Unfortunately, in an ongoing quest to do what’s right – which is to minimize the risk of nosocomial infection and, thereby, create a healthier environment — some healthcare organizations resort to aggressive, often toxic cleaning methods that wind up sabotaging their efforts.

The risks associated with traditional cleaning products have been well documented. According to Arlington, VA-based Practice Greenhealth, a leading membership and networking organization for healthcare institutions that have committed to sustainable, eco-friendly practices, conventional cleaning products are a major contributor to indoor air quality issues in closed environments. Many contain high levels of volatile organic compounds that can initiate or exacerbate respiratory irritation, headaches and other symptoms in building occupants. Even worse, many cleaning products contain cancer-causing carcinogens and an estimated 35% of conventional cleaning products can cause blindness, severe skin damage or damage to organs through the skin, Practice Greenhealth reports.

Of course, some of these products are also making the environment sick. Some cleaner ingredients contribute to harmful hormonal changes in exposed organisms, and can degrade water quality and harm aquatic organisms. "Further, treating the human illnesses by exposure to solvents, pesticides, etc., could cost billions of dollars," added Timothy Corrigan, principal of Timothy Corrigan Inc., a Los Angeles-based manufacturer of environmentally-friendly, plant-based cleaning products.

For these reasons, and others, a growing number of healthcare organizations are exploring alternatives to their traditional cleaning products and practices. And with the ever-growing list of environmentally-friendly products, and eco-focused vendors and suppliers, they’re finding it easier than ever to reap the benefits.

"For facilities looking to go green, cleaning is a great place to look. It’s very visible and it affects everyone," explained Lara Sutherland, director of environmental purchasing consulting for Practice Greenhealth, adding that the fact that a number of hospitals have already successfully implemented green cleaning practices, and, therefore, have substantiated the benefits, is also adding to the allure.

Timothy Corrigan Home Care product line

Consumer demand and competitive advantage are also helping drive the gravitation toward green cleaning practices. As more green-savvy consumers seek services from businesses that share their interest, healthcare organizations are finding that they’re likely to lose out to their more eco-conscious competitors.

Those that don’t board the eco-friendly bandwagon "will be left in the dust as being green will soon be the ‘price of admission,’" predicted Corrigan.

A newly-released report from Green Seal and Enviromedia Social Marketing underscored consumers’ push for green products and services. Despite the economic recession, the report revealed a whopping 82% of consumers are buying green products and services (with 58% of them buying green cleaning products). What’s more, 19% of the 1,000 people surveyed noted they are actually buying more green products today than they were before the economic downturn.

Vendors are certainly getting that message. Today, hundreds of certified green cleaning products are available, many of them from healthcare organizations’ existing vendors and suppliers, which has served to simplify the green purchasing movement. And, despite any disappointments healthcare organizations may have experienced with product performance in the past, the good news is, today, the market is brimming with quality eco-friendly products that perform equally well (and, in some cases, better) than conventional versions.

"While there were some very good products available ten years ago, there are many more out there today," noted Sutherland. Science-based product certification organizations, such as Green Seal, have helped educate the marketplace, while raising product standards and, along with it, consumer confidence.

Even more good news is that growing demand for green cleaning products has led to far more cost-competitive pricing. "Prices of these products are quite comparable to [conventional] ones," Sutherland assured.

Efforts by group purchasing organizations to increase the availability of vendors that offer green products and services are also helping keep costs down.

"We’re seeing a real move by suppliers [to offer greener solutions]," said Jennifer Waddell, RN, senior director of contract and program services for Novation, Irving, TX. She noted that more and more mainstream suppliers are enhancing their existing products – and even their manufacturing, packaging, distribution and shipping practices – to make them more environmentally-friendly.

"What we’re seeing is more hospitals and suppliers taking a more cradle to grave approach to going green, where they’re looking at the entire process, as opposed to just the products themselves," she continued. Hospitals are also looking for information on innovative green products, and through its New Technology Program, Novation is giving it to them.

The new program allows any vendor to register information about their innovative green products and services, even those that aren’t available under Novation contract. After confirming that the products have been approved by the FDA for use in the United States, Novation posts the information on its website, categorizing them by service line (products available on Novation contract are noted).

"Our goal is to take an advocacy role by helping hospitals make more informed decisions and by partnering with [responsible] suppliers," said Waddell.

Enlarged to 20 microns to show detail Sharklet Hygienic Surface’s pattern provides an inhospitable environment for bacteria transference and survival

Greener pastures

With so many different green cleaning products on the market, healthcare facilities often find themselves wondering where to start. That’s a good question considering there’s a green (or at least greener) alternative for virtually every aspect of cleaning – from general cleaners, toilet bowl cleaners, carpet cleaners and glass cleaners to floor strippers and waxes, and even disinfectants.

Because there’s no hard and fast rule – and, certainly, no one size fits all formula – experts generally recommend taking a focused, thoughtful and multi-disciplinary team approach that fosters widespread support of cleaning protocol changes and assesses current products and practices, so areas of improvement can be more clearly identified.

To further focus the efforts and pinpoint changes that can be more readily (and cost-effectively) addressed, Stephen Ashkin, president of The Ashkin Group LLC, a Bloomington, IN-based consulting firm that specializes in greening the cleaning process, recommends facilities follow the three-bucket approach that groups green cleaning products or initiatives into several categories. In the first "bucket" green cleaning committees can list easy and low- or no-cost changes; the third bucket would have more expensive or difficult to implement changes; and the second or middle bucket would consist of products and methods that fall somewhere in-between – such as those that aren’t overly costly, but still require some upfront costs.

"After doing a thorough product and process assessment, a [facility] may have hundreds of ideas, which can be overwhelming," said Ashkin. "By assigning them to these three buckets, you can give them a place and begin prioritizing."

For obvious reasons, the majority of healthcare organizations embarking upon green cleaning programs may want to tackle items in the first two buckets first. Fortunately, there are a number of low- or no-cost approaches that can have a significant impact.

Experts agree that hospitals wishing to go green with their cleaning should think beyond just the contents of the products themselves. While switching to more environmentally preferred products is, of course, a key contributor to the overall greening process, the same can be said of selecting products with greener packaging, as well as supporting vendors committed to sustainable manufacturing practices (a number of industry leaders, including Kimberly-Clark, Rubbermaid Commercial Products, Ecolab, 3M, Medline, Georgia-Pacific and JohnsonDiversey, to name a few, adhere to environmentally sound manufacturing practices, in addition to providing green product alternatives).

"A supplier who is responsible in its own operations and who has a good working knowledge of your business will be the most useful in helping you achieve a true ‘green cleaning’ program," explained Eric Willman, Ph.D., R&D program leader, Ecolab Healthcare, St. Paul, MN. Willman suggests choosing suppliers committed to reducing their carbon footprint and overall impact on the environment. "Companies should use resources efficiently, reduce waste in their manufacturing processes, invest in improving energy efficiency in their facilities and work to minimize the release of pollutants. Also look for suppliers who are socially responsible – for example, companies that have a set of ethical sourcing standards to ensure the responsibility of their suppliers."

With sustainable suppliers in place, healthcare organizations can then turn their attention to high-impact green cleaning solutions. One change that can offer an immediate impact – at little or no additional cost – is the implementation of automatic dispensers.

"Closed-loop dispensing is a good solution. They automatically dispense a precise amount of product at the right concentration," said Robert Israel, PhD., director of corporate product responsibility for JohnsonDiversey Inc., Sturtevant, WI. JohnsonDiversey’s recyclable, compact and maintenance-free RTD dispensing system makes the company’s products ready to dispense.

Georgia Pacific’senMotion with Lotion towels, paired with the enMotion touchless dispensing system, can help improve hygiene by reducing cross-contamination.

Dispensing systems are also well suited to concentrated products. Although concentrated products contain less water and require smaller packaging (which can contribute to a comprehensive green cleaning program), a concentration of chemicals can nonetheless become a health and environmental hazard. As Dr. Israel explained, automatic dispensers that limit human contact and intervention can reduce those risks. A special dispensing head on the RTD dispenser mixes the concentrated product and tap water at precise dilution ratios.

Ecolab’s Asepti-Solids instrument detergent system also offers safe, controlled product dispensing. Asepti-Solids consist of highly-concentrated products in the form of solid blocks. The blocks are color-coded for easy identification and include an enzymatic presoak, neutral detergent, alkaline detergent, acid rinse/detergent and rinse aid. The dispensing system dilutes the product at its point-of-use. Each 2.5-pound solid block is shrink-wrapped for transit and has the same cleaning capacity as a conventional 15 or 30 gallon plastic drums of detergent, depending on the product.

According to Dan Silk, vice president of environmental sustainability for Georgia-Pacific Professional, "portion-controlled dispensing systems also reduce waste and minimize usage, which aids in controlling costs." The company offers a number of variable portion-control dispensers that can deliver controlled amounts of towel or tissue. The enMotion dispenser, for example, dispenses a lotion-enhanced towel that Silk said lowers risk of cross-contamination, reduces towel usage by up to 30% and decreases operational expenses. This package, which adds to sustainability by containing both towel and lotion, is one example of innovative packaging developed under the company’s Packaging Optimization System, a program of Georgia-Pacific Professional’s packaging division.

Switching to all purpose green cleaning products is another way to make a big impact. As one environmental services director pointed out, the selection of one effective product can eliminate five or six (or more) others.

"A product like this may be more costly, however, it has the potential to save in the long run by eliminating other non-green products," said Michael Rodriquez, FABC, administrative director of building services for South Nassau Communities Hospital, Oceanside, NY. The facility, which has been implementing a green initiative for six years, has developed a green purchasing program that focuses on selecting Green Seal-certified products that will be well-received by users and live up to label claims (product trials help meet this need). Also, whenever possible, the facility tries to choose products from a reliable brand and vendor that will offer necessary support. Among other products, Rodriquez said they’ve found success with a Green Seal-certified peroxide- and citrus-based all purpose cleaner, as well as a "more environmentally-friendly floor finish."

Hospitals may be surprised to learn that even disinfectants can fall under the environmentally preferred category. While many contend that a disinfectant, whose purpose it is to kill organisms, can never truly be considered "green," (no disinfectant is Green Seal-certified at this time), there are nonetheless greener alternatives – such as those that use hydrogen peroxide as its active ingredient. JohnsonDiversey’s AHP technology, for example, is a blend of surfactants, chelating agents, and low levels of hydrogen peroxide.

Biotechnology innovations are also contributing to green cleaning efforts –making it possible to inhibit growth of microorganisms through topography, as opposed to the use of chemicals. Sharklet Technologies, a biotechnology company based in Alachua, FL, states it has developed the first no-kill, non-toxic surface technology that controls bacteria, including Staph a, Pseudomonas aeruginosa and E. coli. Inspired by the antimicrobial properties of shark skin, Sharklet surface technology may be used in healthcare environments and on devices to help prevent development of biofilms and hospital-acquired infections.

"The surface itself inhibits growth, which will allow hospitals to reduce the amount of chemicals used for cleaning," said Joe Bagan, CEO of Sharklet Technologies. By imprinting the microscopic topography pattern onto an adhesive-backed polymer film, Bagan explained that the product could be easily applied to high-touch, high-traffic areas – such as bedside tables, railings, nurse call buttons, touch screen monitors, among other surfaces. The company is currently testing a wide range of cleaners to match compatibility with various polymer types. Bagan said the polymers will be durable enough to withstand daily cleaning and will only need to be replaced quarterly – and with the pattern measuring just 3 microns tall (for comparison, a typical human hair measures approximately 50 microns), it will go virtually undetected by patients and staff.

Sharklet Technologies anticipates its Sharklet Hygienic Surface polymer kits will be available for purchase by hospitals this year.

Microfiber, maximum value

The Rubbermaid HYGEN microfiber cleaning System features 100% premium quality split microfiber which traps and holds 95% of microorganisms. They are bleach tolerant and extremely durable.

Sources agreed that one of the biggest trends in green cleaning is the transition to microfiber mops and cloths. Unlike traditional loop mops that are doused in buckets of water and solution (and have been shown to spread dirt and organisms around on the surface), microfiber, which is non-linting, launderable and reusable, has been found to offer superior cleaning, with minimal water and cleaning products.

"Microfiber products can reduce chemical [consumption] by 95%," noted Bill Slezak, healthcare industry segment manager for Rubbermaid Commercial Products. What’s more, he said they’ve been shown to clean floors 45% better than string mops.

While switching to a microfiber cleaning system requires a moderate upfront investment, sources stressed that the return on that investment can be significant – both in terms of its impact on the environment and the facility’s bottom line.

"We’ve seen a big push from hospitals on microfiber," confirmed Tamara Dick, director of marketing for Medline’s Environmental Services Division, noting that, when used properly, microfiber can pick up as much as 99% of bacteria, without redepositing it to other surfaces. And because microfiber cleans best with minimal water and cleaning product, "there’s less risk of slips and falls."

Microfiber is consistently being improved, too. Rubbermaid Commercial Products’ new HYGEN microfiber platform, for example – with its uniquely split fibers – cleans 25% better than the company’s previous microfiber pads. The products have also been developed to withstand cleaning and laundering with bleach – a significant advantage for facilities that need the chemical to eradicate resistant organisms, such as C. difficile, added Slezak. K-C Professional recently introduced its WypAll microfiber cloths with Microban protection to inhibit the growth of stain- and odor-causing bacteria. The cloths, which remove up to 99% of bacteria from non-porous surfaces and continue to provide Microban protection for up to 300 washings, offer further green benefits because they can be used without chemicals, the company notes.

Microfiber is catching on with cleaning service providers, as well. Coverall Health-Based Cleaning Systems of Boca Raton, FL, utilizes microfiber cloths and flat mops during the cleaning process.

"Utilizing a no-dip mopping procedure with microfiber flat mops reduces water and chemical consumption and is more ergonomic," said Peter Sheldon, vice president of operations for Coverall Health-Based Cleaning System. Further maximizing the company’s green impact, Coverall only uses products that contain safe surfactants – a commitment that earned the "champion" label from the EPA for its safer detergents stewardship initiative.

But what about hospitals that haven’t managed to kick the bucket in terms of conventional string mopping? "We offer new looped mops that are made out of recycled plastic bottles," assured Dick, of Medline.

While reusable products, such as microfiber, are gaining momentum, many facilities will still have a need for disposable products, and they can find comfort in knowing environmentally preferred options exist in that category as well. Paper products are a good example. Kimberly-Clark Professional’s Scott brand line features Green Seal-certified, 100% recycled fiber products. These products, which include C-fold towels, multi-fold towels, hard roll towels and bathroom tissue, will soon feature new packaging graphics highlighting the Green Seal certification. Medline Industries, Mundelein, IL, also offers green paper products. Products from the company’s Green Tree basic paper product line are made from 100% renewable sources, such as grass, sugar cane and bamboo.

Whether a disinfectant or other cleaning product, for that matter, is truly green or not really depends on how one defines "green" in the first place. In the absence of a standardized definition – and because healthcare organizations have so many cleaning processes, preferences and requirements – it’s up to each facility to set its own green cleaning definitions and standards.