Constructing a “green” building is only the first step to sustainability in healthcare. Operations and maintenance also play a significant role in supporting a healthy indoor environment—particularly cleaning products and processes. The use of toxic or irritating cleaning products, or cleaning programs that are incompatible with selected surfaces, can undermine careful green choices made in the construction or renovation phases.
Housekeeping activities are key components of the Green Guide for Health Care (GGHC), which sets out criteria for a comprehensive approach to green building and maintenance for healthcare facilities. GGHC criteria directly address environmentally preferable cleaning and recycled content in janitorial paper products, for example. Also, cleaning practices can help achieve GGHC credits for Indoor Air Quality source control, building water-use reduction, and overall waste reduction. Similarly, the U.S. Green Building Council's LEED Existing Building certification standard rewards a number of cleaning-related activities, such as choosing sustainable cleaning products, recycling, waste reduction, and isolation of janitorial closets.
Why the emphasis on cleaning activities? First, cleaning is a never-ending process of facility maintenance and plays an essential role in helping reduce infection and improve patient and staff comfort. In addition, we now know that some of the older cleaning products and processes that facilities have relied on for years can negatively impact both health and the environment. For example:
Patient and staff comfort. Many cleaning products contain high levels of volatile organic compounds (VOCs) that can give rise to respiratory irritation, headaches, and other symptoms in workers and building occupants.
Worker health and safety. An estimated 35% of conventional cleaning products can cause blindness, severe skin damage, or damage to organs through the skin. Housekeeping staff in general have a high rate of occupational injury. Research indicates that more than 10% of confirmed work-related asthma cases may arise from exposure to cleaning products.1
Environmental damage. Some cleaning chemicals are associated with eutrophication of streams and toxicity to aquatic life. Eutrophication is a process whereby bodies of water receive excess nutrients that stimulate excessive plant growth, often called an algal bloom. This process reduces dissolved oxygen in the water when dead plant material decomposes and can cause other organisms to die.
VOCs released to the outdoor environment from consumer products, including cleaning chemicals, contribute to smog formation. Other ingredients, such as alkylphenol ethoxylate surfactants, don't break down readily in the environment and may interfere with the hormone systems of exposed organisms.2
Long-term health issues. Many cleaning products contain carcinogens, asthmagens, and substances associated with reproductive organ damage, birth defects, kidney damage, neurologic effects, and other serious health effects.
Clearly, administrators interested in promoting a healthy indoor environment in their facilities and reducing their impact on the environment must assess potential releases from cleaning products during their use, disposal, and beyond. Fortunately, the market has responded to the growing demand for less-toxic cleaning products that meet demanding performance requirements. Dozens of cleaning chemical manufacturers now have products that are certified by the Green Seal or Environmental Choice certification programs. Government facilities and parks, schools, and businesses across the country have successfully adopted comprehensive green cleaning programs that provide a track record for assessment. Even janitorial/housekeeping service providers are beginning to market green services.
To implement a truly environmentally preferable cleaning program, however, still takes focus and effort. Administrators must decide which green claims are real and which are “greenwash”; they must choose from among competing products and make sure the products and processes they select are compatible with environmentally preferable flooring or other interior surfaces.
While every facility has its own needs, culture, and performance imperatives, some basic components cut across specific circumstances to help ensure successful green-cleaning implementation.
Collaboration. As with all environmental initiatives, cleaning choices and changes involve many disciplines within the facility. Developing a comprehensive green-cleaning program may involve changing long-standing protocols, so it requires collaboration with a multidisciplinary that includes purchasing, environmental services, housekeeping, infection control, and nursing staff.
When renovations or new construction are contemplated, the team should make sure that cleaning practices and products are considered as part of the design process, since these choices will affect housekeeping operations for years to come. For example, selecting a flooring product that does not require frequent stripping and finishing can significantly reduce both labor requirements and VOC releases. Conversely, selecting a green flooring product that may not stand up to the cleaning frequency required can create a huge headache for housekeeping later on. If possible, run some cleaning tests with samples of the materials being considered to better understand the cleaning products and processes that will be needed and to rule out surfaces that may create problems for housekeeping.