1. The Business Case for Sustainability Virginia Energy and Sustainability Conference February 11 th 2014 Joan Plisko, PhD, Technical Director Maryland Hospitals for a Healthy Environment Stephen J. Huebner, FACHE, CMRP Vice President, Materiel Operations-Virginia Bon Secours Health System Richard Morgan Senior Director, Facilities and Real Estate AtSite inc

2. Environmental Sustainability and Health Care Joan Plisko, PhD Technical Director Maryland Hospitals for a Healthy Environment jplisko@som.umaryland.edu 410.706.2107

3. Community health Patient health Worker health First, Do No Harm

4. Why be Sustainable? Climate change resilience Cost savings Community benefit Employee engagement Environmental compliance Environmental protection Operational efficiency Patient safety Quality of Care Social responsibility

5. Energy Usage in Hospitals Accounts for 8% of all U.S. greenhouse gas emissions $10 billion on energy/year 836 trillion BTUs of energy/year > 2.5 times the energy intensity and CO 2 emissions of commercial office buildings Historical reliance on non- renewable sources

6. Hospital Waste > 6,600 Tons/Day BIOHAZARD Solid waste Medical waste, sharps Recyclable Radioactive waste Trace chemo & pathology waste $ Cost to dispose Hazardous Waste, Chemotherapy Waste

7. Toxic Chemicals in the Hospital? Brominated flame retardants (BFRs) Building Materials Cleaning Chemicals Di-2-ethylhexyl phthalate (DEHP) in medical devices Electronics Glutaraldehyde Lab Chemicals Mercury Pesticides RCRA Hazardous Pharmaceuticals Solvents

8. Water One of top ten consumers in community 40 – 350 gallons per capita per day Large U.S. hospitals consume 133 billion gallons of water, totaling $615 million in water expenditures Water and sewer costs are on the rise Toxic wastewaster and stormwater due to: Cleaning chemicals Laboratory waste Laundry chemicals Landscape and pest control Pharmaceuticals

9. Food System

10. FIRE HEAT WAVE WEST NILE VIRUS HURRI- CANE SMOG FLOODING

11. Resiliency The capacity to absorb, respond, and recover from vulnerabilities and to develop capabilities that help the community:

12. Basement Environmental services Facilities management All front line workers… Bedside Nurses, nurses, nurses Physicians, clinicians Dietitians, therapists and more… Management EVS, capital improvement Purchasing, food services Nursing, pharmacy and more… MD H2E: It Takes a Village Boardroom Executives Leadership Board members Community Neighbors Suppliers Builders Local/State government Non-profits organizations Visitors Creating a culture of environmental health and sustainability in Maryland’s health care community

13. MD H2E Mission Audits Awards Case Studies/Pilot Projects Educational Material Listserv Meetings/Conferences Newsletters Partnerships and Collaborations Site Visits Vendor and Peer Connections/Networking Website Through networking, education, technical assistance, and recognition, MD H2E supports Maryland hospitals and health care providers in becoming leaders in environmental health and sustainability www.mdh2e.org

14. MD Health Care Sustainability Leadership Council (HCSLC) Mission: To foster environmentally conscious health care facilities that engage, educate, inspire and advocate for social responsibility in their leaders, employees, patients, and the wider community. 2014 Leadership: Chair: Michael Forthman, GBMC Vice Chair: Rachel DeMunda, Johns Hopkins Bayview Medical Center Secretary, Lisa Grubb, Johns Hopkins Bayview Medical Center Working Groups Education Governance/Advocacy Knowledge Base Membership/Networking

15. www.healthierhospitals.org

16. Sponsoring Health Systems Includes former Vanguard facilities

17. HHI Challenge Areas

18. HHI Tools and Resources Calendar of Events Case Studies How To Guides Newsletter Regional Maps Webinars Jessica Wolff, MSN, MBA jwolff@healthierhospitals.org

19. Engaged Leadership University of Maryland Medical Center, Baltimore, MD

20. Engaged Leadership Bon Secours Health System, Marriotsville, MD (HQ) Ecological Stewardship Plan Goals for 2013-2015 1.Expand ecology visibility internally and externally 2.Conduct evaluation process 3.Build upon level of excellence in waste, recycling 4.Advance cost savings opportunities especially related to energy 5.Foster a culture of sustainability 6.Identify greening efforts that directly link to improvements in population health

21. Leaner Energy 1.Lighting upgrade 2.Lighting Occupancy Controls 3.Vending Machine Controls 4.Water Conservation 5.Chilled Water Loop Repiping 6.Insulation Blankets 7.Steam Trap Replacement 8.Cooling Tower Repiping First Year Savings: Electric – 630,390 kWh saved (15% savings) Fuel oil – 17,835 gallons saved (16% savings) Water – 1,612 kGals saved (40% savings) CO2 emissions reduction of 460,190 pounds 9.Air Handler Unit Retooling 10.Hot Water Reheat Valve Replacements 11.Boiler Room Ventilation 12.Cooling Tower Variable Frequency Drives (VFD) 13.Controls Upgrades 14.OR Humidifiers 15.Night Setbacks Atlantic General Hospital, Berlin, MD

22. Leaner Energy Adventist Health Care, Rockville, MD (HQ)

23. Safer Chemicals Roller Shades – Vinyl-free Millwork – Formaldehyde- free substrates Wall Protection – Vinyl-free Sealants / Adhesives – Low VOC Floor Base – Vinyl-free rubber Flooring – Vinyl-free flooring and Low VOC adhesives (Linoleum flooring) Painting – Zero VOC paint Sinai Hospital Pediatric Hematology/Oncology Clinic, Baltimore, MD

24. Less Waste Logs and tracks items on a database MedStar Union Memorial Hospital, Baltimore, MD

25. Smarter Purchasing University of Maryland Midtown Hospital, Baltimore, MD Reprocessing/Remanufacturing Single Use Devices Operating room: bits, trocars, foreceps, drills Nursing units: compression devices, pulse oximeters, cuffs Approximate savings = $100,000/month or ~$364/bed/month

26. Healthier Food Local, grass-fed beef – no routine antibiotics Certified organic produce from local farmer Local, sustainable “Grocers’ section” in cafeteria On-site composting of coffee grounds Launched herb garden Union Hospital, Elkton, MD

27. www.mdh2e.org Joan Plisko, PhD Technical Director, MD H2E jplisko@som.umaryland.edujplisko@som.umaryland.edu, 410.706.2107 “We need to protect the environment not because we love trees, but because we love people”. - R.F. Kennedy Jr.

29. The Business Case for Sustainability Panel Discussion Stephen J. Huebner, FACHE, CMRP Vice President, Materiel Operations-Virginia Bon Secours Health System Stephen_Huebner@bshsi.org Richard Morgan Senior Director, Facilities and Real Estate AtSite inc rmorgan@atsiteinc.com