In an effort to practice environmentally responsible health care, it is important to consider the notion of “green cleaning.” Hospitals for a Healthy Environment recently hosted a teleconference on this subject led by Stephen Ashkin, of the Ashkin Group, a consulting firm focused on reducing the adverse health and ecological impact of cleaning chemicals and procedures. During the teleconference, he shared tips that can easily be implemented in medical practices. While chemicals like disinfectants are a necessity, many are environmental toxins. It is important to choose and use them wisely.

Here are some suggestions for “greening” your office cleaning procedures:

• Start at the Top and Build a Team: Successful programs begin with strong leadership. Take a look at your practice, and ask who is responsible for the cleaning? Identify who you must speak with to raise awareness about potential toxicity of cleaning procedures. Evaluation and adoption of new cleaning procedures should be a team effort.
• Make Science-Based Decisions: Infection control is serious business. We want to feel confident that our patient care areas are appropriately disinfected. Yet the cleaning compounds we use and where we use them have big health and ecological impact. Make decisions based on science, not “perceived” risk. Assess what your clinic is currently using, the frequency of use, the associated costs, and the staff training. Ask cleaning staff if they experience itchy eyes, skin rashes, or trouble breathing when using certain chemicals.
• Define Cleaning Standards by Area: Just as regulators provide guidance on disinfection of equipment, there are guidelines for designating and disinfecting patient care areas. Clinic areas are defined by three categories: A) critical, B) semi-critical, and C) non-critical, depending on infection risk. Critical areas include emergency rooms, labor and delivery areas, and surgical suites. Semi-critical areas include public restrooms, nurseries, outpatient treatment areas, physical therapy/rehabilitation areas. Non-critical areas include maintenance rooms, administrative areas, patient registration and waiting areas, and hallways. In hospital settings, 45% to 65% of the total area is comprised of non-critical areas, while only 10% is deemed critical.
• Tailor Product and Procedure Choices: The Centers for Disease Control and Prevention guidelines require that critical areas be cleaned with intermediary grade disinfectants that kill pathogens causing tuberculosis and hepatitis B. These are usually phenol-based products or approved quaternary ammonium compounds. Since phenols are persistent environmental toxins, limit their use only to critical areas. The Occupational Safety and Hazard Administration (OSHA) mandates that body fluid spills (blood, semen, cervical secretions, cerebrospinal, amniotic, peritoneal fluid, others) be cleaned with intermediary grade disinfectants. These are not necessary for cleaning spilled urine, feces, saliva or sputum unless visibly contaminated with blood. Check www.osha.gov for further guidelines. In general, try to use products that are Green Seal certified (www.greenseal.org).
• Know Your Cleaning Compounds: Many different cleaning chemicals are used in health care facilities. Here are a few common ones: Chlorine/Sodium Hypochlorite: Effective against TB and hepatitis B, but also corrosive to eyes, skin, floor finishes, carpets and clothing. Can be a respiratory irritant and environmental toxin. Mercury is released during manufacture of bleach products. Phenol-based Products: Also effective against TB and hepatitis B, but damaging to eyes, skin, respiratory system, floor finishes and other surfaces. Persistent environmental toxins, these compounds can mimic estrogen. Quaternary Ammonium: While less toxic than phenols, this is corrosive to eyes and skin, and toxic to aquatic life. Peroxide: This is defined as a sanitizer, not a disinfectant. It is environmentally healthier than phenols and quaternary ammonium compounds. Whenever possible, choose low volatile organic cleaners. Use concentrates whenever possible, and educate staff on proper dilutions (no straight bleach, please!).
• Start Small and Monitor Results: It is difficult to make broad changes, so begin slowly. Start with one or two treatment rooms, and experiment with different cleaning compounds and procedures. Check regularly with staff and note any changes. You will be better able to implement wider changes once you see positive results from small experiments.

For help in greening your cleaning processes, contact Steve Ashkin at 812-332-7950 or SteveAshkin@AshkinGroup.com. Hospitals for a healthy Environment offers a wealth of information as well as ongoing teleconferences on this and related subjects. Visit www.h2e-online.org to learn more.

Janet Brown is the medical Waste Manager for Beth Israel Medical Center, New York City. Beth Israel is firmly committed to reducing the volume and toxicity of its waste stream. Many of the strategies that work for Beth Israel can also work for you.