Green Cleaning in Hospitals

Cleaning to Protect Health Without Harming the Environment

Stephen P. Ashkin 812 / 332-7950 SteveAshkin@AshkinGroup.com

H2E Green Cleaning Presentation 1

The Ashkin Group

Mission: Green the cleaning industry We do NOT see ourselves at advocates. Rather, we aspire to be transformers. Clients include building owners, contract cleaning services, product manufacturers, policy makers, environmental organizations, and others.

Voice:812 / 332-7950 Email: SteveAshkin@AshkinGroup.com Website: www.AshkinGroup.com

H2E Green Cleaning Presentation

Never doubt that a small group of thoughtful committed citizens can change the world. In fact, its the only thing that ever has.

Margaret Mead

H2E Green Cleaning Presentation

Overview

The Process of Change

Defining Green and Green Cleaning

The Cleaning Plan Green Cleaning Opportunities and Examples

H2E Green Cleaning Presentation

Process for Change Administrative Support

Essential to have top management support for implementing green cleaning Recommend having a team to come together to make changes in cleaning products and practice

Administrator, president, marketing, community relations Environmental services, purchasing, infection control, GPO, others

What is the business case?

H2E Green Cleaning Presentation

Process for Change Recognize Differing Agendas

Infection Control - cleaning, disinfection Environmental Services cost containment, ease of use, efficiencies Purchasing group contracts, cost containment Risk Management optimize environment, reduce risks, protect patients Employee Health protect healthcare workers Administration overall performance, community relations Recognize the competition for resources.

H2E Green Cleaning Presentation

Process for Change Create a Baseline

Who What products are being used What do products cost When Where are they being used (are the same products used everywhere?) How Frequency Training and communications how often, issues Are there other opportunities for improvement
H2E Green Cleaning Presentation

Process for Change Who Is Performing the Cleaning?

In-house Services

GPOs Contract issues Contract language How are supplies purchased

Out-sourced Services

Unions Different structures have different challenges

Consider small, low-risk pilots

H2E Green Cleaning Presentation

Defining Green Cleaning and Green Cleaning Products

Green Products: Products that reduce impacts on health and the environment when compared to similar products used for the same purpose. E.O. 13101 Green Cleaning: Cleaning to protect health (patients/occupants, staff, administrators, and visitors) without harming the environment. AG
H2E Green Cleaning Presentation

Define Green Cleaning Its Not Just About Chemicals

Products Disposable Janitorial Products (i.e. paper) Equipment Procedures Source reduction and pollution prevention Safe for patients Safe for staff (especially product users) Safe for environment (creates minimal amount of pollution, especially PBTs) Encourage sustainability

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The Impact of Cleaning on the Environment

5.0 Billion pounds of Chemicals

4.5 Billion pounds of Paper 0.5 Billions pounds of Equipment 35.0 Billion Plastic Liners

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Impact of Cleaning on Staff (Product Users) Health

6% of workers injured on the job Occupational asthma on the increase

20% are eye and skin burns (chemical exposures) Muscular/skeletal injuries (ergonomics)
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H2E Green Cleaning Presentation

Impact on Patients and Staff

Nursing homes and assisted living

3,350,000 residents 2,000,000 staff (full and part time) 660,000 patients (per day) 4,535,000 staff (full time equivalents) 100,000 hospital trainees Visitors???

Hospitals

Many are exposed 24 hours per day

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Impacts on Patients Some Perspective

50,000 Die in Automobile Accidents 7,000 Drown 5,000 Die of Burns 70,000+ Die of Nosocomial Infections

Nine People Every Hour

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Nosocomial Infections

2,000,000 (About 5.7%) of all Patients Admitted to U.S. Hospitals Acquire These Infections. 3.8% of Nosocomial Infections are Fatal 70,000+ People Die Every Year From Nosocomial Infections Approximately one-third are preventable $$$$$

This is NOT an indictment of the cleaning industry. We know how to clean. We just need the budget, time and tools to do the job right.
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Cleaning Plans Matter

Evaluate how facility is defined for cleaning purposes All one level?

Different standards for different areas? www.astm.org

(ASTM E1971-89 Standard Guide for Stewardship for Cleaning Commercial and Institutional Buildings)
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Divide up facility by risk areas

Typically in a hospital..

45 to 65% are Non-critical (low risk) areas

25 to 45% are Semi-critical (medium risk) areas 10% are Critical (high risk) areas

An important first step is to evaluate how the risk areas are defined and identified. You can probably reclassify many areas as low risk areas, which in turn can reduce resources, impacts and costs.
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Divide up facility by risk areas

Non-critical (low risk)

Exterior maintenance Administration Areas, accounting, records, HR, etc. Patient registration and waiting areas Shops, carpentry, mail, printing, materials management Hallways

Semi-critical (medium risk)

Restrooms (public) Nursery Clinics, outpatients, diabetes, respiratory Rehabilitation, physical therapy, cardiac rehab
Emergency Labor and Delivery Morgue Surgery
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Critical (high risk)

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Exterior Building Maintenance (keep the contaminants out)

Monitor pests and weeds Use local plants adopted for the site Use mulches and replenish as necessary Train weed-eater operators not to damage trees Use ice melters before precipitation begins and use to break bonds to remove by shoveling and plowing (not intended to melt the ice or snow) Consider closing redundant entrances Switch from sodium and calcium chloride to potassium and magnesium chloride and dont over apply Use environmentally preferable exterior cleaning chemicals and dispose properly
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Entryway Systems and Maintenance (capture contaminants at the entries)

Design all entrances with permanent entry systems or mats Can be used inside and out Should be appropriate for climate Class 1 Fire Retardency Size approximately 12 feet in length Develop a plan to track cleaning

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Janitorial Chemical Mixing and Storage Areas

Provide adequate and secure storage areas with appropriate plumbing and chemical dispensing equipment
Have a plan to maintain the dispensers Provide training on appropriate chemical storage

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Cleaning and Janitorial Maintenance Products

Use Green Seal Certified products

www.greenseal.org

Use low VOC products for other categories MSDS full disclosure Use concentrates with dispensing equipment Increase the life of finishes Use metal-free floor finishes Maintain a log of all cleaning activities Train cleaning personnel
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What About Disinfectants?

All microorganisms are not bad and we do not want to sterilize the world! Some antimicrobial products may increase resistance Good physical cleaning of environmental surfaces often is enough All antimicrobials are not bad and they are an important tool in the toolbox

Use disinfectants only where they are necessary and select the appropriate product. One size does NOT fit all needs. Cleaning personnel are smart enough to use multiple products.
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Chlorine, Phenols, Quats & Peroxide

High

Chlorine / Sodium Hypochlorite

Risk Continuum

Very effective antimicrobial Corrosive to eyes and skin Damage floor finishes, carpets, clothing, etc. Respiratory irritant Environmental concerns from production, contaminants, byproducts Mixing can create poisonous gas

Phenols

Effective against TB HBV assumed Corrosive to eyes and skin Damage floor finishes and other surfaces Strong pungent odor respiratory irritant Environmental concerns. Possible estrogen mimic. Typically not effective against TB or HBV Less toxic then Phenols eye, skin and surface corrosivity Toxic to aquatic life
EPA Sanitizer. Not a disinfectant. Superior health & environmental profile compared to phenols and quats
H2E Green Cleaning Presentation

Quats

Peroxide

Low

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OSHA Blood Borne Pathogen Standard & Body fluids

Fluids covered by OSHA

Blood, semen, cervical solutions, other

Excluded fluids include

Urine, stool, saliva, sputum (unless visible blood)

Must be cleaned with tuberculocidal or hepacidal disinfectant 29CFR 1910.1030

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EPA Approved Cleaning Solutions For Blood and Body Fluids

Must be hepacidal or tuberculocidal

Purpose of product is to kill hepatitis B, but there was no EPA approved testing methodology, so Surrogate test is killing of M. tuberculosis - if solution can kill M. TB, it will kill hepatitis B

Chlorine / Sodium Hypochlorite can be used

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Janitorial Equipment

Vacuums meet CRIs Green Label Program

www.carpet-rug.com

Extraction equipment remove sufficient moisture to dry carpet in 24 hours Buffers & burnishers with vacuum attachments Propane equipment have high-efficiency, low emission engines Auto scrubbers equipped with variable-speed pumps Battery-powered equipment environmentally preferable batteries (gel batteries) Ergonomic equipment Maintain an equipment log
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Janitorial Paper and Other Disposable Products

Comprehensive Procurement Guidelines

www.epa.gov/cpg/products.htm Toilet tissue: 20% minimum PC content Paper hand towels: 40% minimum PC content Industrial wipes: 40% minimum PC content Facial tissues: 10% minimum PC content Plastic trash liners: 10% minimum PC content

Processed chlorine free Large rolls Hands-free dispensers that limit paper Micro-fiber cloths, mops and bonnets Recycled containers, buckets, carts, mats, etc.
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Integrated Pest Management

Landscape to eliminate safe havens Prevent pests from entering the building Eliminate food and moisture Monitor for pests before they become a problem Eliminate clutter

Use the least toxic pesticide possible

Universal notification
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Integrated Pest Management

Pesticides are relatively unique toxic contaminants in that they are intentionally put into the environment to accomplish their deadly purpose. Therefore, all pest control programs have a special responsibility to be fully knowledgeable on the impact of these chemicals and through a hierarchy of practice, prioritize the use of preventive, nontoxic or least toxic alternatives. IPM is the process by which this is accomplished. It is also the law Public Law 92-516, as amended, The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA). The requirements for the management of hazardous materials and the release of chemicals, particularly pesticides, are becoming more comprehensive. These expanding requirements and increasing costs, are creating incentives to reduce the amount of hazardous materials used and wastes generated. -excerpt from Integrated Pest Management, by Wayne Warren American Society for Healthcare Environmental Services Professional Development Series
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Integrated Pest Management

Public concerns, chiefly centering around the inappropriate use of pesticides and the generation of harmful or toxic by-products from waste treatment and disposal processes, clearly indicate the need for a more comprehensive environmental management technique known as Pollution Prevention. A wellmanaged facility Pollution Prevention Program should incorporate IPM, as well as other proactive opportunities, to address the potential for risk before the accident results in adverse environmental impact, cost and/or liability. The facility Pollution Program should seek to minimize the generation of wastes or environmental releases and provide conscious management of all environmental media (i.e., air, water, and land).

-excerpt from Integrated Pest Management, by Wayne Warren American Society for Healthcare Environmental Services Professional Development Series
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Occupant Recycling

Establish a waste reduction and recycling program that addresses the separation, collection and storage of materials for recycling including (at a minimum) paper, glass, plastics, and metals Encourage a high level of recycling by building occupants

The success of recycling programs is dependant upon ongoing educations

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Insanity has been defined as doing the same thing over and over and expecting a different outcome. Negligence is defined as doing the same thing over and over even though you know it is dangerous, stupid or wrong. Now that we know, its time for a change. Negligence starts tomorrow. William McDonough Cradle to Cradle
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Green Cleaning in Hospitals

Cleaning to Protect Health Without Harming the Environment

Stephen P. Ashkin 812 / 332-7950 SteveAshkin@AshkinGroup.com

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