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UCSF Medical Center’s First Sustainability Report, January 2013

PicUCSF Medical Center (UCSFMC) recognizes that healthcare’s ethical responsibility is “first, do no harm.”  However, the U.S. Environmental Protection Agency (EPA) estimates that one percent of all solid waste in the U.S. originates at healthcare facilities;  the medical industry generates over two million tons of waste annually and consumes more than eight percent of the total energy used in U.S.  Hospitals and other healthcare facilities are on average among the most energy-intensive buildings in the country. 

Balancing saving lives with protecting the environment is a top priority at UCSF and the sustainability report details our journey to green our operations—cutting waste, saving energy and saving money.

Our early successes can be attributed to small groups of caring and passionate staff like the Green Group—motivated nurses that voluntarily came together to focus on the low hanging fruit in the clinical setting. UCSF’s mission of “Advancing Health Worldwide” begins in our own healthcare community.

In the past few years, UC Office of the President (UCOP), each of the UC campuses and UCSF’s Chancellor created formal structures by setting goals and establishing work groups to implement sustainable practices across their universities. UCSF now has a formal infrastructure that reaches across various departments and at many levels of the organization.  UCSFMC was an early adopter of these goals and has played a leadership role in sustainability in healthcare.

UCSFMC’s first achievement in 2003 was recognized by a Making Medicine Mercury Free Award from Hospitals for a Healthy Environment, now renamed Practice GreenHealth (PGH). In 2010, UCSFMC earned PGH’s Partner for Change Award. As we continued to improve, we received PGH’s Partner for Change with Distinction Award in 2011, 2012 and 2013.

In 2012, UCSFMC joined the Healthier Hospital Initiative (HHI) and committed to three of the six planks:  Engaged Leadership, Healthier Food, and Less Waste. This initiative was founded by 11 of the largest, most influential U.S. health systems, comprising over 490 hospitals with more than $20 billion in purchasing power. It serves as a guide to help hospitals reduce energy and waste, purchase safer and less toxic materials, and serve healthier foods. As UCSFMC embraces our accomplishments and awards, we must continue to strive for improvement until we meet and surpass our goals, reduce our environmental impact and improve environmental health consistently with our greater mission, in practice and in teaching. —Gail Lee, Sustainability Manager

Leadership and Infrastructure

The framework of the Chancellor Advisory Committee on Sustainabilty (CACS) includes representation from both the Medical Center and the campus staff and faculty. Co-chairs from the medical center serve on each of the nine work groups who develop our Sustainability Action Plans to achieve campuswide goals and specific goals for the Med Center and campus. The first Sustainability Action Plan (SAP) was completed in 2010. The medical center and campus are now working towards our second phase, SAP 2.0, which will identify goals for the next 2 to 10 years.

Most of these goals are driven by UC Policy on Sustainable Practices developed by the University of California Office of the President( UCOP) staff and representatives from all ten UC campuses.  The policy is also consistent with the American College and University Presidents’ Climate Commitment (ACUPCC). Other goals are specific to UCSF with a healthcare focus, which resonates with our mission.

UCSFMC’s sustainability accomplishments through 2012 are listed below with goals for the upcoming year. These follow the preeminent healthcare sustainability organization, Practice GreenHealth’s (PGH) award categories.

Please see our slide show where we share images of our sustainability activities.

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Toxic Chemicals - Mercury and DEHP

Toxic chemical, mercury and DEHP are a priority for Practice GreenHealth, but have not yet been identified by UCOP or the ACUPCC. However, because UCSF recognizes environmental health as a key component of our mission, the CACS chose to focus on this area in our operations.

Past Accomplishments

  • Completed pilot demonstration for alcohol and formalin filtration recovery systems
  • Replaced Peroxide based cleaner in exchange for bleach-based cleaner
  • Integrated Pest Management policy draft for campus and medical center.  Now pending medical center approval and implementation
  • Eliminated Mercury use in thermometers, sphygmomanometers, barometers, thermostats and bougies.
  • Mercury Elimination Policies in place to prevent new mercury from entering the center.
  • Eliminate DEHP from IV tubing and bags in the Neonatal Intensive Care Unit (NICU)

FY12-13 Goals

  • Develop a LEED compliant Integrated Pest Management Policy for institution-wide adoption in order to reduce accidental, or long term exposure to toxics excluding patient and animal care areas.
  • Develop an institution wide policy to apply guidelines and specifications of Environmentally Preferable Purchasing to all major, strategic and critical purchasing decisions.


  • Reduction of hazardous waste tonnage each year.

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Solid Waste - Reduce, Reuse, Recycle

Solid waste reduction has been the main focus of UCSF, PGH and UCOP goals from the beginning of their programs. UCSFMC began its sustainability efforts focusing on this effort and continues to identify ways to further reduce all our waste streams.


Past Accomplishments

  • 296,000 pounds of waste was eliminated and $240,000 in savings/yr gained from the reuse of 158,000 pillows instead of disposable pillows.
  • All Paper towels in public restrooms are 100% PCW paper and are collected for composting.
  • Implement Paperless Systems: Clinical engineering inspection process; Out-patient clinics adopt APEX paperless medical record system; a paperless Surgery scheduling and patient care management system was implemented.
  • Implemented in-patient room recycling training provide unit by unit to ensure adoption of correct waste sorting practices with 81% of patient rooms completed.
  • Ensured that all new remodeling projects included space for multiple recycling containers and promoted their use to the department managers.
  • Sold or recycled one ton of used furniture in 2011.
  • Donated over 13,000 lbs of medical equipment and supplies to international hospitals/clinics through MedShare in past two years.
  • Initiated a medical library book drive in 2011 and 2012 to donated and recycled medical and health textbooks and other books resulting in 2835 pounds of books being reused or recycled.
  • Use reusable pallets or reused wood pallets on loading dock.
  • Developed Informational posters to to explain recycled batteries, cell phones, eyeglasses, toner cartridges, computers, electronics, furniture and metals.
  • Completed educational waste sorting training video “the Right Bin” for UCSF and medical center community in 2012.
  • Completed inspirational “LivingGreen at UCSF” video for New Employee Orientation in 2012, shown at Department Managers and other department meetings.
  • Included solid waste sorting training in mandatory safety training in 2012.
  • Created metrics to measure Nutrition and Food Services waste diversion rate.


  • Percent diversion of solid waste from landfill.

UC Policy Goals

  • 50 percent waste diversion by June 30, 2008
  • 75 percent waste diversion by June 30, 2012
  • Zero waste by 2020

FY12-13 Goals

  • Increase the volume of materials recycled, composted, and re-used by an additional 5%.
  • Complete educational recycling video to train all members of the UCSF community on how to correctly recycle, compost, re-use, and reduce waste.
  • Incorporate the use of recycling video as part of UCSF annual staff safety trainings.
  • Expand the use of micro-fiber cloths to eliminate the use of paper wipes in more buildings. 

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Regulated Medical Waste and Greening the Operating Room

Reduction of medical waste and greening operating rooms are two strategies to reduce our environmental impact by focusing on staff training for proper sorting of infectious and non-infectious materials and waste.

Past Accomplishments

  • On-site San-I-Pak medical waste sterilizer and trash compactor now process all red bag infectious waste and improved the compaction of solid waste saving up to $250,000/year.
  • Neptune fluid treatment system installed in 30 operating rooms at Parnassus Campus and Out-Patient Surgery Center reduced fluid infectious waste previously collected in canisters and disposed of as medical waste.
  • Reusable sharps containers saves $105,000/year at Ambulatory Care Center, Mt. Zion and Moffit Long Hospitals.
  • Single use devices collected in the Surgery Department, Electrophysiology lab, and patient rooms for reprocessing by Stryker and Hygia.
  • Reprocessed non-invasive devices such as pulse oximeter sensors, pressure bags, DVT compression sleeves and blood pressure cuffs are reprocessed and repurchased through Hygia resulting in diversion of almost 11,800 pounds and saved over $78,000 in 2011-2012.
  • Reprocessed invasive devices such as cardiac catheters, suture passers, ultrasonic scalpels, drill bits and burrs were reprocessed and repurchased through Stryker resulting in the diversion of almost 2500 pounds and saved $673,000 in 2011-12.
  • Sharps and Pharmacy waste are collected in reusable rigid containers through Stericycle, reducing 40% of medical waste by eliminating disposal containers.
  • Recyled blue wrap.
  • Added reusable surgical gowns and towels.
  • Reformulated OR kits to eliminate items that are not used.


  • Medical waste tonnage each year

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Chemical Use and Waste Management

Reduction of chemical waste is addressed through UCSF"s Toxics Reduction work group where we recognize that need to reduce the environmental impact of chemicals and employee exposure. This category is a PGH as a priority, but it has not yet been identified by UCOP.  However, because UCSF recognizes environmental health as a key component of our mission, the CACS chose to focus on this area.

Past Accomplishments

  • Converted to Green Seal/Ecologo certified floor cleaners, strippers and waxes; hard surface and glass cleaners; carpet and upholstery cleaners; and degreasing compounds.
  • Collaborated with Infection Control Committee to determine which disinfectants can be minimized or eliminated.
  • Instituted use of micro-fiber mops and cloths fora floors and high surface cleaning which reduces chemical and water use.
  • Design guidelines so that newly installed flooring that does not requiring stripping and waxing.
  • Integrated Pest Management (IPM) policy draft completed for medical center approval and implementation.
  • Created metrics to measure Nutrition and Food Services waste diversion rate.
  • Replaced bleach-based cleaner with peroxide based cleaner.
  • Green Cleaning Policy: Adopt an institution wide green cleaning policy targeting 100% compliance.

FY12-13 Goals

  • Develop a LEED compliant Integrated Pest Management Policy for institution-wide adoption in order to reduce accidental, or long term exposure to toxics excluding patient and animal care areas.
  • Developing a program around standardizing waste tracking with a consistent, transparent, and accessible waste tracking system.


Environmentally Preferable Purchasing

Environmentally Preferable Purchasing at UCSFMC recognizes that greener purchasing will result in less waste, less toxic chemicals brought into the organization, and support a market for even greener products.

Past Accomplishments

  • Purchase EPEAT (Electronic Products Environmental Assessment Tool) and Energy Star certified electronic equipment through RFP specifications.
  • Purchase rechargeable batteries where possible.
  • Landscape and pest control contracts are pesticide-free as standard practice.
  • 100% of post consumer water (PCW) paper is recycled automatically.
  • 50% PCW is offered to all buyers as an default.
  • 100% B&W re-manufacturer cartridges through Office Max.  2800 cartridges/yr in past 2 years.
  • Reusable color cartridges were trialed last year with some success. Recently discontinued due to quality issues.
  • Efforts to minimize Fed Ex Express (overnight) and maximize Fed Ex Ground 3-7 business days. This zone optimization effort reduced shipping distances and reduce vehicle travel.
  • E-procurement system, Procurement Materials Management and third party Global Healthcare Exchange (GHX) has reduced paper 90% to electronic or e-fax for paper.
  • Conversion to reusable totes for office supplies through Office Max significantly reduced cardboard waste. 23-26,000 totes/month.
  • Conversion to reusable totes for medical supplies through Professional Hospital Supplies significantly reduced cardboard waste (uses 23-26,000 totes/mo).
  • Purchased reusable pillows.
  • Purchased low flow toilets.

FY 12-13 Goals

  • Set up standing meeting with MC Procurement to identify sustainability projects.
  • Develop an institution wide policy to apply guidelines and specifications of Environmentally Preferable Purchasing to all major, strategic and critical purchasing decisions.


  • Percentage of sustainable product spend of total purchases.
  • Measure percentage of paper purchased with PCW recycled content.
  • Number of tote deliveries/mo.

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Food Programs

Sustainable Food efforts at UCSFMC have been robust and progressive based upon the definition of sustainable food by UCOP which requires following 13 different sustainable food criteria. They focus on reducing: air pollution from transportation, pesticide residue on produce, added hormones in livestock, and promote healthier diets and local economies.

Past Accomplishments

  • 14% of total food purchases met UC Office of the President established sustainable criteria.
  • Switched to American Humane Society-approved cage-free liquid eggs.
  • Local and organic comprised averaged 40.6%produce purchased in 2012, a 37% increase over the previous year.
  • 60% of produce comes from 17 counties around the Bay.
  • The spring greens and spinach on the salad bar are local and organic over 95% of the time.
  • Added to menus: Local, organic yoghurt; organic baby food; organic, whole grain bread; Local, organic brown rice; seasonal organic spinach and spring greens; organic canned black, pinto, garbanzo beans, dairy products from rBST-free cows.
  • Completed a comprehensive NSF baseline assessment of all food purchased by NFS.
  • 100% of patient food and retail trays use compostable boxes and containers and are hand sorted to ensure maximized waste sorting.
  • Food waste from staff lounges are collected and composted.
  • Expanded patient foodservice recycling to retail areas and in the kitchen.
  • Launched “Smart Choice” standards at Parnassus to offer nutritious foods only.
  • Digital signs promote vegetarian, vegan, or Smart Choice in Moffitt Cafe.
  • Nutritional information is posted in Moffitt Café and on customer receipts.
  • A monthly newsletter for promoting healthy food choices called Moffitt Café Bites is published.
  • Promoted Meatless Mondays, and ethnic vegetarian foods with local chef restaurateurs, including South Indian and Eritrean cuisines.
  • Staff use public transport to and from Farmers’ Markets (NPS).
  • Moffitt Cafe Express Store received a green business designation from the National Restaurant Association.
  • MC serving organic baby food.
  • Food Day event promoted on October 24, 2012 with selected vendors available to promote the event.

Presentations on sustainable food 2011-12

  • FoodMed, CleanMed (Henderson)
  • Healthcare Foodservice, Food Summit 3, Stanford University (Henroid)
  • 2012 CA Higher Ed Sustainability Conference (Tabrizi).


  • Percentage of annual food purchased that is sustainable (per UCOP policy guidelines)

FY12-13 Goals

  • Create more seasonal menus that increase the use of local and/or sustainable foods.
  • Achieve minimum of 16% sustainable food purchases.

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Facilities and Construction

Capital projects at the Medical Center use green building concepts focusing on energy water conservation, waste reduction and use of recycled content materials consistent with Leadership in Energy and Environmental Design (LEED) principles.

Past Accomplishments

  • LEED-CI (Commercial Interiors) Gold certified renovation - Owens Street Pharmacy
  • LEED-NC (New Construction) Silver certified - Mount Zion Medical Center Osher Bldg
  • Tracked Construction and demolition waste for reporting.
  • Ambulatory Care Clinic (ACC) retro-commissioning project.
  • 2 Boiler retrofits at Mount Zion to meet low NOX requirements, reduced fuel consumption, and increased efficiency.
  • Installed water saving devices on steam sterilizers, ice machines, steam guards, and sink aerators through SF PUC grants.
  • Added living green roof.
  • Planted healing garden.
  • Moffitt Long Lighting Retrofit saved $40,000 in energy costs.
  • Added LED lighting.
  • Specified non-PVC flooring.


  • Total Gross Square Footage of LEED certified space by level over time.

FY12-13 Goals

  • Ensure construction waste documentation is provided for all capital projects.
  • Capital Programs to integrated sustainability measures into Division 1 specifications as a standard.
  • All new projects to integrate sustainability criteria into project specific specifications.
  • Real estate will work with partnerships to incorporate sustainability criteria.
  • Update design requirements making building solar ready with panel brackets installed on roof.
  • Retrofit of water fixtures with low flow alternatives.
  • Leak identification and replacement program.
  • Establish contract specification for water efficient standards in construction and renovation (Environmentally Preferable Purchasing)
  • Expand use of micro-fiber cloths for floor and high surface cleaning which reduces chemical and water use.

UC Goals

  • Install 10 MW of renewable energy systemwide by 2014.
  • 20 percent of energy needs using renewable resources by 2010.
  • Reduce energy consumption per square foot by 10 percent or more from 2000 level by 2014.
  • By 2014, reduce greenhouse gas (GHG) emissions to 2000 levels.
  • By 2020, reduce GHG emissions to 1990 levels.
  • Develop an action plan for becoming climate neutral as soon as possible.

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is a significant source of GHG emissions and UCSF has a robust program that supports the medical center and campus faculty, students, and staff to use public transit and inter-campus shuttles as much as possible. Data is not reported for the Medical Center specifically, so this information pertains to all UCSF locations.

Past Accomplishments

  • Gold award for the 2011 Best Workplace for Commuters.
  • 69% of the UCSF community use alternative transportation to and from our facility locations. Only 31% commute via a single occupancy vehicle.
  • Shuttle services between UCSF facilities uses Smithsafe Fleet Monitoring System – training, QC, back of shuttles “How are we driving?” signs, statistics on GHG saved and safety.
  • City Car Sharing, Emergency Ride Home Program, Vanpools, Pre-Tax Transit Program with reimbursement, carpool matching services, preferred parking for carpools and vanpools, on-site sale of transit passes.
  • Provision of 5 secure bicycle cages for a total of 256 cyclists.
  • Installed four electric Car Charging stations and created 40 carpool parking spaces.
  • Implemented Green Road for vanpool drivers which improved fuel consumption by 15% by real time monitoring of speed, acceleration, turning, with instructional feedback and scores to drivers.
  • Clean Fuels grant award for 10 additonal electric vehicle chargers; four at Parnassus.


  • Reduce emissions to 1990 levels by 2020, become carbon neutral.
  • FY12-13 Goals

    • Construction of new 75 bike cage at Parnassus and 28-bike cage at the Mount Zion garage.
    • Install 10 additional EV charging stations.
    • 10 carpool spaces to be added at Mount Zion.
    • Mission Bay bike-share program pilot to house 20 smart bikes.
    • GPS on all campus shuttles to provide real time notice via smart phone app to increase shuttle ridership.

    culture Shift logo

    The Culture of Sustainability

    UCSF recognizes that our efforts must be accompanied by a strong culture shift by faculty, students and staff to effectively engage and transform our workplace to be more efficient and less wasteful.  Engagement, outreach and education needs to be embedded through all facets of the university to meet our sustainability goals. Much of these efforts are focused at both the medical center and campus staff and are occupant specific.

    Past Accomplishments

    • 12 years of hosting an annual sustainability event.
    • 1000 attendees, 65 vendors at LivingGreen Fair/Bike to Work Day on May 10, 2012.
    • Five sustainability award winners selected from 28 nominees in 2012 (two were from the medical center)
    • 19 LivingGreen Offices were certified in the first award year in the faculty, staff, student and team categories in 2012 (4 offices from the Medical Center)
    • 800 cycling participants received lunch and snacks along their route on Bike to Work Day to Parnassus in 2012.
    • 3853 total visits to LivingGreen at UCSF website, up from 547 (FY09-10) to 1625 unique visitors in FY11-12.
    • 2000 hits on UCSF-produced LivingGreen at UCSF engagement video on YouTube.
    • 1000 viewed of Living Green at UCSF engagement video at the California Higher Education Sustainability and Practice GreenHealth Conferences.
    • 500 viewers of “Living Green at UCSF engagement video at the Clean Med 2011.
    • LivingGreen at UCSF being shown to all new employees at new employee orientation(campus and medical center)
    • Included waste sorting training in online safety training for all hospital employees.
    • Hosted LivingGreen Fair.
    • Initiated Bike to Work Day.
    • Celebrated National Food Day event.

    FY12-13 Goals

    • Identify and reward department level representatives for sustainable practices through the LivingGreen Office, LivingGreen Labs, and Living Green Events, Sustainability Awards, and other venues and events
    • Provide additional sustainability education at New Employee Orientation through presentation, slide show, video, etc.
    • Develop more website traffic through social media: Twitter, Facebook, and Tumblr Blog.
    • Coordinate with medical center for development of medical center focused website presence through a landing page and additional webpages, including the Medical Center Sustainability Report on the website.
    • Launch occupant level engagement marketing effort to gain pledges and LivingGreen Office, LivingGreen Lab, LivingGreen Event certifications.


    • Number of participants in the LivingGreen certifications for office, labs, events, and caterers.
    • Number of pledges, unique visitors to the website.

    In Conclusion

    UCSFMC is proud to be a four-time Practice GreenHealth award winner and a Healthier Hospital Initiative signatory. We expect to continue to increase our sustainability efforts throughout the organization to save money, reduce waste, reduce emissions, improve quality and efficiency, and shift the culture so that the UCSF community can consistently act in ways that reduce or eliminate our impact on the environment and our community.  The CACS vision of a “Healthy Environment, Sustainable Future” is truly consistent with the university’s mission of “Advancing Health Worldwide”.

    This report is brought to you by UCSFMC’s sustainability leadership work groups:

    CACS co-chair, David Odato, Medical Center Chief Adminstrative Officer

    Sustainable Food Work Group
    CACS Member:  Dan Henroid, Director, Nutrition and Food Services
    Co-chair: Jack Henderson, Associate Director, Medical Center Nutrition & Food Services.

    Waste/Procurement Work Group
    CACS Member:  Kevin Pattison, Director, Materiel Services Administration
    CACS Member: Michael Skehan, Executive Director, Clinical Services
    Co-chair: Dave Giovannini, Assistant Director, Hospitality Services and Louise Hallberg, Clinical Nurse IV

    Toxics Reduction Work Group
    CACS member:  Tracey Woodruff, Associate Professor, OB-GYN, Program on Reproductive Health and the Environment
    Co-chair:  Matt Carlson, Medical Center Safety Officer

    Climate Change Work Group
    CACS Member:  Bob Eaton, Director, Environmental Health and Safety
    CACS Member: Tim Mahaney, Director, Medical Center Facilities and Support Services
    Co-chair: Travis Clark, EHS (interim for Dick Chan, Medical Center Facilities Management)

    Sustainable Operations Work Group
    CACS member:  Angela Hawkins, Associate Vice Chancellor, Campus Life Services
    Co-chairs:  Diori Johnson, Medical Center Leaseholds

    Water Conservation Work Group
    CACS member: Tim Mahaney, Director, MC Facilities and Support Services
    Co-chair: Bruce Mace, Director, Building Maintenance

    Green Building Work Group
    CACS Member:  Colin Boyle, Assistant Director, Global Health Sciences
    Co-chair: Deepak Dandekar, Medical Center Design and Construction

    Culture Shift Work Group
    CACS Member: Ellen Weber, Professor, Clinical Medicine, Academic Senate
    Co-chair; Frances Flannery, Marketing Manager

    Gail Lee, Sustainability Manager, Medical Center and Campus