An 82 yr old man is hospitalized after being found at home with altered mental status, a bad skin tear to his left arm, severe dehydration, and a badly infected foot. In the process of his 5 day stay in the hospital, physicians, nurses and aides will use more than a hundred pairs of gloves, suture kits, multiple sterile dressings , two dozen plastic syringes, IV catheters, fluid bags and tubing, disposable surgical gowns and drapes, and more. Now multiply that by approximately 30 million inpatient hospital stays per year in the US. Healthcare facilities contend with the disposal of biohazard, mercury, radioactive and pharmaceutical waste, as well as large amounts of food waste. Millions of gallons of cleaners are used annually in the nation’s healthcare facilities, to maintain an aseptic environment. These are just a few areas of environmental impact.
It doesn’t take much scrutiny of the numbers to realize that our local health care organization, South County Hospital–and the healthcare industry in general–face formidable challenges. As the corporate world is responding to public pressure and environmental regulations to clean up their operations and pursue the elusive concept of “sustainability,” this imperative for health care doubly applies. After all, shouldn’t a hospital—whose mission is to promote health—be a force for the environmental health of a community?
To look at the beginnings of the green hospital movement, one doesn’t have to go back too far. In 1998, the American Hospital Association and the US Environmental Protection Agency signed a groundbreaking agreement to advance pollution prevention efforts in our nation’s healthcare facilities. This was the beginnings of the Hospital for a Healthy Environment (H2E) program.
H2E partnered with the American Hospitals Association, the American Nurses Association and state H2E chapters, and established a mechanism for hospitals to exchange ideas and learn from each other locally. A primary focus was getting hospitals to commit to the goals of the alliance by becoming “Partners for Change”. The program also targeted healthcare companies and the supply chain, encouraging participation in its “Champion for Change” program. A subsequent focus involved setting up state-level support networks for hospitals trying to achieve similar goals. An H2E Environmental Excellence Awards program began in 2002.
By 2006, the H2E program had partners representing 7,148 health care facilities. Despite H2E’s success in reaching the healthcare sector and beginning to engage organizations, EPA funding for the initiative dwindled in 2006, and the international organization Health Care Without Harm (noharm.org) took a leadership role in helping H2E become an independent not-for-profit organization. H2E expanded upon its original goals to include:
- Elimination of mercury
- Reduction of the quantity and toxicity of health care waste – from manufacturing, purchase and use of products and materials, to improved end-of-life management
- Minimization of use and exposure to hazardous chemicals, including persistent, bioaccumulative, and toxic (PBT) substances
- Reducing health care’s environmental footprint through resource conservation and other measurable environmental improvements
- Integrating sustainable design and building techniques with environmentally sound operational practices to create true healing environments
In January of 2008, H2E was reorganized and renamed Practice Greenhealth, in order to more accurately reflect its new role as a membership organization representing healthcare organizations committed to the integration of sustainability principles and practices as a means to better protect the health of patients, staff, the communities served, and the environment.
Rhode Island has become an important part of the national effort, and a statewide coalition, Hospitals for a Healthy Environment in Rhode Island (H2ERI), was founded in 2010. Membership includes health care organizations from around the state, including South County Hospital, as well as representatives from Brown University, RI Environmental Protection Agency and Department of Environmental Management. The coalition held its second annual conference in March, at Women and Infants Hospital, and featured presentations on Medical Waste Management, Sustainable Landscaping, Metrics for Sustainability and much more.
Of course, conferences are important, but what happens back in the workplace is the true test of an organization’s commitment to green principles. South County Hospital is making important strides. The hospital is contracting with a national company to perform a full environmental assessment of operations. The hospital has a “Green Team” that includes representatives from many departments. Facilities crews are replacing lighting ballasts in common areas to improve energy efficiency. Green cleaning products and “low VOC” paints are used whenever possible, and the hospital now uses mechanical floor strippers that do not require harsh and polluting chemical solvents. The new Frost Wing was designed to make use of natural light and passive solar gain, with the concept of a “healing environment” used as a guiding principle.
The Emergency Department has developed a program to reduce the misuse of “Red Bag” biohazard disposal, and signage in patient treatment rooms encourages patients and families to recycle appropriate plastics while in the department. Recycling of paper, cardboard and plastic waste is being mandated hospital-wide, and one-time use items are being reprocessed. Innovative fluid collection systems are being used in the surgical suites to reduce environmental impact. The hospital pharmacy is teaming with Clean Harbors Environmental Services for safe disposal of pharmaceutical waste, in accordance with EPA regulations. Departments have proactively pushed for a reduction in paper printouts of lab results, and have in some cases, cut paper use in half. Some departments are beginning to ask admitted patients on arrival what they will require in the way of toiletries, to reduce the number of common articles that are disposed of once a patient is discharged. There are now three bike racks installed around the hospital campus.
Dietary Services is expanding their offerings of locally raised foods, is reducing the use of disposables, and is exploring the composting of food waste. Weekly, during the growing season, the hospital offers a CSA program where employees can purchase a box of locally grown vegetables.
These are all just initial steps in a process that will be ongoing and continually refined and improved. In this process, South County Hospital, and other forward-thinking healthcare facilities, become a positive force for environmental health as well as patient health. By being an early partner with Hospitals for a Healthy Environment in Rhode Island, and through the commitment of caring individuals on the staff and in management, our local hospital—along with other Rhode Island hospitals doing this work, can take pride in their efforts, as part of a vitally important national movement, to make health care even healthier.