Clean hospitals:
Hospitals move to eliminate things that can harm patients during their stays.
Ferdinand de Veyra still remembers the smell: strong, very much like rubbing alcohol.
Six years ago, as a new custodian at UCSF Medical Center at Parnassus, he used cleaning products that irritated his eyes and caused him to cough. The chemicals’ smell lingered in the hallways and patients’ rooms long after he wiped them down. De Veyra eventually got used to it, but nurses complained of headaches.
Now, the smell isn’t around anymore. Over the last year or so, UCSF has had its workers switch to disinfectants that are gentler on the environment — and workers’ noses. The hospital has also introduced mops and installed floors that don’t need to be cleaned with harsh chemicals.
“We don’t get irritated in the
eyes and we can’t smell it anymore,” said de Veyra, 46, on a recent morning as he and his co-workers prepared to scrub a floor in the pediatric intensive care unit.
Healing health hazards
It’s a paradox that UCSF and other hospitals in the Bay Area and across the nation are trying to reconcile: the things that make medical facilities places of wellness and healing can also be sources of potential health hazards.
Patients can be vulnerable to unclean equipment or an infectious illness making its way around, all on top of the sickness that led them to the hospital in the first place. But the very same chemicals used as disinfectants can be dangerous to patients plus the employees — doctors, nurses, maintenance workers, cafeteria workers and administrators — who log countless hours on-site.
It’s not just cleaning supplies. Anyone who spends much time in a hospital — patient or employee — risks exposure to drugs, radioactive materials and X-rays, and toxic chemicals from lab accidents.
It’s perhaps little wonder that in 2010, the health care and services industry reported more injuries and illnesses than any other private industry — nearly 654,000 cases, according to the federal Occupational Safety and Health Administration. Hospitals also can leave an unhealthy footprint on the environment, as they consume large amounts of energy and water and generate tons of waste.
For the environment
Turning hospitals into cleaner workplaces is part of the goal of the Healthier Hospitals Initiative, a nationwide group of more than 600 medical facilities that have pledged to make their operations more environmentally friendly.
The project was started last year by Gary Cohen, who previously founded Health Care Without Harm, an international campaign for environmentally responsible health care. He was helping hospitals eliminate mercury, burn less medical waste and develop energy-efficiency strategies.
But “our sense was that the uptake of sustainability was very uneven in the sector, and people weren’t measuring progress in the same way,” Cohen said. So he started the Healthier Hospitals Initiative, which works to get health care systems to meet the same standards for tenets of sustainability, such as healthier food, less waste, more efficient energy use and safer chemicals.
In a report last month, the group commended UCSF for its adoption of “greener” chemicals. That change happened last year, after the medical center took part in a national study that examined the link between sterilants, disinfectants and harmful health effects.
Gentler chemicals
UCSF’s custodians used to clean surfaces with disposable alcohol wipes, which gave off the harsh fumes that de Veyra disliked. Now for daily cleaning, they use nonalcohol, non-bleach wipes with chemicals that are generally considered gentler. They use bleach only to scrub out hard-to-kill bacteria in rooms where patients have checked out or where patients with infectious diseases are staying, said Carl Solomon Sr., director of hospitality services at UCSF Medical Center and UCSF Children’s Hospital.
“Not only does the staff like it, but the patients and the nurses like it too,” Solomon said of the new wipes. “It’s much safer.”
UCSF also switched to nontoxic products approved by Green Seal, a sustainability-certification agency, to clean glass, carpets, upholstery, bathrooms and floors.
In addition, the floors of the patient-care areas at the Parnassus campus are slowly being renovated from vinyl, which periodically must be stripped and waxed or refinished to maintain its shine, to rubber, which only needs to be scrubbed with plain water and buffed with a cleaning pad.
To clean all the floors, custodians now use microfiber mops that require less water and last twice as long as string mops. They use cleaning solutions with fewer volatile organic compounds, which create pollution when they are released into the air. Solomon said the patient areas at the new Mission Bay hospital, which is under construction, will also mostly be rubber.
Green is worth the cost
Going green may sound expensive, but Dan Henroid, the sustainability officer of UCSF Medical Center, said the new cleaning materials don’t cost significantly more than the old ones. The floor renovations cost $35 per square foot, but the investment is expected to pay off because the new floors require less upkeep.
“What happened is that the market has finally caught up to the demand,” he said. “(We) and other hospitals have pushed for chemicals that use less toxins, and suppliers finally have enough variety to meet all of our needs, to meet the stringent cleaning standards for hospitals, and also do it with fewer toxins.”
Cohen said that’s part of the power of the Healthier Hospitals Initiative: With a collective budget of upward of $20 billion, hospitals can demand environmentally friendly products. The hope is that eventually, those products will be so affordable and widely available that facilities won’t think twice about buying them.
Dumping toxic supplies
One example of a large health care system that has exercised this kind of buying power is Kaiser Permanente, which has several Bay Area hospitals and is a sponsoring member of the Healthier Hospitals Initiative. Recently it began transitioning away from two main chemicals in some of its most-used supplies: intravenous bags and tubing.
The bags are traditionally made of PVC, a chemical that, when manufactured or incinerated, creates dioxin pollution, a carcinogen. Another chemical, known as DEHP, has been used to make the bags and tubing softer, but has been found to leach from the plastic into the air or liquid running through it. Exposure to DEHP is suspected to cause reproductive damage, including in developing fetuses.
All Kaiser hospitals are now switching to safer kinds of plastic tubes and bags — quite a purchase, since the health care system buys 5 million tubes and 9 million bags every year. Kaiser was able to negotiate its contract to save about $5 million annually, said Kathy Gerwig, Kaiser’s environmental stewardship officer.
“If we know that there’s credible evidence that … certain chemicals in products can cause harm, it’s our obligation to seek a safer alternative,” she said.
Staying out of landfills
Greening hospitals isn’t just about the health of patients or employees. Elsewhere in the Bay Area, Stanford University Medical Center — another sponsor of the Healthier Hospitals Initiative — is working toward putting less waste in landfills. Last year, the campus saved an estimated $750,000 by putting more than 35 percent of its trash, or 2,300 tons, in recycling and composting.
It’s taken a few years to smoothly recycle, compost and otherwise dispose of everything, including 114 tons of discarded food, 7 tons of cooking oil and 4 tons of fluorescent lightbulbs. But the underlying concept is simple, said Krisanne Hanson, the center’s sustainability director.
“We can continue to deliver world-class health care,” she said, “but at a reduced impact on the environment footprint that we have locally.”