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H2E Green Cleaning Presentation 1

Green Cleaning in HospitalsCleaning to Protect HealthWithout Harming the Environment

Stephen P. Ashkin

812 / 332-7950

[email protected]


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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, contractcleaning services, product manufacturers,policy makers, environmental organizations,

and others.Voice:812 / 332-7950

Email: [email protected]

Website: www.AshkinGroup.com


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Never doubt that a small group of

thoughtful committed citizens can change

the world.In fact, its the only thing that ever has.

Margaret Mead


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Overview

The Process of Change

Defining Green and Green Cleaning

The Cleaning Plan

Green Cleaning Opportunities and

Examples


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Process for Change

Administrative Support Essential to have top management support for

implementing green cleaning

Recommend having a team to come together tomake changes in cleaning products and practice Administrator, president, marketing, community

relations

Environmental services, purchasing, infectioncontrol, GPO, others

What is the business case?


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Process for Change

Recognize Differing Agendas Infection Control - cleaning, disinfection

Environmental Servicescost containment, ease ofuse, efficiencies

Purchasinggroup contracts, cost containment

Risk Managementoptimize environment, reducerisks, protect patients

Employee Healthprotect healthcare workers Administrationoverall performance, community

relations

Recognize the competition for resources.


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Process for Change

Create a Baseline Who

What products are being used

What do products cost When

Where are they being used (are the same productsused everywhere?)

How Frequency

Training and communicationshow often, issues

Are there other opportunities for improvement



Process for Change

Who 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



Defining Green Cleaning and

Green Cleaning Products Green Products: Products that reduce

impacts on health and the environment

when compared to similar products usedfor the same purpose. E.O. 13101

Green Cleaning: Cleaning to protect health

(patients/occupants, staff, administrators,and visitors) without harming theenvironment. AG



Define Green Cleaning

Its 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 PBTs)

Encourage sustainability



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



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 (chemicalexposures)

Muscular/skeletal injuries (ergonomics)



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



Impacts on Patients

Some 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



Nosocomial Infections

2,000,000 (About 5.7%) of all Patients Admittedto U.S. Hospitals Acquire These Infections.

3.8% of Nosocomial Infections are Fatal

70,000+ People Die Every Year From NosocomialInfections

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.



Cleaning Plans Matter

Evaluate how facility is defined forcleaning purposes

All one level?

Different standards for different areas?

www.astm.org

(ASTM E1971-89 Standard Guide forStewardship for Cleaning Commercial andInstitutional Buildings)



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 therisk areas are defined and identified.

You can probably reclassify many areas aslow risk areas, which in turn can reduceresources, impacts and costs.



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



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 tomelt the ice or snow)

Consider closing redundant entrances

Switch from sodium and calcium chloride to potassium andmagnesium chloride and dont over apply

Use environmentally preferable exterior cleaning chemicalsand dispose properly



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



Janitorial Chemical Mixing

and Storage Areas Provide adequate and secure storage areas

with appropriate plumbing and chemicaldispensing equipment

Have a plan to maintain the dispensers

Provide training on appropriate chemicalstorage



Cleaning and Janitorial

Maintenance Products Use Green Seal Certified products

www.greenseal.org

Use low VOC products for other categories

MSDSfull 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



What About Disinfectants? All microorganisms are not bad and we do not

want to sterilize the world!

Some antimicrobial products may increaseresistance

Good physical cleaning of environmental surfacesoften is enough

All antimicrobials are not bad and they are animportant tool in the toolbox

Use disinfectants only where they are necessary andselect the appropriate product. One size doesNOT fit all needs. Cleaning personnel are smart

enough to use multiple products.


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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 TBHBV assumed Corrosive to eyes and skin Damage floor finishes and other surfaces Strong pungent odorrespiratory irritant Environmental concerns. Possible estrogen mimic.

Quats Typically not effective against TB or HBV Less toxic then Phenolseye, skin and surface corrosivity Toxic to aquatic life

Peroxide EPA Sanitizer. Not a disinfectant. Superior health & environmental profile compared to phenols and quats

R

iskContinuum

High

Low


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OSHA Blood Borne Pathogen

Standard & Body fluids Fluids covered by OSHA

Blood, semen, cervical solutions, other

Excluded fluids include

Urine, stool, saliva, sputum (unless visibleblood)

Must be cleaned with tuberculocidal orhepacidal disinfectant

29CFR 1910.1030


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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 testingmethodology, so

Surrogate test is killing ofM. tuberculosis - ifsolution can kill M. TB, it will kill hepatitis B

Chlorine / Sodium Hypochlorite can beused


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Janitorial Equipment

Vacuums meet CRIs Green Label Program www.carpet-rug.com

Extraction equipment remove sufficient moisture todry 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 environmentallypreferable batteries (gel batteries)

Ergonomic equipment

Maintain an equipment log


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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.


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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


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Pesticides are relatively unique toxic contaminants in that they areintentionally 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 lawPublicLaw 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 Warren

American Society for Healthcare Environmental Services

Professional Development Series



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Public concerns, chiefly centering around the inappropriate use of pesticidesand 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 beforethe accident results in adverse environmental impact, cost and/or liability.

The facility Pollution Program should seek to minimize the generation of

wastes or environmental releases and provide conscious management of all

environmental media (i.e., air, water, and land).

-excerpt from Integrated Pest Management, by Wayne Warren

American Society for Healthcare Environmental Services

Professional Development Series



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Occupant Recycling

Establish a waste reduction and recyclingprogram 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 isdependant upon ongoing educations


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Insanity has been defined as doing the

same thing over and over and expecting adifferent outcome.

Negligence is defined as doing the same

thing over and over even though you knowit is dangerous, stupid or wrong.

Now that we know, its time for a change.

Negligence starts tomorrow.

William McDonough

Cradle to Cradle


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Green Cleaning in HospitalsCleaning to Protect HealthWithout Harming the Environment

Stephen P. Ashkin

812 / 332-7950

[email protected]

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