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welcome
A self-certifying guidance document for harnessing best practices in the health care industry.
Janet Brown, H2EClark Reed,
EPA Energy Star
environmental health
Healthcare’s primary mission to protect health
=sustainability Design &
operation of our facilities
= opportunities for
improvement
overview
Protect the immediate health of building occupants.
Protect the health of the surrounding local community.
Protect the health of the global community and natural resources.
1
2
3
overviewstrategies
2001 ASHE Green Healthcare Construction Guidance Statement
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Three goals of “healing environments”
Reduce stress of the building’s occupants
Improve Safety
Contribute to Ecological Health
• Connection to nature (daylight/ views)• Choice & Control (light and ventilation)• Social Support (program areas)• Positive Distractions (views/ program)• Elimination of Environmental Stressors (noise)
• Improved Indoor Air Quality• Supportive Lighting Design/ Reduced Glare
• Healthier Materials • Reduce Energy and Water Use
“A better building is one that facilitates physical, mental, and social well-being and productive behavior in its occupants”
http://www.healthdesign.org
What is H2E?H2E was jointly founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association. To achieve our vision, mission and goals, H2E is educating health care professionals about pollution prevention opportunities and providing a wealth of practical tools and resources to facilitate the industry’s movement toward
environmental sustainability.
H2E VisionH2E is based on a vision of a healthy health care system – a system in which an environmentally aware and engaged health care community is dedicated to the health of patients, workers, their communities, and the global environment. We envision a system where patients and staff interact in a healing environment that embraces safer building products, clean air, reduced toxins, safe working practices, energy and water efficiency, education, and a commitment to public health demonstrated through waste volume and toxicity reduction. We envision a system that recognizes the link between our choices and our health, and are working to make that system a reality by creating a national movement for environmental sustainability in health care.
GGHC
But what does this do for the CEO?
1. Personnel shortages2. Reimbursement3. Malpractice Insurance 4. Government mandates 5. Physician-Hospital Relations 6. Capacity7. Care for the uninsured 8. Patient Safety9. Technology10. Patient Satisfaction
How green is my facility?
benchmark
overviewstrategies
Sponsors
Convener
sponsors
Center for Maximum Potential Building Systems, www.cmpbs.org
Hospitals for a Healthy Environment, www.h2e-online.org
NYS Research and Energy Development Authority, www.nyserda.org
Merck Family Fund, www.merckff.org
steering committee
overviewcontributors
Gail Vittori (Convener), CMPBS; Austin, TX
Mike Gallivan, Turner Construction; Boston, MA
Robin Guenther, AIA Guenther5 Architects; New York NY
Tom Lent, Healthy Building Network; Berkeley, CA
Robert Loranger, New England Medical Ctr; Boston, MA
Brendan Owens, US Green Building Council; Washington DC
Clark Reed, US EPA Energy Star; Washington DC
Greg Roberts AIA, Watkins Hamilton Ross; Houston, TX
Kim Shinn PE, TLC Engineers; Nashville, TN
Scott Slotterback, Kaiser Permanente; Oakland, CA
Al Sunseri PhD, ASHE; Chicago, IL
Walt Vernon PE, Mazzetti & Associates; San Francisco, CA
Janet Brown, Hospitals for a Healthy Environment; New York, NY
Steve Guttmann PE, Guttmann & Blaevoet; San Francisco, CA
Jamie Harvie PE, Institute for a Sustainable Future; Duluth, MN
Craig Kneeland, NYSERDA; Albany, NY
Ray Pradinuk AIBC, Stantec Architecture; Vancouver, BC
Alan Traugott, CJL Engineering; Moon Turnpike, PA
Steve Ashkin The Ashkin Group IN
additionalcontributors
overviewcontributors
Laura Brannen Hospitals for Healthy Env, NH
Kathy Gerwig Kaiser Permanente, CA
Robert Guerry, CHFM Duke Univ Med Center, NC
Steve Guttman, PE Guttman & Blaevoet, CA
Jamie Harvie, PE Inst for a Sustainable Future, MN
Tom Hicks US EPA Energy Star, DC
Wayne Klingelsmith FASHE Athens Reg Medical Center, GA
Paul Matthew Lawrence Berkeley Lab, CA
Sue Rubin ASHE, IL
Dale Woodin ASHE, IL
ASHE Green Healthcare Construction Guidance Statement (2002)
LEED® Green Building Rating System
Labs 21 Environmental Performance Criteria
Australia Green Building Council’s Green Star
New York City High Performance Building Guidelines
Savings by Design Healthcare Model (Pacific Gas & Electric)
AIA Guidelines for Healthcare Construction
overviewcontributors
reference documents
The Green Guide for Health Care seeks to reward those organizations that voluntarily steward the environment in the interests of human health. It also creates incentive for the healthcare and related industries to change their practices, build sustainable environments, and enhance their overall accountability and performance.
industrytool
The design and operation of health care buildings is highly regulated with intense economic and life safety oversight
Health care facilities are often multiple building campuses of varying ages, conditions, systems
24/7 operations with patients in place require intensive coordination and redundancy of all services at all times.
Long ownership mean owners realize life cycle implications of their construction choices.1
2
3
4
overviewdesign attributes
Operational issues, such as mercury elimination, have defined industry’s environmental stewardship
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overviewoperational attributes
The H2E is a voluntary program designed to help health care facilities enhance work place safety, reduce waste and waste disposal costs and become better environmental stewards and neighbors.
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Construction frequently occurs within or adjacent to occupied buildings (where health is fragile, or steadiness of hand required)
overviewconstruction attributes
Infection Control Risk Assessment (ICRA) protocols to minimize the impacts of construction on occupants demonstrate leadership to the wider sustainable building industry
Healthcare construction managers can evolve a rigorous, sustainable set of practices for the healthcare industry that may inform wider construction practice
constructionmanual
1 – Integrated Design2 – Sustainable Sites3 – Water Efficiency4 – Energy & Atmosphere5 – Materials & Resources6 – Indoor Environmental Quality
7 – Innovation
2 - 21 - 181 - 73 - 192 - 242 - 220 - 4
11 - 94
Section / Category Name Pre-Req. / Max. Total
operationsmanual
1 – Integrated Operation2 – Energy Conservation3 – Water Conservation4 – Chemical Management5 – Waste Management6 – Environmental Services7 – Environmental Purchasing8 – Innovation
4 - 83 - 181 - 81 - 51 - 60 - 90 - 110 - 7
10 - 72
Section / Category Name Pre-Req. / Max. Total
Intent
Documentation
Health Issues
Reference Standards
Credit Goals
Technologies & Strategies
organization
INTEGRATED DESIGN4 points
How do we ensure a connection to health mission in the design
process?How do we optimize the design
process to consider the facility’s operations?
What protocols are necessary to maintain healthy building
operations?
INTEGRATED OPERATIONS8 points
integrated design
Integrated Design Process
Environmental Health Mission Statement & Program
2 prerequisites
Prereq 1
Prereq 2
prerequisites
integrated operations
Integrated O&M
Re-certification Process
Outside Air Introduction & Exhaust
Environmental Tobacco Smoke
4 prerequisites
Prereq 1
Prereq 2
Prereq 3
Prereq 4
prerequisites
ID Prerequisite 1:Integrated Design Process
Use cross discipline decision making starting early in the design process &
continuing throughout to maximize interrelationships between systems.
ArchitectsEngineers
Interior DesignersBuilders &
Contractors
Facility managersAdministratorsMedical Staff
Patients
Group purchasing
organizations Support services
Integrated design process
winning solutions
ID Prerequisite 2: Establish a health mission statement and environmental health goals for governing the design process & integrating sustainability strategies
IO Prerequisite 1: Create synergies among staff early in the planning process by involving
decisionmakers who influence the building’s operational output. Foster
connections between output systems in order to optimize flows.
Professional Consultants/
Facilities Managers
core credit
ManagersAdministratorsClinical Staff
Patients
PurchasersSupport ServicesInfection Control
Quality Assurance
INNOVATION INDESIGN
Can our organization contribute new industry leadership, working protocols, operational initiatives, and engaging strategies for an evolving environmental health dialog?
What new ideas does our project embody by building upon these goals and principles?
4 points
Does our building design find new and creative ways to support healing environments for our patients, and
supportive environments for our staff?
SS Credit 9 Connection to the Natural World
sustainable sites
Atrium
Cafe
Library
Establish 5% of the building program as
programmed places of respite easily accessible to patients, visitors, and
staff. Provide at least one place of respite dedicated to staff and separate from
patients and visitors.
fresh air
clean site
sustainable sites
Credit 10.1 & 10.2 Community Contaminant Prevention (2)
Exceed by 10% NIH-CDC Guidelines for Airborne
Effluent from Laboratories
Develop a policy for containment and engineering controls to manage fuel and
chemical storage.
Energy Star® compliant (highly reflective) AND high emissivity roofing (emissivity of at least 0.9 for 75% of areaOR a "green" (vegetated) roof for at least 50% of the roof area.
Combinations to collectively cover 75% of the roof area.
Credit 7: Heat Island Effect: Roof
sustainable sites
WATER EFFICIENCY7 points
WATER CONSERVATION
How can we conserve and protect water supplies in rural and urban
environments?
Can we improve use efficiencies and reduce potable water demand?
8 points
prerequisite
(Eliminate) Potable Water Use for Equipment Cooling
1
water efficiency
1 prerequisiteDo not use potable water for once through cooling for any equipment.
•Credit 1: Water Efficient Landscaping (2)•Credit 2: Innovative Wastewater Technologies (1)•Credit 3: Potable Water Use Reduction (2)•Credit 4: Process Water Efficiency (2)
Reduce potable water use
7 pointswater efficiency
Black – as in LEED Green – modified from LEED Blue – new to GGHC
environmentalhealth
Use high efficiency irrigation technologies,
employ xeriscape plantings OR
Use captured rain or recycled site water to
reduce irrigation needs.
Credit 1: Water Efficient Landscaping (2):
Reduce potable water use by 50%, or eliminate potable water usage
water efficiency & conservation
environmentalhealth
Employ strategies that in aggregate use less water
than the water use baseline after meeting the Energy Policy Act of 1992
fixture performance requirements.
Const WE Credit 3 (2): Ops WC Credit 2 (2):
Potable Water Use Reduction Reduce potable water use by 10%
to 30%
Low consuming fixtures
Occupant sensor controls
water efficiency & conservation
environmentalhealth
4.1 Document Baseline process water usage
4.2 Reduce Process water usage by
20% to 30%
Ops WC Credit 3: Process Water Efficiency (3):
Reduce process water use by 20% to 40%
Const WE Credit 4: Process Water Use Reduction (2).
water efficiency & conservation
ENERGY & ATMOSPHERE19 points
18 pointsENERGY EFFICIENCY
How does the hospital reduce energy demand and environmental impacts
from fossil fuel use?
Does the facility utilize renewable sources of energy?
Can healthcare entities conserve and protect natural reserves as a
safeguard measure for human health?
Fundamental Building Systems Commissioning
1
Minimum Energy Performance2
CFC Reduction in HVAC&R Equipment3
3 prerequisites
ENERGY & ATMOSPHERE
New Construction: Model anticipated energy performance
using DOE2.1E excluding equipment loads.
Renovation or Additions:Use results of DOE2.1E models calibrated against actual usage
data.
Use EPA Energy Star™ TargetFinder and Statement of
Design Intent.
Credit 1: Optimize Energy Performance (10):
Reduce energy demand & preserve community supply by
10% to 45%
energy & atmosphereenergy conservation
Credits 2, 4 & 7 / Credits 2 & 4: Reduce environmental health impacts by selecting refrigerants that preserve the ozone layer and protect human health; support renewable power sources that preserve environmental health
Credits 1 & 7 / Credits 3 & 4:Reduce energy demand, increase payback and community health through design energy efficiency measures and improved equipment efficiencies.
energy & atmosphereenergy conservation
credits
Credits 3, 5 & 6 / Credits 1 & 5: Optimize ongoing performance with commissioning, measurement, and energy supply efficiency for even better rate of return.
Credits 2 & 5: Reduce climate change impacts and impacts to community resource infrastructure through support for renewable power sources and emissions reduction reporting.
Prerequisite Credit 1 :Reduce energy demand through design energy efficiency measures and improved equipment efficiencies.
energy conservationcredits
Credits 1, 3 & 4: Optimize ongoing performance with commissioning, measurement, and energy supply efficiency.
•Credit 1/ Construction: Optimize Energy Performance (8)•Credit 1/ Operations: Optimize Energy Performance (10)
reduce energy demand
energy & atmosphereenergy conservation
energy & atmosphere
Credit 7:Medical Equipment Efficiency
Use Energy Star ® qualified products or equipment in the top 25th percentile for at least 75% (based on quantities, not costs) of new equipment that is not building systems related, and at least 30% of all such equipment
prerequisite
Prereq 2: Mercury Elimination
Switches, thermostats, gauges
Low-mercury lamps
Medical devices
Dental amalgam separators
Demolition protocol
materials & resources
materials & resources
2.1 Divert 50% from landfills and incineration.
2.2 Divert 75% from landfills and incineration.
Calculate by weight or volume.
Credit 2: Construction Waste Management (2):
Divert construction, demolition and land clearing debris
Waste management plan
salvage
recycle
Reduce total waste volume by 30-50% below 1998 volumes.
Utilize alternative waste treatment technologies to
reduce reliance on incineration for medical waste.
WM Credit 1 & 2: Waste reductionReduce total and regulated medical
waste disposal in landfills and incinerators
Waste management plan
Reduce use of disposables
Reduce packaging
Recycle
waste management
EP Credit 3: Electronics Purchase & Take Back
Electronics purchasing policy: • Toxics disclosure
• Take Back – no landfill, incineration or export
environmental purchasing
ES Credit 4: Environmentally Preferable Cleaning Policy
• Sustainable floor care systems
• Levels of required disinfection
• GreenSeal GS-37 cleaning products
environmental services
What: Peer-to-peer forum to discuss GGHC
Who: Health care project participants:
- Health care system facility planners
- Contracted design teams (architects, engineers, interior designers, etc)
- GGHC (GGHC Coordinator & Steering committee)
- Not vendor reps
Where: online at www.GGHC.org
gghc forum basics
overviewforum
Green Guidefor Health Care
www.gghc.org
Download the 2.2
For More Information
Clark Reed, EPA
202/343-9146
Janet Brown, H2E
413/253-0254
