Greenviu - The Green Clinic Society
Guidelines for an ecologically sustainable clinic

These guidelines will save you money and reduce your ecological footprint
Principles:
1. Reduce
2. Replace
3. Compensate

ReduceA. Energy Saving
Assign one staff member to the task of an energy officer. That member will set the rules
for the clinic and help the staff to comply with them.

Identify the largest energy consumption:✓ Computers✓ Air conditioner✓ Sterilization unit
✓ Heating✓ Operation Theater✓ Kitchen and hospitality areas

How can you calculate your energy consumption?
On the one hand you can resort to your utility bill. While the bill can give you acomprehensive overview of the entire energy consumption of yourpractice/office/hospital, it won’t give you a detailed insight into each functional unit’s
energy consumption. This however is essential to identify energy guzzlers and reduce
effectively.

There are special applications that allow you to track energy use in certain rooms but
you will need a Smart Solution in place for this to work. Alternatively, you can proceed
the traditional way and simply calculate the energy uptake of each device and multiply
it by the hours it is operating.

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If you do not have the exact numbers for your appliances the data in this article may
prove helpful:

Set Up An Energy Saving Plan:

Not all areas in the clinic are in use all of the time. There are simple daily actions thatcan be taken to significantly reduce energy waste.

✓ Keep lights off unless in use.
✓ Keep windows closed when A/C is on. Regulate the use of A/C and Heating where thetemperature allows it. Office clothing may also be adapted to compensate for fewerresources in use.

✓ Heating is a large part of energy consumption. 1°C higher room temperature uses 6%
more energy use (https://www.vaillant.de/21-grad/rat-und-tat/die-sieben-groessten-heizmythen-entkraeftet/). Define how warm the rooms should be (21°C isoften optimal) and maintain that temperature. Do not completely turn the heating off
at night as heating the room back up takes more energy than keeping it on. Keep thedoors closed to maintain the temperature in the room.

✓ Completely turn off electronics when not in use for a long duration. If we assume adesktop computer uses around 150 - 200W per hour
https://www.researchgate.net/publication/331617162_Environmentally_sustainable_dentistry_energy_use_within_the_dental_practice,https://www.energuide.be/en/questions-answers/how-much-power-does-acomputer-use-and-how-much-co2-does-that-represent/54/ and you use 10
computers in your office, only having your computers on when you need them(approximately 10 hours per day for 280 working days in a year) will save you moremoney than you spend for your Greenviu membership: 10PC´s with 150W will use

1500W per hour. Keeping them off for 14 hours per day on 280 work days results in
5.880kW hours saved in a year. With a price of 0.3€ per kWh this is more than 1700€
saved per day.

Green Energy Supply:

There are various retail energy suppliers available in many countries depending on
where you are in the world. Have an employee search for the three lowest total costenergy suppliers that run solely on green energy. Then you will have the option to switch.

Solar Energy:

If you own the building in which you work consider going solar yourself - the investment
will pay off in a few years as the efficiency of the solar panels rise throughout the years.
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If you are on a rental basis speak with your landlord, they may go green with you andapply solar energy on the roof. Additionally, some governments offer financial benefits
for going solar.

Thermal Heat Pump:
When you have access to green energy a thermal heat pump helps you savesignificantly on your gas and oil consumption. Depending on your office structure, and incombination with solar panels, this might additionally save you money. In somecountries you may also find governmental aids for this process.

Transportation and Travel:

A large contributor to the CO2 footprint of medicine is travel and transport.

Smart Appointment Management can save your patients travel distances and therefore
help reduce the Impact Data:
https://www.ugpti.org/resources/reports/downloads/dp-236.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465872/

https://noharm-europe.org/sites/default/files/documents-files/5624/2018-0925_Reducing_carbon_footprint_healthcare%20WEB.pdf
We suggest:✓ Smart appointment management to save the patients travel.
✓ Install a public transport plan for your employees and patients: Check what kind ofbus and train lines make it easy to reach your office and write a schedule that isorientated towards the ARRIVAL time at your office. (e.g. for your 10am appointment
you can use bus line A from the grand station leaving at 09.34am…)✓ Have an e-mobility offer for the employees at the office such as a e-car lease plan.

B. Water
Water consumption in dental/medial clinics is a complicated topic. IT is vital to combinethe needs of hygienic processes with the demand to use water responsibly. One of thelargest areas of water consumption that can be altered in the clinic is hand washing.

Applying a Hand Washing Protocol involves washing hands correctly and knowing how
often one should wash their hands. Not only will this protocol save your clinic

unnecessary amounts of water but it will also protect skin from unnecessary damage.

3C. Materials
Packages and Transport of Materials:
Order larger amounts of supplies at at time (less package material, less transportcarbon footprint, better price and savings)
https://www.arup.com/-/media/arup/files/publications/h/health-cares-climatefootprint.pdf

Reusable Materials that are Commonly Wasted:Sounds crazy but waste (especially packaging waste) can be reused before being
thrown away therefore saving you resources. Combining the two following tips will easily
save you large amounts of waste and hundreds of dollars per year.

Sterile Drapes
Many medical procedures require sterile coverage of the surrounding areas in which weare active. A sterile drape of 45x75 cm costs between 0,5€ - 1,5€ per piece. When you

perform a treatment that needs sterile coverage you also need sterile gloves. Why notsimply use the paper in which the gloves are packed as a coverage.

Sterile Covers for Light Handles
During sterile procedures you will sometimes need to readjust the light. Either you havesomeone on hand to do that for you or you need sterile covers for the lamp handles. We

have found retail prices between 0,8 to 1,9€ per piece. Many medical consumables comewrapped in plastic hoses, such as suction pieces. These are sterile and can easily beadapted to cover many lamp handles.

You will surely find additional uses for your waste as well. Be creative and please send
your ideas to us so that we can share with the other members within the Green Clinic
Society!

4Paper Towels
Paper towels are superior to hand dryers from a hygiene standpoint, however they havea higher ecological impact (see replace section of this guideline for details). One of thesimplest steps one can take is to limit oneself to a single paper towel at a time, although
unfortunately the material of the towels does not always cooperate. If you have theresources to do so, reusable cotton towels can be an alternative, however, you will needto make sure that washing the cotton towels does not use more resources than using
the sustainable product version you will find in our replace section.

Replace
Not all of the areas will necessarily apply to your clinic. Please use this section as asuggestion. We are always open to new products so if you find something to add please
let us know!

Consumables that have the Highest Impact on the Ecological Footprint:✓ Gloves✓ Masks✓ Cups✓ Disinfecting Agents✓ Paper Towels✓ Medical Gowns✓ Operation Trays✓ Cotton rolls✓ Dressings✓ X-Rayshttps://pubmed.ncbi.nlm.nih.gov/31652534/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012496/

https://www.researchgate.net/publication/266379512_Solid_Waste_Production_and_It
s_Management_in_Dental_Clinics_in_Gorgan_Northern_Iran
https://www.arup.com/-/media/arup/files/publications/h/health-cares-climatefootprint.pdf
Gloves:Nitrile gloves are an essential product used by medical professionals to assist in thehealth of patients and create a safe experience. The consequences of the disposable
nature of these non-biodegradable gloves, however, is not often given adequate
consideration in regards to an ecologically responsible lifestyle.

5The journey of a nitrile glove begins in a large factory, produced using great energy

resources. From the factory they travel to hospitals and medical offices to aid doctors intheir rigorous procedures and allow a safe experience for both the doctor and patient.
However, after a single use these gloves are disposed of and find their way to a landfillcreating significant waste and harm to the environment. A product that at first begins its
journey for good becomes a product that pollutes.
To change this negative impact on nature, it is essential for modern medicine tocultivate an environmentally friendly lifestyle by using products that will sustain naturalresources.

What we suggest:

Greenviu provides access to biodegradable gloves

Masks:

Surgical masks are responsible for thousands of tons of waste, and that waste has risen
exponentially during COVID
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543915/
https://www.greenpeace.org/international/story/44629/where-did-5500-tonnes-ofdiscarded-face-masks-end-up/

https://www.sciencedirect.com/science/article/abs/pii/S0048969721026991
What we suggest:

Greenviu provides access to masks made using Green Energy and European Fair
Conditions

Cups:
Normal cups made from plastic, and many paper cups are lined with plastic to stabilize
the water containment. Plastic cups are not biodegradable.
https://pubmed.ncbi.nlm.nih.gov/24994469/
https://solarimpulse.com/news/cleancup-fighting-plastic-pollution-one-cup-at-atime#https://plastic.education/the-problem-with-disposable-cups/
6What we suggest:

Greenviu provides access to cups that are biodegradable
Other Options: Reusable Steel or Ceramic Cups

Disinfecting Agents / Hand Sanitizers:
Hand sanitizers are largely used as a basis for our daily hygiene.
Many people use them by pumping huge amounts on their hands thinking the more thebetter. This however is not only wasteful but an inaccurate assumption.

Additionally, one issue with hand sanitizing dispensers, especially those that are wallmounted, is that there is an internal plastic hose system that is prone to superinfection
e.g. Pseudomonas Aeruginosa. Therefore these hoses need to be changed regularly
which produces more waste and cost for the office.
What we suggest:

Sustainably produced hand sanitizers
Formula that is a more gel like consistency so that less is wasted and the same volumeof use compared with traditional sanitizers lasts up to 20% longer - therefore saving
resources
Plastic-hose-free hand sanitizing dispensers to remove the internal problem

Paper Towels:
From a hygienic standpoint paper towels are superior
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538484/

but they are part of the huge waste pile that medicine produces
https://pubmed.ncbi.nlm.nih.gov/23063307/
and the ecological impact is worse than modern hand dryers:

https://ec.europa.eu/environment/biodiversity/business/assets/pdf/casestudies/Case%20study%2016_ReCiPe%20Hand%20drying%20systems_final.pdf
https://www.exceldryer.com/wp-content/uploads/2017/02/LCAFinal9-091.pdf
Since the hygiene of paper towels is far superior to that of hand dryers and the level ofhygiene exceeds the negative ecological impact of paper towels we must find paper
towels that are more sustainably produced.
What we suggest:
Greenviu provides access to sustainably produced paper towels
7Sterile Dressings and Gowns:
If you are performing surgery on a highly sterile level you will need complete sterile
covering of the site and you. This results in a huge pile of waste. As an alternative,reusable and washable cloth may be an option.
What we suggest:

Using a service that supplies, cleans, and resupplies reusable sterile dressings andgowns - the ecological footprint will still be smaller in comparison to single use
materials

Individually Packed Operation Trays:
In many clinics sterile instruments are individually packed and are specifically opened
for surgeries. A way to avoid the amount of waste in this area is to use an individually

outfitted surgical set up that comes in a washable and sterilizable tray so that only one
package needs to be opened per surgery. This tray can be individualized for yourpersonal surgical needs.
What we suggest:
Reusable sterile washing trays that are appropriate for your clinical needs

X-Rays:Digital x-rays require only a small fraction of the radiation exposure to patients than do
analog x-rays. Not only does lower x-ray exposure benefit the patient, but it also requires
lower energy consumption to produce the x-radiation.

Analog radiographs create waste in the form of plastic film that is not biodegradable,developing and fixing chemicals that adversely effect the environment and increasewater consumption. For example, the silver in the developing chemicals for analog
radiographs kills the bacteria in the sewage treatment plants which significantlyimpacts the ability of the sewage treatment plant to function efficiently and effectively.
What we suggest:

Replace analog with digital
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