green cleaning in hospitals cleaning to protect health without harming the environment

The Green Cleaning ExpertsThe Ashkin Group

Green Cleaning in Hospitals

Cleaning to Protect Health

Without Harming the Environment

Stephen P. Ashkin812 / 332-7950

[email protected]


The Ashkin Group

Mission: Green the cleaning industry

We do NOT see ourselves at advocates. Rather, we aspire to be “transformers.”

Our clients include building owners & managers, contract cleaning services, product manufacturers & distributors, policy makers, environmental organizations, and others.


“Never doubt that a small group of thoughtful committed citizens can change the world.

In fact, it’s the only thing that ever has.”

Margaret Mead

Commitment


The Process of Change

Defining Green and Green Cleaning

The Cleaning Plan

Green Cleaning Opportunities and Examples

Discussion Overview


Essential to have top management support for implementing green cleaning

Recommend having a team to come together to make changes in cleaning products and practiceAdministrator, president, marketing,

community relationsEnvironmental services, purchasing,

infection control, GPO, others

What is the business case?

Process for Change - Administrative Support


Infection Control - cleaning, disinfectionEnvironmental Services – cost containment,

ease of use, efficienciesPurchasing – group contracts, cost

containmentRisk Management – optimize environment,

reduce risks, protect patientsEmployee Health – protect healthcare

workersAdministration – overall performance,

community relationsRecognize the competition for resources.

Process for Change - Differing Agendas


Who performs the servicesWhat products are being used & what are

costsWhen are services performedWhere are they being used (are the same

products used everywhere?)How are products usedFrequency of services providedTraining and communications – how often,

issues

Are there other opportunities for improvement?

Process for Change - Create a Baseline


In-house ServicesGPOsContract issues

Out-sourced ServicesContract languageHow are supplies purchased

UnionsDifferent structures have different

challenges

Consider small, low-risk “pilots”

Process for Change - Who Performs Services?


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

Defining Green Cleaning & Products


Cleaning chemicalsDisposable janitorial products (e.g.

paper)EquipmentProceduresSource reduction and pollution

prevention

Encourage sustainability

Defining Green – It’s Not JUST Products


Safe for patientsSafe for staff (especially product

users)Safe for environment (creates

minimal amount of pollution, especially PBT’s)

Encourage sustainability

Defining Green – It’s Not JUST Products


5.0 Billion pounds of cleaning chemicals

4.5 Billion pounds of janitorial paper

0.5 Billion pounds of equipment

35.0 Billion plastic liners

The Impact of Cleaning – the Environment


6% of workers injured on the job

Occupational asthma on the increase

20% are eye and skin burns (chemical exposures)

Muscular/skeletal injuries (ergonomics)

The Impact of Cleaning - Product Users


Nursing homes and assisted living3,350,000 residents2,000,000 staff (full and part time)

Hospitals660,000 patients (per day)4,535,000 staff (full time equivalents)100,000 hospital traineesVisitors???

Many are exposed 24 hours per day

The Impact of Cleaning - Patients & Staff


Every Year50,000 people die in automobile

accidents 7,000 people drown5,000 people die of burnsEvery Year70,000+ patients die of nosocomial

infections

Nine People Die Every Hour

A Perspective on Patient Impact


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

Nosocomial Infections


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.

Nosocomial Infections


Evaluate how the facility is defined for cleaning…

Single or multiple levels?Different standards for different

areas?

(ASTM E1971-89 Standard Guide for Stewardship for Cleaning

Commercial and Institutional Buildings)

Cleaning Plans Matter


Typically in a hospital…..45 to 65% are Non-critical (low risk) areas25 to 45% are Semi-critical (medium risk)

areas10% 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.

Divide Hospital by ‘Risk Areas’


Non-critical (low risk)Exterior maintenanceAdministration, accounting, records, HR,

etc.Patient registration and waiting areasShops, carpentry, mail, printing,

materialsHallways & common areas



Semi-critical (medium risk)Restrooms (public)NurseryClinics, outpatients, diabetes,

respiratoryRehabilitation, physical therapy, cardiac

rehab

Critical (high risk)Emergency & SurgeryLabor and DeliveryMorgue



Monitor pests and weedsUse local plants adapted for the

siteUse mulches and replenish as

necessaryTrain weed-eater operators not to

damage treesUse ice melt compounds before the

precipitation begins - use to break bonds for removal by shoveling and plowing (not intended to melt the ice or snow)

Exterior – Keep the Contaminants Out


Consider closing redundant entrances in inclement weather

Switch from sodium and calcium chloride to potassium and magnesium chloride ice melt – do not over apply

Use environmentally preferable exterior cleaning chemicals and dispose of them properly

Exterior – Keep the Contaminants Out


Design all entrances with permanent entry systems or mats

Can be used inside and outShould be appropriate for climateClass 1 fire retardant materialSize approximately 12 feet in

lengthDevelop a plan to track cleaning

Entryways – Capture the Contaminants


Provide adequate and secure storage areas with appropriate plumbing and chemical dispensing equipment

Have a dispenser maintenance plan

Provide chemical storage training

Cleaning Chemicals – Storage & Mixing Areas


Use Green Seal Certified products www.greenseal.org

Use low VOC products when possible

Keep MSDS file up to date & available

Choosing Cleaning Chemicals


Use concentrates with dispensing equipment

Increase the “life” of finishesUse metal-free floor finishes

when feasibleMaintain a log of all cleaning

activitiesTrain personnel to use cleaning

chemicals properly

Choosing Cleaning Chemicals


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 products.

One size does NOT fit all needs. Cleaning personnel are smart enough to use multiple products.

What About Disinfectants?


Chlorine, Phenols, Quats & Peroxide

Chlorine / Sodium HypochloriteVery effective antimicrobialCorrosive to eyes and skinDamage floor finishes, carpets, clothing, etc.Respiratory irritantConcerns regarding production, contaminants & by-

productsMixing can create poisonous gas

PhenolsEffective against TB – HBV assumedCorrosive to eyes and skinDamage floor finishes and other surfacesStrong pungent odor & respiratory irritantEnvironmental concerns. Possible estrogen mimic.

QuatsTypically not effective against TB or HBVLess toxic than phenols – eye, skin and surface corrosiveToxic to aquatic life

PeroxideEPA Sanitizer - not a disinfectant.Superior health & environmental profile vs. phenols and

quats

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High

Low


Blood Borne Pathogen & Body Fluids

Fluids covered by OSHA

Blood, semen, cervical solutions, other

Excluded fluids include

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

Must be cleaned with tuberculocidal or hepacidal disinfectant

29CFR 1910.1030


EPA Approved Cleaning Solutions Blood and Body Fluids

Must be hepacidal or tuberculocidalPurpose 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 may be used


Janitorial Equipment

Vacuums meet CRI’s 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 equipmentMaintain an equipment log

Janitorial Equipment


Janitorial Paper - Other Disposable Products

Comprehensive Procurement Guidelineswww.epa.gov/cpg/products.htm

Toilet tissue: 20% minimum PC contentPaper hand towels: 40% minimum PC contentIndustrial wipes: 40% minimum PC

contentFacial tissues: 10% minimum PC contentPlastic trash liners: 10% minimum PC content

Processed chlorine freeLarge rollsHands-free dispensers that limit paperMicro-fiber cloths, mops and bonnetsRecycled buckets, carts, mats, etc.


Integrated Pest Management

Landscape to eliminate “safe havens”

Prevent pests from entering the building

Monitor before pests become a problem

Eliminate food, moisture, & clutter

Use the least toxic pesticide possible

Universal notification


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.

Excerpted from Integrated Pest Management, by Wayne WarrenAmerican Society for Healthcare Environmental Services

Professional Development Series



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 well managed 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).

Excerpted from Integrated Pest Management, by Wayne Warren American Society for Healthcare Environmental Services

Professional Development Series



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

Occupant Participation in Recycling


“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, it’s time for a change. Negligence starts tomorrow.”

William McDonoughCradle to Cradle

Importance of Change


Thank

Thank

You!

You!

Green Cleaning in Hospitals

Cleaning to Protect Health

Without Harming the Environment

Stephen P. Ashkin812 / 332-7950

[email protected]

green cleaning in hospitals cleaning to protect health without harming the environment

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