The Green Cleaning ExpertsThe Ashkin Group
Green Cleaning in Hospitals
Cleaning to Protect Health
Without Harming the Environment
Stephen P. Ashkin812 / 332-7950
The Green Cleaning ExpertsThe Ashkin Group
The Ashkin Group
Mission: Green the cleaning industry
We do NOT see ourselves at advocates. Rather, we aspire to be “transformers.”
Our clients include building owners & managers, contract cleaning services, product manufacturers & distributors, policy makers, environmental organizations, and others.
The Green Cleaning ExpertsThe Ashkin Group
“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
Commitment
The Green Cleaning ExpertsThe Ashkin Group
The Process of Change
Defining Green and Green Cleaning
The Cleaning Plan
Green Cleaning Opportunities and Examples
Discussion Overview
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Essential to have top management support for implementing green cleaning
Recommend having a team to come together to make changes in cleaning products and practiceAdministrator, president, marketing,
community relationsEnvironmental services, purchasing,
infection control, GPO, others
What is the business case?
Process for Change - Administrative Support
The Green Cleaning ExpertsThe Ashkin Group
Infection Control - cleaning, disinfectionEnvironmental Services – cost containment,
ease of use, efficienciesPurchasing – group contracts, cost
containmentRisk Management – optimize environment,
reduce risks, protect patientsEmployee Health – protect healthcare
workersAdministration – overall performance,
community relationsRecognize the competition for resources.
Process for Change - Differing Agendas
The Green Cleaning ExpertsThe Ashkin Group
Who performs the servicesWhat products are being used & what are
costsWhen are services performedWhere are they being used (are the same
products used everywhere?)How are products usedFrequency of services providedTraining and communications – how often,
issues
Are there other opportunities for improvement?
Process for Change - Create a Baseline
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In-house ServicesGPOsContract issues
Out-sourced ServicesContract languageHow are supplies purchased
UnionsDifferent structures have different
challenges
Consider small, low-risk “pilots”
Process for Change - Who Performs Services?
The Green Cleaning ExpertsThe Ashkin Group
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
Defining Green Cleaning & Products
The Green Cleaning ExpertsThe Ashkin Group
Cleaning chemicalsDisposable janitorial products (e.g.
paper)EquipmentProceduresSource reduction and pollution
prevention
Encourage sustainability
Defining Green – It’s Not JUST Products
The Green Cleaning ExpertsThe Ashkin Group
Safe for patientsSafe for staff (especially product
users)Safe for environment (creates
minimal amount of pollution, especially PBT’s)
Encourage sustainability
Defining Green – It’s Not JUST Products
The Green Cleaning ExpertsThe Ashkin Group
5.0 Billion pounds of cleaning chemicals
4.5 Billion pounds of janitorial paper
0.5 Billion pounds of equipment
35.0 Billion plastic liners
The Impact of Cleaning – the Environment
The Green Cleaning ExpertsThe Ashkin Group
6% of workers injured on the job
Occupational asthma on the increase
20% are eye and skin burns (chemical exposures)
Muscular/skeletal injuries (ergonomics)
The Impact of Cleaning - Product Users
The Green Cleaning ExpertsThe Ashkin Group
Nursing homes and assisted living3,350,000 residents2,000,000 staff (full and part time)
Hospitals660,000 patients (per day)4,535,000 staff (full time equivalents)100,000 hospital traineesVisitors???
Many are exposed 24 hours per day
The Impact of Cleaning - Patients & Staff
The Green Cleaning ExpertsThe Ashkin Group
Every Year50,000 people die in automobile
accidents 7,000 people drown5,000 people die of burnsEvery Year70,000+ patients die of nosocomial
infections
Nine People Die Every Hour
A Perspective on Patient Impact
The Green Cleaning ExpertsThe Ashkin Group
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
Nosocomial Infections
The Green Cleaning ExpertsThe Ashkin Group
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.
Nosocomial Infections
The Green Cleaning ExpertsThe Ashkin Group
Evaluate how the facility is defined for cleaning…
Single or multiple levels?Different standards for different
areas?
(ASTM E1971-89 Standard Guide for Stewardship for Cleaning
Commercial and Institutional Buildings)
Cleaning Plans Matter
The Green Cleaning ExpertsThe Ashkin Group
Typically in a hospital…..45 to 65% are Non-critical (low risk) areas25 to 45% are Semi-critical (medium risk)
areas10% 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.
Divide Hospital by ‘Risk Areas’
The Green Cleaning ExpertsThe Ashkin Group
Non-critical (low risk)Exterior maintenanceAdministration, accounting, records, HR,
etc.Patient registration and waiting areasShops, carpentry, mail, printing,
materialsHallways & common areas
Divide Hospital by ‘Risk Areas’
The Green Cleaning ExpertsThe Ashkin Group
Semi-critical (medium risk)Restrooms (public)NurseryClinics, outpatients, diabetes,
respiratoryRehabilitation, physical therapy, cardiac
rehab
Critical (high risk)Emergency & SurgeryLabor and DeliveryMorgue
Divide Hospital by ‘Risk Areas’
The Green Cleaning ExpertsThe Ashkin Group
Monitor pests and weedsUse local plants adapted for the
siteUse mulches and replenish as
necessaryTrain weed-eater operators not to
damage treesUse ice melt compounds before the
precipitation begins - use to break bonds for removal by shoveling and plowing (not intended to melt the ice or snow)
Exterior – Keep the Contaminants Out
The Green Cleaning ExpertsThe Ashkin Group
Consider closing redundant entrances in inclement weather
Switch from sodium and calcium chloride to potassium and magnesium chloride ice melt – do not over apply
Use environmentally preferable exterior cleaning chemicals and dispose of them properly
Exterior – Keep the Contaminants Out
The Green Cleaning ExpertsThe Ashkin Group
Design all entrances with permanent entry systems or mats
Can be used inside and outShould be appropriate for climateClass 1 fire retardant materialSize approximately 12 feet in
lengthDevelop a plan to track cleaning
Entryways – Capture the Contaminants
The Green Cleaning ExpertsThe Ashkin Group
Provide adequate and secure storage areas with appropriate plumbing and chemical dispensing equipment
Have a dispenser maintenance plan
Provide chemical storage training
Cleaning Chemicals – Storage & Mixing Areas
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Use Green Seal Certified products www.greenseal.org
Use low VOC products when possible
Keep MSDS file up to date & available
Choosing Cleaning Chemicals
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Use concentrates with dispensing equipment
Increase the “life” of finishesUse metal-free floor finishes
when feasibleMaintain a log of all cleaning
activitiesTrain personnel to use cleaning
chemicals properly
Choosing Cleaning Chemicals
The Green Cleaning ExpertsThe Ashkin Group
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
The Green Cleaning ExpertsThe Ashkin Group
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 products.
One size does NOT fit all needs. Cleaning personnel are smart enough to use multiple products.
What About Disinfectants?
The Green Cleaning ExpertsThe Ashkin Group
Chlorine, Phenols, Quats & Peroxide
Chlorine / Sodium HypochloriteVery effective antimicrobialCorrosive to eyes and skinDamage floor finishes, carpets, clothing, etc.Respiratory irritantConcerns regarding production, contaminants & by-
productsMixing can create poisonous gas
PhenolsEffective against TB – HBV assumedCorrosive to eyes and skinDamage floor finishes and other surfacesStrong pungent odor & respiratory irritantEnvironmental concerns. Possible estrogen mimic.
QuatsTypically not effective against TB or HBVLess toxic than phenols – eye, skin and surface corrosiveToxic to aquatic life
PeroxideEPA Sanitizer - not a disinfectant.Superior health & environmental profile vs. phenols and
quats
Ris
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on
tin
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m
High
Low
The Green Cleaning ExpertsThe Ashkin Group
Blood Borne Pathogen & Body Fluids
Fluids covered by OSHA
Blood, semen, cervical solutions, other
Excluded fluids include
Urine, stool, saliva, sputum (unless blood is visible)
Must be cleaned with tuberculocidal or hepacidal disinfectant
29CFR 1910.1030
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EPA Approved Cleaning Solutions Blood and Body Fluids
Must be hepacidal or tuberculocidalPurpose 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 may be used
The Green Cleaning ExpertsThe Ashkin Group
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
The Green Cleaning ExpertsThe Ashkin Group
Auto scrubbers equipped with variable-speed pumps
Battery-powered equipment environmentally preferable batteries (gel batteries)
Ergonomic equipmentMaintain an equipment log
Janitorial Equipment
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Janitorial Paper - Other Disposable Products
Comprehensive Procurement Guidelineswww.epa.gov/cpg/products.htm
Toilet tissue: 20% minimum PC contentPaper hand towels: 40% minimum PC contentIndustrial wipes: 40% minimum PC
contentFacial tissues: 10% minimum PC contentPlastic trash liners: 10% minimum PC content
Processed chlorine freeLarge rollsHands-free dispensers that limit paperMicro-fiber cloths, mops and bonnetsRecycled buckets, carts, mats, etc.
The Green Cleaning ExpertsThe Ashkin Group
Integrated Pest Management
Landscape to eliminate “safe havens”
Prevent pests from entering the building
Monitor before pests become a problem
Eliminate food, moisture, & clutter
Use the least toxic pesticide possible
Universal notification
The Green Cleaning ExpertsThe Ashkin Group
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.
Excerpted from Integrated Pest Management, by Wayne WarrenAmerican Society for Healthcare Environmental Services
Professional Development Series
Integrated Pest Management
The Green Cleaning ExpertsThe Ashkin Group
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 well managed 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).
Excerpted from Integrated Pest Management, by Wayne Warren American Society for Healthcare Environmental Services
Professional Development Series
Integrated Pest Management
The Green Cleaning ExpertsThe Ashkin Group
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
Occupant Participation in Recycling
The Green Cleaning ExpertsThe Ashkin Group
“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 McDonoughCradle to Cradle
Importance of Change
The Green Cleaning ExpertsThe Ashkin Group
Thank
Thank
You!
You!
Green Cleaning in Hospitals
Cleaning to Protect Health
Without Harming the Environment
Stephen P. Ashkin812 / 332-7950