Adapted from H2E presentation

Going Green and Saving GreenEnvironmental Purchasing for Healthcare

Janet Bowen

New England Healthcare CoordinatorSeptember 15, 2006

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

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

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.

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)

Benefits of EPP

• Improved impact on the environment from hospital operations

• Cost savings

• Healthier environment for patients and employees

• Positive publicity

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

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

Prioritizing EPP Activities

• Review mission of organization

• Review recent problems with:Occupational healthEnvironmental compliancePatient safety

• Review environmental costs

• Review waste audit data & costs

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!

Purchase Price (x frequency of purchase)

Disposal Cost

Occupational Health Costs

Liability

Environmental Costs

Total Cost

Total Cost

Don’t Forget Verification!

• When specifying environmental attributes, (or asking GPO to do so) consider what evidence you need:3rd party verificationMSDSSignature of chemistRight to audit manufacturing/processing

facility

• Do not take vendors’ word on product attributes (they’re trying to sell products!)

GPO Buying Power

• GPOs have huge contracting advantages:Buying power that makes vendors careDedicated contracting staff to vet claims

• Communicate with your GPO:Request general EPP contracting Request custom EPP contractsServe on product review committees

H2E Champion GPOs Amerinet, APS, Broadlane, Consorta,

MedAssets, Novation, PremierH2E teleconference with GPOs

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

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)

Specific EPP Targets

• Mercury – Clinical, Lab, Building• Waste reduction – solid and

hazardous• Resource Efficiency • Paper• Electronics• Cleaning• Pest Control

Mercury in Healthcare

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

Clinical Mercury Devices

Gastrointestinal tubes Tungsten or Water

Sphygmomanometers Aneroid or Electronic

Thermometers Electronic or Alcohol

Calibrating Manometers

Electronic

Alternatives widely available, at equivalent performance, cost

Mercury in Building Supplies

•Thermostats,Thermometers, Switches, Relays contain mercury

•Gas and Water Flow Meters, Float Switches can contain gallons of mercury

StrategyStrategy:: •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

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

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

Mercury in the Laboratory

• Histology Fixatives

• Histology Stains

• Antibodies

• Parasitology Fixatives

• Automated testing equipment reagents

• Bleach (contaminant)

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

• 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

Hidden mercury

Mercury Resources

H2E’s 10-step Guide to Reducing Mercuryhttp://www.h2e-online.org/hazmat/mercguide.html

H2E’s 10-Step Guide to Fluorescent Lamp Recycling

www.h2e-online.org/pubs/tensteps/fluor10steps.pdf

Hospital Waste

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

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

Purchasing for Waste Reduction

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

Waste Reduction $ucce$$

Hazardous Materials

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

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

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

Hazardous Waste Reduction $ucce$$

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

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

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

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

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, 2006http://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 trainingenergystar.webex.com

Implement as you build or renovateUse 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

Water Use Reductions

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

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

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!

Paper Recycling Resources

H2E HIPPA pagewww.h2e-online.org/regsandstandards/hipaa.html

H2E HIPPA guidancewww.h2e-online.org/pubs/paper/hipaa.pdf

Paper Recycling HERC websitewww.h2e-online.org/wastereduction/paper.html

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

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

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

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, 9/19/06http://www.energystar.netspoke.com/attendee/default.asp

“Greener” Janitorial Chemicals

Why be concerned about Cleaners?Asthma riskOccupational skin/eye injuriesIndoor Air qualityTraining/Worker protection costsPatient 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

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

Green Cleaning Resources

• INFORM, Cleaning for Healthhttp://www.informinc.org/cfh_00.php

• Janitorial Products Pollution Prevention Project

http://www.wrppn.org/janitorial/jp4.cfm

• H2E Green Cleaning call, August 2005http://www.h2e-online.org/teleconferences/molydesc.cfm?Date=2005-

08-12&teleconfid=64

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

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

Green Guidelines for Healthcare Construction

www.gghc.org

EPP Key Resources

• H2E’s 10-Step Guide to EPPwww.h2e-online.org/wastereduction/epp/10steps.html

• H2E’s Product and Services Directory, newwww.h2e-online.org/directory/index.htm

• EPA EPP websitewww.epa.gov/opptintr/epp/• Sustainable Hospital Projectwww.sustainablehospitals.org/cgi-bin/DB_Index.cgi

• Green Chemical Alternative Wizard, newhttp://web.mit.edu/environment/academic/purchasing.html

• H2E’s EPP websitewww.h2e-online.org/wastereduction/epp/overview.html

Compliance

• What compliance issues are hospitals having?

• How can purchasers impact compliance?

From John Gorman, EPA Region II, June 2006

Compliance Results from Region II:Compliance Monitoring & Incentives Programs

Hospitals

Universe480

Inspections49

Enforcement Actions 36

Formal Enforcement Actions 11 ($1,523,613)

Settlements 9 ($642,612)

Audit Agreements 39

Voluntary Disclosures146 covering 563 facilities ($26,829,489 for

123 resolved)

Violations Corrected 1745

From John Gorman, EPA Region II, June 2006

Breakdown of Healthcare Violations in Region II (NY, NJ and PR)

Breakout of Violations from Hospital Disclosures

SDWA Violations0%

EPCRA Violations7%

CAA Violations18% CWA Violations

4%

TSCA Violations1%

RCRA Violations70%

From John Gorman EPA Region II, June 2006

Healthcare RCRA Violations (Hazardous Waste)

Breakout of RCRA Violations from Hospital Disclosures

Accumulation Time1%

Manifest 5%

ID of HW 25%

Universal Waste21%

General Facility Standards10%

Container Management29%

UST 3% Generator

Requirements6%

Top 10 Violations (From 146 Voluntary Disclosures)

Rank Violation Statute Frequency

1 ID of HW RCRA

(hazardous waste)

497

2 Universal Waste RCRA

(hazardous waste)

417

3 Container Management RCRA

(hazardous waste)

271

4 Labeling RCRA

(hazardous waste)

269

5 CFC (Chlorofluorocarbons)

Leak Detection Records

CAA

(Clean Air Act)

233

From John Gorman EPA Region II, June 2006

Top 10 Violations – Cont.Rank Violation Statute Frequency

6 SIP (State Implementation Plan) Requirements

CAA

(Clean Air Act)

209

7 Chemical Inventory EPCRA

(Emergency Planning and Community Right to Know Act)

118

8 SPCC (Spill Prevention, Control and Countermeasure)

CWA

(Clean Water Act)

114

9 Manifests RCRA

(Hazardous Waste)

103

10 Personnel Training RCRA

(Hazardous Waste)

81

How Can Purchasers impact compliance?

• Purchase Products - Include compliance impacts as a

criteria/consideration in selection process

• Product Specifications - Request products that have less

regulatory impacts

- Request waste characterization from vendors

Talk to your EHS or Facility Staffabout

• Inventory Control Systems

• Waste Management tracking systems

Questions?

Want to be added to the EPA Region I email group for bi-monthly updates?

Email : Bowen.Janet@epa.gov

Phone: 617-918-1795