A green workplace is a healthy workplace

Hospitals going beyond cleaners

Go green for safety.

That could be the mantra of a growing number of hospitals that are finding that green practices help build a culture of safety. Greener chemicals and cleaning processes may be environmentally responsible, but they also present fewer health concerns for employees, patients and visitors.

As green cleaning becomes the norm, so does an attitude toward chemical safety. For example, Dartmouth-Hitchcock Medical Center in Lebanon, NH, switched to less toxic chemicals years ago. But the hospital also considers safety and green practices in facility design and housekeeping techniques.

"It is a culture, a culture of a safer organization," says John J. Welenc, acting director of the hospital's housekeeping service. "It spreads out like a vine."

Hospitals are finding it easier — and less costly — to switch to greener chemicals, says Xiaobo Quan, PhD, EDAC, research associate at the Center for Health Design in Concord, CA, and co-author of a report on green cleaning in health care.1 Slowly, hospitals are beginning to use other methods, such as changes in flooring materials, he says.

"We are still moving from the narrow perception of green cleaning to a broader view," he says. "The ultimate goal is to reduce the use of harsh chemicals. There are multiple ways. It's not just the selection of green products."

Making a green choice in design

In fact, a survey of 150 hospitals, clinics, and experts in health care environmental issues showed that facilities emphasize using less toxic chemicals and reducing toxic waste but less commonly recognize other green practices.

Only 16% identified operational changes, such as placing mats at entrances to reduce floor soil and training employees to minimize the amount of chemicals they use. Only 2% mentioned design changes, such as better ventilation, use of ultraviolet light to kill microorganisms, and changes in floor finishes. The survey and report were sponsored by the Health Care Research Collaborative of Health Care Without Harm, an international coalition based in Arlington, VA.

"Building design can reduce the overall risk of infection," says Quan, citing the use of single patient rooms and HEPA filters. "If you reduce the risk of infection, there's less need for cleaning. There's less need of harsh chemicals."

The report details how five hospitals have integrated green practices into their operations and safety protocols. Those hospitals have valuable lessons to share, but Quan also hopes that further research will answer questions about the best way to ensure a safe environment — including effective infection control. "There's very little research comparing green cleaners or how they perform compared to so-called non-green cleaners," he says.

'Do the right thing'

Dartmouth-Hitchcock has been using green chemicals for 10 years. Any cleaning chemical that has a hazard rating above 1 (slightly toxic) must be approved by the safety committee, says Welenc. That means fewer volatile organic compounds, which can cause eye, nose and throat irritation and headaches. "The main reason we do it is for the health of our employees," he says.

Housekeepers use microfiber mops, which are lighter than the wet cotton string mops and have less ergonomic hazard, he says. As the hospital renovates or builds, new flooring is either rubber or vinyl that has a permanent finish that doesn't need stripping and waxing. "We try to do the right thing as much as we can," Welenc says. "Putting in flooring that doesn't require a finish is something we're committed to."

Dartmouth-Hitchcock trains housekeepers in safer techniques, such as wiping surfaces with a dampened cloth rather than spraying the cleaner. "It's pretty simple. You've got this disinfectant that kills. The more you spray it in the air, the more it kills," and the more housekeepers breathe in, Welenc says. "If you explain it in those terms, it sinks in."

The hospital is also experimenting with some new methods, such as ionized water. A battery-powered spray dispenser adds an electric charge to the water, giving it cleaning and germ-killing properties.

Employees are attuned to the risk of asthma from chemical odors, but sometimes they are still reluctant to change longstanding cleaning practices, says Welenc. "Commit to the program, whatever you do. Don't let the naysayers sway you," he says. If housekeepers complain that the new products don't clean as well, try new techniques or tools, he suggests. Dartmouth-Hitchcock has used smaller scrubbers to get to difficult-to-reach areas or bendable attachments.

Value analysis of chemicals

Ridgeview Medical Center in Waconia, MN, has had a green team — the Hospital Environmental Awareness and Resource Reduction Team — since 2001. New products go through a value analysis. "We look at employee satisfaction, health hazards, reduced exposures, and disposal in addition to cost," says Todd Wilkening, CHST, director of facilities.

In fact, all new chemicals that come into the hospital receive scrutiny, says Kathy Kruger, RN, BSN, manager of employee health. "Sometimes we make a decision not to bring them in and we go with an alternative product," she says. "The title and purpose of the product can seem innocent, but when you actually see what the hazardous ingredients are, it gives you another perspective."

Ridgeview also reviewed its level of cleaning to make sure it was not over-cleaning — using more toxic cleaners than were necessary. For example, offices didn't need to be cleaned with quaternary cleaners and the OR floor did not need to be disinfected, Wilkening says.

The hospital educated employees about the benefits of the new cleaning products, in health and environmental effects. The environmental commitment is multidisciplinary, says Kruger. "It isn't solely an issue for the environmental services department," she says. "We really see it in the broadest sense as a safety issue."

Green practices also benefit the community. Ridgeview shreds its confidential paper, which is then used as animal bedding by local farms. Grease and oil in the dietary service is recycled, and the hospital tries to minimize the use of Styrofoam.

The primary goal is an environmentally sound, healthy workplace. But there are other benefits, says Wilkening. "Employees are learning a lot [about environmental practices] that they take home with them," he says.


1. Quan X, Joseph A, Jelen M. Green cleaning in healthcare: Current practices and questions for future research. Health Care Research Collaborative, September 2011: http://bit.ly/siSd3T.