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McGILL UNIVERSITY HEALTH CENTRE ADVANCED HOSPITAL DESIGN Roadmap for the Development of a Sustainable Hospital Complex

Prepared For: McGill University Health Centre 2155, rue Guy, bureau 200 Montreal, QC H3H 2R9 Prepared By: Stantec Consulting Ltd. 1505 Laperriere Avenue Ottawa ON K1Z 7T1 File: 163379083 April 10, 2006

ADVANCED HOSPITAL DESIGN MCGILL UNIVERSITY HEALTH CENTRE

TABLE OF CONTENTS EXECUTIVE SUMMARY ..........................................................................................................................i

1.0 INTRODUCTION..........................................................................................................................1 1.1 Background .....................................................................................................................1

1.2 MUHC Current Planning and Design Status...................................................................1

2.0 SUSTAINABILITY AND HOSPITALS.........................................................................................4

3.0 SUSTAINABLE DESIGN AND OPERATIONS...........................................................................9

4.0 EXAMPLES OF TYPICAL OPTIONS..........................................................................................11

5.0 SUSTAINABLE DESIGN ISSUES ..............................................................................................13

6.0 HEALING AND PRODUCTIVE ENVIRONMENTS .....................................................................15

7.0 FULLY INTEGRATED PLANNING AND DESIGN .....................................................................17

8.0 GUIDELINES APPLICABLE TO HEALTHCARE .......................................................................18 8.1 Examples of Relevant Guidelines ...................................................................................19

8.2 MUHC Application of LEED®..........................................................................................21 8.3 Additional Guidelines ......................................................................................................24

8.4 LEED® and the Green Guide for Healthcare..................................................................25 8.5 Essential Design Considerations for Advanced Hospitals ..............................................28 8.6 Environmental Management and Procurement Plans ....................................................29

9.0 ENVIRONMENTAL SENSITIVITY...............................................................................................32

10.0 BUILDING HEALTH SCIENCE ...................................................................................................36

11.0 LOW IMPACT CLEANING AND MAINTENANCE MATERIALS AND METHODS ..................38

12.0 INDOOR ENVIRONMENT QUALITY ..........................................................................................42

13.0 MATERIALS ................................................................................................................................44

14.0 WASTE MANAGEMENT ............................................................................................................47

15.0 REPRESENTATIVE MATERIALS AND OPTIONS ...................................................................48

16.0 RECOMMENDATIONS ...............................................................................................................51

17.0 CASE STUDIES...........................................................................................................................53

18.0 CONTACTS .................................................................................................................................55

19.0 BIBLIOGRAPHY..........................................................................................................................56


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EXECUTIVE SUMMARY As part of a forward looking plan to design, build and operate a new campus and facilities for several merged hospitals, the McGill University Health Centre (MUHC) initiated a series of professional and public consultations to determine optimal conceptual and design parameters. MUHC wished to address a wide range of issues that affect the design, construction and operation of an emerging best practice hospital complex. Stantec was contracted to review existing documentation and literature and report on the implications of applying the LEED® family of Sustainable Design Guidelines and other related intelligence to the design development, construction and operation of the new site and facilities. The review was conducted incorporating a broad range of sustainable and advanced health care design issues including the precautionary principle, and a fully integrated, holistic, patient centered and life cycle oriented approach. The MUHC complex will include technology intensive acute care teaching and research facilities which place high demands on design and operations in order to achieve and maintain exemplary performance. These demands require extensive and thorough examination of a wide range of issues that determine the effectiveness of the facilities, early in the conceptual process where there is still time to discuss critical issues and make appropriate decisions that have wide ranging consequences. This review provides a brief introduction to advanced design including science or evidence based design, sustainable design, design for accommodation, flexibility and healing etc. It provides an initial platform to support the development of a comprehensive Roadmap for the design of an emerging best practice Hospital Complex. The review focuses on the cost-effectiveness of design, construction, and operations options related to key performance indicators such as staff attraction and retention, reduced sick leave and absenteeism, improved patient outcomes, reduced length of stay, improved productivity, health and safety, compliance, environmental management, education and procurement systems. The report includes information related to integrated community involvement, the primary health care model, healing environments, resources, special needs, advanced technology/clinical engineering, education and funding, and concludes with recommendations and suggestions for cost-effective next steps in the Triple Bottom Line approach to advanced healthcare. A Triple-Bottom Line approach to healthcare has to focus allot more on patient safety and operational efficiency than does that for normal buildings. This approach is even more important in an acute care teaching hospital setting. The report makes reference to environmental leadership opportunities that may be championed by MUHC in this regard as part of their overall leadership strategy including the following two examples: Preventive health care has long been acknowledged to be the most cost-effective application of health care dollars yet little progress has been made in shifting the budgetary emphasis in this


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direction. The application of this knowledge base to the built environment of a teaching hospital setting with community outreach can demonstrate leadership in this regard while providing significant operating savings and improvements to health care outcomes. Building science indicates that the application of data science (metering, monitoring, measuring, building diagnostics, post occupancy evaluations etc.) combined with advanced commissioning has the potential to significantly improve building operations, satisfaction, health, and productivity outcomes while reducing costs. Similar benefits would accrue in health care settings if medical and clinical engineering statistics were cross-referenced to building science statistics. This option represents a major opportunity for MUHC to establish a world leading position in a relatively new area of medical research. It should be noted that individual hospitals or projects cannot undertake all the research that is needed to advance the art and science of hospital design, construction and operation, therefore these essential components should be considered in the context of sharing and cooperation within the hospital community and particularly with those hospital organizations that are developing new facilities. To establish an emerging best practice acute care teaching facility would require seamless integration of medical science, clinical engineering and building science. This can be done through the application of the Integrated Design Process and a more thorough examination and application of science or evidence based information that is currently available. It is important to note that hospitals evolve more during construction than other buildings and therefore require increased involvement of a larger number of stakeholders through to completion. This report serves as an introduction to a select cross-section of integrated information with a specific emphasis on sustainable design and the LEED® format.


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1.0 INTRODUCTION 1.1 B ACKGROUND The McGill University Health Centre was formed to merge several hospitals into one integrated hospital complex, requiring the development of a new site and the construction of several new hospital buildings. The MUHC has registered the project with LEED® Canada and The Green Guide for Healthcare and intends to demonstrate leadership in the application of advanced design and operations for the new facilities located at the Glen site in downtown Montreal. The MUHC researched the ability to revitalize and reuse existing hospital facilities and determined that a new facility would provide improved services in a more cost-effective manner. Therefore the MUHC intends to build a new hospital complex to consolidate the operations of several existing downtown hospitals that have aging facilities. A series of documents were produced outlining the philosophy and intent behind the initiative. The following points illustrate the direction of this intent. The MUHC will have a tripartite mission including patient services, teaching and research with increased emphasis on specialized and ultra-specialized expertise, skills, technologies, and other resources. The glen site will include four main components, an adult pavilion, children’s hospital, neurosciences hospital and institute and a research centre. The McGill University Health Centre (MUHC) retained Stantec to review progress to date and industry literature, and provide guidance for the development and operation of a sustainable hospital complex to be constructed at the Glen site. The site is to accommodate new facilities for all of the existing MUHC hospitals however, a decision has been made to retain and renovate one of the original hospital facilities in place. 1.2 MUHC CURRENT PLANNING AND DESIGN STATUS The MUHC has initiated an ongoing process to develop design guidance for both new and existing facilities. Some of the key issues discussed thus far include the following. Hospitals are becoming more focused on intensive care such as specialized ambulatory care and day surgery, while other services are increasingly being managed by non-hospital organizations that provide extended community based health care services, together forming networks of care. “These networks of care offer a range of interventions that include home-based care, preventive and primary care in CLSC’s and clinics, rehabilitation and chronic care services, acute care in community hospitals, and highly specialized care in an academic centre”.i


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Some key points from these documents that inform the sustainable design exercise include the following: Hospitals are merging for economies of scale, to provide an enhanced range and quality

of service in one location, and to make optimal use of the reduced number of specialists that will be available,

Improve access to advanced technology support, There is a trend toward merging children’s hospitals with adult facilities to promote

continuity of care, Research and teaching are integral components of the new hospital model, The model is focused on providing the best health care outcomes, (results based

management), Fewer beds will be required (reduced focus on inpatient care), Improve ability to attract and retain staff.

Model Environmental Design Objectives for a Healing Environment Improved infection control, ventilation, lighting, More space and improved privacy on a human scale favoring a campus-like

arrangement of low-rise buildings, Improved access and circulation, Environments that are least disruptive to peoples normal lives, Flexible design to accommodate an increasing rate of change, Ease of access to the site and within the way-finding system, Ease of phasing construction over time, Access to daylight and views, including both natural and landscaped settings, Cost-effectiveness, Create synergy in research, teaching and patient care.

There are additional lists of key improvements that can be made to healthcare settings that can be found in documents such as “The Green Guide to Healthcare” and “Costs and Benefits of an Emerging Best Practices Hospital”ii. MUHC Site The site for the new MUHC Glen campus is downtown Montreal, North of the Lachine Canal and west of Guy St. It was formerly a railway service yard. Sections of the site contained contaminated soils and therefore the site is classified as contaminated with respect to LEED® evaluation. There was no significant vegetation or buildings on the site at the time of purchase.


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Site Remediation A description of the site remediation process related to LEED® is attached as Appendix “A”. Social, Economic and Environmental Impact As outlined in an economic impact study prepared by Daniel Arbour & Associés the rehabilitation of an underutilized site in the downtown area of Montreal will have a major positive impact on local social and economic conditions, bringing a large number of secure, high pay scale jobs from construction, hospital operations and support services to the local economy. The decontamination of the site will remove a major environmental burden from the downtown core. Groupe Cardinal Hardy and associated specialty consultants developed a comprehensive study of the site to determine its suitability as a site for the new hospital complex.


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2.0 SUSTAINABILITY AND HOSPITALS The following summarizes a review of the documentation provided on the MUHC Glen project; the LEED® and Green Guide for Health Care; and other relevant literature on sustainable design and operation of health care facilities. Examples of relevant issues and a brief bibliography are included to provide a sample of the type of issues and related resources that are available. There are over 30 health care facilities that are currently seeking or are already certified by LEED®. MUHC has developed documentation outlining the basic design intent for the project, including discussion of collaborative measures related to sustainable design. This report provides options to explore, that could add depth and breadth to this discussion and lead to a further refinement of the overall sustainable design guidance. It is the next step in an ongoing iterative process used in sustainable design referred to as the Integrated Design Process. Advanced Hospitals Overview Hospitals are large operations that have significant economic, social and environmental impacts (the Triple Bottom Line). Modern hospitals have had relatively short useful lives exhibiting significant declines in efficacy prior to major retrofit or replacement programsiii. Hospitals can use more than twice as much energy as the average building and can be significant generators of waste, emissions and infection. Advanced hospitals have lower costs and a wide range of improved employee, patient and family outcomes. Therefore providing optimal insight into the design of a hospital that can provide and maintain a high level of environmental and health care outcomes in a cost-effective manner is of critical importance. Reducing costs throughout the life cycle of the facility through the application of advanced design, construction and operations is essential to providing the necessary cash flow required to meet rising health care expectations. An advanced hospital should serve as a primary research and educational tool for preventive medicine, with a focus on the many links between the built environment and human health. Cost Effectiveness Building to code only, does not address most of the issues required to provide adequate let alone exemplary health care and is not cost-effective over the life of the facility. “Typically, over the first thirty years of its life, the construction costs of a hospital will represent just 2-3% of the overall cost of the services it will deliver.”iv “Design costs are likely to be 0.3 – 0.5% of the whole life costs of a hospital, yet it is through the design process that the largest impact can be made on the 85% medical service delivery cost figure (CABE)v. There are ample examples of hospital projects that have met high sustainability standards with significant construction and/or operating cost savings. For example the Richard J. Lacks Sr. Cancer Center in Grand Rapids Michigan which will be submitted for LEED® Silver saved $1.2 million on an original $40 million construction budget.


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Kaiser Permanente’s Modesto Medical Center in Modesto California consists of a 50 acre, 650,000 sq. ft. full-service campus that has an overall projected savings of $178,750 after accounting for the inclusion of many high performance attributes including photovoltaic screens and parking lights, reflective roof membranes, PVC free flooring, HDPE electrical piping and eco-elevators. A cost-benefit study done for the Legacy Project in Vancouver identified capital improvements that could be specifically targeted at hospital operational savings and determined that they would cost $96.3 million and provide a 33% rate of return over thirty years with a 3.5 year payback and a net present value of cash flow over thirty years of $512 million.vi Evidence based design is a relatively new focus for the design of health-care facilities. A recent Texas A&M report identified over 600 studies dealing with the relationship between design and health-care outcomes.vii Most studies focus on specific issues with few if any fully comprehensive studies based on full cost or life cycle accounting, or incorporating additive, multiplier or synergistic effects. Therefore it is difficult to characterize aggregate (integrated) cost-benefit outcomes at this point in time. It is reasonable to conclude that integrated cost-benefit advantages are greater than might be concluded from reviewing individual issues in isolation, which is the focus of most current studies. “In Calculating the Value of Intangibles (2004), Sharon VanderKay cites an emerging rule of thumb that 80% of the value of any enterprise is intangible and a growing awareness that decision makers can’t afford to misjudge the value of intangible assets. Because only 20% of what has value can be counted precisely, it is now beginning to be thought that it is “better to be approximately right than precisely wrong”viii It is difficult to apply standard accounting principles to equations that involve costs to one party and benefits to another which may be characterized as split or perverse incentives, disincentives or disbenefits. These equations may involve internalities such as costs to one department or budget that accrue savings to another department or budget, or externalities where a cost to the hospital organization accrues a benefit to a third party such as society or the environment. These equations may involve investment choices in desired attributes driven by personal, departmental or other interests that may override conclusions that might have been arrived at by impartial third party analysis or value engineering. There may be supporting rational for these overriding decisions such as the benefits of attracting and retaining world-class staff, which is critically important to a leading edge, acute-care teaching facility. The complexity of these competing issues makes it difficult to apply the conventional business rational found in most studies to the needs of a high-technology acute-care teaching facility. Labor intensity and related costs are substantially higher in hospitals than in the office and general institutional buildings that most studies address. The higher labor and energy costs are, the higher the payback from investment in advanced building design, therefore cost-benefit ratios should be more favorable for hospitals than the following studies based on office occupancy would typically indicate.


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Cost-Benefit Studies Several cost/benefit studies and databases indicate substantial savings that can be realized by applying sustainable design. Many of these studies address data based on early examples including the first wave of LEED® projects and often historically cheaper energy and labor rates. There is a general consensus within the sustainable design profession that the cost premium if any associated with LEED® projects has been declining steadily, particularly in experienced markets, and where green materials are now readily available, and that integrated benefits are underestimated. Many of these sustainable design projects included attributes that were chosen for demonstration purposes rather than basic cost-benefit analysis. These attributes may be deemed luxuries in the economic sense and should be removed before basic cost-benefit analysis is performed for the purpose of comparing the cost of a design building to a base case building. This is analogous to removing the cost of artwork or luxury materials from the cost of buildings being equivalently compared. Items that would have been included in the base case have a tendency to be accounted for as extras when they are labeled “green” therefore it is important to exercise caution in the process of identifying and costing “green” items. Many benefits are hard to quantify but may be orders of magnitude greater than the perceived costs to institute a measure. If these considerations are taken into account most existing studies overestimate the costs and underestimate the benefits that could be expected from current or future sustainable design projects. Study Examples The following are representative studies and conclusions: The National Science and Technology Council’s Subcommittee on Building and Construction commissioned the National Research Council to compile a bibliography of studies related to worker productivity and health. The database contains hundreds of references.ix The design of facilities directly and indirectly affects the overall cost of operations in a disproportionate manner. In office buildings for instance, on a life-cycle basis office labor costs are 13 times more than the cost of the building and its operation, and the cost of design is 1/50th of the employee costs.x Therefore increasing investment in improved design and building operation has a 13 times multiplier effect on lifecycle employee labor costs (not including turnover) in addition to direct savings on energy, cleaning and maintenance. Using average building operation and staff costs various researchers have demonstrated that even a 1% increase in productivity generally generates savings greater than those expected from typical energy savings in sustainable design projects. Clark Reed, National Healthcare Manager for the US EPA noted in an Energy Star presentation that $1 saved in energy is equivalent to generating new revenue of $20 in hospitals or $10 in medical offices.xi


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“A Business Case for Green Buildings in Canada” This study indicates that the cost premium for most of the green building case studies reviewed was below 8% and that many were 2% or less with some indicating no cost premium. These buildings represented the first wave of green buildings, before costs began to decline and these figures are for first cost only. Centre for Building Performance, Carnegie Mellon University, Database of Studies The studies reviewed indicate that: Improved ventilation resulted in a 0.48 to 11% increase in productivity averaging 1.8% and

up to a 35% reduction in absenteeism. Improvements in temperature control increased productivity by an average of 1.2% Improved lighting increased productivity by 3-15% with an average of 7.1%.

There are several other studies, which draw similar conclusions, including the following: “Cost of Green: A Comprehensive Cost Database and Building Methodology” “General Service Administration LEED® Cost Study” “Lawrence Berkeley National Laboratory Green Building Common Benefits” “The Costs and Financial Benefits of Green Building”.

Many green projects have documented significant savings including the following examples:

The ING Bank study found a 15% drop in absenteeism after moving into a new sustainable design building,

A Pennsylvania Power and Light project found productivity improved by 13% and sick leave was reduced by 25%

A retrofit of the Reno Post Office resulted in a 6% increase in productivity, A lighting retrofit of the San Diego courthouse improved productivity by 3-15% in different

task categories, The West Bend Mutual Insurance Study demonstrated a 16% increase in productivity

related to improved day-lighting and personal workplace controls. There is a substantial and growing body of evidence indicating that advanced buildings are instrumental in attracting and retaining staff, in improving their health and well being and in reducing absenteeism, workers compensation costs, actions such as vandalism associated with negative attitudes and litigation. For example the Commission for Architecture and the Built Environment (CABE) published a major study, which found that the design of health care facilities played a major role in attracting and retaining nursing staff.xii The most compelling justification for improving Indoor Air Quality is reducing adverse events. The Canadian Adverse Events Studyxiii indicates that of the 24,000 deaths annually in Canada I in 70 are inpatients and half of these events are attributed to Nosocomial infection and half by medical error – with half of these two being judged to be avoidable. The US EPA has stated that


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Indoor Air Quality is one of the top five environmental health risks of our time. Improving cleaning and maintenance alone can provide significant benefits as the following examples illustrate. Although little cost-benefit analysis has been done on a product-by-product basis, the following generic examples illustrate the significance of global benefits available from the use of improved cleaning and maintenance products and protocols. U.S. business could potentially save $30-150 billion annually by improving worker

productivity by 0.5 to 5 percent with indoor environment benefits derived from improved cleaning and maintenance. xiv

Lost time and injuries for custodial staff can be reduced by reducing the toxicity of the cleaning chemicals used.xv

By focusing on source control measures such as reducing dust the use of cleaning chemicals and time can be substantially reduced.xvi

The American Lung Association estimates that 3 of every 5 persons suffer from some kind of respiratory difficulty.xvii

One study indicated that in 4.6 to 10 percent of work-related asthma cases cleaning products were the suspected causative agents.xviii

Incentives There are many incentives, which might improve the cost-effectiveness of sustainable design and operations options. For example the Commercial Building Incentive Program (CBIP) can provide up to $60,000.00 toward the sustainable design of a building. A representative list of these options is attached as Appendix “A” Intent The intent behind the development of advanced hospitals is to optimize their efficacy - to make them as effective at what they are intended to do as possible, given the constraints at hand. Some, but not all of this intent can be explored, optimized and applied using sustainable design tools such as Life Cycle Assessment, sustainable design charrettes, the Integrated Design Process, sustainable design guidelines and information from advanced commissioning and applied research projects.


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3.0 SUSTAINABLE DESIGN AND OPERATIONS

This outline provides an introduction to design and operation options that may improve the triple bottom line performance of new hospitals within a life-cycle context. It will serve as a starting point for the development of an advanced design program for the McGill University Health Centre with particular reference to LEED® Silver certification. This outline is intended to be a living document, which sets the stage and provides an introduction to, and tools for progressing toward an advanced design and operation program. It is intended to be modified as additional information becomes available and as experience is gained during the build-out of the full complex, as well as throughout its life cycle. Much of the information presented in this report is borrowed from material gathered by Stantec and others for the development of an Environmental Roadmap for Hospitals and other projects. The following information will focus on the requirements of the LEED® Canada 1.0 program and the Green Guide for Healthcare which expands upon LEED providing comprehensive sustainable design guidance for health care facilities. Additional information relevant to the design and operation of an advanced hospital will also be included, touching upon a wide range of preventive intervention issues and examples that may be taken into account in the design and operation of health care facilities. Information on cost-effectiveness is included where available and appropriate. Most tools and protocols do not address the complete life cycle of materials, components, and systems or of complete facilities. The life cycle of a facility may be broken down as follows: Preconception (constraints – rules & regulations, enterprise and social culture, perceived

risk, resistance to change etc.) Conception Design Construction Commissioning (initial, retro, re, and continuous) Operations (including environmental procurement) Modifications Decommissioning Deconstruction End Fate (final disposition)

Representative tools and design approaches that may address specific components of the life cycle include: Life Cycle Tools (Life Cycle Inventory, Life Cycle Assessment or Accounting) The Integrated Design Process Anticipatory Design Sustainable Design Charrettes


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Simulation/Modeling Product Evaluation and Certification Programs Sustainable Design Programs Advanced Commissioning Post Occupancy Evaluations and other Evidence Based Research

Evidence Based Options The options listed reflect both science (evidence) based and experience based knowledge, including information that may be relevant but has not yet been fully verified through scientific studies or relevant experience. All options are contextually dependent and options are affected by other options in various ways. These interdependencies or conflicts should be discussed when appropriate. In particular the need to consider the lifecycle impact of design decisions on operations and health care outcomes should be discussed in the context of full cost accounting to highlight the significant difference between first cost and integrated cost-benefits. A focus on first costs often equates to a penny wise and pound-foolish approach, which sustainable design and full cost accounting are intended to mitigate. Matrix and Scorecard A decision-making matrix is an essential tool in the Integrated Design Process (IDP) that is used to facilitate the development of an advanced design project and track options. Options that are considered for inclusion are tracked on a scorecard for benchmarking. A sample matrix and trial scorecard for MUHC Glen is attached in Appendix “C” Additional Information A list of primary reference documents that provide additional information on issues and options is included as Appendix “D”


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4.0 EXAMPLES OF TYPICAL OPTIONS Examples of options that have science-based evidence to back up their selection are listed below as illustrations of the breadth and depth of specifications that could be considered within representative categories. An exhaustive list is outside the scope of this report. Specific circumstances may modify the benefits or disadvantages. Stantec makes no recommendation of specific products or options in this outline; specific products and options have been listed as examples only. Typical measures that have been associated with improved operations, environmental and health care outcomes include: Single occupancy rooms, Improved acoustics and anti-vibration, Improved lighting, including day lighting and lighting for circadian rhythms and SAD, Access to views, particularly of natural settings, Improved ventilation including displacement ventilation, Improved air treatment including filtration, sterilization, ionization and humidification, Improved ergonomics for staff and patients, Reduced walking distances and improved access to supplies, Reduced toxicity of cleaning and maintenance and other chemicals, Improved management and control of medical chemicals, and medical waste, Reduced energy use (envelope, systems, process and medical equipment), Application of advanced hospital commissioning and smart technologies, Improved green procurement and waste management.

Some of the key advanced technologies that could be applied in appropriate sections of the facilities to achieve the above benefits include: Heat recovery on all air and water based systems. This includes process water, exhaust air,

and relief air. This may involve a glycol based system, A high performance envelope (windows. walls) to reduce the need for heating and cooling

energy and to allow outdoor air code requirements to govern the air quantities supplied to each area rather than any heating or cooling requirements from the envelope (eg. Dedicated Outdoor Air System),

High performance load, motor, drive, control systems, High performance (low friction) bearings such as magnetic levitation bearings, Reduced or chemical free water treatment such as magnetic anti-scale treatment, UV and

Ozone water treatment, High performance low resistance air filters, Low face velocity Air Handling Units, high performance ducts and louvers, and potentially

static regain fans,


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Daylight harvesting, and high performance lighting with light color, intensity and timing modulation,

Durability and modularity of components, finishes and equipment, A high efficiency heating plant such as a Sofame unit, Displacement ventilation and radiant heating and cooling systems, Geothermal and co-generation systems, Control options for Static, Electomagnetic and Geomagnetic fields, Natural regeneration systems, green roofs, healing gardens, High efficiency appliances (Energy Star - Highest Energuide rating), High Performance and Machine Room Less (Eco) Elevators, High performance acoustic treatments.

Typical Outcomes resulting from the application of advanced design measures include: Reduced initial costs and cost-escalation risk (eg. Energy) Reduced maintenance and repair costs, Reduced environmental impacts, Reduced health and safety incidents, Reduced medical errors, Reduced insurance risk/cost, Reduced length of stay, Improved patient privacy and confidentiality, Improved attraction and retention of staff, and students Improved productivity, learning and healing outcomes, Improved due diligence and compliance, Improved control over infection and contagious incidents, Improved patient and family satisfaction ratings, Improved physical and cognitive accessibility, Improved security, Improved reliability, Improved flexibility, especially related to rapid escalation events.


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5.0 SUSTAINABLE DESIGN ISSUES There are many issues that illustrate the breadth and depth of the subject matter. The following examples provide some insight into representative categories. Flexible Design Sustainable design places significant emphasis on flexibility of design to allow future changes at minimal cost and impact and for maximum retention of value. Design elements that support these issues include where appropriate: Design for dematerialization use less material and energy to achieve more, Design the master plan to accommodate changes in planned build-out, Design for redundancy where appropriate and use dual purpose strategies such as using

load shedding capacity (e.g. cogeneration) as the reserve power capacity, Wide floor plates between columns (but narrow footprints to support day-lighting), Design flat floor plates (reduced structural beams) to increase usable space for ducts etc., Design for compartmentalization of zones to provide in-place fire security and to enable

rapid conversion and to facilitate isolation during repair and renovation etc. and employ decentralized technologies when appropriate,

Design floor carrying capacity and floor to floor heights appropriate for adaptive reuse changes such as medical to office,

Consider interstitial service floors where appropriate, Design chases to accommodate changes in wiring, plumbing and ducting etc., and avoid

unnecessary duplication of linear elements such as wiring, Use mass when appropriate for energy efficiency and vibration control, Shear wall value concentrated in core elements such as elevator shafts to keep floor plates

flexible, Design for disassembly using for example reversible fastenings, Durable components that can be recovered, refurbished and reused, Modular components such as workstations, interlocking flooring, carpet tiles, and walls that

can be easily moved, Architectural finish surfaces in place of for example dropped ceilings, Raised floor systems that facilitate displacement ventilation and reduced churn costs, Through the wall HVAC systems, Plug and play lighting and telecommunications with self recognition software, Lighting capable of meeting environmental, work and health needs such as circadian rhythm

(melatonin regulation), SAD, vitamin D production, shift work, accommodation of an aging population, way-finding, aesthetics, glare, reduced maintenance and energy conservation,

Install high speed, high bandwidth communications backbone, Components designed for interoperability such as BACnet compliant equipment,


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Smart technologies such as addressable components that can be controlled by a building management system or medical management system,

Integrated systems components (fire, communications, security etc.), Wireless systems where appropriate, Design and maintain heavy equipment pathways including through the roof access for major

pieces of building and medical equipment, Design at least one elevator per section for anticipated duties (over size, overweight), and

others for space and energy efficiency (Eco Elevators), Design wards for rapid conversion to isolation wards for epidemic incidents, Design wards for rapid conversion to mass triage wards (extra beds) for disaster relief, Design for enhanced security, Design for recycled content and recyclability, Design for enhanced accessibility, Design for advanced and continuous commissioning, Apply anticipatory design to avoid applying today’s solution to tomorrow’s problem.


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6.0 HEALING AND PRODUCTIVE ENVIRONMENTS There is a solid core of evidence relating improved indoor and outdoor built environments to improved health care, satisfaction and productivity and to reduced accidents, liability and operating costs. The range of related issues is expanding exponentially as medical, engineering and building science continues to reveal additional links. This research expands the concept of extended (producer) responsibility in both the legal and medical sense. For instance: Drugs and chemicals used in hospitals are found in significant quantities in the ambient

environment. Demonstration and educating staff and patients about the significance of built environment

conditions to human health represent a major healing and preventive health care opportunity.

The effects of chemicals and other environmental agents such as endocrine disruptors used in health care settings may have developmental, lifelong and trans-generational effects for both patients and staff.

Examples of model programs and resources for patient centered care include: Planetree, www.planetree.org California Pacific Medical Center, Health and Healing Library

www.cpmc.org/services/ihh/hhc/ihhlibrary/ Checklist for a Green Birthday, www.noharm.org Greening the Acute Care Inpatient Unit, Stantec, www.stantec.com The Center for Health Design, www.healthdesign.org American College of Clinical Engineering, www.accenet.org

Examples of basic design and operation options that can be implemented to improve these outcomes include: Improve indoor environment quality (eg. air quality, lighting, acoustics), Avoid walking slopes greater than 1 in 3, Reduce distances for staff to walk on shifts, Improve way-finding (eg. using the street model), Improve access to daylight and views, Use natural settings indoors and out, Use natural materials and art and avoid stark artistic elements, Include wireless capabilities including wi-fi etc. for patients and high security networks for

staff, Use state-of-the-art walk off mats/grates at entrances, Specify environmentally certified materials and supplies, Specify high efficiency equipment (e.g. NEMA Premium, Highest Energuide Rating),


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Employ intelligent components and systems, Employ advanced and continuous commissioning, Optimize use of feedback information, Educate all staff in relation to environmental programs, Design labs etc. for tomorrow’s diagnostic tools Food on demand programs.


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7.0 FULLY INTEGRATED PLANNING AND DESIGN Integration is a fundamental principle of sustainable design and operations, and is applied using the Integrated Design Process (IDP) that facilitates fully integrated design. The Integrated Design Process encourages a high level of participation by all members of an expanded design team early in the design process to facilitate maximum input toward achieving the sustainable design objectives. IDP encourages the use of advanced design tools including charrettes, simulation, sustainable design checklists and value design and engineering. The earlier fully integrated design concepts are adopted, the higher the return on investment that can be expected from a sustainable design program. To attain optimal results integration must be fully applied at all phases, within and across all specialties, within and across departmental divisions and throughout the life cycle of the facilities, starting with pre-conception and functional programs. The integration exercise must focus on anticipating the needs of tomorrow’s facility to mitigate the effects of conservatism and rapid obsolescence. In most sustainable design projects this process is typically initiated with sustainable design charrettes that are designed to encourage cross-disciplinary fertilization. Charrettes need to be aimed at finding solutions that are not constrained by historic baggage such as traditional culture, and professional roles and responsibilities. Given the complexity of medicine, hospitals and hospital organizations the process of developing and applying an integrated design approach must be initiated at a very early stage ideally at pre-conception. Optimal solutions are fully dependent on mining all available opportunities from the pre-conception and conception phases of the design process. The value of these solutions can greatly exceed the opportunities presented during the actual design and operations phases. Professional and lay cultural barriers, the momentum of historic practice and the inherent difficulty in predicting future needs represent some of the most pervasive barriers to the implementation of optimal solutions, and therefore they must be addressed before conceptual and functional plans are developed. For example, pre-conceptual work including education and community outreach for the Riverdale Health Centre in Toronto was ongoing for three years before initial design began. Lessons learned from existing projects and particularly advanced projects must be incorporated to reduce overall sustainable design development time and to enrich outcomes. It is important to note that improvements to the design of health care facilities must be integrated with system wide improvements in building operations, procurement, outreach and medical practice to achieve desired improvements in health care outcomes. For instance the placement of sinks and alcohol wipes is a critical factor affecting their use in personal hygiene, and therefore the effectiveness of personal disinfection as an effective health care intervention. There are few research programs or documents which explore this fully integrated approach that is essential to the effective development of preventative measures, advanced healthcare settings and improved healthcare outcomes.


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8.0 GUIDELINES APPLICABLE TO HEALTHCARE This report outlines information relevant to the application of the design and operation of a hospital facility within the context of sustainability as defined by several relevant protocols and guidelines and in particular the LEED® Canada New Construction (NC) 1.0xix sustainable design protocol and companion Green Guide for Health Care (GGHC). The LEED® program is an expanding family of design guidelines, including some such as LEED® NC 1.0 which is an official publication of the Canadian Green Building Council (CaGBC) and some such as the Green Guide to Health Carexx which is recognized by, but not officially published by the councils. Various versions of the basic LEED® protocol (released or draft) apply to more specific components. The provisions of the LEED® Campus guideline may have significant implications for the overall planning of the MUHC complex while other guidelines such as LEED® Multi-Unit Residential Buildings (MURB) may apply to specific buildings or sections within the overall complex. It may sometimes be difficult to reconcile the variations in the guidelines for a complex involving multiple building types and functions, such as the MUHC Glen Campus. The application of the LEED® guidelines is being continuously modified through the use of the Credit Interpretation mechanism, updates designed to clarify and simplify the process, and the process of periodically reexamining the system and incorporating developments into a new expanded version of the core program. Access Most relevant documents have been developed by non-profit, government or major hospital groups and organizations and are available for download and public use via the internet. Emerging Best Practice Many of the guidelines and tools discussed are relatively new and have as their guiding intent the transformation of the marketplace (in this case the design of healthcare facilities) to a more sustainable reality. As such they do not necessarily provide comprehensive or in-depth coverage of many issues that could be addressed in the design and operation of an emerging best practice sustainable hospital complex. Therefore information on other issues has been included in this report to provide a more representative picture of the range of opportunity and guidance available. Few hospitals have attempted to apply comprehensive sustainability criteria to the design and operation of their facilities in a comprehensive manner, therefore much of the guidance required must be developed in process, using existing projects, protocols and guidelines as a starting point, while opening lines of communication with other facilities exploring the same path.


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Limitations Stantec senior sustainability consultants have worked on and continue to work on the development of many related environmental and sustainable design guidelines and projects and therefore much of the information presented in this report has been adapted from extensive research and content related to the development of these other documents and projects. 8.1 EXAMPLES OF RELEVANT GUIDELINES The LEED® Family of Products The LEED® family of sustainable design products began with a core product LEED® for New Construction (NC) from the US Green Building Council. Additional products, pilots, supplemental guidelines and updated versions have been developed by the councils and affiliates, including versions appropriate for use in Canada by the Canadian Green Building Council. Over time these products are field tested and modified and then merged to form the next major revision of the core program. This process is partially illustrated in the following chart.


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The following examples illustrate the range of guidelines that may be appropriately applied in the design and operation of health care facilities. GBC Publications LEED® NC 1.0 addresses the design or substantial renovation of new buildings (CaGBC) LEED® EB (Existing Buildings) addresses general renovations (USGBC) LEED® CI (Commercial Interiors) (USGBC) LEED® CS (Core and Shell) (USGBC) LEED® Application Guide for Multiple Buildings and On-Campus Building Projects

(AGMBC) (USGBC) LEED® MURB for Multi-Residential Buildings (CaGBC)

Design and Operation Guidelines recognized by LEED® Green Guide for Health Care (GGHC) LABs 21(sustainable laboratory design and operation).

Other Healthcare Design and Operation Guidelines Green Healthcare Construction Guidance Statement (ASHE) Eco-Toolkit, Environmentally Responsible Design and Construction Practices, (Kaiser

Permanente). Issue Specific Guidelines and Papers Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-

Care Settings, 2005, (Draft) Blood borne Pathogens Standard (OSHA) NIH-CDC Guidelines for Airborne Effluent from Laboratories that Handle Biohazards ISO 14000 series PVC (Greenpeace) Greening the Acute Care Inpatient Unit (Stantec) Commissioning of Hospital Projectsxxi

LEED® Product Descriptions LEED® Canada New Construction (NC) 1.0 LEED® NC 1.0 is intended to act as a guideline for sustainable design for new construction and substantial renovations. It forms a basic platform while other LEED® products provide additional options appropriate for more specific building issues and building types. LEED® EB (Existing Buildings) (USGBC) LEED® EB more specifically addresses issues related to existing buildings.


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LEED® CI (Commercial Interiors) and LEED® CS (Core & Shell) (USGBC) LEED® CI is intended to address issues related to the occupancy of an existing space and is complementary to LEED® CS which is intended to address buildings designed for later occupancy such as speculative office buildings. LEED® H (Homes) and LEED® MURB LEED® H (USGBC) applies to residential applications while LEED® MURB (CaGBC) applies to Multi-Unit Residential Buildings. LEED® ND (Neighborhood Development) (USGBC) LEED® ND applies to the development of neighborhoods. LEED® Application Guide for Multiple Buildings and On-Campus Building Projects (AGMBC) (USGBC) LEED® Campus (Pilot) is intended to provide guidance and supplemental compliance paths dealing with the relationship between individual buildings and issues which they share with other buildings or an entire campus setting such as parking, outdoor lighting, storm water management, common spaces and traffic. It may also provide some leeway and some ability to apportion value for certain credits. It helps clarify the application of some calculations such as density, how to count students vs. staff, and how to calculate weighted averages and enter aggregate data. The October 20, 2005 review draft includes the following examples that may apply to the MUHC Glen site: Develop a campus design master plan, Develop campus design guidelines, Develop a set of prototype credits that could be applied to subject buildings without

having to resubmit them for every individual building, How to deal with central plants, co-generation and other shared infrastructure, Operations staff are permitted to do some of the commissioning in-house, Energy performance can be blended for a group of buildings, Credit may be obtained for services provided elsewhere on campus such as renewable

Energy, Stormwater and Waste Management, Campus manuals can be substituted to some extent for referenced LEED® standards.

8.2 MUHC APPLICATION OF LEED®

The MUHC Planning Office has adopted environmental performance criteria which encourage sustainable development primarily according to LEED® criteria with particular emphasis on energy efficiency and indoor environmental quality. The project has been registered under LEED® Canada-NC, Version 1.0, with the intention of achieving a Silver rating. In addition to the basic LEED® criteria some additional issues of specific concern including accommodation for the hypersensitive, low impact maintenance, flexible design, and the


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creation of healing environments. The project is also registered with the Green Guide for Health Care. MUHC Trial LEED® Score

A conservative trial LEED® score was developed to estimate the approximate range for a hospital on the Glen site. See attached LEED® scorecard and health care comparison charts. This trial score indicates that 33 points could be obtained with basic attention to LEED® requirements, which implies that with some additional effort the project could score within the Silver range. Rational for Assumed LEED® Points

A LEED® Decision making Matrix is attached to complement the scorecard, which outlines the basic requirements and initial commentary on appropriate measures that could meet the requirements. Appendix “E” List of Recommended Studies (Short-term) and Next Steps Required to Achieve a LEED Silver Rating The requirements of the LEED® guideline should be compared on a spreadsheet with the requirements or suggested guidance from other guidelines including the Green Guide to Health Care, ASHE and the Kaiser Permanente Eco Tool-Kit to provide a master sustainability guidance document for an advanced design hospital appropriate to the Glen site. This process should use the following sustainable design resources directly or as a model: LEED® Campus for the master plan element, LEED® 1.0 as the base building element, and Other LEED® guidelines for specific applications as appropriate, Supplemented by other guidance for each specialty requirement such as laboratories (Labs

21) and commissioning. A resource guideline should be developed to determine which materials and other resources are available in Montreal to satisfy the LEED® (plus other) requirements for this project to serve as a list of preferred materials and related background information. Examine the functional program to determine if there are opportunities to improve the sustainability profile of the project. A list of requirements for qualifying information and design direction in view of LEED® certification should be developed to ensure that all aspects of the development are attuned to the need for coordination with respect to meeting the requirements of the master sustainability guidance document at prescribed stages of design, construction, procurement etc. Develop an inventory of medical and office etc. equipment that will be transferred to the new facility. Develop an analysis matrix and do a trial sustainability assessment (emissions, space required, noise generated, plug load, etc.) on this equipment and determine if alternatives are cost-effective. It may be less expensive to replace some


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equipment with more space/energy/use efficient equipment than to design to accommodate older less efficient equipment, particularly when space, use and life cycle costs are included. Interview appropriate representatives from those hospitals which have applied LEED® and the Green Guide to Health Care and consider lessons learned. Determine the base case sustainability data for the existing facilities in order to determine the level of improvement achieved by the new facilities. The Environmental Self-Assessment for Health Care Facilitiesxxii and or similar self-assessment checklists should be applied as a first step in self-evaluation and benchmarking. Research and list appropriate benchmarks for all applications. An Environmental Management Plan, Environmental Procurement Plan and Environmental Monitoring and Waste Minimization and Management Plan should be developed or modified to be in agreement with the guidance from the master sustainability guidance document. The environmental procurement program should be modified to support an optimal outcome for new materials, equipment and furnishings etc. required for the new facilities to achieve optimum sustainability performance. The ISO 14001 Environmental Management System Self-Assessment Checklist, March 1996 could be used as the preliminary tool. A framework for full cost-benefit analysis should be developed to ensure that full cost accounting principles are appropriately applied, and that items are not priced or accounted for prejudicially if they are arbitrarily labeled “green”. An initial assessment of probable sustainable design funding should be developed for each phase of initial construction and for the master plan. A consultative framework should be developed to ensure that the proposed sustainable design interventions for each functional area are appropriate for their unique needs. A series of briefing sessions, workshops or charettes should be planned to ensure that appropriate internal and external parties are included at the early stages of each step within the overall design and development framework. A geothermal study is required to determine the potential of geothermal energy options on site. A groundwater study may also be required to determine if the aquifer has significant implications for construction and dewatering and to determine if the water pumped could be used to displace any municipal water and if its thermal properties could be exploited. Soil tests and/or interpretation of existing tests would be required to determine the ability of the site to facilitate groundwater recharge. Determine if ownership of specific components has to be structured (eg. public or private, owned or leased) to qualify for certain incentives such as accelerated tax write-offs.


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8.3 ADDITIONAL GUIDELINES Green Guide for Health Care The Green Guide for Health Care, Version 2.0 Pilot, November 2004 is a supplemental guideline, intended to be “a best practices guide for healthy and sustainable building design, construction and operations” for early adopters.

Laboratories for the 21st Century Labs21xxiii is an example of a guideline designed to address a specific issue, in this case the design and operation of laboratories. Green Healthcare Construction Guidance Statement The American Society for Healthcare Engineering (ASHE) released the Green Health Care Construction Guidance Statement in January 2002.xxiv Eco-Toolkit Environmentally Responsible Design and Construction Practices Kaiser Permanente developed the Eco-Toolkit as a sustainable design guide for their design and development projects. It provides a good list of issues, options and design directives for the design of a more appropriate health-care facility. Although some issues are most appropriate for the California climate, most of the information could be applied to any facility. It includes a spreadsheet comparing ASHE suggested strategies to LEED® criteria and Kaiser Permanente’s design directives. The format is similar to the LEED® decision matrix used by Stantec and some of the criteria could be adopted for use by MUHC. This core information could be supplemented by information relevant to additional LEED® guides such as Campus, and the particular needs of MUHC and local climate etc.

Examples of applicable design directives from the Eco-Toolkit that illustrate a range of issues include the following: Co-locate core services (stairs, elevators, phones, mechanical shafts etc.), Do not incorporate seismic bracing in walls that might be relocated Do not plant invasive species, Cluster information in one central location such as around the information desk, Develop parking density ratios appropriate for different health care functions, Segregate bicycle and pedestrian pathways, Use wall mounted toilets to reduce cleaning costs, Keep entrance doors far enough apart to ensure that the inner and outer set are not

open at the same time, Avoid the use of hot bulbs where heat sensitive materials might be located, Use two level lighting and sensors/timers in parking lots.


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8.4 LEED® AND THE GREEN GUIDE FOR HEALTHCARE The Green Guide is modeled after and significantly expands upon LEED® in relation to the specific needs of healthcare. It is important to note that LEED® is primarily focused on design and construction, while the Green Guide includes a major focus on operations. The Green Guide mirrors appropriate sections of several LEED® products including NC, EB and CI. The following summarizes some of the main differences at the program level. With permission, the Green Guide borrows the credit scheme of LEED® with some modification, except that the Green Guide is a voluntary self-certifying document. Unlike LEED®, the Green Guide requires monitoring of building performance metrics for up to a year after construction to determine operations credits. The Green Guide is designed for existing operations but can be used for new construction. The Green Guide offers references, strategies, technologies and compliance paths in addition to those offered in LEED®. While LEED® uses a point scale to achieve a rating of Certified, Silver, Gold or Platinum, the Green Guide relies on a total point score with no ranking. The Green Guide process includes a peer to peer forum for ongoing discussion and a steering committee, while LEED® relies on formal lines of communication within an organizational structure managed by a board of directors. LEED currently has individual protocols covering New Construction (NC), Core and Shell (C&S), Existing Buildings (EB) and Commercial Interiors (CI) while the Green Guide is a single more inclusive document. Both LEED® and the Green Guide issue updated versions periodically. Both products are intended to provide guidance and are not intended to set standards. The following chart summarizes approximate differences between LEED® NC and the Green Guide.


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LEED® and Green Guide Comparison

Issue LEED® Green Guide Scoring System LEED® Modified LEED® Certified by Application to LEED® Self Certifying Primary target Design/Construction Plus Operations Time Line Initial Occupancy 1 year of operations Qualifications Reference Standards Additional Options Prerequisites 7 21 Points 69 168 Ranking 4 Levels Only a total point score Communications LEED® organization Peer to Peer forum Control Board of Directors Steering Committee Coverage Individual Products - NC,

EB, CI etc. All inclusive document

Version US -NC 2.1, EB 2.0, CI 2.0 Canada NC 1.0, MURB

V 2.0

Substances of Concern e.g. VOC, CFC, HCFC, particulates

Additional range including medical waste, drugs and chemicals.

The Green Guide for Health Care includes a section on Integrated Design which highlights the modifications and additions relative to LEED® on a point-by-point basis. Most of the changes reflect more breadth and depth coverage of issues relating specifically to health care settings as outlined below. Additional (to LEED®) Prerequisites and Points in the Green Guide By section: Construction

Integrated Design An Environmental Health Mission Statement and Program,

Sustainable Sites

Brownfield Redevelopment to Residential Remediation Level, Connection to the Natural World: Places of Respite, Community Contaminant Prevention: Airborne Releases, Community Contaminant Prevention: Leaks & Spills.

Water Efficiency

Potable Water Use for Equipment Cooling, Process Water Use Reduction: Measurement & Verification, Process Water Use reduction: Low or No Water Use Building System Equipment.


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Energy & Atmosphere Energy Supply Efficiency, Medical Equipment Efficiency.

Materials & Resources

Mercury Elimination, Construction Practices: Site & Materials Management, Construction Practices: Utility & Emissions Control, PBT Elimination Dioxins, PBT Elimination Mercury, PBT Elimination Lead & Cadmium, Copper reduction, Resource Use: Minimize Materials.

Environmental Quality

Asbestos Removal or Encapsulation, Low Emitting Materials: Furniture & Medical Furnishings, Low Emitting Materials: Exterior Applied Products, Chemical & Pollutant Source Control: Indoor, Daylight & Views: Lighting and Circadian Rhythm, Acoustic Environment.

Operations

Integrated Operations, Integrated Operations & Maintenance Process, Recertification Process.

Transportation Operations Alternative Transportation: Low Emitting & Fuel Efficient Vehicles, Alternative Transportation: Car Pool Programs.

Energy Efficiency

Energy Efficient Equipment. Process Water Efficiency

Process Water Efficiency, Polychlorinated BiPhenyl (PCB) Removal.

Chemical Management Community Contaminant Prevention: Airborne Releases, Community Contaminant Prevention: Leaks & Spills, Indoor Pollutant Source Control: High Hazard Chemical Management, Chemical Discharge: Chemical Waste Minimization Plan, Chemical Discharge: Pharmaceutical Waste Minimization Plan.


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Waste Management Regulated Medical Waste Reduction, Food Waste Reduction.

Environmentally Preferable Purchasing

Food: Organic or Sustainable, Food: Antibiotics, Local Production/Food Security, Janitorial Paper & Other Disposable Products, Electronics Purchasing and Take Back, Toxic Reduction: Mercury, Toxic Reduction DEHP, Toxic reduction: Natural Rubber latex.

8.5 ESSENTIAL DESIGN CONSIDERATIONS FOR ADVANCED HOSPITALS

The LEED® and other sustainable design guidelines discussed provide a basic starter kit for the design of more environmentally appropriate facilities, however in order to design and operate an emerging best practice health care facility many additional issues must be considered. Advanced Design applies advanced design tools and concepts within an integrated context to achieve best practice design, construction and operational outcomes addressing an optimal set of life cycle economic, social and environmental issues. Advanced design requires the full participation of an experience integrated design team including significant and timely input from corporate champions, medical staff, design professionals, construction, operations and user groups. Advanced hospital design applies anticipatory design to envision and satisfy the needs of a next generation facility including maintaining the flexibility required to avert rapid obsolescence and deal with epidemics. This vision must be applied at the earliest possible point in the design process (conception, preliminary planning, and preliminary design). It must incorporate significant user input, evaluation and feedback in order to optimize the decision making process. Opportunities to optimize performance decline exponentially as each sequential decision is made. In complex, large scale projects multi-variant analysis is typically sacrificed too early in the process largely due to a scarcity of appropriate fee allotments and senior design team members with in-depth cross-disciplinary knowledge. Additional knowledge of the broad range of issues that would need to be addressed to achieve emerging best practice performance is essential. The design of high performance facilities requires up front investment in advanced design that leads to cost savings throughout the entire life cycle of the facility.


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Concurrent Design In order to be inclusive in addressing a wide range of issues within the time constraints imposed by large-scale projects, concurrent/parallel processes need to be applied. These processes may include high quality simulation, rendering, mock-ups and user group consultations designed to provide immediate feedback on the implications of design options, and thus facilitate timely modifications to design directions. Later stage design decisions such as interior fit-up may be started early in the overall process in order to have appropriate influence over early design options that may otherwise prove unnecessarily restrictive. In advanced design processes multiple sub-groups are typically assigned sub-tasks that are coordinated to provide timely input at specific stages of the decision making process, thus enabling the main design team to incorporate more information within the compressed design schedule typically imposed upon the process. 8.6 ENVIRONMENTAL MANAGEMENT AND PROCUREMENT PLANS An Environmental Management Plan should be developed in conjunction with an Environmental Procurement Plan, Incident Management Plan, Environmental Monitoring, Waste Minimization and Management Plans. Environmental management plans and procurement programs should address a broad range of related issues including potential contaminant sources such as cleaning and maintenance products, medical products and equipment, photocopiers, kitchens, loading docks, building materials, office supplies, office furnishings and personal care products. Environmental Management Plan An Environmental Management Plan should be developed to provide a coordinated framework and time frame for managing existing environmental issues and for planning and implementing new practices. For example the US Department of the Interior has model documents for green purchasing and training for janitorial services http://www.doi.gov/greening/sustain/basics.html. Consider using the ISO 14001 Environment System Self-Assessment Checklist to benchmark current performance. Issues of concern that would typically be listed in an Environmental Management Plan included: Potential effects on the environment, including those potentially related to accidents and

malfunctioning, as well as cumulative effects, Appropriate mitigation measures to address identified adverse environmental impacts; The likelihood of adverse effects occurring, The potential for measures that might improve environmental performance; The significance of residual effects if any, Appropriate waste and effluent management measures, and The need for and appropriate nature of any additional programs, including an Environmental

Management Plan and Environmental Procurement Plan.


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Environmental Procurement Plan An environmental procurement plan should be developed or modified to ensure that procurement objectives are in line with environmental management plan objectives. The CSSS Cote-des-Neiges / Métro Parc Extension, for which the MUHC acts as a front-line community hospital in partnership with the Jewish General and St-Mary’s Hospitals, is developing a group Green Procurement Plan for the health care facilities on the island of Montreal. This initiative could be expanded upon. There are few widely accepted definitions for “Green” chemicals however the US Department of the Interior has one specifically for green chemicals, http://epa.gov/opptintr/epp/ppg/case/doicase.htm. This site also includes a purchasing wizard and procurement checklists that can be used as templates for environmental purchasing of cleaning and other products. Design and long term procurement planning must take into consideration the fact that jurisdictions are continuously increasing requirements. For instance the ability to discharge many substances currently found in hospital wastewater is expected to be increasingly restricted. Although under consideration by Health Canada no definitive directives have been enforced at this time. It should be noted that although some drug residues break down others are relatively stable and persistent in the environment, and that even minute doses may have catastrophic environmental implications for which hospitals may eventually be held responsible. Therefore waste systems should be designed to enable treatment before discharge even if the treatment facility is not constructed at the beginning, and unused drug take-back programs should be considered. Related guidance may be borrowed from the pharmaceutical manufacturing industry, for example: The World Bank Group’s Pollution Prevention and Abatement Handbook July 1998 includes

a section on Pharmaceutical Manufacturing “Guidance for Industry, Environmental Assessment of Human Drug and Biologics

Applications” US Dept. of Health and Human services, Center for Drug Evaluation and Research (CBER), July 1998, CMC 6, Revision 1

Pharmaceuticals, Personal Care Products, and Endocrine-Disrupting Substances: Emerging Contaminants Detected in Water. Canadian Institute For Environmental Law and Policy. www.cielap.org

Environmental Monitoring, Waste Minimization and Management Plan An environmental monitoring, waste minimization and management plan should be developed or revised and implemented including the following example provisions: Cleaning and maintenance materials should be obtained on a just-in-time basis to reduce

on-site inventories, and dispensed in automatic controlled equipment to reduce errors. No incompatible materials should be procured if alternatives are available, Waste materials of concern should be segregated and stored under controlled access,


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Designated substances of concern including toxic waste should be controlled with, storage and audit trails, and should be signed off before being picked up by a third party firm licensed specifically for this purpose,

Wastewater from medical and chemical storage and mixing rooms should be discharged to the municipal sewer only if appropriate, or picked up for disposal by an appropriately licensed firm.

Packaging waste including paper, cardboard, plastic, PVC, glass and metal should be collected and stored in a dedicated recycling room for pick-up.

Fluorescent lamps and ballasts should be collected, stored according to applicable regulations and best practice and picked up by a recycler specifically licensed for this purpose that fully recovers and recycles all relevant toxic materials in an appropriately licensed facility,

Medical waste should be managed according to specific regulatory and best-practice guidance.

Preventive Maintenance

A Preventive Maintenance Program should be developed starting at the beginning of the design program and should be inclusive of advanced and continuous commissioning, and smart technology and control systems.


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9.0 ENVIRONMENTAL SENSITIVITY

This section provides a brief introduction to environmental sensitivities. It is adapted from a paper prepared by Stantec. All persons are sensitive to environmental conditions however some are significantly more sensitive than others. In simple terms environmental hypersensitivity can be defined as a significantly more pronounced degree of sensitivity than average. At one extreme are those sensitivity reactions that are classed as a nuisance and at the other life-threatening anaphylactic reactions. Scientific understanding of the degree of variation in susceptibility within the population has changed dramatically over the past fifty years, with a far broader range having been demonstrated than was previously thought possible.xxv There has been an equally dramatic increase in the range and level of exposures to common chemicals, with over 75,000 chemicals now in common usagexxvi and indoor exposures 10 to 100 times higher than outdoorsxxvii, resulting in dramatic increases in the number of xenobiotic substances in the body. Simultaneously there have been dramatic increases in non-infectious exposure related diseases, with asthma being the best documented. In 1993 the Institute of Medicine reported that “An estimated 20 to 30 million Americans – 8 to 12 percent of the American population – have asthma.” with a 33% increase in the related death rate over the previous decade (4,580 deaths in 1988). xxviii Sensitivity reactions may be caused by non-chemical and non-physical agents. For instance susceptibility to cold varies widely in the general population with some persons succumbing to slow onset hypothermia at temperatures only marginally below normal room temperature. Urticaria can be caused by “physical factors such as trauma, pressure, friction, and vibration”xxix Autism is characterized by sensitivity to sensory stimuli (sensations) in general, Reflex Sympathetic Dystrophy Syndrome (or Complex Regional Pain Syndrome) and Trigeminal Neuralgia are characterized by localized pain sensitivity, Many people exhibit symptoms in relation to other environmental phenomenon including light deprivation (Seasonal Affective Disorder), sensitivity to vibration, electromagnetic fields, time shifts, sensitivity to noise (Hyperacusis), and sensitivity to light (Photophobia). Terms such as Chemical Sensitivity and Chemical Allergy describe diseases that are quite different, are both adverse reactions to environmental agents and are often used incorrectly as synonyms. The terms Environmental Sensitivities in Canada and Multiple Chemical Sensitivity (MCS) in the US are commonly used and accepted as synonyms even though there are technical differences in their literal meaning. There are many other terms used as synonyms for sensitivity and there are many related diseases. The concept of abnormality has undergone a dramatic shift in relevance since the middle of the 20th century, when environmental sensitivities to common agents were first reported.xxx Diseases, which were considered rare and controversial in 1950 are now so prevalent that they have become normal in the sense that they are so familiar that they no longer appear to be


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abnormal. For instance the number of persons affected by allergies has risen to the point where more than half the population may meet the clinical definition, including positive test reactions.xxxi Chemical allergy is a well understood, documented and accepted condition, while environmental sensitivity is not as well understood, documented or accepted. Workplace related allergic and non-allergic sensitization is common, well documented and to the extent that the particular biophysical mechanism is understood, well accepted. “Low molecular weight reactive allergenic chemicals can cause immunologic sensitization and consequent allergic reactions”xxxii “Although many of the protein allergens have long been recognized, a lengthening list of newly recognized allergenic chemicals is developing.”xxxiii The World Health Organization states that for asthma causation alone there is “a huge variety of chemical and biological substances.” xxxiv Progress in documenting physiological sensitivity mechanisms has been slow. “Hypersensitivity disorders are by far the most widely recognized manifestations of immunotoxicity. These disorders can result from exposure to environmental contaminants or chemicals in the workplace and have been widely reported and amply documented (Trizio et al., 1988). Hypersensitivity reactions are also the most common type of immunotoxicity associated with chemicals in the environment.” xxxv Chemical allergy and idiosyncratic reactions (chemical hypersensitivity) are well described in the toxicological literature.xxxvi Most symptoms of (chemical) sensitivity experienced at low doses are highly consistent with the known signs and symptoms associated with exposure of average persons to the same causative chemicals at elevated doses. Controlled studies provide ample evidence of the increased degree of sensitivity experienced by persons with sensitivities.xxxvii Many products commonly used in the construction, furnishing and operation of buildings including cleaning, maintenance and office products contain a wide range of chemical ingredients known to be sensitizers, allergens, asthmagens, irritants, toxins, carcinogens or estrogenic substances. These products may affect both average and at-risk populations, including persons with environmental sensitivities. “About 40% of the population has IgE antibodies against environmental allergens, 20 percent have clinical allergic disease, and 10 percent have significant or severe allergic disease.”xxxviii Asthma rates (both allergic and non-allergic) had already reached 8-12% of the U.S. population by 1990.xxxix The US National Academy of Sciences indicates that Multiple Chemical Sensitivity affects up to 15% of the population to some degree.xl Several population-based studies have found similar incidence, ranging from 3 to 33 percent of the population, depending on the definition of sensitivity.xli Environmentally related diseases including those listed above appear to be considerably more prevalent within the female populationxlii. Women face significantly greater levels of discrimination than men related to adverse health effects.xliii There is a wide range of diseases related to exposures in the office environment, including many for which incidence has been estimated. “Office workers are estimated to develop hypersensitivity pneumonitis at rates of from 1.2 to 4 percent (EPA, 1991B).”xliv By 1989 chronic sinusitis (allergic and non-allergic) already affected 31 million Americans.xlv “Symptom prevalence rates associated with indoor environments vary tremendously, from less than 5 percent to as much as


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50 percent.”xlvi The percentage of buildings reported by researchers to have significant indoor air quality problems averages approximately 30 percent.xlvii Problems related to indoor environments are well recognized within the scientific literature and major policy and regulatory steps have been taken to reduce outdoor and indoor exposure levels to biological, chemical and radiological contaminants. xlviii Even within the general population very significant changes in health effects are repeatedly demonstrated when changes are made and tracked in indoor environmental conditions.xlix Avoidance (reduced exposure) remains the primary medical recommendation “…reduced exposure may represent the most practical approach for preventing allergic disease arising from chemical exposure.”l There are an increasing number of new and resurgent diseases, which like asthma and allergy are growing exponentially, have non-infectious environmentally related causation and often have overlapping signs, symptoms and treatments. Some of those most closely related to environment sensitivities include Multiple Chemical Sensitivity (MCS), Allergy, Asthma, Anaphylaxis, Chronic Fatigue Syndrome, Fibromyalgia, Irritable Bowel Syndrome, and Gulf War Syndrome. There is considerable overlap of reported signs, symptoms and biological mechanisms amongst these diseases, making research, definition, testing and diagnosis very difficult.li There is a considerable amount of legislation (principally the Canadian Human Rights Code) and legal precedent (workplace accommodation proceedings) requiring accommodation of persons with sensitivities, particularly related to workplace accommodation. Note: Individuality of sensitivity is a fundamental principle of environmental sensitivity therefore although it is possible to roughly prioritize the use of some basic materials it is not possible to rely on any listing of products that are deemed to be appropriate for persons with environmental sensitivity. Any use of products for such persons should be used only with appropriate cautions. There are several examples of health care settings or programs that have been designed to accommodate, diagnose or treat sensitive persons including the Women’s College (Sunnybrook) Hospital Clinic and the Riverdale Health Centre in Toronto, and the Nova Scotia Environmental Health Centre, Fall River, Nova Scotia. Some typical accommodation measures include the following: Interviewing sensitive patients before arrival Enclosed office or single occupancy room Enhanced air filtration (particulate and gas) Reserving special rooms for affected persons Posting notification for a room occupied by a sensitive person Posting (scheduling) of all work such as painting, cleaning etc. Assigning specifically trained staff for affected patients Using lowest impact medications Using lowest impact medical devises


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Serving special (organic) meals Allowing patients to bring in some personal substitute products Staff, patient and visitor policy for no scented personal care products Flex time for employees periodically affected Maintain constant ventilation (outdoor air supply) Reduce/eliminate flowers and potted plants that emit pollen, mould or perfume indoors and

out Ovoid office equipment that emits chemicals and place equipment in dedicated rooms

exhausted directly to the exterior Maintain as much distance between sensitive persons and electro-mechanical medical

equipment as possible Make out of room trips for diagnostics etc. as quick as possible Make oxygen available at all times (as appropriate) using a ceramic mask Implement special cleaning and maintenance protocols Use chemicals that the individual tolerates e.g. Oxygen Bleach, Tee Tree Oil Install appropriate materials, furnishings and fixtures: Full spectrum fluorescent lamps with electronic ballasts Non-offgassing mattress, pillows, sheets, mite covers HEPA vacuum cleaners Avoid primary substances of concern e.g. latex, neoprene, formaldehyde, scented products

etc.


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10.0 BUILDING HEALTH SCIENCE

Environmental sensitivity is incompatible with classical diagnostic practices that are focused on narrow, specific and highly consistent symptoms, test protocols and relationships to individual causative agents and target organs. Conventional medical practice focuses on the patient seeing a linear progression of specialists with limited cross-disciplinary communication and virtually no cross-referencing of the patients symptoms with a master data bank. Therefore the recognition of new, complex disease patterns and cause and effect relationships is severely handicapped. This phenomenon is exacerbated by the proliferation of new and resurgent diseases that are environmentally induced or mediated since they tend to have more complex characteristics that are difficult to recognize following conventional medical diagnostic protocols. The prevalence and severity of these diseases tends to track levels of development or wealth and therefore are significantly related to environmental conditions including the built environment, nutrition and lifestyle. There has been a significant increase in the application of the scientific method to the built environment. The field of Building Science includes several areas of applied research related to human health, well being and performance including, building anthropology, building psychology, building sociology, building epidemiology, building diagnostics and forensics. Clinical engineering provides a closely related body of knowledge that must be integrated with building science. The appropriate application of this knowledge to the design and operation of built space has resulted in significant improvements in health, wellbeing, performance, employee attraction and retention, and improved health care outcomes. People are commonly understood to spend up to 90% of their time indoors therefore the elevated degree of exposure (in indoor environments) takes on heightened importance.lii The high level of chemical exposure found in a hospital exacerbates this problem. The terms Sick Building Syndrome (SBS) and Building Related Illness (BRI) have come into common usage in building health science. They are technical definitions related to cases where populations within buildings report common health symptoms, which have been recorded through epidemiological surveys. SBS refers to illness clusters where the causative agent has not been positively identified and BRI refers to illness clusters where the cause and effect relationship (such as Legionella) has been positively identified. The number and severity of Building Related Illness incidents are significantly underreported. Exposure to novel environmental agents such as radiation and endocrine disruptors has also increased significantly. There has been a parallel increase in lifestyle and food science research indicating that specific interventions have a significant impact on health and performance outcomes. Preventive health care has long been acknowledged to be the most cost-effective application of health care dollars yet little progress has been made in shifting the budgetary emphasis in this direction. The application of this knowledge base to the built environment of a teaching hospital setting with community outreach can demonstrate leadership in this regard and provide significant operating savings and improvements to health care outcomes.


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Building science indicates that the application of data science (metering, monitoring, measuring, diagnostics, continuous commissioning, post occupancy evaluations etc.) has the potential to significantly improve building operations, satisfaction, health, and productivity outcomes while reducing costs. Similar benefits would accrue in health care settings if medical statistics were cross-referenced to building science and clinical engineering statistics. This option represents a major opportunity for MUHC to establish a world leading position in a relatively new area of medical research.


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11.0 LOW IMPACT CLEANING AND MAINTENANCE MATERIALS AND METHODS

The following outlines information relevant to due diligence and best practice guidance on appropriate cleaning and maintenance materials and methods. This information is adapted from a Stantec report and is focused on environmental and human health impacts related to generally available information on hazardous ingredients as identified in Material Safety Data Sheets (MSDS). See appendix “F” for addition resource references. There are several protocols for evaluating and/or certifying cleaning and maintenance materials including: TerraChoice [Ecologo], Green Seal, Scientific Certification Systems, the Janitorial Products Pollution Prevention Project, and GREENGUARD. Although there are differences in each program’s screening criteria Green Seal or Terra Choice could be used as general default screens for the purchase of environmentally appropriate cleaning materials. Some comparisons are included in brackets as representative examples of differences. Only designated (hazardous) chemicals accounting for more than 1% of the product are required to be disclosed under the Workplace Hazardous Materials Information System (WHMIS). Therefore full ingredient disclosure is not available for most products through the WHMIS system e.g. in an MSDS. Many manufacturers or suppliers do not know the actual chemical composition of the products they supply. Product chemistry may vary over time particularly when there is significant price volatility for ingredients or changes in suppliers. Fewer than 2% of the 70,000 chemicals in common use have been comprehensively evaluated for human and environmental health impactsliii. Therefore definitive environmental and health information for most substances of concern does not exist. Consequently the absence of information does not imply that there are no environmental or human health effects, or that these effects if any are not significant. Human and environmental impact assessment information is extremely diverse, inconsistent and not highly reliable. Therefore direct comparison is very difficult and not highly accurate and due diligence and the precautionary principle indicate that reputable third party comparative analysis must be relied upon to provide usable data. Many variables determine the actual potential environmental and human health impact including for example the actual concentration in the end use product, the amount of the end use product used, the timing and conditions under which they are used and the presence of people who might be affected. A wide range of benchmarks, checklists, databases and guidelines must be reviewed and used to develop recommendations for product options for cleaning and maintenance products and services. Based on a review of the MSDS and related literature the potential for positive and negative impacts related to the hazardous materials listed, on human and environmental health including potential cumulative effects and potential impacts from accidents must be assessed. To establish an environmentally appropriate cleaning and maintenance program information must be gathered, and analyzed relating to major impact categories such as aquatic, terrestrial,


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atmospheric, waste, workplace environment, resource and hazardous and non-hazardous materials as well as specific research environment and patient category concerns. The efficacy of some cleaning materials may be addressed using existing test protocols (see ‘Standards’ section in appendix “A”), each of which uses particular definitions of performance. Test information must be considered in relation to the appropriateness of the standard and the stakeholders who developed it. The effectiveness of efficacy testing is controversial, and products tested by the EPA frequently failed the test.liv The issue of effectiveness of alternative products may be addressed through product trials and industry peer-to-peer communications. Cleaning products and related MSDS should be reviewed to determine if there are any: Chemicals of concern, in Quantities of concern, or Uses of concern.

This process is onerous therefore most agencies rely on third party evaluations and the experience gained through pilot projects rather than trying to do their own assessments from scratch. However this may not be an appropriate strategy for some of the products typically used in healthcare settings or for some of the chemicals of concern such as endocrine disrupters. Third Party Evaluations Although many references can be reviewed, the Environmental Defense Scorecard system provides a simple, science based and common method for comparing the human and environmental health impact of subject chemicals of concern identified in an MSDS for cleaning products. The following example includes the name of the subject product followed by the related substances of concern and the Environmental Defense (ED) Scorecard rating. The ED Scorecard rating indicates a percentage range estimate of adverse environmental impacts by category, in 25% increments. Examples of Third Party Agencies that provide material guidance include: Environmental Choice Program [Ecologo] www.environmentalchoice.ca Green Seal www.greenseal/org Pennsylvania Green Building Operations and Maintenance Manual,

http://www.dgs.state.pa.us/dgs/cwp/view.asp?a=3&q=118184 Scientific Certification Systems [Green Cross] (SCS) www.scsi.com The US General Service Administration maintains a major data base ‘Safer Paints, Cleaning

and Other Chemical Products’ at: http://apps.fss.gsa.gov/environ/safer-chemicals.cfm.


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Pilot Projects Several pilot projects and environmental product purchasing programs have recently been implemented by cities and states, and can be used as templates for the development of a program. These pilots range from the original US GSA Cleaning Products Pilot Program begun in 1993 up to the City of Ottawa pilot underway in 2005 and Hospitals for a Healthy Environment provides general guidance in “How to Do EPP in Hospitals”. Some of these programs have concluded that the Green Seal GS-08 Household Cleaners and GS 37 Industrial and Institutional Cleaners standards provide a reasonably comprehensive standard for evaluation and certification for the cleaning products covered. Other certification programs such as TerraChoice also provide third party benchmarks. GS 37 and 08 (and other certification programs) can be used to provide a primary benchmark, which in addition to any particular criteria considered important to the specific requirements of the subject facility can be used to fast track the development of procurement guidelines for immediate implementation. These programs represent a range of criteria. Some organizations such as the US Department of the Interior have established more stringent guidance that could be applied when appropriate.lv Environmental Management and Procurement plans should include specific measures addressing cleaning and maintenance materials and methods, including the following: Products should conform to the requirements of appropriate standards and have a Canadian

Pest Control Products (PCP) number or U.S EPA equivalent when required.

The development of chain of custody procedures for tracking received goods at the dock and in storage. Product packaging contains unique identifiers and is traceable. Most typical cleaning chemicals in the quantities typically handled should not pose an exceptional risk related to transportation accidents and/or other accidental release to the environment if industry and regulatory recommended practices are followed.

Typically some products are premixed and some are received as concentrates for mixing on site. Material handling, quality control, and other procedures should be posted on the wall in each storage/mixing area and materials should be stored on shelves or plastic pallets with spill containment and appropriate drains etc. as per manufacturers recommendations as appropriate.

Goods should be controlled with a combination of access keys, logs, and an audit trail. They should be kept in segregated rooms and/or areas within rooms. Storage rooms should be controlled by temperature and humidity as appropriate to the stored materials. Negative pressure (direct powered exhaust to the exterior) should be maintained in all chemical storage areas.

Cleaning products should be delivered just in time in order to maintain relatively small quantities of cleaning chemicals on site. Attention should be paid to materials that require segregation for reactivity and most chemicals should be kept in their original containers as appropriate. No unlabelled or otherwise inappropriate containers should be used at any time.


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The following measures can be implemented to reduce the negative human and environmental health impact and liability associated with the use of typical cleaning chemicals and methods: Take a baseline inventory of existing cleaning and maintenance materials,

Appropriately dispose of all chemicals that are stale dated, unlabelled, damaged or not on a current list of approved chemicals,

Ensure that all chemicals are in correct concentrations and are properly labeled and stored,

Ensure that there is an up-to-date (not older than 3 years past the current date) MSDS for each product stored in each location, in an appropriately labeled binder,

Ensure that chemical storage rooms are equipped with appropriate spill containment and are maintained under negative air pressure (exhausted continuously directly to the exterior). Ensure that no incompatible chemicals are stored together,

Ensure that all employees have been appropriately trained in preventive measures, spill containment and appropriate chemical use,

Implement options from the Best Practice Options listed below,

Substitute water based cleaning products for solvent based cleaning products. The Janitorial Products Pollution Prevention Project website (http://www.westp2net.org/janitorial/tools/riskevaluation.htm) includes comprehensive lists of chemicals to avoid or use with caution, in four categories: Ingredients to avoid, Ingredients to avoid if possible/otherwise use with extreme care, Ingredients to use with extreme care, and Ingredients to use with ordinary care.


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12.0 INDOOR ENVIRONMENT QUALITY

Mitigation Reduce the incidence of indoor environment complaints by insuring that lighting, acoustics, ventilation and humidification meet the requirements of appropriate standards. Ventilation Ensure that ventilation air intakes are appropriately protected to reduce risks related to re-

entrainment of exhausts or intake of emissions from outdoor sources, Ensure that ventilation systems are monitored and periodically inspected for possible system

generated emissions related to equipment, insulation and biological contaminants, Ensure that ventilation rates and relative humidity levels are maintained within ASHRAE

guidelines, Ensure that ventilation is ramped up sooner on Mondays than on other weekdays to address

the additional indoor air contaminant load accumulated over the weekend or holidays, Ensure that ventilation is kept on where and when appropriate during after hours events, Ensure that commissioning or re-commissioning of ventilation systems and particularly

diffuser layouts occurs after occupation and after workstation or other layout modifications, Ensure that ventilation air actually reaches the breathing space particularly in workstations

(desktop) and special needs locations such as day-care (floor), Isolate areas of construction and use local exhaust when appropriate to reduce cross

contamination through ventilation systems, Increase ventilation rates and periods during construction, renovation or stripping and

waxing etc. and ensure that the Sheet Metal and Air Conditioning Contractors National Association, Guideline for the Protection of HVAC Systems During Construction in Occupied Buildings is applied during all construction and renovation activities, www.smacna.org

Ensure that intakes are located at least 2 metres above grade to reduce intake of ground level contaminants,

Implement a no scent policy (no added scent) for cleaning and maintenance products, Implement a no scent/perfume policy for staff and visitors, Implement a no dye policy, unless the dye is a low impact (e.g. food grade) chemical

necessary for product (safety) identification, Plants Implement a policy restricting the type of plants used indoors (building and staff), Eliminate the use of flowering plants (that release natural perfume, turpenes or pollen), Plants that smell (particularly those such as geraniums and eucalyptus that are known to

adversely affect persons with respiratory conditions, and Plants that require fertilizers (do not use synthetic or toxic fertilizers, pesticides, anti-

desiccants, waxes etc.),


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Avoid plantings that are prone to producing mould on soil surfaces, and control fallen leaves to reduce mould incubation,

Do not install plants or biodegradable ground covers immediately adjacent to walls, windows or intakes,

Avoid plants that require intensive maintenance, Use lawn mowers that bag grass near buildings to reduce the ambient mould count from

decomposing grass clippings, Avoid exterior plants with major pollen loads (male species, birch etc.), Wash lawns, bushes etc. with soapy water immediately after snow melt.

Other Typical Issues/Options to be Considered Air Treatment High Efficiency Air Filtration: High Efficiency Particulate Arrestance (HEPA) 99.97 efficiency can be used to reduce the

movement of contaminants within HVAC systems or specific environments. Absolute filters can be used to reduce the movement of contaminants within HVAC systems

or specific high-risk environments such as operating rooms and isolation applications. Rating System - consider using Minimum Efficiency Reporting Value (MERV) or European

filtration rating systems which may provide a more accurate indication of the efficacy of the filters under consideration as compared to the historic ASHRAE system

Catalytic treatment e.g. Room Temperature Catalysts can break down target substances with minimal resistance to airflow and without the need for high temperatures thus reducing energy requirements. Room temperature catalysts can reduce or eliminate the need for other more energy or material intensive treatments such as activated carbon and potassium permanganate.

Ultra Violet - UV Air Sterilizers can reduce the quantity of viable microorganisms circulated through HVAC systems or within specific environments.

Desiccant Cooling - Desiccant cooling may help reduce the quantity of viable microorganisms imported through the ventilation outdoor air intake through desiccation. The system can reduce the moisture content of air before the application of air conditioning, thus improving overall energy efficiency and comfort while reducing relative humidity levels and therefore the potential to incubate microorganisms.

Flexible Design Options – Layouts, functional programs, HVAC systems and air treatment systems such as filter housings should be designed to facilitate rapid conversion to enable pre-designated rooms and sections of a hospital to be converted to higher levels of isolation to combat epidemics/pandemics at minimal costs.


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13.0 MATERIALS

Many materials used in health care settings for buildings, furnishings, equipment, cleaning and maintenance and health care supplies have significant immediate and life cycle environmental and human health impacts (direct and indirect) that must be considered. Both the substance and ingredients may be of concern for example PVC and substances found in many formulations such as DEHP, lead and cadmium. Targeting of materials of concern should focus on the most significant substances and the most vulnerable populations and procedures within the context of an overall program. The list of substances of concern is expanding due to increasing knowledge of adverse effects, increasing regulation and the application of the precautionary principle and leadership in due diligence and best practice by both hospitals and their Group Purchasing Organizations. A proactive approach is of particular importance in preventing these substances from becoming embedded problems with escalating costs for management and remediation. If only today’s priority substances are targeted then most of the opportunity will be lost and will be locked in for the lifecycle of the material, component or building. In many cases the substitute products provide both improved health care and improved environmental outcomes, therefore cost-benefit analysis must include both considerations. Material Phase Out Initiatives Several reports including those from Tufts Universitylvi and The Center for Health, Environment and Justicelvii have determined that there are cost-effective substitutes for many substances of concern. LEED® which is primarily aimed at office buildings addresses some substances of concern such as CFC’s, particulates and VOC’s. Hospitals must be concerned with a wider range of substances of concern including pathogens, medical waste, medical gasses, drugs, endocrine disrupters and other chemicals. Major health care organizations such as Kaiser Permanente are phasing out the use of targeted substances of concern using a prioritized and phased plan. The American Hospital Association and US EPA have a memorandum of understanding to phase out all mercury use in hospitals by 2005, to reduce hospital waste volume by 50% by 2010 and to target additional substances. There are six steps to eliminating substances of concern and maintaining best practice: Identification and targeting of substances of concern Finding appropriate substitutes Overcoming resistance to change Implementing environmentally preferable purchasing Monitoring compliance Continuous quality improvement.


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It is also essential to educate staff and to use trial runs to ensure a smooth transition to new materials and practices. There are many resources that outline these concerns and provide lists of possible alternatives including the following examples: LEED® Rating Systems and Resource Manuals Environmentally Preferable Purchasing, How to Guide and associated documents. Hospitals

for a Healthy Environment. Environmentally Preferable Products, Health Care Environmental Purchasing Tool. Art & Creative Materials Institute Inc. C2P2 Online Greenpeace Healthy Building Network Alternative Products, University of Massachusetts, Lowell, Sustainable Hospitals Project and

Lowell Center for Sustainable Production Sustainable Hospitals Project


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Sample Matrix Typical Substances of Concern and Possible Substitutes Examples of Typical Substances and Issues of Concern (with or without) Alternative Product Examples

SUBSTANCE CONCERN or MAY CONTAIN ALTERNATIVE

CFC’s refrigerant, blowing agent for foam insulation etc.

Greenhouse Gas Transitional and Non-CFC Refrigerants

diethylehexyl phthalate (DEHP)

Medical materials

Endocrine Disruptors Formaldehyde (carcinogen) Wood adhesives, paints and

finishes, medications, cleaning and maintenance products

Icocyanurate, Lignin, Urethane

Halon – fire retardant Green house gas HCFC – refrigerant, blowing agent

Transitional greenhouse gas CFC/HCFC free refrigerants

Polycarbonate PVC (Vinyl) may be found in blinds, bottles, hard and resilient flooring, carpet, gloves, bags, tubing, pipes, wallpaper, window frames, rub rails, wiring.

Formulations may contain phthalates (e.g. DEHP), lead, cadmium, tin). Produces toxic byproducts of combustion including PCB’s Found in many building, medical and office products.

Acrylic, Polyethylene, Polyurethane, Polypropylene, Polyester, Silicone, Nitrile, EVA, Nylon,

Latex Nitrile, Polyurethane, Tactylon, Neoprene

Mercury (medical & laboratory thermometers, pressure gauges, thermostats, gastrointestinal equipment, sphygmomanometers, fluorescent and HID lamps, fixatives, regents, batteries.

Non-mercury or low mercury light bulbs. Mercury free thermometers. Lead free batteries.

Wood Dust (carcinogen, allergen, asthmagen)


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14.0 WASTE MANAGEMENT

There are LEED® points for both construction and operations waste. Medical Waste In addition to typical waste considerations, medical waste includes designated substances that must be treated under specific protocols to ensure health safety from pathogens. The choice of treatment technologies can have significant energy and environmental implications. Single-Use Medical Devises (SUDs) are a special category with ongoing discussion of management practices including protocols for appropriate reuse in some instances. The ability to reuse SUD’s under appropriate circumstances may decrease both costs and waste. The US EPA has issues guidance in this regard.lviii An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities, American

Hospital Association Waste Minimization Starter Kit, Kaiser Permanente.


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15.0 REPRESENTATIVE MATERIALS AND OPTIONS

The following are representative examples of materials and options that could be considered for sustainable design: Air Filtration High Efficiency air filtration: High Efficiency Particulate Arrestance (HEPA) 99.97 efficiency at 0.3 microns Absolute: (NATO definition) – A filter capable of cutting off 100% by weight of solid particles

greater than a stated micron size. Rating System - Minimum Efficiency Reporting Value (MERV).

Catalysts Room Temperature Catalysts – consider the input chemicals likely to pass through the unit

and the breakdown chemicals likely to be emitted. Ultra Violet UV air sterilizers – consider the input chemicals likely to pass through the unit and the

breakdown chemicals likely to be emitted. Ozone Ozone water filtration and ozone air filtration with neutralizer – consider the input chemicals

likely to pass through the unit and the breakdown chemicals likely to be emitted. Ceiling Ceiling Tiles – should be avoided when appropriate to reduce material, cleaning and

maintenance costs. If required consider high-recycled content and avoid tiles which may emit fibers of concern such as man made mineral fibers (MMMF) and gasses of concern such as formaldehyde. Avoid excelsior board, which may emit turpenes. Consider tiles, which are inherently inert such as steel tiles.

Dust accumulates on the upper surface of suspended (T Bar) ceiling tiles and constant vibration causes dust to be re-entrained into the ventilation air stream if the ceiling space is used as an HVAC plenum. Suspended ceiling HVAC plenums should be used with caution in health care settings.

Control Systems Building Control Systems Interoperability Lighting Controls Digital Addressable Lighting Interface (DALI) Proprietary Control Systems Continuous commissioning system.


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Floor Carpet, pad, adhesives, treatments, cleaning and maintenance requirements Certification e.g. CRI Green Label and Green Label Plus Non-Allergenic Non-Woven Floor Tiles

Heating Ventilating and Air Conditioning Increased ventilation rates Laminar air flow Dedicated Outdoor Air System (DOAS) Air Monitoring System (e.g. Aircuity) Elimination or reduction of duct lining.

Lighting Fluorescent T 8, T5, T 2 Compact Fluorescent Lamps (CFL) HID Daylight Daylight Harvesting Low impact (low/no mercury, phosphors of concern) bulbs.

Refrigeration Refrigerants Energuide, Energy-Star rating

Steel Recycled content

Structured Cabling High speed, high bandwidth, Internet Protocol (IP) based Ethernet system to support

real time, whole enterprise communications for all systems such as medical telepathy, building controls, security, continuous commissioning and telemedicine. Attributes: flexible, scaleable, secure, cost-effective.

Medical Telepathy The AHA Website has an overview of ‘medical telepathy’. Reference: American Society of Health Care engineers, www.ashe.org


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Surfaces Biostatic Materials Anti-Microbial Treatments (lowest toxicity/impact). Materials have anti-microbial chemicals

incorporated into them or the coatings applied to them. Many anti-microbials lose their efficacy over time and/or are toxic and therefore should be used only with appropriate consideration and caution.

Building materials such as certain metals may have inherent anti-microbial properties. Some are active only in the presence of an energizing source such as UV light (from regular room lighting or special lamps). Products with inherent/non-toxic, low impact anti-microbial properties should be considered.

Walls Wall Paper (moisture caution) Gypsum Board (moisture caution)

Water Treatment UV Filtration Activated Carbon Filtration (caution Silver Iodide and limitations) Ceramic After-filters Nano Filtration (caution limitations) Reverse Osmosis

Wood FSC certified Non-Allergenic


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16.0 RECOMMENDATIONS

This list includes some initiatives already underway: Appoint a high level executive champion such as a vice president with primary responsibility for sustainability and related responsibilities such as health and safety; preferably before initial design commences. Develop a sustainability training and development program to establish and nourish a sustainability culture focused on continuous improvement for staff, suppliers and clients. Appoint a multi-disciplinary steering committee for sustainability and develop sustainability guidance including a campus design master plan, sustainable design and operations guidelines and a set of prototype LEED® Campus credits. Ensure that each functional area has input into the development of the guidelines and that customized supplemental guidelines are developed that are appropriate for the special needs of each functional area. Existing guidelines and tools such as the Kaiser Permanente Eco-Toolkit, the Green Guide to Healthcare and a LEED® decision making matrix could form the nucleus for the development of a comprehensive guideline and tool-kit for use by MUHC. Compatible supplemental modules could be developed to address the specific needs of special function issues and buildings such as food services and laboratories. Carefully document the information developed for this project and the lessons learned to facilitate improvements on subsequent MUHC and other health care projects. Develop, implement, continuously monitor and improve a fully integrated environmental procurement program for all purchasing. Place a high visibility priority on recognition and promotion of environmentally appropriate actions by staff and stakeholders, including an incentive program for continuous quality improvement and cost savings ideas and actions. Place a high priority on flexibility and durability as appropriate. Ensure that advanced commissioning is incorporated starting at the design stage. Metrics Appropriate metrics should be developed, applied, monitored and continuously improved for a wide range of measurable factors such as benchmarking, load management, reliability, repairs, absenteeism, turnover, staff churn etc., which directly or indirectly relate to sustainable building design and operation.


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Integrate capital and operations budgets as appropriate to reduce or eliminate internal perverse incentives, and to provide a more informative life-cycle indication of real costs. For example saving a few dollars on the ice-melt budget by using salt instead of appropriate salt substitutes can accelerate corrosion of building materials, and negatively impacting respiratory conditions. Review budgets in relation to integrated activities to determine true costs where possible (full cost accounting). Develop appropriate benchmarks and implement, continuously monitor and improve a metering, monitoring, measuring and commissioning program for all facilities, furnishings, equipment and plug loads, including issues such as: Peak load charges and savings due to peak load management (load shedding) Energy, Water and Waste Substances of Concern including Greenhouse gasses, Toxic Substances, Allergens

Attempt to achieve more than 95% waste diversion from landfill in order to qualify for an Innovation point by exceeding a requirement by a significant margin. Interview staff for input in general and on issue specific items before design and post occupancy to help inform and validate the process.


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17.0 CASE STUDIES

There are several Canadian health care facilities that have or are applying sustainable design to new facilities including the following projects: Riverdale and Regent Park Health Centres, Toronto, Ontario Bloorview MacMillan Rehabilitation Centre, Toronto, Ontario Canadian Chiropractic College, Toronto, Ontario Bluewater Health Centre, Sarnia Ontario Bridgepoint Health, Toronto Ontario North Bay Regional Health Centre, North Bay Ontario Sault Area Hospital, Sault Ste. Marie Ontario Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario Vancouver General Hospital, Jim Pattison Pavilion, Vancouver, BC The Legacy Project, Vancouver.

Vancouver General Hospital, Jim Pattison Pavilion Advanced Design Attributes An increased number of isolation rooms or entire wards (e.g. Bone Marrow Transplant

Ward), with pressure monitoring controls to maintain positive, neutral or negative pressure, with the ability to be switched from positive to negative pressure in some applications.

100% outdoor air for ventilation, with HEPA filters on diffusers, heat recovery, night (volume) setback and redundancy of supply.

Central chilled water wet economizer (high-efficiency plate heat exchanger between the cooling tower and chilled water circuits).

Variable speed drive fans with static regain fan silencers to reduce system operating pressure and fan power consumption.

Free cooling. Equipment was sealed during construction and floors exhausted to reduce cross

contamination. USA Boulder Community Foothills Hospital This new $53 million, 200,000 sq. ft. 60 bed maternity and pediatric hospital in Boulder Colorado was the first to be certified LEED Silver. The project included typical LEED options such as reduced parking area, porous paving, xeriscaping, waterless urinals, low flow fixtures, local and recycled content materials, high performance glazing, reflective roofing and energy efficient lighting as well as a central energy plant. The project has specifications for green cleaning. The project achieved a 30.6% reduction in energy use, 53% reduction in potable water use and 64% waste diversion. By using integrated controls technologies the project reduced duplication,


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improved communications and controls capacity and saved $480,000 on systems integration and installation. Richard J. Lacks Sr. Cancer Center in Grand Rapids Michigan This new hospital is also LEED certified. Children’s Medical Center of Central Texas This new Seaton Healthcare Network, $110 million, 454,000 sq. ft.169 bed pediatric facility is scheduled for completion in 2007. It is aiming for LEED Platinum and will incorporate a wide range of sustainable design features. Other healthcare facilities that were designed for sustainability (from Healthy Building Network) include: Continuum Center for Health and Healing, Beth Israel Medical Center, New York, NY, Fletcher Allen Renaissance Project, Burlington VT, Heather Hill Hospital& Health Partnership, Geauga YMCA Center for Health Partnership,

Munson, OH Legacy Good Samaritan Hospital, Marshall Street addition, Portland OR, Mount Sinai Medical Center, Obstetrics Services, Postpartum Units, New York, NY, Sullivan County Diagnostic and treatment Center, Center for Discovery, Harris, NY, University of Texas Houston, School of Nursing, Houston TX,

UK Swindon Hospital, Swindon, UK


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18.0 CONTACTS

Cathy Ann Barr Planning Coordinator 2155, rue Guy, bureau 200 Montreal Quebec, H3H 2R9 Tel: (514) 934-5060 x 306 Fax: (514) 934-5551 [email protected] General contractor conducting the site remediation Patrick Caron, Eng. L.A. HÉBERT LTÉE 260 rue St-Pierre St-Constant, Quebec, J5A 2N9 License RBQ : 1149-1149-36


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19.0 BIBLIOGRAPHY

i “Origin of the McGill University Health Centre Project” MUHC Report on Planning Activities http://www.muhc.ca/construction/documentation/parc/2/ ii Costs and Benefits of an Emerging Best Practices Hospital, The Legacy Project, Provincial Health Care, Vancouver, B.C. Canada, Provincial Health Care Planning and Redevelopment, Stantec Architecture Ltd. And Stantec Consulting Ltd. December 2004. iii “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity” Report to The Center for Health Design for the Designing the 21st Century Hospital Project, September 2004, Roger Ulrich, Ph.D. and Craig Zimring, Ph.D. principal authors, P 2 iv Costs and Benefits of an Emerging Best Practices Hospital, The Legacy Project, Providence Health Care, Vancouver, BC, Providence Health Care Planning and Redevelopment, Stantec Architecture Ltd. And Stantec Consulting Ltd. December 2004. v v “The Role of hospital design in recruitment, retention and performance of NHS nurses in England”, Commission for Architecture and the Built Environment (CABE), www.healthyhospitals.org.uk vi Costs and Benefits of an Emerging Best Practices Hospital, The Legacy Project, Providence Health Care, Vancouver, BC, Providence Health Care Planning and Redevelopment, Stantec Architecture Ltd. And Stantec Consulting Ltd. December 2004. vii The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity, Roger Ulrich, Xiaobo Quan, Center for Health Systems and Design, College of Architecture, Texas A&M University. September 2004 viii Costs and Benefits of an Emerging Best Practices Hospital, The Legacy Project, Providence Health Care, Vancouver, BC, Providence Health Care Planning and Redevelopment, Stantec Architecture Ltd. And Stantec Consulting Ltd. December 2004. ix Worker Productivity and Health, NRC, http://pc08.dc.lbl.gov/wp/wphome.asp x National Bureau of Standards xi Clark Reed, Washington State Society of Health Care Engineering Semi-annual Symposium, Power Point, April 28, 2005 xii “The Role of hospital design in recruitment, retention and performance of NHS nurses in England”, Commission for Architecture and the Built Environment (CABE), www.healthyhospitals.org.uk xiii The Canadian Adverse Events Study, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=408508 xiv William Fisk and Arthur Rosenfeld, “Improved Productivity and Health from Better Indoor Environments” Center for Building Science Newsletter (currently the Environmental Energy Technologies Newsletter), Lwrence Berkeley Labs, Summer 1997, 5, http://eetd.lbl.gov/cbs/newsletter/NL15/productivity.html. xv Cleaning Products, Greenbuiz Essentials, http://www.greenbuiz.com xvi Research Triangle Institute, Indoor Environment Characterization of a Non-Problem Building: Assessment of Cleaning Effectiveness (US EPA Environmental Criteria and Assessment Office) 1994, 49, 118 xvii Allergy Newswire, Vol. 1, No. 3, July 2002, p2 xviii Cleaning National parks, Using Environmentally Preferable Janitorial Products at Yellowstone and Grand Teton National Parks, Sophia Wakefield and Angele Ferre, S.A.F.E. Consulting for The Earth, Inc. www.epa.gov/region08 Appendix “A” p 28 xix LEED Canada NC 1.0, Canadian Green Building Council, wwwcagbc.org xx Green Guide for Health Care, Version 2.0 Pilot, November 2004, www.gghc.org xxi Commissioning of Hospital Projects, Michael K. Mantai, PE, CCP, LEED AP, System WorCx, LLC, Kevin L. Stanley, Director of Engineering Services, Lexington Medical Center. National Conference on Building Commissioning, May 4-6, 2005. xxii The Environmental Self Assessment for Health Care Facilities, A Quick and Easy Checklist of Pollution Prevention Measures for Health care Facilities, May 2001, Prepared for Health Care facilities in New York State, by New York State Department of Environmental Conservation Pollution Prevention Unit, www.dec.state.ny.us


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xxiii LABS 21 Laboratories for the 21st century, US Environmental Protection Agency xxiv Green Healthcare Construction Guidance Statement, American Society of Heathcare Engineering, www.gghc.org xxv “Episodic exposure to chemicals: what relevance to chemical intolerance?” MacPhail RC, Neurotoxicology Division, National Health and Environmental Effects Research laboratory, United States Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA. xxvi Chemical Carcinogens, Human Carcinogens, Victor A, Fung, J.Carl Barrnet, James Huff, National Toxicology Program, National Institute of Health, Bethesda MD., http://ehp.niehs.nih, gov/docs/1995/103-7-8/fung.html xxvii “Actions to Improve IAQ, Your Role on the Indoor Air Quality Action Team”, US EPA, Indoor Air Quality, IAQ Tools for Schools, http://www.epa.gov/iaq/schools/promotional/administrators.html xxviii “Indoor Allergens, Assessing and Controlling Adverse Health Effects, Andrew M. Pope, Roy Patterson, Harriet Burge, Editors, Institute of Medicine, National Academy Press, Washington D.C. 1993 xxix “Environmental and Occupational Medicine Hypersensitivity Diseases” Environmental & Occupational Health, National Jewish Medical & Research Center, “Urticaria” www.njc.org/deoh/eodiseases5. xxx Dr. Theron Randolph, J. Clin Lab Med (40:931-2) 1952 xxxi Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. xxxii “Indoor Allergens, Assessing and Controlling Adverse Health Effects”. P 28, Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. 1993 xxxiii Ibid P. 52 xxxiv “The Healthy Environments For Children Initiative” World Health Organization, WHO/SDE/OEH/99.11 – page 23 xxxv “Biological Markers for Immune-Mediated Disease, P33-52, National Academies Press, National Academy of Sciences, 1992 xxxvi “Casarett and Doull’s Toxicology, The basic Science of Poisons” Fifth Edition, P. 16-18, Curtis D. Klassen Editor, McGraw-Hill, NY, 1996 xxxvii “Identification of responsible volatile chemicals that induce hypersensitive reactions to multiple chemical sensitivity patients” Shinohara N, Mizukoshi A, Yanagisawa Y. Graduate School Of Frontier Sciences, Institute of Environmental Studies, University of Tokyo, Japan.; and “Multiple chemical sensitivity in male painters; a controlled provocation study”, Georgellis A, Lindelof B, Lundin A, Arnetz B, Hillert L., department of occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden. xxxviii Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. P. 39, 1993 xxxix Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. P. 601993 xl National Academy of Science MCS incidence 15% xli “Environmental Sensitivities: Prevalence of Major Symptoms in a Referral Center: 1995 The Nova Scotia Environmental Sensitivities Research Center Study, Joffres Michael m., Williams Tim, Sabo Brenda, Fox Roy A., Dept. of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia. xlii Environmental Project, 988, Multiple Chemical Sensitivity, MCS 5 Frequency, Forsiden, Miljostyrelsens, Hjemmeside, Denmark, http://www.mst.dk/homepage/adresse.htm xliii Medical Treatment Varying by Sex and Race, www.estronaut.com/a/doctors_treat_by_race.html xliv Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. P. 77, 1993 xlv Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. P 79, 1993 xlvi Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. P. 81, 1993


58

xlvii Indoor Allergens, Assessing and Controlling Adverse Health Effects”. Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. P. 206, 1993 xlviii Ministry of Finance Canada, Tax Assistance provisions for the (hypersensitive), Dec 22, 1988 xlix Personal Projects with PWGSC (eg. Industry Canada, Office of the Auditor General) l “Indoor Allergens, Assessing and Controlling Adverse Health Effects”. P 28, Pope Andrew M, Patterson Roy, Burge Harriet, Editors, Institute of Medicine, National Academy Press, Washington D.C. 1993 li “A review of the Evidence for Overlap Among Unexplained Medical Clinical Conditions. Aaron LA, Buchwald D. Department of Medicine, Division of Internal Medicine, Harbourview Medical Center, 325 Ninth Ave. Box 359780, Seattle, WA 98104, USA. lii Draft Report on the Indoor Environment 2003, U.S. Environmental Protection Agency. P1-29. liii Green Seal Choose Green Report, Industrial and Institutional Cleaners, www.greenseal.org liv Product Performance Tests and Standards, University of Tennessee, Center for Clean Products and Clean Technologies, http://eerc.ra.utk.edu/ccpct/index.html lv US Dept. of the Interior, http://greeninginterior.doi.gov/sustain/trad.html lvi“The Economics of Phasing Out PVC” Global Development and Environmental Institute, Tufts University, Frank Ackerman, Rachel Massey, December 2003 lvii PVC Bad News Comes in #rs, The Poison Plastic, Health Hazards and the Looming Waste Crisis, Michael Belleview, Center for Health, Environment and Justice, Stephen Lester, Environmental Health Strategy Center, December 2004. lviii Guidance for Industry and FDA Staff-Enforcement Priorities for Single-use Devices Reprocessed by Third Parties and Hospitals. August 2, 2000. www.fda.gov/cdrh/comp/guidance/1168.pdf

ADVANCED HOSPITAL DESIGN McGILL UNIVERSTIY HEALTH CENTRE

APPENDICES

APPENDIX “A” – SITE REMEDIATION MUHC GLEN

APPENDIX “B” – INCENTIVES

APPENDIX “C” – LEED SCORECARD

APPENDIX “D” – ADDITIONAL INFORMATION

APPENDIX “E” – RATIONALE (MATRIX) FOR ASSUMED LEED POINTS

APPENDIX “F” – LOW IMPACT CLEANING AND MAINTENACE MATERIALS

APPENDIX “G” – EXAMPLES OF SUBSTANCES OF CONCERN


A- 1

APPENDIX ‘A’

SITE REMEDIATION MUHC GLEN LEED® Prerequisite 1 Erosion and Sediment Control LEED® Requirements: Design a sediment and erosion control plan, specific to the site that conforms to USEPA Document No. EPA 832/R-92-005 (Sept. 92), Storm Water Management for Construction Activities, Chap. 3, OR local erosion and sedimentation control standards and codes, whichever is more stringent. LEED® Requirements: Prevent loss of soil during construction by Stormwater runoff and/or wind erosion, including protecting topsoil by stockpiling for reuse. Prevent sediment of storm sewer or receiving streams, and prevent polluting the air with dust and particulate matter. Site Remediation Plan Hébert has developed and is following a site remediation plan addressing the above requirements including the following actions: Rainwater is being stored in two settling ponds, filtered through a sand filter and used for wetting the ground surface to reduce dust. Mme Leibovich researched this action and determined that a previous credit interpretation was favorable for a similar action and therefore a LEED® Innovation credit can be applied for. Hébert is tracking water flows to the settling ponds and then for reuse (dust control) or controlled discharge to the storm sewer. Soil Excavation Experts Enviroconseil Inc, were commissioned to prepare a summary environmental assessment report of the Glen Yard titled “Rapport synthèse de la situation environmental à la cour Glen”, March 2002. This report concluded that numerous soils studies had been performed by qualified consultants following the guidelines and best practices required by the Ministère de l’ Environment du Québec (MENV). Approximately 440,000 tons of soil was removed from the site. Of this the approximately tonnage of soil contaminated with hydrocarbons or metals from the former rail yards and slag, clinker and cinder fill that is being decontaminated off site will be calculated along with the end fate. Clean soil has been stockpiled on site for temporary use as sound barriers and eventual use as site backfill. Construction refuse was used as cover material at the Miron dump in St. Michel. The quantities of soil by category and destination are being recorded and a photographic record of the site decontamination process is being maintained by Hébert and delivered to the corporation at monthly LEED® review meetings.


A- 2

There are two small buildings constructed of metal, concrete and masonry with built up roofs remaining on site which will be retained as long as possible to be used as site construction offices. They will eventually be deconstructed and a minimum of 75% (target 95%) of the materials from these buildings and other site materials such as erosion control membranes will be diverted from landfill. Materials that are being tracked by weight, transporter and destination for reutilization or recycling include: Telephone poles that will be reutilized, Scrap (mixed) to be recycled, Components of chain-clink fencing system that will be reutilized, Heavy large diameter PVC pipe that will be reutilized, Sheet aluminum to be recycled, Electrical wiring to be reutilized A steel tank that will be reutilized, Railroad ties to be reutilized.

Contractor: Hébert-Loiselle construction consortium Contact: M. Patrick Caron, L.A. Hébert, [email protected] Soil testing and removal oversight: Queformat. Additional testing: Tecsult


B- 1

APPENDIX ‘B’

INCENTIVES Funding Opportunities

The following is a brief indication of some available sustainable design and incentive programs. There are various conditions for each program, and changes occur frequently therefore the complete information provided at each web site should be reviewed before proceeding with a project. There are many other federal, provincial and foundation programs. Commercial Building Incentive Program (CBIP) http://www.oee.nrcan.gc.ca/newbuildings/cbip.cfm

For New Building Design (can be retroactive under certain circumstances) The MUHC should qualify for the full amount for CBIP ($60,000) and/or possibly an additional $80,000 from the sister program Industrial Building Incentive Program (IBIP). This funding may be repeated for individual buildings up to an overall limit under specific circumstances. The CBIP program may provide up to $60,000.00 for design of an energy efficient building that achieves a 25% energy use reduction compared to a similar (control) building designed to the Model National Energy Code for buildings (MNECB). The savings are calculated using the EE4 software program. The incentive is two times the predicted annual energy savings (up to $60,000.00), and is available for new buildings, additions and major renovations. Payment 80% following an initial payment request form submission if the design meets program requirements, 20% after proof of completion of construction according to the approved design. CBIP (MURB) Additional qualifying measures have been added for Multi-Unit Residential Buildings. EEI/CBIP Equipment Bonus (EB) Current qualifying equipment: Space heating/cooling (found on Terasen gas list of qualifying IBR boilers) Condensing Boilers> 88% efficiency Near Condensing Boilers 85-88% efficiency

Incentive: Direct base incentive of $4,000 for qualifying equipment installation, with additional incentive of $2/MBU for near-condensing, $6MBU for condensing. The price of a standard-efficiency boiler will be estimated using $7MBH of the input required to meet the space-heating load and ventilating load. Purchase price incentive payments are limited to a maximum of 75% of the purchase price premium over a standard-efficiency boiler. Back-up boilers do not qualify.


B- 2

Lighting Premium Efficiency (Super) T8’s (complete bulb/fixture installations).

Qualifying Levels: Premium Efficiency T8 (fixtures/bulbs). NRCan qualifying equipment listed on CEE list of qualifying Premium T8 fixtures. Incentive: Premium Efficiency T8 4 ft. 1-4 lamp fixture $20. Purchase price incentive payments are limited to a maximum of 75% of the purchase price premium over a standard T8 bulb and fixture. Basis of payment: CBIP/EII – 2nd payment. Based on approved equipment listed on: CEE High-Performance T8 Specification. http://www.cee1.org/com/com-lt/com-lt-specs.pdf Terasen qualifying lists. www.terasengas.com > commercial > efficient boiler program > Terasen gas efficient boiler program > eligible boiler list Application Process: Through CBIP/EII applications. Additional page added to standard application for each respective qualifying technology. Financial Details and Caps: $200k lifetime cap per applicant for EB top-up program. CBIP applicants: $40k cap per application for EB top-up program. Enbridge Design Advisory Program (DAP) (for Enbridge service areas only) $4,000.00 to retain a DAP approved advisor, simulation, LEED® or Green Globes™ assessment, examining energy/environmental design alternatives, following an IDP process, CBIP application assistance. Can apply for both DAP and New Building Construction Program incentives. www.enbridge.com/dap 1-866-844-9994, [email protected] Enbridge New Building Construction Program $0.075/m³ of projected annual natural gas savings to a maximum of $15,000.000 for energy efficient design. Can apply for both DAP and New Building Construction Program incentives. www.enbridge.com/dap 1-866-844-9994, [email protected] ERA (P) = Planning The Energy Innovators Program (NRCan) can provide financial (up to 50% of annual energy consumption to a maximum of $25,000) and in-kind assistance for energy audits, feasibility studies, energy management plans and other project development and facilitation measures that can lead to energy savings. http://oee.nrcan.gc.ca/eii/


B- 3

ERA (3) for 3 or Fewer Buildings Must have a combined energy bill of $100,000.00 (for 1 or more buildings). Maximum $250,000.00 incentive. ERA (4) for 4 or More Buildings Maximum $250,000.00 incentive plus must agree to implement similar measures in 255 of remaining buildings. Payment Schedule for ERA (3) or (4) Payment 1 request submitted at 25% expenses incurred mark. Payment 2 request submitted at 25% additional expense incurred mark. Payment 3 request submitted for 50% after final submission showing actual savings (e.g. after 1 year operating mark). Canadian Renewable and Conservation Expenses (CRCE) Tax Incentives Class 43.1 in Schedule II of the Income Tax Act allows taxpayers an accelerated write-off of certain equipment that is designed to produce energy in a more efficient way or to produce energy from alternative renewable sources. Canadian Renewable and Conservation Expenses (CRCE) is a category of fully deductible expenditures associated with the start-up of renewable energy and energy conservation projects for which at least 50% of the capital costs of the property would be described in Class 43.1 For an eligibility ruling contact: Income Tax Rulings and Interpretations Directorate, Revenue Canada, 25 Nicholas St. Ottawa, ON, K1A 0L5, Ph: (613) 957-8953, Fx: (613) 957-2088. and; Class 34/43.1 Secretariat, CANMET Energy Technology Centre, Natural Resources Canada, 1 Haanel Dr. Building 3, Nepean, ON, K1A 1M1, Ph: (613) 996-0890, Fx: (613) 995-7868. www.nrcan.gc.ca/es/erb/reed/. Eligible examples include (plus some related expenses): Certain co-generation and specified-waste fuelled electrical generation systems, Small-scale hydro-electric installations (not exceeding 15 megawatts of average annual

capacity), Wind energy electrical generation systems, Expansion engines, Photovoltaic electrical generation systems (three kilowatts capacity or larger), Geothermal electrical generation systems, Electrical generating systems using solution gas that would otherwise be flared during the

production of crude oil.


B- 4

Thermal Energy Systems Active solar systems (including ground source heat pumps), Heat recovery systems, Specified-waste fuelled heat production equipment.

Emissions Trading (Carbon Credits) Pilot emissions trading systems are operational and some projects may be able to benefit on a case by case basis. The Royal Architectural Institute of Canada (RAIC) The Royal Architectural Institute of Canada (RAIC) has a design incentive program that might apply. (approximately $10,000). Energy Efficiency Fund, Quebec

CBIP program with some top-up funding Solar Systems - 0% financing for purchase and installation of REDI qualifying

technologies Green Roofs - $1.00 per square foot of green roof installed Drain water heat recovery (for installation of a power pipe heat exchanger).

Empower Program for Building Optimization, Hydro-Québec Incentive: Up to 40% of the total costs of measures applicable to an existing building. Maximum $500,000.00.

Feasibility Study Supplement Building Optimization.

Incentive: half the cost of a feasibility study related to the program up to $7,500 or $15,000 depending on eligibility. Gazifère (Enbridge) will pay up to 50% of the cost related to computer modeling of a building’s energy plan, to the owner of a commercial building, up to a maximum of $3,500 per building.(In addition to the $1,000. modeling incentive from CBIP).


1

APPENDIX ‘C’

LEED SCORECARD

Yes ? No Yes ? No

9 5 Sustainable Sites 11 6 Materials & Resources 10

Y Prereq 1 Erosion & Sedimentation Control Required Y Prereq 1 Storage & Collection of Recyclables Required

1 Credit 1 Site Selection 1 Credit 1.1 Building Reuse , Maintain 75% of Existing Walls, Floors and Roof

1 Credit 2 Development Density Credit 1.2 Building Reuse , Maintain 95% of Existing Walls, Floors and Roof

1 Credit 3 Redevelopment of Contaminated Site Credit 1.3 Building Reuse , Maintain 50% of Interior Non-Structural Elements

1 Credit 4.1 Alternative Transportation , Public Transportation Access 1 1 Credit 2.1 Construction Waste Management , Divert 50% From Landfill 1

1 Credit 4.2 Alternative Transportation , Bicycle Storage & Changing Rooms 1 1 Credit 2.2 Construction Waste Management , Divert 75% From Landfill 1

? Credit 4.3 Alternative Transportation , Alternative Fuel Vehicles 1 Credit 3.1 Resource Reuse , Specify 5% 1

? Credit 4.4 Alternative Transportation , Parking Capacity 1 Credit 3.2 Resource Reuse , Specify 10% 1

? Credit 5.1 Reduced Site Disturbance , Protect or Restore Open Space 1 Credit 4.1 Recycled Content , Specify 7.5% (post-consumer + ½ post-industrial) 1

? Credit 5.2 Reduced Site Disturbance , Development Footprint 1 1 Credit 4.2 Recycled Content , Specify 15% (post-consumer + ½ post-industrial) 1

1 Credit 6.1 Stormwater Management , Rate and Quantity 1 1 Credit 5.1 Regional Materials , 10% Extracted and Manufactured Regionally 1

? Credit 6.2 Stormwater Management , Treatment 1 1 Credit 5.2 Regional Materials , 20% Extracted and Manufactured Regionally 1

1 Credit 7.1 Heat Island Effect , Non-Roof 1 Credit 6 Rapidly Renewable Materials 1

1 Credit 7.2 Heat Island Effect , Roof 1 Credit 7 Certified Wood1 Credit 8 Light Pollution Reduction 1 Credit 8 Durable Building 1

Yes ? No Yes ? No

3 2 Water Efficiency 5 8 7 Indoor Environmental Quality 13

1 Credit 1.1 Water Efficient Landscaping , Reduce by 50% 1 Y Prereq 1 Minimum IAQ Performance Required

1 Credit 1.2 Water Efficient Landscaping , No Potable Use or No Irrigation 1 Y Prereq 2 Environmental Tobacco Smoke (ETS) Control Required

? Credit 2 Innovative Wastewater Technologies 1 ? Credit 1 Carbon Dioxide (CO2 ) Monitoring 1

1 Credit 3.1 Water Use Reduction , 20% Reduction 1 ? Credit 2 Increase Ventilation Effectiveness 1

? Credit 3.2 Water Use Reduction , 30% Reduction 1 1 Credit 3.1 Construction IAQ Management Plan , During Construction 1Yes ? No 1 Credit 3.2 Construction IAQ Management Plan , Testing Before Occupancy 1

5 3 Energy & Atmosphere 7 1 Credit 4.1 Low-Emitting Materials , Adhesives & Sealants 1

1 Credit 4.2 Low-Emitting Materials , Paints and Coating 1Y Prereq 1 Fundamental Building Systems Commissioning Required 1 Credit 4.3 Low-Emitting Materials , Carpet 1Y Prereq 2 Minimum Energy Performance Required 1 Credit 4.4 Low-Emitting Materials , Composite Wood and Laminate Adhesives 1

Y Prereq 3 CFC Reduction in HVAC&R Equipment Required 1 Credit 5 Indoor Chemical & Pollutant Source Control 1

4 Credit 1 Optimize Energy Performance 4 ? Credit 6.1 Controllability of Systems , Perimeter Spaces 1Credit 2.1 Renewable Energy , 5% ? Credit 6.2 Controllability of Systems , Non-Perimeter SpacesCredit 2.2 Renewable Energy , 10% 1 Credit 7.1 Thermal Comfort , Compliance 1Credit 2.3 Renewable Energy , 20% ? Credit 7.2 Thermal Comfort , Monitoring

? Credit 3 Best Practice Commissioning ? Credit 8.1 Daylight & Views , Daylight 75% of Spaces 1

1 Credit 4 Elimination of HCFCs and Halons 1 ? Credit 8.2 Daylight & Views , Views for 90% of Spaces 1

? Credit 5 Measurement & Verification 1 Yes ? No

? Credit 6 Green Power 1 2 Innovation & Design Process 1

1 Credit 1.1 Innovation in Design : Provide Specific TitleCredit 1.2 Innovation in Design : Provide Specific TitleCredit 1.3 Innovation in Design : Provide Specific TitleCredit 1.4 Innovation in Design : Provide Specific Title

1 Credit 2 LEED™ Accredited Professional 1

Yes ? No

Certified 26-32 points Silver 33-38 points Gold 39-51 points Platinum 52-70 points 33 17 Project Totals (pre-certification estimates) 47

LEEDca Registered Project Checklist

McGill University Health Centre Glen Conservative 33 points Silver

CaGBC LEED Ca Checklist Page 1


D- 1

APPENDIX ‘D’

ADDITIONAL INFORMATION References Academy of Architecture for Health, American Institute of Architecture, www.aia.org/aah/ Alternative Products, University of Massachusetts, Lowell, Sustainable Hospitals Project, www.sustainablehospitals.org American Art Therapy Association, www.arttherapy.org American College of Clinical Engineering, www.accenet.org American Society for Healthcare Environmental Services, www.ashes.org American Society of Healthcare Engineering, www.ash [email protected] American Society for Quality, (ASQ) health division, www.asq.org/health/ An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities, American Hospital Association, www.hospitalconnect.com Arts and Healing Network, www.artheals.org Art & Creative Materials Institute Inc. (safety certification), www.acminet.org Blueprint for Mercury Elimination, Western Lake Superior Sanitary District, 218-722-3336, www.wlssd.com/publications/Blueprint%20for%20mercury/HG1.HTM

California 1350 (environmental requirements for building materials) “LEED Canada NC 1.0” www.CaGBC.ca Canadian Coalition for Green Healthcare, Works to reduce the environmental impact of health care. www.greenhealthcare.ca Canadian College of Health Service Executives (CCHSE) Ken Waddington, Energy Efficiency Coordinator, [email protected] Canadian Medical and Biological Engineering Society (CMBES), www.cmbes.ca Center for the Advancement of Health, www.cfah.org Center for Health Design, www.healthdesign.org


D- 2

Center for Universal design, www.design.ncsu.edu/cud Coalition for Health Environments research, (CHER), www.cheresearch.org Construction-related Nosocomial Infections in Patients in Health Care Facilities: Decreasing the Risk of Aspergillus, Legionella and Other Infections, http://www.phac-aspc.gc.ca/dpg_e.html Consumer Perceptions of the Healthcare Environment – An Investigation to Determine What Matters, www.healthdesign.org/store/ Costs and Benefits of an Emerging Best Practices Hospital, The Legacy Project, Providence Healthcare Planning and Redevelopment, Stantec Architecture Ltd. And Stantec Consulting Ltd. December 2004. Design Evaluation of Six Primary Care Facilities for the Purpose of Informing Future Design Decisions, www.healthdesign.org/store/ ECRI (formerly Emergency Care Research Institute), www.ecri.org Environmental Management System Self-Assessment Checklist, March 1996, ISO 14001, Global Environmental Management Initiative (GEMI), www.gemi.org Environmentally Preferable Products, Health Care Environmental Purchasing Tool, http://www.nihe.org/hcept_tool/ Environmental Self-Assessment for Health Care Facilities, May 2001, Prepared for Health Care Facilities in New York State by New York Sate Department of Environmental conservation Pollution Prevention Unit. www.dec.state.ny.us/website/ppu/esahcf.pdf Gardens in Healthcare Facilities: Uses, Therapeutic Benefits, and Design recommendations, www.healthdesign.org/store/ Greening Healthcare, A Program of the Living City, www.thelivingcity.org Greening the Acute Care Inpatient Unit, Ray Pradinuk, Paul Marion, Stantec, www.stantec.com/StantecCom/CmtDocs/30.PDF Guidelines for Airborne Effluent from Laboratories that Handle Biohazards (NIH-CDC Biosafety in Microbiological and Biomedical Laboratories), May 1999 www.cdc.gov Green Guide for Healthcare™, A best practices guide fot healthy and sustainable building design, construction and operations.Version 2.0 Pilot, November 2004, www.gghc.org


D- 3

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005 (Draft), Department of Health and Human Services, Center for Disease Control and Prevention, 26pp, www.cdc.gov Greener Hospitals: Improving Environmental Performance, Edited – Environmental Science Center, Augsburg, Germany, www.bms.com/static/ehs/sideba/data/greenh.pdf Healthcare Environet, (C2P2) Canadian Centre for Pollution Prevention, www.c2p2online.com Health Energy Guidebook: Results of the Healthcare Energy Project, November 2001-December 2003, American Society for Healthcare Engineering of the American Hospital Association, www.ashe.org Healthcare Design Action Kit, www.healthdesign.org/store/ Healthcare Technology Foundation, www.acce-htf.org Healthcare Without Harm, www.noharm.org The High Performance Hospital Partnership, www.betterbricks.com/default.aspx?pid=hoapitals Hospital Audiences Inc. www.hosaud.org Hospitals for A Healthy Environment (H2E), a voluntary program to help health care facilities enhance work place safety, reduce waste disposal costs and become better environmental stewards. H2E includes a tools and resources section. www.h2e-online.org IEEE Engineering in Medicine and Biology Society (CMBES), http://embs.gsbme.unsw.edu.au IFMA Healthcare Council, www.ifma-hc.org In Sickness and in Healt; Healthy Workplaces for British Columbia’s Health Care Workers, BC Auditor Generals Report Institute for Family-Centered Care, www.familycenteredcare.org Institute for Healthcare Improvement, www.ihi.org Journal of Healthcare Design, www.healthdesign.org Laboratories for the 21st Century (Labs 21), US EPA, www.labs21century.gov Lowell Center for Sustainable Production, www.sustainableproduction.org Making Medicine Mercury Free, a Resource Guide for Mercury-Free Medicine, Heathcare Without Harm.


D- 4

http://www.noharm.org/library/docs/Going_Green_Making_Medicine_Mercury_Free.pdf Nightingale Institute for Health and Environment, www.nihe.org Planetree, www.planetree.org Promote Health, Protect the Environment, Eco-Toolkit, Environmentally Responsible Design and Construction Practices, National Facilities Services, Kaiser Permanente, July 2002, 66pp www.healthybuilding.net/healthcare/Eco_ToolKit_2.0_copyrighted.pdf Public Health Agency of Canada, (Guidelines), http://www.phac-aspc.gc.ca/dpg_e.html The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity, Report to The Center for Health Design for Designing the 21st Century Hospital project. Roger Ulrich, Xiabo Quan, Center for Health Systems Design, College of Architecture, Texas A&M University, September 2004. http://www.healthdesign.org/research/reports/physical_environ.php SARS: A Planning Guide for the “New Normal” Frazer Health Authority Facilities Planning, Don Mah, Facilities Planner, March 2004, Society of Arts in Healing, www.societyartshealthcare.org Status Report: An Investigation to Determine Whether the Built Environment Affects Patient’s Medical Outcomes. www.healthdesign.org/store/ Sustainable Hospitals Project, www.sustainablehospitals.org Therapeutic Landscape Resource Center, www.healinglandscapes.org University of Wisconsinn-Milwaukee Institute on Aging & Environment, www.uwm.edu/dept/iae/ Waste Minimization Starter Kit, Kaiser Permanente, www.kaiserpermanente.org World Health Organization, www.who.int


E- 1

APPENDIX ‘E’

RATIONALE (MATRIX) FOR ASSUMED LEED POINTS

Appendix "A" LEED Matrix, MUHC GlenSTANTECNov 14-05

1. Sustainable Sites

LEED Requirement Project Commitment

Develop an erosion and sedimentation control plan specific to the site, that conforms to US EPA Doc. # EPA 832/R-92-005 (Sept. 1992) , Stormwater Management for Construction Activities Chap. 3, OR local erosion and sedimentation control standards and codes, whichever is more stringent. The plan shall meet the following objectives: Prevent loss of soil during construction by stormwater runoff and/or wind erosion, including protecting topsoil by stockpiling for reuse. Prevent sedimentation of storm sewer or recieving streams. Prevent polluting the air with dust and particulate matter.

An erosion and sedimant control plan has been devloped and implemented

YES

Requirements: Do not develop buildings, roads or parking areas on portions of sites that meet any of the following criteria: Not part of a provincial agricultural or forest land preserve. Previously undeveloped land whose elevation is lower than 1500 mm (5 ft) above the elevation of the 100 year flood plain, OR 900 mm (3 ft) above the elevation of the 200 year flood plain. ecologically sensitive land. Land that provides habitat for rare or endangered species. Within 30.5 m (100ft) of any wetland. Land which prior to acquisition for the project was public parkland, unless land of equal or greater value as parkland is accepted in trade by the public landowner.) Park Authority projects are exempt)

The Ministry of Natural Resources of Canada (equivalent to US FEMA) does not consider the site to be a high flood hazard area. The current site is not a public park or prime farmland and is not within 100 ft of wetlands and is not a habitat for endangered species.

1

Requirements: Increase localized density to conform to existing or desired density goals by utilizing sites that are located within an existing minimum development density of 13,900 m2 per hectare (60,000 sq ft/ acre) (2 story downtown development)

The site development denisty will exceed these requirements.

1

Requirements - Develop on a contaminated site and provide remediation as required by Provincila Contaminated Sites Program

The site is a brownfield 1 ?

Requirements - locate building within 800 metres (0.5 miles) of a commuter rail, light rail or subway station or 400 metres (0.25 miles) of 2 or more public bus lines offering frequent service.

The site is served by 2 or more public bus lines offering frequent service. (within 800 metres ).

1 No

Requirements - For commercial or institutional buildings, provide secure bicycle storage, with convenient changing/shower facilities (within 183 metres (200 yards) of the building) for 5% or more of reqular building occupants, OR requirements of local authority, whichever are more stringent. For residential buildings, provide covered storage facilities for secure bicycles for 15% or more of building occupants in lieu of changing/shower facilities, OR requirements of local authority, whichever are more stringent.Provide secure bicycle storage with convenient changing/shower facilities.

Bicycle storage, change and shower facilities will be provided. Would require - Covered secure bicycle storage areas with camera surveillance will be provided for a minimum of 5% of the regular building occupants (minimum ( ) bicycle storage spaces) in various locations throughout the site.

1 ?

Requirements - Either - Provide high efficiency hybrid or alternative fuel vehicles for 3% of building occupants AND provide preferred parking for these vehicles and highly efficient fuel-efficient vehicles, OR Install alternative-fuel refuelling stations within 500 metres (545 yards) of the site for 3% of the total vehicle parking capacity of the site. Liquid or gaseous fuelling facilities must be separately ventillated or located outdoors.

Need an interpretation if car share available within 800 metres of the site would qualify and if there are any hybrid or alternative fuel vehicles.

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Requirements - Size parking capacity to meet, but not exceed, minimum local zoning requirements AND provide preferred and designated parking for carpools, van pools or car co-ops equal to 10% of the total number of non-visitor parking spaces. OR Add no new parking for rehabilitation projects AND provide preferred parking and designated parking for carpools, van pools, or car co-ops equal to 10% of the total number of non-visitor parking spaces.

Need to calculate. Can provide preferred and designated parking for car pools, van pools or car co-ops.

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Cost LEED SCORE

C 4.1 Public Transportation Access 1 Point

LEED Category and Available Points

C 4.3 Alternative Transportation, Hybrid and Alternative Fuel Vehicles 1 Point

C 4.4 Parking Capacity 1 Point

Prerequisite 1 Erosion & Sediment Control

C 2 Development Density 1 Point

C 1 Site Selection 1 Point

C 3 Redevelopment of Contaminated Sites 1 Point

C 4.2 Bicycle Storage & Change Rooms 1 Point

Requirements - On greenfield sites, limit site disturbance including earthwork and clearing of vegetation to 12 metres (40 ft) beyond the building perimeter, 1.5 metres (5 ft) beyond primary roadway curbs, walkways, and main utility branch trenches, and 7.5 metres (25 ft) beyond constructed areas with permeable surfaces (such as pervious paving areas, stormwater detention facilities and playing fields) that require additional staging areas in order to limit compaction in the constructed area, OR On previously developed sites, restore a minimum of 50% of the site area (excluding the building footprint) by replacing impervious surfaces with native or adapted vegetation.

A minimum of 50% of the site area (excluding the building footprint) will be restored with native or adapted vegetation

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Requirements - reduce the development footprint (defined as entire building footprint, access roads and parking) to exceed the local zoning's open space requirement for the site by 25%. For areas with no local zoning requirements (e.g. some university campuses and military bases) designate open space area adjacent to the building that is equal to the building footprint.

Calculate ? ?

Requirements - If existing imperviousness is less than or equal to 50%, implement a stormwater management plan that prevents the post-development 1.5 year, 24 hour peak discharge rate and quantity from exceeding the pre-development 1.5 year, 24 hour peak discharge rate and quantity. OR If existing imperviousness is greater than 50%, implement a stormwater management plan that results in a 25% decrease in the rate and quantity of stormwater runoff.

The stormwater management system will decelerate the stormwater flow from the site by a minimum of 25% over the existing conditions. A stormwater harvesting system will be installed to allow for reuse of stormwater volumes for irrigation. Organic fertilisers be used in replacement of petro-chemical based fertilisers to minimize the need for treatment of stormwater. Site management program will be - organic (or interim Integrated Pest Management) in order to support environmental impact reduction strategies and demonstrate leadership. Need to start sourcing organic/IPM grown plant stock and convert to organic/IPM maintenance materials and practices. Send staff to annual organic conference, and develop a model organic maintenance manual. Need to reduce salt use for ice and use urea etc. alternatives when appropriate. Some modification of equipment and supplies may be necessary - an environmental procurement program will be required to support the functional program.

1 1

Requirements - Construct site stormwater treatment systems designed to remove 80% of the average annual post-development total suspended solids (TSS) and 40% of the average annual post-development total phosporous (TP) based on the average annual loadings from all storms less than or equal to the 2-year/24-hour storm. Do so by implementing Best Management Practices (BMPs) outlined in Chapter 4, Part 2 (Urban Runoff), of the USEPA Guidance Specifying Managemnt Measures for Sources of Nonpoint Pollution in Coastal Waters, January 1993 (Document No. EPA-840-B-92-002) or the local government's BMP document (whichever is more struingent).

Measures will be taken to minimize soil compaction in order to maintain soil porosity and allow for ground water recharge. Stormwater treatment measures such as stormceptor, oil grit separator and biofilter will be implemented. The stormwater treatment plan shall include training and education programs as well as describe adequate inspection, maintenance and revegetation measures to be taken to ensure effectiveness of systems. Temporray detention/settling ponds with sand filters are being used.

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Requirements - Provide shade (within 5 years) and/or use light coloured/high albido materials (reflectance of at least 0.3) and/or open grid pavement for at least 30% of the site's non-roof impervious surfaces, including parking lots, walkways, plazas, etc. OR Place a minimum of 50% of parking spaces underground or covered by structured parking OR Use an open-grid pavement system (less than 50% imperviousness) for a minimum of 50% of the parking lot area.

( )% of parking will be underground. ( )% of paving will be pervious. Sidewalks and paving will use light colored materials. Fast growing trees will be used to provide additional shading, and sidewalks etc. will be designed to take full advantage of shading and reduce maintenance.

1

Requirements - Use Energy Star® compliant (highly reflective) AND high emissivity roofing (emissivity of at least 0.9 when tested in accordance with ASTM 408) for a minimum of 75% of the roof surface; OR Install an extensive or intensive "green" (vegetated) rood for at lesst 50% of the roof area. Combinations of high albido and vegetative roof can be used providing they collectively cover 75% of the roof area.

Use Energy Star membrane or determine if the ballast could be 100% white to match the innovation credit previously approved. Construction cost

1

C 7.1 Heat Island Effect Non-Roof 1 Point

C 7.2 Heat Island Effect - Roof 1 Point

C 5.1 Protect or Restore Open Space 1 Point

C 5.2 Development Footprint 1 Point

C 6.1 Stormwater Management Rate and Quantity 1 Point

C 6.2 Stormwater Management Treatment 1 Point

Requirements - Meet or provide lower light levels and uniformity ratios than those recommended bu the Illuminating Engineering Society of NA (IESNA) Recommended Practice Manual: Lighting for Exterior Environments (RP-33-99) Designexterior lighting such that all exterior luminaires with more than 1000 initial lamp lumens are shielded and all luminaires with more than 3500 initial lamp lumens meet the Full Cutoff IESNA Classification. The maximum candella value of all interior lighting shall fall within the building (not out through the windows) and the maximum candella value of all exterior lighting shall fall within the property. Any luminaire within a distance of of 2.5 times its mounting height from the property lboundary shall have shielding such that no light from that luminaire crosses the property boundary.

A low indoor and outdoor illumination level will be achieve without compromising security. Exterior lighting system will consist of indirect lighting fixtures with reflectors oriented towards the ground.

1

Total Sustainable Sites 9 1

C 8 Light Pollution Reduction 1 Point

2. Water Efficiency

Requirements LEED Credit Description Related to the Building LEED Points

Cost

Requirements - Use high-efficiency irrigation technology. OR Use captured rain or recycled site water to reduce potable water consumption for irrigation by 50% over conventional means.

Indigenous or adapted species suitable for the water conditions on site will be planted as part of the overall bioenhancement of the site. The type of soil, sun shade and wind exposure, as well as the slope of the areas will be considered in an integrated plan. Need to consider - Rainwater cistern supplied irrigation if necessary will use high efficiency irrigation system components and retained rainwater from roof areas. The use of low water demand plantings where appropriate and efficient irrigation systems where necessary will reduce the irrigation requirement for municipal water by a minimum of 50% as required to achieve this credit. Settling ponds are used.

1 ?

Requirements - Use only captured rain or recycled site water to eliminate all potable water use for site irrigation (except for initial watering to establish plants), OR Do not install permanent landscape irrigation systems.

A stormwater harvesting system will be instaled to fill a cistern large enough to provide for approximately two weeks of demand. The storage tank will be the source of water for irrigation thus eliminating the need for municipal water for irrigation. The tank will be provided with an emergency overflow and cleanout provisions. Stormwater will be collected in a ground level cisterns to reduce pumping costs. Stormwater will be filterd through limestone gravel and a biofilter (leaf mulch) and/or sand filter as necessary to provide water clean enough for the irrigation system if necessary.

1 ?

Requirements - Reduce the use of municipally provided potable water for building sewage conveyance by a minimum of 50%. OR Treat 100% of wastewater on site to tertiary standards.

Dewatering water and/or rainwater will be available and the building will be equipped with dual flush toilets and low flow showerheads, and low flow faucets on all sinks. The use of these fixtures will minimise the volume of water required for sewage conveyance by a minimum of 30%.

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Requirements - Employ strategies that in aggregate use 20% less water than the water use baseline calculated for the building (not including irrigation) after meeting the fixture performance requirements listed in table 1.

Dual flush toilets, waterless urinals, low flow sinks and showers will be used to reduce water use by a minimum of 20% to fully comply with this credit.

1 ?

Requirements - Employ strategies that in aggregate use 30% less water than the water use baseline calculated for the building (not including irrigation) after meeting the fixture performance requirements listed in table 1.

Would require approval from the City to use dewatering water or rainwater to flush toilets. Requires separate plumbing supply system.

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Total Water Efficiency 3 0

C 1.2 Water Efficient Landscaping No potable water use or No Irrigation 1 Point

C 2 Innovative Wastewater Technologies 1 Point

C 3.1 Water use reduction 20% Reduction 1 point

C 3.2 Water use reduction 30% Reduction 1 Point

C 1.1 Water Efficient Landscaping Reduce by 50% 1 Point


3. Energy & Atmosphere



Cost

Requirements - Implement or have a contract in place to implement the following fundamental best practice commissioning proceedures. - Engage a commissioning team that does not include individuals directly responsible for project design or construction management. - Review the design intent and the basis of design documentation. - Incorporate commissioning requirements into the construction documents. - Develop and utilize a commissioning plan. - Verify installation, functional performance, training and operation and maintenance documentation. - Complete a commissioning report.

A qualified commissioning agent who is experienced in commissioning green buildings will be engaged to verify installation, functional performance, training and operation as well as prepare maintenance documentation. The commissioning requirements will be included in contract documents. The agent will act as the commissioning authority for the duration of the project.

YES YES

Requirements - New Buildings - Reduce the design energy consumption to comply with Natural Resources Canada's CBIP requirement for a 25% reduction relative to the consumption of the reference building designed to the Model National Energy Code for Buildings 1997. Compliance shall be demonstrated by using whole building energy simulation. The calculation of percentage energy reduction shall be in accordance with the proceedures used in the CBIP program (i.e. includes "non-regulated" plug loads but excludes process equipment). OR Reduce the design energy cost by 18% relative to the reference building designed to ASHRAE/IESNA 90.1-1999 (without amendments). Compliance shall be demonstrated using whole building energy simulation. The calculation of percentage energy reduction shall be in accordance with ASHRAE 90.1 proceedures and excludes "non-regulated" loads. Major Renovations to Existing Buildings - Reduce the design energy consumption by 10% relative to the consumption of the reference building designed to the MNECB. Compliance shall be demonstrated by a whole building energy simulation. The calculation of percentage energy reduction shall be in accordance with the proceedures used in the CBIP program (i.e. includes "non-regulated" plug loads but excludes process equipment). OR Desig

A highly insulated building envelope, high efficiency boilers combined with a dedicated outdoor air system (DOAS) and central exhaust/heat recovery will contribute to meeting the minimum energy performance target as stated by ASHRAE 90.1. Option - community energy system, geothermal.

YES YES

Requirements - Zero use of CFC-based refrigerants in new base building HVAC&R systems and zero use of halons in fire suppression equipment. When reusing existing base building HVAC equipment, complete a comprehensive CFC phase-out conversion.

All HVAC&R equipment specified shall be CFC free. Products will be specified where appropriate to also use the lowest Ozone Depletion Potential (ODP) refrigerants.

YES YES

Requirements - New Buildings - Reduce design energy cost compared to the energy cost of the MNECB OR ASHRAE.IESNA 90.1-1999 reference building for energy systems regulated by these standards. Points are awarded according to Table 1. Compliance shall be demonstrated by using whole building energy simulation. The calculation of percentage energy cost reduction shall exclude "non-regulated" loads.

The building envelope will be insulated over and above the minimum requirement to meet ASHRAE 90.1. The insulation values will be as follows: RSI 7.0 (R-40) roof, RSI 5.6 (R-32) wall, RSI 3.5 (R20) walls below grade, RSI 1.8 (R10) floors on grade and R-4 glazing system. (R values to be confirmed) Green roofs will contribute to the superior building envelope performance.

11

Possible 1Possible 1

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Requirements - Supply at least 5% of the building's total energy use (as expressed as a fraction of annual energy cost) through the use of on-site renewable energy systems.

Not claimed.(consider solar domestic hot water) ? ?


Not claimed. NO NO


Not claimed. NO NO

Prerequisite 1 Fundamental Building Systems Commissioning Required

Prerequisite 2 Minimum Energy Performance

Prerequisite 3 CFC Reduction in HVAC Equipment

C 1 Optimize Energy Performance (Option = % Below MNECB)

C 2.1 Renewable Energy , 5% 1 Point

C 2.2 Renewable Energy , 10% 1 Point

C 2.3 Renewable Energy , 20% 1 point

24%29%33%38%

60%64%

42%47%51%55%

Requirements - In addituion to the Fundamental Building Commissioning prerequisite, implement or have a contract in place to implement the following additional commissioning tasks: 1 - A commissioning authority independent of the design team shall conduct a review of the design prior to the construction documants phase. 2 - An independent commissioning authority shall conduct a review of the construction documents near completion of all the construction document development and prior to issuing the contract documents for construction. 3 An independent commissioning authority shall review the contractor submittals relative to systems being commissioned. 4 - Provide the owner with a single manual that contains the information required for re-commissioning building systems. 5 Have a contract in place to review building operation with O7M staff, including: - a plan for how occupants may report IAQ concerns, the subsequent investigation process and how they will be reported back to the occupant, and, - a plan for resolution of outstanding commissioning-related issues within one year after construction completion date.

A review process performed by the commissioning agent throughout the entire design process shall be included as well as a review and resolution of the building operation in the first year. Require commissioning agent to be a LEED accredited Professional (LAP) before final contract is signed. Basic commissioning is included in the base cost. This element would add cost to the construction and also to engineering fees. Significant cost.

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Requirements - Install base building level HVAC and refrigeration equipment that do not contain HCFC's

To fully comply all buildings included in the Leed submission will be HCFCs and Halon free. Where required, a clean agent fire suppression system (e.g. 3M zero ODP suppressant) will be used in lieu of a Halon system to fully comply with the requirements of this credit. May limit competition of manufacturers that rely on "transition" refrigerants.

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C 3 Best Practice Commissioning 1 Point

C 4 Ozone Depletion 1 Point

Requirements - Install continuous metering equipment for the following end-uses: - Lighting systems and controls - Constant and variable motor loads - Variable frequency drive (VFD) operation - Chiller efficiency at variable loads (kW/ton) - Cooling load - Air and water economizer and heat recovery cycles - Air distribution static pressures and ventilation air volumes - Boiler efficiencies - Building-related process energy systems and equipment - Indoor water risers and outdoor irrigation systems - Develop a measurement and verification plan that incorporates the monitoring information from the above end-uses and is consistent with Option B, C or D of the 2001 International Performance Measurement & Verification Protocol (IPMVP) Volume 1: Concepts and Options for Determining Energy and Water Savings.

Need to consider - would read - A measurement and verification plan will be developed prior to project completion. The plan will include M&V responsibilities, a definition of the baseline building performance to generate projected savings, a post installation inspection plan, an outline of quality assurance measures and the content requirement of the final measurement and verification report. Review system separation of utility breakdown and metering in separate monitoring and verification room or exterior service space. This would also require additional electrical metering instruments and result in additional capital cost. Can temporary clamp on meters provide usefull feedback at reasonable cost - can we use interval meters to provide direct feedback to a computer.

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Requirements - Provide at least 50% of the building's electricity from renewable sources by engaging in at least a two-year renweable energy contract. Renewable sources are those that meet the Environmental Choice programs EcoLogo requirements for green power supplies.

Cost premium to purchase green power. ? ?

Total Energy & Atmosphere 5 0

C 5 Measurement & Verification 1 Point

C 6 Green Power 1 Point

4. Materials & Resources


LEED Points

Requirements - Provide an easily accessible area that serves the entire building and is dedicated to the separation, collection and storage of materials for recycling including(at a minimum) paper, corrugated cardboard, glass, plastic and metals.

Clearly labelled containers for the collection of occupant related waste and recycling streams will be located in each suite. Waste/ recycling streams collected will be based on analysis of existing waste streams in the industry. A dedicated waste recycling room will be located in the building and will be sized to sufficiently accommodate containers for the various streams of recycling which are anticipated to include: fine paper/ mixed paper, glass, metal, plastic and cardboard. Occupancy waste analysis will also examine the need for special equipment (compactors, bins, earth tubs/ composters, etc.) and these requirements will be accommodated in the building design. Will consider an Earth Tub composter to provide compost for landscaping.

YES YES

Requirements - Maintain at least 75% of existing building structure and shell (exterior skin and framing, excluding window assemblies and non-structural roofing materials).

Not applicable NA NA

Requirements - Maintain an additional 20% (95% total) of existing building structure and shell (exterior skin and framing, excluding window assemblies and non-structural roofing materials).

Not aplicable NA NA

equirements - Maintain at least 50% of non-shell areas (interior walls, doors, floor coverings and ceiling systems).

Not applicable NA NA

Requirements - Develop and implement a waste management plan, quantifying material diversion goals. Recycle and/or salvage at least 50% of construction, demolition and land clearing waste. Calculations can be done by weight or volume, but must be consistent throughout.

As per 2.2 below 1

Same as 2.1 above A construction waste management plan will be developed to divert a minimum of 50% of materials such as wood, gypsum, brick/stone, insulation, glass, roofing materials, etc. to recycling depots in the area. Contractor to be trained on proper recycling protocol. All recyclable materials to be separated on-site in labelled storage bins. Will arrange a pre-construction interview on potential building green construction management practice.

1

Requirements - Use salvaged, refurbished or reused materials, products and furnishings for at least 5% of the total cost of building materials.

To be determined. Furnishings? ? ?

Requirements - Use salvaged or reused materials, products and furnishings for at least 10% of the total cost of building materials.

To be determined. Furnishings? NO NO

Requirements - Use materials with recycled content such that the sum of post-consumer recycled content plus one-half of the post-industrial content constitutes at least 7.5% of the total value of the materials in the project. The value of the recycled content portion of a material or furnishing shall be determined by dividing the weight of recycled content

The primary construction materials of the proposed building offer significant potential for recycled content. Materials such as gypsum board, structural steel members and rebar, composite wood flooring, MDF, carpet and fly-ash concrete may have a high percentage of recycled content.

1

As above total 15% May be possible depending on materials used. 1

Requirements - Specify a minimum of 10% of building materials that are extracted, processed and manufactured within a radius of 800km (500 miles). OR Specify a minimum of 10% of building materials that are extracted, processed, manufactured and shipped primarily by rail or water within a radius of 2400 km (1,500 miles). OR Specify a minimum of 10% of building materials that reflects a combination of the above extraction, processing, manufacturing and shipping crtieria (e.g. 5% within 800 km (500 miles) and 5% shipped by rail within 2400 km (1,500 miles).

Regional materials are readily available in the local market. (e.g. CGC Drywall from Montreal Plant)

1

As above for a total of 20%. Regional materials are readily available in the local market.

1

C 4.2 Recycled Content Specify 15% 1 Point

C 5.1 Regional materials 10% Extracted and Manufactured Regionally 1 Point

C 5.2 Regional Materials 20% Extracted and Manufactured Regionally 1 Point

C 2.2 Construction Waste Management Divert 75% from Landfill 1 Point

C 3.1 Resource Reuse Specify 5% 1 Point

C 3.2 Resource Reuse Specify 10% 1 Point

C 4.1 Recycled Content Specify 7.5% 1 Point

C 1.1 Building Resuse Maintain 75% of Existing Walls, Floors, and Roof 1 Point

C 1.2 Building Resuse Maintain 95% of Existing Walls, Floors, and Roof 1 Point

C 1.3 Building Resuse Maintain 50% of Interior Non-Structural Elements 1 Point

C 2.1 Construction Waste Management Divert 50% from Landfill 1 Point

Prerequisite 1 Storage & Collection of Recyclables


Requirements - Use rapidly renewable materials and products (made from plants that are typically harvested within a ten-year cycle or shorter) for 5% of the total value of all building materials and products used in the project.

Possible but not likely ? ?

Requirements - Use a minimum of 50% of wood-based materials and products, certified in accordance with the Forest Stewardship Council's Principles and Criteria, for wood building components including but not limited to, structural framing and general dimensional framing, flooring, finishes, furnishings, and non-rented temporary construction applications such as bracing, concrete form work and pedestrian barriers.

May be possible depending on materials used. ? ?

Requirements - Develop and implement a Building Durability Plan, in accordance with the principles in CSA S478-95 (R2001) - Guideline on Durability in Buildings, for the components within the scope of the Guideline - (refer to full text of requirements)

Cost issue - significant expense ? ?

Total Materials & Resources 6 0

C 7 FSC Certified Wood 1 Point

C 8 Durable Building 1 Point

C 6 Rapidly Renewable Materials 1 point

5. Indoor Environmental Quality


Claimed

LEED Points

ClaimedRequirements - Meet the minimum requirements of ASHRAE standard 62-2001., Ventilation for Acceptable Indoor Air Quality, and Addenda approved at the time the building was permitted. Mechanical ventilation systems shall be designed using the Ventilation Rate Proceedure.

Building ventilation systems will be designed to meet and exceed the requirements of ASHRAE 62-1999 through mechanical and/or natural ventilation. Minimum outdoor air requirements of Standard 62-1999 for each occupancy type in this particular building are as follows:

YES YES

Requirements - Coose one of the following options: - Option 1 - Prohibit smoking in the building and locate any exterior designated smoking areas at least 7.5 metres (25 feet) away from entries, outdoor air intakes and operable windows. - Option 2 - Establish negative pressure in the rooms with smoking (refer to full text). - Option 3 - Reduce air leakage between rooms with smoking and non-smoking areas in residential buildings. - prohibit smoking in all common areas of the building - Locate any exterior designated smoking areas at least 7.5 metres (25 feet) away from entries, outdoor air intakes and operable windows opening to common areas. - Minimize uncontrolled pathways for ETS transfer between individual residential units (refer to full text).

Required by municipal bylaw. Airtight Drywall Approachwill be used to control suite to suite migration. Central ducted air supply to suites and weatherstriped entry doors will be used to avoid hall pressurization cross contamination to suites. Exterior smoking zones will be located metres from entry doors.

YES YES

Requirements - Install a permanent carbon dioxide (CO2) monitoring system that provides feedback on space ventilation performance in a form that affords operational adjustments. Refer to the CO2 differential for all types of occupancy in accordance with ASHRAE 62-2001, Appendix C.

A permanent carbon dioxide detection and monitoring system will be installed and will be used to optimise indoor air quality by controlling the amount of outdoor air introduced into the building. Fresh air CO2 levels, outdoor air temperature, relative humidity and wind direction will also be monitored through an outdoor environmental station. This station will allow for the optimal operation of the building under various outdoor conditions. Review manufacturers history of reliability and calibration.

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Requirements - For mechanically ventilated buildings, design ventilation systems that result in an air change effectiveness (Eac) greater than or equal to 0.9 as determined by ASHRAE 129-1997. For naturally ventillated spaces demonstrate a distribution and laminar flow pattern that involves not less than 90% of the room or zone area in the direction of air flow for at least 95% of hours of occupancy.

Add relevant details for each occupancy ? ?

Requirements - Develop and implement an Indoor Air Quality (IAQ) Management Plan for the construction and pre-occupancy phases of the building as follows: During construction meet or exceed the recommended Design approaches of the SMACNA IAQ Guideline for Occupied Buildings under Construction 1995, Chapter 3. Protect stored on-site or installed absorptive materials from moisture damage. If air handlers must be used during construction, filtration media with a MERV of 8 must be used at each return air grill, as determined by ASHRAE 52.2-1999. Make provisions for inspections of building and HVAC systems for deficiencies that could adversely affect IAQ (e.g. moisture in HVAC system, water damageed walls, construction debris in ceiling spaces, materials stored near air intakes, etc.) and the correction of any deficiencies found from building inspections.

A construction IAQ plan will be developed to address construction-related IAQ issues. The plan will include but will not be limited to the following control measures: 1) Protection of the ventilation system and return air side of the HVAC system, 2) Provide source control by specifying use of non-toxic materials utilised during construction, 3) Mitigate pathway interruption by isolating clean or unoccupied areas where air contamination may occur, 4) Housekeeping requirements to remove contaminants from the building prior to occupancy and 5) Scheduling of construction shall be sequenced to reduce absorption of VOCs by materials that will act as sinks or contaminant sources. The SMACNA Guideline for protection of the HVAC system during construction will be applied

1

Requirements - Develop and implement an Indoor Air Quality management plan for the pre-occupancy phase that follows one of the two options below: (see full text - flush out or test)

Flush out option: After construction and prior to building occupancy, a minimum two-week building flushout with new filtration media in all HVAC equipment and 100% outside air will be performed. Pre-construction interview on potential building green construction management practice.

1

Requirements - The VOC content of adhesives, sealants and sealant primers used must be less than the current VOC content limits of SCAQMD Rule 1168.

Where required, adhesives and sealants will have low VOC content that will meet the 10mg/m2/hr emission factor limit required to obtain this credit thus minimising impact on indoor air quality. Ed - lowest VOC products will be specified where appropriate.

1

Requirements - VOC emissions from paints must not exceed the VOC and chemical component limits of Green Seal's Standard GS-11 requirements. AND The VOC content of anti-corrosive coatings used must be less than the current VOC content limits of Green Seal Standard GS-03 AND For interior paints

Throughout the project,durable/low VOC paints will be specified. Paints and coatings will also be selected using the Master Painters Institute durability guidelines to ensure that appropriate durability is combined with low VOC content.

1

Reduce the quantity of indoor air contaminants that are odorous, potentially irritating and/or harmful to the comfort and well-being building occupants.

Add relevant details e.g. Carpet with high recycled content, low embodied energy will be used. Carpet alternatives such as non-woven textiles will be considered.

1

Requirements - Composite wood and agrifibre products, including core materials, must contain no added urea-formaldehyde resins. Adhesives used to fabricate laminated assemblies containing these products must contain no urea-formaldehyde.

All composite wood specified for the project will have no urea-formaldehyde resins added.

1 ?

C 4.3 Low Emitting Materials Carpet 1 Point

C 4.4 Low Emitting Materials Composite Wood & Laminate Adhesives 1 Point

C 3.1 Construction IAQ During Constructio 1 Point

C 3.2 Construction IAQ Testing Before Occupancy 1 Point

C 4.1 Low Emitting Materials Adhesives & Sealants 1 Point

C 4.2 Low Emitting Materials Paints and Coatings 1 Point

C 1 Carbon Dioxide (CO2) Monitoring 1 Point

C 2 Increase Ventilation Effectiveness 1 Point

Prerequisite 2 Environmental Tobacco Smoke (ETS) Control Required


Prerequisite 1 Minimum IAQ Perfomance

Requirements - Design to minimize pollutant cross-contamination of reqularly occupied areas: Employ permanent entryway systems (grills, grates, etc.) to capture dirt, particulates, etc. from entering the building at all high volume entryways. Where hazardous gasses or chemicals may be present or used (including garages, housekeeping/laundry areas, and copying/printing rooms), provide segregated areas with deck to deck partitions with separate outside exhaust at a rate of at least 0.5 cubic feet per minute per square foot, no air re-circulation, and operated at a negative pressure compared with the surrounding spaces of at least an average of 5 Pa (0.02 inches of water guage) and with a minimum of 1 Pa (o.004 inches of water) when the door(s) to the room(s) are closed. Provide containment drains plumbed for appropriate disposal of hazardous liquid wastes in places where water and chemical concentrate mixing occurs for maintenance or laboratory purposes. Replace all filtration media immediately prior to occupancy. Filtration media shall have a MERV of 13, as determined by ASHRAE 52.2-1999 for media installed at the vend of construction.

Add relevant details ....... would read e.g. Non-toxic, allergy-free maintenance products shall be used throughout the complex. Indoor generated pollutant propagation such as maintenance material emissions will be limited through the installation of floor to floor partitions, dedicated exhaust systems and negative air pressure design in these spaces.

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Requirements - Provide at least an average of one operable window and one lighting control zone per 18.5 m2 (200ft2) for all regularly occupied areas within 5 metres (15 feet) of the perimeter wall.

To be determined. ? ?

Requirements - Provide controls for each individual for airflow, temperature and lighting for at least 50% of the occupants in non-perimeter, regularly occupied areas.


Requirements - Comply with ASHRAE Standard 55-2004, Thermal Comfort Conditions for Human Occupancy.

The proposed buildings will be designed to maximise natural ventilation and free cooling opportunities as appropriate

1 1

Requirements - Provide a permanent monitoring system to ensure building performance to the desired comfort criteria as determined by EQ Credit 7.1, Thermal Comfort - Compliance.


Requirements - Achieve a minimum Daylight Factor of 2% (excluding all direct sunlight penetration) or achieve at least 250 Lux (25 foot candles) using a computer simulation model in 75% of all regularly occupied areas. Exceptions for areas where tasks would be hindered by the use of daylight will be considered on their merits.

Needs a calculation - would read - Fenestration allows for a daylight factor of 2% in 75% of all regularly occupied spaces.

? ?

Requirements - Achieve direct line of sight to vision glazing for building occupants in 90% of all regularly occupied areas. Areas directly connected to perimeter windows must have a glazing-to-floor area ratio of at least 0.07. Parts of the floor area with horizontal view angles of less than 10 degrees at 1.27m (50 inches) above the floor can not be included in this calculation. Areas not directly connected to perimeter windows must have a horizontal view angle of at least 10 degrees at 1.27m (50 inches) above the floor involving 50% or more of the floor area. If a room meets these requirements then the entire room area is considered to meet the view requirement. Exceptions will be considered on their merits.

Needs a calculation - would read - All perimeter spaces are provided with vision glazing which allows for views in all directions.

? ?

Total Indoor Environmental Quality 8 1

C 8.2 Daylight & Views View for 90% of Spaces 1 Point

C 6.2 Controlability of Systems Non- Perimeter Spaces 1 Point

C 7.1 Thermal Comfort Comply with ASHRAE 55-2004 1 Point

C 7.2 Thermal Comfort Monitoring 1 point

C 8.1 Daylight & Views Daylight 75% of Spaces 1 Point

C 5 Indoor Chemical & Pollutant Source Control 1 Point

C 6.1 Controllability of Systems Perimeter Spaces 1 Point

6. Innovation & Design Process

LEED Category and Available PointsOverview of Plan LEED Credit Description Related to the Building LEED Points

LEED Points

Claimed ClaimedRequirements - In writing identify the intent of the proposed innovation credit, the proposed requirement for compliance, the proposed submitals to demonstrate compliance, and the design approach (strategies) that might be used to meet the requirements.

1.1 Innovation in Design: Specific Title

e.g - 90% construction waste not to landfill 1 ?


Use of HRV's and the corresponding reduction in heating and cooling plant sizes by employing heating/cooling credits (not typically done) may realize an additional point.



Requirements - At least one principal participant of the project team that has successfully completed the LEED Accredited Professional Certificate.

1

Total Innovation & Design Process 2 0

Grand Total 33 2

C1 Innovation & Design Process (1 Point Each)

Credit 2 LEED Accredited Professional


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APPENDIX ‘F’

LOW IMPACT MAINTENANCE AND CLEANING MATERIALS Cleaning and Maintenance Materials and Methods The following outlines information relevant to due diligence and best practice guidance on appropriate cleaning and maintenance materials and methods. This information is adapted from a Stantec report and is focussed on general environmental and human health impacts related to generally available information on hazardous ingredients as identified in Material Safety Data Sheets (MSDS). Only designated (hazardous) chemicals accounting for more than 1% of the product are required to be disclosed under the Workplace Hazardous Materials Information System (WHMIS). Therefore full ingredient disclosure is not available for most products through the WHMIS system. Many manufacturers or suppliers do not know the actual chemical composition of the products they supply. Product chemistry may vary over time particularly when there is significant price volatility for ingredients. Fewer than 2% of the 70,000 chemicals in common use have been comprehensively evaluated for human and environmental health impactsi. Therefore definitive environmental and health information for most substances of concern does not exist. Consequently the absence of information does not imply that there are no environmental or human health effects, or that these effects if any are not significant. Human and environmental impact assessment information is extremely diverse, inconsistent and not highly reliable. Therefore direct comparison is very difficult and not highly accurate and due diligence and the precautionary principle indicate that reputable third party comparative analysis must be relied upon to provide usable data. Many variables determine the actual potential environmental and human health impact including for example the actual concentration in the end use product, the amount of the end use product used, the timing and conditions under which they are used and the presence of people who might be affected. A wide range of benchmarks, checklists, databases and guidelines must be reviewed and used to develop recommendations for product options for cleaning and maintenance products and services. Based on a review of the MSDS and related literature the potential for positive and negative impacts related to the hazardous materials listed, on human and environmental health including potential cumulative effects and potential impacts from accidents must be assessed. Cost-Benefit Although little cost-benefit analysis has been done on a product-by-product basis the following examples illustrate the significance of global benefits available from the use of improved cleaning and maintenance products and protocols.


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U.S. business could potentially save $30-150 billion annually by improving worker productivity by 0.5 to 5 percent with indoor environment benefits derived from improved cleaning and maintenance. ii

Lost time and injuries for custodial staff can be reduced by reducing the toxicity of the cleaning chemicals used.iii

By focussing on source control measures such as reducing dust the use of cleaning chemicals and time can be substantially reduced.iv

The American Lung Association estimates that 3 of every 5 persons suffer from some kind of respiratory difficulty.v

One study indicated that in 4.6 to 10 percent of work-related asthma cases cleaning products were the suspected causative agents.vi

Environmental Management Plan An Environmental Management Plan should be developed to provide a coordinated framework and time frame for managing existing environmental cleaning and maintenance initiatives and for planning and implementing new practices. The US Department of the Interior has model documents for green purchasing and training for janitorial services http://www.doi.gov/greening/sustain/basics.html. Consider using the ISO 14001 Environment System Self-Assessment Checklist to benchmark current performance. Environmental Procurement Plan An environmental procurement plan should be developed to ensure that procurement objectives are in line with environmental management plan objectives. There are few widely accepted definitions for “Green” chemicals however the US Department of the Interior has one specifically for green chemicals, http://epa.gov/opptintr/epp/ppg/case/doicase.htm. This site also includes a purchasing wizard and procurement checklists that can be used as templates for environmental purchasing of cleaning and other products. Issues of concern that would be listed in an Environmental Management Plan related to typical cleaning products included: Potential effects on the environment, including those potentially related to accidents and

malfunctioning, as well as cumulative effects; Appropriate mitigation measures to address identified adverse environmental impacts; The likelihood of adverse effects occurring; The potential for measures that might improve environmental performance; The significance of residual effects if any; Appropriate waste and effluent management measures; and The need for and appropriate nature of any additional programs, including an Environmental

Management Plan and Environmental Procurement Plan. To establish an environmentally appropriate cleaning and maintenance program information must be gathered, and analysed relating to major impact categories such as aquatic, terrestrial,


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atmospheric, waste, workplace environment, resource and hazardous and non-hazardous materials as well as specific research environment and patient category concerns. The efficacy of some cleaning materials may be addressed using existing test protocols (see ‘Standards’ section in appendix “A”), each of which uses particular definitions of performance. Test information must be considered in relation to the appropriateness of the standard and the stakeholders who developed it. The effectiveness of efficacy testing is controversial, and products tested by the EPA frequently failed the test.vii The issue of effectiveness of alternative products may be addressed through product trials and industry peer to peer communications. Cleaning products and related MSDS should be reviewed to determine if there are any: Chemicals of concern, in Quantities of concern, or Uses of concern.

Third Party Evaluations Although many references can be reviewed, the Environmental Defense Scorecard system provides a simple, science based and common method for comparing the human and environmental health impact of subject chemicals of concern identified in an MSDS for cleaning products. The following example includes the name of the subject product followed by the related substances of concern and the Environmental Defence (ED) Scorecard rating. The ED Scorecard rating indicates a percentage range estimate of adverse environmental impacts by category, in 25% increments. Product: Aquaress Hand & Body Shampoo

Substances of Concern: Non listed – WHMIS exempt “cosmetic” product Product: Acrylic Seal

Substances of Concern: Methyl Carbitol (2-(2-methoxyethoxy)ethanol (a glycol ether - solvent) CAS No. 111-77-3 Concentration: 1.0% ED Scorecard Data: Suspected – developmental, endocrine, gastrointestinal or liver, kidney and neurotoxicant Ranking Human Heath 25-50% Ecological health 25-50%.

Examples of other Third Party Agencies which provide material guidance include: Environmental Choice Program [Ecologo] www.environmentalchoice.ca Green Seal www.greenseal/org


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Pennsylvania Green Building Operations and Maintenance Manual, http://www.dgs.state.pa.us/dgs/cwp/view.asp?a=3&q=118184

Scientific Certification Systems [Green Cross] (SCS) www.scsi.com The US General Service Administration maintains a major data base ‘Safer Paints, Cleaning

and Other Chemical Products’ at: http://apps.fss.gsa.gov/environ/safer-chemicals.cfm. Pilot Projects Several pilot projects and environmental product purchasing programs have recently been implemented by cities and states, and can be used as templates for the development of a program. Some of these programs have concluded that the Green Seal GS-08 Household Cleaners and GS 37 Industrial and Institutional Cleaners standards provide a reasonably comprehensive standard for evaluation and certification for the cleaning products covered. Other certification programs such as TerraChoice also provide reputable third party benchmarks. GS 37 and 08 (and other certification programs) can be used to provide a primary benchmark, which in addition to any particular criteria considered important to the specific requirements of the subject facility can be used to fast track the development of procurement guidelines for immediate implementation. Products should conform to the requirements of the appropriate standards listed in Appendix “B” and have a Canadian Pest Control Products (PCP) number or U.S EPA equivalent when required. Environmental Plan Details An Environmental Management Plan should be developed in conjunction with an Environmental Procurement Plan, Incident Management Plan, Environmental Monitoring, Waste Minimization and Management Plan. Improving the environmental profile of cleaning materials is only one of many actions that can be applied to improve environmental performance and human exposure. Environmental management plans and procurement programs should address a broad range of related issues including other contaminant sources such as photocopiers, kitchens, loading docks, building materials, office supplies, office furnishings and personal care products. These plans should include specific measures addressing cleaning and maintenance materials and methods. These plans must consider: The development of chain of custody procedures for tracking received goods at the dock

and in storage. Product packaging contains unique identifiers and is traceable. Most typical cleaning chemicals in the quantities typically handled should not pose an exceptional risk related to transportation accidents and/or other accidental release to the environment if industry and regulatory recommended practices are followed.

Typically some products are premixed and some are received as concentrates for mixing on site. Material handling, quality control, and other procedures should be posted on the wall in each storage/mixing area and materials should be stored on shelves or plastic pallets with


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spill containment and appropriate drains etc. as per manufacturers recommendations as appropriate.

Goods should be controlled with a combination of access keys, logs, and an audit trail. They should be kept in segregated rooms and/or areas within rooms. Storage rooms should be controlled by temperature and humidity as appropriate to the stored materials. Negative pressure (direct powered exhaust to the exterior) should be maintained in all chemical storage areas.

Cleaning products should be delivered just-in-time in order to maintain relatively small quantities of cleaning chemicals on site. Attention should be paid to materials that require segregation for reactivity and most chemicals should be kept in their original containers as appropriate. No unlabelled or otherwise inappropriate containers should be used at any time.

Typical Materials of Concern Found in Buildings: see Appendix “G”. Typical Substances of Concern: see Appendix “G”. The following briefly summarizes typical Criteria for Environmentally Appropriate Cleaning Products used in screening protocols. (e.g. TerraChoice [Ecologo], Green Seal, Scientific Certification Systems, the Janitorial Products Pollution Prevention Project, and GREENGUARD). Although there are differences in each program’s screening criteria. Green Seal or Terra Choice could be used as immediate default screens for the purchase of environmentally appropriate cleaning materials. Some comparisons are included in brackets as representative examples of differences. The TerraChoice [Environmental Choice Program] (ECP) has individual standards for several categories of cleaning materials including: Biologically-based Cleaning and Degreasing Compounds Carpet and Upholstery Care Products Hard Floor Care Products Hard surface Cleaners including: Window and Glass Cleaner Degreasers Industrial Cleaners Disinfectants Cleaning products with Low Potential for Environmental Disruption Bathroom cleaners.

The Janitorial Products Pollution Prevention Project website (http://www.westp2net.org/janitorial/tools/riskevaluation.htm) includes comprehensive lists of chemicals to avoid or use with caution, in four categories: Ingredients to avoid, Ingredients to avoid if possible/otherwise use with extreme care,


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Ingredients to use with extreme care, and Ingredients to use with ordinary care.

The Green Seal GS-37 and GS 08 Standards evaluate cleaning materials under the following categories of concern: ‘Recommended Industrial and Institutional Cleaners’ and ‘General Purpose Cleaners’ Criteria (Green Seal) Not toxic (human, aquatic) VOC levels of less than 10% by weight when diluted for use Readily biodegradable Works optimally in room temperature water Has a pH level between 2.5 and 12 (ECP 3.0 to 11.0 - general) Is not made of petroleum or petrochemical compounds Does not contain chlorine bleach or sodium hypochlorite Is free of phosphates and derivatives Does not contain EDTA or NTA Does not contain phenolic compounds or glycol ethers Does not contain nonylphenol ethoxylate Is free of heavy metals: arsenic, cadmium, chromium, lead, mercury, nickel and selenium

(ECP + silver), (EPA + cobalt, zinc). Lethal Dose 50 The California Code of Regulations provides a benchmark for comparing toxicity as defined by the lethal dose 50 information provided on product MSDS which calls for: Whole product LD50 (oral) prefer > 5,000 mg/kg Whole product LD50 (skin) prefer > 4,300 mg/kg Whole product LC50 (inhalation) prefer >10,000 parts per million.

LD 50 information may have to be interpolated from individual chemical ingredient information when whole product information is not available. Typical General Criteria Some of the key recommendations for an environmentally appropriate program include the following: Preference should be given to manufacturers and suppliers who: Have environmental management and procurement programs such as ISO 14000 series, Provide full ingredient disclosure, Are e-commerce enabled,


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Use low impact, reusable or recyclable packaging (HDPE, PET, cardboard), and offer vendor take-back options for both packaging and unused product,

Provide training, Provide products in a concentrated form and in bulk, Provide automatic dispensing equipment designed to reduce mixing errors, reduce and

contain spills. Preference should be given to products that:

Are derived from natural sources (biobased), Are derived and manufactured locally (limit transportation), Do not contain substances of concern (e.g. hazardous substances, greenhouse gasses,

ozone depleting chemicals, endocrine disruptors, allergens, asthmagens, sensitizers, etc.), Are fragrance free - no added fragrance (if added are USDA approved food grade), Are dye free – no added fragrance (if added are USDA approved food grade) (ECP less

than 1% by weight), Are not aerosols (prefer liquids over pump sprays and pump sprays over aerosols), Do not cause skin and eye irritation, Do not cause skin sensitization, Are non-combustible, (e.g. ECP flashpoint above 61 degrees Celcius) Do not contain smog or ozone precursors (Volatile Organic Compounds [VOC’s]), (ECP –

not aromatic solvents, not halogenated solvents, not listed glycol ethers) (ECP not more than 1% by weight VOC’s after dilution - general),

Are concentrated (less than 20% water), Do not contain substances prohibited by legislation or by the designated certification

programs. Certified Products Products that are certified by tier-one certification agencies such as Environmental Choice or Green Cross should be given preference over products certified by less stringent programs, Material Safety Data Sheets (MSDS) An MSDS should be on file for every product for which an MSDS is available, kept in a binder located in each location where the products are stored or handled, Although not required by Canadian regulations it is desirable to have a U.S. MSDS when available for each product and ingredient of concern. A U.S. MSDS contains more categories of environmental information than a Canadian MSDS.


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MITIGATION AND BEST PRACTICE OPTIONS In order to inform a continuous quality improvement program, the following mitigation and best practice options should be considered for implementation where feasible and cost effective. Tier-one agencies such as the U.S. Environmental Protection Agency (EPA) and Canada Mortgage and Housing Corporation (CMHC) and medical associations have recently modified their guidance on the need for and use of biocides for cleaning and disinfection. This guidance relates to the need to use biocides more appropriately in order for them to be effective for their intended purpose and to reduce the unnecessary overuse of biocides that may result in the development of resistant microbial populationsviii. New recommendations indicate that: Soap and water should (when indicated) be used to clean a surface before using a biocide,

Biocides should only be used for the category and target organism listed on the label (e.g. Antiseptic, Pesticide, Sanitizer, Disinfectant), and must be used according to an appropriate (usually indicated) protocol to be effective; typically involving cleaning, then application of the biocide for the recommended residence time, followed by rinsing. Some biocides must be formulated to be effective in relation to the hardness of the water at the point of dilution and use.

Biocides may not be effective: If used on rough surfaces, If used on incompatible materials, If used on soiled surfaces, or If not left on the surface for the recommended dwell time.

Biocides should not be added to general purpose products where there is no significant improvement in efficacy and a possible increased risk (e.g. hand soap). Biocides and other chemicals should be used only at the recommended concentration (incorrect concentrations – too much or too little – may be ineffective). Mitigation Reduce the incidence of indoor environment complaints by: Ensuring that lighting, acoustics, ventilation and humidification meet the requirements of

appropriate standards. Ventilation Ensure that ventilation air intakes are appropriately protected to reduce risks related to re-

entrainment of exhausts or intake of emissions from outdoor sources, Ensure that ventilation systems are monitored and periodically inspected for possible system

generated emissions related to equipment, insulation and biological contaminants,


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Ensure that ventilation rates and relative humidity levels are maintained within ASHRAE guidelines,

Ensure that ventilation is ramped up sooner on Mondays than on other weekdays to address the additional indoor air contaminant load accumulated over the weekend or holidays,

Ensure that ventilation is kept on where and when appropriate during after hours events, Ensure that commissioning or re-commissioning of ventilation systems and particularly

diffuser layouts occurs after occupation and after workstation or other layout modifications, Ensure that ventilation air actually reaches the breathing space particularly in workstations

(desktop) and special needs locations such as day-care (floor), Isolate areas of construction and use local exhaust when appropriate to reduce cross

contamination through ventilation systems, Increase ventilation rates and periods during construction, renovation or stripping and

waxing etc. and ensure that the Sheet Metal and Air Conditioning Contractors National Association, Guideline for the Protection of HVAC Systems During Construction in Occupied Buildings is applied during all construction and renovation activities, www.smacna.org

Ensure that intakes are located at least 2 metres above grade to reduce intake of ground level contaminants,

Implementing a no scent policy (no added scent) for cleaning and maintenance products, Implementing a no scent/perfume policy for staff and visitors, Implementing a no dye policy, unless the dye is a low impact (e.g. food grade) chemical

necessary for product (safety) identification. Plants Implementing a policy restricting the type of plants used indoors (building and staff) to:

Eliminate the use of flowering plants (that release natural perfume, turpenes or pollen), Plants that smell (particularly those such as geraniums and eucalyptus that are known to

adversely affect persons with respiratory conditions, and Plants that require fertilizers (do not use synthetic or toxic fertilizers, pesticides, anti-

desiccants, waxes etc.), Avoid plantings that are prone to producing mould on soil surfaces, and control fallen leaves

to reduce mould incubation, Do not install plants or biodegradable ground covers immediately adjacent to walls, windows

or intakes, Avoid plants that require intensive maintenance, Use lawn mowers that bag grass near buildings to reduce the ambient mould count from

decomposing grass clippings, Avoid exterior plants with major pollen loads (male species, birch etc.),


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Additional Measures Not using masking chemicals (plug-ins, scented urinal pucks etc.), Reducing the use of porous surface materials and furnishings such as carpets that can act

as sources of contaminants and as temporary sinks for contaminants. If carpets are required consider specifying low impact products such as non-woven floor

textiles and certified non-allergenic carpet that can tolerate steam cleaning, Specifying maintenance-free and/or no-shine products whenever appropriate (e.g. avoid the

specification of products requiring stripping, buffing and waxing, Reducing the incidence of repeated wetting of moisture susceptible materials (e.g. mop

water at baseboard details), Taking immediate steps to dry wetted moisture susceptible materials (gypsum board and

carpet wetted by leaks and spills), to reduce the incidence of mould which may typically incubate within 24-72 hours,

Force drying carpets as appropriate after accidental and intentional (shampooing, steam cleaning) wetting and avoiding intentionally wetting carpets when the building is not being heated,

Using dehumidifiers when appropriate in humid areas such as below grade spaces, Selecting surface materials and coatings that are inherently non-marking and are easily

cleaned without harsh chemicals, Avoiding unnecessary surfaces such as dropped ceilings through the use of exposed

architectural surfaces, Maintaining a library of the most up-to-date versions of industry association recommended

practices e.g. carpet cleaning, Purchasing only the amount of product that will be used during the products recommended

lifespan (e.g. bleach rapidly loses its effectiveness even in a sealed container), Not mixing chemicals that: Cause reactions (e.g. bleach and ammonia) Reduce the effectiveness of either or both chemicals (e.g. tri-sodium phosphate and bleach) Not using chemicals: On surfaces that will neutralize their effectiveness (e.g. bleach on concrete), Are stale dated (are past their recommended use or expiry date).

The following measures can be implemented to reduce the negative human and environmental health impact and liability associated with the use of typical cleaning chemicals and methods: Take a baseline inventory of existing cleaning and maintenance materials, Appropriately dispose of all chemicals that are stale dated, unlabelled, damaged or not on a

current list of approved chemicals, Ensure that all chemicals are in correct concentrations and are properly labelled and stored, Ensure that there is an up-to-date (not older than 3 years past the current date) MSDS for

each product stored in each location, in an appropriately labelled binder,


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Ensure that chemical storage rooms are equipped with appropriate spill containment and are maintained under negative air pressure (exhausted continuously directly to the exterior). Ensure that no incompatible chemicals are stored together,

Ensure that all employees have been appropriately trained in preventive measures, spill containment and appropriate chemical use,

Implement options from the Best Practice Options listed below, Substitute water based cleaning products for solvent based cleaning products.

Prevention Reducing the amount of particulates (dust) entering the building may be the most cost-effective cleaning intervention available. The two primary entry routes are foot traffic and ventilation air intakes. To reduce the entry of dust: Use generously sized entrance walk-off mats and wells to reduce transport of particulates

into the building, and vacuum frequently, Use the highest Maximum Efficiency Reporting Value (MERV) intake filtration that the HVAC

equipment will economically support. Use two-stage filtration where appropriate to extend filter life and improve filter performance, Avoid the use of tackified air filters, Change filters according to loading when appropriate, before adhering to a calendar

schedule, Reduce the quantity of cleaning chemicals used by: Reducing the amount of ambient dust (use HEPA vacuums, statically charged dusters, and

improved walk-off mats and intake filters), Ensuring that biocides are only used for the target organisms listed on the product label, Ensuring that surfaces are cleaned (when indicated) before biocides are applied, Ensuring that biocides are not used on inappropriate surfaces (rough surfaces or

incompatible materials), Ensuring that products are used at the recommended concentration level, Using lower cost/impact products such as soap and water (when indicated) before using

higher cost/impact products, Avoiding the use of aerosols and sprays.

Elevated Risk Populations Spaces used by elevated risk populations such as infants, the elderly and pregnant women, those with immunocompromized conditions or recovering from surgery, as well as persons with asthma, allergies, environmental sensitivity or emphysema may require different cleaning and maintenance products and protocols. For instance: Chemical exposure limits for children are generally considered to be 1/10 of the adult (non-industrial) exposure limit, which in turn is 1/10 of the industrial exposure limit. Exposure limits for


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at-risk sub-populations such as children with asthma may be even lower. Exposure limits for children with anaphylaxis are essentially zero for specific substances. Some common cleaning chemicals such as phenols may pose an elevated risk in specific circumstances (e.g hyperbilirubinemia, or latex allergy, asthma, or anaplylaxis to infants). The Terra Choice/Environmental Choice Program lists specific criteria for lower risk products under CCD-146 – Hard Surface Cleaners - Cleaning Products with Low Potential for Environmental Illness and Endocrine Disruption. This does not provide a definitive method of sourcing appropriate materials for specific elevated-risk populations however it does provide a starting point. No formal or informal program can provide conclusive recommendations for appropriate cleaning products for persons with asthma, environmental sensitivity or other intolerances that may be specific for each individual. Tolerated products as recommended by official associations representing affected populations should be considered whenever appropriate. Accommodation should take into account the specific needs and recommendations of affected persons on an individual basis when appropriate. Incompatible Materials Some chemicals are incompatible and when in contact may cause one or both to be neutralized or to react. For instance both 2-butoxy ethanol and ammonia are incompatible with bleach. Material Storage & Handling Ensure that unauthorized persons can not gain access to chemicals in storage (e.g. use

locks, automatic door closers, and place dangerous chemicals out of reach), Ensure that automatic mixing equipment is used to reduce the incidence of incorrect mixing

and ensure that this equipment is periodically examined and calibrated as necessary, Store chemicals in original containers, and copy labelling, dilution (actual concentration) and

expiry information to new containers when new containers are used, Ensure that MSDS and emergency response (fire, ambulance, chemical exposure hotline

etc.) phone numbers are prominently displayed in all chemical storage and handling areas and in each building cleaning and maintenance management office, and ensure nearby and obvious access to a phone,

Ensure that materials are stored without contact with floors or walls, particularly in below grade spaces,

Ensure that all chemicals are stored in appropriately approved containers, with tight fitting lids,

Ensure that all storage rooms and containers are appropriately labelled, Ensure that chemicals are stored in appropriately vented (direct to the exterior) storage

rooms, with dedicated drainage, Rotate stock to ensure that first in products are first out and that stale dated (expired) and

depleted effectiveness products are returned, Avoid the use of latex (allergen) (e.g. gloves), use substitutes approved for the chemicals

involved.


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Contractors Ensure that contractors are made aware of requirements for the use of environmentally

appropriate materials, and that appropriate quality assurance measures are implemented to ensure compliance (e.g. periodic unscheduled inspection),

Ensure that cleaning staff are appropriately trained in the use of cleaning chemicals and cleaning methods,

Ensure that contractors on site follow appropriate health and safety procedures, Schedule the use of chemicals and methods of concern for periods when the building (or

when appropriate, the area) of concern is not occupied, and will not be occupied for an appropriate period of time,

When appropriate, clean on an as-need, not on a calendar scheduled basis, Avoid using one product for multiple uses when two, more appropriate products can be used

more effectively, Use statically charged mops and dusters where appropriate to reduce or eliminate the use of

chemically treated products. Health and Safety There are several websites that provide specific health/risk information on chemicals including: Canadian Centre for Occupational Health and Safety, www.ccohs.ca Environmental Defense Scorecards, http://www.scorecard.org/chemical-profiles/ New Jersey Right to Know, http://www.state.nj.us/health/eoh/rtkweb/ Occupational Safety and Health Administration (ASHA), www.osha.gov Purdue University, Clean Manufacturing Institute, http://www.ecn.purdue.edu/CMTI/ U.S. Environmental Protection Agency, http://www.epa.gov/ngispgm3.iris/, and

http://www.epa.gov/epahom/search.html. The following list provides a summary of typical health and safety actions that should be considered: Assign a knowledgeable person to review all current and new MSDS to ensure that they

contain up-to-date and appropriate information, Ensure that gas cylinders are secured to prevent them from falling over, Ensure that face masks (respirators) are used when indicated on an MSDS, and that they

are fit tested by a registered fit tester and that employees are trained in their use according to an appropriate agency/protocol such as OSHA.,

Phase in a program to convert or replace current regular vacuum cleaners to units equipped with HEPA filters,

Service all (e.g. split, window and rooftop) air conditioning units regularly including filter cleaning and coil/drain pan cleaning and disinfection,

Vacuum HVAC diffusers periodically using a HEPA vacuum,


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Ensure that all staff (custodial and non-custodial) are educated with respect to the implications of mercury containing fixtures and equipment, and the appropriate measures required in the event of an accident.,

Determine if LED lighting can be substituted for compact fluorescents (typically exit signs at the moment) at an appropriate time (emerging mercury free lighting technology), and if mercury free (electronic) thermometers may be appropriate,

Store diesel fuel and other substances of concern in a system providing adequate spill containment,

Ensure that all exposed lamps are protected from potential impact, Remove any torchieres with high temperature bulbs, Ensure that vehicles do not idle at near buildings/entrances/intakes or in loading docks.

Accessibility Off-gassing from cleaning materials may present an accessibility barrier for employees and members of the public related to a wide range of sensitivities such as asthma, allergies, emphysema and environmental sensitivity. Appropriate steps should be considered to reduce these risks including: The development of an ongoing process focussed on improving the human health profile of

cleaning and maintenance materials, The development of a mechanism to facilitate the accommodation of susceptible persons,

including identified elevated risk populations/settings such as day-care, The development of a mechanism to facilitate the accommodation of susceptible members

of the public, particularly in areas where public access is provided. Waste Management Ensure that potential hazardous wastes are identified (inventory and/or identify and label

potential sources as appropriate), Use purpose made and/or international symbol labels (e.g. ‘biohazard’) for wastes of

concern, Segregate and dispose of hazardous waste substances following applicable regulations.

Environmental Procurement An environmental procurement program should be developed to better address

opportunities for appropriate purchasing of cleaning and maintenance materials and contract services.

Purchase products that do not contain substances of concern, Purchase products certified by tier-one certification agencies such as: Green Seal GS-37 – industrial and institutional cleaning materials Use existing model environmental cleaning materials program guidance such as those

produced by the states of Massachusetts, Minnesota, Washington or Vermont and the cities of San Francisco, Santa Monica, or Seattle


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Ensure that all new mercury containing lamps are low mercury, and phase out mercury containing lamps as mercury free substitutes become available (LED exit, sign, task lamps, flashlights etc.),

Convert all lubricants to USDA food processing approved products as appropriate. Additional Measures Additional measures should be considered, including the development of an: Environmental baseline audit/update of emissions sources, hazardous materials, HVAC

systems, and cleaning and maintenance materials and methods, Environmental Management Plan, Environmental Procurement Program, using products that are certified by or meet the

requirements of the Green Seal and/or Terra Choice (Ecologo) systems as an immediate default requirement,

Periodic re-commissioning of HVAC systems as appropriate, Review, update or develop emergency preparedness guidelines and measures for Sick

Building Syndrome (SBS) Building Related Illness (BRI) and Safeguarding buildings and ventilation systems for terrorist attacks,

Develop and implement related training programs as appropriate, Maintain a library of the most up-to-date versions of industry association best practice

cleaning and maintenance recommendations e.g.: Carpet, Carpet Cleaning Standard, IICRC S001-2002, “Standard Reference Guide for

Professional On-location Cleaning of Installed Textile Floor Covering Materials, Institute of Inspection, Cleaning and restoration Certification, www.iicrc.org

Mould “New York Protocol” Blood-borne pathogens “OSHA” http://www.osha-slc.gov/SLTC/bloodbournepathogens/index.html Latex “NIOSH” http://www.cdc.gov/niosh/latexpg.html.

DATA SOURCES Bid Specifications (examples) “City of Santa Monica 1998 Custodial Products Bid Specifications” www.aehf.com/IAQSch/Bidform.htm Certification GREENGUARD Environmental Institute, www.greenguard.org

“Industrial and Institutional Cleaners (GS-37) Green Seal, Oct. 19, 2000,

http://www.greenseal.org/standards/industrialcleaners.htm

“List of Certified CAS Products and Companies”, Air Quality Monitoring Board,


F- 16

http://www.aqmd.gov/rules/cas/prolist.html

Chlorine Free Products Association, List of Chlorine free products, www.chlorinefreeproducts.org Checklists ISO 14001 Environmental System Self-Assessment Checklist, March 1996 (revised 2000), Global Environmental Management Initiative (GEMI), www.gemi.org/docs/PubTools.htm

“Cleaning Products Pilot Project” Feb. 1997 US EPA, Single, Multiple and Weighted Attribute Ranking Tools. http://www.epa.gov/opptintr/epp/cleaners/select/tool2/tool2frm.htm

“Product Assessment Matrix” A tool for evaluating products based on human health, environmental impact and indoor air quality. Working Group, for the Toronto Board of Education Sept. 1997

“Purchasing Decision Wizards” US EPA, http://www.epa.gov/opptintr/epp/cleaners/select

“Risk Evaluation Criteria” etc. Western Region Pollution Prevention Network (EPA) http://www.wrppn.org/janitorial/tools.cfm

“Technical Specification For the Evaluation of Environmentally Preferable Janitorial Chemicals” State of California, Department of General Services, Golden Seal Charter Team, Nov. 2000, Revised June 2001, www.ciwmb.ca.gov/GreenBuilding/Specs/Janitorial/Janitorial.docc Databases Defense Logistics Information Service, Green Products List, http://www.dlis.dla.mil/epp/eproshopping/enac.asp

Environmental Products & Services Guide (2003-2004), US General Services Administration, www.gsa.gov/portal/gsa/ep

Household Products Database, National Institutes of Health,

http://householdproducts.nlm.nih.gov/faq.htm#7

Janitorial Products Pollution Prevention Program, www.westp2net.org/janitorial/tools-htm

Suppliers of Low-VOC Cleaning Materials and Equipment, South Coast Air Quality Monitoring

board, http://www.aqmd.gov/prdas/water.html

“Surface Cleaning Research”, Pacific Pollution Prevention Resource Centre Pollution

Prevention Research Projects Database, 10/96,

http://www.pprc.org/pprc/rpd/fedfund/epa/epaappcd/surface.html

Environmental Defense Scorecards, http://www.scorecard.org/chemical-profiles/summary

Toxics Use Reduction Institute, www.turi.org

University of Tennessee Center for Clean Products and Clean Technologies, Household Cleaners, http://soapdetergents.com/doc/doc_clean_2_2.asp?IDDOC=11


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Guidelines “Defining and Understanding “GREEN” Cleaning Products, Healthy Clean Buildings, http://www.cleaningpro.com/green.cfm

“Environmentally Preferable Cleaners: All Purpose Cleaners, Glass Cleaners, and Dishwashing Liquids, Report to Greenseal, by Center for Clean Products and Clean technologies, University of Tennessee, Knoxville, Mary B. Swanson, Gary A. Davis, Diane G. Perhac, October 11. 1995, www.greenseal.org

Environmental Products & Services Guide, U.S. General Service Administration, www.gsa.gov/portal/gsa/ep

“Good Housekeeping Guide for Small & Medium Sized Enterprizes, Pilot Programme for the Promotion of Environmental Management in the Private Sector of Developing Countries (P3U), Working Paper No. 9e, Sustainable Business Associates, February 1998

Greenguard Certification Standards for Low Emitting Products for the Indoor Environment, (Cleaning Systems), Greenguard Environmental Institute, www.greenguard.org

GS-08 Household Cleaners, November 2, 1993, Greenseal, www.greenseal.org

GS-37 Industrial and Institutional Cleaners, October 18, 2000, Greenseal, www.greenseal.org

Guidelines for Volatile Organic Compounds in Consumer Products, Canadian Environmental Protection Act, 1999

The Canadian Environmental Assessment Act (CEAA).

Indoor Air Quality in Office Buildings: A technical Guide, Health Canada, 1995,

Maintaining Acceptable Air Quality in Office Buildings Through Ventilation, National research Council, Institute for research in Construction, 1997

Pollution Prevention and Abatement Handbook, Pharmaceutical Manufacturing section. World Bank Group, January 1998

Proposed Environmental Standards for Floor-Care Products, Proposed Amendments to GS-37 Concerning Carpet Cleaners and Packaging, May 28, 2004, Greenseal, www.greenseal.org

“Cleaning for Health: Products and Practices for a Safer Indoor Environment”, Alicia Culver, Marian Feinberg, David Klebenov, Judy Musnikow, Lara Sutherland, Inform, Inc. 2002, www.informinc.org Implemented Programs Commonwealth of Massachusetts, Environmentally Preferable Products Procurement Program, http://www.state.ma.us/osd/enviro/enviro.htm

City of Santa Monica, http://www.ci.santa-monica.caus/environment

City of San Jose/ Santa Clara County, http://www.westp2net.org/janitorial/jp4.htm

City and County of San Francisco, Year 1 Report, June 2000, http://www.ci.sf.us/sfenvironment/aboutus/toxics/epp/report.pdf


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Cleaning National Parks: Using Environmentally Preferable Janitorial Products at Yellowstone and Grand Teton National Parks, Sophia Wakefield and Angele Ferre, Safe Consulting for the earth, Inc. http://www.epa.gov/region08

Environmentally Preferable Products (EPP), List of Approved Environmental Attributes, Defence Logistics Information Service, https://www.dlis.dla.mil/epp/attributes/approved.asp

Minnesota, http://www.moea.state.mn.us/lc/purchasing/cleaners-mn.cfm

The Commonwealth of Massachusetts, Environmentally Preferable Products Procurement Program, http://www.mass.gov/epp/vendor/vcleaning.htm. Standards CA/CGSB 2-GP-11, Method 20.3 Methods of Testing and Analysis of Soaps and Detergents

California 94509 Standards for Consumer Products, www.calregs.com

ISO 14000 series

S100, Carpet Cleaning Standard, Institute of Inspection, Cleaning and Restoration Certification, Vancouver Washington, 1994 (revised 2002), www.iicrc.org

“94509 Standards for Consumer Products”, California Air Resources Board, Subchapter 8.5, Consumer Products, Article 2 Consumer Products. (VOC content for floor wax strippers), http://www.calregs.com

ASTM D 4488-95 (2001)e1, “Standard Guide for Testing Cleaning Performance of Products Intended for Use on Resilient Flooring and Washable Walls”.(for multi-purpose cleaners), www.astm.org

ASTM E1971-98, Standard Guide for Stewardship for the Cleaning of Commercial and Institutional Buildings, www.astm.org

ASTM D5343-97 Standard Guide for Evaluating Cleaning Performance of Ceramic Tile Cleaners, www.astm.org

ASTM D6215-98a Standard Guide for Removal of Oily Soils from Metal Surfaces, www.astm.org Chemical Specialties Manufacturers Association (CSMA), www.csma.org CSMA DCC-04 Hard surface cleaners CSMA DCC-02 Floor tile Reference Documents “Cleaning for Health: Products and Practices for a Safer Indoor Environment” Alicia Culver, Marian Feinberg, David Klebenov, Judy Muskinow, Lara Sutherland. 86pp, ISBN 0-918780-79-9 (not reviewed)

Environmental Health Criteria: International Programme of Chemical Safety (IPCS), http://www.inchem.org/documents/ehc/ehc/ehc169.htm


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National Institute of Occupational Safety and Health (NIOSH), http://www.cdc.gov/niosh/rtecs/db682428.html MANUFACTURERS / SUPPLIERS OF ENVIRONMENTALLY CERTIFIED CLEANING PRODUCTS The following manufactures/suppliers have lines of environmentally certified cleaning materials (TerraChoice [EcoLogo], Green Seal, Scientific Certification Systems, Envirodesic etc.) that should be considered. Lists of additional manufacturers may be found at www.environmentalchoice.com Archer Chemical 4090 Belgreen Dr. Unit 1 Gloucester ON, K1G 3N2 Ph: 613-737-5332 Fx: 613-737-3329 www.archerchemical.com Avmor 950 Michelin, Laval Quebec Ph: 450-629-8074 Fx: 450-629-4512 www.avmor.com Bebbington Industries, 44 Wright Avenue, Dartmouth, Nova Scotia, Canada, B3B 1G6 e-mail: [email protected] www.bebbington.ns.ca Chemspec – Hunnisett Chemicals Ltd. 200 Wicksteed Ave. Toronto, ON, M4G 2B6 Ph: 1-800-268-6093 www.chemspec-canada.com Church & Dwight Canada 6600 Kitimat Rd. Mississauga, ON, L5N 1L9 Ph: 905-826-6200 Fx: 905-826-0389


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Ecover Enviro-Solutions 120 Eglinton Ave. E., Suite 1100 Toronto, ON, M4P 1E2 Ph: 1-877-674-4373 Fx: 416-487-4125 www.enviro-solutions.com Flexo Products. Ltd. 4777 Kent Avenue, Niagara Falls, ON, Canada L2H 1J5 e-mail: [email protected] www.flexoproducts.com Frank T. Ross & Sons Ltd. 6550 Lawrence Ave. E. Toronto, ON, M1C 4A7 Ph: 416-282-1107 Fx: 416-282-8150 www.franktross.com Lord and Partners Ltd. 741 Muskoka Road, #3 North Suite #9 Huntsville, ON, Canada, P1H 2L3 Ph: 705-788-1966 Fx; 705-788-1969 e-mail: [email protected] www.lordandpartners.com Nature’s Environmental Products, Inc. 70 Newkirk Road Richmond Hill, ON Canada, L4C 3G3 Ph: 905-737-0172 Fx: 905-737-0162 e-mail: [email protected] Prism Environmental Inc. 1200 Speers Road, Suite 50 Oakville, ON, Canada, L6L 2X4 Ph: 905-337-1874 Fx; 905-337-0328 www.prismchemicals.com


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Rivers Run International, 32 Ash Street, Eden Mills, ON, Canada, N0B 1P0 Ph: 519-856-0038 Fx: 519-856-0074 e-mail: [email protected] Rochester Midland (US Enviro-Care, Canadian Enviro-Chem label) 333 Hollenbeck St. Rochester, NY 14613 Ph: 800-836-1627, 585-336-2200 www.rochestermidland.com Royalpak Inc. 1870 Albion Rd. Etobicoke, ON, M9W 5T2 Ph: 416-746-4226 Fx: 416-746-8291 3M Canada Ph: 1-888-364-3577 ALTERNATIVE PRODUCT BRAND NAMES BY CLEANING CATEGORY Antimicrobials: 3M Sanitizer Cleaner Concentrate, 3M Corp. Carpet/Upholstery Care: Carpet Cleaner Ultra Concentrate, Prism Environmental., Inc. Carpet Extraction Cleaner, ENVIRO-Solutions Green Knight Carpet Cleaner, Bebbington Industries Patriot Carpet Extraction Shampoo Concentrate, Flexo Produsts, Ltd. Enviro Care Carpet and Upholstery Concentrate, Rochester Midland ECOgent Carpet Cleaner, Chemspec – Hunnisett Chemicals Ltd. Degreaser: BRAD G.P.S, Lord and Partners Ltd. BRAD G.P.S Heavy Duty, Lord and Partners Ltd. Green Night Degreaser, Bebbington Industries Green Night Degreaser 501, Bebbington Industries Heavy Duty Degreaser, ENVIRO-Solutions Ipax, Archer Chemical OBP 1082 Degreaser (NY-3), Nature’s Environmental products, Inc. Degreaser Ultra Concentrate, Prism Environmental, Inc. E2, Rivers Run International Enviro Care Tough Job Cleaner, Rochester Midland


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Floor Care: Neutral Cleaner Ultra Concentrate, Prism Environmental, Inc. Neutral Floor Cleaner, ENVIRO-Solutions Enviro Care Floor Cleaner Concentrate, Rochester Midland Glass and Window Cleaner: Enviro Care Glass Cleaner Concentrate, Rochester Midland Glass & Surface Cleaner, ECOVER Glass Cleaner, ENVIRO-Solutions Green Knight Glass and Window Cleaner, Bebbington Industries Patriot Glass Cleaner Concentrate, Flexo Products, Ltd. Enviro Care Glass Cleaner Concentrate, Rochester Midland General Purpose Cleaners: All Purpose Cleaner, ECOVER Patriot All Purpose Cleaner Concentrate, Flexo Products, Ltd. General Purpose Cleaner Ultra Concentrate, Prism Environmental Inc. General Purpose Cleaner, ENVIRO-Solutions Spray Cleaner Ultra Concentrate, Prism Environmental Inc. Enviro Care All-purpose Cleaner, Rochester Midland E2, Rivers Run International ECOgent Carpet Cleaner, Chemspec – Hunnisett Chemicals Ltd. Spot and Stain Removers: Spot & Stain Remover, ENVIRO-Solutions Stain Remover, ECOVER Tile and Grout Cleaner: Patriot Tile and Grout Cleaner, Flexo Product, Ltd. Patriot Bathroom Foam Cleaner Concentrate, Flexo Products, Ltd. Enviro Care Washroom and Fixture Cleaner, Rochester Midland Toilet Cleaner: Bowl Cleaner Alkaline Ultra Concentrate, Prism Environmental, Inc. Green Knight Bowl Cleaner Acid, Bebbington Industries Green Knight Bowl Cleaner Alkaline, Bebbington Industries Toilet Cleaner, ECOVER


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Commonly Used Environmentally Appropriate Generic Cleaning Products: Other low impact cleaning products that are generally recommended by alternative cleaning programs include: Baking Soda – (sodium carbonate)e.g. Arm & Hammer Baking Soda, Church & Dwight Borax Oxygen bleach – typical active ingredient - Sodium Perchlorate, Sodium Perborate or Hydrogen Peroxide (substitutes for chlorine bleach) Vinegar Washing Soda (sodium bicarbonate) i Green Seal Choose Green Report, Industrial and Institutional Cleaners, www.greenseal.org ii William Fisk and Arthur Rosenfeld, “Improved Productivity and Health from Better Indoor Environments” Center for Building Science Newsletter (currently the Environmental Energy Technologies Newsletter), Lwrence Berkeley Labs, Summer 1997, 5, http://eetd.lbl.gov/cbs/newsletter/NL15/productivity.html. iii Cleaning Products, Greenbuiz Essentials, http://www.greenbuiz.com iv Research Triangle Institute, Indoor Environment Characterization of a Non-Problem Building: Assessment of Cleaning Effectiveness (US EPA Environmental Criteria and Assessment Office) 1994, 49, 118 v Allergy Newswire, Vol. 1, No. 3, July 2002, p2 vi Cleaning National parks, Using Environmentally Preferable Janitorial Products at Yellowstone and Grand Teton National Parks, Sophia Wakefield and Angele Ferre, S.A.F.E. Consulting for The Earth, Inc. www.epa.gov/region08 Appendix “A” p 28 vii Product Performance Tests and Standards, University of Tenesee, Center for Clean Products and Clean Technologies, http://eerc.ra.utk.edu/ccpct/index.html viii Ibid, 154


G- 1

APPENDIX ‘G’

EXAMPLES OF SUBSTANCES OF CONCERN Typical Substances of Concern The following sample list outlines typical impact categories and substances of concern that could be screened by environmental procurement evaluations. Categories Heavy Metals (Mercury, Lead, Cadmium, Hexavalent Chromium), Other Metals (Aluminum, Copper, Zinc, Silver), Allergens (Latex, Nickel, Peanut, Bisulphites), Asthmagens (Amines, Chlorine, Ammonium Quat Disinfectants), Irritants & Sensitizers (Latex, Fragrances), Estrogenic Substances (Phthalates, DEHP) Volatile Organic Compounds (PERC, Paint, Hydraulic Oil), Chlorinated Substances (PVC, Refrigerants) Ozone Depleting Substances and Greenhouse Gasses PBDE fire-retardants Other (Solvents, Glycol Ethers, Dioxins, Regents), Drugs Microorganisms

Products/Ingredients must not: Be toxic to humans (e.g. no carcinogens, mutagens, or teratogens), Be corrosive to skin or eyes, Be combustible (e.g. have a flashpoint above 150 degrees F), Be toxic to aquatic life, Contain significant amounts of phosphorous (e.g. more than .5% total phosphorous by

weight), Be non-biodegradable (e.g. OECD guidelines)

Products must not contain: Alky phenol ethoxylates (APE’s) Aromatic solvents Halogenated solvents Phthalates e.g Dibutyl phthalate


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Phosphates Chelates e.g. Ethylene diamine tetraacetic acid (EDTA) Nitrotrilotriacetic acid (NTA) Glycol Ethers: e.g. Ethylene glycols Butoxy ethanol Heavy metals (e.g. arsenic, lead, cadmium, cobalt, chromium, mercury, nickel, selenium), Phenolic compounds Smog precursors (e.g. Volatile Organic Compounds – above specified limits) Ozone Precursors and Ozone Depleting Substances, Unnecessary biocides (e.g. anti-microbials/disinfectants), Skin sensitizers (e.g. using OECD guidelines), Added fragrance (minimum criteria if present: Code of Practice, International Fragrance

Association) Added dye (unless it is food grade [US EPA] and necessary to differentiate products for

safety Allergens eg. Peanut or other nut derived oils Latex Bisulphites Asthmagens (comprehensive list : http://www.remcomp.fr/asmanet/asmapro/agents.htm).

Examples: Amines Chlorine D-limonene Enzymes Latex Silica (dust) Isocyanurates/Urethane Chloramine T (CAS 127-65-1) Ammonium Quaternary Disinfectants (include but not limited to CAS#: 8001-54-5, 121-54-0,

122-18-9, 8044-71-1, 123-03-5, 122-19-0) Products should not cause dangerous reactions with other products or materials in common usage, or be neutralized by other products or materials in common usage


G- 3

Typical Materials of Concern Found in Buildings Typical hazardous substances of concern that could be present in many materials used in new or existing buildings include the following examples: Fluorescent tubes containing mercury and phosphors, Old ballasts and transformers possibly containing PCB’s, Hydrocarbons including solvents, oils, greases, fuels, hydraulic fluids, Heavy metals e.g. mercury (thermometers), lead (plumbing), Asbestos Containing Materials, (ACM) Pesticides, Fertilizers

There may be non-hazardous (non-medical) substances of concern present in buildings including the following examples:

Compressed gasses (oxygen, acetylene, propane),

Chemical waste water (in cleaning, cooling towers, boilers) Small quantities of cleaning and maintenance products Detergents Air filters Paints Oils, grease and other lubricants Batteries

Emissions There are many potential sources of (non-medical) emissions from buildings including: Air conditioning and refrigeration refrigerants, Occasional diesel exhaust (emergency generators), Cleaning and maintenance products, Photocopiers, Personal care products, Office supplies and furnishings, Boilers, Batteries.