Constructing a “green” building is only the first step to sustainability in healthcare. Operations and maintenance also play a significant role in supporting a healthy indoor environment—particularly cleaning products and processes. The use of toxic or irritating cleaning products, or cleaning programs that are incompatible with selected surfaces, can undermine careful green choices made in the construction or renovation phases.

Housekeeping activities are key components of the Green Guide for Health Care (GGHC), which sets out criteria for a comprehensive approach to green building and maintenance for healthcare facilities. GGHC criteria directly address environmentally preferable cleaning and recycled content in janitorial paper products, for example. Also, cleaning practices can help achieve GGHC credits for Indoor Air Quality source control, building water use reduction, and overall waste reduction. Similarly, the U.S. Green Building Council's LEED Existing Building certification standard rewards a number of cleaning-related activities, such as choosing sustainable cleaning products, recycling, waste reduction, and isolation of janitorial closets.

Why the emphasis on cleaning activities? First, cleaning is a never-ending process of facility maintenance and plays an essential role in helping reduce infection and improve patient and staff comfort. In addition, we now know that some of the older cleaning products and processes that hospitals have relied upon for years can negatively impact both health and the environment. For example:

  • Patient and staff comfort. Many cleaning products contain high levels of volatile organic compounds (VOCs) that can give rise to respiratory irritation, headaches, and other symptoms in workers and building occupants.

  • Worker health and safety. An estimated 35% of conventional cleaning products can cause blindness, severe skin damage, or damage to organs through the skin. Janitorial workers in general have a high rate of occupational injury. Research indicates that more than 10% of confirmed work-related asthma cases may arise from exposure to cleaning products.1

  • Environmental damage. Some cleaning chemicals are associated with eutrophication of streams and toxicity to aquatic life. Eutrophication is a process whereby bodies of water receive excess nutrients that stimulate excessive plant growth, often called an “algal bloom.” This process reduces dissolved oxygen in the water when dead plant material decomposes and can cause other organisms to die.

    VOCs released to the outdoor environment from consumer products, including cleaning chemicals, contribute to smog formation. Other ingredients, such as alkylphenol ethoxylate surfactants, don't break down readily in the environment and may interfere with the hormone systems of exposed organisms.2

  • Long-term health issues. Many cleaning products contain carcinogens, asthmagens, and substances associated with reproductive organ damage, birth defects, kidney damage, neurologic effects, and other serious health effects.

Clearly, managers interested in promoting a healthy indoor environment in their facilities and reducing their operation's impact on the environment must assess potential releases from cleaning products during their use, disposal, and beyond. Fortunately, the market has responded to the growing demand for less-toxic cleaning products that meet demanding performance requirements. Dozens of cleaning-chemical manufacturers now have products that are certified by the Green Seal or Environmental Choice certification programs. Government facilities and parks, schools, and businesses across the country have successfully adopted comprehensive green-cleaning programs that provide a track record for assessment. Even janitorial/housekeeping service providers are beginning to market green services.

To implement a truly environmentally preferable cleaning program, however, still takes focus and effort. Managers must decide which green claims are real and which are “greenwash”; they must choose from among competing products and make sure the products and processes they select are compatible with environmentally preferable flooring or other interior surfaces.

While every facility has its own needs, culture, and performance imperatives, some basic components cut across specific circumstances to help ensure successful green-cleaning implementation.

Collaboration. As with all environmental initiatives, cleaning choices and changes involve many disciplines within the facility. Developing a comprehensive green-cleaning program may involve changing long-standing protocols, so it requires collaboration with a multidisciplinary team.

The team that oversees green-cleaning efforts should include purchasing staff, as well as environmental services, housekeeping, infection control, nursing, and environmental health and safety (EHS) staff. It may also include operating room and/or emergency room staff who have concerns about infection control. If an environmental committee exists, it may take on this task, as long as the particular interests listed above are represented.

When renovations or new construction are contemplated, the team should make sure that cleaning practices and products are considered as part of the design process, since these choices will affect housekeeping operations for years to come. For example, selecting a flooring product that does not require frequent stripping and finishing can significantly reduce both labor requirements and VOC releases. Conversely, selecting a green flooring product that may not stand up to the cleaning frequency required in a hospital can create a huge headache for housekeeping later on. If possible, run some cleaning tests with samples of the materials being considered to better understand the cleaning products and processes that will be needed and to rule out surfaces that may create problems for housekeeping.

Understanding existing policies and prod-ucts. Working together, the team needs to review current products, practices, and policies; to research alternatives; and possibly to develop pilot projects to assess various new approaches before going facility-wide. Before making major changes, it is essential to understand whether existing infection control, purchasing, EHS, or other policies present barriers. If, for example, a facility's infection-control policy states that all floors in every area of the facility will be disinfected daily, the team will need to address this policy in a comprehensive way with interested parties (asking, for example, is such disinfection necessary? Are there areas—e.g., waiting rooms, specific labs—where this goes beyond what is needed? Is the practice effective in controlling infection transmission? Injurious to staff exposed to disinfectants?).

The team also needs to review approaches to verifying the environmental benefits of specific products. Requiring certification or going through a group purchasing organization (GPO) that has researched specific products and verified environmental claims may save your facility time and effort. A team that includes an industrial hygienist, environmental engineer, or other expert can also do individual research on products' health impacts and environmental properties.

Communication. Communicating clearly about the adoption of environmentally preferable approaches to cleaning is essential to success. That means making sure that the steps taken are shared with facility management, frontline workers, clinical staff, and even with patients and visitors. Solicit feedback, especially from janitorial workers, as you implement measures. The more information that is provided about contemplated changes, including explanation of their relationship to the health and well-being of facility staff and patients, and the more opportunities there are for constructive feedback, the more likely it is that workers and supervisors will accept changes. (Should a specific change run into trouble, there will likely be more support for the initiative, allowing time for continued experimentation to find workable solutions.)

Comprehensive efforts. While it is possible to simply switch out one product for another and achieve some level of environmental improvement, truly successful green-cleaning programs will address multiple aspects of housekeeping. Changes in tools, such as implementation of microfiber systems over conventional mopping or adoption of floor buffers with minimal emissions and HEPA filtration, can reduce water and chemical consumption and worker and building occupant exposure. Product-dispensing systems that ensure more controlled mixing of chemicals can significantly reduce chemical and water usage and costs, as well as reducing waste and protecting workers from chemicals that can cause injury.

Training programs that help workers understand and use new cleaning techniques are an essential component of green-cleaning implementation. Many manufacturers provide these services, which are required under Green Seal and Environmental Choice certification programs. Integration of recycled paper goods into janitorial operations (including paper goods used for cleaning, but also those used in bathrooms, break areas, and so forth) is an easy step.

Conclusions

Less-toxic cleaning products and processes are becoming an integral component of the healing environment in many healthcare facilities by reducing stress on the building's occupants, improving safety, and contributing to improved ecologic health.3 By working together to implement safer, less-toxic cleaning protocols throughout the healthcare sector, facility staff can help protect patient and worker health—and we can all breathe a little easier.

Sarah O'Brien is Champion Coordinator (working with green design leaders) and Environmental Purchasing Specialist for Hospitals for a Healthy Environment (H2E). H2E's mission is to provide education, tools, and information about best environmental practices to help healthcare professionals improve operational efficiency, increase compliance, and improve the health of their communities. H2E Partner affiliates include more than 1,400 hospitals, 450 other healthcare facilities, and more than 150 businesses and organizations that work with the healthcare sector.

For further information, phone 802.479.0317, e-mail sarah.obrien@h2e-online.org, or visit http://www.h2e-online.org.

Reference

  1. Rosenman KD, Reilly MJ, Schill DP, et al. Cleaning products and work-related asthma. J Occup and Environ Med 2003; 45:556-63.
  2. Dickey P. Troubling bubbles: The case for replacing alkylphenol ethoxylate surfactants. Washington Toxics Coalition, 1997. Presented at Meeting III of the Unified Green Cleaning Alliance in Auburn, Wash., Dec. 10, 2002. Accessible as a PDF at http://www.zerowaste.org/ugca/mtgIII/Presentation_Troubling_Bubbles.pdf.
  3. The Center for Health Design; http://www.healthdesign.org/research/pebble.