Greening Healthcare: The Reasons and How to Make It Happen

When it comes to Greening healthcare, the first thing we need to know is that antimicrobial products, otherwise known as disinfectants, are used in virtually all healthcare facilities to kill bacteria and germs. Although they have and continue to serve us well, they can negatively impact human health and the environment. The U.S. Environmental Protection Agency (EPA) classifies these products as pesticides, with some more harmful to the environment than others. 

These include the following.  

• “Quats” or quaternary ammonium compounds, such as benzalkonium chloride, are effective as sanitizers or disinfectants on a wide range of bacteria and viruses. Sometimes they are combined with alcohols, which can be corrosive to metals and surfaces. There are also concerns that quats in high concentrations can cause or trigger asthma.   

• Phenols can kill more organisms than quats but have high environmental and health consequences. They can also destroy plastic, paint, and rubber surfaces.  

• Aldehydes are often used as a form of disinfectant. These are extremely harmful to human health and the environment and can cause headaches, nausea, vomiting, skin, eye, and respiratory problems. Hospital staff using aldehydes, as well as all antimicrobials, should always wear protective clothing.  

• Oxidizers such as hydrogen peroxide are used as disinfecting ingredients in medical facilities and, if properly diluted, are considered to have fewer negative impacts on health and the environment than many other cleaners and disinfectants.  

• Chlorine bleach is a powerful disinfectant but is known to be corrosive to eyes and skin, a respiratory irritant, and when mixed with other commonly used cleaning products, can produce poisonous gas. Bleach must be appropriately diluted and replaced frequently as the solution is unstable.  

• Alcohol can also be used as a disinfectant and a respiratory irritant. Alcohol, along with bleach, should not be used for cleaning. They are not considered cleaning agents.  

Some cleaning chemicals, including those listed here, are mandated by law or meet accreditation requirements in some medical facilities. However, they are often used in areas of the facility where they are not necessary. 

As a result, one of the first ways we can Green a medical facility and still abide by laws and regulations is to use these chemicals only where needed. This can best be determined by dividing the facility into three sections, using antimicrobials only in those sections where required or necessary. 

These three sections include the following.  

Critical Care Zones: items and areas that come in contact with broken skin. These areas include operating rooms, labor, delivery rooms, and the morgue. Usually, the types of cleaning chemicals used here are mandated by law.   

Semi-Critical Care Zones: These areas require an elevated level of disinfection and include the nursery, clinics, restrooms, and physical therapy rooms. Hospital administrators may have more flexibility regarding which cleaning products and chemicals are used in these areas.  

Non-Critical Care Zones: areas that require soap and water and a low level of disinfection. These areas include administration, accounting, mailrooms, shops, and waiting areas. Administrators may make their own cleaning chemical and product selections.  

Patient rooms may fall into any of these three care categories. Hospital administrators will have to decide what products are to be used based on the vulnerability of the patient and the uses of the room.

 Greening Healthcare Implementation

 With more medical facility administrators now seeking to make their buildings healthier, more sustainable, and Greener, the first question is, “how do we get the program working?”

 There are specific steps in the Green Cleaning process.   

·     Form a team. This may include personnel from a hospital’s environmental services department, infection control, nursing, employee health, administrative staff, and public affairs. The team will be responsible for reviewing the technical aspect of cleaning products and systems, decision-making, some training, and coordinating the Green cleaning process.  

·     Benchmark. To convert to Green cleaning, we must determine where we are now so we might identify needs and opportunities. This requires evaluating and inventorying all of the products currently used for cleaning, determining which can be replaced with Green alternatives and identifying products that have been linked to worker injuries or staff/patient complaints. This must include all cleaning products such as chemicals, paper, vacuum cleaners, floor machines, extractors, carpet care equipment, etc.   

·     Determine Green criteria. It is essential to have some requirements or standards on which to base Green cleaning product buying selections. For instance, chemicals should be selected only if they have been certified by leading Green certification organizations.   

·     Product testing and selection. Just because products are Green does not necessarily mean they all perform the same. This is true of any cleaning solution. Testing the product in your facility may be necessary before making a product selection.   

 ·     Execute the program. Change is not always easy, and some cleaning professionals will resist losing cleaning tools and products that have performed dependably for years. However, education, training, and communication about why the environmentally preferable products are being implemented usually help make the change and the adjustment easier.   

There are more steps in the process, and how long it takes to convert from conventional to Green cleaning depends on many factors such as the size and use of the facility, the number of environmental services personnel involved, and other dynamics. However, hospital administrators’ desire to make their facilities Green is key to the process. If there is a powerful desire for Green cleaning, this will be transferred to all involved, and the process will usually move along more rapidly and smoothly.

Stephen P. Ashkin is president of The Ashkin Group, a consulting firm specializing in Green cleaning and sustainability, and CEO of Sustainability Dashboard Tools LLC, for measuring and monitoring sustainability with the goal of protecting natural resources and reducing facility operating costs.  He is considered the “father of Green Cleaning,” is on the Board of the Green Sports Alliance, and has been inducted into the International Green Industry Hall of Fame (IGIHOF).  He can be reached at steveashkin@ashkingroup.com