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What is green?

The search for information on environmentally friendly cleaning products can be confusing. Part of the reason is the language. You’ll run into terms such as environmentally preferable, environmentally friendly, environmentally safe, and sustainability. Do they all mean the same thing?

"Those terms mean different things to different people," said Stacy Malkan, communications director, Health Care Without Harm, Berkeley, CA. "To Health Care Without Harm, it means safer for people and the environment. It’s not just an environmental concern but a human-health concern."

Patti Costello, executive director, American Society for Healthcare Environmental Services (ASHES), Chicago, IL, agreed: "There is no widely accepted definition of green. Is it environmentally preferred cleaning products? Is it green cleaning products? What does green mean? What does environmentally preferred mean? No one can agree as to what is the definition of green."

Cleaning is a science, so decisions on choice of cleaning products should be based on science. Costello highlighted the importance of evidence-based decision making when considering the switch to greener cleaners. "Until ASHES sees efficacy data demonstrating green chemicals are effective in killing harmful pathogens, we’re not going to widely embrace them. I am not aware of empirical evidence that green chemicals demonstrate an equal or better level of ‘kill’ than current practices for cleaning and disinfecting patient-care areas."

Mark Regna, director of healthcare services, Jani-King, Dallas, TX, agreed: "Many claims made on environmentally friendly products have no science-based evidence. Part of the problem, explained Regna, is that "There are no guidelines or industry standards for environmentally friendly products."

Rubbermaid Commercial Products offers a variety of microfiber cleaning solutions.

"Products that kill are not the safest products," continued Regna, "but they are the best for protecting patients from getting an infection. Patients come first. Our job is to protect their environment while they’re a patient. It’s just like protecting patients from fire while they’re in the facility. Environmental services, nursing staff, and others involved have a responsibility to protect the safety of the patient from things seen and things not seen."

Traditional cleaning products can sometimes mean a headache, literally, as well as for the environment and human health. Janet Brown, partner program manager, Hospitals for a Healthy Environment (H2E), Amherst, MA, and a member of the steering committee for the Green Guide for Health Care, explained: "An estimated 35% of conventional cleaning products can cause blindness, severe skin damage, or damage to organs through the skin. Many contain high levels of volatile organic compounds, which can give rise to respiratory irritation, headaches, and other symptoms."

Malkan added: "Patients whose immune systems are compromised can be more sensitive to toxic chemicals. Chemicals used for disinfection, such as glutaraldehyde and ethylene oxide, are highly problematic because they can trigger or exacerbate asthma. That’s one health outcome that we’re concerned about with toxic chemicals." A report by Health Care Without Harm provides an overview of scientific evidence that several substances used in a typical healthcare setting, including some cleaning agents, can cause or trigger asthma. See "Risks to Asthma Posed by Indoor Health Care Environments: A Guide to Identifying and Reducing Problematic Exposures" at www.noharm.org.

Going green for the sake of green simply isn’t practical for every area of the healthcare facility. Nondisinfectant cleaning products may be appropriate for noncritical areas, but who is defining what those areas are, questions Costello? "Even in nonpatient-care areas, organisms can be carried through heating and ventilation systems and lurk even in medical offices. Practically speaking, there are certain areas that absolutely must be cleaned and disinfected for patient safety, and although those disinfectants may be tough on equipment and finishes, they simply can’t be eliminated." Costello called them "a necessary evil."

"There are no green disinfectants," stated Regna. "None. There are biodegradable products, claiming it can kill this and that, but there is no efficacy data. I get phone calls all day long about ‘great new EPA-approved products.’ When I ask for efficacy data, 9 times out of 10, I never receive it."

However, noted Regna, Jani-King: "Not every surface in the building needs to be disinfected." Superbugs may be at least partly to blame for a tendency sometimes to indulge in overkill when it comes to cleaning the hospital environment. Identifying critical versus noncritical areas can help to determine where more environmentally friendly cleaning products can be used effectively.

Green 2011 is Jani-King’s program for sustainability. "We’re going to use the right sustainable cleaning products for the right environment," said Regna. "Jani-King wants to be good stewards of the environment, but every environment calls for something different. We try to mitigate out the risk factors by doing it correctly. Determine what you can do to make the environment safer for the patient and not do any harm to the patient. At Jani-King we preach the five Rs: (1) right staff, (2) right training, (3) right equipment, (4) right chemical, (5) at the right time. Without any one of those 5 Rs, you don’t have proper surface disinfection. The bottom line for Jani-King is that, as long as we can provide a clean, safe environment for our clients, we’ll do everything we possibly can for sustainability."

Medline’s MicroMax microfiber cleaning products

Brown, H2E, observed: "Many hospitals respond to high infection rates by using disinfectants in almost every area, on almost every surface. According to the Centers for Disease Control and Prevention, no epidemiological evidence supports over-disinfection. Microorganisms are normal contaminants of walls, floors, and other housekeeping surfaces but are rarely associated with direct transmission of infection. Noncritical-care areas, like hallways, restrooms, and administrative areas, do not require disinfection. These types of areas can be good starting places for less toxic cleaners. Of course one wouldn’t use a greener cleaner in a critical-care area, but there is plenty of room for less toxic options throughout the medical center: toilet cleaners, oven cleaners, window cleaners, drain cleaners, the list of opportunities goes on and on."

There is no single answer as to what makes a cleaner greener. There are a number of paths that can be taken to more environmentally friendly cleaning. Choices in materials can reduce the need for toxic cleaning chemicals. For example, rubber flooring would eliminate the need for chemicals used in waxing and stripping floors. Using concentrates could reduce packaging and container waste. Switching to microfiber mops reduces use of water and chemicals.

"When ASHES talks about environmentally preferred products," said Costello, "we’re talking about products that will not be harmful to the environment, yet will still be effective in a healthcare environment. Where appropriate, we urge members to try to minimize the amount of chemicals used; for example, not using disinfectants on floors in noncritical areas. We encourage use of high-efficiency particulate air (HEPA)-filtered vacuum cleaners, mercury-free products, and microfiber as a cleaning system because it reduces water and chemical usage and is ergonomically better for staff."

Tamara Dick, product manager, environmental services division, Medline Industries Inc, Mundelein, IL, said: "If a facility wants to get started using environmentally friendly cleaning products, they could start with one area and then expand. They may want to consider using microfiber, which picks up 99% of the bacteria in the room. Microfiber will not only clean better, it will significantly reduce the chemicals used, which in turn will drastically reduce the amount spent on chemical cleaning supplies. Medline provides a free cost analysis to show a facility how much money they will save on chemicals alone."

Rubbermaid Commercial Products, Winchester, VA, makes tools that allow healthcare facilities to clean greener, including microfiber products. Bill Slezak, healthcare industry segment director for Rubbermaid Commercial and member of ASHES’ Board of Directors, explained how microfiber works. "Microfiber is positively charged; dirt is negatively charged; so the microfiber acts like a magnet to dirt."

Ecolab solid technology helps facilities reduce packaging and shipping waste.

Rubbermaid’s microfibers are thin filaments created from a blend of polyester and nylon. The filaments are split into even thinner fibers, for an increased surface area, enabling them to capture more dirt hiding in nooks and crannies. Ultra-fine quality microfiber is defined as <.2 denier; Rubbermaid’s is even finer at .13 denier. "One microfiber mop pad is used per room, to cut down on potential cross-contamination," said Slezak. "We have to clean for health first. It’s critically important to break the chain of infection."

As Costello mentioned, all microfiber products are not created equal. The best way to determine effectiveness of products is to insist on seeing third-party documentation, ie, independent laboratory tests. "It’s important to look at the science," emphasized Slezak.

Kaivac, Hamilton, OH, recently won the 2007 green innovation award at the ISSA/INTERCLEAN North America trade-show. Tom Morrison, vice president of marketing, was quoted as saying he believed their new KaiFly system was a key reason for the award. The product combines microfiber, a window squeegee, and a chemical injection system to help remove harmful biopollutants.

PURE Bioscience, San Diego, CA, claims their silver dihydrogen citrate-based disinfectant kills certain viruses and some powerful superbugs. Additionally, it has low toxicity, is odorless, colorless, noncorrosive, nonflammable, and is compatible with other disinfecting and cleaning chemicals.

Some companies have programs focusing on environmentally friendly cleaning. With their program "Clean Hands Clean Surfaces," Jani-King has taken an interesting approach to reduction of cleaning chemicals. The program focuses on the connection between handwashing and surface disinfection. Regna explained: "Clean hands and clean surfaces go hand in hand. If everyone washes their hands and if proper surface disinfection is performed, bioload can be reduced in the building, so the amount of cleaning chemicals can be reduced."

Regna also mentioned that there are even simple measures that can be taken toward sustainability. "Mats placed on both sides of the doors hold dirt at the entranceway instead of dragging it all through the building, which can reduce need for harsh cleaning chemicals."

Recycling is a well-known avenue to environmental friendliness. Medline’s Green Tree Paper products are made of recycled products. "No virgin trees are cut down to make toilet paper and paper towels," explained Dick. "As of August 2007, Medline and its customers have saved 24,190 trees, 9,893,801 gallons of water, 658,828 gallons of oil, 977,570 pounds of air pollution, 4,354 cubic yards of landfill, and 5,801,384 kilowatt hours of energy.

"Ecolab’s approach to sustainability," said Dave Keil, vice president, marketing, Ecolab Healthcare, St. Paul, MN, "includes creating products that clean right the first time. If customers don’t get great results in one pass, they have to do it again, using more product and more resources."

Jani-King Clean Hands Clean Surfaces program

"When we talk about environmentally safe/preferable products at Ecolab," continued Keil, "we concentrate on the total impact our solutions have on the environment. Total impact is the cumulative effect of our products throughout their lifecycle, from manufacture to use to disposal. This includes lowering energy consumption, enhancing safety, conserving water, and reducing waste. Total impact includes raw materials, processes, and facilities to make products, how products are packaged and shipped, what other tools and resources are involved when our products are used, and how the packaging and the products are disposed of after they are used. Our product development policies state that products will not be formulated with chemicals that are known carcinogens, mutagens, and reproductive toxins or with chemicals that persist, or bioaccumulate, in the environment. Packaging designs will reduce volume and waste and use recyclable materials where possible, and product delivery systems must minimize the potential for chemical exposures, releases, and other safety concerns."

If a facility is ready to adopt environmentally friendly cleaning products, how do you get the green ball rolling? The experts we interviewed had some helpful advice.

Brown, H2E, recommends approaching the facility’s infection control committee, using the H2E Ten Step Guide to Green Cleaning Implementation (www.h2e-online.org/docs/h2e10stepgreenclean-r5.pdf)."

Costello suggests approaching ASHES. "Healthcare cleaning is our business. Ask us. We also have a business directory where you can search by category to see which companies have what products, and certainly environmentally preferred products is one of the categories. Members also have access to a listserv, where they can broadcast questions as to what products and vendors others are using and what their successes and failures have been."

Costello further advises: "Do your homework. If you’re going to be respected as a professional, you have to do the due diligence. Information is what environmental services needs to arm themselves with when helping ICPs make decisions about product selection. It’s incumbent on everyone in environmental services to ask the right questions of vendors. If you don’t know what you need to ask, call or email ASHES (312-422-3860; ashes@aha.org), and someone will help you to prepare questions before you meet with suppliers."

Reports that might be useful for those new to the green cleaning-product movement include Kaiser Permanente’s "Greener Cleaners in Health Care: Reducing Chemical Exposures for Workers and Patients," (www.kaiserpermanente.org) and INFORM’s "FAQs: Cleaning for Health, Products and Practices for a Safer Indoor Environment" and "Implementing Environmentally Preferable Cleaning Practices: An Eight-Step Plan" (www.informinc.org).

Don’t overlook vendors as a source of information. They’ve already done a lot of the legwork for you; just remember to ask for independent studies performed on the product. "Most of the major manufacturers have made a strong push into this area and can provide detailed information about products that fit the green profile," said Dick, Medline. Keil, Ecolab, added: "Facilities should contact their suppliers and ask them how their products have an impact on the environment. Ask about product formulations, conservation of resources, packaging waste, etc. Discuss a product’s total environmental impact and what exactly they want their products to accomplish."

Rubbermaid has available teams of healthcare-product specialists, located in major cities, to train staff on how to use their products and to teach best practices in professional cleaning. They also offer a DVD on how to use microfiber.