May/June 2013

Greening the Cleaning

By Lindsey Getz
Today’s Geriatric Medicine
Vol. 6 No. 3 P. 18

Long term care facilities and hospitals have shown increasing interest in green cleaning products that offer eco-friendly infection control.

Cleaning products such as disinfectants play critical roles in hospitals’ and long term care facilities’ efforts toward infection prevention. Unfortunately, many contemporary cleaning products and practices in health care settings are not only detrimental to the environment but also may pose a danger to human health. As a result, many health care facilities are beginning to explore and adopt green cleaning products and practices that offer eco-friendly infection-control solutions.

Because many cleaning and disinfectant products contain high levels of volatile organic compounds (VOCs)—that is, gases emitted from certain solids and liquids—the move toward greener supplies represents a safer alternative for hospital and long term care facilities’ patients. According to the Environmental Protection Agency (EPA), VOCs include a variety of chemicals, some of which may have short- and long-term adverse health effects that can include exacerbation of respiratory problems, headaches, and other symptoms. Concentrations of many VOCs can be up to 10 times higher indoors. Sodium hypochlorite (bleach), for instance, is a known respiratory irritant. While it’s effective against pathogens, it can be dangerous to humans, particularly if it’s accidentally mixed with other commonly used cleaning products, which can produce poisonous gases.

“Among the various cleaning products available, many of them have chemicals that do pose some risk to people, whether they are residents or staff,” says Ted Schettler, MD, MPH, science director for the Science and Environmental Health Network and a coauthor of Generations at Risk: Reproductive Health and the Environment and Environmental Threats to Healthy Aging: With a Closer Look at Alzheimer’s and Parkinson’s Diseases. “They fall into various categories. Some are respiratory irritants that can cause or trigger asthma attacks. Many can cause skin reactions and other allergies. People who are in nursing and in janitorial positions have an extraordinarily high risk of developing occupational asthma as compared to other professions.”

There currently are many green cleaning products available on the market—everything from all-purpose cleaners to disinfectants. But the lack of research in this area has left many unanswered questions and possibly slowed adoption rates. Typically the effects of green cleaning practices undergo no monitoring or evaluation. In addition, aside from the EPA-approved disinfectants, including some of the products with lower VOC levels, no standard recommendations for adopting green cleaning practices exist. Organizations such as Practice Greenhealth and Health Care Without Harm offer assistance, but until there are industrywide standards put in place, the lack of research and standardized recommendations will continue to serve as obstacles to more widespread adoption.

In addition, product formulation poses its own problems, says J. Hudson Garrett, Jr, PhD, MSN, MPH, FNP-BC, CSRN, VA-BC, senior director of clinical affairs for PDI, which produces infection prevention products, including those made from sustainable or recyclable applicators and packaging. “The challenge with many infection prevention and control solutions is the ability to manufacture a ‘green’ formulation,” he says. “There is currently no standardized definition for green products in this arena. For example, the EPA regulates disinfectants as pesticides because they inactivate microbes. But PDI sees interest in green products and has made substantial improvements in both packaging and manufacturing processes to preserve the environment.”

Making Changes
Many hospitals, and long term care facilities in particular, are looking to make changes in light of the potential for significant benefits. “Typically green products have both ecological and safety benefits for the environment and worker,” Garrett says. “Green products tend to be less abrasive to the environment and less hazardous to the user as well as the patient.”

As more long term care facilities and hospitals become familiar with eco-friendly cleaning methods and techniques, they’ve begun implementing greener practices. For example, the Sanctuary at the Park in Muskegon, Michigan, a Trinity Senior Living Community, has made several efforts to go green, including the selection of more environmentally friendly infection control products as well as adopting greener cleaning routines.

“Introducing harsh chemicals into a resident’s environment can have a very negative effect,” says David Henry, director of home office facilities management for Trinity Senior Living Communities. “But the great thing is that current research has shown we don’t need to use all those harsh chemicals or the high concentrations that were once used so regularly. In the past, hospitals and long term care facilities used a lot of bleach and ammonia, which are very dangerous and unstable chemicals. Now we’re realizing there is more opportunity to use less chemical and still get the same efficacy with micro-organism contact.”

At Courtland Gardens Nursing & Rehabilitation Center in Baltimore, the efforts to implement eco-friendly infection control are multifaceted, including diligent product selection and a look at changing certain cleaning practices. Ra’Son Alexander, assistant director of environmental service at Courtland, says the facility has implemented water-based pads for stripping wax off floors in place of the chemical-heavy pads with strong odors, which could have been problematic for residents with breathing difficulties as well as staff members who also complained about the odor.

“Next month we’re also switching to a program that will use a measured amount of chemical in our buckets instead of just having staff pour on their own,” Alexander explains. “This will mean we’re not wasting or overusing chemical. We’re also implementing a policy of one microfiber mop per room. That’s a big change that I think will help us do a better job. The clean mops will help with infection control because I will no longer have to stay as on top of staff about remembering to change their mops and their buckets.”

Courtland will be implementing the J-Fill dispensing system, a type of container that automatically controls the amount of cleaning solution to be used for each specific job. Solutions are dispensed into a container calibrated to regulate how much solution to use for a particular job. The system will be used for cleaning floors and glass and for some disinfecting jobs.

The amount of chemical used certainly is an important consideration for many facilities. Schettler points out that facilities have a choice not only among the large array of products but also choices in how they’re utilized. “If you need to disinfect a surface, there are various ways to go about doing that,” he says. “Some facilities may have their staff liberally spray a surface, but that can put the applicator or those in the area unnecessarily at risk. More attention should be given to how much chemical is being used.”

Evaluation also is warranted regarding exactly which surfaces require chemical usage. Schettler says that some long term care facilities and hospitals take the default assumption that it’s better to be safe than sorry. But that may mean using abrasive and possibly dangerous disinfectants in places where they aren’t really necessary. “Fortunately it does seem more attention is being given to this,” he says. “Even in hospitals where they’re dealing with acutely ill people, many have started a closer analysis of what surfaces really need to be kept clean vs. disinfected—and there’s a difference there. A disinfectant that has potentially hazardous chemicals may not be necessary on certain surfaces that just need cleaning. By limiting disinfectant use to areas deemed necessary, patients aren’t unnecessarily exposed to chemicals.”

Practices and Policies
Henry says implementing microfiber mopping systems has helped Trinity Senior Living Communities reduce infection rates and become friendlier to the environment because pads are laundered and recycled. “Mops have a single use per room,” Henry says. “We’ve found that the mop pads have a one-year life span through all laundering cycles. That’s pretty good considering you can’t get much of a life span out of a string mop.”

However, Henry admits the investment in microfiber cleaning initially is higher. However, he says there are long-term cost savings as well as other benefits. “We no longer have staff lifting heavy buckets of water, which is a savings in workers’ compensation,” Henry says. “Also, when you had a mop bucket sitting out full of water, a demented person could come by and play with the water or it could be inadvertently spilled. With our microfiber cleaning system we use snap-top lid containers, and we toss the cleaning pads into a laundry bag when we’re done one room, then move on to the next. Those elements of safety are very valuable.”

Making the initial capital investment to go eco-friendly can pay off in numerous ways. Henry says that even with hand-washing policies, there are opportunities for eco-friendly change that may have other benefits as well. For example, moving to touchless dispensers seems to have long-term benefits for Trinity’s facilities. “We’ve seen that we don’t go through as much soap with a touchless dispenser,” Henry says. “We’ll stick with the same brand of soap, but we’ve found a new way of delivery that helps from an eco-standpoint as well as having infection-control benefits since it doesn’t require everyone touching the dispenser.”

Garrett says that overall, many green solutions do tend to be more costly than traditional formulations. However, the financial benefits of recyclable materials as well as savings in waste disposal can begin to offset those added costs. “More infection prevention products are introducing green benefits such as recyclable packaging, sustainable raw goods, and green manufacturing processes,” he says. “All of these green enhancements provide significant benefit to the environment as well as the user.”

Recyclable materials can contribute greatly to long-term cost savings and have a major impact on waste reduction. While single-use and disposable products have been heavily marketed in terms of reducing infection, Schettler says they create the new problem of a heavy waste stream. “We’re seeing a pushback on single-use products because of the waste problems they create,” Schettler says. “Single use isn’t really necessary for patient safety, and many products designed for a single use are actually being re-used after going through a sterilization process. Hospitals and long term care facilities are now reconsidering discardable items like linens and instead are cleaning, sterilizing, and reusing them.”

Looking Ahead
Experts say that the interest in eco-friendly infection control is positioned to grow substantially. Creative manufacturers continue to roll out new products and innovations. Henry believes that the evolution of infection will drive even more attention. “As we’re getting more long term care residents with resistant bugs, it’s going to force the industry to evolve and come up with better solutions,” he says. “The idea that it’s going to cost more shouldn’t deter the effort. There’s more to it than dollars. Of course you can’t ignore the return on investment, but you also have to look at the reduction in infection with an effective system. That’s quite valuable in itself.”

As these evolutions take place, there’s likely to be an increasing demand for related research and a development of standards. “It’s important that long term care facilities and hospitals are critical in evaluating the performance of products they select,” Schettler says. “The market for alternative cleaning is growing, and some products will be better than others. When a facility thinks about making switches, it should be encouraged and embraced. But they still need to do their due diligence in terms of developing actual data on performance. These choices should be made on sound science.”

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.

Keeping It Simple
When it comes to switching out caustic chemicals for greener options, a nursing and rehabilitation center in Seattle has found an unexpected way to sanitize: plain water and ultraviolet (UV) light. With the help of some new technology, the environmental services staff at Cristwood Nursing Center and Rehabilitation is creating a more healthful environment while eliminating the use of potentially harmful chemicals.

“Bleach may do the trick, but it can also make you nauseous and leave you smelling like the chemical,” says Luis M. Romo, CHESP, CEH, manager of environmental services and laundry services for Cristwood Nursing and Rehabilitation. “We wanted to create a nontoxic, green environment that still does an effective job of battling infection.”

One of the ways Romo and his team achieved this goal was by using UV light to disinfect items such as computer equipment and telephones. “We use a portable UV wand that nurses can run over the keyboard before using it,” he explains. “With a lot of people utilizing the same computers for charting, this makes them feel good about disinfecting in a safe and easy manner.”

Romo and his team also utilize steam technology to sanitize without chemicals. “Steam is very effective in a short amount of time because it can reach over 200˚F very quickly,” he explains.

Cristwood uses the Windsor Zephyr steam cleaner, a commercial, continuous-use device. Romo says it can be refilled without the need to waste time waiting until the unit cools down, which helps maintain an effective workflow. At Cristwood, the cleaner has worked well for bathrooms, bedframes, and overall terminal cleanings. “It works immediately, whereas some chemicals have to sit for 10 minutes until they’re fully effective,” Romo says. “While bleach also works right away, that is one of the chemicals we’re trying to get away from. You don’t go to a hotel and smell bleach, and we want to create the same kind of ambiance here. We’re focused on creating an environment of hospitality while still meeting rigorous health care expectations.”

Since making some of these changes, Romo says he’s received positive feedback as well as acknowledgment from grateful staff members. “I’ve had staff thanking me that they don’t leave the job smelling like bleach or ruined their pants because it stains so easily,” he says. “But more than anything, we feel like we’re creating a healthier environment. These are caustic chemicals and when you can use things like water or UV light and still do an effective job, that’s a big success.”

— LG