IndOOr Air  Quality:  Materials Selection
                            HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES

                                                              EPA Publication 909-F-07-001

  What?  Building materials can have a major impact on air quality and can affect
            occupants, especially sensitive ones including children, the elderly, and patients
            who are immunocompromised or have respiratory problems.  Careful selection of
            materials along with proper ventilation, operation, and maintenance can improve
            air quality.
   Why?  Enhanced Community Reputation:

             • Improves indoor air quality and
               promotes community awareness
             • Enhances reputation as caring facility
             • Better air quality attracts patients
               and helps recruit and retain staff

            Environmental /Staff/Patient
            Benefit:

             • Provides healthy surroundings for
               patients, workers, and visitors

             • Supports "Primum non nocere" ("First
               do no harm")

             • Often requires less cleaning
               chemicals

            Cost Competitive:

             • Initial cost often offset by reduced
               maintenance
   How?
Less use of finished surfaces can reduce costs


Minimize the need for surface coatings
Meet low emission standard (low VOC):  LEED, regulatory agencies, or labeling
organizations
Collect air quality data during commissioning and occupancy
    Case
 Studies
Emory University
University of Florida
Kaiser Permanente
Discovery Health Center
Green Guide for Health Care (GGHC) Criteria: Construction:  Environmental Quality and Operations:
Integrated Operations www.gghc.org
  This is one of 5 Building Healthy Hospitals case studies developed by EPA's Pacific Southwest Regional Office,
                  with Resource Conservation Challenge and Pollution Prevention funds.
                       www.epa.qov/reqion09/waste/p2/pro1ects/hospart.html

Indoor Air • Sustainable Flooring • Process Water Efficiency • Lighting Efficiency • Energy Efficiency
Building Healthy Hospitals                1

This fact sheet was produced by EPA's Pacif c Southwest Regional Office. Mention of trade names, products, or serv ces does not
convey, and should not be interpreted as conveying off cial EPA approval, endorsement, or recommendation.
Printed on 100% recycled paper, 50% post-consumer content - process chlorine-free
                                                                     2007
                                                                       ~

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                                      IndOOr Air Quality:  Materials Selection
                            HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
                CASE STUDY: LOW-VOC MATERIAL SELECTION

                Applicability:        New construction, major renovation, or remodeling
                                   projects.
                Environmental      Not quantified.
                Impact:

                Other Benefits:      Not quantified.
Background
Many healthcare construction projects, including many of the case studies profiles here,
incorporate interior finishes and products characterized as "reduced or non-toxic," low-VOC
or PVC-free. After flooring (see Strategy #3), most of the focus for low-VOC product
selection falls on products applied in liquid form that cover,  adhere, or seal interior surfaces.
All of the healthcare facilities completed their analysis and selection of these materials
based on the intuitive assumption that they will reduce exposure to occupants to potentially
dangerous or harmful chemicals. At the same time, the facilities have collected scant
empirical data  documenting any actual difference or benefit following the initial construction
and commissioning phase. While this lack of data likely leads to underestimating benefits,
most healthcare organizations proceed as part of "green building" initiatives and out of
concern for people involved in building construction.
Discover Health Center, Emory University and the University of Florida pursued IAQ credits
to achieve LEED certification and in so doing considered a broad spectrum of materials  when
selecting low-VOC materials, including:

       •   Adhesives                   •    Sealants
       •   Caulk                       •    Coating
          Finish                       •    Paints

In addition, Kaiser is developing specifications that eliminate harmful chemicals from entire
categories of building materials including moldings and paints to add to their efforts with
more sustainable carpet specifications.

Performance
Discovery Health Center:  Discovery specified and installed low-VOC and "low-toxicity"
finishes, including paints, stains, cabinetwork, sealers, and adhesives, but did  not collect
data on any potential benefits during construction or after installation.

University of Florida: The Orthopedic Center used low-VOC interior finishes, mainly focusing
on paints and adhesives and used the LEED standards as guidance. Though staff (building
Building Healthy Hospitals                                                      200?
An EPA P2 Project                          2

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                                        IndOOr Air Quality:  Materials Selection
                             HEALTHCARE - TOP 5 GREEN  BUILDING STRATEGIES
management and janitorial) are generally positive about the products, the University of
Florida has not collected additional data on potential benefits.

Emory Winship Cancer Institute:  Emory specified low-VOC adhesives, sealants, paints, and
carpets be used throughout the Winship Cancer Institute. Post-construction commissioning
analysis did not include air monitoring for chemical contaminants.  Defining "low-VOC" for
each product type was dictated by the LEED criteria.  In  many cases, LEED references
standards specific to the product type and defined by its respective industry association (see
Exhibit 1). For example, the carpet used in the Winship  Cancer Institute met
the requirements of the Carpet & Rug Institute's (CRI) Green Label Indoor Air Quality Test
Program.  CRI's Green Label indicates that the  manufacturer participates in a voluntarily
program to test products to ensure it meets established  requirements that define the lowest
emitting  interior  products on the market.  Specifications  for other product categories are
evolving  and
     EXHIBIT 1 |  SUMMARY OF LOW-VOC BUILDING MATERIALS
     Material
Applicable Low-VOC Standard
Cost Premium
    Adhesives used for all
    finishing applications.
California Air Resources Board (CARB): 15%
current; 1.5% proposed
     Carpeted flooring
     installed throughout the
     facility.
Carpet and Rug Institutes Green Label Indoor Air
Quality Test Program.
   Total VOC <0.5 mg/m3
•  4 -Phenylcyclohexene) <0.05 mg/m3
•  Formaldehyde (to prove that none is used)
   <0.05 mg/m3
•  Styrene <0.4 mg/m3
     Caulk applied to tile, wall
     and flooring seams, and
     other applications.
CARB: 4.0 % currently, 0.5% proposed

Green Guard (www.greenguard.org) Environmental
Institute—do testing for all interior finishing
products
     Finish applied to
     woodwork, casing, and
     other applications.
5 to 20%
10-20% initially, but
depending on the type
can yield significantly
cost savings over
useful life
5 to 20%
                                           10-50% (but
                                           increasingly commonly
                                           available and cost
                                           competitive)
Building Healthy Hospitals
An EPA P2 Project
                                                          2007

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                                      IndOOr Air Quality:  Materials Selection
                            HEALTHCARE - TOP 5 GREEN  BUILDING STRATEGIES
    EXHIBIT 1 | SUMMARY OF LOW-VOC BUILDING MATERIALS
    Material
Applicable Low-VOC Standard
Cost Premium
    Interior paints used for
    walls, fixtures, and other
    applications.
Green Seal:  Interior <50 grams/liter

GreenGuard:
•   Individual VOCs<0.1 TLV (Threshold Limit Value)*
•   Formaldehyde <0.05 ppm
•   Styrene <0.07 mg/m3 (milligrams per cubic meter)
   Total VOCs <0.5 mg/m3
•   Total aldehydes <0.1 ppm

US EPA: Zero-VOC <5 grams/liter
Minimally more costly;
paint quality is primary
cost factor
    Sealants
CARB:  4.0 % currently, 0.5% proposed
20-50% (but
increasingly commonly
available and cost
competitive)
    Note:  The Green Guide for Healthcare contains a good summary of more stringent and emergent
          standards,  http://www.qqhc.org/
The application of low-VOC products is in many instances identical to that of standard
products.  Based on their experience applying and maintaining low-VOC products, Emory
University and the University of Florida have noted the following:

   •   Color Availability. Emory indicated that very low-VOC and  no-VOC paints are not
       as widely available in dark or vibrant colors.

   •   Application. Low and No-VOCs paint can be applied in nearly the same way as
       conventional, high-VOC paints.  Both Emory and University of Florida maintenance
       staffs indicated that low-VOC paints are thinner than standard paints and require an
       additional coat for complete coverage. The Emory construction manager stated that
       use of low-VOC sealants had a "significant impact on indoor quality, primarily during
       construction, but the impact after construction was not as significant."

   •   Waste Management. Low-VOC and no-VOC paints are not  considered  hazardous
       waste materials, so disposal  is much easier than with standard paints.

Cost
All of the organizations specified low-VOC building materials where they were available and
did not conduct a cost/benefit analysis or cost comparison with more conventional choices
where  a low-VOC option existed.  In the absence of empirical data on cost comparisons, the
Building Healthy Hospitals                                                       200?
An EPA P2 Project                           4

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                                     IndOOr Air Quality:  Materials Selection
                            HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES

facilities estimated from 5-15% higher initial costs for the low-VOC alternatives depending
on the product, but no higher than a 10% overall increase in initial costs of the building for
specifying low-VOC materials. In fact, most cited a lower overall cost of interior finishes as
a result of minimizing the need for paints and finishes from other sustainable  material
choices (e.g., natural products like linoleum, concrete, steel, and wood).
          Case Study Vitals
The following summarize success criteria for implementing this project at other healthcare
facilities:

       Low-VOC products are widely available and increasing available for all interior finish
       products; specifications are product category-specific (e.g., different acceptable
       levels for adhesives versus paints).
   •   Specifying low-VOC materials should begin with design of underlying materials to
       minimize the need for finishes.
       Facilities select and specify low-VOC materials based on their assumed effect during
       construction and do not measure benefits past the commissioning stage.
Building Healthy Hospitals                                                     200?
An EPA P2 Project                         5

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