Making Hospitals Greener — and Patients Healthier

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Ear thermometers use an infrared beam to detect temperature, rather than mercury.

A doctor's principle code is, "First, do no harm." The irony is that your doctor's office or hospital may be making you sicker. Indeed, many hospitals are built with materials, like particleboard, PVC flooring and even conventional paint, that can leach poisonous substances. What's more, the chemicals used to clean hospitals — chlorine, laundry detergents and softeners, ammonia — contain toxic ingredients and can cause respiratory disease. In fact, studies suggest that nurses, who spend long hours at the hospital, have among the highest rates of environmentally induced asthma of any profession.

In the typical hospital, "while we are trying to treat or cure illness and disease...we expose our staff and patients to irritants and carcinogens, and our treatments often contribute to the development of other diseases," says Dr. Kristin Bradford, a family physician in Willits, Calif. (See the Year in Health, from A to Z.)

Enter "green medicine" — the effort to detoxify the healing environment and enhance patients' and employees' health, while reducing costs all around. The international advocacy group Health Care Without Harm (HCWH) — whose 2006 study of 1,200 nurses suggested a link between the hospital environmental and health problems among the staff — has been a pioneer in the movement, recently initiating collaborative research among major U.S. health systems to document how removing toxins from the environment impacts worker safety and lost time due to employee illness.

It was HCWH, for example, that in the mid-1990s got U.S. hospitals to stop using thermometers containing mercury, a potent neurotoxin associated with health problems, such as respiratory, kidney and gastrointestinal disorders, as well as interruption of fetal development (which occurs when pregnant women consume too much mercury, usually through fish). Today most hospitals have swapped out their mercury-based measuring devices — including sphygmanometers, which are used to measure blood pressure and contain more mercury than thermometers — for safer alternatives.

The problem with mercury is, of course, that it can escape — think how easy it is to break a thermometer. The vast majority of health-care-related mercury emissions, however, happen outside hospital walls. "When we started HCWH, in 1996, medical-waste incinerators [generated] 10% of all mercury air emissions as well as being a major source of mercury water emissions," says Gary Cohen, a co-founder and co-executive director of HCWH. In 1997, the last year for which data is available, according to the EPA, the health-care sector was the country's fourth largest source of mercury emissions, and mercury fever thermometers alone accounted for about 17 tons of mercury deposited yearly in solid waste landfills. Despite the lack of hard data, industry watchers estimate that the phase-out of mercury-based instruments has greatly reduced that burden.

Over the same time period, hospitals began eliminating their incinerators altogether, reducing one of the toxic byproducts of burning waste: dioxins. Says Gary Cohen: "In 1996 there were 4,200 medical incinerators in the country. Now there are 83."

Cohen says that the HCWH is now also urging hospitals to replace their ubiquitous PVC (vinyl) flooring with rubber floors. PVC can emit toxins such as dioxin and phthalates, particularly when wet, which studies suggest may affect reproductive health and fetal development, and may also trigger asthma. "Hospitals change to rubber flooring because of the toxic emissions," says Cohen, "As it turns out, switching to rubber actually cuts down on noise and reduces slips and falls, which are also a threat to patient and worker safety."

The investment in new flooring, says Cohen, also saves hospitals money, if one considers the costs over the entire life cycle of a produc. Although PVC flooring is cheap to buy, it ends up costing more later; its tendency to become brittle requires frequent maintenance or replacement. The environmental costs are high as well. With PVC flooring, "the manufacturing process creates dioxin. In the end, it is burned, releasing additional dioxin. In between, there's the [emission] of phthalates," says Cohen, noting that PVC is found throughout the hospital, not only in flooring, but also in shower curtains, blood bags and intravenous tubing. "If you can have a safer IV system without exposing patients to toxic substances, especially pregnant women and babies in the neonatal intensive care unit, then hospitals have a responsibility to replace PVC with safer alternatives." Fortunately, safer alternatives exist and may cost as much or less as PVC products.

Hospitals have also managed to save money by greening their cleaning supplies. The Hackensack University Medical Center's pediatric oncology center in New Jersey swapped its toxic-chemical-laden cleaners for its own custom-made natural products, dropping cleaning costs by 15% — and, more important, minimizing employees' and young patients' exposure to irritants and harsh substances, such as ammonia. The hospital has also developed a "Greening the Cleaning" program for other hospitals, schools and organizations and, more recently, even began selling a consumer product line that includes laundry detergent and glass cleaner.

The idea of greener — and cheaper — health is catching on fast among health-care CEOs. Some 150 registered health-care industry construction projects currently underway — involving about 30 million sq. ft. of new building space — have pledged to adopt the Green Guide for Health Care (GGHC), a sustainable design toolkit developed in part by HCWH, which helps the health-care sector construct healthier buildings from the start, according to Cohen. For example, the guide suggests ways to maintain indoor air quality, as indoor pollution can cause or aggravate many health conditions and threaten the well-being of patients with compromised immune systems.

But much can be done without building anew, and although support at the executive level is crucial, the impetus for change can come from any member of the staff. At the Community Hospital of the Monterey Peninsula in Calif., for instance, Joy Colangelo, an occupational therapist, helped launch the "Green Team" about six months ago. The team's first task was to do a "waste audit" in order to tally unnecessary expenditures, says Colangelo. She found that the hospital's heart department was churning out 20 pages of patient-identification labels per patient, but using only six.

Beyond cutting down waste, says Colangelo, the hospital also attempts to wield the "power of aesthetics to heal," with musical performances, a koi pond filled with 70 koi in the atrium, a "healing garden" and a nursing floor that wraps around a waterfall and patio. All patient rooms also have large windows that provide views of nature and lots of natural light — which cuts electricity costs and is associated with high staff morale and better patient outcomes. "Our green efforts are done under the premise that we have two patients, the environment and the ill patient," says Colangelo, "and the ill patient can't get well without improving our environment."

See the top 10 green ideas of 2008.

See TIME's special report on the environment.