The notion of “Green Building” is getting a lot of attention lately. But what is it and how does it apply to hospitals and physicians’ practices? Does it mean building for energy efficiency? Reducing water use? Limiting volatile organic chemicals? Improving ventilation? Using less toxic building supplies? Green construction can mean any or all of these things. There are variations on green—different shades, perhaps, depending on where you are in the process.

When building a new office, it makes sense to plan for energy efficiency at the outset, because the cost of constructing for energy efficiency is minor compared to ongoing costs of heating and cooling a structure. But most practices are in rented spaces, and eco-conscious doctors are limited to working with existing physical structures and materials. Renovations, moves, new equipment purchases, re-allocations of space and other changes in a practice provide opportunities to improve ventilation, energy use, and construction materials.

Most doctors are aware of their responsibility to provide a safe environment for patients and staff. Poor ventilation, fragrances, molds, photocopiers in small spaces, toxic chemicals in building supplies all have impact on indoor air quality and health. Some people can tolerate these toxins with no symptoms at all. Others experience headache, nausea, respiratory irritation, and asthma. I’ve seen staff members report symptoms so severe that they notice them as soon as they come to work. The symptoms dissipate when they are back in fresh air. To provide a safe, healing environment, you must make careful purchasing decisions.

But you can’t just decide to be “Green” and have it happen overnight. You get there one product or process at a time. So where can you start? It is not always simple. Some “alternatives” have their own set of issues. While you have to consider health and environmental impact, you can’t forget practical issues like cost, durability and maintenance. Here are a few ideas to get you started towards a healthier work environment:

Reduce PVC: If you’ve read this column before, you’ve learned of the hazards of chlorinated plastics or PVC. When manufactured and when burned, PVC creates dioxin. PVC is very common in construction materials. It’s in window frames, floor or ceiling tiles, wall covering, bordering and piping. When renovating or building, try to avoid PVC wherever possible.

Be Aware of Volatile Organic Compounds (VOCs): These are vapors from glues, adhesives, carpeting, and paints, among other things. Some carpeting, for example, emits formaldehyde, a carcinogen. When purchasing carpeting, wall covering, kick plates or anything else, look for materials rated as low VOC.

Improve Ventilation Around Chemical Use: Whether it’s a photocopier or film processor in a small space, or a high-level disinfectant in an area with poor ventilation, you’re going to have problems with employee or patient exposure. Read manufacturers’ recommendations when purchasing equipment and ensure proper placement. Air quality is not just a health issue, but a regulatory issue as well. OSHA sets acceptable levels for chemicals from glutaraldehyde to formaldehyde to waste anesthetic gases. For more information on OSHA, refer to <www.osha.gov>.

Pay Attention to Little Things: You may not be able to transform your office into a green utopia, but you can make small changes that could have big impact over time. Consider installing low-flush toilets and no flush urinals, or electric eye faucets to save water—this is particularly effective in scrub areas in the OR. EPA-labeled “Energy Star” products reduce energy consumption, as can turning off electrical equipment when not in use.

The U.S. Green Buildings Council (USGBC) promotes environmentally responsible, profitable, and healthy buildings. Learn more by visiting <www.usgbc.org>. The Leadership in Energy and Environmental Design (LEED) has set national standards for building sustainable buildings. Within LEED is a section called “LEED EB”—for existing buildings. It has many tips for renovating existing structures in an environmentally responsible way. USGBC also has many links including the Construction Materials Recycling Coalition, Business for Social Responsibility, Building Concerns, Natural Step, Used Building Material Association, as well as lots of information on funding, design, research, media, and building codes.

For more information on non-PVC building products, low VOC products and other materials refer to these websites which often provide links to still more sites: Greenpeace has a PVC-free campaign (<www.greenpeace.org.au/pvc/>), as does Health Care Without Harm (<www.noharm.org>). Also refer to <www.sustainablehospitals.org> for non-PVC medical devices. The Healthy Building Network (<www.healthybuilding.net/>) is a national network promoting use of healthier building materials as a means of improving public health and preserving the global environment. Specific questions can be directed to a listserve at <www.buildinggreen.com/elists/gb_signup.html>.

These websites will help you get started. Green construction can seem overwhelming if you go at it alone. It is easier if you work with an architect and a general contractor with experience in green construction. For specific questions about this topic or any other health care environmental issues, please email me at <jhbrown@bethisraelny.org>.

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.