June 2008

Dear Colleague:

This edition of Premier's Green Link newsletter brings you the latest news, resources, and cost-saving success stories in green purchasing and healthcare practices. Please share with your colleagues so they can subscribe and join our 12,000 readers.

Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute

• Premier's Green Corner: Case studies, success stories on green purchasing and healthcare practices
• Key sustainability organizations create Practice Greenhealth for greater effectiveness
• Global Health and Safety Initiative launched to share best practices
• AHRQ offers free DVD with case studies for evidence-based design
• New carpet standard seeks to promote sustainability and reduce waste
• NIOSH Prevention through Design - Safer products and environmental design
• Cost and energy savings with transparent low-e glass
• Practical guidance on energy-efficient improvements with return on investment
• Green, safer fabric alternatives – New report urges leadership by industry

Premier's Green Corner

Case studies – Success stories on green purchasing and healthcare practices

Visit the Safety Institute’s Green Corner Web site with more than 60 case studies of healthcare organizations and suppliers that are taking their environmental responsibility seriously – and sharing their success stories. Topics include:

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Key sustainability organizations create Practice Greenhealth for greater effectiveness

Practice Greenhealth resources
The newly combined organization offers its members a full range of tools, resources, forums, technical assistance, and networking opportunities to engage the healthcare design, construction and operations sectors in creating safe, healthy healthcare environments. This powerful combination of leading sustainability initiatives offers greatly enhanced services, including:

• Assistance from the HCEE to lower facilities' energy bills while increasing the percentage of clean energy in their energy procurement portfolios. This can cut energy costs from 5 percent to 30 percent, while reducing the facilities' carbon footprint.
• Strategies and services to achieve the integrated design, construction, and operation of high-performance healing environments, as defined by the GGHC. The Green Guide is a foundational document for the U.S. Green Building Council’s "LEED for Healthcare," a third party certification rating system, due to launch in spring 2008.
• H2E brings to PGH its full range of tools and resources including Webinar series, peer networking events, the Waste Data Tracking Tool, national environmental excellence awards, a new business alliance, and much more.

Practice Greenhealth is committed to working with three categories of organizations in moving environmental sustainability in healthcare and has structured fees accordingly:

• Facility partners – Healthcare facilities and health systems committed to environmental sustainability. Membership fees are based on the number of licensed beds per facility. Discounts apply if health systems sign up a percentage of their facilities at the same time.
• Business alliance – Includes architecture and engineering firms, service providers, consultants, group purchasing organizations, and product vendors, distributors, and manufacturers. Membership fees are based on the type of business and annual revenue.
• Strategic resource network – Includes government and non-government agencies, technical resources, hospital and professional associations, and nonprofit organizations.

Some healthcare organizations have asked about the rationale for moving from free to a fee-based membership organization. PGH explains that the success of the free programs, tools and services from each of the organizations forming the new PGH dramatically exceeded capabilities – coupled with dwindling foundation grants and significant cuts in the availability of government funding. "We have attempted to create a fee structure that reflects the value of our suite of tools and resources and enables us to support and expand our offerings," said Mark Tecca, business alliance manager for PGH. PGH's new identity – based on the understanding that protecting the environment is a health imperative – symbolizes the recognition of the huge strides the healthcare industry has made toward a sustainable healthcare sector.

Downloads and links

• Practice Greenhealth brochure For membership information Contact Julie Taylor or Mark Tecca at 603.795.9966
• Practice Greenhealth Background from Healthcare Design Magazine; search on "Practice GreenHealth"
• Green Guide for Health Care
• Hospitals for a Healthy Environment

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Global Health and Safety Initiative launched to share best practices

An influential group of leading healthcare systems, environmental leaders and healthcare industries created the Global Health and Safety Initiative (GHSI), a major, first-of-its-kind partnership, to energize healthcare efforts to help spread green practices across the industry, create leverage in the marketplace for practices that improve patient and worker health and safety while reducing the healthcare industry’s environmental footprint.

October 2007 marked the initiative’s kick-off meeting and drew 22 healthcare systems representing 200 hospitals, as well as hospital alliances including Premier. A growing number of hospitals and healthcare organizations, non-profit organizations, architectural and engineering firms, academia, industry and governmental organizations joined together to build a social movement within healthcare to improve patient safety, workplace safety and environmental health and safety. GHSI receives support from the non-profit groups Health Care Without Harm, the Center for Health Design, and Hospitals for a Healthy Environment (now part of Practice Greenhealth - see related story).  GHSI identified four first-year goals at the kick-off meeting:

• Create widely accepted green purchasing guidelines with the goal of using healthcare’s purchasing clout to drive markets toward cleaner energy, safer products, and innovative green technologies;
• Develop a shared research agenda to prioritize research for the improvement of environmental, patient and worker health and safety;
• Develop open source sharing of information and best practices across the industry;
• Develop an eco-footprint tool tailored specifically to the healthcare industry.

GHSI organizers recognized the need for a collaborative effort to move the healthcare sustainability agenda. Healthcare is one of the largest and fastest growing sectors of the economy, representing more than 15 percent of the nation's gross national product and a large eco-footprint. Healthcare facilities in the United States generate 2 million tons of waste per year that pose occupational health and environmental threats. In addition, healthcare accounts for 11 percent of all commercial energy use in America and is a major water consumer.

Downloads and links

• Global Health and Safety Initiative – How To Get Involved
• PracticeGreenhealth
• Health Care Without Harm
• Greener, safer products, Premier Safety Institute

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AHRQ offers free DVD with case studies for evidence-based design

Evidence-based design (EBD) is a term used to describe how the physical design of healthcare environments affects patients and staff based on the best available information and research evaluations. Key characteristics of EBD in hospital settings include single-patient rooms, use of noise-reducing construction materials, easily accessible workstations, and improved layouts for patients and staff. Patient safety outcomes addressed by these designs include falls, hospital-associated infections and medical errors.

A new, free DVD from the Agency for Healthcare Research and Quality, "Transforming Hospitals: Designing for Safety and Quality,"  reviews evidence-based hospital design and how it increases patient and staff satisfaction and safety, quality of care, employee retention, and results in a positive return on investment. A growing body of literature describes the link between a hospital’s physical design and its key quality and safety outcomes.

The DVD presents the experiences of three model hospitals - Griffin Hospital in Derby, CT; Holy Cross Hospital in Silver Spring, MD; and Woodwinds Health Campus in Woodbury, MN - that incorporated EBD elements into their construction and renovation projects. Hospital planners, expected to spend nearly $250 billion on new construction in the next 10 years, are consulting this evidence and incorporating it into their designs for capital construction projects. Hospital executives planning or executing major capital construction projects or minor renovations can use the information presented in this DVD to help identify how EBD can improve the quality and safety of their hospitals’ services.

Downloads and links

• Download DVD summary Transforming Hospitals: Designing for Safety and Quality
• Premier Safety Institute - Safer, green building design See AHRQ Designing hospitals for safety for information on ordering the DVD and more on evidence based design.

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New carpet standard seeks to promote sustainability and reduce waste

Use of sustainable floor covering materials and reduction of the environmental impact caused by the manufacturing of these floor coverings are addressed in a new standard that should help organizations achieve LEED certification, with the goal that at least 40 percent of the total amount of carpet produced will be diverted from landfills by 2012.

In an effort to encourage the use of sustainable materials and reduce the environmental impact caused by the manufacturing of these floor coverings, two members of the American National Standards Institute (ANSI) have spearheaded the publication of a new standard, NSF/ANSI 140-2007, Sustainable Carpet Assessment. The Carpet and Rug Institute teamed with NSF International, an ANSI-accredited standards developer, to design a certification system for sustainable carpeting. End users, architects, government officials, academics, and manufacturers weighed in on the new standard, which measures the environmental footprint of carpet products in five major performance categories:

• Public health and environment
• Energy and energy efficiency
• Bio-based, recycled content materials, or environmentally preferable materials
• Manufacturing
• Reclamation and end-of-life management

The standard was developed in order to increase the economic value of sustainable carpet throughout the supply chain and to provide information to help specifiers and supply chain stakeholders sort out information on sustainable attributes. In addition, the standard should encourage manufacturers and their suppliers to seek out or develop environmentally preferable processes, practices, power sources, and materials.

• Minimizing the use of pollutants.
• Using renewable energy and implementing energy conservation measures.
• Using bio-based materials, renewable agricultural materials, or recycled material.
• Minimizing the generation of waste materials during production.
• Adhering to the Memorandum of Understanding for Carpet Stewardship;
  this states that by 2012, at least 40 percent of the total amount of
  carpet produced will be diverted from landfills.

Downloads and links

• Download NSF/ANSI 140-2007 ordering information go to
  http://www.ansi.org/news_publications/news_story.aspx?menuid=7&articleid=1700
• Green purchasing Premier Safety Institute
• Greener, safer products Premier Safety Institute

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NIOSH Prevention through Design - Safer products and environmental design

One of the best ways to prevent and control occupational injuries, illnesses, and fatalities is to "design out" or minimize hazards and risks early in the design process. NIOSH is leading a national initiative called Prevention through Design (PtD)  to promote this concept and highlight its importance in all business decisions. The concept of PtD can be defined as: Addressing occupational safety and health needs in the design process to prevent or minimize the work-related hazards and risks associated with the construction, manufacture, use, maintenance, and disposal of facilities, materials, and equipment.

A growing number of business leaders recognize PtD as a cost-effective means to enhance occupational safety and health. Many U.S. companies support PtD concepts and have developed management practices to implement them.

Approach to organizing PtD
The approach that is being used to develop and implement the PtD National Initiative is framed by industry sectors within four functional areas: Research, Education, Practice, and Policy. This process encourages stakeholder input through a sector-based approach consistent with the one used under the National Occupational Research Agenda (NORA). The ultimate goal of the PtD initiative is to prevent or reduce occupational injuries, illnesses, and fatalities through the inclusion of prevention considerations into all designs that impact workers. Along the way, intermediate goals will be identified to provide a path toward achieving the ultimate goal. NIOSH serves as a catalyst to establish this initiative and includes the design of work premises, structures, tools, plants, equipment, machinery, materials, work methods, and systems of work.

PtD launch
The first Prevention through Design (PtD) Workshop was held in Washington DC in July 2007 PtD and attracted approximately 225 participants from diverse industry sectors and disciplines including healthcare. Participants in industry-centered breakout sessions identified opportunities and barriers, and developed recommendations for each industry. Cross-industry breakout sessions then mapped out the over-arching issues for PtD in Research, Education, Practice, and Policy. The output from the workshop is being used to develop a strategic plan that highlights actions and milestones to institutionalize the concept throughout the United States. The first 2008 PtD newsletter, "PtD in Motion" has been distributed and is available on the NIOSH PtD Web site.

PtD in action - University of Lowell
Margaret Quinn ScD, I.H., Director of the Sustainable Hospitals Program (SHP) at the University of Massachusetts Lowell and a facilitator at the PtD workshop described an application of PtD in a recent PtD in Motion newsletter. The project evaluated potentially hazardous products, their function in the work process, associated job requirements and work practices, and possible alternatives. The SHP team performed an evaluation of mercury manometers, which are used in pulmonary labs and blood gas machines, revealing mercury-free manometers did not give readings in the desired units of measure. The SHP team then bridged the gap between a mercury-free manometer manufacturer and the hospital. The manufacturer modified the device for the desired readout and the outcome was beneficial for the patients and healthcare works, and yet remained mercury-free – a benefit also for the environment. See the first, February 2008 issue of the "PtD in Motion" newsletter for additional practical examples.

Downloads and links

• NIOSH PtD Home http://www.cdc.gov/niosh/topics/PtD
• Download "PtD in Motion" February, 2008
• Stainable Hospitals Program (SHP) Web site http://www.sustainablehospitals.org
• Safety A-Z, Premier Safety Institute

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Cost and energy savings with transparent low-e glass

Transparent low-emissivity (low-e) glass can save up to $400,000 in upfront capital cooling equipment costs and ongoing energy-related savings up to $97,000 per year according to recent findings. A recently published white paper highlights the environmental and economic advantages of specifying transparent low-e glass in commercial buildings.

The 24-page technical document summarizes a study comparing the energy and environmental performance of the low-e glass with that of dual-pane tinted glass and several other commonly specified high-performance architectural glasses.

Depending on the size, type, and location of a building, the study showed the low-e glass has the potential to reduce initial air-handling (HVAC) equipment requirements by up to 20 percent, or more than $400,000, when specified in place of dual-pane tinted glass. According to the same study, ongoing energy-related savings could range from $43,000 to $97,000 per year, based on 2006 energy prices.

Using calculations provided by the U.S. Department of Energy, the white paper demonstrates that substituting low-e glass for dual-pane tinted glass in a standard, window-walled, eight-story office building could reduce annual carbon dioxide emissions by more than 500 tons, or more than 20,000 tons over the building's life cycle - equivalent to removing more than 4,000 passenger cars from the road each year. PPG Industries, a manufacturer of the low-e glass, Solarban 70XL, commissioned Architectural Energy Corporation (AEC), a business-to-business energy engineering firm, to carry out the comparative study.

Download and links

• Download the white paper (.pdf)(144KB) or go to http://corporateportal.ppg.com/NA/IdeaScapes/solarban_z50.htm
• More on Safer, green buildings Premier Safety Institute

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Practical guidance on energy- efficient improvements with return on investment

The Green Guide for Health Care's (GGHC) report, "A Prescriptive Path to Energy Efficiency Improvements for Hospitals,"  provides for the first time to hospitals, a set of energy efficiency criteria tailored to the healthcare sector. According to the 2003 Commercial Buildings Energy Consumption Survey published by the U.S. Energy Information Administration, inpatient healthcare facilities average 2.7 times the gross energy use intensity of office buildings. However, hospitals' exemption from compliance with state and local energy codes in most municipalities across the country has reduced energy efficiency in hospital design and construction to a secondary consideration for owners and design teams.

The report is a peer-reviewed methodology for hospitals greater than 70,000 square feet to achieve a 14 percent energy efficiency improvement over ASHRAE Standard 90.1-2004 in all U.S. climate zones. Compliance with this methodology is designed to qualify projects to earn two points through Energy & Atmosphere "Credit 1: Optimize Energy Performance." The report's methodology has been adopted in GGHC v2.2, and is being considered for adoption in "LEED for Healthcare" scheduled for publication spring 2008.

Promoting the design of energy-efficient hospitals and healthcare facilities is a core component of the GGHC. The Prescriptive Path report identifies cost-effective strategies to reduce energy consumption in a single set of 11 Energy Efficiency Measures (EEMs). The EEM set can be applied across U.S. climate zones with a high level of confidence and without the expense, technical resources, and capacity needed to develop an energy model. All EEMs were evaluated for climate dependency, return on investment, practicality, reliability of savings, maintenance requirements, and predictability of savings.

A joint research committee representing both the GGHC Steering Committee and the "LEED for Healthcare" core committee developed the Prescriptive Path report. Steven Winter Associates and Viridian Energy and Environmental, LLC, provided energy modeling services. The report was funded by New York State Energy Research and Development Authority, the Massachusetts Technology Collaborative, and two California utilities - Pacific Gas & Electric and Southern California Edison. Through generous support from the Environmental Protection Agency, ICF International performed a sensitivity analysis to verify the Prescriptive Path's applicability to all U.S. climate zones.

Downloads and links

• Download "A Prescriptive Path to Energy Efficiency Improvements for Hospitals," or;
• Purchase a printed version of the report. Go to: http://www.gghc.org. Log in, and go to the downloads section of the Web site.

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Green, safer fabric alternatives – New report urges leadership by industry

A new report was published to assist the efforts of healthcare practitioners, architects, interior designers and fabric manufacturers to help transform the fabric industry into a leadership role in developing safer and sustainable materials.

The purpose of the report "Future of Fabric" is to help all stakeholders develop an awareness of the potential hazards associated with fabric and to spur the development and use of safer alternatives. It provides:

• A brief history of fabrics;
• A summary of some of the key chemicals of concern found in fabrics that have been developed and marketed to meet the high performance demands of key contract markets including healthcare;
• An overview of standards and certification programs governing fabric; and
• Examples of some of the innovative efforts coming to market from fabric manufacturers, nonprofit organizations and trade associations as they begin to bring safer materials into hospitals and other healthcare institutions.

Many sectors of the fabric industry, have already responded by removing or substituting some of the worst-in-class chemicals from their products and investing research dollars into bio-based materials and safer alternatives.

The report is based upon scientific studies, government documents and industry information obtained through the authors’ work with manufacturers and healthcare organizations via Internet-based research. The monograph was published by Health Building Network (HBN), in conjunction with Health Care Without Harm’s Research Collaborative (HCWH).

Downloads and links

• Download The Future of Fabric- Healthcare
• Healthy Building Network
• Health Care Without Harm
• Green purchasing Premier Safety Institute

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