Greening of Hospitals: How should energy and the environment be considered in purchasing decisions?


A large training hospital can produce as much waste as a small town! Care and treatment of the average hospital patient can produce about 5.5 kilograms of waste each day. That translates to over 400 tonnes of waste each year from a medium-sized hospital with 200 beds. Approximately 15 per cent of the waste is biomedical, chemical and liquid, laboratory, pharmaceutical, or hazardous. At the same time, health-care facilities use large amounts of energy, water and natural resources.

Purchasing environmentally responsible products is one of the most effective ways to manage environmental concerns within a health-care system. Studies have shown that 80 per cent of waste is produced from 20 per cent of the purchased products. Through Environmental Responsible Purchasing (ERP), purchasing practices can be designed to favour products, services and activities that reduce impacts on the environment. Environmental ChoiceTM is Canada’s ecolabelling program. Products and services that have been certified under the program have been proven to have less impact on the environment and display the EcoLogo, a registered mark of Environment Canada (

In Canada, the international ENERGY STAR symbol helps businesses and consumers identify products that are at the “top of their class” in terms of energy efficiency. Products must meet or exceed technical specifications endorsed by the Government of Canada to qualify for ENERGY STAR. Requirements vary, but typically the product must be from 10 to 50 per cent more efficient than standard products to be allowed to carry the symbol. In addition to helping Canadians save energy and reduce greenhouse gases which contribute to climate change, ENERGY STAR labelled products save money over their operational lifetime. The less energy and/or water the product uses, the more the energy and dollar savings over the lifetime of the product. The ENERGY STAR HIGH EFFICIENCY initiative involves office equipment; heating, ventilating, and air-conditioning equipment (HVAC); consumer electronics; lighting and signage; commercial and industrial products (commercial clothes washers, solid door refrigerators and freezers, distribution transformers); and residential appliances. For more information on ENERGY STAR and tips on buying energy-efficient products, visit the ENERGY STAR Web site at

The health-care sector can help with air pollution by conserving energy, increasing employee awareness of energy efficiency, increasing facility efficiency, encouraging the use of alternative forms of energy, and joining voluntary programs to reduce pollution. This can include lighting, heating, ventilation, and air conditioning retrofits of facilities. In 1993, an energy retrofit program was initiated at the British Columbia Children’s Hospital and the British Columbia Women’s Hospital and Health Centre and by 1998 the annual electricity use was reduced by 33 per cent.

The health-care sector uses many substances and products, some of which are considered toxic. Environment Canada has established a process under the Canadian Environmental Protection Act (CEPA) whereby new and/or existing substances undergo steps in characterization, screening, risk assessment, and management in order to identify toxic substances and protect the environment and human health from harm. Once Environment Canada has deemed a substance CEPA toxic, the federal government will undertake preventative or control measures including establishing regulations, environmental objectives, environmental guidelines, environmental release guidelines, codes of practice, pollution prevention plans, environmental emergency plans, or agreements respecting environmental data and research. These measures can be implemented at any stage of a substance life cycle; from the research and development stage through manufacture, use, storage, transport, and ultimate disposal.

Pollution prevention (P2) is a winning environmental protection strategy that the health care sector can use to be proactive in managing toxic substances. Pollution prevention can reduce operational and maintenance costs, improve efficiency, lower risks for public, staff and the environment, and reduce liabilities. Pollution prevention is the use of processes, practices, materials, products, substances or energy that avoid or minimize the creation of pollutants and waste, and reduce the overall risk to the environment and human health. Environmentally responsible purchasing is recognized as one of the general pollution prevention practices.

In the City of Toronto, health care facilities were required to submit pollution prevention plans by December 31, 2001, if they discharged any of the pollutants identified in the new Sewer-use By-law. Pollutants such as mercury, chromium, methyl chloroform, nonyl phenol ethoxylates, and PCB’s are typical subject pollutants for the health care sector. By undertaking pollution prevention planning, health care facilities are now identifying pollution prevention opportunities to reduce or eliminate pollutants and wastes at the source.

Over the last several years the health-care sector has worked hard to reduce mercury exposure through pollution prevention. The Hospital for Sick Children in Toronto has reduced use of many items containing mercury such as thermometers, sphygmomanometers, weighted esophageal dilators, mercury switches, and old microwave ovens. The facility has also phased out the use of mercury-containing defibrillators and retrofitted lighting to use more energy efficient lamps that contain less mercury. In 1999, Environment Canada surveyed 188 hospitals in Ontario regarding mercury reduction initiatives. Over half of the 93 respondents indicated that their hospital had reduced mercury by greater than 51 per cent. Again, over half of the respondents had established and implemented an Environmental Management System (EMS), while 45 per cent of that number had also put in place an evaluation system to monitor EMS effectiveness.

The US Environmental Protection Agency has determined that medical waste incinerators are the third largest source of dioxin contamination in the United States. Many factors contribute to dioxin production during incineration, including the presence of chlorine in the waste stream. Health care facilities have begun replacing some of their chlorine containing plastics such as polyvinyl chloride with non-toxic alternatives such as non-chlorinated plastics or metals. In Canada, Canada Wide Standards have been developed for medical waste incineration to reduce atmospheric releases of dioxins and furans. In Ontario, the Ministry of Environment recently announced a phase-out of hospital incinerators by December 2003.

Ethylene oxide and nonyl phenol ethoxylates have recently been declared CEPA toxic substances. Ethylene oxide is used as a sterilant and in Canada this application is the most significant point source release of ethylene oxide to the environment. It is estimated that hospitals account for 27 per cent of the ethylene oxide emissions released into the air from sterilization applications. Nonyl phenol ethoxylates are used as a surfactant in many products including cleaning products. Environment Canada is currently developing control measures for both of these substances. Consultations for ethylene oxide are scheduled for the Spring of 2003.

The Canadian Centre for Pollution Prevention (C2P2) on behalf of Environment Canada and Natural Resources Canada, Office of Energy Efficiency, will be holding a one day workshop in March in Toronto on Health Care’s Impact on the Environment and Energy Consumption – What is the Role of Purchasing?

For further details about this workshop contact the C2P2 at 1-800-667-9790 ( If you would like more information on the topics discussed in this article contact Sandy Rossi, Environment Canada at 416-739-4381 or by email at