Investigatinon of Green Hospital Standards in Jiroft Hospitals
 
Najme Mashayekhi Mazar ¹, Mohammad Hassan Ehrampoush ¹, Ali Asghar Ebrahimi ¹, Mohammad Taghi Ghaneian ¹, Maryam Dolatabadi ¹, Roohollah Askari ^2*
 
1 Environmental Science and Technology Research Center, Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
² Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
 

Citation: Mashayekhi Mazar N, Ehrampoush MH, Ebrahimi AA, et al. Investigating Green Hospital Standards in Jiroft Hospitals. J Environ Health Sustain Dev. 2019; 4(1): 701-9.
 

Nowadays, organizations need a type of performance assessment system to expand development and stability in the competitive arena. Applying performance assessment systems in hospitals is considered as an important priority since it can increase the service quality and lead to accountability transparency. Hospitals throughout the world attempt to create innovation in the field of patient care, however, maintaining high-quality standards is necessary. In executing this innovation, hospitals affect the natural environment; therefore, to decrease the damage to patients, the surrounding societies, environment, hospital managers always design managerial plans on energy maintenance, proper disposal of medical waste, and safe pharmaceutical management ^{1, 2}. These plans have been introduced as green hospital. Green and healthy hospital is the one which improves people's health through the constant decrease of environmental consequences and improving its part against the illnesses. Green Hospital knows the connection between human's health, environment and demonstrates this knowledge through the type of control, strategy, and operation ^3-5. Through investing in safe buildings, green purchase and executing a stable operation, hospital and health systems, in addition to confronting climate changes, can improve stability, equality and maintaining the environment ^{6, 7}. Hospitals, clinics, and doctors' offices have been established as organizations which aim at controlling and treating illnesses and keeping people healthy.  Therefore, they have the responsibility of maintaining the environment ^{8, 9}. Improper management, high-risk garbage production, air spreading and disposed sewage can lead to soil, water, and air pollution ^{10, 11}. Improperly refinement, storage, transfer or management, can have negative effects on human's health and the environment. In Brazil, the execution of solid waste management plan in health units is mandatory ¹². For the proper management system of the waste material, it is necessary to join many factors such as collective health, economic situation, social aspects, discipline, and hospital management in the system ^{13, 14}. One of the most important and basic steps in developing a plan or executing risk and cost analyses about solid waste management is to know the quantity and characteristics of the materials ¹⁵. Environmental innovations in this setting include reuse and recycling plan ¹⁶. There are many tools for improving the environmental effects of an organization and its connections which are optional approaches. The stable hospital plan at Massachusetts Lowell University began in 1100 to present a technical scientific guideline to the medical industry for choosing products and promoting actions of occupation and health and environment safety Sustainable Hospital Program (SHP). The complete aggregation of occupational, environmental and safety health is a comprehensive solution to the health stability ^{17- 19}. 

To attain green hospital approaches, Environmental Management System (EMS) helps companies to reduce the negative effects on the environment while ameliorate their economic effectiveness ²⁰.

In Iran, the majority of the problems is accompanied using a considerable development in the medical care section, with little compatibility or lack of compatibility with advice and strategy ²¹. There are nearly no training courses on hospital waste management and hazardous waste ²². The provided training courses were ineffective or inappropriate. One of the specific obstacles to attaining the environmental management system is training. Training is a key factor throughout the execution of EMS and it may change attitude and behavior among managers and staff ²¹. 

Shabani et al explored and compared the existing patterns green hospital in the world. This study has been conducted in a comprehensive overview by searching on the corporate sites and validated domestic and foreign electronic databases to identify green hospital types ²². As well as, Jongwutiwes et al, has been known the role of environmental education to improve the level of awareness of staff and hospital managers as the most important and fundamental step in the process of establishing and maintaining an environmental management system in hospitals ²³.

By implementing the environmental management system, good health facilities can prevent pollution and potentially adjust the effects of their products and services life cycle. As a step to support stable development in the society, executing environmental systems is vital ²⁴. Therefore, considering the importance and significance of this issue, the present study investigates the presence of green hospital standards on improving Jiroft hospitals performance.  Current study, investigates the presence of green hospital standards in accordance with ISO 14000 standard in Jiroft hospitals in order to improve the performance of them. Finally, based on the obtained results, the condition of Jiroft hospitals in attaining green hospital standards in accordance with ISO 14000 will be identified and presented more precisely and comprehensively. 

Materials and Methods
Research Questions

The main purpose of the study is investigating and analyzing the condition of Jiroft hospitals in attaining green hospital standards in accordance with ISO 14000 in the year 2016.

 
Table 1: Analysis of variables in the research questions.

Variables	Mean ± SD	P-Value
Environmental management system	2.30 ± 0.22	0.000
Laboratory, laundry, and kitchen condition	3.06 ± 0.46	0.003
Hospital solid waste material management	3.02 ± 0.25	0.001
Energy management	2.16 ± 0.25	0.000
Dangerous and infected waste material management	2.47 ± 0.26	0.000
Water management	3.03 ± 0.32	0.001
Sewage management	2.80 ± 0.32	0.010
Contaminants management and spreading to the air	3.03 ± 0.41	0.005
Outlet water management and use	2.79 ± 0.42	0.027
Material management and environmentally preferable purchase	2.45 ± 0.29	0.000
Environmental strategies	2.96 ± 0.42	0.000

Discussion

Organizations, of any type, are constantly interested in creating accurate environmental attitude through controlling the consequence of their services and products on the environment. Since, consequences such as the ever-increasing environmental pollution as well as decreasing of natural resources and energy crisis have caused green hospital design to play an important role. It is done by increasing the efficiency of the building, saving energy consumption, and generally being aligned with environmental standards. Observing safety in clinical laboratories to protect the staff and patients' health, the equipment and facilities of the laboratory as well as the environment is of the highest importance. Neglecting the safety in the clinical laboratories can be very costly. The occurrence of safety accidents in laboratories can have secondary results, such as losing reputation, decreasing the number of clients and consequently the income, negative effect on keeping the staff, and finally increasing the expenses regarding the legal issues and  insurance. Due to the constant progress of technology, human community is suffering from numerous problems. Duty of architects is providing mental and spiritual well-being of people in society. One of the areas being neglected is hospital environment.  People are hospitalized for various reasons. Nowadays, hospitals have adopted an approach which has changed them into medical care centers accompanied with innovation and conscientious care of patients, where the high standards of quality are present in accordance with current expenses. Since hospitals manage their expenses while paying purposeful and conscientious attention to patients, adopting this approach seems to be effective. Furthermore, the managerial approaches in today's hospitals have pressured the environment enormously. This has increased the hospital expenses, and also has had a serious effect on the increase of illnesses in society. In other words, hospitals have become entangled in a managerial paradox. 

Therefore, to control the environment in recent years, various formations and organizations have been pressuring the medical centers for protecting energy and appropriate disposal of medical waste. However, these social and governmental pressures have caused the increase of expenses and superficial control. In the meantime, some hospitals have adapted the "Do No Harm" approach, which is doing what is harmless not only for patients but also for their surrounding societies and  environment. The main task of the hospital is health improvement. Performing this task is affected by various factors; including observing the environmental hygiene standards and neglecting which can cause problems for the hospital in performing its mission. This point is important that any new approach for environmental management includes systems to guarantee permanent success, and needs a continuous process of refinement and improvement in this regard. This environmental management system should include specific purposes, timing, personal responsibility for pursuing projects and other time-taking and practically long chances. This managerial plan should also include improving environmental conditions for the future of strategic planning or other predictable tools. In this method, the environmental management system can be a part of greater goals of organization which new needs and specific obstacles can get more attention. With regard to the constant increase of population and subsequently producing more waste material, creating the accurate management system for disposing is inevitable. Hospital waste forms a considerable amount of produced waste. Given the fact that hospital waste is normally infected, attaining a fixed, management model seems highly crucial. The results of this part of study confirmed with the study of Shabani et al and Jongwutiwes et al ^{22, 23}, but in conflict with the results of the investigation of Tudor et al ²¹.

Medical waste management (MWM) is an important general health concern throughout the world. One of the first essential steps in the process of developing a reliable plan for garbage management is the need to comprehend the quantity and quality of the garbage. Furthermore, medical waste is a special group of waste which is highly dangerous due to the infected or toxic features. Neglecting the management and control of the medical waste in different phases of production, storage and collecting, transporting, and final disposal will cause numerous problems. Therefore, the environment and human's health will be subject to serious danger. Hence, planning medical waste management is done for the purpose of preventing the undesirable effects on human's health and the environment. Askarian et al in his study concluded that effective waste management in hospital could reduce health risks and increase environmental protection, which is consistent with the results of this study ²⁷.

Conclusion

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