Stephen P. Ashkin 812 / 332-7950 SteveAshkin@AshkinGroup

H2E Green Cleaning Presentation 1

Green Cleaning in HospitalsCleaning to Protect Health Without Harming the Environment

Stephen P. Ashkin812 / 332-7950

[email protected]


The Ashkin Group Mission: Green the cleaning industry

We do NOT see ourselves at advocates. Rather, we aspire to be “transformers.”

Clients include building owners, contract cleaning services, product manufacturers, policy makers, environmental organizations, and others.

Voice:812 / 332-7950Email: [email protected]: www.AshkinGroup.com


“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


Overview The Process of Change

Defining Green and Green Cleaning

The Cleaning Plan

Green Cleaning Opportunities and Examples


Process for ChangeAdministrative Support Essential to have top management support for

implementing green cleaning Recommend having a team to come together to

make changes in cleaning products and practice Administrator, president, marketing, community

relations Environmental services, purchasing, infection

control, GPO, others

What is the business case?


Process for ChangeRecognize Differing Agendas Infection Control - cleaning, disinfection Environmental Services – cost containment, ease of

use, efficiencies Purchasing – group contracts, cost containment Risk Management – optimize environment, reduce

risks, protect patients Employee Health – protect healthcare workers Administration – overall performance, community

relationsRecognize the competition for resources.


Process for ChangeCreate a Baseline Who What products are being used What do products cost When Where are they being used (are the same products

used everywhere?) How Frequency Training and communications – how often, issues Are there other opportunities for improvement


Process for ChangeWho Is Performing the Cleaning? In-house Services

GPOs Contract issues

Out-sourced Services Contract language How are supplies purchased

Unions Different structures have different challenges

Consider small, low-risk “pilots”


Defining Green Cleaning and Green Cleaning Products

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


Define Green CleaningIt’s Not Just About Chemicals Products Disposable Janitorial Products (i.e. paper) Equipment Procedures Source reduction and pollution prevention Safe for patients Safe for staff (especially product users) Safe for environment (creates minimal

amount of pollution, especially PBT’s)

Encourage sustainability


The Impact of Cleaning on the Environment 5.0 Billion pounds of Chemicals

4.5 Billion pounds of Paper

0.5 Billions pounds of Equipment

35.0 Billion Plastic Liners


Impact of Cleaning on Staff (Product Users) Health

6% of workers injured on the job

Occupational asthma on the increase

20% are eye and skin burns (chemical exposures)

Muscular/skeletal injuries (ergonomics)


Impact on Patients and Staff Nursing homes and assisted living

3,350,000 residents 2,000,000 staff (full and part time)

Hospitals 660,000 patients (per day) 4,535,000 staff (full time equivalents) 100,000 hospital trainees Visitors???

Many are exposed 24 hours per day


Impacts on PatientsSome Perspective 50,000 Die in Automobile Accidents 7,000 Drown 5,000 Die of Burns 70,000+ Die of Nosocomial Infections

Nine People Every Hour


Nosocomial Infections 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 $$$$$

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.


Cleaning Plans Matter Evaluate how facility is defined for

cleaning purposes

All one level?

Different standards for different areas? www.astm.org

(ASTM E1971-89 Standard Guide for Stewardship for Cleaning Commercial and Institutional Buildings)


Divide up facility by ‘risk areas” Typically in a hospital…..

45 to 65% are Non-critical (low risk) areas 25 to 45% are Semi-critical (medium risk) areas 10% 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 up facility by ‘risk areas” Non-critical (low risk)

Exterior maintenance Administration Areas, accounting, records, HR, etc. Patient registration and waiting areas Shops, carpentry, mail, printing, materials management Hallways

Semi-critical (medium risk) Restrooms (public) Nursery Clinics, outpatients, diabetes, respiratory Rehabilitation, physical therapy, cardiac rehab

Critical (high risk) Emergency Labor and Delivery Morgue Surgery


Exterior Building Maintenance(keep the contaminants out)

Monitor pests and weeds Use local plants adopted for the site Use mulches and replenish as necessary Train weed-eater operators not to damage trees Use ice melters before precipitation begins and use to break

bonds to remove by shoveling and plowing (not intended to melt the ice or snow)

Consider closing redundant entrances Switch from sodium and calcium chloride to potassium and

magnesium chloride and don’t over apply Use environmentally preferable exterior cleaning chemicals

and dispose properly


Entryway Systems and Maintenance(capture contaminants at the entries) Design all entrances with permanent entry

systems or mats Can be used inside and out Should be appropriate for climate Class 1 Fire Retardency Size approximately 12 feet in length Develop a plan to track cleaning


Janitorial Chemical Mixing and Storage Areas Provide adequate and secure storage areas

with appropriate plumbing and chemical dispensing equipment

Have a plan to maintain the dispensers

Provide training on appropriate chemical storage


Cleaning and Janitorial Maintenance Products Use Green Seal Certified products

www.greenseal.org

Use low VOC products for other categories MSDS – full disclosure Use concentrates with dispensing equipment Increase the “life” of finishes Use metal-free floor finishes Maintain a log of all cleaning activities Train cleaning personnel


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 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 product. One size does NOT fit all needs. Cleaning personnel are smart enough to use multiple products.


Chlorine, Phenols, Quats & Peroxide Chlorine / Sodium Hypochlorite

Very effective antimicrobial Corrosive to eyes and skin Damage floor finishes, carpets, clothing, etc. Respiratory irritant Environmental concerns from production, contaminants, byproducts Mixing can create poisonous gas

Phenols Effective against TB – HBV assumed Corrosive to eyes and skin Damage floor finishes and other surfaces Strong pungent odor – respiratory irritant Environmental concerns. Possible estrogen mimic.

Quats Typically not effective against TB or HBV Less toxic then Phenols – eye, skin and surface corrosivity Toxic to aquatic life

Peroxide EPA Sanitizer. Not a disinfectant. Superior health & environmental profile compared to phenols and quats

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OSHA Blood Borne Pathogen Standard & Body fluids Fluids covered by OSHA

Blood, semen, cervical solutions, other

Excluded fluids include

Urine, stool, saliva, sputum (unless visible blood)

Must be cleaned with tuberculocidal or hepacidal disinfectant

29CFR 1910.1030


EPA Approved Cleaning Solutions For Blood and Body Fluids Must be hepacidal or tuberculocidal

Purpose 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 can be used


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 Auto scrubbers equipped with variable-speed pumps Battery-powered equipment environmentally

preferable batteries (gel batteries) Ergonomic equipment Maintain an equipment log


Janitorial Paper and Other Disposable Products

Comprehensive Procurement Guidelines www.epa.gov/cpg/products.htm Toilet tissue: 20% minimum PC content Paper hand towels: 40% minimum PC content Industrial wipes: 40% minimum PC content Facial tissues: 10% minimum PC content Plastic trash liners: 10% minimum PC content

Processed chlorine free Large rolls Hands-free dispensers that limit paper Micro-fiber cloths, mops and bonnets Recycled containers, buckets, carts, mats, etc.


Integrated Pest Management Landscape to eliminate “safe havens” Prevent pests from entering the building Eliminate food and moisture Monitor for pests before they become a

problem Eliminate clutter Use the least toxic pesticide possible Universal notification


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.

-excerpt from Integrated Pest Management, by Wayne WarrenAmerican Society for Healthcare Environmental Services

Professional Development Series

Integrated Pest Management


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 ofwastes or environmental releases and provide conscious management of all environmental media (i.e., air, water, and land).

-excerpt from Integrated Pest Management, by Wayne WarrenAmerican Society for Healthcare Environmental Services

Professional Development Series

Integrated Pest Management


Occupant Recycling 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


“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


Green Cleaning in HospitalsCleaning to Protect Health Without Harming the Environment

Stephen P. Ashkin812 / 332-7950

[email protected] You

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Stephen P. Ashkin 812 / 332-7950 SteveAshkin@AshkinGroup