Greening the Health Care Sector

Ravindra Gupta, MD Co-Chair Inova Health System Sustainability Committee Assistant Clinical Professor of Medicine, George Washington School of Medicine Assistant Professor Department of Internal Medicine, VCU Medical Center Inova Fairfax Hospital Falls Church, Virginia
Ravindra Gupta, MD Co-Chair Inova Health System Sustainability Committee Assistant Clinical Professor of Medicine, George Washington School of Medicine Assistant Professor Department of Internal Medicine, VCU Medical Center Inova Fairfax Hospital Falls Church, Virginia
In this article, Dr. Ravindra Gupta explains the importance of environmentally friendly initiatives for hospitals, and lists some of the changes that were recently made at Inova Fairfax Hospital. A hospital is one of the few pillars in a community. It is a beacon of health that signifies the well-being of individuals and the community. A patient imagines entering a hospital sick and coming out improved physically and mentally. The community in general also envisions a hospital as a wonderful addition. But does a hospital really live up to this ideal? Unfortunately, the answer is undeniably no. In fact, a health care system inadvertently harms a community, mostly through negative environmental impacts. While the benefits of a hospital clearly outweigh the harms, these negative impacts definitely deserve closer inspection. Hospitals that tackle these negative impacts in a systematic way are called “green hospitals”. In other words, a green hospital is one where the management understands the negative environmental impacts and takes steps to mitigate and negate them. This is not done out of the pure goodness of their hearts either. Green hospitals have been shown to increase financial gains, improve patient outcomes, improve staff health, reduce staff turnover, as well as create an improved perception in the community.1 So what are the negative environmental impacts, and why does it matter? Take a step back and consider a hospital as a “machine” made to produce a desired outcome: a healthy patient. You put energy, materials, time, and natural resources into this machine for it to work. However, you also get byproducts. This includes regulated medical waste that has to be incinerated, releasing chemicals and toxins into the air. Municipal waste has to be put in a landfill, which takes up precious green space. Greenhouse gasses are released from natural resource use. Pharmaceuticals and toxins are mixed with the wastewater. Also, in order to get this machine to work, you have to shuttle people back and forth over thousands of miles, which has its own adverse effects. If you look into the inner workings of the “machine”, other byproducts are revealed. Volatile organic compounds originate from carpets, paints, mattresses, and other finished materials. Mercury arises from thermostats, thermometers, light bulbs, and other hospital equipment. Phthalates and dioxin come from PVC plastics, which are used for saline bags, tubing, and ventilator equipment. Pesticides that are toxic by definition are used in landscaping. Arsenic, asbestos, benzene, CO, lead, nitrogen oxides, particulate matter, and radon are also other toxic byproducts. There are more and more data demonstrating the adverse effects of toxins and greenhouse gasses released into the environment. Global warming and high mercury content in seafood are some of the more common sequelae we hear about in the press. However, what about hospital employees and patients? The nurses’ health survey2 sponsored by the University of Maryland’s School of Nursing, American Nurses Association, and Health Care Without Harm show that nurses exposed to daily toxins, pharmaceuticals, and x-rays have a higher incidence of cancer, children with birth defects, and asthma. The Environmental Protection Agency’s (EPA) Science to Achieve Results (STAR) program partnering with the National Center of Environmental Research also points toward autism, asthma, and neurodevelopmental disorders in children who are exposed to certain toxins. 3 Of course, randomized, prospective studies are impossible given the subject matter, so the strength of the studies may be limited by necessity. However, the data still shows worse outcomes and indicates that more research is definitely needed. Therefore, could this “machine” function cleaner and better? At the Inova Health System, we asked the same question. The first step was realizing the need for change and getting buy in from the top. We put together a “sustainability” team including clinicians, architects, materials management staff, engineers, and administrators. The sustainability team and the upper level administrators came together to create a vision of our sustainability goals and action plan to tackle them. Thankfully, we did not have to reinvent the wheel to make this action plan, which otherwise would have been quite cumbersome. This has already been done by several other organizations: the Green Guide for Health Care (www.gghc.org), Practice Greenhealth (http://www.practicegreenhealth.org), and LEED (Leadership in Energy and Environmental Design) for Healthcare. Then, we benchmarked energy usage and waste production, so the results achieved could be measurable. Many health care products purchased were reviewed, and were changed where possible to environmentally preferable ones. Energy audits were completed and the recommended changes were enacted. A sustainable recycling, reprocessing, and composting plan was created. We are attempting xeriscaping (irrigation-free landscaping with native plant usage) to decrease water waste and pesticide usage. We are putting together a transportation program that incentivizes the use of public transportation and carpooling. All new construction will be or close to be LEED certified. Finally, we are discussing ways to incorporate the community into our project to spread the idea of social responsibility and community health. Not only are these changes decreasing our environmental footprint, promoting social responsibility and improving community health, but they also improve profit. The quickest ways for a high return on investment (ROI) are to tackle energy usage and waste production. Energy is getting increasingly expensive, and it only makes sense to become more efficient. Red bag waste costs as much as 5-10 times as much to dispose of as municipal waste. Therefore, decreasing this waste by some simple ways can save large sums of money. Reprocessing devices is also a large money saver. At Inova, the potential savings of reprocessing alone achieves upwards of $1 million/year. Many devices that are labeled as single use can actually be cleaned, tested, resterilized and reused. This process saves natural resources, materials, and disposal fees. EP diagnostic catheters in particular are quite expensive and can be fiscally rewarding if reprocessed. Typically these catheters can be purchased for half the cost and are guaranteed to work exactly the same as the new ones, with full indemnification. Many of the major medical centers are involved with reprocessing. At Inova, we use Ascent Healthcare Solutions for reprocessing. Other reprocessing companies include SterilMed, Inc. as well as Cascade Refining and Accurate Recovery Systems (for catheter tips). Unfortunately, too frequently the most paramount motivation for a corporation or organization is to increase profit. However, our society is finally coming to the realization that people and the environment are just as important, if not more so. In fact, bringing workers and the environment into the equation can even increase profit. The “triple bottom line” is now often quoted as criteria for measuring an organization’s success: “people, planet, and profit”. It is sensible and responsible that a hospital embraces this ideal and cares for the health of the community as well the individual. In this role, a hospital will serve as a role model in the community and truly will be a beacon of health in all aspects of the word.