1. Environmentally Preferable Purchasing and Green Resources from Premier

2. In partnership with our members to improve the health and safety of patients, workers, environment, and communities. Office –recycling Paper Bottles, cans Printer cartridges Computers Energy savings Green Team Office –recycling Paper Bottles, cans Printer cartridges Computers Energy savings Green Team Safety Institute Web Topics A to Z: green buildings, mercury, PVC-DEHP, recycling CEO Scorecard Case studies Green Link Newsletter Safety Institute Web Topics A to Z: green buildings, mercury, PVC-DEHP, recycling CEO Scorecard Case studies Green Link Newsletter RFI – green attributes SCA Catalog: Standard terms Searchable Champions Team Latex catalog RFI – green attributes SCA Catalog: Standard terms Searchable Champions Team Latex catalog Support for CleanMed - Food Med Conferences Partnerships with H2E, HCWH, CDC/NIOSH, AHA Global Health & Safety Initiative Support for CleanMed - Food Med Conferences Partnerships with H2E, HCWH, CDC/NIOSH, AHA Global Health & Safety Initiative Educational tracks at Breakthroughs Governance CDs of case studies Conference Services - Green Educational tracks at Breakthroughs Governance CDs of case studies Conference Services - Green Premier – Yes to Green Corporate Tools-ResourcesSupply Chain Advocacy Training

3. Yes to GreenEnvironmentally Preferable Purchasing (EPP) The goal of Premiers Yes to Green initiative is to promote health care that is safe and healthy for patients, workers, the environment, and the community. The Environmentally Preferable Purchasing (EPP) program, a component of Yes to Green, involves collaboration with our members through our committees to identify and contract with suppliers for products and services that are healthier and less damaging to the environment or human health when compared to competing products and services that serve the same purpose.

4. Environmentally Preferable Purchasing EPP: What is it? The act of purchasing products and services for which the environmental impacts have been considered and found to be less damaging to the environment and human health than competing products and services that serve the same purpose. Premier position statement available at www.premierinc.com/safety

5. Why do we care about EPP? Newborns – Show evidence of toxins CDC study of newborns: –287 chemicals per child –180 known to be cancer producing –217 are toxic to the brain and nervous system –208 cause birth defects or abnormal development

6. Why do we care about EPP? A few examples… Why mercury-free? –Mercury is toxic to brain, kidneys & liver –Persists in the environment for decades –Premiers goal: mercury-free contracts Why DEHP-free? –DEHP used to soften PVC/plastic medical devices –Linked to birth defects in animals –FDA warning: risk to infants and nursing mothers Why latex-free? –Latex exposure can cause severe/fatal reactions –FDA requires products & packaging labels –Latex products must be identified

7. Why do we care about EPP? A few examples Why products with less packaging? –Hospitals generate 6,000 tons of waste a day –Half the waste is cardboard, paper and packaging Why computer recycling and take back programs? –Computers contain toxic materials like lead & mercury –95% of computers are not recycled - end up in landfills Why energy-efficient? –Energy efficient products (eg, energy star rated) save electricity and green house gas emissions –Slows global warming

8. Why do we care about EPP? A few examples Why organic foods? –70% of US chickens fed arsenic as growth promoter –75% of antibiotics are used as feed additives in animals & promote antibiotic resistance Why safer flooring? –Flooring, floor coverings and floor-care products may contain substances that negatively impact indoor air quality and human health. –Can be carcinogens or cause asthma- like reactions

9. The role of Premier committee members Help identify additional EPP criteria by product category Consider EPP criteria when reviewing supplier proposals and making contract award recommendations Recommend products that are safer for patients, workers and the environment

10. Most importantly…… With our committee members, Premier is able to make a difference and provide an opportunity for members to purchase products that promote the safety and health of our patients, workers, the environment, and our communities.

11. Premiers Environmentally Preferable Purchasing (EPP) Program is a collaboration between Group Purchasing and the Safety Institute

12. H2E = Hospitals for a Healthy Environment First GPO to win award In recognition of its environmental leadership role in helping hospitals: Eliminate mercury and other toxic substances Reduce volume of waste Purchase environmentally preferred products www.h2e-online.org Premier - H2E Champion for Change Award Winner five consecutive years, 2003 TO 2007

13. Highlights of Premiers EPP Program Mercury Elimination –2001 – Pledged to eliminate mercury from contracted products; launched web site on mercury elimination –2002 – Developed list of pharmaceuticals with mercury to assist in identification, management and disposal of drugs with mercury –2006 – List of Mercury-free pharmaceuticals under contract DEHP –Support DEHP product labeling –List of DEHP-free contracted products

14. Highlights of Premiers EPP Program Reuse of single use devices –Presented testimony to US FDA urging an evidence-based approach to any reuse of single use device policy –Web site devoted to reuse –No position for or against reuse of single use devices but support member efforts with contracts Led industry in standardizing EPP attribute terminology – now used in SCA to enhance product searching –LATEX-FREE for products without latex –DEHP-FREE for products without DEHP Di-2-ethylhexyl phthalate) –MERCURY-FREE for products without mercury –PVC-FREE for products without polyvinyl chloride Latex-free product catalog –2008 published latex-free catalog for members –Includes 16,675 items in 250 product groups from 445 suppliers

15. EPP Integrated into the Sourcing Process EPP questions included in standard RFI sent to all suppliers –Corporate environmental and green initiatives Energy efficiency Impact on indoor-air quality Recyclable/takeback programs for products and packaging Availability of green product and/or packaging options –Environmental attributes of products including Mercury, PVC, DEHP, latex EPP information requested as applicable to product category –Additional product content such as hazardous chemicals and persistent, bio-accumulative and toxic pollutants –Green product / packaging details Post consumer recycled content Reusable Biodegradable EPP info included in supplier-product matrix for committee members to use in selection process

16. Included in item level spend data request Described in RFI instructions Detailed rationale in supplier disclosure EPP Product Attributes in Standard RFI

17. Information on EPP Products available for members in Supply Chain Advisor catalog and Safety Institute Web site

18. Ability to search SCA Catalog for Latex, DEHP, PVC, and Mercury – free items View Master Contracts: Item Search

19. Environmentally preferable products attributes also included in launch materials in SCA

20. Products and Contracted Supplier Lists Safety Institute Web site www.premierinc.com/saferproducts

21. Greener, Safer, Environmentally Preferred Products, Supplier lists Emergency preparedness Back injury and fall prevention equipment Hand hygiene products IV systems - product specific information –PVC –DEHP –Latex Latex-free products Medical device reprocessing Mercury-free products Mercury-free and latex-free pharmaceutical report Personal protective attire (PPA) PPA (masks, respirators, gowns, gloves, etc.) contracts and suppliers Pesticide management - environmentally preferable PVC-DEHP-free products Recycling and waste reduction products and services Sharps injury prevention devices Safety Institute Web site www.premierinc.com/epp

22. Product, supplier list examples IV Systems Product Specific Information Product cross-reference includes content information for: –Latex –PVC –DEHP

23. Latex-free Product Catalog Industrys most comprehensive Latex-free medical products, devices, equipment –Premier latex-free product catalog – February 2008 16,675 items; 250 product categories; 445 suppliers Located on Safety Institute Web site OR Supply Chain Advisor, Premier Reports OR Search SCA – item search for latex-free Latex-free pharmaceuticals –Download Latex-Mercury-free pharmacy portfolio 2006-09 OR –Search Supply Chain Advisor (SCA) by individual drug

24. Product, supplier list example

25. PVC-DEHP-free product lists include: Pharmaceuticals IV bags, solutions, nutrition, pumps, tubing GI –enteral Respiratory, ventilator, humidification, chest drain devices Wound care OR – urologics, neuro, trocars, catheters, ports

26. Safety Institute Web Site Safety resources, tools for –Patients –Workers –Environment –Green purchasing –Green healthcare www.premierinc.com/safety

27. Highlights- Safety Institute Web site All Safety topics A to Z Back injury prevention Bar Coding and UPN Cell Phones and EMC Clostridium difficile Computerized physician order entry Computers and electronics Construction – ICRA Culture of Patient Safety Emergency Preparedness Environmentally Preferable Purchasing (EPP) Environmental-Safety Product Lists Evidence-based practices-bundling Fall prevention Green, Safer Products, Suppliers Guidelines-Infection Prevention & Safety Hand hygiene guideline Healthcare Associated Infections Influenza resources Latex Allergies Mercury Pollution Prevention Occupational TB Risks Patient Safety Pharmaceutical waste management Recalls and product notifications Reuse of Single-use Devices Surgical Care Improvement Project (SCIP) Sharps Injury Prevention Tubing Misconnections

28. Green - Highlights- Safety Institute Web site Green - Safety topics A to Z Computers - electronics Safer Green design - construction Environmentally preferable purchasing PVC-DEHP Safer cleaners & Pesticides Green, Safety Products Latex allergies Mercury pollution prevention Pharmaceutical waste management Reuse of single-use devices 28

29. Highlights Executive scorecard Download at www.premierinc.com/safety Use Quick link: Environmental safety

30. Subscribe on line at www.premierinc.com/safety www.premierinc.com/safety Highlights Premiers GreenLink Newsletter

31. Highlights Success stories, suppliers and members www.premierinc.com/greencorner

32. Highlights Computers & Electronics in Healthcare Environmentally conscious purchasing End-of-life solutions –Reduce, Reuse, Recycle Searchable database- recyclers Sample procedures and tools Premier Contracted suppliers –Environmental initiatives –Asset Recovery Services

33. Premier in the news for our computer contracts July 17, 2007 In January, President Bush signed an executive order requiring all federal agencies to buy only EPEAT-registered products in its computer purchases. Case cited Premier Healthcare, a major purchasing organization for hospitals and health care facilities, as an example of a company that took EPEAT to heart from the beginning. "They actually take the Hippocratic oath, which is 'First, do no harm to your patients' very seriously, they specify EPEAT products because they see the connection with their patients' health."

34. Member Education -- Safety Store On-line catalog Safety and environmental products Items available include: –Audio files –Books –CD-ROMs –DVDs –Premier co-sponsored conference materials –Presentations –Safety tools www.premierinc.com/safetystore

35. Advocacy at Premier Sponsor of national EPP Programs –CleanMed, FoodMed Public position statements –DEHP labeling of products –Reuse of single use devices- science based approach; contracts to support member choice Partnerships –Hospitals for a Healthy Environment / Practice Green Health –Healthcare Without Harm –CDC/NIOSH –AHA –Global Health and Safety Initiative

36. Premiers Internal Corporate Yes to Green Initiative Corporate Operations Goal Green and environmentally preferable considerations will guide the acquisition, use, maintenance, reuse, recycling and disposal of all products and services throughout Premier Corporate offices and business operations.

37. Yes to Green …. Charlotte Office Office recycling –Cardboard, paper –Shredded paper –Small batteries, cell phones –Printer ink cartridges Printing on recycled paper Default double-sided printing Conference services –Green Hotels; reusable/ recyclable supplies Staff Communications on Green –Monday Minutes –Web site – Inside Premier –Special Email for suggestions YesToGreen@premierinc.com Examples of what Premier is doing

38. Slides and Flyers of Premiers Programs available for download

39. Location of slides and flyers for download

40. Summary – available downloads Safety Institute Overview Slides Safety Institute Flyer EPP Program Summary Flyer Selected EPP products List Green Link Newsletter Hurricane resource List Influenza Resources Fact sheet Influenza overview Slides and audio file

41. Co-sponsorship Environmental -Safety Conferences 2008 National Patient Safety Foundation – Annual CongressNational Patient Safety Foundation – Annual Congress May 14-16, 2008 Nashville Clean Med – Pittsburgh PAClean Med – Pittsburgh PA May 20-22, 20082007 Food Med 2007 –June 28-29, 2007 Boston National Patient Safety Foundation- Annual Congress –May 2-4, 2007 Washington DC2006 Clean Med – Environmental Purchasing and Green Health Care –April 19-20, 2006 Seattle National Patient Safety Foundation- Annual Congress –May 10-12, 2006 San Francisco

42. Contact us On the Web: –www.premierinc.com/safety Email: –safety_institute@premierinc.com Voice mail –Safety Institute: 704 733 5865