2. The Ashkin GroupThe Green Cleaning Experts Green Cleaning in Hospitals Cleaning to Protect Health Without Harming the Environment Stephen P. Ashkin 812 / 332-7950 SteveAshkin@AshkinGroup.com www.ashkingroup.com

3. The Ashkin GroupThe Green Cleaning Experts The Ashkin Group Mission: Green the cleaning industry We do NOT see ourselves at advocates. Rather, we aspire to be “transformers.” Our clients include building owners & managers, contract cleaning services, product manufacturers & distributors, policy makers, environmental organizations, and others.

4. The Ashkin GroupThe Green Cleaning Experts “Never doubt that a small group of thoughtful committed citizens can change the world. In fact, it’s the only thing that ever has.” Margaret Mead Commitment

5. The Ashkin GroupThe Green Cleaning Experts The Process of Change Defining Green and Green Cleaning The Cleaning Plan Green Cleaning Opportunities and Examples Discussion Overview

6. The Ashkin GroupThe Green Cleaning Experts Essential to have top management support for implementing green cleaning Recommend having a team to come together to make changes in cleaning products and practice Administrator, president, marketing, community relations Environmental services, purchasing, infection control, GPO, others What is the business case? Process for Change - Administrative Support

7. The Ashkin GroupThe Green Cleaning Experts Infection Control - cleaning, disinfection Environmental Services – cost containment, ease of use, efficiencies Purchasing – group contracts, cost containment Risk Management – optimize environment, reduce risks, protect patients Employee Health – protect healthcare workers Administration – overall performance, community relations Recognize the competition for resources. Process for Change - Differing Agendas

8. The Ashkin GroupThe Green Cleaning Experts Who performs the services What products are being used & what are costs When are services performed Where are they being used (are the same products used everywhere?) How are products used Frequency of services provided Training and communications – how often, issues Are there other opportunities for improvement? Process for Change - Create a Baseline

9. The Ashkin GroupThe Green Cleaning Experts In-house Services GPOs Contract issues Out-sourced Services Contract language How are supplies purchased Unions Different structures have different challenges Consider small, low-risk “pilots” Process for Change - Who Performs Services?

10. The Ashkin GroupThe Green Cleaning Experts Green Products: Products that reduce impacts on health and the environment when compared to similar products used for the same purpose. E.O. 13101 Green Cleaning: Cleaning to protect health (patients/occupants, staff, administrators, and visitors) without harming the environment. AG Defining Green Cleaning & Products

11. The Ashkin GroupThe Green Cleaning Experts Cleaning chemicals Disposable janitorial products (e.g. paper) Equipment Procedures Source reduction and pollution prevention Encourage sustainability Defining Green – It’s Not JUST Products

12. The Ashkin GroupThe Green Cleaning Experts Safe for patients Safe for staff (especially product users) Safe for environment (creates minimal amount of pollution, especially PBT’s) Encourage sustainability Defining Green – It’s Not JUST Products

13. The Ashkin GroupThe Green Cleaning Experts 5.0 Billion pounds of cleaning chemicals 4.5 Billion pounds of janitorial paper 0.5 Billion pounds of equipment 35.0 Billion plastic liners The Impact of Cleaning – the Environment

14. The Ashkin GroupThe Green Cleaning Experts 6% of workers injured on the job Occupational asthma on the increase 20% are eye and skin burns (chemical exposures) Muscular/skeletal injuries (ergonomics) The Impact of Cleaning - Product Users

15. The Ashkin GroupThe Green Cleaning Experts Nursing homes and assisted living 3,350,000 residents 2,000,000 staff (full and part time) Hospitals 660,000 patients (per day) 4,535,000 staff (full time equivalents) 100,000 hospital trainees Visitors??? Many are exposed 24 hours per day The Impact of Cleaning - Patients & Staff

16. The Ashkin GroupThe Green Cleaning Experts Every Year 50,000 people die in automobile accidents 7,000 people drown 5,000 people die of burns Every Year 70,000+ patients die of nosocomial infections Nine People Die Every Hour A Perspective on Patient Impact

17. The Ashkin GroupThe Green Cleaning Experts 2,000,000 (About 5.7%) of all Patients Admitted to U.S. Hospitals Acquire These Infections. 3.8% of Nosocomial Infections are Fatal 70,000+ People Die Every Year From Nosocomial Infections Approximately one-third are preventable Nosocomial Infections

18. The Ashkin GroupThe Green Cleaning Experts This is NOT an indictment of the cleaning industry. We know how to clean. We just need the budget, time and tools to do the job right. Nosocomial Infections

19. The Ashkin GroupThe Green Cleaning Experts Evaluate how the facility is defined for cleaning… Single or multiple levels? Different standards for different areas? (ASTM E1971-89 Standard Guide for Stewardship for Cleaning Commercial and Institutional Buildings) Cleaning Plans Matter

20. The Ashkin GroupThe Green Cleaning Experts Typically in a hospital….. 45 to 65% are Non-critical (low risk) areas 25 to 45% are Semi-critical (medium risk) areas 10% are Critical (high risk) areas An important first step is to evaluate how the “risk areas” are defined and identified. You can probably reclassify many areas as low risk areas, which in turn can reduce resources, impacts and costs. Divide Hospital by ‘Risk Areas’

21. The Ashkin GroupThe Green Cleaning Experts Non-critical (low risk) Exterior maintenance Administration, accounting, records, HR, etc. Patient registration and waiting areas Shops, carpentry, mail, printing, materials Hallways & common areas Divide Hospital by ‘Risk Areas’

22. The Ashkin GroupThe Green Cleaning Experts Semi-critical (medium risk) Restrooms (public) Nursery Clinics, outpatients, diabetes, respiratory Rehabilitation, physical therapy, cardiac rehab Critical (high risk) Emergency & Surgery Labor and Delivery Morgue Divide Hospital by ‘Risk Areas’

23. The Ashkin GroupThe Green Cleaning Experts Monitor pests and weeds Use local plants adapted for the site Use mulches and replenish as necessary Train weed-eater operators not to damage trees Use ice melt compounds before the precipitation begins - use to break bonds for removal by shoveling and plowing (not intended to melt the ice or snow) Exterior – Keep the Contaminants Out

24. The Ashkin GroupThe Green Cleaning Experts Consider closing redundant entrances in inclement weather Switch from sodium and calcium chloride to potassium and magnesium chloride ice melt – do not over apply Use environmentally preferable exterior cleaning chemicals and dispose of them properly Exterior – Keep the Contaminants Out

25. The Ashkin GroupThe Green Cleaning Experts Design all entrances with permanent entry systems or mats Can be used inside and out Should be appropriate for climate Class 1 fire retardant material Size approximately 12 feet in length Develop a plan to track cleaning Entryways – Capture the Contaminants

26. The Ashkin GroupThe Green Cleaning Experts Provide adequate and secure storage areas with appropriate plumbing and chemical dispensing equipment Have a dispenser maintenance plan Provide chemical storage training Cleaning Chemicals – Storage & Mixing Areas

27. The Ashkin GroupThe Green Cleaning Experts Use Green Seal Certified products www.greenseal.org www.greenseal.org Use low VOC products when possible Keep MSDS file up to date & available Choosing Cleaning Chemicals

28. The Ashkin GroupThe Green Cleaning Experts Use concentrates with dispensing equipment Increase the “life” of finishes Use metal-free floor finishes when feasible Maintain a log of all cleaning activities Train personnel to use cleaning chemicals properly Choosing Cleaning Chemicals

29. The Ashkin GroupThe Green Cleaning Experts What About Disinfectants? All microorganisms are not “bad” and we do not want to sterilize the world! Some antimicrobial products may increase resistance Good physical cleaning of environmental surfaces often is enough

30. The Ashkin GroupThe Green Cleaning Experts All antimicrobials are not ‘bad’ and they are an important ‘tool in the toolbox’ Use disinfectants only where they are necessary and select the appropriate products. One size does NOT fit all needs. Cleaning personnel are smart enough to use multiple products. What About Disinfectants?

31. The Ashkin GroupThe Green Cleaning Experts Chlorine, Phenols, Quats & Peroxide Chlorine / Sodium Hypochlorite Very effective antimicrobial Corrosive to eyes and skin Damage floor finishes, carpets, clothing, etc. Respiratory irritant Concerns regarding production, contaminants & by-products Mixing can create poisonous gas Phenols Effective against TB – HBV assumed Corrosive to eyes and skin Damage floor finishes and other surfaces Strong pungent odor & respiratory irritant Environmental concerns. Possible estrogen mimic. Quats Typically not effective against TB or HBV Less toxic than phenols – eye, skin and surface corrosive Toxic to aquatic life Peroxide EPA Sanitizer - not a disinfectant. Superior health & environmental profile vs. phenols and quats Risk Continuum High Low

32. The Ashkin GroupThe Green Cleaning Experts Blood Borne Pathogen & Body Fluids Fluids covered by OSHA Blood, semen, cervical solutions, other Excluded fluids include Urine, stool, saliva, sputum (unless blood is visible) Must be cleaned with tuberculocidal or hepacidal disinfectant 29CFR 1910.1030

33. The Ashkin GroupThe Green Cleaning Experts EPA Approved Cleaning Solutions Blood and Body Fluids Must be hepacidal or tuberculocidal Purpose of product is to kill hepatitis B, but there was no EPA approved testing methodology, so Surrogate test is killing of M. tuberculosis - if solution can kill M. TB, it will kill hepatitis B Chlorine / Sodium Hypochlorite may be used

34. The Ashkin GroupThe Green Cleaning Experts Janitorial Equipment Vacuums meet CRI’s Green Label Program www.carpet-rug.com www.carpet-rug.com Extraction equipment remove sufficient moisture to dry carpet in 24 hours Buffers & burnishers with vacuum attachments Propane equipment have high-efficiency, low emission engines

35. The Ashkin GroupThe Green Cleaning Experts Auto scrubbers equipped with variable- speed pumps Battery-powered equipment environmentally preferable batteries (gel batteries) Ergonomic equipment Maintain an equipment log Janitorial Equipment

36. The Ashkin GroupThe Green Cleaning Experts Janitorial Paper - Other Disposable Products Comprehensive Procurement Guidelines www.epa.gov/cpg/products.htm Toilet tissue:20% minimum PC content Paper hand towels:40% minimum PC content Industrial wipes:40% minimum PC content Facial tissues:10% minimum PC content Plastic trash liners:10% minimum PC content Processed chlorine free Large rolls Hands-free dispensers that limit paper Micro-fiber cloths, mops and bonnets Recycled buckets, carts, mats, etc.

37. The Ashkin GroupThe Green Cleaning Experts Integrated Pest Management Landscape to eliminate “safe havens” Prevent pests from entering the building Monitor before pests become a problem Eliminate food, moisture, & clutter Use the least toxic pesticide possible Universal notification

38. The Ashkin GroupThe Green Cleaning Experts Pesticides are relatively unique toxic contaminants in that they are intentionally put into the environment to accomplish their deadly purpose. Therefore, all pest control programs have a special responsibility to be fully knowledgeable on the impact of these chemicals and through a hierarchy of practice, prioritize the use of preventive, nontoxic or least toxic alternatives. IPM is the process by which this is accomplished. It is also the law – Public Law 92-516, as amended, The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA). The requirements for the management of hazardous materials and the release of chemicals, particularly pesticides, are becoming more comprehensive. These expanding requirements and increasing costs, are creating incentives to reduce the amount of hazardous materials used and wastes generated. Excerpted from Integrated Pest Management, by Wayne Warren American Society for Healthcare Environmental Services Professional Development Series Integrated Pest Management

39. The Ashkin GroupThe Green Cleaning Experts Public concerns, chiefly centering around the inappropriate use of pesticides and the generation of harmful or toxic by-products from waste treatment and disposal processes, clearly indicate the need for a more comprehensive environmental management technique known as Pollution Prevention. A well managed facility Pollution Prevention Program should incorporate IPM, as well as other proactive opportunities, to address the potential for risk before the “accident” results in adverse environmental impact, cost and/or liability. The facility Pollution Program should seek to minimize the generation of wastes or environmental releases and provide conscious management of all environmental media (i.e., air, water, and land). Excerpted from Integrated Pest Management, by Wayne Warren American Society for Healthcare Environmental Services Professional Development Series Integrated Pest Management

40. The Ashkin GroupThe Green Cleaning Experts Establish a waste reduction and recycling program that addresses the separation, collection and storage of materials for recycling including (at a minimum) paper, glass, plastics, and metals Encourage a high level of recycling by building occupants The success of recycling programs is dependant upon ongoing educations Occupant Participation in Recycling

41. The Ashkin GroupThe Green Cleaning Experts “Insanity has been defined as doing the same thing over and over and expecting a different outcome. Negligence is defined as doing the same thing over and over even though you know it is dangerous, stupid or wrong. Now that we know, it’s time for a change. Negligence starts tomorrow.” William McDonough Cradle to Cradle Importance of Change

42. The Ashkin GroupThe Green Cleaning Experts Thank You! Green Cleaning in Hospitals Cleaning to Protect Health Without Harming the Environment Stephen P. Ashkin 812 / 332-7950 SteveAshkin@AshkinGroup.com www.ashkingroup.com