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Janet Brown, H2E Clark Reed, EPA Energy Star. A self-certifying guidance document for harnessing best practices in the health care industry. . welcome. Healthcare’s primary mission to protect health = sustainability. Design & operation of our facilities =

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  1. Janet Brown, H2E Clark Reed, EPA Energy Star A self-certifying guidance document for harnessing best practices in the health care industry. welcome

  2. Healthcare’s primary mission to protect health = sustainability Design & operation of our facilities = opportunities for improvement environmental health overview

  3. 2001 ASHE Green Healthcare Construction Guidance Statement Protect the immediate health of buildingoccupants. Protect the health of the surroundinglocalcommunity. Protect the health of theglobal communityand natural resources. 1 2 3 strategies overview

  4. Three goals of “healing environments” Reduce stress of the building’s occupants “A better building is one that facilitates physical, mental, and social well-being and productive behavior in its occupants” • Connection to nature (daylight/ views) • Choice & Control (light and ventilation) • Social Support (program areas) • Positive Distractions (views/ program) • Elimination of Environmental Stressors (noise) Improve Safety • Improved Indoor Air Quality • Supportive Lighting Design/ Reduced Glare Contribute to Ecological Health • Healthier Materials • Reduce Energy and Water Use http://www.healthdesign.org

  5. 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.

  6. H2E Vision H2E 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.

  7. GGHC But what does this do for the CEO? 1. Personnel shortages 2. Reimbursement 3. Malpractice Insurance 4. Government mandates 5. Physician-Hospital Relations 6. Capacity 7. Care for the uninsured 8. Patient Safety 9. Technology 10. Patient Satisfaction

  8. How green is my facility? benchmark strategies overview

  9. Center for Maximum Potential Building Systems,www.cmpbs.org Convener Merck Family Fund, www.merckff.org Sponsors Hospitals for a Healthy Environment, www.h2e-online.org NYS Research and Energy Development Authority, www.nyserda.org sponsors

  10. 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 RobertsAIA, 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 steering committee contributors overview

  11. Steve Ashkin The Ashkin Group IN 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 additional contributors 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 contributors overview

  12. 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 reference documents contributors overview

  13. 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. industry tool

  14. Long ownership mean owners realize life cycle implications of their construction choices. 1 24/7 operations with patients in place require intensive coordination and redundancy of all services at all times. 2 Health care facilities are often multiple building campuses of varying ages, conditions, systems 3 The design and operation of health care buildings is highly regulated with intense economic and life safety oversight 4 design attributes overview

  15. 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. Operational issues, such as mercury elimination, have defined industry’s environmental stewardship 5 operational attributes overview

  16. Construction frequently occurs within oradjacent to occupied buildings (where health is fragile, or steadiness of hand required) 6 Infection Control Risk Assessment (ICRA) protocols to minimize the impacts of construction on occupants demonstrate leadership to the wider sustainable building industry 7 Healthcare construction managers can evolve a rigorous, sustainable set of practices for the healthcare industry that may inform wider construction practice 8 construction attributes overview

  17. Section / Category Name Pre-Req. / Max. Total 1 – Integrated Design 2 – Sustainable Sites 3 – Water Efficiency 4 – Energy & Atmosphere 5 – Materials & Resources 6 – Indoor Environmental Quality 7 – Innovation 2 - 2 1 - 18 1 - 7 3 - 19 2 - 24 2 - 22 0 - 4 11 - 94 construction manual

  18. Section / Category Name Pre-Req. / Max. Total 1 – Integrated Operation 2 – Energy Conservation 3 – Water Conservation 4 – Chemical Management 5 – Waste Management 6 – Environmental Services 7 – Environmental Purchasing 8 – Innovation 4 - 8 3 - 18 1 - 8 1 - 5 1 - 6 0 - 9 0 - 11 0 - 7 10 - 72 operations manual

  19. Intent Health Issues Credit Goals Documentation Reference Standards Technologies & Strategies organization

  20. INTEGRATED DESIGN 4 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 OPERATIONS 8 points

  21. Prereq 1 Integrated Design Process Environmental Health Mission Statement & Program Prereq 2 2 prerequisites prerequisites integrated design

  22. Prereq 1 Integrated O&M Re-certification Process Prereq 2 Prereq 3 Environmental Tobacco Smoke 4 prerequisites Prereq 4 Outside Air Introduction & Exhaust prerequisites integrated operations

  23. ID Prerequisite 1: Integrated Design Process Use cross discipline decision making starting early in the design process & continuing throughout to maximize interrelationships between systems. Architects Engineers Interior Designers Builders & Contractors Integrated design process Group purchasing organizations Support services Facility managers Administrators Medical Staff Patients winning solutions

  24. ID Prerequisite 2:Establish a health mission statement and environmental health goals for governing the design process & integrating sustainability strategies Managers Administrators Clinical Staff Patients Professional Consultants/ Facilities Managers Purchasers Support Services Infection Control Quality Assurance 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. core credit

  25. What new ideas does our project embody by building upon these goals and principles? Does our building design find new and creative ways to support healing environments for our patients, and supportive environments for our staff? 4 points Can our organization contribute newindustry leadership, working protocols, operational initiatives, and engaging strategies for an evolving environmental health dialog? INNOVATION IN DESIGN

  26. SS Credit 9 Connection to the Natural World 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. Library Atrium Cafe sustainable sites

  27. Credit 10.1 & 10.2 Community Contaminant Prevention (2) fresh air 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. clean site sustainable sites

  28. Credit 7: Heat Island Effect: Roof Energy Star® compliant (highly reflective) AND high emissivity roofing (emissivity of at least 0.9 for 75% of area OR a "green" (vegetated) roof for at least 50% of the roof area. Combinations to collectively cover 75% of the roof area. sustainable sites

  29. WATER EFFICIENCY 7 points 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 WATER CONSERVATION

  30. (Eliminate) Potable Water Use for Equipment Cooling 1 Do not use potable water for once through cooling for any equipment. 1 prerequisite prerequisite water efficiency

  31. Reduce potable water use • 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) Black – as in LEEDGreen – modified from LEED Blue – new to GGHC 7 points water efficiency

  32. Credit 1: Water Efficient Landscaping (2): Reduce potable water use by 50%, or eliminate potable water usage Use high efficiency irrigation technologies, employ xeriscape plantings OR Use captured rain or recycled site water to reduce irrigation needs. environmental health water efficiency & conservation

  33. Const WE Credit 3 (2): Ops WC Credit 2 (2): Potable Water Use Reduction Reduce potable water use by 10% to 30% Employ strategies that in aggregate use less water than the water use baseline after meeting the Energy Policy Act of 1992 fixture performance requirements. Occupant sensor controls environmental health Low consuming fixtures water efficiency & conservation

  34. 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). 4.1 Document Baseline process water usage 4.2 Reduce Process water usage by 20% to 30% environmental health water efficiency & conservation

  35. ENERGY & ATMOSPHERE 19 points 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? 18 points ENERGY EFFICIENCY

  36. ENERGY & ATMOSPHERE Fundamental Building Systems Commissioning 1 Minimum Energy Performance 2 3 prerequisites CFC Reduction in HVAC&R Equipment 3

  37. Credit 1: Optimize Energy Performance (10): Reduce energy demand & preserve community supply by 10% to 45% 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. energy & atmosphere energy conservation

  38. credits Credits 1 & 7 /Credits 3 & 4: Reduce energy demand, increase payback and community health through design energy efficiency measures and improved equipment efficiencies. 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, 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 energy & atmosphere energy conservation

  39. Prerequisite Credit 1 : Reduce energy demand through design energy efficiency measures and improved equipment efficiencies. Credits 1, 3 & 4: Optimize ongoing performance with commissioning, measurement, and energy supply efficiency. Credits 2 & 5: Reduce climate change impactsand impacts to community resource infrastructure through support for renewable power sources and emissions reduction reporting. credits energy conservation

  40. reduce energy demand • Credit 1/ Construction: Optimize Energy Performance (8) • Credit 1/ Operations: Optimize Energy Performance (10) energy & atmosphere energy conservation

  41. 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 energy & atmosphere

  42. Prereq 2: Mercury Elimination Switches, thermostats, gauges Low-mercury lamps Medical devices Dental amalgam separators Demolition protocol prerequisite materials & resources

  43. Credit 2: Construction Waste Management (2): Divert construction, demolition and land clearing debris 2.1 Divert 50% from landfills and incineration. 2.2 Divert 75% from landfills and incineration. Calculate by weight or volume. salvage recycle Waste management plan materials & resources

  44. WM Credit 1 & 2: Waste reduction Reduce total and regulated medical waste disposal in landfills and incinerators Waste management plan Reduce total waste volume by 30-50% below 1998 volumes. Utilize alternative waste treatment technologies to reduce reliance on incineration for medical waste. Recycle Reduce use of disposables Reduce packaging waste management

  45. EP Credit 3: Electronics Purchase & Take Back • Electronics purchasing policy: • Toxics disclosure • Take Back – no landfill, incineration or export environmental purchasing

  46. ES Credit 4: Environmentally Preferable Cleaning Policy • Sustainable floor care systems • Levels of required disinfection • GreenSeal GS-37 cleaning products environmental services

  47. gghc forum basics 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 forum overview

  48. Green Guide for Health Care www.gghc.org Download the 2.2

  49. For More Information Clark Reed, EPA Reed.clark@epa.gov 202/343-9146 Janet Brown, H2E Janet.brown@h2e-online.org 413/253-0254

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