A cup and a request started it all back in 1995. That's when 2 nurses suggested we switch our disposable cups from polystyrene to a biodegradable material that could be composted. The idea sparked an environmentally friendly initiative in our 25-bed hospital that has reduced our standard and medical waste, lowered our energy bills, improved employee safety and sent fewer greenhouse gases into the environment. Last year our green movement culminated in our becoming the first hospital to receive the Vermont Governor's Award for Environmental Excellence and Pollution Prevention. These steps can help you become more eco-friendly and save you money along the way, too.

1. Change sterilizers. Consider asking central sterile to change the way it processes instruments and equipment requiring low-temperature sterilization. We converted from a common ethylene oxide (EtO) system to a hydrogen peroxide plasma sterilization system. EtO is a highly effective low-temperature sterilant, but it also poses risks to employees and the environment. It is a respiratory poison and causes nausea, vomiting and neurological disorders. It can also irritate and burn the skin, eyes and lungs. Long-term and repeated exposure can cause asthma, cancer and birth defects, according to the Centers for Disease Control and Prevention. What's more, EtO is a greenhouse gas. The sterilization system we used released EtO in a freon-class halogenated hydrocarbon, another greenhouse gas, into the outside air.

Since our existing system was getting old at the time and would have to be replaced within a few years, we decided to make the leap to hydrogen peroxide sooner rather than later. The hydrogen peroxide system was not a cheap alternative. It cost $95,000 at the time and the payback period was 8 years, compared to 3 years for a new EtO system.

However, we believed that the environmental benefits were worth the cost of purchasing new equipment. Since making the switch in 1997, we've avoided sending more than 1,200 pounds of ethylene oxide and 5 tons of halogenated hydrocarbon into the atmosphere. The only emissions from our hydrogen peroxide system sterilizer are small amounts of oxygen and water vapor. And we've also removed an occupational hazard from the workplace.

2. Streamline recycling. More than 70 tons of paper products flow through our hospital each year. We recycle or reuse 45 tons of corrugated cardboard and more than 19 tons of white paper. One of our goals is to direct as much of that material as possible into the recycling stream rather than the landfill; the hospital saves $20 on every ton it sends to the recycling facility. Over the next year, that savings is projected to be more than $1,400.

Think about investing in a new recycling compactor, which costs about $25,000. Compacting recyclable materials makes it economically and ecologically feasible to send commingled recyclable material to a recycling facility. When recyclable material is compacted, more can be loaded onto hauling trucks. This reduces the need for additional trips that consume fuel and send pollutants into the air.

Try to participate in single-stream recycling. That makes it easier for staff to recycle because they don't need to deal with separate containers for different materials. We currently use 65-gallon recycling bins that collect paper, glass and plastic. At the recycling center, an automated process separates paper, plastic, glass and metals.

Shredded paper was once a challenge to recycle. That's no longer the case. Our recycler accepts it as long as it's in clear plastic bags. The clear plastic allows the recycler to verify that only recyclable paper is in the bag. Recyclable material that has been contaminated by blood or other biohazards is diverted to medical waste containers.

Currently, we're working on a system to segregate and recycle the polypropylene wraps from procedure packs and gowns. When the program launches, the wraps will be saved in containers that our medical supplies distributor will pick up for recycling.

3. Decontaminate medical waste on site. Nationwide, hospitals throw 50 percent to 70 percent of the trash they generate into the regulated medical waste system, according to Practice Greenhealth. Recycling and proper waste segregation help reduce the amount of medical waste generated, which in turn saves money.

Think about decontaminating all biohazardous waste in a large autoclave, which will let you dispose of it locally. After decontamination for 1 hour, medical waste is transported to the local landfill, where it is buried immediately and its location is logged for future reference.

We process about 38,000 pounds of biohazardous material per year and decontaminate needles and syringes used by diabetic patients and other providers in the community. Proposing proper needle disposal in your community will keep sharps out of the public trash, lessening the risk that sanitation workers will suffer needlesticks.

4. Switch heating oil. Retrofit your boiler system to run on the cleaner No. 2 fuel oil rather than the sludgier No. 4 fuel oil, which sends more sulfur particles into the air. Our conversion — which cost about $6,000 to adapt our boiler's fuel delivery system — has eliminated about 6 tons of sulfur-dioxide emissions each year. We also save on the labor costs of maintaining and cleaning the boilers.

5. Give a second life to equipment. Try to keep all medical and office equipment and furniture out of the waste stream by trading surplus medical equipment in for new equipment, selling it through a broker or donating it to recipients in developing countries through a not-for-profit intermediary. This puts equipment into productive use in facilities that can't afford to buy the equipment. Sell furniture and non-medical equipment to employees for a nominal sum or donate it to not-for-profit organizations in your community. Dispose of equipment or furniture in solid waste only when it's broken.

6. Remove mercury. Mercury is a neurotoxin that accumulates over time in the body's tissues. We've worked to become mercury-free by replacing thermometers, blood pressure cuffs, esophageal dilators and electrical switches that contain mercury. We send fluorescent lights, which also contain mercury, to a reclamation facility. Removing mercury from your facility can also save you money. Cleaning up just 3 broken thermometers can cost as much as $1,000. As part of our mercury-free program, we buy bleach from sources that don't use the mercury-cell process in manufacturing. This helps reduce mercury levels in wastewater.

7. Make wise chemical choices. Work with environmentally friendly chemicals to reduce greenhouse gas emissions and workplace hazards. For high-level disinfection of heat-resistant instruments and equipment, such as endoscopes and ENT instruments, replace liquid glutaraldehyde, which causes headaches, burning eyes and other irritation, with ortho-phthalaldehyde (OPA).

The wise choice isn't necessarily the cheapest. For example, we've avoided using a hand sanitizer foam that contains a halogenated hydrocarbon even though it's less expensive than the more environmentally friendly product.

8. Ban polystyrene. Replace disposable polystyrene and plastic food service containers with reusable items. The cost to convert to reusable foodware was about $4,000. Our cafeteria still has a few disposable containers for takeout orders, but they're made of paper or a biodegradable polymer made from corn sugar.

Meeting the challenge
In the end, we determined that composting bio-plastic cups wasn't feasible, because the industrial composting facility wouldn't accept anything that looked like plastic made from petroleum. Our solution was to give all employees reusable mugs. But I'm delighted that the 2 nurses challenged us to do better. Their idea helped start a process that brought our hospital in line with our mission to advance the health of the communities that we serve and the value we place on the natural environment of our rural area.