Green Cleaning in Hospitals
Cleaning to Protect Health
Without Harming the Environment
Stephen P. Ashkin
812 / 332-7950
SteveAshkin@AshkinGroup.com
H2E Green Cleaning Presentation
1
The Ashkin Group

Mission: Green the cleaning industry

We do NOT see ourselves at advocates.
Rather, we aspire to be “transformers.”

Clients include building owners, contract
cleaning services, product manufacturers,
policy makers, environmental organizations,
and others.
Voice:812 / 332-7950
Email: SteveAshkin@AshkinGroup.com
Website: www.AshkinGroup.com
H2E Green Cleaning Presentation
2
“Never doubt that a small group of
thoughtful committed citizens can change
the world.
In fact, it’s the only thing that ever has.”
Margaret Mead
H2E Green Cleaning Presentation
3
Overview

The Process of Change

Defining Green and Green Cleaning

The Cleaning Plan

Green Cleaning Opportunities and
Examples
H2E Green Cleaning Presentation
4
Process for Change
Administrative Support


Essential to have top management support for
implementing green cleaning
Recommend having a team to come together to
make changes in cleaning products and practice


Administrator, president, marketing, community
relations
Environmental services, purchasing, infection
control, GPO, others
What is the business case?
H2E Green Cleaning Presentation
5
Process for Change
Recognize Differing Agendas
Infection Control - cleaning, disinfection
 Environmental Services – cost containment, ease of
use, efficiencies
 Purchasing – group contracts, cost containment
 Risk Management – optimize environment, reduce
risks, protect patients
 Employee Health – protect healthcare workers
 Administration – overall performance, community
relations
Recognize the competition for resources.

H2E Green Cleaning Presentation
6
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 products
used everywhere?)
How
Frequency
Training and communications – how often, issues
Are there other opportunities for improvement
H2E Green Cleaning Presentation
7
Process for Change
Who Is Performing the Cleaning?

In-house Services



Out-sourced Services




GPOs
Contract issues
Contract language
How are supplies purchased
Unions
Different structures have different challenges
Consider small, low-risk “pilots”
H2E Green Cleaning Presentation
8
Defining Green Cleaning and
Green Cleaning Products

Green Products: Products that reduce
impacts on health and the environment
when compared to similar products used
for the same purpose.
E.O. 13101

Green Cleaning: Cleaning to protect health
(patients/occupants, staff, administrators,
and visitors) without harming the
environment.
AG
H2E Green Cleaning Presentation
9
Define Green Cleaning
It’s Not Just About Chemicals
Products
Disposable Janitorial Products (i.e. paper)
Equipment
Procedures
Source reduction and pollution prevention
Safe for patients
Safe for staff (especially product users)
Safe for environment (creates minimal
amount of pollution, especially PBT’s)
Encourage sustainability








H2E Green Cleaning Presentation
10
The Impact of Cleaning on the
Environment

5.0 Billion pounds of Chemicals

4.5 Billion pounds of Paper

0.5 Billions pounds of Equipment

35.0 Billion Plastic Liners
H2E Green Cleaning Presentation
11
Impact of Cleaning on Staff
(Product Users) Health

6% of workers injured on the job

Occupational asthma on the increase

20% are eye and skin burns (chemical
exposures)

Muscular/skeletal injuries (ergonomics)
H2E Green Cleaning Presentation
12
Impact on Patients and Staff

Nursing homes and assisted living



3,350,000 residents
2,000,000 staff (full and part time)
Hospitals




660,000 patients (per day)
4,535,000 staff (full time equivalents)
100,000 hospital trainees
Visitors???
Many are exposed 24 hours per day
H2E Green Cleaning Presentation
13
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
H2E Green Cleaning Presentation
14
Nosocomial Infections





2,000,000 (About 5.7%) of all Patients Admitted
to U.S. Hospitals Acquire These Infections.
3.8% of Nosocomial Infections are Fatal
70,000+ People Die Every Year From Nosocomial
Infections
Approximately one-third are preventable
$$$$$
This is NOT an indictment of the cleaning industry.
We know how to clean. We just need the budget,
time and tools to do the job right.
H2E Green Cleaning Presentation
15
Cleaning Plans Matter

Evaluate how facility is defined for
cleaning purposes

All one level?

Different standards for different areas?
 www.astm.org
(ASTM E1971-89 Standard Guide for
Stewardship for Cleaning Commercial and
Institutional Buildings)
H2E Green Cleaning Presentation
16
Divide up facility by ‘risk areas”

Typically in a hospital…..

45 to 65% are Non-critical (low risk) areas

25 to 45% are Semi-critical (medium risk) areas

10% are Critical (high risk) areas

An important first step is to evaluate how the
“risk areas” are defined and identified.

You can probably reclassify many areas as
low risk areas, which in turn can reduce
resources, impacts and costs.
H2E Green Cleaning Presentation
17
Divide up facility by ‘risk areas”

Non-critical (low risk)






Semi-critical (medium risk)





Exterior maintenance
Administration Areas, accounting, records, HR, etc.
Patient registration and waiting areas
Shops, carpentry, mail, printing, materials management
Hallways
Restrooms (public)
Nursery
Clinics, outpatients, diabetes, respiratory
Rehabilitation, physical therapy, cardiac rehab
Critical (high risk)




Emergency
Labor and Delivery
Morgue
Surgery
H2E Green Cleaning Presentation
18
Exterior Building Maintenance
(keep the contaminants out)








Monitor pests and weeds
Use local plants adopted for the site
Use mulches and replenish as necessary
Train weed-eater operators not to damage trees
Use ice melters before precipitation begins and use to break
bonds to remove by shoveling and plowing (not intended to
melt the ice or snow)
Consider closing redundant entrances
Switch from sodium and calcium chloride to potassium and
magnesium chloride and don’t over apply
Use environmentally preferable exterior cleaning chemicals
and dispose properly
H2E Green Cleaning Presentation
19
Entryway Systems and Maintenance
(capture contaminants at the entries)
Design all entrances with permanent entry
systems or mats
 Can be used inside and out
 Should be appropriate for climate
 Class 1 Fire Retardency
 Size approximately 12 feet in length
 Develop a plan to track cleaning

H2E Green Cleaning Presentation
20
Janitorial Chemical Mixing
and Storage Areas

Provide adequate and secure storage areas
with appropriate plumbing and chemical
dispensing equipment

Have a plan to maintain the dispensers

Provide training on appropriate chemical
storage
H2E Green Cleaning Presentation
21
Cleaning and Janitorial
Maintenance Products

Use Green Seal Certified products








www.greenseal.org
Use low VOC products for other categories
MSDS – full disclosure
Use concentrates with dispensing equipment
Increase the “life” of finishes
Use metal-free floor finishes
Maintain a log of all cleaning activities
Train cleaning personnel
H2E Green Cleaning Presentation
22
What About Disinfectants?




All microorganisms are not “bad” and we do not
want to sterilize the world!
Some antimicrobial products may increase
resistance
Good physical cleaning of environmental surfaces
often is enough
All antimicrobials are not “bad” and they are an
important “tool in the toolbox”
Use disinfectants only where they are necessary and
select the appropriate product. One size does
NOT fit all needs. Cleaning personnel are smart
enough to use multiple products.
H2E Green Cleaning Presentation
23
Chlorine, Phenols, Quats & Peroxide
Risk Continuum
High









Very effective antimicrobial
Corrosive to eyes and skin
Damage floor finishes, carpets, clothing, etc.
Respiratory irritant
Environmental concerns from production, contaminants, byproducts
Mixing can create poisonous gas
Phenols





Effective against TB – HBV assumed
Corrosive to eyes and skin
Damage floor finishes and other surfaces
Strong pungent odor – respiratory irritant
Environmental concerns. Possible estrogen mimic.
Quats




Low
Chlorine / Sodium Hypochlorite
Typically not effective against TB or HBV
Less toxic then Phenols – eye, skin and surface corrosivity
Toxic to aquatic life
Peroxide


EPA Sanitizer. Not a disinfectant.
Superior health & environmental profile compared to phenols and quats
H2E Green Cleaning Presentation
24
OSHA Blood Borne Pathogen
Standard & Body fluids

Fluids covered by OSHA


Excluded fluids include


Blood, semen, cervical solutions, other
Urine, stool, saliva, sputum (unless visible
blood)
Must be cleaned with tuberculocidal or
hepacidal disinfectant
29CFR 1910.1030
H2E Green Cleaning Presentation
25
EPA Approved Cleaning Solutions
For Blood and Body Fluids

Must be hepacidal or tuberculocidal



Purpose of product is to kill hepatitis B, but
there was no EPA approved testing
methodology, so
Surrogate test is killing of M. tuberculosis - if
solution can kill M. TB, it will kill hepatitis B
Chlorine / Sodium Hypochlorite can be
used
H2E Green Cleaning Presentation
26
Janitorial Equipment

Vacuums meet CRI’s Green Label Program








www.carpet-rug.com
Extraction equipment remove sufficient moisture to
dry carpet in 24 hours
Buffers & burnishers with vacuum attachments
Propane equipment have high-efficiency, low
emission engines
Auto scrubbers equipped with variable-speed pumps
Battery-powered equipment environmentally
preferable batteries (gel batteries)
Ergonomic equipment
Maintain an equipment log
H2E Green Cleaning Presentation
27
Janitorial Paper and Other
Disposable Products

Comprehensive Procurement Guidelines











www.epa.gov/cpg/products.htm
Toilet tissue:
20% minimum PC content
Paper hand towels:
40% minimum PC content
Industrial wipes:
40% minimum PC content
Facial tissues:
10% minimum PC content
Plastic trash liners:
10% minimum PC content
Processed chlorine free
Large rolls
Hands-free dispensers that limit paper
Micro-fiber cloths, mops and bonnets
Recycled containers, buckets, carts, mats, etc.
H2E Green Cleaning Presentation
28
Integrated Pest Management

Landscape to eliminate “safe havens”

Prevent pests from entering the building

Eliminate food and moisture

Monitor for pests before they become a
problem

Eliminate clutter

Use the least toxic pesticide possible

Universal notification
H2E Green Cleaning Presentation
29
Integrated Pest Management
Pesticides are relatively unique toxic contaminants in that they are
intentionally put into the environment to accomplish their deadly purpose.
Therefore, all pest control programs have a special responsibility to be fully
knowledgeable on the impact of these chemicals and through a hierarchy of
practice, prioritize the use of preventive, nontoxic or least toxic alternatives.
IPM is the process by which this is accomplished. It is also the law – Public
Law 92-516, as amended, The Federal Insecticide, Fungicide and Rodenticide
Act (FIFRA). The requirements for the management of hazardous materials
and the release of chemicals, particularly pesticides, are becoming more
comprehensive. These expanding requirements and increasing costs, are
creating incentives to reduce the amount of hazardous materials used and
wastes generated.
-excerpt from Integrated Pest Management, by Wayne Warren
American Society for Healthcare Environmental Services
Professional Development Series
H2E Green Cleaning Presentation
30
Integrated Pest Management
Public concerns, chiefly centering around the inappropriate use of pesticides
and the generation of harmful or toxic by-products from waste treatment and
disposal processes, clearly indicate the need for a more comprehensive
environmental management technique known as Pollution Prevention. A wellmanaged facility Pollution Prevention Program should incorporate IPM, as
well as other proactive opportunities, to address the potential for risk before
the “accident” results in adverse environmental impact, cost and/or liability.
The facility Pollution Program should seek to minimize the generation 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
H2E Green Cleaning Presentation
31
Occupant Recycling

Establish a waste reduction and recycling
program that addresses the separation,
collection and storage of materials for
recycling including (at a minimum) paper,
glass, plastics, and metals

Encourage a high level of recycling by
building occupants
The success of recycling programs is
dependant upon ongoing educations
H2E Green Cleaning Presentation
32
“Insanity has been defined as doing the
same thing over and over and expecting a
different outcome.
Negligence is defined as doing the same
thing over and over even though you know
it is dangerous, stupid or wrong.
Now that we know, it’s time for a change.
Negligence starts tomorrow.”
William McDonough
Cradle to Cradle
H2E Green Cleaning Presentation
33
Green Cleaning in Hospitals
Cleaning to Protect Health
Without Harming the Environment
Stephen P. Ashkin
812 / 332-7950
SteveAshkin@AshkinGroup.com
H2E Green Cleaning Presentation
34