Back to Table of Contents | April 2011

Clinical and Health Affairs

Health Care and the Environment: Local Champions, Global Impact

By Jeanette Augustson, M.A., and Carl Patow, M.D., M.P.H., F.A.C.S.

■ Health care as a sector has recently become aware that it is a major user of energy and generator of waste. Now, many institutions are taking steps to curb their energy consumption, reduce waste, and design processes and facilities that are more environmentally friendly and, as a result, healthier. This article describes these trends as well as specific efforts underway in Minnesota that could serve as models for providers in other parts of the United States.

Doctors, hospitals, and patients tend to embrace new technology. Blazing fast scanners, advanced therapeutic devices, and disposable single-use equipment have improved the experience of and outcomes for patients. But what happens to devices, gadgets, and machines when they become obsolete or can no longer be used? What happens to medical waste? How can hospitals and clinics minimize their impact on the environment? More and more, doctors, nurses, and health care administrators are considering the environmental impact of the choices they make related to technology and their facilities.

Health care as an industry has only recently begun to take its environmental responsibility seriously. This is the result of growing awareness that health care contributes significantly to environmental problems and that environmental problems, especially climate change, contribute significantly to health problems.¹ Thus, physicians have begun to broaden their understanding of their obligation to “do no harm” and see that it extends to the environment as well as to individual patients. As a result of this understanding, health care facilities have begun to implement programs and policies that minimize the impact of their activities on the environment. This article outlines how this often works and describes several initiatives underway in Minnesota that might serve as models for other institutions.

The Green Journey

Most organizations begin their efforts to decrease medical waste and minimize their environmental impact by tackling small and focused problems. For example, they find simple ways to use less paper or stop buying single-use Styrofoam cups. In many cases, a local champion will step forward and energize the effort by leading a committee or study group. These groups often evolve into “green teams” that suggest other common-sense initiatives such as making recycling bins for paper waste and plastic bottles more accessible.

As organizational green teams become more sophisticated, they begin to include departments such as food service, engineering, purchasing, pharmacy, and surgical services. Pharmacies, for example, might be asked to keep medicines out of the waste stream and develop systems to shelve drugs according to their expiration date or refuse samples scheduled to expire soon. As departments pursue change, the organization’s efforts tend to become more comprehensive. They address bigger issues such as energy use, inefficiencies in processes and systems, and medical waste disposal.

The next step in the “green” journey is to incorporate sustainable thinking into the design of new and remodeled and renovated space. Architects and facility planners are becoming increasingly savvy about including environmental considerations in facility plans. They are using sustainable materials and those made from low-volatile compounds both to improve indoor air quality and to lessen the impact of the building on the environment. Many are incorporating outdoor features such as rain and rooftop gardens, sustainable landscapes, and healing gardens. And they are trying to reduce the use of toxic substances in cleaning and other products. The Center for Health, Environment, and Justice reports that hundreds of health care institutions in the United States are undertaking efforts to reduce their use of products that contain polyvinyl chloride (PVC) and/or Di(2-Ethylhexl) Phthalate (DEHP).²

Health care facilities are also looking at generating energy and becoming more energy efficient in order to reduce fossil fuel consumption and save money. The U.S. Environmental Protection Agency estimates that 30% of the health care sector’s current energy use—costing $1.95 billion—could be reduced without sacrificing quality of care through a shift toward energy efficiency and use of renewable energy sources.³ Construction practices such as increasing wall and ceiling insulation, using double-paned windows, and assuring proper ventilation can significantly contribute to lower fuel costs and energy savings.

Health care facilities are also becoming aware that disposal of equipment can cause the release of hazardous substances that may be toxic to humans. For example, there are chlorinated plastics in cable wiring, lead in cathode ray tube (CRT) monitors, brominated flame retardants in computers, and mercury in LCD displays.⁴ Improper disposal poses significant threats to the environment and to people. Dumping medical technology into landfills may result in the release of heavy metals into the water table, contaminating groundwater and polluting the air. Incinerating it may foul the air. Incorrect disposal of equipment in developing countries has caused children and adults to be exposed to toxic and radioactive substances.

What Area Hospitals and Clinics Are Doing

A number of clinics and hospitals in Minnesota and Wisconsin have launched programs to reduce the size of their environmental footprint and make their facilities healthier. In fact, many hospitals now have extensive programs. Here’s a sampling of what some are doing:

Regions Hospital in St. Paul began recycling the blue wrap used in its OR to cover surgical instruments in 2009. Last year, this effort kept more than 10,000 pounds of the wrap out of landfills. Regions also reprocesses (cleans, tests, and sterilizes) single-use medical devices that in the past would have been thrown away, saving $300,000 per year. Devices that can be recycled in this way include surgical instruments such as cutting tools, burrs, catheters, endoscopes, and cannula sets.

Minneapolis-based Fairview Health Services is decreasing the amount of recyclables in its waste stream. In early 2009, Minnesota Waste Wise (www.mnwastewise.org), a nonprofit organization that assesses organizations’ recycling practices, performed an environmental sustainability assessment and did waste-stream analyses at two Fairview locations. Although Fairview had recycling programs in place, items were going into the trash that could have been recycled such as cans, bottles, glass, and nonconfidential office paper. Fairview is now recycling 30 more tons each month than it was before doing the waste-stream analysis. Since 2009, Fairview has saved more than $900,000 because of this and other waste-reduction projects and initiatives.

St. Luke’s Hospital in Duluth purchases food from local sources whenever possible. Buying locally decreases transportation costs and fuel consumption, stimulates the local economy, and provides fresh food for patients and their families.

St. Luke’s and Hennepin County Medical Center in Minneapolis both have rooftop gardens that produce fresh vegetables and herbs that are used in the hospitals’ cafeterias, reducing transportation and storage costs.

In 2008, Bloomington-based HealthPartners began using recyclable vials for the more than 50,000 prescriptions its pharmacies fill every month. The new University of Minnesota Amplatz Children’s Hospital followed LEED (Leadership in Energy and Environmental Design) principles as it designed and built its new facility.⁵ It used lumber from sustainable forests, low-volatile organic compound paints, sorghum wallboard, and a nonvinyl flooring made with linseed oil and backed with jute fibers. The terrazzo flooring in the lobby incorporates recycled glass and mirrors.

Ridgeview Medical Center in Waconia has been a champion of sustainability since 2001. When renovating a laboratory recently, Ridgeview officials chose nonvinyl wall coverings to improve indoor air quality and mobile furniture to make the workspace more flexible in hope of minimizing the need for future renovations.

The campus of Hudson Hospital and Clinics in Hudson, Wisconsin, has outdoor gardens featuring native, drought- resistant plants. The landscape design conserves water and is a source of comfort to patients and families.

Olmsted Medical Center in Rochester has adopted “green” cleaning policies that decrease staff and patient exposure to toxic and allergenic chemicals. St. Cloud Hospital in St. Cloud reduced its natural gas costs by 38% per square foot between 2009 and 2010 by taking measures such as upgrading heating, cooling, and ventilation systems; installing energy-efficient motors, equipment, and lighting fixtures; installing compact fluorescent lamps (CFL) and light-emitting diode lamps (LED); using automated control systems that manage energy use; conducting annual comprehensive energy audits; and simply having employees turn off lights when leaving a room or turn off computers at the end of the day.⁶

Gundersen Lutheran in La Crosse, Wisconsin, is developing its own energy infrastructure. Its goal is to meet 100% of its facilities’ energy needs by 2014 through both conservation and power generation. Its renewable energy project takes waste biogas, primarily methane discharged from a local brewery’s waste treatment facility, and turns it into 3 million kilowatt hours of electricity per year—enough electricity to power 299 homes. The initiative has the same positive impact on the environment as planting 490 acres of forest or removing 395 cars from the road.⁷

Beyond Buildings

In addition to individual hospitals and clinics, entire communities need to take action to improve the health of their population and the health of their environment. One way they can do this is by avoiding unnecessary and wasteful duplication. Community leaders should be asking themselves a number of questions as they consider plans for hospital and clinic expansions: How many specialty hospitals are needed in a given area? How many MRI scanners and other high-tech devices and facilities are needed? How can care be made accessible (particularly in rural areas) without requiring people to drive great distances? Through coordination and planning, communities can find ways to decrease energy utilization, reduce unnecessary duplication of technology and resources, and maintain essential access to care.

The health care industry has a major stake in improving the environment, and doing so is increasingly a matter of health. A 2009 article in The Lancet called climate change the biggest global health threat of the 21st century.1 The World Health Organization predicts that temperature shifts will lead to the spread of infectious diseases and an increase in deaths and injury from environmental disasters.8 Extreme weather events such as floods and droughts already are having a dramatic effect on the health of people around the world, especially those living near rivers, in coastal areas, and on islands.

Only recently has the health care industry begun to take its environmental responsibility seriously. Leaders of Minnesota health care organizations are taking steps to improve the health of their facilities, their staff members, and the patients they serve. These efforts could serve as models for other organizations throughout the United States. MM

Jeanette Augustson is senior manager of operations and Carl Patow is executive director of HealthPartners Institute for Medical Education.
 

References
1. McMichael AJ. Climate change and human health: present and future risks. Lancet. 2006; 367 (9513): 859-69.
2. Center for Health, Environment, and Justice. PVC: The Poison Plastic. Company PVC Policies. Available at: www.besafenet.com/pvc/companypolicies.htm. Accessed March 14, 2011.
3. Health Care Without Harm. Health Impacts of Climate Change. Available at: www.noharm.org/us_canada/issues/climate/. Accessed March 14, 2011.
4. Health Care Without Harm. Electronics. Available at: www.noharm.org/us_canada/issues/toxins/electronics. Accessed March 14, 2011.
5. Deegan M. University of Minnesota Amplatz Children’s Hospital. MDNews. Feb 2011. Available at: www.mdnews.com/news/2011_02/05838_feb2011_university-of-minnesota. Accessed March 14, 2010.
6. CentraCare Health System. Green Initiatives: Environmental Sustainability. Available at: www.centracare.com/hospitals/sch/green_initiatives.html. Accessed March 14, 2011.
7. Gundersen Lutheran. Environmental Leadership. Available at: www.gundluth.org/green. Accessed March 14, 2011.
8. World Health Organization, Health Care Without Harm. Healthy Hospitals, Healthy Planet, Healthy People. Discussion Draft. 2009. Available at: www.who.int/globalchange/publications/healthcare_settings/en/index.html. Accessed March 14, 2010.