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Technical Briefs


The Green Guide offers technical briefs covering a broad range of sustainable design, construction and operations issues. Authored by experts from the healthcare design and construction industry, each technical brief addresses industry best practices, health, ecologic and economic benefits, and case studies. Most offer specific correlation to Green Guide credits.

Acoustic Environment

Managing health care facilities’ acoustic environments by lowering noise levels and introducing appropriate levels of background sound to mask intruding noise can improve health care delivery. In addition, reducing noise-related stress may improve patient outcomes and staff performance and reduce health care costs. This technical brief applies to Environmental Quality Credit 9. (11 pages) Download PDF (0.96 MB)

Brownfield Redevelopment

Recognizing the additional effort required to develop brownfield sites and the benefits of infill construction, this technical brief provides guidance on achieving three points for brownfield remediation and redevelopment: Sustainable Sites Credit 3.1 directs projects to “effectively remediate site contamination,” Sustainable Sites Credit 3.2 rewards projects that reach the residential standard of remediation put forward by the EPA Region 9 Preliminary Remediation Goals (PRGs), and Sustainable Sites Credit 3.3 awards a point for projects that prevent infiltration from adjacent contaminated sites. (6 pages) Download PDF (0.52 MB)

Environmentally Preferable Products (EPP)

EPP criteria can target a wide variety of environmental and health issues and are addressed in EPP Credits 4.1, 4.2, and 4.3. However, comprehensive EPP policies in the health care sector should, at a minimum, avoid products containing mercury and DEHP (Diethyl-hexyl-phthalate) and provide alternatives to natural rubber latex products, the three materials focused on in this Technical Brief. (9 pages) Download PDF (0.75 MB)


Healthy food purchasing for health care facilities is achievable in several way, including 1) adopting a sustainable food policy and plan; 2) educational outreach both to facility staff and the surrounding community; 3) local, sustainably produced food purchasing; 4) use of reusable and environmentally preferred non-reusable food service ware items; 5) support of local farms, farmers’ markets, and community supported agriculture; 6) food donation and waste reduction; and 7) alignment of food vendor options with the facility’s healthy, sustainable food program. This Technical Brief provides guidance to achieve seven Food Credits of the Green Guide. (12 pages) Download PDF (0.24 MB)

Furniture and Furnishings

This Technical Brief provides guidance for achieving Environmentally Preferable Purchasing (EPP) Credit 5: Furniture & Medical Furnishings, which encourages phased purchasing of green furniture and furnishings in operational facilities. These EPP programs should address both the content of products (addressed in the Materials & Resources section Credits 5.1–5.3) and the level of toxic emissions produced by the product after installation (addressed in the Environmental Quality section Credit 4.5). (4 pages) Download PDF (0.39 MB)

Low-Emitting Materials

Common building materials emit chemicals during and after installation that can compromise indoor air quality (IAQ) and adversely affect the health of occupants. The smell commonly associated with new paint and new carpet can lead to acute reactions and chronic illnesses inside the building as well as causing smog formation outside. Advances in both testing technologies and understanding the health impacts of some of these chemicals have led to increasingly powerful health-based standards to screen materials based on their IAQ effects. This Technical Brief addresses the issues relevant to EQ Credits 4.1– 4.6. (7 pages) Download PDF (0.58 MB)

Low-Impact Construction

Low impact construction management practices covered in this Technical Brief can not only help minimize waste and potential undesirable cost overruns, but also prevent long-term adverse health impacts. The Green Guide for Health Care credits that encourage responsible construction management are organized into two groups — Construction Waste Management credits (GGHC v2.2 Materials & Resources Credits 2.1 & 2.2) and Construction Practices credits (GGHC v2.2 Materials & Resources Credits 2.3 & 2.4). (7 pages) Download PDF (0.58 MB)

Mercury Elimination

Mercury, a potent neurotoxin and a global priority pollutant, is a PBT, i.e., an environmentally persistent, bioaccumulative and toxic chemical. PBTs accumulate in animal tissue, resulting in increasingly higher concentrations as they travel up the food chain. Each of these conditions is further complicated by the toxicity of these chemicals, leading to long term impacts on human health and the environment. Up to 50 times more mercury has been found in medical waste than in general municipal waste, reflecting the high usage of mercury-containing devices in health care settings. Three Mercury Elimination credits are unique to the Green Guide for Health Care and reinforce the connection between green building practices and human health: Materials & Resources Prerequisite 2, Materials & Resources Credit 4.2, and Environmentally Preferable Purchasing Credit 4.1, as discussed in this Technical Brief. (5 pages) Download PDF (0.13 MB)

PBT Elimination

Persistent bioaccumulative toxicants (PBTs) are chemicals that do not break down rapidly in the environment, accumulate in living tissues and concentrate as they move up the food chain, and are hazardous to human and environmental health. A variety of PBTs, including halogenated compounds and heavy metals, are used in building materials or are a byproduct of the material life cycle, produced in manufacture or at disposal. The issues around several Green Guide credits (Materials & Resources Credit 4.1, Materials & Resources Credit 4.3, Materials & Resources Prerequisite 2 and Credit 4.2, and Environmental Quality Credit 4.5) are discussed in this Technical Brief. Download PDF (0.59 MB)

Pharmaceutical Management

Too often, pharmaceuticals and controlled substances, personal care products, and antimicrobials are disposed directly to the sewer. Conventional wastewater treatment is inadequate to render these compounds harmless; as a result, they are often discharged virtually unchanged to lakes, rivers, streams and oceans, where they can impact wildlife and humans. Waste pharmaceutical agents that are incinerated produce hazardous air emissions such as dioxins, acid gases, carbon monoxide, heavy metals and carbon dioxide. Chemical Management Credit 3 encourages health care facilities to develop and implement an integrated pharmaceutical waste management system and a pharmaceutical waste minimization plan, as discussed in this Technical Brief (17 pages) Download PDF (1.9 MB)

Places of Respite

To act as a place of retreat and revitalization, both indoor and outdoor places of respite must be disassociated from the direct delivery of medical care. The intent of the Green Guide Places of Respite credits (Sustainable Sites Credit 9.1 and Environmental Quality Credit 8.2) is to provide all occupants of health care facilities — patients, staff and visitors — places where they can come in direct contact with nature or natural elements. This Technical Brief reviews the issues and strategies associated with achieving these credits. (7 pages) Download PDF (0.6 MB)

Indoor/Outdoor Chemical and Pollutant Source Control

In health care facilities, the need for highly controlled interior environments can result in sealed buildings that re-circulate contaminants through the mechanical system. Staff, visitors, and patients track in particulates and other pollutants through entryways. Airborne pollutants can be introduced to the indoor air supply through improperly placed air intakes located near areas designated for idling vehicles. Facilities operations, clinical activities, and materials can further impair indoor air quality by emitting a variety of chemicals. This Technical Brief applies to Environmental Quality Credits 5.1 and 5.2. (7pages) Download PDF (0.65 MB)

Reducing Potable Water Use

Water use in hospitals reflects the services they provide, and varies by as much as 40 to 350 gallons per capita per day, depending on the facility type. The Green Guide for Health Care offers credit for reducing domestic potable water use in fixtures such as toilets and lavatories (referred to as domestic water), and for reducing potable water use in mechanical and medical equipment (referred to as process water). Process water comprises a majority of most health care facilities’ total annual water budget — about 70%. The Green Guide specifies three groupings of water efficiency strategies, plus Prerequisites: Construction Section Credits 2.–-2.5, and Operations Section Credits 2.1–5, and Credit 3, all of which are covered in this Technical Brief. (5 pages) Download PDF (0.11 MB)

Sustainable Site Design: Stormwater Mitigation

The Green Guide Sustainable Sites Credits 6.1 and 6.2 (Stormwater Management) recognize that responsible site design must be coupled with strategies that can capture, reuse, treat, and infiltrate the storm water runoff resulting from development by increasing the site’s total pervious area. Most of the recommendations in this technical brief combine both land and storm water management strategies because storm water quantity and quality concerns are significant consequences of site development. (7 pages) Download PDF (0.61 MB)

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