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      THE GREENING OF HEALTHCARE: FABRICS USED IN HEALTH CARE FACILITIES

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          INTRODUCTION

          “There is no separation between environmental issues and health issues” (Smith and Lourie, 2010 a). Researchers from Environment Canada (Muir and Zegarac, 2001) estimate that North American healthcare costs and lost productivity linked to environmental factors total between $568 billion and $793 billion per year ($46 billion and $52 billion for Canada alone). These are staggering numbers and could be easily overlooked when various government budgets are examined as “silos” and the interconnectivity of the environment and health care costs are not considered. They are costs borne both financially and in terms of quality of life.

          The greening of healthcare textiles is a topic of great importance for the overall greening of healthcare spaces due to the large number of chemicals used in the production of fabrics. Both patients and healthcare workers are exposed to these chemicals through dermal contact, inhalation, and ingestion. Hospital “green” teams and purchasing agents need to be aware of how to best select textiles for their facilities.

          LEED (Leadership in Energy and Environmental Design) is a comprehensive internationally recognized standard for certification and construction of green buildings (Canada Green Building Council, 2004a). The U.S. Green Building Council (USGBC) started this program in 1993, and there are currently non-profit green building councils in 77 countries around the world (World Green Building Council, 2010). LEED standards are set for energy savings, water efficiency, carbon dioxide emissions reduction, improved indoor environmental quality, stewardship of resources, and sustainable locations. Innovation and education are also rewarded in the certification process. Verifiable third-party standards are set for practical and measurable design, construction, operation, and maintenance of buildings. Programs are available for commercial and residential buildings and neighbourhoods. The USGBC is currently developing a program specifically for healthcare (US Green Building Council, 2010).

          The general principles from LEED (Leadership in Energy and Environmental Design) (Canada Green Building Council, 2004a) provide the analytical framework for the five criteria for selecting textiles for healthcare use presented in Table 1.

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          Most cited references 37

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          Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications.

          To study the possible role of contaminated environmental surfaces as a reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. A prospective culture survey of inanimate objects in the rooms of patients with MRSA. A 200-bed university-affiliated teaching hospital. Thirty-eight consecutive patients colonized or infected with MRSA. Patients represented endemic MRSA cases. Ninety-six (27%) of 350 surfaces sampled in the rooms of affected patients were contaminated with MRSA. When patients had MRSA in a wound or urine, 36% of surfaces were contaminated. In contrast, when MRSA was isolated from other body sites, only 6% of surfaces were contaminated (odds ratio, 8.8; 95% confidence interval, 3.7-25.5; P < .0001). Environmental contamination occurred in the rooms of 73% of infected patients and 69% of colonized patients. Frequently contaminated objects included the floor, bed linens, the patient's gown, overbed tables, and blood pressure cuffs. Sixty-five percent of nurses who had performed morning patient-care activities on patients with MRSA in a wound or urine contaminated their nursing uniforms or gowns with MRSA. Forty-two percent of personnel who had no direct contact with such patients, but had touched contaminated surfaces, contaminated their gloves with MRSA. We concluded that inanimate surfaces near affected patients commonly become contaminated with MRSA and that the frequency of contamination is affected by the body site at which patients are colonized or infected. That personnel may contaminate their gloves (or possibly their hands) by touching such surfaces suggests that contaminated environmental surfaces may serve as a reservoir of MRSA in hospitals.
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            Survival of enterococci and staphylococci on hospital fabrics and plastic.

            The transfer of gram-positive bacteria, particularly multiresistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), among patients is a growing concern. One critical aspect of bacterial transfer is the ability of the microorganism to survive on various common hospital surfaces. The purpose of this study was to determine the survival of 22 gram-positive bacteria (vancomycin-sensitive and -resistant enterococci and methicillin-sensitive and -resistant staphylococci) on five common hospital materials: smooth 100% cotton (clothing), 100% cotton terry (towels), 60% cotton-40% polyester blend (scrub suits and lab coats), 100% polyester (privacy drapes), and 100% polypropylene plastic (splash aprons). Swatches were inoculated with 10(4) to 10(5) CFU of a microorganism, assayed daily by placing the swatches in nutritive media, and examining for growth after 48 h. All isolates survived for at least 1 day, and some survived for more than 90 days on the various materials. Smaller inocula (10(2)) survived for shorter times but still generally for days. Antibiotic sensitivity had no consistent effect on survival. The long survival of these bacteria, including MRSA and VRE, on commonly used hospital fabrics, such as scrub suits, lab coats, and hospital privacy drapes, underscores the need for meticulous contact control procedures and careful disinfection to limit the spread of these bacteria.
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              Detection of organophosphate flame retardants in furniture foam and U.S. house dust.

              Restrictions on the use of polybrominated diphenyl ethers (PBDEs) have resulted in the increased use of alternate flame retardant chemicals to meet flammability standards. However, it has been difficult to determine which chemical formulations are currently being used in high volumes to meet flammability standards since the use of flame retardant formulations in consumer products is not transparent (i.e., not provided to customers). To investigate chemicals being used as replacements for PentaBDE in polyurethane foam, we analyzed foam samples from 26 different pieces of furniture purchased in the United States primarily between 2003 and 2009. Samples included foam from couches, chairs, mattress pads, pillows, and, in one case, foam from a sound-proofing system of a laboratory-grade dust sieve, and were analyzed using gas chromatography mass spectrometry. Fifteen of the foam samples contained the flame retardanttris(1,3-dichloro-2-propyl) phosphate (TDCPP; 1-5% by weight), four samples contained tris(1-chloro-2-propyl) phosphate (TCPP; 0.5 -22% by weight), one sample contained brominated chemicals found in a new flame retardant mixture called Firemaster 550 (4.2% by weight), and one foam sample collected from a futon likely purchased prior to 2004 contained PentaBDE (0.5% by weight). Due to the high frequency of detection of the chlorinated phosphate compounds in furniture foam,we analyzed extracts from 50 house dust samples collected between 2002 and 2007 in the Boston, MA area for TDCPP, TCPP, and another high volume use organophosphate-based flame retardant used in foam, triphenylphosphate (TPP). Detection frequencies for TDCPP and TPP in the dust samples were > 96% and were log normally distributed, similar to observations for PBDEs. TCPP was positively detected in dust in only 24% of the samples, but detection was significantly limited by a coelution problem. The geometric mean concentrations for TCPP, TDCPP, and TPP in house dust were 570, 1890, and 7360 ng/g, respectively, and maximum values detected in dust were 5490, 56,080 and 1,798,000 ng/g, respectively. These data suggest that levels of these organophosphate flame retardants are comparable, or in some cases greater than, levels of PBDEs in house dust. The high prevalence of these chemicals in foam and the high concentrations measured in dust (as high as 1.8 mg/g) warrant further studies to evaluate potential health effects from dust exposure, particularly for children.
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                Author and article information

                Journal
                jgrb
                Journal of Green Building
                College Publishing
                1552-6100
                1943-4618
                1943-4618
                Fall 2011
                Fall 2011
                : 6
                : 4
                : 45-64
                Author notes

                1B.A.Sc., Dip Interior Design, LEED® AP. Dayle Laing Interior Designs Inc., P.O. Box 41559, 230 Sandalwood Pkwy, Brampton, Ontario, Canada, L6Z 4R1, Phone: (905) 846-3221, Email: info@ 123456daylelaing.com .

                2MD (Glas), FRCP (Edin, Glas, & C), Clinical Professor in Medicine (Rheumatology), McMaster University, Hamilton, Ontario, Canada, L8N1T8, Phone: 905 521 0514, Fax: 905 528 2385, Email: keanmac@ 123456cogeco.ca .

                Article
                jgb.6.4.45
                10.3992/jgb.6.4.45
                ©2011 by College Publishing. All rights reserved.

                Volumes 1-7 of JOGB are open access and do not require permission for use, though proper citation should be given. To view the licenses, visit https://creativecommons.org/licenses/by-nc/4.0/

                Page count
                Pages: 20
                Product
                Categories
                INDUSTRY CORNER

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