A recycling bin here, a geothermal system there: St. Cloud VA gets greener

Sometimes it's the small changes that make a difference: A recycling bin. Motion-sensor lighting. Reused envelopes. 

Then there are the big-ticket items.

• A new water reclamation system for the laundry reduced water use by 12,750 gallons a month. 
• A multi-million dollar geothermal heating and cooling system controls the temperatures in five buildings. 

Those are some examples of the small — and big  — changes the St. Cloud VA Health Care System is making every day to become a more environmentally friendly, sustainable entity.

For the second straight year, the system was named among the top 25 hospitals in the U.S. for environmental stewardship in health care. The award comes from Project Greenhealth, a national group dedicated to environmental sustainability in health care. More than 700 health care entities applied for the award, said Mary Wenck, green environmental management system project manager and facility sustainability coordinator.

The VA was also recognized for excellence in six categories: leadership, greening the OR, energy, water, climate and green building.

"(We're) recognizing that medicine is growing and is bigger, and now there's a true sense of modernization in what we do," said Stephen Black, health care system director. "Not only have we embraced it, but we're leading the country now."

The health system was also recognized for being mercury-free, a challenge in places such as the laboratory where mercury is used as a preservative in many chemicals. The VA has a process to ensure mercury isn't reintroduced into the system. 

In addition to being better for the environment, the process of becoming more sustainable helps staff evaluate systems for efficiency and quality. So almost every sustainability effort saves the VA money, Wenck said. 

For example, the St., Cloud VA received $68,000 in rebates from the various initiatives from its energy supplier and saved more than $54,500 in energy costs. 

"That's another LPN," Black said.

The yearly application process for the Project Greenhealth awards has become a way to make progress, Wenck said. 

"Writing in that application, we get to tell the stories about the stuff that every staff person, staff people do," she said. "It's just kind of fun because you get to collect all that, from the smallest thing to major water savings. It's such a good feeling."

All the small changes have added up to something big, Wenck said. 

"I think it really speaks to a culture we've really developed over the course of the last decade, plus," associate director Cheryl  Thieschafer said. "There's an incredible amount of enthusiasm and buy-in. A lot of our best ideas are coming from the staff themselves." 

They know they're not done. It's not an easy process as staff evaluates, tests and re-evaluates changes, Wenck said.

"That's how we bite off all of these things. You know, you can't do it all at once," Thieschafer said.

"It's a culture of continuous improvement," Black said.

Find out how staff are making small changes to become more sustainable below and using the Google map. 

Surgery departments can create a lot of waste because of the need to keep tools and environments sterile, said Brenda Schoenberg, a registered nurse in the department. 

"One of the things that makes it so hard to be green in health care is because there's just rules due to infection control," she said.

But many things can be reused or recycled if they are not contained. Anything that is contaminated is still treated as medical waste. Staff can also search for reusable alternatives that are just as safe and effective as one-use items. 

"So recycling, we really focused on in the last year," said Jody Wessel, certified surgical technician and LPN in the VA's surgery department. 

One material that continues to be difficult to recycle: soft, unformed plastic. 

A staff "green" team used a checklist to assess what they were doing and how it could be improved. Not everything they wanted to try was possible, but it was worth asking, they said. 

"That's one of the frustrations on our end," Wessel said, pointing to the blue wrap. "In a third-world country, this would be reused." 

Still, they've seen significant results. The department has increased its recycling from 30 to 40 percent. 

"It's a good start," Schoenberg said. "We'll find more." 

The surgery department now uses reusable sterilization cases. They hold surgical tools through sterilization and into the operating room. About 75 kits that are created for different types of surgeries now use reusable cases. Then, when the cases are no longer useful, they too can be recycled. 

Previously, sterile blue wrap was used. Now, it is only used when the reusable cases won't work. Staff also found a way to recycle the blue wrap if it's not contaminated, by getting it down to the Twin Cities. Staff is recycling about 100 pounds of blue wrap per month. 

"We could not find anyone who would recycle that in our area," Wenck said. "So we call that the underground railroad to Minneapolis, because they have the ability to do that."

People in the surgical unit collect the blue wrap throughout the day, and a housekeeper loads it on a bus to Minneapolis the next morning. Wenck said. At the end of the day, it goes into the housekeeping closet. The housekeeper brings it to their main office. The first housekeeper the next morning brings it out to load it on to the bus that goes to Minneapolis every day. 

"These guys, they just wouldn't give up," Wenck said. 

Sometimes it gets reused in more entertaining ways. For an event, staff made cheerleader pompoms, capes and Ninja glasses out of materials that can be recycled — and recycled them the next day. 

Staff made other simple changes, including adding recycling bins and looking for ways to replace one-use supplies with reusable items or recycle them after use. For instance, worn-out surgical towels are reused by maintenance workers in the workshop, as long as they are clean.  

"We tried everything," Wessel said. The towels clean up oil, bird pens and flower potting areas. 

Many changes are practices other medical facilities are already using. 

"(Some employees) came from facilities where they do this routinely," Wessel said. "So we've been wanting to do this for a while. But everybody just jumped on board, almost to the extreme. ... We're just doing a little bit of catchup."

The surgery department was been open only about six years, she said. 

The effort is fun for employees, and it aligns with the VA's greater mission to make a difference for veterans. 

"We're making a difference, and what better thing can you do in health care?" Wessel said. 

In a laboratory that performs about 100,000 tests a month, small changes to reduce waste, recycle and contain toxins can add up.

"It was an easy sell in the laboratory, in my opinion," said Jody Staples, a medical laboratory scientist. "This is our future, so let's take care of it."

The St. Cloud VA's laboratory has been mercury-free since 2011.

"There are very few medical laboratories that could claim that," she said.

Many chemicals have mercury in them as a preservative, but it's highly toxic. It took about six years of finding new products and then ensuring they worked as well by doing side-by-side comparisons.

"To find appropriate substitutes or to make a complete change in a product is hard," Staples said.

It continues to be a challenge as they have to check with manufacturers about exactly what is in every new product, in detail.

"Before anything can come in, it has to go through that entire process, so that we do not reintroduce any mercury," Staples said. "If there's a substitute that would be less harmful, then we'll go with that," 

Supply companies are changing too, following the trend. Now, when you order something, you can pull up a list and see everything that's in the product. 

"Back then, no. You had to call, fax, call fax," Staples said. "It got to the point where after maybe about six months I would get on the phone with their customer service and they would say, are you from Minnesota?"

Minnesota's Pollution Control Agency has tighter guidelines than the rest of the country, Staples said. 

Everyone in the lab tries to recycle as much as they can, by, for example, breaking down all the materials supplies are shipped in: cardboard and plastic.

"We've gotten to the point where we can recycle so much of our material that we had to have ... a very, very large bin. And by the end of the day, we will have this essentially full, of nothing going in the garbage and everything going into the recycling," Staples said. 

While their efforts are measured separately, they contribute to the St. Cloud VA's overall work. 

"Our facility recycling rate is 58 percent," Wenck said. 

There are small boxes to collect recyclables under almost every station.

"We're always collecting," Staples said. "Honestly, it's so ingrained in our staff that when we get a new product in, they look at what's left over. Is this recyclable? That's the first question."

Staff has also cut down paper use. By making one process paper-free, they save about a ream, or 325 sheets of paper, each week.

"That's a big deal. It adds up over the year," Staples said.

Across the VA, staff has reduced the amount of paper it uses and recycles all it can. The result: Paper purchases declined 8.5 percent in 2016. 

Laboratory staff also changed the blood culture collection system to reduce biowaste. 

The lab uses as many automatic light systems as it can to save electricity. 

The staff also tries to keep chemicals out of its wastewater. Nothing stronger than a light detergent goes into the city sewer system, which ends up in a river.

And staff has created ways to capture excess toxic chemicals so they can be properly recycled or disposed of.

It takes another container for Marcia Vejtruba, a radiological technologist, to show the numerous bottles and containers used for just one patient's CT, X-ray or MRI.

Some examples: cardboard that basic supplies come in, saline containers, syringes for contrast, glass bottles, IV water bags and IV bags.

"Once you get in the habit of doing it, it's pretty easy," she said.

"It's a culture thing," said Marilyn Crandell, a radiological technologist. "If you recycle at home, I think it's easier." 

"Not only do we recycle, but we reuse whatever we can," Vejtruba said.

They reuse envelopes to hold some scans as well as paper that doesn't have patient information on it.

"It might seem like a minor thing," Vejtruba said, but it makes a difference.

The department uses automatic light switches that shut off if a room isn't in use. They also reuse plastic bags. 

"We reuse them until we're really down to nothing," Vejtruba said. 

Sometimes they have to get creative, breaking stuff down to recycle at least part of the item.

"I keep getting calls all the time ... We've got this or we've got that. What can we recycle here?" Wenck said. 

In another department, staff discovered silver in electrodes for EKGs, and employees are trying to get that recycled, she said. 

Water reclamation saves water and energy, said Tony Arend, laundry mechanic. About 12,750 gallons a month in savings, he said. 

Efficiencies add up quickly: The VA laundry does 5,000 pounds of laundry a day, using three machines, two of which hold 500 pounds and third which holds 700.

A new water reclamation system was installed in 2016. The previous machines were from 1986.

Water from the final rinse is reused in the first cycle for the next load, which essentially just gets the laundry wet.  After that, water goes through a heat reclamation system. Water leaves the laundry cycle at about 140-150 degrees and is used to preheat fresh water — from 55 degrees to 105 degrees — without expending any energy. Then the laundry system only has to heat the water from 105 to 150 degrees.

"Instead of throwing that water away, we're actually reusing," Arend said. "It's a huge savings back." 

The VA is replacing heating and cooling systems with geothermal systems as they age out, said Jonathan Copeland, general engineer for the VA, or, as Wenck calls him, "Geothermal Jon." 

So far, four projects totaling $14.8 million are essentially complete, heating and cooling five buildings. 

Typically, geothermal heating and cooling only makes sense for buildings in use 24 hours a day, seven days a week, Copeland said. It's inefficient and difficult to heat or cool a building for only office hours.

The system can be used until it gets to be about 10 degrees outside.

"There's just not enough oomph to (heat) these buildings when it gets close to zero or below," Copeland said. Steam supplements when temperatures fall below that threshold. 

The systems works by exchanging heat through two closed water systems: one that flows from the wells  and back again, and the other which flows from the buildings and back again. So water that heats and cools buildings never directly mixes with water from the well field.

The well field has to be carefully managed.

"When it's hot in the summer, you take that heat out of the building by taking the cooler water from the ground. Then then you can put that heat into the ground over the summer. So that the temperature of bank of wells will increase throughout the summer," Copeland said. "Then in winter, when it's 40 degrees outside, you're reversing the process. You want more heat in the building. Since that bank of geothermal energy has been built up over the summer months, now you can rob it, you can take it back."

So the temperature of the source water decreases over winter and the process starts over again.

Engineers try to design a system big enough so that the difference in the groundwater temperatures from summer and winter is relatively small. For instance, a good rate would be from 50 to 60 degrees. If the groundwater gets too hot or too cold, the system won't work.

To keep this careful balance, each loop has a double. The system has redundancy and a dedicated generator in case the VA campus loses power. 

The well field that gathers water for the geothermal system contains more than 1,300 wells. They are 160 feet deep, which isn't ideal. The field is wider than it is deep, Copeland said.

"If you were doing geothermal, you'd prefer them to be 300 to 600 feet deep, but the challenge here is — what's the name of our city? — we have a granite ledge that runs from 160 to 180 feet deep," Copeland said. "The economics of trying to drill through that ledge to do a deeper heat exchanger is just not there." 

Right now, the system is moving about 3,000 gallons a minute through the pipes.

There is also plenty of room to expand the well field if more buildings switch to geothermal heating and cooling.  

When the VA added impervious surfaces by expanding a parking lot near a new building, it also built a stormwater reclamation system. The system prevents contaminants such as salt and sand used on winter roads from going into the river, Copeland said.

"Since 2010, we have reduced our ... direct discharge to the Sauk River by 7 percent," Wenck said. "That's improvement." 

The system captures rain and melting snow that covers the roof or parking lot, directing it into a collection tank. The water is routed into a below-ground chamber about two-thirds the size of the parking lot, and then seeps back into the ground

The system is big enough to contain any amount of water, as long as St. Cloud doesn't experience a 100-year-flood event.  

As a 93-year-old campus, much of the VA's sustainability efforts contend with the practicalities of older buildings. Still, the system has 20 buildings that are certified with three or four Green Globes, the highest ratings available for existing buildings. Green Globes is an online green building rating and certification tool, similar to LEED ratings. Two newer buildings have earned LEED silver status. 

Staff has also find a way to recycle or reuse old equipment. The St. Cloud VA is part of a General Services Administration excess program, sharing items such as computers, hardware and supplies with federal agencies. And they can look for items they're in need of. 

Last year, the St. Cloud VA sent out six and a half tons of materials to be used by another agency. 

The recent Veteran Summer Games are one example of the VA's commitment to the health and wellness of its patients and staff and the public. Wenck considers wellness to be part of sustainability for the VA.

The VA has built a walking path with exercise stations, baseball fields and a golf driving range for the use of veterans, staff and the public.

"It's a big thing. We're walking the talk. We're not just trying to fix ... sick people, we're trying to promote health and wellness," Wenck said. 

They also have wellness programs, Wenck said. The spaces can also be used for public events and VA initiatives, such as the Veterans Summer Games.

The VA's wind turbine was expected to significantly increase the facility's use of renewable energy, but performance  issues have hindered the project, said Barry Venable, public affairs officer with the St. Cloud VA. 

Projections indicated the turbine would produce 15 percent of the facility's annual electricity usage. During the brief periods when the turbine worked, it generated about 464,000 kilowatt hours of electricity. 

To put that in perspective, the St. Cloud VA consumed about 37 million kilowatt hours of electricity, costing $2.9 million in two years. 

A contractor was hired in 2009 to begin building the turbine and was ready for testing in 2011. However, it never successfully completed its tests, Venable said, due to "unresolved significant and material performance deficiencies."

The VA argued the contractor didn't complete its duties, and eventually settled with them for $450,000. Staff decided pursuing litigation would have further delayed the project and would not have resulted in an operable wind turbine. 

Last September, the VA commissioned a study on what to do with the existing windmill. The study will look at wind energy in the area, whether another turbine can be installed on top of the existing tower or if a new turbine is needed. The VA expects the study to be complete in 2018. 

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