please feel free to visit our website atwww.bms.com. tovisitourwebsite please feelfree our policiesandprocedures, Squibb, wouldlikeadditionalinformationonBristol-Myers you If www.wzu.uni-augsburg.de. at ScienceCenterplease visitourwebsite additionalinformationontheEnvironmental For ispossible. Thus, innovation practicalapplications. involving useful forprojects industrysectors,whichisparticularly various withdecision-makersfrom us todealdirectly WEC enables The partnershipwiththe Umwelt. Wissenschaftszentrum located adjacenttothe Centeris Environment World ofthe office thattheEuropean for ourwork a majoradvantage itis Therefore, understanding oftechnicalandindustrialissues. athorough science requires inenvironment Progress the sustainablehandlingofsubstances,materialsandenergy. foraspecifiedperiodontopicswithinthecontextofourcentraltheme - towork Umwelt Wissenschaftszentrum setupat are groups usuallytakenforgranted.Research which are methods, to aquestioningofthetraditionalacademicdivisionsandfield-specificworking otherfieldsofstudyshouldlead withscientistsfrom The exchange staff. university our own othercountrieswillcomplementthepotentialof andfrom otheruniversities scientists from The participationof fields. different from thecollaborationofresearchers studied through topicscanonlybefittingly dialogue.Environmental ofinterdisciplinary energy productive focusingonthe are this,we achieve To Studies. inthefieldofEnvironmental developments andtechnological research innovative aimistostimulatecross-disciplinary, Our research. environmental ofinterdisciplinary projects forinternationalco-operative 'crossroads' expertsand acenterand international meeting-placeforselectedhigh-rankingenvironmental isan University Augsburg ScienceCenter)at (Environment Umwelt Wissenschaftszentrum The Umwelt/WZU Wissenschaftszentrum ISBN 3-00-012582-5 Greener Hospitals W ISSENSCHAFTSZ ENTRUMU MWELT WZU With support from: Bristol-Myers Squibb Company Squibb supportWith Bristol-Myers from: Germany Augsburg, ScienceCenter, Environment by: Edited Greener Hospitals Greener Performance Environmental Improving Greener Hospitals Notes We would like to thank all the individuals and organizations that contributed to this manual. Reviewers included: Kai Abelkis - Boulder Community Hospital, Boulder, Colorado; Laura Brannen - Hospitals for a Healthy Environment, Lebanon, New Hampshire; Bonnie Eskenazi - The Deirdre Imus Environmental Center for Pediatric Oncology, Hackensack, New Jersey; John N. Gamble - The UTMD Anderson Cancer Center, Houston, Texas; Jill Kavoukian - Stony Brook University, Stony Brook, New York; Dr. Klaus Kümmerer - University Hospital, Freiburg Institute for Environmental Medicine and Hospital Epidemiology, Germany; Melissa Leone RN, BSN - Apria Healthcare, Hamden, Connecticut; Dr. Uta Müller - Institut für Management und Umwelt- schutz; Martin Scherrer - University Hospital Freiburg. Institute for Environmental Medicine and Hospital Epidemiology, Germany; Isabelle Secher - World Environment Center, Europe, Augsburg, Germany; Karen Shapiro - Tellus Institute, Boston, Massachusetts; Dr. Francesco Violante - University of Bologna, Bologna, Italy; Marian Condon - College Park, Maryland; Charlotte Burg - Gentofte County Hospital, Hellerup, Denmark; Bo Jonoe - Sonderbrog Hospital, Sonderbrog, Denmark; Erica Stewart and Kathy Gerwig, Kaiser Permanente, Oakland, California; the American Society for Healthcare Environmental Services, Chicago, Illinois; Klaus Meier - European Society of Oncology Pharmacy, Hamburg, Germany; James G. Veras - World Environment Center, Executive Vice President Emeritus, Palm Beach, U.S.. This manual has been prepared by Wissenschaftszentrum Umwelt, Augsburg, Germany, with support of Bristol-Myers Squibb. Edited by: Wissenschaftszentrum Umwelt University Augsburg, Germany Printer: OrtmannTeam GmbH, 81379 Munich, Germany Designed by: Cordula Schwab, Art and Design, Augsburg, Germany Coordinated by: Prof. Dr. Armin Reller, Chairman Wissenschaftszentrum Umwelt, Augsburg, Germany Supported by: Bristol-Myers Squibb Company Ludwig Metz and Team ISBN 3-00-012582-5 Greener Hospitals As a leading pharmaceutical company, Bristol-Myers Squibb’s mission is …to extend and en- hance human life. The company’s core values, as embodied in the Bristol-Myers Squibb Pledge, focus on sustaining and improving the lives of people throughout the world. We feel that our support of this document is tangible evidence of our firm commitment to be a global environ- mental leader while helping healthcare facilities become more aware of their environmental impacts and responsibilities. For more information on Bristol-Myers Squibb Company, please visit our website at www.bms.com. For more information on the Wissenschaftszentrum Umwelt University Augsburg, Germany, please visit their website at www.wzu.uni-augsburg.de. For additional copies, please contact: D. Pulkinen Bristol-Myers Squibb P.O. Box 4755 Syracuse, NY 13221-4755 Telephone: + 315-432-2997 Fax: + 315-432-2836 All rights reserved Bristol-Myers Squibb Co. This publication is protected by Copyright. No part of this publication may be reproduced. This manual sets forth broadbased general guidance relating to environmental management systems, and does not address all issues in any given country. With regards to country-specific legal regulatory requirements, it is the reader’s responsibility to seek competent professional guidance. Editors, coordinators, supporters, suppliers and reviewers do not assume any liability. This manual has been prepared with an environmental focus throughout the production process. It is printed on paper made of 100 percent post consumer waste fiber, processed chlorine free, using vegetable-based inks. 1 EnvironmentalSpecific Areas for Potential Improvement Management for Healthcare Facilities Forward Throughout the world, hospitals and other healthcare facilities are dedicated to providing innovative and compassionate patient care that meets high standards of quality in a cost-effective manner. How- ever, in fulfilling this important mission to care for patients, healthcare facilities have an impact on the natural environment. Over the past few years, regulatory agencies and local communities have pushed for greater environmental controls within the healthcare setting. From energy conservation to the proper disposal of medical waste and the safe handling of highly potent pharmaceuticals, healthcare facilities are discovering that the adage “do no harm” is applicable not only to their patients but to the natural environment and communities around them. Healthcare facilities across the globe are rising to this challenge by identifying and reducing the negative enviromental impact of their operations. In particular, hospitals, clinics, and doctors’ offices are adopting formal environmental management systems and sharing best practices that have been successfully used by other organizations in the healthcare sector. This manual provides practical advice to help healthcare facilities improve their environmental management systems and performance. By clearly outlining the benefits of sharing best practices and developing formal environmental management systems, we feel that this document will better prepare healthcare facilities to meet the rising expectations of regulators and their local communi- ties. Key features of this manual include: ½ Internet addresses for more than 40 sites that provide additional background information and case studies from Europe, Asia, and the United States Self-assessment checklists covering: Environmental management systems Laboratory, cleaning, laundry, kitchen Waste management Energy management Hazardous substances Water management Wastewater management Air emissions Purchasing and material management Due to space limitations, this document does not address employee health and safety issues. However, we recognize that protecting healthcare workers is an important responsibility that is connected not only to environmental stewardship, but also to the mission of healthcare facilities. Prof. Dr. Armin Reller, Chairman Wissenschaftszentrum Umwelt, Augsburg, Germany 2 Table of Contents 1. Introduction 1.1. Why an Environmental Management System is Important for Healthcare Facilities page 5 1.2. What is an Environmental Management System and How Can It Benefit Healthcare Facilities and Their Patients? page 5 1.3. What is Covered in the Manual? page 6 2. Hospitals Today 2.1. Stakeholders in Hospitals page 7 2.2. Hospitals as “Role Models” page 8 2.3. Environmental Impacts and Prevention page 8 2.4. Evaluating and Benchmarking Environmental Impact page 9 2.4.1. Influence of Hospital Characteristics on Environmental Impact page 9 2.5. Environmental Impacts page 10 2.5.1. Energy Consumption page 10 2.5.2. Water Consumption page 12 2.5.3. Waste Management page 13 3. Environmental Management System 3.1. What is an Environmental Management System? page 15 3.2. Eco-Management and Audit Scheme (EMAS) and International Standards Organization (ISO) page 15 3.3. ISO 14001 and Aspects Analysis page 15 3.3.1. Key Elements of ISO 14001 page 15 3.3.2. Aspects Analysis page 18 3.3.2.1. Categories of Environmental Aspects page 18 3.3.2.2. Aspects Analysis Methodology page 18 3.4. Web Addresses: Environmental Management Systems page 20 4. Implementing an Environmental Management System 4.1. General page 21 4.2. Practical Tips page 21 4.3. Environmental Management System Checklists page 23 4.4. Training page 23 3 SpecificTable of AreasContents for