Healthcare providers adding eco-friendly buying to their routine

A growing spate of healthcare organizations are getting serious about environmentally conscious purchasing, in some cases stressing cultural and social responsibility in the same breath as pricing, features and benefits. Vendors have noticed the spiking interest, too, and have been rolling out more lines of "green" products to meet increased demand.

The bevy of environmentally and patient safe products spans the spectrum of stock showing up in healthcare facility storerooms, from commodities to physician-preference items. They include medical/surgical supplies, laboratory supplies, radiology supplies, clinical equipment, cleaning and maintenance supplies, food service supplies, furnishings, flooring, energy- efficient appliances and utilities, as well as building and construction materials, structural design elements and waste reduction processes. Woven throughout this laundry list of products is information technology, which can help identify and locate sources of green products and services.

Green-rapt healthcare facilities’ motivations are noble and reasonable enough. Aside from the marketing advantages hinging on cultural awareness, these facilities argue that green products and services are healthier and safer for the patients and the workers exposed to or using them.

But questions linger. Are green products and services really any better for people? How? Is there any reliable and valid clinical or scientific proof? Or are providers relying on anecdotal data, marketing hype and gut feelings? Historically, green products tend to be more costly, so what are the conversion incentives for budget-conscious and reimbursement-challenged healthcare facilities? How many providers need to go green to truly make a difference and how pervasive should their green buying patterns be? Finally, do providers have enough of an available inventory of green products and services from which to choose in order to be environmentally responsible?

Tim Richards, B. Braun

"Healthcare providers’ ability to use ‘green’ products relies heavily on suppliers’ ability to manufacture cost-effective and cost-efficient products," said Tim Richards, senior vice president of marketing, B. Braun Medical Inc., Bethlehem, PA. "While no medical device company currently offers a complete line of ’green products,’ suppliers are continually seeking out new environmentally responsible manufacturing processes and products. It’s important to note that bringing such products to market is often a very time-consuming and costly process, especially pharmaceutical products, which must also adhere to strict FDA guidelines."

Still, Richards noted that his company has been supplying environmentally responsible products for more than 30 years, even contending that it offers the industry’s "largest line of ‘green products.’" That includes products free of latex, polyvinyl chloride (PVC) and Di (2-ethylhexyl) phthalate (DEHP).

From a health perspective, the proven and potential risks of latex, PVC and DEHP have been reported and widely known for years. For example, exposure to latex can trigger skin and respiratory sensitivities that can erupt into full-blown allergic reactions.

"DEHP leaches out of vinyl plastic medical devices into fluids delivered to patients, possibly posing risks to male neonates’ developing reproductive systems, including reduced fertility," Richards said. "Additionally, by elimating these substances from medical packaging, the environment is protected from unnecessary waste and chemicals.

"Another advantage of medical device suppliers ‘going green’ is reduced landfill waste," he continued. "New recycling programs are enabling providers to recycle IV materials that would have otherwise been sent to landfills or incinerated, which reduces pollution associated with these products. When PVC plastics are burned, they produce harmful dioxins, which are released into the air. Additionally, the DEHP plasticizer can leach into the soil and groundwater." B. Braun tackled this by improving its product lines, according to Richards. For example, EXCEL IV containers produce 30 times less HCI than PVC containers when incinerated and when empty, EXCEL IV containers and their overwrap weigh between 28 percent and 48 percent less than comparable PVC containers with overwrap, he added.

Dave Keil, Ecolab

St. Paul, MN-based Ecolab Inc. prefers not to limit itself to emphasizing a green philosophy, but stresses the health and safety of patients, providers and their employees, according to Dave Keil, vice president, marketing and business development, for the company’s healthcare unit.

"We take a more comprehensive approach by considering the total impact of our products – from manufacturing and transport to use and disposal," he said. "For us sustainability really goes beyond ‘green’ to how we are training our customers to use products safely and correctly to get the best results without rework or reuse. This ‘total’ approach enables Ecolab to deliver the highest-level results at the lowest total economic and environmental impact – our solutions provide ease of application, increased user safety, energy and water economy, and reduced end-of-life disposal and packaging waste."

For that reason, Ecolab doesn’t offer a separate green line of products, Keil emphasized. "We believe that all products should be developed with sustainability in mind," he added. Ecolab has several case studies that demonstrate its approach to sustainability, according to Keil. One example shows that a particular waterless surgical scrub saved water and time, while improving skin health. Another example is a product that provides instrument cleaning chemistry in a 2.5-pound solid block, equal to 15 gallons of liquid.

Ecolab’s total approach to sustainability motivates the company to develop products that lower energy consumption, enhance safety, conserve water and reduce waste, including products that clean at lower temperatures to no-rinse formulas to innovative packaging designed to reduce volume and waste, using recycled materials where possible, according to Keil.

"Not all medical suppliers offer full lines of eco-friendly packaging," Richards indicated, "which can make it difficult for providers looking to purchase only ‘green’ products." In addition to green products, B. Braun also offers green container systems and is continually working to expand its portfolio of green packaging offerings to new product lines, he added.

Gina Pugliese, R.N., vice president, Premier Safety Institute, agreed that anything involving green should be a component of a much broader, much larger initiative.

Gina Pugliese, Premier Safety Institute

"When we launched the Premier Safety Institute we emphasized the link between patients, workers and the environment," she said. "You have to connect the dots. This really is more than just green. It involves the health and safety of patients and workers, visitors and the community."

A veteran healthcare safety expert, Pugliese, in addition to running the Institute, oversees the online content of Premier’s "Safety Share" and "Green Link" electronic newsletters, as well as the hospital and supplier success stories posted on Premier’s "Green Corner" Web site. "Green Corner" features green case studies about computers/electronics, energy efficiency, Energy Star winners, environmental purchasing, environment of care, food, indoor air pollution, recycling and waste reduction and toxic chemicals.

Pugliese urges healthcare facilities first to define what they mean by green. "Our definition includes the term ‘environmentally preferable purchasing,’" she said. "It includes products that are less toxic, minimally polluting, generally energy efficient and safe for patients. But what is green really? Green could be anything from how much waste is produced to what kind of energy is used and whether it’s renewable. It’s more than making something out of recycled material, but what you do with it after it’s used. You want something to be sustainable rather than have to go back to the well for virgin products. That kind of thinking has to be shared by providers and suppliers. Everybody can contribute something to this process."

For example, Premier created the Electronic Product Environmental Assessment Tool (EPEAT) that ranks computers by such environmental attributes as energy efficiency, toxicity and end-of-life take-back programs. Premier relies on EPEAT as part of the computer contracting process. "Because we have been asking suppliers for this information they have become more aware of the [environmental] issue," she said. "We believe that this has created an expanded market for it."

Pugliese said Premier also is one of more than two dozen organizations helping to launch the Global Health and Safety Initiative, a national grassroots movement to build, promote and improve patient, workplace and environmental health and safety. Co-founded by environmentally conscious organizations such as Kaiser Permanente, Cleveland Clinic, Catholic Healthcare West and a dozen other companies, the group held its inaugural meeting last fall to develop and share information, best practices and purchasing guidelines.

Pugliese and Richards both acknowledge that environmentally sensitive purchasing practices have been slower to gain momentum in the U.S. than in other countries. With little national regulation, save for guidelines and recommendations,
providers and suppliers have to follow myriad state requirements that vary. California, for example, has more stringent environmental-oriented rules on the books, than say, Illinois. But that shouldn’t be surprising.

"In general, the U.S. government has been a little slower to respond to studies that aren’t airtight," Pugliese said. "To show toxicity requires huge epidemiological studies. You have to have airtight evidence. In the area of electronics, for example, the U.S. lags behind Europe. They don’t wait for the smoking gun."

B. Braun’s EXCEL IV containers

Both Keil and Richards acknowledge that "going green" can be a challenge. Keil argued that healthcare facilities need to broaden their definition and understanding of the green philosophy, stressing the total environmental impact throughout a product’s lifecycle, from manufacture to use to disposal. That includes raw materials, processes and facilities to make products, how products are packaged and shipped, what other tools and resources are involved when products are used, and how the packaging and the products are disposed after they are used, he noted.

"Although the medical device industry recognizes the importance of environmental responsibility, the challenge is getting the U.S. healthcare market as a whole to fully embrace the concept and make it a priority," Richards said. "Some issues medical device manufacturers face in ‘going green’ are the increased costs associated with changing to eco-friendly materials. Along with this issue, customer compliance, which includes the willingness to dispose of recycled materials properly, is another challenge medical device manufacturers may run into and should consider in the need to make the recycling process easier for providers, as the busy hospital environment can distract clinicians from thinking about recycling materials."

More often than not, green products and processes tend to cost more than traditional products and processes, erecting another roadblock for budget-conscious purchasers.

"The ‘green’ material itself is often more expensive," Richards admitted. "The manufacturing process can also be more costly. As medical device manufacturers begin to incorporate ‘green’ materials into their product lines, the transition is slow and the costs can be restrictive."

But there are ways to offset those costs, according to Keil. "Sustainability does not automatically mean that a product costs more," he said. "In fact, we have found that our own manufacturing process and efficiencies have resulted in a cost savings that we pass along to our customers. For those sustainable products and services that do cost slightly more, the facilities partnering with Ecolab are generally able to recoup any additional product cost through energy and/or water reduction cost savings."

Cleaning product costs pale in comparison to other major expenses, according to Keil. "In reality, [healthcare-associated infections] are the most costly expense hospitals face today, and significantly more money is spent on energy costs and labor than cleaning chemistries."

Featuring a multilayer plastic film, Hospira Inc.’s VISIV large-volume flexible I.V. container requires no overwrap, resulting in less waste. Made from PVC- and DEHP-free materials, the VISIV container offers virtually impenetrable port tubes with a greater needlestick protective area for medication additives.

Going totally green may not be the answer either, nor realistic, according to Keil.

"Healthcare facilities must select the products that work best for their specific environment, and provide clinically-proven efficacy," he said. "If a product is not effective and does not clean right the first time, the step will have to be repeated – using more product and more resources." That defeats one of the fundamental purposes of using green products and processes.

Another challenge to the green approach involves healthcare-associated or hospital-acquired infections. "To kill disease-causing microorganisms like MRSA, it is important for healthcare workers to wash their hands or clean surfaces with products that are formulated with antimicrobial ingredients and carry appropriate claims," Keil noted. "The conundrum is that there is no standard definition for a ‘green’ antimicrobial soap or ‘green’ disinfectant outside of a bathroom cleaner. As such, green products may not be the correct solution for what a customer wants to accomplish, especially in a healthcare setting where infection prevention is the priority."

But Richards argues that as more companies manufacture more environmentally responsible products, "there needs to be an overall change in the marketplace in terms of perception and acceptance."

Observed Keil: "Going green makes sense economically and for the environment and is not just a short-lived trend. People are making these positive changes because the benefit lies in the result – a cleaner, safer, healthier environment. We predict that businesses will continue to adopt more sustainable practices because it’s the right thing to do for the environment, and because it’s good business." Further, he said he believes "an environmentally conscious decision-making approach is here to stay," one that places patient safety first, efficacy second, balanced with a total environmental impact.