'Green' movement makes hospitals safer

EH can be a part of 'green teams'

Being greener is safer. As hospitals join the sustainability movement, they are making the workplace safer for their own employees.

Employee health professionals should join their hospitals' "green teams" as a way to reduce chemical hazards, says Barbara Sattler, RN, DrPH, FAAN, a professor at the University of Maryland School of Nursing in Baltimore and program director of Maryland Hospitals for a Healthy Environment.

"These green teams are creating a remarkable opening," says Sattler, who is also director of the Environmental Health Education Center at the School of Nursing. "It's a profound shift that people in occupational health should take advantage of."

Green teams pose questions that impact a broad constituency, says Sattler: "What is safe and healthy for our patients? What is safe and healthy for our employees? What is safe and healthy for our community?"

Based on a 2007 survey of nurses, chemical exposures in the health care workplace are widespread. The online survey of more than 1,500 nurses from all 50 states, conducted by the Environmental Working Group and Health Care Without Harm, found that one third (32%) were exposed at least twice weekly to combinations of at least five chemicals and other hazardous agents for ten years or more. Almost half (46%) said they did not think their employers are doing enough to protect them.1

Nurses also are suffering from the effects. The survey found that nurses with high exposures to anti-neoplastic agents (at least once a week for 10 years) had a higher incidence of cancer, and nurses with high exposures to sterilizing and disinfecting agents and housekeeping chemicals had higher rates of asthma. A recent study of Texas nurses also found that those exposed to disinfectants and cleaning products and those involved in cleaning medical instruments had higher rates of asthma.2

Green teams can begin by seeking safer substitutes for some hazardous chemicals, says Sattler. "Often these chemicals that may trigger or cause asthma have other health effects, as well," she says.

Growing a 'green team'

At the University of Maryland Medical Center, Denise Choiniere, RN, MS, began her sustainability efforts as a nurse in the cardiac intensive care unit who wanted to recycle batteries. She was planning to take them home and recycle them on her own.

Then she heard of the newly formed Green Team, and she became involved in the team's efforts to improve the hospital's waste management program. Soon, she was sharing her ideas with the vice president of facilities, the chief nursing officer — and the hospital CEO. The grass-roots program became a mission of the hospital leadership, says Choiniere, who is now the hospital's sustainability manager.

Some hospital departments have taken on their own "green" initiatives, as hospital employees grow accustomed to looking for environmentally safe practices, she says. "I'll know I'm successful when [the departments] don't need me anymore, when sustainability is incorporated in every department, just the way patient safety is incorporated," she says.

Here are some ways the University of Maryland Medical Center has used "green" strategies to improve health and safety:

• Reducing exposure to hazardous chemicals. The hospital uses Green Seal-certified cleaners and tries to eliminate chemicals, when possible. "When parts of the hospital are renovated, we're installing a rubber flooring that doesn't require stripping and waxing. That's another way to improve the indoor air quality," says Choiniere. An added benefit: The rubber flooring is less slippery than waxed floors and reduces the risk of slipping and falling, the second most common injury in hospitals.

The hospital also has worked to eliminate mercury and Di(2-ethylhexyl)phthalate (DEHP), a plasticizer used in some tubing and medical devices. (DEHP is primarily a patient safety issue, especially for critically ill male neonates.)

If nurses or other health care workers have adverse effects from chemicals, it's important for them to inform employee health — and for employee health professionals to pass on that information to the green team, says Choiniere. "It's hard for me to build my case without numbers," she says, noting that often nurses will simply treat a reaction to an exposure with Benadryl and go back to work.

• Reducing pesticides and microbicides. The University of Maryland Medical Center has gotten rid of ethylene oxide, a sterilant, and has reduced its use of glutaraldehyde. An analysis of surveillance data in four states by the National Institute for Occupational Safety and Health revealed 401 cases of work-related injury due to anti-microbial pesticides — cleaning or disinfecting products — from 2002 to 2007.

Meanwhile, on its grounds, the hospital has adopted "integrated pest management." The first response to complaints about bugs is to seek the source of the problem, such as plugging holes or cleaning up sitting water. "Pesticides are actually the last resort," says Choiniere.

Choiniere works with the purchasing department to seek safer alternatives to some products.

"It's definitely a process," she says. "You need patience and perseverance to make changes."

• Raising awareness of environmental health. Choiniere attends monthly meetings of the nursing managers, chairs an interdisciplinary Green Team with about 25 active members, and sometimes attends unit meetings. She promotes green initiatives in the hospital's newsletter

The hospital also hosts a farmer's market, providing much-needed fresh fruits and vegetables to their urban community. It also makes it easier for hospital employees to adopt healthy eating habits, she notes. "People incorporate this in their personal life," she says.

Convincing 8,000 employees to change their habits isn't easy. But Choiniere builds on the support of people who are already committed to living a more sustainable lifestyle. "There are passionate people out there," she says.


1. Environmental Working Group. Nurses health: A survey on health and chemical exposures. December 2007. Available at http://bit.ly/pdy3kN

2. Arif AA, Delclos GL and Serra C. Occupational exposures and asthma among nursing professionals. Occup Environ Med 2009; 66:274-278.