Green Guide for Health Care Version 2.2 Operations Section, 2008 Revision Comparison with GGHC Version 2.2, January 2007

Green Guide for Health Care Version 2.2 Operations Section, 2008 Revision Comparison with GGHC Version 2.2, January 2007 2.2 Mod New 0 79 42 Green Guide for Health Care Version 2.2 Operations Section, 2008 Revision - Total Credit Changes 0 0 1 Integrated Operations & Education P Prereq 1 Integrated Operations & Maintenance Process Source: Prerequisite new to the GGHC. IO Prereq 2. Credit Goals tightened to require inclusion of organizational stakeholders in the integrated operations decision-making process. Additional a credit goal requiring the creation of a health mission statement. 1 Credit 1 Education: Staff, Patient and Community Environmental Sustainability Education 0 1 8 Sustainable Sites Management 1 Credit 1.1 Site Management: Building Exterior & Hardscape Management Plan Source: LEED EB 2008 SS c2: Building Exterior & Hardscape Management Plan. Formerly half of GGHC ES c1. Updated to LEED EB 2008 language. Added more extensive guidance on the scope of the building exterior and hardscape management plan. Updated reference standards. 1 Credit 1.2 Site Management: Integrated Pest Management, Erosion Control & Landscape Management Plan 1 Credit 2.1 Reduced Site Disturbance: Protect or Restore Open Space or Habitat Source: LEED EB 2008 SS c3: Integrated Pest Management, Erosion Control and Landscape Management Plan. Formerly half of GGHC ES c1. Updated to LEED EB 2008 language. Added more extensive guidance on the scope of the landscape management plan. Updated reference standards. Source: GGHC v2.2 SS c5.1 and LEED EB 2008 SS c5: Reduced Site Disturbance: Protect or Restore Open Space. Source: GGHC v2.2 SS Credit 5.3: Site Development: Structured Parking. 1 Credit 2.2 Reduced Site Disturbance: Structured Parking 1 Credit 3 Stormwater Management Source: LEED EB 2008 SS c6: Stormwater Management. 1 Credit 4.1 Heat Island Reduction: Non-Roof Source: LEED EB 2008 SS c7.1: Heat Island Reduction: Non-Roof 1 Credit 4.2 Heat Island Reduction: Roof Source: LEED EB 2008 SS c7.2: Heat Island Reduction: Roof 1 Credit 5.1 Connection to the Natural World: Outdoor Places of Respite 1 Credit 5.2 Connection to the Natural World: Exterior Access for Patients Source: GGHC v2.2/leed HC SS c9.1: Connection to the Natural World: Places of Respite. Source: GGHC v2.2/leed HC SS c9.2: Connection to the Natural World: Exterior Access for Patients. 0 4 1 Transportation Operations 4 Credit 1.1-1.4 Alternative Transportation: Commuting 1 Credit 1.5 Alternative Transportation: Allowances Source: LEED EB 2008 SS c4.1-4.4: Alternative Commuting Transportation. TO c1.1-c1.3. Combined TO c1.1-c1.3 into a single, basket credit. Updated to LEED EB 2008 thresholds. 1 of 7

0 34 6 Facilities Management P Prereq 1 Energy Efficiency Best Management Practices: Planning, Documentation & Opportunity Assessment Source: LEED EB 2008 EA Prereq 1:Energy Efficiency Best Management Practices: Planning, Documentation & Opportunity Assessment. EE Prereq 1. Updated to LEED EB 2008 language. Added envelope systems as one of the P Prereq 2 Minimum Building Energy Efficiency Performance P Prereq 3 Refrigerant Management - Ozone Protection P Prereq 4 Minimum Indoor Plumbing Fixture and Fitting Efficiency P Prereq 5 Outdoor Air Introduction & Exhaust Systems P Prereq 6 Environmental Tobacco Smoke (ETS) Control 15 Credit 1.1-1.15 5 Credit 2.1-2.5 systems under review. Source: LEED EB 2008 EA Prereq 2: Minimum Energy Efficiency Performance. EE Prereq 2. Updated to LEED EB 2008 language. Added a phase-in pathway for facilities that cannot meet the threshold immediately. Require verification of energy performance ratings through certification by a licensed professional engineer or facility manager, either on staff or third party. Source: LEED EB 2008 EA Prereq 3: Refrigerant Management - Ozone Protection. EE Prereq 3. Credit Goal scope narrowed to new and replacement HVAC&R base building equipment. Source: LEED EB 2008 WE Prereq 1. WC Prereq 1. Updated to LEED EB 2008 language. Source: GGHC v2.2/leed HC EQ Prereq 1 and LEED EB 2008 IEQ Prereq 1. IO Prereq 4. Updated to LEED EB 2008 reference standard Source: LEED EB 2008 IEQ Prereq 2 and GGHC v2.2/leed HC EQ Prereq 2. IO Prereq 3. Credit Goals modified to require a smoke-free campus, including all buildings and public outdoor spaces. Exceptions: Licensed residential health care facilities, psychiatric wards, and substance abuse clinics. Optimize Energy Efficiency Performance Source: LEED EB 2008 EA Credit 1: Optimize Energy Efficiency Performance. EE c1. Updated to LEED EB 2008 language. Require verification of energy performance ratings through certification by a licensed professional engineer or facility manager, either on staff or third party. Potable Water Use Reduction: Total Building Reduction 1 Credit 2.6 Potable Water Use Reduction: Water Efficient Landscaping Source: GGHC v2.2 WE Credit 2: Building Water Use Reduction. WC c2. Added requirement prohibiting once-through potable water use for interior water features. If potable water is used in interior or exterior water features, it shall be separately metered and the water features consumption shall be excluded from the numerator of the water reduction calculation. Source: LEED EB 2008 WE c3: Water Efficient Landscaping and GGHC v2.2/leed HC WE Credit 1: Water Efficient Landscaping: No Potable Water Use or No Irrigation. WC c1.1. Reduced from 2 points to one: eliminate use of potable water for irrigations. Exceptions: If Infection Control does not permit non-potable irrigation, vegetated areas in compliance with GGHC SSM c4.2 and/or SSM c5.1-c5.2 may use a higefficiency irrigation system. 1 Credit 2.7 Potable Water Use Reduction: Cooling Tower (Chemical Management) Source: LEED EB 2008 WE c4.1: Cooling Tower Management. 1 Credit 2.8 Potable Water Use Reduction: Cooling Tower (Non-Potable Water Source Use) Source: LEED EB 2008 WE c4.1: Cooling Tower Management. 1 Credit 3.1 Existing Building Commissioning: Investigation & Analysis Source: LEED EB 2008 EA Credit 2.1: Existing Building Commissioning: Investigation & Analysis. 1 Credit 3.2 Existing Building Commissioning: Implementation 1 Credit 3.3 Existing Building Commissioning: Ongoing Commissioning 1 Credit 4.1 Building Operations & Maintenance: Staff Education 1 Credit 4.2 Building Operations & Maintenance: Building Systems Maintenance Source: LEED EB 2008 EA Credit 2.2: Existing Building Commissioning: Implementation. Source: LEED EB 2008 EA Credit 2.3: Existing Building Commissioning: Ongoing Commissioning. Reduced the number of hours of continuing education required from 24 to 8, but specified that hours do not count unless they are above and beyond licensure requirements on topics covered in the GGHC Facilities Management section. Added continuous commissioning to the list of appropriate course topics. Qualifying courses shall meet the quality standards for continuing education required by the staff member s licensing board. IO c1.2. Added credit goal for recently completed buildings requiring O&M documentation from the design and construction team. Added credit goal to use a formal Computerized Maintenance Management System (CMMS) to track equipment and trigger preventive maintenance, document history, and manage the maintenance program. 2 of 7

1 Credit 4.3 Building Operations & Maintenance: Building Systems Monitoring 2 Credit 5.1-5.2 Performance Measurement: System- Level Energy Metering 1 Credit 5.3 Performance Measurement: Enhanced Water Metering 1 Credit 5.4 Performance Measurement: Emissions Reduction Reporting 1 Credit 6 IAQ Management: Maintaining Indoor Air Quality 4 Credit 7.1-7.4 On-Site & Off-Site Renewable Energy Source: LEED EB 2008 IEQ c1.2: IAQ Best Management Practices - IAQ Management Program. IO c1.3. Updated to LEED EB language. Added credit goal that CO2 sensors be tested and calibrated once a year (rather than once every 5 years in LEED EB). Source: LEED EB 2008 EA c3.2-c3.3: Performance Measurement: System Level Metering. Formerly EE c5.1. Updated to LEED EB language. Source: GGHC v2.2 credit language rather than aligning with LEED EB 2008: WE c1.1-1.2. WC c3. Specify that metering is limited to potable water use. Revised the Intent Statement to align with LEED EB 2008. Source: LEED EB 2008 EA c6: Emission Reduction Reporting. EE c5.2. Added a credit goal to meet CA SCAQMD guidelines for all products of combustion. Develop and implement a review process to upgrade existing equipment to least emitting every 5 years. Use biofuels or other low-emitting fuels for generators and other diesel equipment. Source: LEED EB 2008 IEQ c1.1: IAQ Best Management Practices: IAQ Management Program. IO c2.1 Update to LEED EB 2008 language. Verify that the IAQ plan is in accordance with infection control and prevention protocols in the 2003 CDC/HICPAC Guidelines for Environmental Infection Control in Health-Care Facilities AND requires routine review of location of sterilization equipment, copiers, paint shops, and other indoor pollutant sources requiring air monitoring. Annually undertake air testing in compliance with OSHA Table Z-1 Limits for Air Contaminants. Maintain a minimum annual indoor air quality satisfaction rate of 80%. The IAQ plan must analyze and determine the root cause of IAQ incidents and compile documentation on the short term and long term actions taken. Source: LEED EB 2008 EA Credit 4: On-Site and Off-Site Renewable Energy. EE c2. Align on-site thresholds with LEED HC and off-site thresholds with LEED EB 2008. Require that on-site power generated through a Purchase Power Agreement only count towards the credit if it is used on-site or an equivalent number of Green-e certificates are purchased. Only facilities meeting an Energy Star score of 75 or nonrated facilities that use 25% less energy than industry average can achieve more than 1 off-site renewable energy point. 1 Credit 8 Refrigerant Management Source: LEED EB 2008 EA c5: Refrigerant Management, Option 2. EE c4. Update to LEED EB 2008 language. Aded an exception for small HVAC units. 1 Credit 9 Light Pollution Reduction Source: LEED HC SS c8: Light Pollution Reduction. 0 8 0 Chemical Management P Prereq 1 Polychlorinated Biphenyl (PCB) Removal and Asbestos-Containing Materials (ACM) Management Source: LEED EB Version 2, July 2005 edition: IEQ Prerequisite 4: PCB Removal. Expanded Prerequisite to include Asbestos-Containing Materials (ACM). Bifurcated the prerequisite into 2 paths: new construction and existing facilities. P Prereq 2 NEW: Chemical Management Policy and Audit New prerequisite. P Prereq 3 Community Contaminant Reduction: Leaks & Spills 1 Credit 1.1 Indoor Chemical Contaminant Reduction: Sanitary Sewer 3 Credit 1.2-1.4 Indoor Chemical Contaminant Reduction: Hand Hygiene Products, Sterilization & High Level Disinfection CM c1.2 Expanded prerequisite to cover both aboveground and belowground tanks. Safety requirements for outdoor storage facilities. Develop a plan to prevent materials/substances from dumpsters, compactors and outdoor hazardous or medical waste storage areas from entering stormwater runoff, and inspect and monitor storm drains at least quarterly to ensure proper clearance. facility. Credit 1.1: Sanitary Sewer: Ban discharge of untreated chemicals into sanitary sewer; test wastewater discharge. facility. Credit 1.2: Hand Hygiene: use an ICRA process to determine which areas of the facility may require the use of antimicrobial hand soaps. Credit 1.3: Sterilization: Replace the sterilant ethylene oxide (EtO) with safer alternatives for a minimum of 90% of equipment requiring sterilization. Credit 1.4: High Level Disinfection: Replace the high level disinfectant (HDL) glutaraldehyde with safer alternatives for a minimum of 90% of equipment requiring high level disinfection. 3 of 7

1 Credit 1.5 Indoor Chemical Contaminant Reduction: Laboratories 1 Credit 1.6 Indoor Chemical Contaminant Reduction: Radiology 2 Credit 2.1-2.2 Pharmaceutical Minimization, Management & Disposal facility. Credit 1.5: Labs: maintain a lab solvent reprocessing program; phase out use of mercury-containing fixatives, stains, and equipment; use automated lab equipment to maximize sample throughput while minimizing sample size. facility. Credit 1.6: Radiology: recycle silver and used lead aprons from Radiology; ensure that fixer solution from x-ray technology (where not digital) is properly captured and disposed of. Do not dispose to sanitary sewer unless tested for heavy metal content. Use either local exhaust controls or other HVAC design element(s) that facilitates safe removal of chemical vapors, to minimize occupational exposure in radiology per FM Credit 6: IAQ Management: Maintaining Indoor Air Quality. CM c3. Reorganized to cover both pharmaceutical management and disposal. Credit 2.1: Utilize a formulary review process to characterize hazardous pharmaceuticals per NIOSH and RCRA guidance and regulations. Develop and implement a policy for the receiving, handling, storage, labeling, transport and end disposal of hazardous pharmaceuticals. Credit 2.2: Minimize generation of waste pharmaceuticals. Best Management Practices for handling and disposal of toxic non-regulated pharma. Use stock rotation strategies to minimize waste. Log all pharma samples into the facility. 4 of 7

0 5 1 Waste Management P Prereq 1 Waste Management Plan Source: LEED EB 2008 MR Prereq 2: Solid Waste Management Policy. New prerequisite. P Prereq 2 Waste Generation Profile & Measurement P Prereq 3 Solid Waste Land Disposal New prerequisite. Solid Waste & Material Management: Waste Prevention & Reduction 3 Credit 1.1-1.3 Source: LEED EB 2008 MR c6: Solid Waste Management: Waste Stream Audit. Formerly WM Prereq 1. Scope expanded to cover more waste streams but also allow invoice review instead of a physical audit. Establish a current waste baseline. Convert baseline to adjusted patient day. Annually set waste segregation and reduction goals in alignment with GGHC WM Credits 1-3. Standardize vendors and set up a data collection procedure. Establish and maintain a process for tracking and continuous review/updating. Source: LEED EB 2008 MR c7: Solid Waste Management: Ongoing Consumables and MR c8: Solid Waste Management: Durable Goods. Waste Management Plan was moved to GGHC WM Prereq 1. Updated credit goals focus on developing policies specific to each waste stream/diversion program to be included in the Waste Management Plan. Raised the credit thresholds. Added credit goal to conduct site inspections at minimum on contract renewal for all final waste treatment, storage and disposal facilities. Avoid municipal waste incineration except where required. Construction and Demolition debris for new construction and renovations are excluded from this credit. 1 Credit 1.4 Solid Waste & Material Management: Source: LEED EB 2008 MR c9: Solid Waste Management: Facility Alterations & Recycling & Reuse of Facility Alterations Additions and LEED HC MR c2.1-2.2: Construction Waste Management: Divert & Additions from Disposal. 2 Credit 2.1-2.2 Regulated Medical Waste Reduction GGHC WM c2.1: Maintained the credit threshold, but expanded the scope of the credit to focus on education and collaboration with Infection Control and the Joint Commission s Environment of Care (EOC) committee or equivalent decisionmaking body. GGHC WM c2.2: Added a credit goal to segregate waste streams to ensure that no mercury or batteries are present in the portion of regulated medical waste stream bound for incineration. When considered non-infectious (or when feasible under regulations), avoid incineration of any halogenated compound. 0 7 1 Environmental Services 2 Credit 1.1- Environmentally Preferable Cleaning: Source: LEED EB 2008 IEQ c3.1: Green Cleaning: High Performance Cleaning 1.2 Policy Development Program. ES Credit 3 Expanded from 1 to 2 points with more clearly defined criteria. Reorganized to act as a gateway to GGHC ES c1.3-c1.6. As a result, it references the other credits in the ES section more than the old credit. GGHC ES c2.1: Establish standard operating procedures for the policy and strategies for promoting hand hygiene. Establish guidelines for safe handling and storage of cleaning chemicals used in the facility and regular staff education. GGHC ES c2.2: Establish a commitment to phase in implementation of ES c1.3-1.5 and c1.6, as well as floor care systems. No anti-microbial hand soaps/cleaners. Evaluate new technologies and collect occupant feedback. 3 Credit 1.3-1.5 Environmentally Preferable Cleaning: Products & Materials 1 Credit 1.6 Environmentally Preferable Cleaning: Equipment Source: LEED EB 2008 IEQ c3.4-3.6: Green Cleaning: Purchase of Sustainable Cleaning Products and Materials. ES Credit 4 Requires achievement of both points under GGHC ES Credit 1.1-1.2 before achieving this credit. Expanded the scope of the credit to many more certifications and updated the reference standards. Content for GGHC ES c1.5 was moved from GGHC v2.2 EP Credit 6: Janitorial Paper & Other Disposable Products. Source: LEED EB 2008 IEQ c3.7: Green Cleaning: Sustainable Cleaning Equipment. ES Credit 5 Requires achievement of both points under GGHC ES Credit 1.1-1.2 before achieving this credit. Updated list of standards for cleaning equipment program. Removed reference to propane-powered equipment. Added a requirement for staff training on proper equipment operating techniques before use. 1 Credit 2 Entryway Systems Source: LEED EB 2008 IEQ c3.8: Green Cleaning: Entryway Systems. 1 Credit 3 Indoor Integrated Pest Management Source: LEED EB 2008 IEQ c3.9: Green Cleaning: Indoor Integrated Pest Management. ES c2 Expanded scope of the credit goals and updated requirements regarding least toxic pesticides. Develop and implement the IPM program within 1 year. Include IPM requirements in in all pest control bid specifications. 5 of 7

0 5 12 Food Service 1 Credit 1.1 Sustainable Food Policy & Plan 1 Credit 1.2 Food Nutrition 1 Credit 2 Sustainable Food Education & Promotion 3 Credit 3.1-3.3 Local, Sustainably Produced Food Purchasing 2 Credit 4.1-4.2 Reusable & Non-Reusable Products: Food Service Ware 1 Credit 4.3 Reusable & Non-Reusable Products: Non-Food Service Ware Items 1 Credit 4.4 Reusable & Non-Reusable Products: Bottled Water Elimination & Public Drinking Water Access 1 Credit 5 Hospital Supported Agriculture: Food & Farm Linkages 1 Credit 6.1 Food Waste Reduction, Donation & Composting 1 Credit 6.2 Food Services Recycling 2 Credit 7.1-7.2 Food Vendors 2 Credit 8.1-8.2 Chemical Management for Food Services Source: LEED EB 2008 MR c5: Sustainable Purchasing: Food. EPP Credit 1.1 & 1.2. Expanded the scope of the credit to cover the majority of food types. Updated reference standards to the most recent certification and labeling information. Credit Goals transformed into a basket credit worth up to 3 points for annual combined food and beverage purchases from: 1) an independent 3rd party certified ecolabel, 2) a label claim allowed by USDA or FDA, 3) farms, ranches, and production/processing facilities located within a 200 mile radius. Updated thresholds: 1 point at 15%, 2 points at 25%, 3 points at 50%. EPP c1.3. Credit structure converted from either/or to a basket of options. 3 out of 7 options required to achieve a point. WM c3. Combines food waste reduction with composting/donation. Develop and implement a food donation program. Develop and implement a food waste composting program for all food use areas. Develop and implement food donation and food waste composting written management plans and include in the overall Waste Management Plan outlined in GGHC WM Prerequisite 1. Estimate and track pounds of donated food. Integrate food donation and composting programs into the facility's IPM plan. 0 8 12 Environmentally Preferable Purchasing P Prereq 1 Mercury Reduction Source: LEED EB 2008 MR c4: Sustainable Purchasing: Reduced Mercury in Lamps. EP c4.1. Broadened the scope of the credit to include more products and an emphasis on education. Specified a 5 year window for mercury phase out. Updated the reference standards. P Prereq 2 Electronic Assets Environmental Management Plan New prerequisite 1 Credit 1 Solid Waste Reduction in Purchasing New credit 2 Credit 2.1-2.2 Toxic Chemical Reduction in Purchasing EP c4. Updated to establish a framework for a facility-wide purchasing policy rather than targeting a small handful of chemicals of concern. GGHC EP c2.1: Establish a chemicals purchasing policy. Avoid: PBTs, bisphenol-a, carcinogens, mutagens, reproductive toxic chemicals, halogenated flame retardants, mercury, phthalates (specifically those listed under California Proposition 65 (Prop 65) plus Di-isononyl phthalate (DINP)), PVC. Give preference to: high post-consumer recycled content, readily recycled, reprocessed, and/or reused, latex-free, Take Back programs. Ensure regular staff education and an annual meeting with the facility's GPO. GGHC EP c2.2: Achieve 5 Credit 3.1- Toxic Chemical Reduction: Facility Source: active change LEED in HC minimum MR c4: PBT 3 chemical Source categories. Reduction. 3.5 Maintenance, Alterations & Additions New credit 1 Credit 3.6 Toxic Chemical Reduction: Furniture & Medical Furnishings 5 Credit 4.1-4.5 Sustainably Sourced Materials & Products: Facility Alterations & Additions Source: LEED HC MR c5: Furniture and Medical Furnishings EP c5. Updated to LEED HC language. Group 1 thresholds updated from LEED HC. Source: LEED EB 2008 MR c3: Sustainable Purchasing: Facility Alterations & Additions and LEED HC MR c3: Sustainably Sourced Materials and Products. New credit 6 of 7

3 Credit 5.1-5.3 Electronics Purchasing & End of Life Management Source: LEED EB 2008 MR c2.1-2.2: Sustainable Purchasing - Durable Goods EP c3. The GGHC v2.2 credit requiring the development of a purchasing plan was moved to GGHC EP Prereq 2. Updated format requiring achievement of GGHC EP c5.1 prior to achievement of GGHC EP c5.2 or c5.3. EP c5.1: End of Life Management is a new credit. GGHC EP c5.2 & c5.3 were formerly GGHC EE c3: Energy Efficient Equipment. GGHC EP c5.2 updated to align with LEED EB 2008 MR c2.1: Sustainable Purchasing - Durable Goods: Electric-Powered Equipment. GGHC EP c5.3 updated to align with LEED HC EA c7: Medical and Process Equipment Efficiency. 1 1 Credit 6 Office Supplies Source: LEED EB 2008 MR c1: Sustainable Purchasing - Ongoing Consumables. EP c2. Narrowed scope to office supplies. Simplified credit goals to require that 50% of all office supplies must meet the reference standards. Educate employees on environmentally preferable office products initiative upon hire and annually. 1 Credit 7 Low Emitting & Fuel Efficient Fleet Vehicles Source: GGHC v2.2 & LEED HC SS Credit 4.3: Alternative Transportation: Low Emitting & Fuel Efficient Vehicles. TO c1.2. Narrowed scope to fleet vehicles. Included owning, leasing or contracting with a service that supplies a low-emitting and fuel-efficient or alternative fuel vehicle fleet. Expanded alternative fuel fueling station criteria to cover both onsite and contracted off-site. 0 7 0 Innovation in Operation 4 Credit 1.1-1.4 Innovation in Operations Source: LEED EB 2008 IN c1: Innovation in Operations. Added credit goal that innovation proposals must require and track continuous improvement. 1 Credit 2.1 Documenting Sustainable Operations Cost Impacts: Overall Operating Costs Source: LEED EB 2008 IN c3: Documenting Sustainable Building Cost Impacts. Updated Credit Title and Intent. 1 Credit 2.2 Documenting Sustainable Operations Cost Impacts: Absenteeism & Health Care Cost Impacts IN c3.1. Removed reference to productivity. Expanded the scope to cover staff retention. Narrowed scope to documenting FTE staff activities, rather than all building occupants. 1 Credit 3 Research Initiatives Removed reference to productivity. Focused on public, third party research initiatives. Expanded the scope of research goals to include the local community and global environment. 7 of 7