A P R A C T I C E G R E E N H E A LT H M E M B E R P U B L I C AT I O NA P R A C T I C E G R E E N H E A LT H M E M B E R P U B L I C AT I O N

Greenhealth N O V E M B E R /D E C E M B E R 2 0 1 1

E N E R G Y M A N A G E M E N TF O C U S O N :

Getting Started on Energy Management

2012 Environmental Excellence Awards Applications Open

Green Cleaning in Health Care Research Report

1.888.888.3433 www.ascenths.com

Ascent Healthcare Solutions leads the medical device industry’s development of more sustainable and responsible solutions in healthcare. Reprocessing and remanufacturing medical devices are the single most impactful sustainability initiatives currently under-taken by hospitals in the U.S. Our reprocessing and remanufacturing programs allow our partner hospitals to divert thousands of pounds of medical waste from landfills and to redirect substantial financial re-sources to patient care quality initiatives.

Harmonic ACE®, ENDOPATH® and XCEL™ are trademarks of Ethicon Endo-Surgery.

Ascent_PracticeGreenHealth_Sept/Oct2010_v1.indd 1 8/9/10 1:07 PM

1.888.888.3433 sustainability.stryker.com

Stryker Sustainability Solutions (formerly Ascent), is the leading provider of medical device reprocessing and remanufac turing services, offering comprehensive financial and environmental sustainability solu tions to hospitals and health systems across America and beyond. Stryker’s sustainability services are embraced by most U.S. News & World Report “Honor Roll” hospitals. Through Stryker’s reprocessing and remanufacturing services, hospitals can reclaim and redirect resources, enabling them to become healthy hospitals.

WE’VE ADJUSTEDOUR NAME, BUT NOTHING ELSE

Ascent_PGH_Stryker_Bridge_June_Full_Pg.indd 1 5/9/11 10:42 AM

in this issue...

A D V E R T I S I N G : Greenhealth accepts display and classified advertising. To obtain a copy of our rate card, or to place an ad, contact Lara Sutherland, (866) 598-2210; email: lsutherland@practicegreenhealth.org, or view the card on our website, www.practicegreenhealth.org/greenhealth

PRODUC TION NOTES:

Printed on New Leaf Primavera, a processed chlorine-free, 80% recycled paper.

Printed by Mosaic, a member of the U.S. EPA’s Climate Leaders. The process is 100% wind powered, waterless, employs soy inks, and is FSC certified.

A P R A C T I C E G R E E N H E A LT H M E M B E R P U B L I C AT I O NA P R A C T I C E G R E E N H E A LT H M E M B E R P U B L I C AT I O N

Greenhealth N O V E M B E R /D E C E M B E R 2 0 1 1

E N E R G Y M A N A G E M E N TF O C U S O N :

Getting Started on Energy Management

2012 Environmental Excellence Awards Applications Open

Green Cleaning in Health Care Research Report

Message from the Executive Director ....................................................................................................... 2

Cover StoryGetting Started on Energy Management .................................... 4

Columns & Articles

Creating a more Sustainable Environment in the OR ..................................6

Green Cleaning Study Shows Breadth of Green Cleaning Programs in Hospitals, Need for Health Outcomes Research ......8

Practice Greenhealth Announces Sustainability Benchmark Report ........... 10

Practice Greenhealth 2012 Environmental Excellence Awards ........11

Practice Greenhealth Member Spotlight: Crystal Saric ......................................................12

Hydrate for Health: A Call for Healthy Beverages in Health Care ........................... 13

Practice Greenhealth Member Spotlight: Michael Geller .................................................15

Practice Greenhealth Welcomes New and Renewing Members................. 16

N O V E M B E R / D E C E M B E R 2 0 1 1 • G R E E N H E A L T H 1

GreenhealthGreenhealth is published by Practice Greenhealth, the nation’s leading membership and networking organization for institutions in the health care community that have made a commitment to sus-tainable, eco-friendly practices. Members include hospitals, health care systems, businesses, NGOs, and other stakeholders engaged in the greening of health care to improve the health of patients, staff and the environment.

BOARD OF DIRECTORS

BARBARA BLAKENEY, RN, MS Innovations Specialist Massachusetts General Hospital Boston, MA

CHARLOTTE BRODY, RN Director of Chemicals and Green Chemistry Blue Green Alliance

KATHY GERWIG Vice President, Workplace Safety Kaiser Permanente Oakland, CA

BRUNO GIACOMUZZI Vice President of Cardiac and Support Services Resurrection Medical Center Chicago, IL

JEFFREY HOLLENDER Entreperneur, Author Co-founder and Board Chair American Sustainable Business Council

JOHN STRONG Principal John Strong, LLC

SUSAN VICKERS, RSM Vice President, Community Health Catholic Healthcare West San Francisco, CA

NOE COPLEY-WOODS, Magee-Womens Hospital of UPMC MD, FACOG Fellow of the American College of Obstetricians Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences University of Pittsburgh School of Medicine

ALAN R. YUSPEH Senior Vice President, Chief Ethics & Compliance Officer HCA, Inc. (Hospital Corporation of America). Nashville, TN

ANTHONY ROBBINS, MD, MPA Professor of Public Helath Tufts University

STAFF LAURA WENGER Interim Executive Director

ANNA PROW COO

ROBERT JARBOE Executive Vice President, Business Development

JANET BROWN Director of Sustainable Operations

STAN CAHILL Senior Director of Membership Development

JOHN EBERS Associate Director, Sustainability Education & Training

BETH ECKL Director, Environmental Purchasing

LIN HILL Director of Awards

CECILIA DELOACH LYNN Director of Sustainability Programs & Metrics

SHERRY MACDONALD Director of Marketing and Communications

KAELEIGH SHEEHAN Greening the OR Coordinator

LARA SUTHERLAND Director of Business Membership

ANDREA DEDOMINICIS Member Engagement and Education Coordinator

DESIGN & LAYOUT WINKING FISH www.winkingfish.com

© 2011 Practice Greenhealth.Subscriptions free to Practice Greenhealth members.

All other $95/year. Contact: greenhealth@practicegreenhealth.org

A moment for reflection as 2011 draws to a close, the leaves have fallen, seasons are changing and I have to ask, “Where did the time go?” Practice Greenhealth has had quite a year of successes and changes. Since 2009 Practice Greenhealth has added 224 new members, a 25 percent increase, with a retention rate of our existing members above 90 percent. These impressive rates of growth and retention show the expanding focus on environmentally friendly practices in the health care sector across the country. Our members’ ongo-ing commitment to sustainable health care shows through into the quality of care they provide, the energy and supply savings they are achieving and the over arching environmental improvements they share with the communities they serve. As I think back on the successes we have had in 2011, I have to think about Practice Greenhealth’s launch of our new website this summer, at www.practicegreenhealth.org. This new site allows our members a more user-friendly experience to access all of the exten-sive members-only resources available from Practice Greenhealth. In addition we expanded our educational programs through use of a new online library and added additional case studies and imple-mentation guides for our members to use in their own facilities. One of the greatest benefits of membership is the ability to learn from other members both formally and informally so you can have ideas, tools and resources to implement sustainability practices back at your facility. In 2011 a major achievement was made when the five larg-est GPOs agreed to and finalized the Standardized Environmental Disclosure Questions for Medical Products. This standardization helps ensure vendors know key environmental concerns facing health care today and encourages them to provide greener products. By using this approach it will also assist our business community by having a much more reasonable process as opposed to attempting to answer different sets of questions for each GPO for each con-tract. This standardized process will also allow health care providers to compare and evaluate products based upon not only price and clinical quality, but now have the information to compare their environmental attributes as well. This is quite an achievement and a huge step forward in our journey to Greening the Supply Chain™.

With the arrival of December also comes the official start of our awards season. The Practice Greenhealth Environmental Excellence Awards program continues to be a highlight of the great success and sustainability achievements that our members are doing all year round in their facilities and businesses. Over the past several years the applications have become more detailed and challenging but our members continue to rise to that challenge. The review teams are always so impressed with the caliber of the applications and the creative ways our members have found to make their goals attainable. The Awards program is a great way to truly put a spotlight on those achievements that don’t always get the credit they deserve. Please be sure to submit your application by February 3, 2012. As we look forward into 2012, the Practice Greenhealth Awards Gala and Dinner program will be held at the CleanMed conference in Denver on May 2, 2012. Registration for the CleanMed 2012 conference is now open. Please mark your calendar now as spring is right around the corner and we hope to see you there! On a personal note, while we’re reflecting on our business and professional successes, this is the season we each take some time for thought about our families, homes and communities. It’s the season of gift-giving and when the concept of sharing takes on a special imperative. Members of the Practice Greenhealth community are all especially dedicated to making our world truly a better place for all. So I know you’ll join me please this holiday season to perform a random act of kindness, put a few extra dollars in the red kettle, hug your dear ones and take time to remember how all of us are so interconnected in our efforts to make our world a happier and healthier place for all.

Laura WengerInterim Executive DirectorPractice Greenhealthlwenger@practicegreenhealth.org

A SEASON OF REFLECTION

E X E C U T I V E D I R E C T O RA M E S S A G E F R O M T H E

2 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

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While it provides the great capacity to heal, the health care industry is a sizable consumer of natural resources. The health care sector uses more than 800 trillion BTUs of energy annually, costing $6.5 bil-lion each year. Hospitals that have as many as 500-plus beds can use between 1 to 2 million gallons of water annually, and they can gener-ate more than 6,500 tons of waste per day, costing $15 billion each year for solid waste disposal alone. There’s no dispute that the health care sector, comprising 17 percent of the gross national product (GNP), leaves a significant environmental footprint. Data from the U.S. Energy Information Administration illustrates that buildings are responsible for almost half of the energy con-sumed and 38 percent of all GHG emissions in the United States. According to the EPA, inpatient health care ranks as the second larg-est commercial energy user after the food service industry. The current infrastructure that delivers energy and water to hos-pitals relies heavily on fossil fuels – with nearly 90 percent of the United States’ energy derived from fossil fuels that emit such toxins as mercury, arsenic and greenhouse gases, as well as particulate mat-ter such as NOx and SOx. Consequently, these byproducts negatively affect human health through the air we breathe and the water we drink, and have been linked to premature mortality, chronic bronchi-tis, asthma attacks and various respiratory symptoms.1 Climate change has also been linked to a host of impacts on public health. A 2009 study in The Lancet suggests that climate change will have severe impacts on human health including changing patterns of disease and mortality, extreme events, food, water, shelter and population.2

As energy prices rise and energy security becomes an issue of increasing importance for the health care sector, reining in energy use will be paramount. The challenge is to reduce energy and water con-sumption while enhancing patient outcomes and minimizing costs. Health care organizations are finding they can significantly increase energy and water efficiency—and often without huge capital outlays. Benchmarking energy and water use, and even greenhouse gas emis-sions through programs such as EnergyStar’s Portfolio Manager software, is providing clarity to understanding where inefficiencies exist and what are the viable sets of strategies to address those inef-ficiencies. Initiatives such as the Hospital Energy Alliance and EPA’s WaterSense are building out the set of tools and resources support-ing hospitals in identifying viable, cost-effective strategies to reduce energy and water use. More hospitals are also beginning to explore the use of renewable energy as a mechanism to reduce their environmen-tal footprint—with Practice Greenhealth member Gundersen

Lutheran committed to be 100 percent energy independent by 2014. And with the first new regulations on greenhouse gas emis-sions, hospitals are finding a growing need to track and assess their greenhouse gas emissions and develop mitigation strategies—to ensure they are ahead of the regulatory curve.

How Health Care Uses EnergyThe health care sector utilizes energy for a variety of reasons from space heating to powering diagnostic equipment. A typical hospital derives its power from an electric and gas utility. Nationally, energy use by application within a hospital is illustrated in the following graphs:

Lighting, 27 billion kWh, 43%

Ventilation, 5 billion kWh, 8%

Cooling, 6 billion kWh, 10%

Office Equipment, 11 billion kWh, 18%

Misc., 8 billion kWh, 13%

Refrigeration, 3 billion kWh, 5%

Other, 2 billion kWh, 3%

Gas Usage in Hospitals

Other, 47 billion cu ft,

19%Space Heating, 77 billion cu ft, 31%

Cooking, 25 billion cu ft, 10%

Water Heating, 102 billion cu ft,

40%

Electricity Usage in Hospitals

Source: www.eia.gov/emeu/consumptionbriefs/cbecs/pbawebsite/health/health_howuseng.htm

Getting Started on Energy ManagementGetting Started on Energy Management

4 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

By-Products of Energy ProductionEnergy generation produces a host of air emissions that can have significant human health impacts. Coal-fired power plants, for example, generate carbon dioxide, nitrous oxides, sulfur oxides; carcinogenic and mutagenic substances; and recoverable minerals of commercial value—including aluminum and iron, and radionuclides such as thorium and uranium naturally occurring in coal.3 Emissions from power plants have been linked to premature deaths, chronic bronchitis, asthma attacks, emergency room visits and more. Energy generation is also a huge source of greenhouse gas emissions—linked to climate change and a different range of potential health impacts. The energy needed to run commercial and industrial buildings in the United States produces 19 percent of U.S. carbon dioxide emissions, 12 percent of nitrogen oxides, and 25 percent of sulfur dioxide, at a cost of $110 billion a year.

Best Practices in Energy Efficiency Increased energy efficiency can provide the triple benefit of decreasing health care’s contribution to deleterious air emissions, reducing the burden on the struggling energy grid and significantly reducing operating costs. Learn more about how your facility can track its energy usage, identify energy efficiency strategies, move to greener energy solutions and benchmark its progress. The health care sector is in need of cost-effective solutions to address the rising cost of energy and the health implications of energy use. Once a facility has developed an energy baseline by tracking and mea-suring its energy use, it can begin to zero in on key areas of inefficiency and review potential energy reduction strategies with an eye for what will work given the finan-cial resources of the organization.

Supply-Side ManagementImproving the efficiency of energy end uses reduces both energy cost and greenhouse gas emissions—and is often called “demand-side management.” A robust energy efficiency program is the foundation for a hospital to take its next step towards a cleaner energy portfolio—and is often called “supply-side management.” Supply-side management is a management approach that seeks the most cost-effective ways to procure and distribute

the needed energy supply. Supply-side con-siderations for energy use in the health care industry include:• Integrating renewable sources of power

into the organization’s energy portfolio;• Deregulation of power suppliers;• Outsourcing energy management;• Load profiling or understanding existing

loads;• Load aggregation, which combines the

loads of multiple buildings, campuses or companies;

• On-site generation alternatives such as cogeneration;

• New procurement strategies such as pur-chasing energy from suppliers other than the local utility company;

• Peak shaving opportunities where alter-nate energy sources are used to reduce the maximum amount of energy used and the demand charges on invoices.

Displacing the use of conventional energy with clean, renewable energy reduces GHG emissions and contributes to softening price volatility associated with oil, natural gas, coal and the electricity generated from these fuels. Learn more about supply-side and demand-side management on Practice Greenhealth’s website energy pages at www.practicegreenhealth.org/topics/energy-water-climate.

RenewablesRenewable energy is considered to be “envi-ronmentally” clean—meaning it is typically non-polluting. It is commonly used inter-changeably with green energy or renewable energy. Categories of renewable energy (green power) include: solar, wind, geothermal, biomass, and low-impact small hydroelectric sources. Renewable energy resources and tech-nologies provide the highest environmental benefit. Hospitals often buy green power for avoided environmental impacts and its greenhouse gas reduction benefits. Renewable power sources produce electricity with an environmental profile superior to conven-tional power technologies and produce no anthropogenic (human-caused) greenhouse gas emissions. Energy consumers can purchase clean energy or implement renewable sources of energy to help reduce the environmental

impacts from their consumption of con-ventional energy and to support further development of clean energy resources. Conventional power includes the combus-tion of fossil fuels (coal, natural gas, and oil) and the nuclear fission of uranium. Fossil fuels have environmental costs from min-ing, drilling, extraction and emit greenhouse gases and air pollution during combustion. Although nuclear power generation emits no greenhouse gases during power generation, it does require mining, extraction and long-term radioactive waste storage.

Health Care Access to Renewable EnergyTypically hospitals utilize renewable energy in two different ways. The hospital may gain access to on-site renewable energy through the utilization of renewable technology placed on the building or property of the institution, such as roof top solar panels. Secondly, hospitals may procure Renewable Energy Certificates (RECs). RECs may be purchased through a third party that has nationally accepted standards and verifica-tion (Green-e) for renewable energy credits.

Power Purchase Agreements (PPAs)PPAs are contracts between two parties, one who generates electricity for the pur-pose of sale (the seller) and one who is looking to purchase electricity (the buyer). There are various forms of Power Purchase Agreements; these are differentiated by the source of energy harnessed (solar, wind, etc.). Financing for the project is delineated in the contract, which also specifies relevant dates of the project coming into effect, when the project will begin commercial opera-tion, and a termination date for which the contract may be renewed or abandoned. All sales of electricity are metered to provide both seller and buyer with the most accurate information about the amount of electricity generated and bought. Rates for electricity are agreed upon in the contract between both parties to provide an economic incen-tive for creating the PPA.

continued on page 7 >

Getting Started on Energy ManagementGetting Started on Energy Management

N O V E M B E R / D E C E M B E R 2 0 1 1 • G R E E N H E A L T H 5

Creating a More Sustainable Environment in the OROur journey to make our operating rooms (ORs) more “green” at

Gundersen Lutheran Health System began in earnest over the last several

years. Our organization put a greater focus on sustainability across the

health system, and we’ve taken that to heart in the ORs. We now have

more than 30 separate initiatives—some big and some small—related to

reuse and recycling in Gundersen’s Inpatient Surgery area alone. Like in

many ORs across the country though, that wasn’t always the case.

Starting smallSeveral years ago a few nurses began look-ing around the ORs and we noticed a lot of waste. From plastic and cardboard to blue wrap galore to bottle caps and rubber bands, there was a lot going into the garbage. One of our first initiatives related to those rubber bands. The rubber bands around most of our blue wrap packages were being thrown away, but we realized other areas in the hospital could use them again. We put up a bag on the wall, so the rubber bands could go there instead of the trash, then on to other departments. It was something

small, but it was eye-opening how quickly those rubber bands piled up. It got staff in the habit of looking around them and rethinking how things could be done.

Building momentumOne of our larger initiatives got underway a couple of years ago. There is a lot of #1 and #2 plastic and white cardboard used in the packaging of surgical instruments, and we were throwing away an average of 35 pounds every day. Our nurse champion worked closely with Gundersen’s sustainability coordinator to develop a system for recycling. We placed

recycling bins just outside of the ORs. Before the patient is brought into the OR, nursing staff separate the plastic and cardboard and put the materials into the bins. A reuse program that’s resulted in a huge annual cost savings for the organization is the reprocessing of single-use surgical items. Items that have hard plastic or metal on them are placed in one bin in the OR. Using one bin is key. We found that anything you can do to streamline the process for staff

Laura Grant, the nurse champion for the sustainability initiative in Gundersen Lutheran’s ORs, seen here with one of Gundersen’s many recycling tubs. 

Practice Greenhealth invites Greening the OR™ endorsers to plan and produce your own Greening the OR™ video! This is your opportunity to show your creativity and talent, while illustrating how you reduce costs and waste, energy, and worker and patient exposure to hazardous chemicals.

You have a great story to tell. Create a video that best captures your success in greening your OR. • HighlightPracticeGreenhealthandtheGreeningtheOR™program

• Promotesustainabilityinhealthcareandyourhospital

• Entertainandinterestviewers–yourindustrypeers

Thevideowillbejudgedoncontent,popularity,creativityandviewercomments.PracticeGreenhealth will show the winning video at the 2012 CleanMed conference in Denver, Colorado, and the winner will receive a prize!

Havefun,makeitinteresting,butreallyshowcasethebenefitsofagreenOR.PostyourvideoonYouTubeandemailthelinkto: GOR@PracticeGreenhealth.org

Deadline for entries is Friday, April 6th, 2012.

Video Contest

C r e a t e Y o u r O w n C o m m e r c i a l a n d W i n !

6 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

Renewable Energy CertificatesIn the case of Renewable Energy Certificates (RECs), (aka Green Tags, Green Certificates, Clean Energy Certificates) the standards require certificates to represent new clean generation that would not oth-erwise exist or be built without the RECs being sold. In some states, the best indica-tor of how much a purchase will contribute directly to the development of more renew-able energy is the percentage of the product that is classified as new. New renewable energy facilities are generally considered to be those created after 1997. Many states have Renewable Portfolio Standards, which require all electricity suppliers (utilities) to gradually increase the percentage of the electricity they sell from new renewable energy facilities. The theory is that increasing demand should lead to the construction of additional renewable energy facilities. When a consumer purchases new RECs, those RECs are retired. Because these purchased RECs have been taken out of circulation, electricity suppliers can’t use these same RECs to fulfill their legal obligation under the Renewable Portfolio Standard. They then need to get RECs from other renewable energy facilities. One goal of voluntary clean energy programs is for more renewable energy facilities to be built than the Renewable Portfolio Standard requires. Learn more about RECs on Practice Greenhealth’s website energy pages at www.practicegreenhealth.org/topics/energy-water-climate.

Demand-Side ManagementDemand-side management is a facilities management approach that involves ways to reduce the need for energy. The key in demand-side management is conservation through system-wide energy conservation programs. These types of programs iden-tify cost-effective procedures that reduce energy consumption and develop system-atic programs of energy system efficiency improvements. Health care facilities exam-ine and analyze energy use to determine where it could be possible to cut back. There are several key areas a health care facility can target when looking for energy efficiencies. The following areas are the energy use categories laid out by EnergyStar and provide a useful framework for assessing

opportunities for energy reduction, including: retrocommissioning, lighting, supplemental load reduction, air distribution systems, and heating and cooling upgrades.

A Staged ApproachEnergyStar recommends a staged approach to energy efficiency, meaning that an organization would want to look at the efficiency mechanism categories above in sequential order. EnergyStar points to the fact that many of these strategies build upon each other and can increase efficien-cies in later strategies if the early strategies are completed first. Practice Greenhealth recognizes that there are a variety of drivers for selecting which energy initiative comes first—including availability of capital, but generally supports this framework.

Purchase of Energy Efficient Products & EquipmentA key element in a comprehensive energy-efficiency program involves specifying products and equipment that meet certain energy-efficiency standards. While specifying energy-efficient equipment is clearly integrated into the strategies above, health care organiza-tions can also benefit from putting some clear guidance into place for purchasing staff, so that other departments and units ordering supplies and equipment are informed of the preference for energy-efficiency where possible.

Learn MorePractice Greenhealth offers comprehensive information, tools and resources for energy and water management, accessible through our website at: www.practicegreenhealth.org/topics/energy-water-climate. nG

By John Ebers, LEED AP, CEM & CEAAssociate Director of Sustainability Education and TrainingPractice Greenhealthjebers@practicegreenhealth.org

References1 U.S. Department of Energy; Commercial Building

Energy Alliances. 2 Costello, A. et al. The Lancet, Volume 373, Issue

9676, pages 1693 - 1733, 16 May 2009.3 Gabbard, A. Coal Combustion: Nuclear Resource

or Danger. Oak Ridge National Laboratory, UT for the U.S. Department of Energy. February 2008. Available at: www.ornl.gov/info/ornlreview/ rev26-34/text/colmain.html

leads to better compliance. A reuse and recycling company, called Ascent, separates the items that can be reprocessed from those that must be recycled. The repro-cessed items are remanufactured and sent back to Gundersen, and Ascent recycles the other items. This program alone saves the organization more than $450,000 annually. These are just a few of the many exam-ples of our sustainability initiatives in the Gundersen ORs.

Overcoming obstacles along the wayWhile we have developed a successful “green” program in our ORs, it hasn’t always been easy. Space is limited in the ORs, so finding room for recycling bins was a challenge. With the support of our sustainability coordinator, we found creative ways to put recycling bins outside the ORs. Finding the budget for larger initiatives can be a challenge. However, when you have early success and can show the cost savings that are possible, your administration may be more willing to make the investment. Another option is to phase in programs so they have less of a budget impact.

Key to success: Nursing staff buy-inOne of the biggest keys to our “green” OR program is having a nurse champion who believes in the program and helps get the buy-in of the nursing staff. The nurses are often the ones who are called on to make the programs successful, so their support is essential. Gundersen’s nurse champion spent time educating nurses about the reasons behind the process changes and the benefits those changes provide. She allowed people to ask questions, and listened to their ideas. The result has been a successful program that continues to grow, saves money for the organization and is leading to a healthier environment for our community. nG

Laura Grant is the nurse champion for the sustainability initiative in Gundersen’s ORs, and has been a nurse at Gundersen for 16 years. Peg Guzman is the clinical manager for Inpatient Surgery at Gundersen, and has been a nurse at Gundersen for 29 years.

By Laura Grant, RN, and Peg Guzman, RN, Gundersen Lutheran Health System

Getting Started on Energy Managementcontinued from page 5

N O V E M B E R / D E C E M B E R 2 0 1 1 • G R E E N H E A L T H 7

A new research report released by the Health Care Research

Collaborative points out the need for studies to determine the impact

of green cleaning programs on health outcomes in patients and staff,

and for additional studies to determine the impact of green cleaners on

environmental cleanliness and hospital-acquired infection transmission.

The report, “Green Cleaning in Healthcare: Current Practices and

Questions for Future Research,” noted that studies need to address a

number of topics to to help health care facilities choose an effective

green cleaning program. The report is available for download at:

http://www.noharm.org/us_canada/reports/

“This report indicates that in their efforts to implement green cleaning programs, most hospitals do not have the research avail-able to them in order to determine the best cleaners for their programs, nor do they have sufficient guidance to determine which of the green cleaners are proven to be most effec-tive in the health care setting,” said Xiaobo Quan, Ph.D., EDAC, of The Center for Health Design. “We also found that we need additional information about green alterna-tive cleaners—such as their impact on staff illness and reaction to the cleaners.” For the report, authors Quan; Anjali Joseph, Ph.D., EDAC; and Matthew Jelen, all from The Center for Health Design, conducted a literature review and five case studies, and analyzed 150 responses to an online hospital survey conducted by the Healthier Hospitals Initiative Pebble Project, which was initiated to promote and support development of green cleaning initiatives by better understanding current green clean-ing practices and identifying future research topics of high priority. The authors found that variations exist in green cleaning prac-tices across different facilities. The selection of cleaning products that contain or use

less harsh chemicals is the most commonly adopted method. Almost all case study facilities conducted initial evaluation of new products and procedures before implementa-tion, but rarely monitored or evaluated the performance of the products and procedures after adoption. “We need to provide more informa-tion—for example, what constitutes a green cleaning program for a health care facility,” stated Dr. Joseph. “Further, there is no clear evidence indicating whether cleaners that are promoted as ‘green cleaners’ effectively meet infection prevention needs and standards given the current focus on the environmen-tal contribution to HAIs or whether such cleaners have unknown health risks. There is an urgent need to conduct research around cleaning in health care.” Hospitals participating in the case stud-ies were Dartmouth-Hitchcock Medical Center, Lebanon, NH; Ridgeview Medical Center, Waconia, MN; Magee-Women’s Hospital of UPMC, Pittsburgh, PA; Boulder Community Hospital, Boulder, CO; and Cleveland Clinic, Cleveland, OH. All of these hospitals are award winners and active members of Practice Greenhealth. nG

Green Cleaning Study Shows Breadth of Green Cleaning Programs in Hospitals, Need for Health Outcomes Research

“We found that we need additional information

about green alternative cleaners—such as

their impact on staff illness and reaction

to the cleaners.”—Xiaobo Quan, Ph.D., EDAC, The Center for Health Design

8 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

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Practice Greenhealth has been recognizing environmental excellence in health care sus-tainability since the inception of its Awards program in 2002. This report is based on data supplied in applications by the 118 Partner for Change (PFC) and 23 Environmental Leadership Circle (ELC) 2011 Award winners and is designed to assist Practice Greenhealth member hospitals to measure their perfor-mance and define steps in their efforts toward sustainability in health care. This is the only report that shows com-prehensive data illustrating the progress of sustainability across the health care sector. The report analyzes data provided by health care facilities of various types and sizes located across the country. In addition to reporting out on metrics, the report shares sustainability trends and emerging areas of focus. Hospitals and health systems are increas-ing recycling, use of greener cleaners, toxicity reduction, healthier food options, and mak-ing progress in almost every area of the report. Some activities are in place virtually across the board, such as the creation of green teams to manage program implementa-tion, energy efficient lighting upgrades, and pharmaceutical waste management. Other emerging growth areas include sourcing local food, polystyrene (Styrofoam) elimination, water bottle elimination and solvent distilla-tion in laboratories. Although access to the complete 2011 Sustainability Benchmark Report is a benefit of membership in Practice Greenhealth, the report does cite notable trends among these highly engaged hospitals.

Waste and Recycling Recycling and diversion programs helped the 141 reporting hospitals save $19 mil-lion in avoided solid and hazardous waste disposal fees.

Green Cleaning More hospitals are increasing their use of green cleaning products, equipment and techniques, and are formalizing their cleaning procedures and contracts. Hospitals continue to recognize the value of reducing toxicity in the cleaning process. In 2011, 68 percent of PFC and 83 percent of ELC winners reported having green cleaning plans for their hospitals. Lin Hill, Director of Awards at Practice Greenhealth notes that “Formalizing green cleaning shows an increase in awareness of environmental issues around cleaning by envi-ronmental service teams as well as an increase in commitment from hospital management. In addition to improving the indoor environ-ment for patients and staff, green cleaning programs drive the market toward offering more environmentally friendly products.”

WaterTrend: Implementation of new water conser-vation activities has decreased since last year, with 41 percent of PFCs and 52 percent of ELCs reporting implementation of “recent” water conservation activities. Those facili-ties that are conserving water are reducing their total water use and their water bills by an average of 10-14 percent. The full report details specifically which projects are being implemented.

While cooling tower upgrades continue to give big paybacks in water and energy efficiency, Award winners implemented a host of other projects to conserve water, including eliminating the practice of defrosting meat with running tap water, using xeriscaping technologies such as native plants and/or gray water irrigation and sub-metering their water use for better tracking.

EnergyThe 141 Award winners reduced their elec-tricity costs by a combined 4.6 percent from implementing energy efficiency projects. These savings are equivalent to 0.77 kilowatt hours per square foot of their facility or 12 cents per square foot. Overall, Practice Greenhealth member hospitals are achieving dramatic reductions in their environmental footprints and are committed to implementing sustainable, eco-friendly practices. Christina Vernon, Senior Director, Sustainability & Environmental Strategy Office for a Healthy Environment, Cleveland Clinic Health System, observed, “It is critical to establish baseline and periodic sustainability performance data processes and review patterns for inter-nal management and continuous process improvement. Access to comparative data, via tools like Practice Greenhealth’s annual Sustainability Benchmarking Report, allows us to validate our data management processes, refine assumptions and identify sector best practices.” nG

Practice Greenhealth Announces Sustainability Benchmark ReportHighlights sustainability trends and emerging areas of focus

Practice Greenhealth has published its third annual Sustainability Benchmark Report – an analysis of activities and programs at a number of hospitals that are highly engaged in their commitments to sustainable, eco-friendly practices.

10 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

continued on page 14 >

“It is critical to establish baseline and periodic sustainability

performance data processes and review patterns for internal

management and continuous process improvement. Access to comparative

data, via tools like Practice Greenhealth’s annual Sustainability

Benchmarking Report, allows us to validate our data management

processes, refine assumptions and identify sector best practices.”

— Christina Vernon, AIA, LEED AP BD+C, Sr. Director, Sustainability and Environmental

Strategy, Office for a Healthy Environment, Cleveland Clinic

Each year, Practice Greenhealth offers its members a chance to receive some well-deserved recognition for their efforts towards sustainability through our annual Environmental Excellence Awards Program. Award winners get recognition within:• Theirfacility – Awards can be used

to gain internal recognition for green team staff, raise awareness of sustainable activities, and help maintain momentum for future activities.

• Theircommunity – Winners can garner local, regional and national press for their environmental improvement efforts.

• Nationalhealthcarecommunitypeers – Winners enjoy national recognition within the health care sector for sustainability success. Businesses seeking the Champion for Change Award can stand out with environmental improvement recognition both for accomplishments in their own organization and with customer facilities.

Whether you have won an Environmental Excellence Award in the past, or have not been involved in the Awards program before, we encourage you to consider applying for an Award this year. There are different levels of Awards to recognize and encourage your efforts along the path to sustainability.

The new web-based electronic Award application forms are available on the Practice Greenhealth website at: www.practicegreenhealth.org/awards. We hope that the new electronic appli-cation will streamline your application process. Most of the applications are similar to last year, with a few updates.• Theminimumrecyclingrequirements

have been raised to 10 percent of total waste stream for the Partner Recognition Award, our introductory level Award designed to encourage “young” sustainability programs.

• Minimumrecyclingrequirementshavealsobeen raised to 15 percent of total waste stream for the Partner for Change Award. Appendix A, the Recycling Appendix, includes only recycled items, while diversion activities are spread throughout the application. A new Greening the OR section has been added, and the LEED section has been greatly enhanced. So even if you are a repeat winner, you might want to take a peek at the revised application and get started early this year. Completed Award applications are due Friday, February 3, 2012.

We will be holding a webinar on the awards process Wednesday, January 11, at 2:00 p.m. ESTRegister at www.practicegreenhealth.org/tools/webinars/calendar

N O V E M B E R / D E C E M B E R 2 0 1 1 • G R E E N H E A L T H 11

P R A C T I C E G R E E N H E A L T H M E M B E R S P O T L I G H T :

Why sustainability is important to me: I didn’t major in environmental studies, but I’ve always been a “jam band hippie” and being environmentally conscious has always been part of who I am. We need to figure this out because our resources are precious. We need to find a balance between economy and ecology, and preserve the beauty of our amazing planet.

My biggest challenge in this work: Public speaking! I am the shyest person you’ll ever meet who can speak to a crowd of several hundred without passing out (at least it hasn’t happened yet).

What “keeps me going” in this work: Knowing that others are out there with the same struggles and the same passion. Practice Greenhealth has been a great network for me.

Project most proud of: We employ 12 adults with disabilities, in a completely cost-neutral way, to run our recycling programs at our hospitals.

Currently working on: A “reuse store” that will offer one phone number for anyone wanting to get rid of anything from office supplies, to medical equipment, to furniture. We can do better with reusing our stuff, or when we can’t reuse it in-house, making sure we find a meaningful end-of-life for it.

You can’t make this stuff up: We almost sent an amputated body part to our hazardous waste vendor instead of through our yel-low bag waste – they opened the container, freaked out, and we got it corrected. Though it was several years ago and it never hap-pened before (or since!), they (our hazardous waste project managers) give us grief every chance they get.

What/who inspires me: Housekeepers! I don’t think people really appreciate how busy they are and the huge role they play in mak-ing sustainability initiatives successful. And, they always seem to find time to smile, even though they probably have the most difficult job with the least financial reward.

Hobbies: Most of my free time is spent with my three-year-old. So I guess you could say my hobbies are coloring, crafts, dress-up and going to the park! Oh, and watching Dora the Explorer. Dora is a celebrity on the pre-school circuit.

Currently Listening to: Widespread Panic, my favorite band. Or Minnesota Public Radio.

Suggested Reading: It’s corny, but Ishmael by Daniel Quinn had a huge impact on my environmental conscience; I like to reread it when I am having a difficult time remem-bering why I do this work. Also, I read the Twilight series a few years ago to make sure my teenager sister was reading something appropriate. She wasn’t, but it was one of the best fiction stories I’ve ever read.

Guilty Pleasure: A glass of white wine after my daughter has gone to bed.

Perfect Day would be: Spending the day at Orlando’s Wet-n-Wild water park – so unsus-tainable, but oh so much fun.

Shout out to: Janet Brown at Practice Greenhealth. What would we ever do with-out her?!?!

Crystal SaricSustainability Program ManagerFairview Health Services

Crystal Saric Sustainability Program ManagerFairview Health Services, Minneapolis, MN

“Practice Greenhealth has been a great network for me.”

12 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

In the past thirty years U.S. obesity rates have doubled among adults and tripled among children. Numerous studies have found that sugar-sweetened beverages (SSB) consumption is associated with the development of obesity, type 2 diabetes, heart disease, metabolic syn-drome and gout. The development of these chronic diseases has caused our health care costs to sky rocket and the health of our communi-ties to plummet. Health care institutions at the core of this battle are beginning to make efforts to provide healthy food and beverages in order to support the health of their community. With their substantial purchasing dollars, hospitals can have a significant impact on mar ket trends to support overall health. A new educational tool from HCWH and the Healthy Food in Health Care program explores the negative health and envi ronmental impacts associated with sugar-sweetened beverage consump tion, and the opportunities for hospi tals to take a leadership role in transi tioning to healthier options for their patients, staff and the community— hydration for health. To learn more about implementing a Healthy Beverage Program in your facility download the Hydrate for Health educational tool available at www.healthyfoodinhealthcare.org

Hospital Profile: Reducing Sugar Sweetened Beverages at Cleveland ClinicIn August, 2010, Cleveland Clinic’s expansive health care operation serving approximately five million guests per year and 42,000 employ-ees had removed all sugar-sweetened beverages from catering, vending and retail outlets. Initiated by the hospital’s CEO, the phase-out spanned the 45 days prior and was supported by the Clinic’s mission to provide an environment of total wellness with patient health as the focus. All incoming contracted retail outlets and newly negotiated con-tracts prohibited the sale of sugar-sweetened beverages. Although the facility saw a drop in sales after initiating the ban, they have recouped 81 percent of their losses after only one year post implementation with expectations for a full financial rebound in the coming year.

Tips on developing a Healthy Beverage Program1. Contact the Healthy Food in Health Care regional organizer in

your area for resources and support. Let them know that you are working on a healthy beverage program at your health care facility.

2. Create a multi-disciplinary “Healthy Beverage Task Force,” with representatives from multiple departments (food service, patient care, senior management, facilities, etc.).

3. Conduct a simple beverage audit to identify where and when SSBs and public drinking water is made available throughout your health care facility. Document what types of beverages are avail-able, where they are located and how frequently they are used (or total sales per month) at each location and event.

4. Utilizing your beverage audit, create a healthy beverage program that works to reduce the amounts of SSBs and bottled beverages sold and served.

5. Incorporate a healthy beverage policy into your broader sustainable food policy. Include purchasing specifications that meet your healthy beverage criteria. Establish goals with timelines for the various stages of implementing your policy and plan. Use the Green Guide for Health Care (GGHC) Food Service Credit Toolkit to benchmark and track your success (see food service credit 1.2 and 4.4).

6. Contact your beverage vendors and discuss the healthy beverage criteria you have established.

Encourage Clinicians in your facility to stand with you.Health care clinicians have a critical voice within health care settings to shift institutional practices to support health. The Healthy Beverage Clinician Petition is available at www.healthyfoodinhealthcare.org for clinicians to voice their support for their facility and larger community to create a healthy beverage environment by reducing access to sugar-sweetened beverages and increasing access to freely accessible water.

Hydrate for Health: A Call for Healthy Beverages in Health Care Promoting human and environmental health by encouraging healthy beverage selections

N O V E M B E R / D E C E M B E R 2 0 1 1 • G R E E N H E A L T H 13

HCWH Applauds Premier for Contract that Provides Healthier, More Sustainable Chicken to MembersEarlier this fall the HCWH Healthy Food in Health Care Program was very pleased to announce that Premier Healthcare Alliance had contracted with Murray’s Chicken of South Fallsburg, N.Y. Murray’s chicken is raised on Pennsylvania farms without the use of antibiotics and arsenic and is pro-cessed in New York state. Murray’s Chicken is also certified to meet the Humane Farm Animal Care Certified Humane Raised & Handled standards. Due to the human and environmental health issues associated with the routine use of antibiotics and arsenic compounds in chicken production, HCWH and its partner organizations have been working to achieve this result for more than six years. Many hospitals we work with want to buy these products, but the increased cost and lack of availability through mainline dis-tributors have been significant barriers. To demonstrate their interest in having sustain-ably produced chicken options, earlier this year representatives of 99 Premier alliance

member hospitals sent a letter to Premier asking them “to make a concerted effort to meet our needs [for sustainably produced and regionally sourced chicken]” when going out to bid for chicken in 2011. This type of demand is what ultimately contributed to Premier’s contract with Murray’s Chicken. As of October 1, all Premier Alliance members have been able to buy a wide range of raw and pre-cooked frozen chicken

products through U.S. Foodservice. In addi-tion, non-Premier alliance hospitals that buy from U.S. Foodservice are seeing if they can take advantage of this new availability. Regardless of which GPO, distributor or supplier your hospital uses we hope this story will inspire you to communicate your interest in more sustainable options and do your best to purchase them for your facility when you can. nG

Education and Networking Events in Your Area

The Healthy Food in Health Care Initiative is led by a team of representatives from the following HCWH member groups:  Ecology Center, Institute for Agriculture and Trade Policy, Institute for a Sustainable Future, Healthlink, Maryland Hospitals for a Healthy Environment, San Francisco Bay Area Physicians for Social Responsibility, Oregon Physicians for Social Responsibility, Vermont Fresh, Washington Physicians for Social Responsibility and Women’s Health and Environmental Network.

2ndAnnualNewEnglandHealthyFood inHealthCareRetreatJanuary 19-20, 2012 • Norwich Inn, Norwich, VT For more information contact: Alyssa Nathanson alyssa@vermontfresh.net or 802-371-8741

4thAnnualNorthwestEnvironmentalHealthConference:BridgingResearch,PracticeandPolicyFebruary 10, 2012 • Portland, ORFor information and registration: www.oeconline.org/nwehc or contact Emma Sirois: emma@oregonpsr.org

Regional Healthy Food in Health Care Happenings:

Because we recognize that sustainability is a journey, there is an Award for every stage along that path. We want to reward your hard work, no matter how far you have come in your greening efforts, from just getting started to leading the country in innovative sustainability programs. Award applications are comprehensive, and require assessments/reporting from various departments in the hospital. To properly complete the Partner for Change Award, we encourage you to take an opportunity to talk to colleagues in many different departments (such as facilities, environmental services, material management, food services) to gather information on sustainable activities in energy, green building, waste reduction, purchasing, buying local and healthier menus, community benefits, and more. In addition, by submitting an appli-cation, your organization will provide

valuable data for Practice Greenhealth’s annual Sustainability Benchmark Report. This report summarizes information collected from last year’s Partner for Change and Environmental Leadership Circle Award applications, and presents the data in a format where you can easily check your data against the average of the Award winners. The report also provides examples of outstanding performance to strive for. This year’s Sustainability Benchmark Report, a member benefit, is available for download through the Practice Greenhealth website, www.practicegreenhealth.org. As usual, Practice Greenhealth staff will be on hand to assist you with questions during the Awards process. You may contact Janet Brown at jbrown@practicegreenhealth.org, (866) 598-2110, or Lin Hill at lhill@practicegreenhealth.org, (866) 998-9973.

The Environmental Excellence Awards Program Turns Ten Years Old in 2012!Come celebrate ten years of health care sustainability successes with your peers in Denver, Colorado from April 30 to May 2 at CleanMed 2012, the premier global conference for sustainability in health care. CleanMed is the most important meeting of the year for those engaged in sustainable health care. Find out more about and register to attend CleanMed 2012 at: www.cleanmed.org Learn more about the Environmental Excellence Awards, see past winners, and apply online at: www.practicegreenhealth.org/awards Get the recognition you deserve – apply for an Environmental Excellence Award today. Deadline for applications is February 2. nG

Lin HillDirector of AwardsPractice Greenhealthlhill@practicegreenhealth.org

2012 Practice Greenhealth Environmental Excellence Awardscontinued from page 11

14 G R E E N H E A L T H • N O V E M B E R / D E C E M B E R 2 0 1 1

P R A C T I C E G R E E N H E A L T H M E M B E R S P O T L I G H T :

Why sustainability is important to me: I want the future generations to have a safe and plentiful world to grow in as we have by taking care of their environment.

My biggest challenge in this work: Prioritizing all the work that needs to get done and finding the time.

What “keeps me going” in this work: The people I work with every day and how excited they are about how sustainability is important to our organization, even with the amount of work they have in their “real jobs.”

Project most proud of: We use a group of developmentally disabled adults to sort our commingled recycling from our hospitals. This program enables us to have a 50 percent plus recycling rate but most importantly it provides jobs for individuals that may otherwise not have jobs.

Currently working on: A project to install electric car charging stations at our hospitals. Expanding our sustainability programs to our rural hospitals that have been successful in our metropolitan hospitals. Working on a project to have our first community garden, supported by the hospital Green Team.

You can’t make this stuff up: The day we had a large piece of pathological waste show up at our recycling center in the commingled recycling; yuck. A phone call I won’t soon forget.

What/who inspires me: Working with younger generations who sometimes have a better understating of sustainability than people our age.

Hobbies: Dirt bike riding and hiking with my 11-year-old daughter and mountain climbing.

Currently listening to: Sometimes it comes down to whatever my daughter wants to listen to; I’m not picky.

Suggested Reading: Real-life stories on mountain climbing experiences and anything about sustainability in health care.

Guilty Pleasure: All the pizza I can eat after a fourteen-hour summit climb on a mountain!

Perfect Day would be: Summiting a 10,000-foot mountain at day break and watching the sun come up.

Shout out to: The entire Practice Greenhealth staff; I’m sure I don’t need to tell you why! Laura Brannen for being so wonderful to work with too.

Michael Geller Manager, Regional SustainabilityProvidence Health & Services Oregon (eight hospitals)

Mountaineer Michael Geller atop Mount St. Helens

“We use a group of developmentally disabled adults to sort our

commingled recycling from our hospitals. This program enables us to have a 50 percent plus recycling rate but most importantly it provides jobs

for individuals that may otherwise not have jobs.”

N O V E M B E R / D E C E M B E R 2 0 1 1 • G R E E N H E A L T H 15

NEW AND RENEWING FACILITY MEMBERS, FROMSEPTEMBER,2011THROUGHNOVEMBER2011

N e w Fa c i l i t y M e m b e r s :Holy Redeemer Medical Center, Meadowbrook, PA

R e n e w i n g Fa c i l i t y M e m b e r s : Advocate Health, (nine facilities), Oak Brook, IL

Bon Secours Health System, (26 facilities), Marriottsville, MD

Borgess Health, (two facilities), Kalamazoo, MI

Kaiser Permanente, (37 facilities), Oakland, CA

MEDCOM – U.S. Army Hospitals, 31 facilities, San Antonio TX

Meritus Health, Hagerstown, MD

Partners HealthCare, (12 facilities), Boston, MA

Seton Family of Hospitals, (10 facilities), Austin, TX

University Hospitals, (nine facilities), Cleveland, OH

Vanguard Health Systems, (24 facilities), Nashville, TN

NEW AND RENEWING BUSINESS MEMBERS, FROMSEPTEMBER,2011THROUGHNOVEMBER2011

R e n e w i n g B u s i n e s s M e m b e r s : Action Bag, Bensenville, IL

Augustine Temperature Management, Eden Prairie, MN

Dornoch Medical Systems, Inc., Riverside, MO

GT Environmental Inc., Westerville, OH

HealthTrust Purchasing Group, Brentwood, TN

MedAssets Supply Chain Systems, Bridgeton, MO

Naturepedic, Chagrin Falls, OH

Pro-Line Solutions, Farmingdale, NY

Stryker, Kalamazoo, MI

NEW AND RENEWING STRATEGIC RESOURCE NETWORK (SRN) MEMBERS,FROMSEPTEMBER, 2011THROUGHNOVEMBER2011

R e n e w i n g S R N M e m b e r s :

Green Seal, Washington, DC

Practice Greenhealth Welcomes New and Renewing MembersPracticeGreenhealthispleasedtoannouncethenewandrenewingmembershipforanumberofindividualhospitalsandhealthcaresystemsandbusinessmembers.Wevaluetheirsupportandcontributiontoleadingthegreeningofhealthcare.

Acompletelistofmemberscanbefoundonourwebsite: www.practicegreenhealth.org.

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Reusable surgical products — the right thing to do.

“A major source of the waste produced in the OR is disposable surgical supplies.”1 These supplies include surgical gowns, drapes, towels, back table and Mayo stand covers, and basin sets. Unfortunately, “the majority of these supplies become regulated medical waste.” Up to 70% of the medical waste created in your OR can be eliminated by utilizing reusable surgical products.

1 “Reducing Medical Waste” - AORN Journal Volume 91, Issue 6 , Pages 711-721, June 2010 Julie Conrardy, RN, MSN, CNOR, Mary Hillanbrand, RN, MSN, CNOR, Sandra Myers, RN, MSN, CNOR, George F. Nussbaum, RN, EdM, PhD, CNOR