Health System Finds New Ways to Combine Quality and Sustainability

By Eric Bishop

For Duke Medicine -- and all health care centers -- balancing quality treatment with environmental friendliness has long been a tough task.

The heavy energy use, presence of disinfectant chemicals, and large waste streams -- while vital to the patient care process -- can leave a negative stamp on the environment.

In recent years, Duke has taken steps to “green” its operations, in everything from large-scale construction projects to everyday housekeeping services, bucking the conventional wisdom that being green means sacrificing quality or cost-efficiency.

“More and more, we are viewing our facilities not just as medical delivery systems, but as an active participant in public and environmental health,” says Greg Warwick, medical center campus architect. “Sustainability and environmental quality are at the beginning of every discussion we have.”

The results: less negative impact on the environment, lower energy and waste disposal costs, and safer facilities for patients.

Healthy Environment, Healthy Patients

The sustainability movement at Duke Medicine gained momentum when Duke University Hospital became a partner with Hospitals for a Healthy Environment (H2E) several years ago.

H2E is leading a national push for best environmental practices in health care. It requires partner hospitals to commit to environmental goals such as waste reduction and mercury elimination.

When Duke began phasing out products with mercury in 2003, the benefit was twofold: improved sustainability and tangible benefits for care.

Like most health care providers, Duke has used mercury-containing thermometers, blood pressure cuffs, feeding tubes, and other devices for many years. Despite its utility, mercury’s noxious discharge hurts water quality and poisons fish and other animals.

Mercury is harmful to not only the natural environment, but also the hospital environment -- dropped thermometers and other accidents have potential to expose patients and employees to dangerous levels of the toxic metal.

Since 2003, the elimination program has recycled mercury-containing instruments and swapped them out for safer devices, to the tune of 4,000 thermometers replaced and a 95 percent reduction of mercury in the waste stream.

Duke University Hospital roof work“Within the hospital, we’ve virtually eliminated mercury thermometers and mostly eliminated mercury blood pressure cuffs,” says Bill Brewer, director of environmental programs at the Occupational and Environmental Safety Office (OESO), which spearheaded the effort. “The hospital is a safer place because we’re eliminating mercury.”

Environmental stewardship and hospital safety have gone hand in hand on other projects as well, including green housekeeping programs.

Duke replaced conventional wet mops with microfiber mops in several buildings. The new mops use less water and corrosive chemicals that pollute the waste stream, and they’re also more sanitary.

“There’s less of a chance that disease will be spread from room to room,” says Mary Crawford, associate director for procurement and supply chain management.

Reducing Costs Through Green Practices

Environmental sustainability isn’t just good for the earth -- it’s often good for the bottom line.

”Green housekeeping products and practices reduce our water and energy consumption immediately, which in turn saves money,” Crawford says. “The return on investment for initial green product purchases happens very quickly as well, especially when environmental sustainability and staff and patient health impact savings are realized.”

Cost savings can appear in unexpected places -- for example:

• Recycling roof materials: Constructing Duke Life Flight’s new rooftop heliport at the Emergency Department required demolition of the old roof, a task that typically produces massive amounts of debris. Instead of trucking the 718 tons of demolition waste to the landfill -- which would have required 2,120 miles of dump truck travel and cost $29,797 in disposal fees -- workers salvaged many components from the old roof for reuse on other projects. They brought the roof ballast stone to nearby Duke Forest for road stabilization, and used the insulation to re-roof the laundry facility at Durham Regional Hospital and the Civitan Building on Duke’s campus.
• Recycling rechargeable batteries: An OESO program to recycle rechargeable batteries -- from watches, PCs, server systems, and other pieces of equipment -- has cut down on hazardous waste disposal fees. The batteries contain such toxic metals as nickel and cadmium. Prior to the program, the batteries either polluted the environment as part of the solid waste stream or cost Duke money by adding to the hazardous waste stream. So far, the program has diverted 1,600 pounds of batteries from the two waste streams to a free recycling service.
• Cutting down on sick days: Eliminating toxic cleaning products cuts down on sick days for employees by improving the air quality around them and reducing their exposure to harsh chemicals such as quaternary ammonium chlorides and butoxyethanol.

Bringing It All Together

In the recent construction of the Duke Integrative Medicine building on the Center for Living Campus, durability, sustainability, and a healthy patient environment all came into focus.

Construction achievements included the use of 25 percent recycled materials and the diversion of 50 percent of construction waste -- and disposal costs -- from landfills.Duke Integrative Medicine Center

In the building itself, low volatile organic compound (VOC) emitting carpets, adhesives, paints, and sealers, as well as indoor chemical and pollutant source control planning, contribute to higher air quality for patients and employees.

“As a program where nature and the setting are highly related to care delivery, stewardship of the environment was a major consideration in the design and is integral to the daily operations of the Integrative Medicine building,” Warwick says.

The Green Future at Duke

Duke Medicine officials hope to build on their green efforts with several projects in the pipeline.

The Duke Medicine Campus Architect’s Office and Duke University Procurement Services are looking at ways to reduce the waste stream and energy use of operating rooms. This means researching green-friendly options for lighting, curtains, flooring, paint, and other products.

On the construction side, Tim Pennigar, a construction project manager for the health system, sees a strong emphasis on high-performance building design. In particular, he mentions “green” roofs -- vegetated structures that combine durability with environmental benefits.

In addition, all new buildings will be certified through the U.S. Green Building Council's Leadership in Energy and Environmental Design (LEED) program, which is a rating system for the design, construction, and operation of green buildings.

Last year, Duke Medicine brought in its first sustainability and LEED coordinator to help push that conversation. The hire, Katherine Jordan, assistant director for campus design and sustainability, notes that today environmental friendliness is largely seen as a benefit to patients and staff. The key, she says, is finding ways to eliminate this “either-or” dilemma.

Take green housekeeping, Jordan says. “Historically, we have fought the perception that green chemicals and products would not perform as well. What we are seeing, though, in the buildings we have implemented green housekeeping in, is that not only is the air cleaner and the downstream negative impact removed, but the staff like it better and it performs just as well.”