Hospitals play a pivotal role in protecting health. But they may also have a surprising unhealthy side inadvertently contributing to illness and pollution by exposing patients and staff to a witch's brew of toxins from building materials, medical waste, hospital supplies, and cleaning products.

Environmental health experts warn that materials that cover floors, walls, and ceilings release hundreds of chemicals into hospital air, and chemicals used to clean and maintain hospitals add more. Volatile organic compounds such as formaldehyde, acetaldehyde, naphthalene, and toluene are released into the air from particle board, carpets, and other finish materials and are inhaled by patients and staff. Polyvinyl chloride (PVC), which releases the carcinogen dioxin, is widely used in the production of IV and blood bags, plastic tubing, and other hospital products.

In addition, inadequate ventilation and generally high energy consumption have contributed to poor air quality and pollution, studies show, with effects ranging from longer patient recovery times to more sick days for staff. Under pressure from local and state governments, as well as health-care architects and designers and their own environmentally conscious donors, hospitals are building more efficient, eco-friendly facilities with sustainable design features that conserve energy, use natural light and materials and reduce potentially dangerous emissions.

At the same time, studies show that environmental improvements associated with sustainable buildings, such as bringing in more natural daylight, meditation areas, and healing gardens can shorten patients' length of stay, reduce reliance on medication, and lessen mental and physical stress.

As hospitals move to make such changes, the challenge now is not only to build hospitals to rigid environmental standards, but also to operate them with the same principles in mind. Stiffer regulations governing emissions of chemicals and heavy metals like dioxin and mercury are required to drive some changes, in particular regarding incinerator's use to dispose of medical waste. Since the mid 1990s, when regulators found that hospital incinerators were a major contributor to mercury and dioxin emissions, more than 5,000 medical-waste incinerators have closed, and hospitals have adopted safer waste-disposal and treatment technologies in the US.

Hospitals are also scrambling to find substitutes for building and interior finish materials. And companies that supply to the industry are under growing pressure to come up with greener products, including latex-free examination gloves, greener cleaners without harsh chemicals, and recyclable solvents.

What is the Green Guide for Health Care?

The Green Guide is the health care sector's first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations, and maintenance of their facilities. This guide provides the health care sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress towards high performance healing environments.

The Green Guide is divided into a construction section and an operations section. The construction section is relevant for new construction, renovations, and additions. Existing facilities are encouraged to track their ongoing performance using the operations section, while making a commitment to utilize the Construction section on future 
projects.

Following are few examples of the innovative green ideas which have potential for application apart from a lot of other benefits:

• Green heat and heat recovery for domestic water and hydronic heating
• Water reduction process
• Demand control of sterilizer condensate cooling
• Cooling coil condensate harvesting for landscape irrigation or cooling tower makeup
• Eliminating use of domestic water for once-through cooling
• Design for flexibility and minimizing use of materials
• Utility and emissions controls during construction
• Circadian rhythm lighting
• Day lighting and views for diagnostic and treatment spaces
• Acoustic environment

Ipsofacto, it can be said that the increase in the level of awareness among health care providers and receivers as well will culminate into overall improvement in the quality of health care provisioning, in years to come.

Hospital waste management is increasingly becoming a critical concern. How is AIIMS dealing with this important aspect?

AIIMS has been on forefront in implementing the rules and regulations concerned with bio-medical waste management. We have taken initiatives to collect, segregate, transport, and dispose the bio-medical waste in a non-hazardous manner, in compliance with the laws of the land. Periodically we do conduct environmental audits by an external expert agency to see that if there is any need to take further initiatives.

On your hospital's present as well as planned green initiatives

• Indoor healing gardens, outdoor walking spaces, staff break rooms with views
• Green housekeeping, landscaping, and integrated pest management practices
• Low-emission finishes
• Sensitizing the employees by different means of internal communications.
• Eliminating materials that contain or produce persistent, bio-accumulative, toxic chemicals

On essential benefits obtained from your green initiatives

There are a variety of benefits obtained. These are:

• Reduced maintenance and operating costs (commissioning)
• Improved medical outcomes
• Community good will
• Better employee recruiting and retention due to greater satisfaction with the work environment
• Sustainable Development

On cost implications of deploying green solutions

In an era of rising construction costs we should force suppliers to generate environmentally sensitive products. For example - industry has come up with ‘dual-flush' washrooms, which use more water for flushing solid waste and less for liquid, saving half a gallon of water for the latter. While many of the innovations cost more up front, they can actually reduce operating costs over time. Rubber flooring is more expensive to install than PVC, for example, but the hospital will save much more during the lifetime of the flooring due to the fact that it doesn't need to constantly strip the floor with toxic chemicals and relax it.

On problems faced in deploying these solutions

The hospitals should start teaching medical interns about environmental health and reaching out to underserved populations to educate them about issues such as how second-hand smoke can harm their children. In addition to cost, hospitals have to break new ground with green technologies. Design standards for green buildings - known in the industry as Leadership in Energy and Environmental Design, or LEED - can't always be used in a medical setting for safety reasons, so the health industry had to come up with its own standards for green building certification.