Setting specific goals can help health care facilities in their efforts to implement Environmentally Preferable Purchasing (EPP). Purchasing/Materials Managers can work with vendors, distributors, manufacturers and GPOs to ask for products that are more environmentally responsible and worker-friendly.
One great tool for finding alternatives to toxic hospital products is the Sustainable Hospitals Project (SHP), part of the Lowell Center for Sustainable Production at the University of Massachusetts, Lowell.
Other EPP ideas:
- Buying in Bulk
- Buying Recycled Content
- Double-Sided Copiers
- Eliminate Products Containing Latex
- Energy Efficiency
- Less Packaging/Reusable Totes
- Alternatives to Products Containing Flame Retardants
- Alternatives to Products Containing Mercury
- Alternatives to Products Containing PVC/DEHP
- Purchasing Food with Reduced Antibiotics
- Reprocessing Single Use Devices
Health care facilities can realize significant cost-savings by buying certain items in bulk. This can range from ordering five cases of something rather than one carton at a time, to ordering bulk cleaning products that must be diluted for use.
Buying Recycled Content
The more products you buy with recycled content, the more the market increases for these products, making them more available and less costly. In addition, buying products with recycled content helps keep our communities cleaner and healthier.
Check to make sure that recycled papers are also chlorine free (bearing the mark PCF, or processed chlorine free). Because the process of bleaching paper with chlorine creates dioxin, hospitals should strive to purchase PCF products when possible.
Examples of common recycled content products include office paper, paper towels, toilet paper and paper napkins. Check out the California Integrated Waste Management Board's Recycled-Content Product Directory. See our Sample Policy for Purchasing Reusable Products (pdf)
Double-sided copy machines can dramatically reduce the amount of paper going out of your facility. Check out Energy Star's list of low energy, double-sided copiers.
The increased use of natural rubber latex gloves in health care has been associated with an increase in reported latex allergies among both patients and workers. Prevalence studies indicate that 6-17% of the exposed health care workforce has become allergic to latex. Symptoms range from irritating to life-threatening. For more information on purchasing latex-free gloves, see the Going Green Factsheet Latex Allergy in Health Care (pdf) or go to the Sustainable Hospitals Project website.
Buying products that have a higher energy efficiency level helps your facility cut dollars in energy costs and expands the market for energy efficient products. The EPA's Energy Star program provides free energy audits for health care facilities as well as tools to help them evaluate their energy use and purchase more energy efficient products.
One of the key waste streams generated by the Purchasing Department is packaging. Many medical products are individually wrapped and then packed with additional cardboard, outer plastic packaging, inserts, etc. Discuss these key issues you can approach your vendors, manufacturers and distributors:
- Unnecessary Packaging
Materials Managers should work with vendors and manufacturers to use less packaging, where it will not impact the integrity of the products.
- Environmentally Friendly Packaging Materials
Ask manufacturers to use packaging materials that are recyclable or biodegradable. Ask for no PVC plastic and no styrofoam.
- Reusable Totes
Some facilities have worked with vendors to deliver supplies in reusable plastic totes, thereby eliminating the cardboard and paper waste inherent in cardboard shipping crates. Ask manufacturers with whom your facility orders high volumes of materials to demonstrate how they can help your facility meet its waste minimization goals through less packaging and reusable totes. Find out about Kaiser Permanente's Reusable Totes Program (pdf) and how to implement this program in your facility.
- Pallet Take-Back Programs
Some vendors are willing to reuse the pallets on which boxes are shipped. Talk to your distributor about backhauling and reusing pallets.
A wide variety of products within the hospital setting contain flame retardants, including many items of furniture and most electronics. Ask your GPO or vendors to identify and label products that contain flame retardants and offer alternatives to these products on contract.
For a list of common products that contain flame retardants in a hospital setting, see What Health Care Purchasers Can Do to Reduce Flame Retardants (pdf). For more on the problem with flame retardants, check out Flame Retardants: Alarming Increases in Humans and the Environment (pdf)
Ask your GPO or vendors to identify and label products that contain mercury and offer alternatives to these products on contract. A variety of products within the hospital setting contain mercury, including pharmaceuticals and cleaning products.
For a list of common mercury-containing items in a hospital setting, see the Going Green Factsheet List of Mercury-Containing Items in Hospitals (pdf) or check out the National Institutes of Health list. Premier Inc. has developed a comprehensive list of pharmaceuticals containing mercury (available for Premier members only).
The Mercury Assessment Worksheet (requires Microsoft Excel to view and use) was designed to help organizations inventory their mercury-containing devices. This spreadsheet was developed by the California Office of P2 and Technology Development and the California Department of Health Services' Hospital Pollution Prevention Program.
Be sure to check out INFORM's Purchasing for Pollution Prevention Project for more tips and purchasing specifications on alternatives to mercury-containing products and the Sustainable Hospitals Project for a list of mercury-free alternatives.
Ask your GPO or vendors to identify and label products made with PVC plastic that contain DEHP, and offer alternative products. A recent Public Health Notification from the FDA advises healthcare facilities to look for alternatives to DEHP-containing products for certain vulnerable patient populations.
For more information on the problems associated with medical devices made from PVC and DEHP, see the PVC/DEHP page of this web site.
To identify products used in your hospital that contain PVC and DEHP, use HCWH's PVC/DEHP Audit Tool (pdf).
See our list of Alternatives to medical devices containing PVC and DEHP (pdf). Also check out the Sustainable Hospitals Project for lists of other products that do not contain PVC or DEHP.
Sign the List of Health Care Leaders (pdf) that are Reducing Polyvinyl Chloride (PVC) and Di-2-ethylhexyl phthalate (DEHP). To add the name of your institution to this list of health care leaders promoting healthier purchasing choices, please contact firstname.lastname@example.org
Hospitals and health care institutions have a substantial interest in ensuring that existing antibiotics remain effective for treating human infections as long as possible. The majority of U.S. antibiotics currently are given to animals, with a substantial proportion given to food animals without any diagnosed illness (non-therapeutic use), either to promote growth or to compensate for the infectious risk stemming from crowded, stressful, and often unsanitary conditions.
HCWH supports policies and practices that initially reduce, and in the longer term eliminate, the procurement of meat, fish, and dairy products produced with routine, non-therapeutic uses of antibiotics. See our fact sheet, policy statement and sample purchasing policy for more information. (all pdf)
The reprocessing of single use devices has been commonplace in health care facilities across the country. This practice emerged when manufacturers began to label certain medical products as 'single-use' rather than 'reusable' without significantly changing the product. Hospitals became aware that some of this was due to manufacturers looking for increased profits when facilities were forced to buy single use items repeatedly, rather than reusing/reprocessing them.
The reprocessing of medical devices can help facilities cut costs. Reprocessed devices can offer a 50% cost-savings over purchasing a new device. It can also help decrease waste volumes as these materials are diverted from the waste stream and reused.
The FDA has been unrolling new guidelines for medical device reprocessing. As a result, hospitals have frequently begun to outsource to third part reprocessors. For more information, visit the Association of Medical Device Reprocessors (Note: HCWH does not endorse any specific product or manufacturer.)
Twenty-five years ago, many products in the medical setting were reusable. As manufacturers have introduced a growing number of single-use disposable medical products, the number of reusables has decreased.
As a result, waste volumes have ballooned-the waste stream is full of packaging and medical products that could be substituted with reusables. Re-examining the use of reusables can help hospitals make an educated choice on what products actually need to be single-use and disposable, and which products can be safely reused. Facilities should make sure that product evaluation committees consider whether certain products are more durable, refillable, or more easily repairable. A transition toward more reusables can bring significant cost-savings to purchasing, as well as a reduction in waste disposal costs.
See the Going Green Factsheet Disposables and Their Alternatives (pdf) for more information on typical types of reusable products, or check out the Sample Policy for Purchasing Reusable Products (pdf).