Following the Green Path in Healthcare

Red regulated medical waste cans were once ubiquitous at Mercy Medical Center in Baltimore.

Now, at least on the ninth floor where the hospital is testing a pilot program, those red cans are smaller and few and far between.

With hopes of slashing the trash leaving the hospital bound for the medical waste incinerator, now staff is just given red bags to bag and carry the waste to a centralized red can.

The idea is that without that giant red can conveniently in the corner, staff will be less likely to just toss lunch wrappers and wadded paper into cans designated for hazardous medical waste.

"That's our big initiative right now," says Rachel DeMunda, director of safety and sustainability at Mercy Medical Center, adding that almost all of the hospital's physician practices use red bags and a centralized can.

Red bag or green?

Mercy's medical waste program, began a few years ago when hospital administrators decided to shut down their on-site incinerator in favor of a new hospital building. The move is part of an overall sustainability program. The goal is to cut down on medical waste, boost recycling and adopt greener techniques.

In the healthcare arena, patient care has often clashed with green practices. Piles of wrappers, the remains of individually wrapped swabs, cotton pads, gauze, tongue depressors and a slew of other frequently use basic medical supplies and mounds of plastic bottles that once contained the harsh cleaning agents. Much of this can be traced to the AIDS epidemic of the early 80s, when hospitals' knee-jerk reaction was to treat everything as toxic, burn every bit of trash, and make sure medical supplies were only single use.

As other industries make the shift to become more environmentally friendly, now hospitals are increasingly merging sustainability into their health care mission, says Joan Plisko, technical director for Maryland Hospitals for a Healthy Environment, an initiative promoting sustainability in health care.

For example, Plisko says, "It doesn't make sense to spray pesticides in an area where there are sick, infirm people," adding the Hippocratic Oath says physicians will do no harm.

Now, about three-quarters of the 73 hospitals in Maryland have multidisciplinary "Green Teams"-- physicians, nurses, department heads and other hospital staff -- leading sustainability efforts, Plisko says, working in nearly every corner of hospital operations to make the practices a little more environmentally friendly.

Lag time

Lacking a mandate from state agencies, hospitals throughout the state had little, if any, incentive to separate medical waste from the pizza boxes, shredded paper and plastic packaging,

While the Center for Disease Control and Prevention (CDC) update its definition of medical waste, state officials didn't revise its classifications until a few years ago, DeMunda says. Even after the changes had been made, the new criteria remained very broad, "so a lot of hospitals were stuck and throwing everything in medical waste, anything that may have touched a patient," she says. They do so despite the fact that only articles "saturated" with blood, for example, are considered medical waste, she explains.

Another impediment to the greening of area hospitals is a long-term contract with the Curtis Bay Energy, which operates the state's largest medical waste incinerator.

According to Leonard Taylor, vice president for facilities at the University of Maryland Medical Center (UMMC), , roughly 25 years ago Baltimore area hospitals banded together to have a medical waste incinerator built in the region. The new facility was configured to ensure that waste was properly disposed of and without releasing hazardous toxins to pour into the atmosphere.

As a part of that deal, the hospitals agreed on a guaranteed annual tonnage each would send to the incinerator. At the time, however, much of the waste generated was not by definition medical waste, he says.

"The cheapest thing to do was to bundle it all as medical waste," he says. "There was no economic reason not to treat it all as medical waste. That made it easy to manage waste in the hospital, but it also made no sense to recycle. That would have added cost to that operation."

Changing the culture

Things have begun to get greener. Taylor recently worked with Curtis Bay Energy changing the terms for UMMC to allow the hospital to only send medical waste where it made sense. This reduces the tonnage of medical waste burned, and gives the hospital more incentive to recycle, Taylor says.

UMMC is now in the process of converting its procedures in order to separate trash, medical waste, and recyclables.

"Now in my office, I just have one basket for paper and if I have a sloppy sandwich I walk it across the hall" to a different trash can, he says.

Waste management has been one of the toughest environmental hurdles for many hospitals, and much of the shift has meant educating staff to stop seeing everything as regulated medical waste.

UMMC staff didn't even use red bags � it was all considered medical waste, says Denise Choiniere, who leads the greening activities at the hospital. Now, hospital personnel have to consider whether what they are throwing away goes in a red bag or a green recycling container. The goal is to reduce medical waste by 60 percent, so that it comprises just 20 percent of the total waste produced, she says.

"It's not going to happen overnight," she says. "But I think there is a lot of interest. It's part of our culture now."

Going green has not been easy at Johns Hopkins Hospital. Rolled out in January, the relatively new recycling program has been somewhat of a challenge, says Colleen Cusick, chair of the hospital's Green Team.

"There really is a lot of education that goes along with it," she says, adding that they're starting to see the hospital's culture change.

The less-toxic route

Sustainable health care isn't just about greening the trash heap, it's also about reducing finding more earth-friendly ways to keep hospitals pest-free.

In addition to its new recycling initiative, Johns Hopkins Hospital also has an integrated pest management program, which uses a variety of strategies and less toxic means to rid the place of pests � not simply relying on harsh chemicals.

Perhaps one of the most popular programs at Johns Hopkins Hospital is the weekly farmer's market. The market is in its first year, and sets up on hospital grounds each Thursday.

"It's been very successful," Cusick says. "We are very proud of it."

Hospitals are also shifting to less toxic cleaning materials, microfiber mops to cut down on water usage, and hormone-free milk products.

Perhaps one of the most popular sustainability programs at Johns Hopkins Hospital is the weekly farmer's market. The market is in its first year, and sets up on the hospital grounds each Thursday. The market, and similar ones at other area hospitals, supports local farmers and promotes healthy foods, becoming a critical piece of the sustainability effort.

Changing the market

Health facilities are beginning to shift their focus and are making an effort to purchase greener supplies. This can be a tricky, as it means putting heavy pressure on vendors to cut down on the amount of packing used and opt for more sustainable materials.

"You could not believe the amount of cardboard that comes into this hospital every day that we then have to deal with and recycle or throw away," Taylor says.

"We are trying to push back [at] our vendors and say 'figure out a way to get our supplies here in a safe and hygienic way that doesn't create all this trash.'"

Hospitals are also beginning to ask whether the supplies are recyclable or made out of recycled material, Choiniere says.

Those ubiquitous slipper socks for patients are even fair game. UMMC switched and now buys socks made out of cotton scraps, so new cotton isn't harvested to make the socks, Choiniere says.

As the move further down the green path it is the larger hospitals and health systems that will have a lot of leverage and influence the vendors.

"Our intent is to change the market," Plisko says.


Whether it's using red bags or buying from green vendors, hospitals are recognizing that every piece of sustainability in health care requires education. It has to � and often does � make economic sense, as well as sense for patient safety and prevention. But the Green Teams continue to make the case for their institutions to move to a greener healthcare path.

"Sustainability, the whole concept, is sometimes a difficult sell," DeMunda says. "It's a total business practice. It's not a touchy feely green thing. My challenge is to sell that concept so we can take it step further."

Sara Michael, who lives in Remington, is a writer and editor who has written about health, science and technology.