stephen p. ashkin 812 / 332-7950 steveashkin@ashkingroup
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H2E Green Cleaning Presentation 1
Green Cleaning in HospitalsCleaning to Protect Health Without Harming the Environment
Stephen P. Ashkin812 / 332-7950
SteveAshkin@AshkinGroup.com
H2E Green Cleaning Presentation 2
The Ashkin Group Mission: Green the cleaning industry
We do NOT see ourselves at advocates. Rather, we aspire to be “transformers.”
Clients include building owners, contract cleaning services, product manufacturers, policy makers, environmental organizations, and others.
Voice:812 / 332-7950Email: SteveAshkin@AshkinGroup.comWebsite: www.AshkinGroup.com
H2E Green Cleaning Presentation 3
“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
H2E Green Cleaning Presentation 4
Overview The Process of Change
Defining Green and Green Cleaning
The Cleaning Plan
Green Cleaning Opportunities and Examples
H2E Green Cleaning Presentation 5
Process for ChangeAdministrative Support Essential to have top management support for
implementing green cleaning Recommend having a team to come together to
make changes in cleaning products and practice Administrator, president, marketing, community
relations Environmental services, purchasing, infection
control, GPO, others
What is the business case?
H2E Green Cleaning Presentation 6
Process for ChangeRecognize Differing Agendas Infection Control - cleaning, disinfection Environmental Services – cost containment, ease of
use, efficiencies Purchasing – group contracts, cost containment Risk Management – optimize environment, reduce
risks, protect patients Employee Health – protect healthcare workers Administration – overall performance, community
relationsRecognize the competition for resources.
H2E Green Cleaning Presentation 7
Process for ChangeCreate a Baseline Who What products are being used What do products cost When Where are they being used (are the same products
used everywhere?) How Frequency Training and communications – how often, issues Are there other opportunities for improvement
H2E Green Cleaning Presentation 8
Process for ChangeWho Is Performing the Cleaning? In-house Services
GPOs Contract issues
Out-sourced Services Contract language How are supplies purchased
Unions Different structures have different challenges
Consider small, low-risk “pilots”
H2E Green Cleaning Presentation 9
Defining Green Cleaning and Green Cleaning Products
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
H2E Green Cleaning Presentation 10
Define Green CleaningIt’s Not Just About Chemicals Products Disposable Janitorial Products (i.e. paper) Equipment Procedures Source reduction and pollution prevention Safe for patients Safe for staff (especially product users) Safe for environment (creates minimal
amount of pollution, especially PBT’s)
Encourage sustainability
H2E Green Cleaning Presentation 11
The Impact of Cleaning on the Environment 5.0 Billion pounds of Chemicals
4.5 Billion pounds of Paper
0.5 Billions pounds of Equipment
35.0 Billion Plastic Liners
H2E Green Cleaning Presentation 12
Impact of Cleaning on Staff (Product Users) Health
6% of workers injured on the job
Occupational asthma on the increase
20% are eye and skin burns (chemical exposures)
Muscular/skeletal injuries (ergonomics)
H2E Green Cleaning Presentation 13
Impact on Patients and Staff Nursing homes and assisted living
3,350,000 residents 2,000,000 staff (full and part time)
Hospitals 660,000 patients (per day) 4,535,000 staff (full time equivalents) 100,000 hospital trainees Visitors???
Many are exposed 24 hours per day
H2E Green Cleaning Presentation 14
Impacts on PatientsSome Perspective 50,000 Die in Automobile Accidents 7,000 Drown 5,000 Die of Burns 70,000+ Die of Nosocomial Infections
Nine People Every Hour
H2E Green Cleaning Presentation 15
Nosocomial Infections 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 $$$$$
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.
H2E Green Cleaning Presentation 16
Cleaning Plans Matter Evaluate how facility is defined for
cleaning purposes
All one level?
Different standards for different areas? www.astm.org
(ASTM E1971-89 Standard Guide for Stewardship for Cleaning Commercial and Institutional Buildings)
H2E Green Cleaning Presentation 17
Divide up facility by ‘risk areas” Typically in a hospital…..
45 to 65% are Non-critical (low risk) areas 25 to 45% are Semi-critical (medium risk) areas 10% 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.
H2E Green Cleaning Presentation 18
Divide up facility by ‘risk areas” Non-critical (low risk)
Exterior maintenance Administration Areas, accounting, records, HR, etc. Patient registration and waiting areas Shops, carpentry, mail, printing, materials management Hallways
Semi-critical (medium risk) Restrooms (public) Nursery Clinics, outpatients, diabetes, respiratory Rehabilitation, physical therapy, cardiac rehab
Critical (high risk) Emergency Labor and Delivery Morgue Surgery
H2E Green Cleaning Presentation 19
Exterior Building Maintenance(keep the contaminants out)
Monitor pests and weeds Use local plants adopted for the site Use mulches and replenish as necessary Train weed-eater operators not to damage trees Use ice melters before precipitation begins and use to break
bonds to remove by shoveling and plowing (not intended to melt the ice or snow)
Consider closing redundant entrances Switch from sodium and calcium chloride to potassium and
magnesium chloride and don’t over apply Use environmentally preferable exterior cleaning chemicals
and dispose properly
H2E Green Cleaning Presentation 20
Entryway Systems and Maintenance(capture contaminants at the entries) Design all entrances with permanent entry
systems or mats Can be used inside and out Should be appropriate for climate Class 1 Fire Retardency Size approximately 12 feet in length Develop a plan to track cleaning
H2E Green Cleaning Presentation 21
Janitorial Chemical Mixing and Storage Areas Provide adequate and secure storage areas
with appropriate plumbing and chemical dispensing equipment
Have a plan to maintain the dispensers
Provide training on appropriate chemical storage
H2E Green Cleaning Presentation 22
Cleaning and Janitorial Maintenance Products Use Green Seal Certified products
www.greenseal.org
Use low VOC products for other categories MSDS – full disclosure Use concentrates with dispensing equipment Increase the “life” of finishes Use metal-free floor finishes Maintain a log of all cleaning activities Train cleaning personnel
H2E Green Cleaning Presentation 23
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 product. One size does NOT fit all needs. Cleaning personnel are smart enough to use multiple products.
H2E Green Cleaning Presentation 24
Chlorine, Phenols, Quats & Peroxide Chlorine / Sodium Hypochlorite
Very effective antimicrobial Corrosive to eyes and skin Damage floor finishes, carpets, clothing, etc. Respiratory irritant Environmental concerns from production, contaminants, byproducts Mixing can create poisonous gas
Phenols Effective against TB – HBV assumed Corrosive to eyes and skin Damage floor finishes and other surfaces Strong pungent odor – respiratory irritant Environmental concerns. Possible estrogen mimic.
Quats Typically not effective against TB or HBV Less toxic then Phenols – eye, skin and surface corrosivity Toxic to aquatic life
Peroxide EPA Sanitizer. Not a disinfectant. Superior health & environmental profile compared to phenols and quats
Ris
k C
onti
nu
um
High
Low
H2E Green Cleaning Presentation 25
OSHA Blood Borne Pathogen Standard & Body fluids Fluids covered by OSHA
Blood, semen, cervical solutions, other
Excluded fluids include
Urine, stool, saliva, sputum (unless visible blood)
Must be cleaned with tuberculocidal or hepacidal disinfectant
29CFR 1910.1030
H2E Green Cleaning Presentation 26
EPA Approved Cleaning Solutions For Blood and Body Fluids Must be hepacidal or tuberculocidal
Purpose 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 can be used
H2E Green Cleaning Presentation 27
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 equipment Maintain an equipment log
H2E Green Cleaning Presentation 28
Janitorial Paper and Other Disposable Products
Comprehensive Procurement Guidelines www.epa.gov/cpg/products.htm Toilet tissue: 20% minimum PC content Paper hand towels: 40% minimum PC content Industrial wipes: 40% minimum PC content Facial tissues: 10% minimum PC content Plastic trash liners: 10% minimum PC content
Processed chlorine free Large rolls Hands-free dispensers that limit paper Micro-fiber cloths, mops and bonnets Recycled containers, buckets, carts, mats, etc.
H2E Green Cleaning Presentation 29
Integrated Pest Management Landscape to eliminate “safe havens” Prevent pests from entering the building Eliminate food and moisture Monitor for pests before they become a
problem Eliminate clutter Use the least toxic pesticide possible Universal notification
H2E Green Cleaning Presentation 30
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.
-excerpt from Integrated Pest Management, by Wayne WarrenAmerican Society for Healthcare Environmental Services
Professional Development Series
Integrated Pest Management
H2E Green Cleaning Presentation 31
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 ofwastes or environmental releases and provide conscious management of all environmental media (i.e., air, water, and land).
-excerpt from Integrated Pest Management, by Wayne WarrenAmerican Society for Healthcare Environmental Services
Professional Development Series
Integrated Pest Management
H2E Green Cleaning Presentation 32
Occupant Recycling 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
H2E Green Cleaning Presentation 33
“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
H2E Green Cleaning Presentation 34
Green Cleaning in HospitalsCleaning to Protect Health Without Harming the Environment
Stephen P. Ashkin812 / 332-7950
SteveAshkin@AshkinGroup.comThank You
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