This report originally appeared in the April 2010 issue of DOTmed Business News

For hundreds, maybe even thousands of years, humans relied on things found in nature to attend to various ailments. In the last hundred years, there has been a strong shift from nature as cures and treatments were created with chemical compounds in labs. But as is often the case, the pendulum is swinging the other way, or maybe it's ready to settle closer to middle as nature is beginning to turn up more in hospitals and health care settings. DOTmed took some time to check-in with environmental advocate Deirdre Imus to see where things sit a year since our last interview. Imus offered a little background of the catalyst behind the decision for her to throw her hat into the green arena and then updated us on new developments in the field.

"My big question was, 'Are hospitals' physical environments a place of healing?' and to me they should be, but the answer I quickly found was, 'No.' In fact, they're often places that when you're sick, you can potentially become sicker because of all the toxic cleaning and the pest control agents that are used, bad air and germs - all these things. Even that hospital smell that people talk about," said Imus.

Deirdre, who is married to radio personality Don Imus, first began wondering about that smell in 1998, when she and her husband co-founded the Imus Cattle Ranch for Kids With Cancer, which seeks to help heal its young patients using the cowboy work ethic in an environmentally friendly environment.

As she continued her research for the ranch, Deirdre realized that many of the chemicals commonly used to clean the hospitals where she met these children were carcinogens. To her, it simply made no sense to expose people with cancer to chemicals known to cause cancer.

So, in 2000, Mrs. Imus met with former Hackensack University Medical Center president John Ferguson with the hopes that the information she'd gathered would help convince him to start "greening the cleaning" in the nation's fourth-largest hospital.

Less than a year later, the "Greening the Cleaning" program was launched at HUMC. Deirdre sees that moment in Spring 2001 as a game-changer.

"If you can have an impact in a hospital like this and make that kind of change, that's huge!" she said.

With the success of the Greening the Cleaning program, Deirdre founded The Deirdre Imus Environmental Center for Pediatric Oncology® at HUMC, a 501c3 not-for-profit. It's one of the first hospital-based programs designed to identify, control and ultimately prevent exposures to environmental factors that may cause adult, and especially pediatric cancer, as well as other health problems with children.

Deirdre has also spearheaded efforts to create legislation limiting the use of toxic chemicals, particularly where children might be exposed to them. As a result, New York City passed the "Greening Our Cleaning Act" in 2006, which reduced the city's use of toxic and hazardous products in schools and more than 6,000 city-owned or contracted buildings. The states of New York, New Jersey and Connecticut have also since passed legislation regulating toxic cleaners and many more states are coming on board.

Since then, other hospitals began to green their cleaning. In 2004, Jacobi Medical Center and North Central Bronx Hospital became the first two facilities in New York City to replace traditional cleaners with environmentally friendly ones.

"You start going through the material safety data sheets on these products, you realize they all have persistent bioaccumulative affects, meaning once they get into your body, they don't get out. So these were problems," said Peter Lucey, associate executive director for logistics and support services for the
North Bronx Healthcare Network, which manages both hospitals.

For NBHN, worries over asthmatic patients helped spark the decision to go green, as the Bronx has the highest incidence of the disease in the country. The concern was that hospital cleaning products might prompt an asthma attack in a patient who had come in with another ailment.

"We had no data on it, we didn't know, but we all felt it to be the right thing to do," said Lucey.

WHAT IS "GREEN"?

After a facility makes the decision to go "green," officials must navigate a confusing world in which just about everybody is slapping a "green" claim on their product, as the U.S. government has not yet formed an official regulatory definition of the term.

"People unfortunately have many interpretations on how to use the word green," Imus pointed out.

But while Lucey and Imus agree that hospitals switching to environmental cleaners should seek out products that carry an independent third-party certification, they disagree on which certificates carry merit.

The North Bronx Healthcare Network opted to use products certified by Green Seal.

"When people say they're green, there's nothing to prevent them from buying whatever chemical it is - ammonia, gasoline, I don't care - putting it in a bottle with some blue food coloring and calling it a green cleaner. There's no standard and that's why we look to Green Seal," he explained.

"Our standards are based on a life cycle approach, so we examine the impact of a product through its whole life cycle; through the raw materials, the manufacturing process, how the product or service is used and how it's disposed," said Linda Chipperfield, vice president of marketing and outreach at Green Seal. "And we try to reduce the environmental impact in all of these areas and we also look at performance."

Green Seal's process of standard development is recognized by the American National Standards Institute and also follows a development process recognized by the International Organization for Standardization.

Imus, however, is unsatisfied with Green Seal's standards. She says they charge a huge price for their "green seal" - upwards of $7500 per product.
She also objects strongly to the fact that they do not stipulate natural or naturally-derived ingredients. But perhaps her biggest point of contention is that Green Seal does not require manufacturers to list all their ingredients.

"If you ask somebody for a list of all their ingredients and they wouldn't give it to you, why would you buy their products?" Imus asked. "How do you know it's really green?"

While Imus' Greening the Cleaning products are third party certified (Ecologo), she has her own set of standards for her green products. These include full disclosure of all ingredients, a purified water supply that is free of chlorine and residual chlorine and formulations that meet or exceed American Society for Testing and Materials standards for the specific product category for efficacy and, they must be cost competitive with traditional cleaners. "You don't have to pay more to be green," said Imus.

Officials with both organizations agreed that regardless of which products are chosen, using disinfectants in a targeted way is a key step toward greening any facility.

By law, hospitals must use traditional germicidal sanitizers to combat contagious diseases, like tuberculosis. But, as Jim Ronchi, project manager at the Deirdre Imus Environmental Center for Pediatric Oncology pointed out, cleaning crews don't need to use those toxic chemicals everywhere.

"What you need disinfectants for are isolation rooms and any surfaces that have been contacted with blood or body fluids," Rondi explained. "In addition, on a daily basis, mattresses, over bed tables, toilet seats and handles on doors and faucets should also be disinfected."

North Bronx Healthcare Network follows a similar strategy of targeted use of disinfectants.

"You don't necessarily have to go out with a sledge hammer instead of a fly swatter," said Peter Lucey.

Lucey looked to further minimize any risk posed by sanitizers by using hyperconcentrated products with a very low odor that are applied with a microfiber mopping system so that very little gets into the air.

GETTING RID OF THAT HOSPITAL SMELL

Once Lucey and Imus were finally ready to implement their new product regimes, they quickly discovered that doing the right thing wasn't always easy.

Both were met with skepticism by their respective departments of immunology and infectious disease, which worried that green products wouldn't be as effective as traditional cleaners.

"We were successfully able to prove that not only did they work as well, most of the product ended up working better than many of the existing toxic products," said Deirdre Imus.

That proof silenced that group of critics. But then they had the housekeeping staff to win over.

"The biggest thing is change. Especially in housekeeping departments, there are people who've been there a long time and they don't like change," said Ronchi, who has implemented Deirdre's Greening the Cleaning program at hundreds of facilities.

Part of the problem, according to Peter Lucey, can be traced back to the hospital smell. "When people begin cleaning with the new product, you don't have the heavy perfumes anymore. You don't have the deep, dark blue color like you might see in a bottle of Windex," which, Lucey explained, led some of his housekeeping staff to believe that the products weren't working. Some skeptics even went so far as to try to secretly return to their old favorite cleaners.

"Just when you think your old chemicals are gone, they reappear because people had them squirreled away in their lockers or under cabinets," said Lucey. "You'd be amazed where we would find stuff!"
Ronchi said that story has been echoed at nearly every hospital he has helped to make the transition. And in every case, education and hands-on training has been the solution.

"I'll go into a bathroom and clean the bathroom for them and then say, 'See, it works just as well as what you were using without the harsh odors, without the burning and the rashes that you may receive from using the traditional products. You don't have to use a mask when you're cleaning. You can mix all our products together and not have to worry about a poisonous gas," said Ronchi.

Ronchi also stressed the need to have a dispensing system, particularly where legally-mandated toxic disinfectants are concerned. Dispensing systems help reduce the amount of toxic chemicals that have the potential to be released into the environment, but they also help hospitals save money by reducing the amount of product while keeping the staff safe.

"It calibrates how much product is going to come out of that bottle. So if you need a half ounce of product in a gallon, that's exactly what's going to be diluted into the gallon once you add water. The staff does not have to touch the product. The dispensing system is usually in a locked container, so all the staff has to do is press a button, and it dilutes the product right into the bottle."

THE LINK BETWEEN COST AND SAFETY

Many hospital officials are reluctant to switch to environmentally-friendly cleaners because they're worried about the cost. But both HUMC and NBHN have seen double-digit reductions in their maintenance budgets since implementing the change.

"The knock I would always hear about green cleaning was that it's more expensive to use those green chemicals than it is to use the stuff I've been using," said Lucey. "I've got one word for that: 'bunk.' It comes down to your dispensing system and it comes down to your training."

In 2004, Jacobi Medical Center and North Central Bronx had a combined total of 15 chemical exposure incidents resulting in 54 lost days. Within a year of implementing green cleaning, those numbers were cut in half, and for the last three years running, they have completely eliminated employee illnesses due to chemical-related accidents.

That has helped contribute to an 18 percent annual cost savings since 2005, even while the organization has expanded square footage. It also gives Lucey peace of mind.

"On the moral end, I don't have an employee out," he said.

Likewise, Hackensack University Medical Center has seen a 15 percent cost savings since implementing green cleaning, with a big part of that savings coming from a 98 percent reduction in employee injuries due to cleaning products.

"We used to average 12 to 13 incidents per year when we used the traditional products; somebody would get a rash, a burn or an asthma attack," said Ronchi. Since we started using these products back in 2001, there have been two occurrences of a complaint from a staff member and one was actually from a disinfectant that is not one of our products and the other one was from a floor stripper that was being used by a team member who actually shouldn't have been using it."

Those savings have since led both organizations to further green their facilities.

HUMC has built an entirely green 300,000-square-foot center for women and children and Deirdre Imus has gone on to help implement her Greening the Cleaning line in hundreds of other facilities including schools, hospitals and even an airport.All profits from the sales of Mrs. Imus' cleaners go to support education and research at the Deirdre Imus Environmental Center for Pediatric Oncology.

Meanwhile, North Bronx Healthcare Network set about expanding its recycling program, switching to a reusable disposal system for sharps and doing away with paper gowns in favor of reusable ones, which are then laundered in an environmentally responsible way.

All those changes have resulted in further cost savings for the hospitals.

"We've pulled approximately $300,000 to $400,000 a year out of disposable costs going to reusable products for the past four years," said Lucey. "If you don't start changing the way you do business, you're going to go bankrupt."

More New York City hospitals are following NBHN's lead, with nine more facilities in the nation's largest public hospital system now coming on board.

"Start by doing what's necessary, then what's possible," said Lucey. "Suddenly, you're doing the impossible and that's what we found with our green cleaning program," said Lucey. "If we don't get on top of it and try to lead it and try to be involved with the process change, somewhere, the change is going to be implemented upon you. I'd rather be ahead of it than try to scramble and catch up."