plastics flexible, they use a plasticizer called phthalates. One of the phthalates used is DEHP or Di-ethylhexyl phthalate. � Another concern of health care facilities that want to provide quality care involves plastics -PVC or poly vinyl chloride is the most widely used plastic in medical products � 27% in 1996 To make plastics flexible, they use a plasticizer called phthalates. One of the phthalates used is DEHP or Di-ethylhexyl phthalate. �

34. 34 Issues with PVC/DEHP PVC � Dioxin, a reproductive toxin, is released in production and disposal of PVC DEHP � a reproductive and developmental toxicant, leaches from the softened PVC material (IV bags, etc.) into fluids When PVC is produced or disposed of by incineration, it can release dioxin, a highly toxic and carcinogenic chemical. Dioxin has been linked to reproductive and developmental defects, endometriosis, learning disabilities, endocrine disorders, and cancer. The health care sector produces dioxin by incinerating waste containing large amounts of chlorinated plastic (e.g., PVC � polyvinyl chloride). Some PVC contains DEHP to make it flexible. Most PVC medical devices contain 20-40% DEHP by weight, but PVC tubing may contain up to 80% DEHP. The problem is DEHP does not chemically bind to PVC and may leach when a medical device comes into contact with fluids, lipids, and or heat. A concern for health care facilities is that DEHP-plasticized PVC products are common in neonatal intensive care units (NICUs). FDA issued a notice in 2002 recommending alternatives to DEHP-containing products. When PVC is produced or disposed of by incineration, it can release dioxin, a highly toxic and carcinogenic chemical. Dioxin has been linked to reproductive and developmental defects, endometriosis, learning disabilities, endocrine disorders, and cancer. The health care sector produces dioxin by incinerating waste containing large amounts of chlorinated plastic (e.g., PVC � polyvinyl chloride). Some PVC contains DEHP to make it flexible. Most PVC medical devices contain 20-40% DEHP by weight, but PVC tubing may contain up to 80% DEHP. The problem is DEHP does not chemically bind to PVC and may leach when a medical device comes into contact with fluids, lipids, and or heat. A concern for health care facilities is that DEHP-plasticized PVC products are common in neonatal intensive care units (NICUs). FDA issued a notice in 2002 recommending alternatives to DEHP-containing products.

35. 35 Flame retardants � particularly brominated flame retardants � are widely used in plastics but the alarming news is that they are being found in the Artic, they�re turning up in womens breast milk, in dust in homes The chemical structure is stable so HFRs tend to be persistent and bioaccumulate in the environment, just as you saw in the mercury slide. They are also toxic and are linked to liver, thyroid, reproductive,/developmental and neurological effects. Share common traits with PCBs that were banned years ago So your disclosure form asks suppliers to identify the use of HFRs Flame retardants � particularly brominated flame retardants � are widely used in plastics but the alarming news is that they are being found in the Artic, they�re turning up in womens breast milk, in dust in homes The chemical structure is stable so HFRs tend to be persistent and bioaccumulate in the environment, just as you saw in the mercury slide. They are also toxic and are linked to liver, thyroid, reproductive,/developmental and neurological effects. Share common traits with PCBs that were banned years ago So your disclosure form asks suppliers to identify the use of HFRs

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37. 37 Food-Related Resources www.healthyfoodinhealthcare.org To learn more about the Pledge and what Pledged facilities are doing see the recently released HCWH report Menu of Change at www.healthyfoodinhealthcare.org. Many other resources on topics ranging from how to purchase sustainably produced chicken to starting a hospital-based farmers market also be found at this site. To learn more about the Pledge and what Pledged facilities are doing see the recently released HCWH report Menu of Change at www.healthyfoodinhealthcare.org. Many other resources on topics ranging from how to purchase sustainably produced chicken to starting a hospital-based farmers market also be found at this site.

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39. 39 A few months ago, I had a chance to review contract language that said they wanted the bidder to supply �environmentally safe� janitorial cleaning products� Well�the problem was �environmentally safe� was not defined. One GPO came across produce literature stating that it �was certified �green and clean� by UL� CLICK If you are told a product is green, it might have AN environmental attribute� but what is it? If it is not specified, then how do you know. CLICK So when buying green products Look for specific environmental claims CLICK Become familiar with the environmental issues for the product area CLICK Not every product that claims has an environmental attribute, may be preferable� such as organic cigarettes? A few months ago, I had a chance to review contract language that said they wanted the bidder to supply �environmentally safe� janitorial cleaning products� Well�the problem was �environmentally safe� was not defined. One GPO came across produce literature stating that it �was certified �green and clean� by UL� CLICK If you are told a product is green, it might have AN environmental attribute� but what is it? If it is not specified, then how do you know. CLICK So when buying green products Look for specific environmental claims CLICK Become familiar with the environmental issues for the product area CLICK Not every product that claims has an environmental attribute, may be preferable� such as organic cigarettes?

40. 40 Examples of �Greenwashing� �Recycled content� Steel All steel is recycled �Mercury-free IV Bag� Mercury is not a problem in IV bags �Nontoxic� � Everything is toxic in sufficient doses (i.e., water, oxygen, and salt) �All Natural� � Arsenic, mercury, and uranium are all natural & all poisonous Some claims are simply Irrelevant recycled steel when steel is commonly recycled (Chlorofluorocarbons) CFC-free products when CFCs were banned 30 years ago Mercury free IV Bag � mercury is not a problem in IV bags Vague claims that a product is recyclable � but in some parts of the country there not be a local program to recycle it No Proof �chemical free� - water is a chemical as are all of our products �nontoxic� when everything is toxic in sufficient amounts �all natural� � arsenic, mercury and uranium are all natural and all poisonous Fibbing dishwasher detergent says its packaged in 100% recycled paper when the container is plastic But there are ways to ensure environmental claims are legitimate. Some claims are simply Irrelevant recycled steel when steel is commonly recycled (Chlorofluorocarbons) CFC-free products when CFCs were banned 30 years ago Mercury free IV Bag � mercury is not a problem in IV bags Vague claims that a product is recyclable � but in some parts of the country there not be a local program to recycle it No Proof �chemical free� - water is a chemical as are all of our products �nontoxic� when everything is toxic in sufficient amounts �all natural� � arsenic, mercury and uranium are all natural and all poisonous Fibbing dishwasher detergent says its packaged in 100% recycled paper when the container is plastic But there are ways to ensure environmental claims are legitimate.

41. Hierarchy of RFP Strategies Notification (signaling) Requests for specific disclosures EPP Product preferred EPP Product required

42. Verification Sales people sometimes assume things�always verify. Consider verification requirements for each attribute Follow up during contract life to ensure compliance Consider certification programs such as GreenSeal who undertake verification independently.

43. EPP Contracting: Learning Curve This is a learning process for both contractor/purchaser and the vendor. The first time a vendor is asked about an environmental issue, they may have no clue. Next time, the good ones will be more prepared.

45. 45 Environmentally Preferable Purchasing (EPP) Services Product and service-specific RFP/RFI Language Training Webinars Where to Find EPP Products Consulting Services EPP can be a key to saving money, reducing waste, and meeting the needs of patients. Whether you�re a GPO, healthcare facility, or supplier, we provide you with the tools and information you need to achieve concrete environmental goals through contracting activities.EPP can be a key to saving money, reducing waste, and meeting the needs of patients. Whether you�re a GPO, healthcare facility, or supplier, we provide you with the tools and information you need to achieve concrete environmental goals through contracting activities.

46. 46 EPP Resources: Practice Greenhealth Fact sheets Specifications Listserve Webinars Trainings www.practicegreenhealth.org Practice Greenhealth has many resources such as -fact sheets -listserves -webinars and more on our website to provide you with guidance in environmental purchasing. Can I answer any questions?Practice Greenhealth has many resources such as -fact sheets -listserves -webinars and more on our website to provide you with guidance in environmental purchasing. Can I answer any questions?