Naval Hospital Bremerton (NHB) is a recipient of the Chief of Naval Operations (CNO) Environmental Award for fiscal year 2016.

Deputy CNO for Fleet Readiness and Logistics, Vice Adm. Phil Cullom, announced the winners of competition in a naval message released March 15 which honored exceptional achievements in environmental stewardship among nominated ships, installations, and individuals on an annual basis. NHB earned recognition for the Sustainability, Non-Industrial Installation category.

Since 1897, NHB has been present in one form or another along the western shores of Puget Sound, Washington. The current hospital buildings opened in 1980, and are located along Ostrich Bay on a 49-acre campus.

"We live and work in such a great area, and our staff continually focus on keeping the environment in a pristine state," said Cmdr. Robert McMahon, Fellow of the American College of Healthcare Executives (FACHE), NHB director for administration. "We promote recycling, waste reduction programs, water and energy conservation all the time. Our Environmental Management Division is always helping us improve and evaluate what we can do to get better in our environmental stewardship."

In such an ecological diverse region of open-ocean, old growth forest and surrounding mountain ranges, NHB has continually maintained high standards of environmental stewardship and has fostered environmental collaboration with community neighbors such as Native American tribal entities, local city and county agencies and other federal departments. From reclamation projects on existing campus grounds and shared beach/tribal clamming areas, to energy conservation, to strict regulation of hazardous material, the NHB and branch clinic staff of over 1,400 military, civilian, contractor, and American Red Cross volunteer personnel have long been at the vanguard of compliant and proactive environmental stewardship.

The sustainability program at NHB is managed by Facility Management Department's Environmental Management Division, led by Robert Mitchell, environmental program manager; and Ramon Calantas, environmental technician; and assisted by all contributing staff members, who collectively for the last several years have deployed programs to improve NHB's sustainability posture.

Environmental policies and procedures regarding sustainability are routinely explained with all new incoming staff during command orientation on a monthly basis.

"The continued awareness campaign efforts have helped with a behavioral and culture change at NHB to be environmentally conscious, and in turn good stewardship to the environment," said Mitchell, who noted the most difficult aspect of them is to be constantly aware of laws and regulations -- be it federal, Navy, state, county, or city.

"My goal is to protect the environment, as well as our staff, beneficiaries, and visitors," stated Mitchell, who has been at NHB for 17 years, six as an environmental contractor and 11 in his current role. "It is most gratifying to have no environmental incidents, mainly spills or exposures to the staff and to ensure we have trained personal and operating procedures in place."

Additionally, staff, volunteers, guests, and beneficiaries receive information regarding environmental concerns and issues through Plan of the Week and Daily Updates notifications, and at specific events like Earth Day, and Energy Conservation Awareness week.

"During command orientation, I emphasize that every person in the command plays a key role in our environmental sustainability successes," added Calantas. "Some of our sustainability achievements were ideas shared by new staff members that we have applied. Many have taken ownership of our mantra, 'Celebrating Earth Day every day, get involved.' We keep preaching at every opportunity that environmental sustainability is not a program that our office manages; rather it is an all hands on deck evolution."

The command has a robust waste reduction program and partners with Stryker Corporation, a medical materials and equipment manufacturing company, to collect and return FDA classified "single used devices" used in the operating room, instead of disposing of them as medical waste. After reprocessing, these devices are available for purchase at up to a 50-percent reduction in cost as compared to new devices. Devices used in this program include arthroscopic wands and shavers, bits, blades and burs, laparoscopic instruments, suture passers, trocars, ultrasonic scalpels, and ligature sealer/dividers. In fiscal years 2015 and 2016, almost two tons of single use devices were recycled through this process.

The hospital also recycled approximately 250 pounds during the last two fiscal years of various non-invasive medical devices, including compression sleeves, pneumatic tourniquet cuffs, pulse oximeter sensors, electrocardiogram (ECG) leads and cables, blood pressure cuffs, splints, cervical collars, stethoscopes, and pressure infuser bags. At one point in time, all of these items were disposed of as solid waste, with associated costs and environmental impact.

The laboratory's histology department supports the hospital's sustainability program by recycling chemicals used in the laboratory processes. Alcohol stains and xylene are used in the preparation of patient specimen for analysis, and in many hospitals the waste fluids generated are disposed of as hazardous waste. But at NHB, these solvents are recycled and reused many times over through use of a solvent still. Along with reducing waste volume, this process also significantly reduces the need and cost to purchase the large volumes of chemicals needed for these processes.

NHB's branch dental clinics located in Naval Station Everett, Naval Base Kitsap Bangor, and Puget Sound Naval Shipyard all have a toxic chemicals reduction program. Each has installed an amalgam collection filter to collect amalgam debris from the dental chairs. Amalgam fillings contain silver and mercury, heavy metals which can have major effects on the nervous system, and are designated toxic waste in Washington State. There are environmental compliance rules to keep the amalgam out of waste water systems.

The amalgam separator systems utilized at NHB dental clinics met the necessary standards and are certified to remove greater than 99 percent of mercury and other heavy metals from the dental clinic wastewater, which exceeds federal requirements. Once collected, the amalgam separator is sent to an Environmental Protection Agency approved recycler, rather than the more common practice of disposal as hazardous waste. Along with costs savings, recycling of amalgam waste helps to ensure the heavy metal contaminants do not have the opportunity to enter any water systems.

NHB Pharmacy, in partnership with the Environmental Division, implemented an innovative program to safely handle discarded medications. A MedSafe disposal container was placed in the outpatient pharmacy lobby, and also at Branch Health Clinic Everett which are available during normal hours of pharmacy operations for patients to discard used or outdated pharmaceuticals. This process ensures pharmaceuticals are disposed of in a safe manner, and do not inadvertently enter the environment. This program also involves patient education and public relations efforts regarding the potential for abuse of medications, and the importance of a safe collection and disposal.

As a major patient portal, the deployment of a high-profile program such as this in the pharmacy sends a strong message to patients and staff regarding our commitment to sustainability and environmental stewardship.

NHB was also one of only two Navy military treatment facilities recognized by the Secretary of the Navy's Energy and Water Management Award program for fiscal year 2016. NHB received a gold-level award, reflecting the command's "very good to outstanding energy or water program." The award was a result of several different strategies, including energy awareness static displays, staff training, implementation of a formal command energy policy, attentiveness to culture and awareness, and installation of occupancy sensors for lighting and ventilation. Additionally, the completion of energy audits and recommended system modifications and replacements created significant savings.

NHB implemented using the Navy's regional qualified recycling program (QRP), enabling efficient recycling of used cooking and motor oil, antifreeze, printer cartridges, plastics, office paper, cardboard, scrap metals and light bulbs, ensuring these materials are not sent to a landfill. Additionally, the QRP is able to sell many of these waste products, helping to sustain the program through internally generated revenue.

Cost savings resulting from the hospital's sustainability programs has helped to support the command mission by improving the efficiency and cost effectiveness of internal medical departments. NHB utilizes established medical principles of continuous process improvement to assess and evaluate programs for sustainability opportunities, as well as improvement opportunities created by the availability of new technologies and revisions to applicable regulations and policies.

And NHB continues to be proactive with environmental stewardship. Recently installed bottle fillers in 14 drinking fountains is reaping ecofriendly benefits. Just one has dispensed the equivalent of 192 bottles of water in one work week, thus theoretically keeping that many plastic containers out of recycle bins, trash cans, and landfills.

"Being recognized is validation that the environmental staff and departmental environmental management system champions are actively involved and engaging staff to adhere to environmental concerns and procedures," concluded Mitchell.

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