Teaching hospitals across the country have moved far beyond putting out blue recycling bins to promote the planet’s sustainability and the health of its population. To put the brakes on harmful environmental practices, academic medical centers have been incorporating energy-efficient features in new buildings, reprocessing medical equipment, and reducing waste.
There are many reasons for institutions to improve their environmental profiles. By going green, teaching hospitals are having a positive effect on population health and social determinants of health. Cleaner air reduces the incidence of asthma and reducing hazardous chemical waste lowers the risk of potentially harmful microorganisms that can infect people. And hospitals are finding that they can save thousands of dollars by being environmentally conscious—money that can now be spent on patient care or medical research.
The “greening” of hospitals began in the 1970s after the environmental movement emerged with individual departments opting to make simple changes like recycling bottles and cans. Even two decades ago, incinerating mercury from broken thermometers or dumping it down the drain (ultimately landing in lakes and oceans) was common practice. Today, mercury measurement devices are being phased out.
What started as a grassroots effort to go green has spread throughout the University of Wisconsin Hospital and Clinics (UWHC) and changed the mindset on campus, said Shannon Bunsen, UWHC’s sustainability specialist, about efforts to implement green practices throughout the organization. “UW Health began to make decisions through a lens of sustainability, incorporating it into the strategic plan, new employee orientation, and patient and stakeholder communications.” UW Health, in fact, added a commitment to sustainability in its mission statement.
“It’s about wellness in the community, being a good environmental steward, and helping keep patients out of the hospital,” Bunsen added. “We realize that you don’t have to compromise patient care.”
Building it green
Greener innovations are common now in new hospital construction. Architects are incorporating energy-efficient mechanical systems and designing more environmentally friendly structures that conserve natural resources.
As the sun beams through the glass façade of New York–Presbyterian’s Vivian and Seymour Milstein Family Heart Center, electronically controlled vertical shades track its movement to maintain a temperate internal environment. The facility also features occupant-sensitive lighting and computer-controlled heating and ventilation.
A number of hospitals have built roof gardens—green environments shown to help patients reduce anxiety and blood pressure and speed recovery from surgery. The gardens can also give families and staff a calming respite from the bustle of the hospital floors below.
Atop a building at Thomas Jefferson University Hospital in Philadelphia, a vegetative roof was planted with sedum, a succulent that needs little watering. The green roof absorbs rainfall, reducing the consumption of water from local purification plants. The plants produce oxygen through photosynthesis and absorb sunlight, reducing the amount of solar heat that would normally be reflected back into the atmosphere.
Sun and wind
More institutions are moving away from fossil fuels toward renewable sources of energy and more efficient heating, ventilation, and air-conditioning systems. Health care facilities account for 11 percent of all commercial use of energy annually, according to sustainability personnel at Thomas Jefferson University and Hospital, which obtains 35 percent of its electricity from a wind farm in northern Pennsylvania. The hospital also built a new energy-efficient chilled water plant that provides cooling to six buildings and saves water and more than $1 million a year in energy costs.
“Since 2000, Jefferson has saved more than $132 million by implementing energy saving measures,” explained Randolph Haines, energy manager. “Our campus has grown by 25 percent, but the energy we’ve used has remained virtually unchanged.”
Jefferson is embarking on a new program projected to save $2 million per year by replacing less efficient equipment and technology. All its 85,000 fluorescent lights will be replaced with energy-efficient and LED bulbs, for example. Occupancy sensors will automatically turn off lights in unoccupied areas and send a signal to a control system to turn down the volume of air entering a vacant room.
The George Washington University Hospital (GW Hospital) relies on the sun for half of its electrical use. It partners with American University, the George Washington University, and Duke Energy to bring solar power from a North Carolina power grid to the Washington, D.C., region. GW Hospital is committed to the production of solar energy equal to 50 percent of its yearly consumption, which is about 10,000 megawatt hours per year.
Reducing, treating, and safely disposing of waste
Despite progress, the World Health Organization reports that each hospital or nursing home bed in the United States currently generates about six pounds of waste daily—one pound of which is considered hazardous (infectious materials, potent chemicals and drugs, or radioactive material). Plastics also slowly release toxins as they break down, which can worsen waste problems.
Operating rooms (ORs) are among hospitals’ heaviest users of supplies and largest producers of waste. According to Practice Greenhealth, a nonprofit organization promoting environmental stewardship in the health care community, U.S. hospitals create 5.9 million tons of waste annually. Of that waste, between 20 and 30 percent of it is generated by the OR, according to the organization.
Rather than incinerating waste, Practice Greenhealth and other environmental groups encourage hospitals to implement technologies to treat waste through autoclaves, microwave units, hybrid steam treatment systems, and other steam-based technologies. Under guidelines issued by the U.S. Food and Drug Administration (FDA), hospitals are also reprocessing more single-use and reusable medical devices.
Sometimes waste reduction begins with a simple observation. Anesthesiologists at UWHC noticed that sterile, single-use items were often opened before a patient entered the OR and then wasted if a last-minute change occurred. Now, these supplies aren’t opened until the patient enters the room. Anesthesia and surgical services are also recycling sterile wrappers. Recycling efforts have resulted in an 18 percent reduction in landfill waste produced by the OR.
“U.S. hospitals create 5.9 million tons of waste annually. Of that waste, between 20 and 30 percent of it is generated by the OR.”
Among measures to reduce paper waste, UWHC orders only copy paper with at least 30 percent recycled content, and double-sided printing is the default print option for all networked printers. Switching to double-sided printing reduced UWHC’s paper use by 25–30 percent, lowering costs between $11,000 and $13,000 each month.
In addition to reducing the amount they incinerate, other hospitals have adopted purchasing practices to avoid products containing DEHP, a compound that the FDA says has produced a range of adverse effects in animals. IV bags, blood and respiratory tubing, and nasogastric feeding tubes are commonly made of polyvinyl chloride (PVC) plastic, which contain DEHP. By seeking out safer alternatives, institutions have reduced their use of hazardous materials.
And in the kitchen…
As hospitals feed thousands of patients, visitors, and staff each day, food contributes to about 10 percent of a hospital’s overall waste stream, according to Sustainability Roadmap for Hospitals, a 2014 report published by the American Hospital Association (AHA). To improve their bottom line and be more environmentally responsible, some hospitals are adopting sustainable food practices, such as composting food waste into nutrient-rich soil used in landscaping around the hospital or adding dehydrators to disposal systems to reduce the volume of food waste sent to landfills. “Waste management initiatives offer tremendous opportunities for a facility to reduce both its environmental footprint and its supply chain and waste disposal expenses,” the AHA report noted.
Forming partnerships has helped to promote sustainable food sourcing for several Philadelphia hospitals. Temple University Hospital, Einstein Medical Center, Pennsylvania Hospital, and Jeanes Hospital worked together with a food distributor to obtain most food produced from within the region. This enterprise helps hospital kitchens shrink the organization’s carbon footprint because locally sourced fruits and vegetables require less transportation and refrigeration than trucking in lettuce from California or strawberries from Florida.
All these sustainability efforts can pay off in multiple ways. “Hospitals that hire sustainability directors and energy managers and make the connection to population health and community benefit are the ones daring to think differently and to get the rewards … and reduce costs,” said Janet Howard, director of Practice Greenhealth’s Healthier Hospitals program and member engagement. “Shouldn’t teaching institutions teach their next generation of care providers and public health advocates about environmentally responsible health care?”