As more and more health care organizations embrace environmental sustainability, experts say epidemiologists need to have a seat at the table to stave off infection control and prevention concerns.
When a company decides to improve its environmental footprint, the first topics to come up are likely things like energy use, waste reduction, and cost.
Yet, although the concept of “going green” is popular in corporate America and American households, when it comes to health care settings, the issue of environmental sustainability comes with a major asterisk.
“In the health care environment the primary focus is on patient and worker safety and quality care,” Janet Howard, EDAC, the director of member engagement at Practice Greenhealth, a membership organization that works with health care organizations to integrate sustainable, environmentally friendly solutions shared with Contagion®.
“You would never jeopardize patient and worker safety by trying to ‘go green,’” she said.
Environmental sustainability is often seen as a way to improve human health in the long term; however, in the short term, issues of energy use, chemical safety, and waste reduction can have immediate implications for patient care and safety. After all, swapping out harsh cleaning chemicals for ineffective ones could spell disaster from an infection-prevention standpoint.
Richard Van Enk, PhD, the director of infection prevention and epidemiology at Bronson Healthcare, in Kalamazoo, Michigan, told Contagion® he sees the goals of infection prevention and environmental stewardship as closely aligned.
“We have always been about safety of all different types,” he said. “And so, although we’re concerned about infectious diseases, we’re also worried about chemical toxicity and so on.”
Fortunately, Dr. Van Enk said a balance can be found through the field of epidemiology which has come around to the realization that when it comes to microorganisms, a targeted approach is better than slash-and-burn.
“There was an old idea when I started in this business maybe 30 years ago that the only good microorganism was a dead microorganism,” he said. Back then, sterility was the goal and so every hospital tried to kill every last microorganism. “That has completely changed now because of [studies of the human microbiome] which show that microorganisms belong here in our environment and they are good for us and we don’t want to kill them all,” he explained.
Still, Contagion® Editorial Advisory Board member, Saskia V. Popescu, MPH, MA, CIC, a hospital epidemiologist and infection preventionist at Phoenix Children’s Hospital in Arizona said hospitals can’t take chances when it comes to cleaning and disinfection.
“Our concern is the ability to disinfect, not the environmental burden,” she said. “I’m not aware of green products that can kill Clostridium difficile or Mycobacterium tuberculosis in 2 minutes like we need. I’d love if that was an option, but I haven’t been presented with anything like that.”
Ms. Popescu acknowledged there are some products, such as hydrogen peroxide disinfectants, that have less potent smells and do not degrade products and medical equipment; however, she noted that most of the daily cleaning that occurs in the hospital is via disposable wipes, a product that makes it easier to disinfect, but which also has the negative environmental impact of generating extra waste.
Nevertheless, there is still a lot that hospitals can do without changing how they disinfect.
“What we do is focus in on the low-hanging fruit when it comes to cleaning,” shared Ms. Howard. For instance, she encourages hospitals to use products that have been certified as environmentally-friendly when cleaning things like windows, toilets, and carpets. Those products use gentler chemicals that aren’t just better for the environment, they’re better for workers as she often hears complaints about headaches or nausea after stripping and re-coating flooring. Fortunately, newer floor technologies don’t require that cleaning process.
Another issue hospitals face is waste. Efforts to keep hospitals sterile have led to a proliferation of disposable products in the hospital setting. Yet all that waste eventually ends up in landfills.
Brendan Molony, environmental coordinator at Bronson, shared with Contagion® that eliminating waste sometimes involves balancing different concerns.
For instance, Mr. Molony said Bronson is currently evaluating options for the water cups given to patients. Using disposable plastic cups is not an ideal solution from an environmental standpoint; however, reusing cups and bringing pitchers of water from room to room creates a risk of transporting germs. Furthermore, reusable cups require water and energy to clean. According to Mr. Molony, although decision-makers at Bronson are still thinking about the issue, the solution might be to continue using disposable cups and to replace the plastic cups with a more environmentally-friendly product.
“From a sustainability standpoint there are so many different ways to go about it,” Mr. Maloney added. For example, Ms. Howard shared that she would focus first on waste in the cafeteria setting where changes like reusable dishes and silverware can make a major impact on a hospital’s environmental footprint. “There are places where there’s a lot that can be done without any risk,” she said.
When it comes to clinical equipment, Dr. Van Enk shared that Bronson has found ways to reduce waste by re-using certain items that other hospitals might dispose of. He said they ensure the equipment has been fully cleaned and sterilized prior to its reuse by using a US Food and Drug Administration-certified processor.
And, when that sterilized equipment comes back, Ms. Howard said hospitals should also stop using products like blue wrap to store it. Blue wrap is disposable, but it’s no safer than the rigid reusable containers that were used in the past.
As with so much in health care, however, cost is a major limiting factor when it comes to going green.
Financial Bottom Line
“Sadly, the bottom line in health care is cost and trying to reduce it,” lamented Ms. Popescu. “That often sparks a debate between single-use items or ones that can be reprocessed (think blood pressure cuffs).” She explained that those discussions are generally had in terms of patient safety and cost, rather than in terms of waste control.
Dr. Van Enk added that a lot of the major environmental upgrades a health care facility can make require major up-front capital investments.
“It’s easier to do that for new construction and remodeling,” he said. “It’s harder to justify if you’re retrofitting an older building.” After all, if a hospital building is only expected to last 50 years, and you’re halfway through that time frame, he explained, many people would question whether it’s worth investing in more energy-efficient appliances.
“Many hospitals, unless they have a funding source that’s outside of normal patient reimbursement, are basically dependent on their own patient revenue to operate and there’s not much of a margin there,” he said.
There are rebates and other governmental programs available that can help defray the cost of green upgrades, according to Mr. Molony. There are also donors who care about environmental stewardship and donate money to the hospital’s foundation specifically to help the health system make environmental upgrades.
For example, Ms. Howard shared that when Practice Greenhealth works with members, it usually tries to start by finding cost-savings. They will look at a given hospital’s per-square-foot energy usage and find out if it would be able to cut its energy use. If so, the savings can build up a bank of money as well as a bank of goodwill, and that positive experience can help build momentum for later expenses.
Ms. Howard is a strong advocate for the idea that hospitals can be environmentally-friendly, but she said the complicated nature of the issue means it needs to be managed by a team that can look out for not just the environment, but also worker safety and the financial health of the hospital. She said that the team also needs to include infection control specialists to protect patients and ensure widespread buy-in across the team. As such, hospital epidemiologists who aren’t involved in conversations about conservation should find a way to get involved.
“They should have a seat at the table [in this important discussion],” she concluded.