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'Green' revolution in hospitals boosts employee health programs
Efforts to reduce hazardous chemicals
The "greening" of American hospitals may be a golden opportunity for employee health.
Six major health systems have joined together to promote "green" purchasing and sustainability that promises to substantially reduce health care worker exposure to hazardous chemicals.
This Healthier Hospitals Initiative offers a new role for employee health professionals as they help reshape the environment for employees, patients, and the community, says Anna Gilmore Hall, RN, CAE, co-executive director of Health Care Without Harm, an international coalition based in Arlington, VA.
"We can improve patient outcomes, occupational health and safety, community health and environmental health," says Hall. "We're encouraging other hospitals and health care systems to adopt this agenda [of sustainability]. If we all work together and leverage the purchasing power and the status health care has in our community, we can reduce our own footprint in a way we think will save money in the long run for the health care sector."
The Healthier Hospitals Initiative will share best practices that redesign processes to reduce waste, substitute safer materials, and conserve energy. The goals include altering food choices by reducing meat purchases, buying local and organic products, and eliminating soft drinks.
"What we really want to do is improve the environmental performance of the health care sector. That's our aim," says Kathy Gerwig, vice president for workplace safety and environmental stewardship officer at Kaiser Permanente in Oakland, CA.
The other participating health systems are also among the largest in the country: Advocate Health Care, an Oak Brook, IL-based system of nine hospitals, two children's hospitals, and 200 sites of care; Catholic Healthcare West, based in San Francisco with hospitals in California, Arizona, and Nevada; Hospital Corporation of America (HCA, Inc.) of Nashville, TN, the nation's largest hospital system with 163 hospitals and 105 freestanding surgery centers in 20 states; MedStar Health, a network of nine hospitals and 20 other sites in the Maryland and Washington, DC region, and Partners Healthcare, a Boston-based health system founded by Brigham and Women's Hospital and Massachusetts General Hospital.
The initiative has a broad aim to reduce environmental hazards, but it also directly impacts health care workers. The potential occupational hazard of chemical exposures was underscored in a recent report that identified 401 cases of injuries linked to anti-microbial pesticides, or disinfecting chemicals, in a five-year period. There was one fatality due to acute asthma.
Environmentally preferred purchasing
At Kaiser Permanente, environmental and sustainability concerns are an integral part of the purchasing process. Kaiser adopted an "Environmental Performance" scorecard as a part of product evaluation.
When soliciting bids, Kaiser asks suppliers about the content of products, such as if they contain mercury or polyvinyl chloride or one of hundreds of chemicals identified by California as causing cancer or reproductive harm, and the proportion of recycled materials. Multi-use items are favored over single-use, and latex-free are preferred over those with latex.
"The environmental considerations are never going to trump something like patient safety considerations," Gerwig says. "We're never going to go for a product where we're compromising on safety to meet environmental goals."
But Kaiser has been emphatic about the desire to reduce exposure to toxic substances. Gerwig testified before the U.S. Senate subcommittee that is reviewing the Toxic Substances Control Act.
"In the U.S. today, it is perfectly legal and commonplace for manufacturers to use known hazardous ingredients in the products we all buy," she says. "We think the chemical ingredients in products ought to be tested for their safety in human health prior to being put into products."
Glove purchases provide one example of Kaiser's approach. When the health system decided to eliminate latex exam gloves due to concerns about latex allergy, vinyl gloves were not considered a preferred alternative. Kaiser uses tens of millions of gloves per year, and dioxin is released when those gloves are produced and when they are incinerated in their disposal, says Gerwig. Instead, Kaiser selected nitrile gloves.
"Kaiser Permanent was the first large health care system to move to nitrile gloves. It really changed the marketplace," she says.
More recently, Kaiser selected a rigid endoscope that can be steam sterilized and doesn't require chemical disinfecting. "We're removing hazards from the workplace, and we're getting the same efficacy. Why wouldn't you choose that?" says Gerwig, who notes that clinicians were involved in the selection.
Kaiser also substituted vinyl flooring with rubber, which meant it didn't require harsh cleaners and strippers, she says. As a side benefit, nurses reported that they had fewer foot problems as the rubber was more comfortable.
Now the health system is reviewing its flooring options again. "New materials have come on the market that we think might be even better than rubber and have more advantages for workers, patients and the environment," she says.
Cost has not been a barrier to this environmentally-conscious approach, says Gerwig. "We've not found that picking the sustainable products costs us more. In most cases, it ends up being cost-neutral or it saves us a little money," she says.
EH can build awareness
The Healthier Hospitals Initiative plans to share and promote best practices, such as those of Kaiser. "We're trying to establish a system where we can share this information in a non-competitive way," says Hall. Hospitals around the country can sign a pledge of endorsement as part of the initiative.
Employee health professionals can play an important role in their hospitals, Hall says. For example, they can promote product selection that reduces hazardous exposures, such as the purchase of greener cleaning products. Resources and a list of safer alternatives are available from the Lowell, MA-based Sustainable Hospitals Project, at http://www.sustainablehospitals.org/cgi-bin/DB_Index.cgi.
A movement toward "greener" policies also requires increased awareness. For example, employees need to understand which waste needs biohazardous disposal and which does not, says Gerwig. Reducing the waste that goes into biohazard containers unnecessarily will reduce the amount of incineration, she says.
"[Employee health professionals] are positioned really well to be champions in educating workers and clinicians about the impact of chemicals in their workplace," Gerwig says. "They can expand that view to include the health of the environment overall."
Hospitals can start with modest goals. "I would just encourage them to look around their workplaces and target a few products and see if they can't make a few changes and leverage that success," she says.
As the goals of energy conservation, sustainability, and "greener" living take center stage nationally, hospitals can become leaders in the community by taking proactive steps, says Hall. "I would argue that if you aren't currently working on this you are way behind the ball," she says.
[Editor's note: More information about the Healthier Hospitals Initiative is available at www.healthierhospitals.org/.]