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November 27, 2006

Green With Envy
By Tracy Meadowcroft
For The Record
Vol. 18 No. 24 P. 26

Learn how some healthcare facilities are making the competition jealous by adopting environmentally friendly policies.

In many ways, hospitals have become the butt of numerous jokes. People who have spent any amount of time in a hospital know “hospital food” may consist of meat covered with translucent gravy, wilted vegetables, and the omnipresent brightly colored gelatin cup.

And there’s the “hospital smell”—a chemical cloud that hangs in the corners of every hallway, examination area, and patient room. Even better, the smell often follows you once you leave the premises.

More seriously, however, is the fact that the hospital environment can actually cause people to become more ill or prolong their treatment. Staph infections, for example, have wreaked havoc in hospitals for many years and may now even be spreading into the community at large.

Now, some hospitals are trying to erase this poor image for medical facilities by taking steps to become “green,” or environmentally friendly.

Guidelines
Though it is voluntary, some healthcare organizations are attempting to earn certification for their greening efforts. The Leadership in Energy and Environmental Design (LEED) Green Building Rating System is a tool primarily focused on the construction of new commercial and office buildings, though some organizations are looking to the guidelines for certification of their newest medical facilities, says Gail Vittori, secretary of the national board of the U.S. Green Building Council, an organization involved in the development of the guidelines.

LEED guidelines specifically for the healthcare industry are under development, says Vittori, though for the past three years, the independent initiative Green Guide for Health Care has been filling the gap until LEED for Healthcare is finalized. Version 2.2 of the Green Guide for Health Care is being completed, while version 2.1 has been in place for 11/2 years.

“LEED has served as a guide for the Green Guide for Health Care and now the Green Guide for Health Care is serving as a guide for LEED for Healthcare,” explains Vittori.

More than 100 projects have been registered through the pilot program for the Green Guide for Health Care, equal to approximately 28 million square feet of healthcare facility space, says Vittori. These pilot projects will inform ongoing refinement of green building and operations best practices tool customized for the healthcare sector.

Those healthcare organizations that choose to seek LEED certification must fulfill seven prerequisites plus at least 26 of an additional 69 subrequisites, says Vittori. The requirements include addressing erosion and sedimentation control issues, establishing recycling programs, and avoiding the use of chlorofluorocarbons (CFCs).

“Healthcare really should have been the poster child for green buildings for a variety of reasons,” says Vittori. “Hospitals are essentially a civic facility; they serve a function that is quite unique. More than taking care of sick people, they have an opportunity to set the bar about health and well-being and to raise standards in a very explicit way about how the built environment influences health.”

The Drawing Board
“It is much more difficult but not impossible to make a green hospital,” says Michael Hinchcliffe, AIA, LEED AP, an associate for Payette, a Boston architectural firm.

Hinchcliffe has been involved with the planning of a cancer institute and parking garage at the Pennsylvania State University Milton S. Hershey Medical Center. Construction on the estimated $82 million, 174,000-square-foot project began in August and is currently scheduled for completion in the fall of 2008.

To successfully complete a green hospital, “it is a matter of educating the entire project team, including the owner’s representatives, that sustainable features do not add significant construction cost or operational expenses to the project,” says Hinchcliffe.

“There are hundreds of years of thinking in the medical, institutional, and construction industry traditions to shift to more holistic viewpoints,” he adds. “Elements as varied as windows to the outside, food and cutlery choices in the cafeteria, cleaning products in the janitors’ closets, and sorting bins for construction waste will all help patients heal more quickly. In the end, the ‘green’ design process just takes into account more factors, meaning more time and more persuasion to help everyone make better choices.”

Among the green components planned for Hershey’s cancer institute are high-efficiency lighting, heat recovery of the ventilation systems, monitoring of carbon dioxide levels to reduce energy consumption, and roofing that is Environmental Protection Agency Energy Star-compliant.

All wood used in the construction will be from sustainable sources and an environmental education center will be created to provide information about the building’s features to patients and visitors. Also, a special healing healthcare environment will be constructed with connections to the outdoors for all cancer treatment spaces, with a healing garden as the centerpiece. The rooms will have a view of the garden and special access will be given to patients and their caregivers as part of treatment.

An “eco-friendly housekeeping” program will be instituted to use ecologically sensitive cleaning products and the campus will be smoke-free in January with plans for a plastic recycling program underway as well.

“The staff is very excited about the prospect [of a green facility], especially the connection to the outdoors and nature that the facility will provide,” says Hinchcliffe. “Patients will hopefully have speedier recovery times and more pleasant treatment experiences.”

From the Ground Up
With an opening date scheduled for August 1, 2007, MaineGeneral Medical Center’s new freestanding Harold Alfond Center for Cancer Care hopes to earn LEED silver certification as the healthcare system works to make it their first environmentally friendly building.

“We felt that, especially if you were building a facility to treat cancer, we also wanted to build a facility that would potentially help prevent cancer,” says Andrew Hertler, MD, FACP, medical director of the oncology services at MaineGeneral’s Augusta and Waterville centers. “We wanted it to be a healthy place for people to work in and to come and be treated in.

“Though they are a place where people are cared for, hospitals and medical care facilities also traditionally consume huge amounts of energy and generate large amounts of toxins. We would like to have our patients treated in an environment with as few toxins as possible and we would like to contribute as little additional toxicity as possible [to the environment],” Hertler adds. “The whole design of the building is for a healthy place to treat patients and a green building is only part of it.”

When planning for the new cancer treatment center began several years ago, Hertler says the consensus among those involved was to strive to make the facility more environmentally friendly. “We felt strongly that we wanted a green building,” he says. And though the cost of the project may prove somewhat more expensive upon completion, “we believe it will be cost-efficient in the long run,” Hertler says.

Among the steps taken to make the new center green and have it comply with the LEED guidelines are not burning or leaving waste at the building site, which is a former farm and golf course that will be allowed to return to a meadow environment except for the small portion with the new cancer center; utilizing building materials local to the area; installing no synthetic flooring; and creating a passive solar roof that will help the hospital use less fossil fuel energy.

Also, more glass is being installed to “open up” the building and the landscaping will include gardens and trails so patients with cancer can go outside, even during their treatments. The hospital is even using rocks that look like mulch instead of the real product, which can contain mold and bacteria.

“People are beginning to be very accepting and supportive of the idea of building an environmentally friendly building,” says Hertler. “We wanted to have a new cancer treatment center regardless, but to have it be a green building makes a statement not only about treating people with cancer but the prevention of cancer and being healthy in general.”

One Year and Counting
Officials at Northern Westchester Hospital in Mount Kisco, N.Y., have spent the last year trying to green their facility in ways that appear to have made a difference in the facility’s overall environment.

With encouragement to investigate options for making the hospital more environmentally friendly, Evelyn Colon, director of environmental services, began the search.

“I was interested in it myself,” says Colon. “It was sort of a passion for me.”

The hospital began using products such as dispensing systems equipped with an antisiphon backflow to prevent cross-contamination. All-purpose, glass, and bathroom cleaners with a “green seal” were also purchased, along with floor cleaners that contain no ammonia.

Low-decibel vacuum cleaners are utilized, especially around the nurseries and the neonatal intensive care unit. These vacuums weigh 12% less than standard industrial vacuum cleaners and are high efficiency particulate air approved, according to Colon.

A recycling program for paper and cardboard was established while floor mats and scrapers were placed outside the hospital to capture dirt before foot traffic tracks it into the building. Liquid disposal systems to deal with waste from the operating rooms and mercury elimination programs have begun, making the hospital 99% mercury-free.
There have been some cost savings for the hospital, with additional expenditures often balanced by savings in energy and other areas, officials say.

“We’ve gotten positive feedback since day one about the program,” says Colon. “The housekeepers have their own testimony that since they started using green products, they feel better, they’re not as allergic [to the products], or their breathing has improved, compared to when some of the other products were being used.
“We don’t have the typical hospital smell here and everyone who comes here will tell you that,” adds Colon.

“We’re being mindful of the next generation,” says Michael Caruso, the hospital’s director of facilities management, of the efforts to go green. “It’s certainly the right thing to do and just a little piece that people can contribute.”

A Big Vision
Deirdre Imus has spent years working with children with cancer and sickle cell anemia, creating an environment at the Imus Cattle Ranch for Kids With Cancer in Ribera, N.M., that has avoided toxic products and pesticides and features organic gardens. Through this work, Imus began to think about the hospital environment in which many of the children were being treated “and I wondered if hospital environments were true places of healing and I found out they weren’t.”

In 2000, Imus approached the president of Hackensack University Medical Center (HUMC) in New Jersey, already having a working relationship with the healthcare organization. She then pitched the idea of greening the facility, which was eagerly received, according to Imus, who is also the founder and president of the Deirdre Imus Environmental Center for Pediatric Oncology at HUMC.

The first step was to change the cleaning products used in the facility. “I knew all the facts [about cleaning products],” says Imus. “Everyone has to use them. We’re constantly exposed to them and they commonly contain carcinogens, neurotoxins, endocrine disruptors, and hormone disruptors.”

In 2001, all the “toxic” cleaning products used on the medical center’s campus had been eliminated and replaced with the Greening the Cleaning product line Imus developed. The environmentally friendly products, both commercial and industrial types, are used in numerous facilities across the country, with 100% of the profits going to educational programs and research to identify, control, and ultimately prevent environmental factors that may cause adult and especially pediatric cancer and other health problems in children.

For the first year of using the Greening the Cleaning products, Imus says HUMC saved approximately 15% in costs. Of the roughly 200 other healthcare facilities, schools, and businesses using the products, Imus says they have seen 3% to 75% savings.

In addition to the cleaning products, HUMC opened the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion in April. The $117 million, 300,000-square-foot facility features the Joseph M. Sanzari Children’s Hospital, the Donna A. Sanzari Women’s Hospital, and the Mark Messier Skyway for Tomorrows Children.

According to Imus, components for constructing the facility included recycled steel for the frame; approximately 117,000 pairs of preconsumer cotton denim blue jeans used for insulation instead of fiberglass; the elimination of carpeting and fabrics that commonly contain carcinogens, neurotoxins, etc; and using straw and wheat board materials for cabinetry and millwork instead of particle or pressure-treated boards.

The cafeteria environment was also eliminated and replaced with a full-service restaurant for staff, patients, and visitors. Many organic and whole foods are found on the menu, with meal options such as organic buckwheat pancakes with organic syrup, blueberries, and strawberries.

“At this point in our country, hospitals really only have the potential to make you sicker because of their physical environment,” says Imus. “If a hospital is really going to call themselves green, to me, that means the hospital also has to be a place of healing. So that means cleaning products, but it also means creating an environment where you’re not walking in and everything feels white and sterile and unfriendly.”

Imus says additional time may be needed to investigate using more environmentally friendly construction materials and the cost of the project at HUMC was approximately 10% to 15% higher than it would have been otherwise. However, she maintains the savings will accrue in the long run as facilities realize lower energy bills and experience fewer employee absences caused by workman’s compensation or illness, among other benefits.

“These, to me, seem like real, tangible, obvious, common sense ways to truly make a change,” she says. “I don’t see anything as being a small change because even if something is a single, fundamental change, like a cleaning product, it’s an enormous change that’s created not just for the hospital but the community in Bergen County [all patients, staff, and visitors].”

— Tracy Meadowcroft is an editorial assistant at For The Record.

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