Tuesday
October 10, 2006
Since Florence Nightingale first helped make the connection between cleaning and improved health outcomes, health care workers and the cleaning profession have responded with a wide variety of products and processes.
However, we now know that some of these older cleaning products and processes can negatively impact both health and the environment.
Today, less-toxic cleaning products are becoming an integral component of a healing environment by reducing stress on the building’s occupants, improving safety and contributing to improved ecological health. To understand why this is so, it is useful to review cleaning products’ documented health and environmental impacts:
Clearly, managers interested in promoting a healthy indoor environment in their facilities and in reducing their operations’ impact on the environment must assess potential releases of irritating and toxic contaminants from cleaning products during their use, disposal and beyond.
Infection control is serious business. Because of this, hospital staff and administrators often react anxiously to suggested changes in cleaning practices.
Yet many current practices are based on perceived rather than actual risk. For example, many hospitals react to concerns about infection by disinfecting almost every area and almost every surface. Yet, according to the Centers for Disease Control and Prevention (CDC), no epidemiologic evidence supports overdisinfecting.
Microorganisms are a normal contaminant of walls, floors and other surfaces, and are rarely associated with transmission of infections to patients or personnel. Increased hand washing is a much more important and effective infection control mechanism. Moreover, hospitals that have completely switched over to greener products and processes, such as Hackensack (N.J.) University Hospital, show no increase in nosocomial infection rates.
Additionally, many expectations about cleaning—shiny floors, strong fragrances—have more to do with marketing of cleaning products than they do with actual cleanliness or low rates of infection. To adequately clean facilities and maintain low rates of infection, we need to distinguish between actual efficacy and assumptions based on customary practice.
Because it may involve changing long-standing protocols (whether based on questionable assumptions or simply familiar through long practice), developing a comprehensive green cleaning program requires collaboration with a multidisciplinary team, including background research, careful implementation and oversight.
The team that oversees the transition should include purchasing staff as well as environmental services, housekeeping, infection control, nursing and environmental health and safety staff. It may also include operating room and/or emergency room staff with concerns about infection control. Working together, this team needs to review current products, practices and policies, research alternative products and practices and develop pilot projects to assess various new approaches before going facilitywide.
Determine what performance and environmental criteria—no carcinogens, no mercury, low VOCs—your facility wants to specifically require (and has the means to evaluate). It is crucial to include infection control team members in the product review process, as they need to be comfortable with the efficacy and the environmental attributes of the new products chosen. Remember that using third parties—a group purchasing organization (GPO), a certifying organization or an outside procurement entity that has done product testing and verification—may streamline and simplify your choices and allow you to address more than single-issue criteria.
• Certification. Using a third-party environmental certification such as Green Seal (www.greenseal.org) or its sister program, Canada’s Environmental Choice (www.environmentalchoice.com), as a product screen takes much of the guesswork out of product selection. Third-party certification provides assurance that a product has been independently tested and found to meet criteria, which verifiably reduces its negative environmental and health impacts. It also ensures that a program of repeat verification and factory inspection is in place for continuing compliance.
If a product is certified by Green Seal, for example, you know it has met numerous environmental criteria, and that it has also been evaluated for successful cleaning performance. Check with your cleaning product vendor or GPO to see if they carry Green Seal or other certified products, or specify Green Seal or other certifications when issuing RFPs.
• GPO contracts. Before putting work into developing independent contract specifications, inquire about resources available through your GPO. They may have already done a lot of the background work by developing green cleaner contracts or including environmentally preferable alternatives in their general cleaning chemicals contracts.
Request specific information—what criteria did the GPO use to qualify products as “green,” and how were vendors’ products evaluated? Do their criteria meet the concerns of the facility staff? Have the products been selected by other purchasing entities, such as states or cities with environmental purchasing programs? Have other GPO members been satisfied with the products available on contract?
• Operational changes. In addition to determining desired product criteria, consider physical plant and process changes as well as new tools.
Preventive strategies like removing absorbent materials such as carpet from areas where moisture is present to address mold contamination; or reducing soiling and wear on floor surfaces by installing walk-off mats at all entrances, can reduce the need for cleaning with harsh chemicals.
Eliminating spray application in favor of pour-and-wipe products where possible can significantly reduce airborne contamination inside a facility. Reducing the frequency of floor-finish buffing—which can aerosolize finish polymers and cause respiratory problems—and using buffing equipment with active vacuum attachments, can minimize patient and staff exposures.
New tools, such as microfiber mops or rags and automated equipment like autoscrubbers and extraction machines, can significantly reduce chemical and water usage as well as improve the ergonomics of floor cleaning. You will need to decide if you want to incorporate them into your pilot project as well.
Use suppliers and distributors as support for your transition efforts—being sure to require training and education as part of their service. Ask them to help with placement of dispensing units, to provide posters and other training materials, and conduct hands-on training with workers. Enlist them to speak with senior management if needed to explain the benefits of the new products in terms of worker safety, patient and staff satisfaction and environmental improvements. Make sure they are part of your team when developing and implementing pilot efforts and are able to quickly respond to questions and issues.
Clear communication and shared planning is crucial to ensure smooth testing and adoption of environmentally preferable cleaning products and methods. That means making sure the steps are shared with the facility’s management, front-line workers, clinical staff and even patients and visitors.
The more you can communicate and explain why the changes are important to the health and well-being of staff, patients and the environment, the more support you will receive. Advice on dealing with key players includes the following:
• Housekeeping/environmental services staff. These employees are essential for implementing green cleaning in a facility. Front-line staff can be your best allies and promoters, or can be resistant when changes require new thinking. Make sure you explain the health benefits and ensure that staff have the training required to successfully change practices, with their input clearly solicited and valued.
ES workers will inevitably be ambassadors to facility visitors and staff. By educating them on the health and environmental benefits involved, and encouraging them to explain these to others, you can help them become key promoters of your program changes
• Administration. Make sure supervisors and top management know about the changes you are adopting. Provide them with information on the health, environmental performance and cost-savings benefits of the plan before you launch any significant changes. Make sure vendors provide cost analysis so that you can provide accurate information. (If new equipment is involved, specify a return on investment interval.)
Also ask for the support of risk management and worker safety colleagues to communicate with management about the potential to reduce worker exposure or environmental compliance problems. Communicating the desired outcomes and enlisting assistance from infection control professionals will also support your efforts.
• Patients and visitors. Let patients, families and visitors know about the programs, so they know what to expect. In patient orientation materials, include information about green cleaning practices they will encounter in the facility and the environmental health benefits. If the budget allows, posters, tabletop cards or door hangers can explain some of the details of your programs, especially where patient participation is needed (such as for recycling).
When customers understand that changes are being made to improve their comfort and health, as well as benefiting the environment, they are less likely to find differences unsettling or annoying, and more likely to become positive participants in the changes.
Sarah O’Brien is environmental purchasing specialist for Hospitals for a Healthy Environment (H2E), a nonprofit organization that works with health care facilities on improving their environmental performance. She can be contacted at sarah.obrien@H2E-online.org. This article is adapted from H2E’s Ten Step Guide to Green Cleaning Implementation, available through the group’s Web site at www.h2e-online.org.
This month’s “Environmental Services” piece is a joint project of the American Society for Healthcare Environmental Services (www.ashes.org) and Health Facilities Management.