DISINFACTS | Special edition 2023

Special edition 2023 DISINFACTS GREEN

This edition is printed on recycled paper PRACTICE Where are most climate-damaging emissions generated? 04 Sustainable hand hygiene 17 Sustainability in healthcare facilities: Status quo and future challenges 21 Single-use and reusable products: The green equation 22 INTERVIEW Professional waste management pays off 06 Bacillol® Zero is the next generation of surface disinfection 12 The highlight is the novel active ingredient 13 Climate protection must reach the management level of hospitals! 19 KNOWLEDGE Recycling of foil packaging 09 Sustainability: The most important terms 10 Sustainability: The most important certifications and labels 14 Global Perspectives on Sustainability 18 FORUM Bacillol® Zero Tissues 17 EVENTS Highlights of the HSC online symposium 2023 20

3 Editorial Dear readers, Precaution for human health also includes the protection of the natural environment. This is becoming increasingly clear - at the latest - in times of climate change and in view of dwindling natural resources. The entire healthcare industry therefore has a duty to develop sustainable working methods and products. For this reason, we have decided to publish this special issue of our DISINFACTS magazine. In this issue you will find food for thought and solutions that show how the balancing act between patient and environmental protection can succeed. One such solution that we would like to present to you are the new Bacillol® Zero Tissues from HARTMANN. We have used sustainable components at every level of the product for these disinfectant wipes. This ranges from the packaging - foil and cardboard - to the wipes themselves and our new active ingredient complex based on organic fruit acids. However, recyclable products only achieve their full environmental effectiveness if they are actually recycled. In an interview, an expert from Bonn University Hospital explains why this is a problem in the German healthcare sector and what modern and financially rewarding waste management in hospitals can look like. The project "Klimaretter - Lebensretter" (Climate Savers - Life Savers), which was launched in 2017 by the viamedica Foundation in Freiburg, shows what climate protection in the healthcare sector can look like. At the same time, however, a study by the foundation also shows that there is still a lot to be done if climate protection and everyday hospital life are to be reconciled in the future. With this in mind: enjoy reading and stay healthy! Yours, Dr. Heide Niesalla Head of HARTMANN SCIENCE CENTER Dr. Henning Mallwitz Director Research & Development Dr. Heide Niesalla Dr. Henning Mallwitz

are 17.5 and 9.2 kg per scan, respectively. To save resources, unnecessary examinations could be avoided, and equipment could be utilised more intelligently and switched off completely during idle periods [9]. A ward with 20 beds consumes up to 10,000 litres of water per day The valuable resource of water is also consumed on a large scale in hospitals, e.g. for laundry, sterilisation, heating, and cooling. In Germany, for example, about 500 litres of water are needed per bed every day [10], which amounts to 10,000 litres in a 20-bed ward or 250,000 litres in a 500-bed hospital. For the prevention of legionella in drinking water alone, the 5-minute flushing of 40 taps at 15 L/min each, which should be done every 72 hours, results in 7,000 litres per week. The road to a climate-neutral hospital is long, but things are happening In order to counteract climate change, the healthcare system must also be drastically rethought. Since more and more people will fall ill as a result of climate change - e.g. due to extreme heat or poor air and water quality - not only must the hospital's own emissions be reduced, but efforts must also be made towards primary prevention. The topic of "sustainable hospitals" is fortunately gaining more and more attention, but there is still a long way to go and it requires the commitment of everyone involved. 4 KNOWLEDGE While direct (Scope 1) and indirect emissions from purchased electricity, heating, etc. (Scope 2) together account for just under a third, the lion's share is accounted for by the so-called Scope 3 emissions [1], which include goods, services, production, and transport (see article "Sustainability reporting" on p. 21). To identify potential savings, it helps to take a closer look at the biggest "climate sinners" in hospitals. Anaesthetic gases account for the majority of emissions in the operating room Anyone who is not an expert would hardly think that anaesthetic gases have an extreme greenhouse effect. In fact, gases such as desflurane and sevoflurane are hundreds to thousands of times more harmful to the climate than CO2 and can account for two-thirds of the emissions in the operating room or onethird of hospital-wide emissions [2-4]. For example, the climatedamaging effect of a 7-hour operation with desflurane is roughly equivalent to a car journey from Germany to China (approx. 8,000 km) [4]. In addition, the heating, ventilation, and air conditioning of operating rooms can account for up to 84% of the emissions of the operating room in individual cases, depending on the type of electricity generation [3], while the heating of the entire hospital accounts for about a quarter of all hospital emissions on average [5]. Inpatient care, catering, and transport with a large carbon footprint Inpatient care has not been resource-saving either. While an acute ward produces 5.5 kg of waste and 45 kg of CO2 per patient per day, an intensive care unit produces 7.1 kg of waste and 138 kg of CO2 [6]. In a fully occupied 500-bed hospital with 20 intensive care beds, this would add up to almost 9,000 t of CO2 per year. There is also great potential for savings in catering, which is responsible for about 17% of all hospital emissions: here, for example, a wider range of regional vegetarian dishes could have a positive effect on the carbon footprint [5]. There is also considerable potential for savings in commuting or travel by employees and in patient and visitor transport, which together account for about 18% of CO2 emissions, e.g. through more sustainable types of driving and switching to public transport or the bicycle [7]. As the production of medicines is energy-intensive and medicines cause about 12% of hospital emissions, it would also help to deal with them in a more sustainable and forward-looking manner [3]. Diagnostic imaging also contributes to emissions Diagnosis always precedes treatment. Since about every fourth to fifth hospital stay requires diagnostic imaging [8], these - often energy-intensive - procedures are also included in the overall calculation. For example, the average CO2 emissions of a magnetic resonance imaging and a computed tomography Where are most climate-damaging CO2 emissions in the healthcare system The healthcare system promotes the health and well-being of the population. However, greenhouse gas emissions from the healthcare system are high and contribute significantly to man-made climate change and thus to health damage. The healthcare sector is responsible for 4.4% of all CO2 emissions worldwide and thus - if it were a country - would rank fifth among the countries with the highest CO2 emissions [1]. References 1. Karliner J et al. (2019) Health care’s climate footprint, How The Health Sector Contributes To The Global Climate Crisis And Opportunities For Action. https:// noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf (accessed 26.06.2023) 2. Richter H et al. (2020) Der CO2-Fußabdruck der Anästhesie. Wie die Wahl volatiler Anästhetika die CO2-Emissionen einer anästhesiologischen Klinik beeinflusst. Anästh Intensivmed 61: 154-161. https://doi.org/10.19224/ai2020.154 3. MacNeill AJ et al. (2017) The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health 1: e381-e388. https://doi.org/10.1016/s2542-5196(17)30162-6 Water consumption: 500 L per bed per day [10], approx. 7,000 L per week for water pipes flushing

5 KNOWLEDGE emissions generated? Note: The figures come from different studies from different hospitals in different countries and are therefore only comparable to a limited extent. In this article, CO2 equivalents also fall under the term CO2 for simplification. CT = computed tomography; MRI = magnetic resonance imaging. The global healthcaresystem is responsible for 4.4% of CO2 emissions, and would rank fifth among the countries with the highest CO2 emissions [1]. KLINIKUM Heute: Up to1/3 of total hospital emissions [4] Anaesthetic gases: Imaging in hospitals per year: approx. 13 million MRI and CT: 17.5 and 9.2 kg (Ø) per scan, respectively [9] Catering: approx. 18% of hospital emissions [5] [8] 4. https://www.bund-berlin.de/fileadmin/berlin/publikationen/Klimaschutz-pdf/Fact-Sheet_Narkosegase_und_Klimaschutz_Update.pdf (accessed 26.06.2023) 5. Keller RL et al. (2021) From bandages to buildings: Identifying the environmental hotspots of hospitals. J Cleaner Prod 319: 128479. https://doi.org/10.1016/j.jclepro.2021.128479 6. Prasad PA et al. (2022) Environmental footprint of regular and intensive inpatient care in a large US hospital. Int J Life Cycle Assess 27: 38-49. https://doi.org/10.1007/ s11367-021-01998-8 7. Tomson C (2015) Reducing the carbon footprint of hospital-based care. Future Hosp J 2: 57-62. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465872/ 8. https://www.bpb.de/kurz-knapp/zahlen-und-fakten/datenreport-2021/gesundheit/330100/diagnose-und-behandlung-im-krankenhaus/ (accessed 26.06.2023) 9. McAlister S et al. (2022) The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac 24: 100459. https://doi.org/10.1016/j.lanwpc.2022.100459 a 10. https://www.abfallmanager-medizin.de/zahl-des-monats/ein-krankenhaus-verbraucht-pro-bett-bis-zu-500-liter-wasser-am-tag/ (accessed 26.06.2023) HOSPITAL

6 INTERVIEW "Professional waste management pays off" As a maximum care provider, Bonn University Hospital (UKB) is increasingly relying on sustainable processes for waste disposal. Michael Schmitz, Head of Department in Facility Management, Waste Management Officer, and Head of the Sustainability Unit, explains why this feels good and what’s more, it pays off. Example Bonn: Using hospital waste as an opportunity We have therefore completely restructured our waste management processes. In collaboration with a company from Hamburg, we developed a digital management system as an industry solution for medical facilities in 2019. We now have the capacity to electronically document all waste streams. I can now see exactly what waste is generated where and in what quantity, and how and where it is disposed of. I can also assess the utilisation of the respective areas, such as the optimisation of our logistics. This is immensely valuable if you want to optimise routes and disposal flows and avoid traffic congestion. In short, we now have all the important data and a complete overview! Did you come across any surprising discoveries? Not particularly. The data largely revealed what I feared: really poor waste separation. However, this is a very big problem throughout the healthcare system. The healthcare sector is Germany’s fifth-largest waste producer, with 1.2 million tonnes. This highlights the enormous potential for improvement in terms of closing the material cycles and not burn the recyclables. In the meantime, we have introduced numerous separation containers at the various collection points and now prioritize early-stage waste separation. How many fractions do you distinguish? Currently, we categorise our waste into approximately 20 distinct fractions. It spans from non-infectious hospital waste to medical waste – such as pathological waste or cytostatics – and extends to items we aim to recycle. This includes cardboard, paper, and lightweight packaging, akin to what is in the yellow bag at households. We also collect wood separately. Construction waste is also a consistent by product in a hospital environment, as is bulky waste and electronic waste. We also have a dedicated separation process for glass waste. For instance, infusion bottles are no longer incinerated at our hospital. Even though there is a higher potential for further separation in the clinics, we are subject to strict waste legislation, which limits our sorting efforts. For example, materials that have come into contact with patients must not end up in a sorting plant, but must be disposed of thermally. In other words, they must be incinerated. Mr Schmitz, you have been at Bonn University Hospital since 2017. How important is sustainability in your institution today? And how has it changed since you joined? Sustainability has become a very important topic. For example, we have founded a sustainability working group which came into being at the initiative of the employees. All ideas for restructuring also came from the staff and were not suggested or demanded by the board. The working group is called "UKB Green". It currently consists of 42 colleagues from different disciplines. I find that the interactions within the group are a real added value because they offer me fresh insights from the different disciplines. But basically, our goal has always been about making the healthcare system more sustainable. What are the specific topics you discuss? And how effective have the measures that you and your colleagues at the UKB have implemented in recent years been? Let me briefly explain the dimensions involved: healthcare as a whole exerts a very large influence on our environment. And waste management is a very important area in this context. In a hospital like ours, there are many big levers for sustainability that can be pulled. We have more than 1,300 planned beds and about 350,000 outpatients and 50,000 inpatients every year. There are also about 40,000 emergency patients. In total, about 8,400 people are employed here at the hospital. However, we are not a hospital that was planned as a whole and built on a greenfield site. Our campus, with its 38 clinics and institutes, looks more like a district that has organically developed over decades. The disposal routes are correspondingly complex. I come from the waste management industry. As someone involved in waste disposal, I have always been amazed at how little understanding of waste management there is within hospitals. This is still a problem in many clinics. After all, patient care comes first. Waste disposal is usually secondary. There is often a lack of experts well-versed in waste regulations. Consequently, waste separation suffers and data on waste is inadequate. Naturally, effective measures for improved waste separation and recycling can only be implemented when there is comprehensive knowledge about all waste streams. „Effective measures for improved waste separation and recycling can only be implemented when there is comprehensive knowledge about all waste streams“

7 Does this legal situation make sense from your point of view? From the perspective of promoting recyclables, it would make sense to open up the regulations. However, the staff in the clinics would have to be trained much better. What must be avoided at all costs is that a used syringe ends up in a waste management company’s sorting plant, as many items still have to be separated by hand. With regard to recycling, it would undoubtedly be desirable if manufacturers integrated recycling considerations early in the product design phase. A comprehensive assessment of a product’s entire lifecycle is much needed. A simple way to improve this would be, for example, packaging made only of plastics. We at the hospital also try to recycle as much as possible. For example, we have started a pilot project in which we recycle single-use medical devices such as bronchoscopes. Although this pilot project is yielding positive results, it is very time-consuming. How do you do that specifically? We have implemented a colour-coded waste system. Each type of waste has a specific colour. Disposable surgical equipment is wipe-disinfected after use and is then placed in the green container. Before the devices are sent to our waste management company for further recycling, they undergo a brief decontamination process in an autoclave. This is required by waste legislation. This step ensures that the equipment no longer poses any risk of infection. Then, our disposal company dismantles the devices, which are usually made of aluminium, electrical materials and polypropylene, i.e. plastic. These fractions are then shredded and can be repurposed. To be honest, however, it should be acknowledged that this effort is currently more expensive than taking everything to a waste incineration plant. However, given the looming scarcity of raw materials, we firmly believe that we should not incinerate valuable resources. A restructuring of this magnitude is likely not a straightforward endeavour within the realm of daily hospital operations. Did you encounter any resistance when implementing these measures? The level of enthusiasm to back such initiatives is remarkably high among our staff. Undoubtedly, effective communication practices within the UKB play a significant role in fostering this environment. We also use our intranet as a platform to showcase and highlight all our projects. As previously mentioned, our sustainability working group comprises 42 members from diverse disciplines, each offering a unique perspective on the matter. This diversity greatly aids our internal communication efforts for our projects and goals. In fact, the ideas for our projects often come from different disciplines. As a facility manager, I am not familiar with the majority of the processes that occur in the operating room. But if there is a report stating that the disposing of soda lime from ventilators causes substantial costs, everyone collaborates to find a better disposal method that, above all, complies with waste regulations. If this endeavour is successful, we develop a new disposal protocol, which we then present to the relevant department. In most cases, the response is very positive! But this positive reception is undoubtedly influenced by the increasing social importance of climate protection and sustainability. What changes have you implemented in the handling of soda lime? Like any other medical facility, we constantly generate cartridges of used soda lime. Until now, they had to be disposed of as waste requiring special monitoring due to regulatory requirements. „A simple way to improve this would be, for example, packaging made only of plastics“ Continued next page INTERVIEW

8 That meant that they were incinerated in specialised facilities at very high temperatures. Today we treat the soda lime so that it can be recycled afterwards; not for medicinal purposes, but in agriculture. At least it's a step in the right direction. Which measure are you particularly proud of? The big highlight for me is our digital waste management system. However, on the whole, I am proud of each and every pilot project that we have launched, whether it’s the innovative approach to soda lime or the recycling of single-use surgical instruments, which we previously discussed. Here at the UKB alone, we use about 130,000 of these disposable instruments every year. They no longer end up in an incinerator. Another good example is the aluminium packaging for stapling machines. These machines usually come in exceptionally highquality aluminium packaging. We now collect the packaging and sell it once a year through our waste management partner. The proceeds are then donated to Operation Smile, an initiative dedicated to aiding children with cleft palates and cleft jaws in the Third World. In addition to the satisfaction of doing the right thing, financial viability is always imperative within an organisation. Have the measures you have implemented also yielded any financial benefits for the hospital? Absolutely, the answer is yes. Waste management provides us with a distinct advantage. Disposal represents a significant cost component, and waste incineration is becoming more and more expensive. Furthermore, from the beginning of 2024, an additional CO2 levy will be charged for each tonne of incinerated waste. Through the multitude of measures we have taken, we have effectively managed to achieve substantial cost savings. We have been able to reduce logistics by 39% through waste separation and optimised container management. In total, we save more than 90,000 euros annually. We use press containers at our collection points and have also adjusted the emptying schedules. In the past, some containers were emptied weekly even though they were not yet full. This practice was abolished; now, containers are only emptied when they reach full capacity. We are currently exploring the implementation of sensors that automatically send a message via our digital waste management system to our waste disposal company when the bin is 85% full, so that they can schedule the collection accordingly. Ultimately, we will no longer need to manually intervene in the process. What do you recommend to other healthcare facilities that want to become more sustainable? What should be their first step? They definitely need a full understanding of their waste streams and someone on site with real expertise in waste management and recycling. If a company seeks to establish its credibility in terms of sustainability, entrusting this responsibility to an individual who holds other primary responsibilities and possesses limited knowledge of waste regulations should be avoided. From a legal point of view, hospitals are classified as waste producers and as such are obliged to prove what happens to their waste. Noncompliance can result in severe penalties under environmental law. This means that the realm of waste management inherently needs more attention across the entire organisation. But as we can see, professional waste management also pays off! But you also have to put your heart and soul into it - like you do. How important is sustainability in your personal daily life? Yes, that's true. The topic has always interested me. I can't even pinpoint what the initial spark was. At some point – likely influenced by the many reports I read at the time – it simply became clear to me: We cannot go on like this! In the long run, we are eroding the basis of life on this planet. I have two children and I want them to be able to live in a healthy environment in the future. I then delved deeper and deeper into the subject and finally turned it into my profession. ‘Profession’ and ‘future’ are good keywords to take us to the last question: How will we in the healthcare sector deal with our waste in 20, 30 years? My vision is called “Zero Waste”. I would like to see a circular economy within the healthcare sector. To achieve this, all stakeholders – ranging from manufacturers and facilities to waste management companies – would have to sit down and collaborate extensively. They would need to develop a robust closed-loop system by integrating licensing or take-back models. This transformation also necessitates a revaluation of product design. How must equipment and packaging be modified in order to minimise waste? What strategies can be employed to effectively reintegrate materials into the cycle? These are the pivotal questions we need to find answers to! My vision is called “Zero Waste”. 0 INTERVIEW Continuation

9 KNOWLEDGE Mono foils facilitate the return of valuable raw materials to the economic cycle system Recycling of foil packaging References 1. Schlummer M et al. (2022) Lösungsmittelbasierte Recyclingverfahren. Recycling von Verbundfolien. Kunststoffe 1; 38-40. https://www.kunststoffe.de/a/fachartikel/ recycling-von-verbundfolien-358227 (accessed on 07.06.2023) 2. Stiftung Zentrale Stelle Verpackungsregister (2022) Mindeststandard für die Bemessung der Recyclingfähigkeit von Systembeteiligungspflichtigen Verpackungen gemäß § 21 Abs. 3 VerpackG. https://www.verpackungsregister.org/fileadmin/files/Mindeststandard/Mindeststandard_VerpackG_Ausgabe_2022.pdf (accessed on 07.06.2023) 3. Schwerpunkt Recycling. Das Magazin des Umweltbundesamtes 01/2018. https://www.umweltbundesamt.de/sites/default/files/medien/2546/publikationen/uba_sp_ recycling_01-2018_web.pdf (accessed on 07.06.2023) Unfortunately, not all packaging can be easily and completely recycled. Foil packaging, such as that used for flow packs of ready-to-use disinfectant wipes, also presents numerous challenges. Here, it is worth taking a closer look at the exact composition of the material and, as a manufacturer, improving its recyclability. The following applies: The fewer different materials come together and the higher the proportion of a particular material in the composite, the easier it is to return the valuable material to the economic cycle. Multilayer composite foils made of different plastics are often hardly recyclable Multilayer composite foils are flexible films that consist of layers of different plastics, none of which is predominant (> 95%). Plastics frequently used in multilayer composite foils include polyethylene (PE), polypropylene (PP) or polyethylene terephthalate (PET). Such foils are ideal for packaging products in a safe and durable manner. They also reduce transport-related emissions due to their light weight [1]. However, their recyclability usually leaves much to be desired, because the different plastics are so tightly interwoven that they cannot be separated and thus cannot be clearly assigned to a specific recyclable material cycle (e.g., that for PE or PP) [1, 2]. These materials are therefore not recycled, but incinerated like residual waste. Mono foils make recycling much easier If foil packaging consists of at least 95% one plastic material - usually PE or PP - this plastic is referred to as mono-material and the foils as mono-material foils (also known as "mono foils"). Mono foils can also be multilayered to improve the desired properties (e.g., protecting the product from air or light). Current models for evaluating recyclability recommend that manufacturers of packaging foils increasingly rely on monomaterial foils in the future [1-3]. Since these can be recycled well into the material cycle, mono foils help to save resources. The fact that a large amount of plastic waste is generated in healthcare facilities every day is by no means surprising. Since many medical devices, such as syringes or infusion tubes, are single-use products and must be packaged in sterile conditions, waste cannot be completely avoided. Even though they are colloquially referred to as "plastic waste," they are actually made of valuable secondary raw materials. If foil packaging consists of at least 95% one plastic material - this plastic is referred to as mono-material What is mono foil? Composite foil A multi-layer packaging foil made of different types of plastics. These can no longer be separated from each other, so that recycling is not possible. Mono foil Packaging foil made from a single layer. Because mono foils are made from a single type of plastic, they can be fully recycled.

Bio-based CO2 Biodegradable CO2 equivalents Carbon footprint Example: Fibres of nonwoven cloths KNOWLEDGE Are things in the green? Sustainability: The most important terms Sustainability is on everyone's lips. But the related vocabulary is not always immediately understandable in detail. So that you are still able to see the wood for the trees and join in the conversation about sustainability, we have compiled the most important terms for you. The material has been produced from renewable raw materials such as maize starch, vegetable cellulose, or lactic acid. Since further processing also plays a role, bio-based materials are not necessarily biodegradable and therefore should not be disposed of blanketly in the organic waste bin. Bio-based materials are not made from fossil raw materials, but depending on how they are produced, they can still have a large ecological footprint [1]. Biodegradable materials are naturally converted into biomass by microorganisms such as fungi or bacteria, releasing CO2, water, minerals, and possibly methane. The process may take several years. Therefore, biodegradable materials should not be disposed of in the organic waste bin or on the compost heap [1]. Note: Plastics from fossil resources can also be biodegradable. Bio-based and biodegradable therefore do not necessarily go hand in hand. Although carbon dioxide (CO2) makes up only a very small part of the Earth’s atmosphere (approx 0.04%), it has a major impact on global warming. This is because it absorbs heat and reflects it back to Earth instead of releasing it into space [2]. Processes or production steps frequently release not only CO2, but also other greenhouse gases such as methane (CH4) or nitrous oxide (N2O). Since CO2 is most relevant for man-made climate change, the total amount of greenhouse gases released is often expressed as so-called CO2 equivalents (CO2e). In this context, CO2 serves as a reference gas into which the greenhouse effect of the other gases is converted [3]. The carbon footprint is the estimated emission of a product or its CO2 impact. The entire life cycle of the product is taken into account: from raw material extraction to production, storage, transport, and use to final disposal or recycling. The term indicates how much greenhouse gas is released in total and is often expressed in CO2 equivalents (CO2e) [4]. However, the carbon footprint should not be used as the only measure of sustainability. It is also crucial, for example, how much water a process or product consumes during production, use, and subsequent maintenance. MILK 1.100 g CO2 caused by 1 litre milk1 2.370 g CO2 caused by 1 litre petrol2 380 g CO2 caused by one flowpack Bacillol® Zero 10 biodegradable Cellulose acetate* lyocell modal viscose cotton silk wool synthetic fibre fossil fuels-based semi-synthetic fibre biobased regenerated fibre natural fibre not biodegradable Cellulose acetat* PET PA PP Abbreviations: PA Polyamide PET Polyethylene terephthalate PP Polypropylene * depending on the degree of chemical modification, cellulose acetate is biogradable or not

Greenhouse Gas (GHG)- Protocol Greenwashing Climateneutral Compostable Recyclable Ecological footprint The so-called Greenhouse Gas (GHG) Protocol establishes globally standardised frameworks for measuring and managing greenhouse gas emissions from businesses or value chains in the private and public sectors, as well as mitigation measures [5]. Greenwashing refers to when a product is portrayed as particularly sustainable, environmentally friendly, and "green" even though there is no evidence to support it. Manufacturers who engage in greenwashing sometimes use made-up labels instead of certified test seals. Greenwashing is deliberate deception that can be fined under the proposal of the European Commission (Proposal for a Directive on Green Claims) [6]. Climate neutrality means that the same amount of greenhouse gases (CO2 equivalents, CO2e) is emitted as is absorbed from the atmosphere. In contrast, in so-called climate offsetting, greenhouse gases are saved in a sector other than the one that generates the emissions [7]. Composting refers to the process by which (organic) matter is broken down under the influence of oxygen and the release of CO2. There are various institutes, test seals, and labels that indicate compostability. Compostability of plastics is tested according to EN 13432. According to this standard, the product to be tested must be 90% decomposed within 90 days in an industrial composting plant. In order to exclude ecotoxicity of the product, the quality of the general compost must not be negatively affected by its decomposition [8]. A product or material is recyclable, if it can be broken down or shredded into its components and used as a recovered raw material for new products when it has reached its maximum service life. Whether a product is recyclable depends significantly on whether its individual components can be properly isolated from each other in practice [9]. So-called composite foils, for example, are not recyclable. Although these consist of different recyclable plastics, they are inseparably fused together during foil production. Therefore, the foil can only be thermally recycled ‒ i.e. incinerated. So-called mono foils, which consist of only one type of plastic, are more sustainable. These are almost completely recyclable. > please read the article on page 9 The resource consumption of a person, country, or company can be converted into a hypothetical biologically productive area that would be necessary to meet the needs of this person/country/company. The total area is called the ecological footprint and includes, among other things, areas for the production of food, energy, clothing, and waste disposal [10]. References 1. https://www.umweltbundesamt.de/biobasierte-biologisch-abbaubare-kunststoffe#haufig-gestellte-fragen-faq (accessed on 22/06/2023) 2. https://www.swr.de/wissen/1000-antworten/der-co2-gehalt-in-der-atmosphaere-liegt-bei-004-prozent-wie-kann-eine-so-geringe-menge-das-klima-erwaermen-100.html (accessed on 22/06/2023) 3. https://allianz-entwicklung-klima.de/toolbox/was-bedeuten-co2-aequivalent-co2e-und-global-warming-potential-gwp/ (accessed on 22/06/2023) 4. https://www.umweltpakt.bayern.de/energie_klima/fachwissen/279/carbon-footprint (accessed on 22/06/2023) 5. https://ghgprotocol.org/ (accessed on 22/06/2023) 6. https://www.ihk.de/hamburg/produktmarken/beratung-service/recht-und-steuern/wirtschaftsrecht/wettbewerbsrecht/greenwashing-5739388 (accessed on 28/06/2023) 7. https://www.europarl.europa.eu/news/de/headlines/society/20190926STO62270/was-versteht-man-unter-klimaneutralitat (accessed on 22/06/2023) 8. https://www.beuth.de/de/norm/din-en-13432/32115376 (accessed on 22/06/2023) 9. Stiftung Zentrale Stelle Verpackungsregister (2022). Mindeststandard für die Bemessung der Recyclingfähigkeit von Systembeteiligungspflichtigen Verpackungen gemäß § 21 Abs. 3 VerpackG. https://www.verpackungsregister.org/fileadmin/files/Mindeststandard/Mindeststandard_VerpackG_Ausgabe_2022.pdf (accessed on 22/06/2023) 10. https://www.bpb.de/kurz-knapp/lexika/das-junge-politik-lexikon/321523/oekologischer-fussabdruck/ (accessed on 22/06/2023) 11 KNOWLEDGE

12 INTERVIEW “Bacillol® Zero is the next generation of surface disinfection“ As Surface Product Manager in the global marketing team of HARTMANN subsidiary BODE Chemie in Hamburg, Leonie Weichsel is an expert in surface disinfection. In an interview with DISINFACTS, she explains what customers can expect from the innovative Bacillol® Zero Tissues. Sustainable at all levels: active ingredients, wipes, packaging What is so special about the components used that ultimately make Bacillol® Zero Tissues such a sustainable product? Unlike with the active ingredient, you haven't reinvented the wheel again, have you? Not that, but we have consistently focused on sustainable substances. With Bacillol® Zero Tissues, we have a green concept on all levels! The disinfectant wipe itself, for example, is made from raw materials that come from sustainable forestry. It is therefore completely free of plastic fibres. This is an innovation. In the past, plastic wipes were always the standard. The non-woven cloth fibres used now are biodegradable. It is similar with the packaging: as a consequence of our claim to sustainability, we have also decided to use a packaging foil that is 100% recyclable. The foil is made of a plastic monomaterial, more precisely polypropylene. This is also not the market standard in the disinfectant wipes sector. Composite foil consisting of several plastics are normally used. However, these are not recyclable because the different processed plastics can no longer be separated from each other. Our new Bacillol® Zero Tissues are therefore particularly sustainable, from the formulation to the wipe to the packaging. We can therefore say with a clear conscience: Green on all levels! Ms. Weichsel, with Bacillol® Zero Tissues, HARTMANN is offering a new product in the field of surface disinfection. What additional values do Bacillol® Zero Tissues offer your customers? Our customers benefit from Bacillol® Zero Tissues in many ways. First and foremost, it is a very sustainable product because it has more than 98.5% ingredients of natural origin and sustainable components are used at every level. This ranges from the primary packaging to the secondary packaging - i.e. the foil and the cardboard - to the disinfectant wipes and the new, innovative active ingredient complex: "Organic Acid Complex". Another important aspect for our customers in this context is that the product is free of any hazardous substance labelling thanks to its ingredients. Overall, Bacillol® Zero Tissues have up to 75% lower carbon footprint than conventional low-alcohol surface disinfectant wipes due to the consistent use of sustainable components. The calculation is based on the raw materials and other substances used as well as the transport routes required for production. What motivated HARTMANN to develop such a sustainable product? Did your customers demand it? We developed the product concept out of our own drive and conviction. At HARTMANN, we are committed to protecting people and their health. This has always been the goal of our products, including surface disinfection. We wanted to expand this protection claim by going beyond the task of disinfection to include the protection of the world around us. Bacillol® Zero Tissues live up to this claim: it is a holistic, sustainable product concept. If you like, Bacillol® Zero Tissues embody the next generation of surface disinfection, because it is ensured from the outset that application, efficacy, and packaging concept are tailored to the user and the environment. We are convinced that this is exactly what the market will need in the coming years. That is why we developed Bacillol® Zero Tissues. Ingredients Wipes Packaging

13 INTERVIEW “The highlight is the novel active ingredient” With Bacillol® Zero, HARTMANN is expanding its range of surface disinfectants with a thoroughly sustainable product. Dr. Marco Krewing, Scientist at the HARTMANN SCIENCE CENTER (HSC) and expert in surface disinfection, explains what this requirement meant for product development and how exactly the now market-ready product works. Organic active ingredient complex fights pathogens from within then that some of the active ingredients used were not forwardlooking. We wanted to develop a consistently sustainable product and therefore focused early on acids that also occur naturally. Altogether, the finished product now consists of 98.5% ingredients of natural origin. However, the goal was always to cover all the spectrums of activity that are required in everyday clinical practice and also to meet the highest standards in terms of material compatibility. We have succeeded in doing this with the new Bacillol® Zero Tissues. The approval process was a challenge for us. We wanted to use the so-called "simplified authorisation procedure" of the EU Biocidal Products Regulation. This is always possible if the product consists exclusively of the 17 ingredients that have been classified as less hazardous according to the Biocidal Products Regulation. Due to their composition, Bacillol® Zero Tissues are, according to this approval, free of hazard symbols and may also be used without protective clothing if occupational safety and infection control allow it. In addition, Bacillol® Zero Tissues are dermatologically tested. But your customers won't have to compromise on efficacy, will they? No. Quite the opposite: according to European standards, our active ingredient complex offers bactericidal, yeasticidal, and virucidal efficacy within two minutes. We have also examined the various efficacies with demanding four-field tests, which our product withstood without exception. The results were consistently positive. Customers do not have to make any compromises in terms of material compatibility either. We have tested the product with many different materials: You can use Bacillol® Zero on displays and keyboards and on sensitive materials where you otherwise always have to be careful, for example acrylic glass. This also applies to medical devices used for non-invasive procedures. There are basically no surfaces in the near-patient environment that cannot be disinfected with Bacillol® Zero. Dr. Krewing, with the new Bacillol® Zero Tissues, HARTMANN has developed a completely sustainable agent for surface disinfection. How was that possible? The highlight is the novel active ingredient that we have developed specifically for this purpose. It is based on organic acids. We call it the Organic Acid Complex. This complex contains two organic acids that ideally complement each other in their effectiveness. This has not been done in disinfection for a very long time: to disregard the classic active ingredients and use a new type of active ingredient complex. This is the great novelty of Bacillol® Zero Tissues. That means that the new Bacillol® Zero Tissues contain no alcohol, no oxygen releasers, and no quaternary ammonium compounds - in short: QACs. And it is precisely the QACs that are repeatedly the focus of discussions. Bacillol® Zero Tissues already meet the latest requirements for a modern surface disinfectant. We have also patented the new active ingredient complex. It consists of two acids that are also found in fruits - benzoic and tartaric acid, known from berries and grapes. They work together and inactivate the pathogens from the inside. And that is also what is special about the effect of this active ingredient complex. What prompted the decision to develop a completely new active ingredient complex for surface disinfection? Did you anticipate the current discussions about certain active ingredients? In Germany, these discussions date back to last year, when the new guideline for surface cleaning and disinfection was published. We have been working on the new active ingredient complex for considerably longer because we already saw back More than 98.5% ingredients of natural origin

14 Universal recycling symbol International recycling code It's no book with seven seals! Sustainability: The most important certifications and labels There are many certification seals and labels that attest to the (supposed) sustainability of products. In addition to many reputable certifications, there are unfortunately also occasional "bad apples" that do not take actual sustainability very seriously or that do not even refer to an independently tested product. We have compiled a list of the most important reputable certifications and labels so that they do not remain a book with seven seals for you. The universal recycling symbol showing three arrows is probably familiar to everyone, as it has been in use worldwide since 1970 and can be found in slightly modified form on numerous types of packaging. In most countries, the use of this symbol is not subject to licensing restrictions. Manufacturers can use it to indicate that the material of the product is recyclable. However, this is not a guarantee that the material will actually be recycled. The international recycling code is a variation of the universal recycling symbol. The symbol also consists of three arrows, but a number plus possibly an acronym also indicate what material the packaging is made of. This primarily helps consumers when making purchasing decisions and sorting waste correctly. In some countries, thanks to modern technologies, sorting plants usually no longer need this code [1]. The EU Ecolabel was established by the European Commission in 1992. The label highlights products and, since 2000, services that have a lower impact on the environment than the market average. As a so-called "Type 1 eco-label" according to ISO 14024, the EU Ecolabel ‒ just like the German Blue Angel, for example ‒ fulfils the highest quality category for eco-labels. It differentiates between 24 different product and service categories. The EU Ecolabel is awarded by the respective national authorities of member states [2, 3]. EU Ecolabel KNOWLEDGE

15 Labels for forest stewardship The seals of the Forest Stewardship Council® (FSC) and the Programme for the Endorsement of Forest Certification (PEFC) both certify that the wood used for a product comes from sustainably managed forests. This means that forests are not overexploited and biodiversity is preserved. Furthermore, fair labour conditions are promoted and community rights are taken into account. Both organisations are internationally active and recognised [4, 5]. TÜV Rheinland (Germany) certifies industrially compostable products. Consumers can rely on the fact that certified materials, packaging, and products are biodegradable and can be returned to the industrial circular economy [6]. TÜV Austria offers a similar certification, whereby a distinction is made here between industrial compostability and compostability in consumers' own gardens [7]. This distinction is important because garden compost has a lower temperature due to the smaller amount of waste and composting is therefore slower and more difficult. Labels for compostability KNOWLEDGE References 1. https://www.verbraucherzentrale.de/wissen/lebensmittel/lebensmittelproduktion/recyclingcode-das-bedeuten-die-symbole-auf-verpackungen-11941 (accessed 23/06/2023) 2. https://eu-ecolabel.de/ (accessed 23/06/2023) 3. https://www.bmuv.de/themen/nachhaltigkeit-digitalisierung/konsum-und-produkte/eu-umweltzeichen-eu-ecolabel (accessed 23/06/2023) 4. www.fsc.org (accessed 23/06/2023) 5. www.pefc.org (accessed 23/06/2023) 6. https://flustix.com/ (accessed 23/06/2023) 7. https://www.dincertco.de/din-certco/de/main-navigation/products-and-services/certification-of-products/environmental-field/flustix-plastikfrei/ (accessed 23/06/2023)

16 The sustainable future of surface disinfection. complex organic acid NEW Sustainable on all levels – organic formulation, 100% plastic-free wipes, recyclable packaging Extensively effective – bactericidal, yeasticidal, and virucidal in 2 minutes Bacillol® Zero Tissues

17 Hygienic hand disinfection instead of washing: substantial savings potential Hygienic hand disinfection with ABHR eliminates germs transferred to the surface of the skin, for example by touching contaminated objects. If, for the same purpose, hands are only washed in everyday ward life, yearly water consumption increases by ~52 million liters, energy consumption by 1.3 million kWh, and working time by 130,000 hours. Surgical hand disinfection also contributes to savings Before any surgery, the transient skin flora should be eliminated and the resident skin flora reduced for the duration of the operation. Nowadays, it is recommended to only scrub hands and forearms before the first surgery or when visibly soiled and to use ABHR throughout the day [2]. Using only scrubbing increases the consumption of water, energy, and time by 220,000 liters, 5,600 kWh, and 525 hours. Beyond that, Sustainable hand hygiene Hand hygiene is one of the most important measures to prevent healthcare-associated infections [1]. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) clearly advocate the use of alcohol-based rubs (ABHR) for the implementation of hand hygiene [2, 3]. However, using preparations containing chlorhexidine, especially on a daily basis, is not recommended due to the risk of skin irritation, allergies, and the development of resistance [2], even though these preparations are still used in practice in many places [4]. ABHR are not only more skin-friendly but can also help conserve resources. The example of an average hospital illustrates the potential for savings. References 1. Kampf G et al. (2009) Hand hygiene for the prevention of nosocomial infections. Dtsch Arzteblatt Int 106: 649-655. https://doi.org/10.3238/arztebl.2009.0649 2. WHO (2009). WHO Guidelines on Hand Hygiene in Health Care (accessed June 6, 2023) 3. Centers for Disease Control and Prevention (2002) Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 51: RR-16. https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf (accessed June 6, 2023) 4. Badia JM et al. (2020) The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study. Int J Surg 82: 231-239. https:// doi.org/10.1016/j.ijsu.2020.08.027 5. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankenhaeuser/Publikationen/Downloads-Krankenhaeuser/grunddaten-krankenhaeuser-2120611207004.pdf?__blob=publicationFile (accessed June 7, 2023) 6. Golpe MC et al. (2022) Chlorhexidine residues in sludge from municipal wastewater treatment plants: analytical determination and toxicity evaluation. Anal Bioanal Chem 414: 6571-6580. https://doi.org/10.1007/s00216-022-04214-0 7. Östman M et al. (2017) Screening of biocides, metals and antibiotics in Swedish sewage sludge and wastewater. Water Res 115: 318-328. https://doi.org/10.1016/j.watres.2017.03.011 8. Duane B et al. (2022) Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences? Environ Sci Pollut Res Int 29: 48736-48747. https://doi.org/10.1007/s11356-022-18918-4 chlorhexidine, which is contained in many antimicrobial soaps, accumulates in the environment [6, 7]. Advantages of ABHR Using ABHR instead of antimicrobial soap is more effective, less time-consuming, usually better tolerated by the skin, and saves both water and energy [2, 3, 8]. Example hospital 260 beds 500 employees (med. 90, care 190, other non-med. 220) 10 surgeries with each 3.25 professionals per day • Water consumption of 52 million litres/ year corresponds to 21 Olympic pools • Energy consumption of 1.3 million kWh/ year corresponds to a distance of > 7 million km or > 4.3 million miles with an electric car Handwashing/scrubbing Surgical preparation scrubbing 6 min Handwashing 2 min Water temperature 37°C No water and no energy for heating required Hand disinfection using ABHR Surgical HD 1.5 min Hygienic HD 0.5 min Hand disinfectants are more skin-friendly than washing hands The better skin compatibility of ABHR compared to (especially chlorhexidine-containing) handwash preparations has been clinically proven. This applies all the more, the more often hand hygiene is carried out. Washing hands with antimicrobial detergents should therefore primarily be used to remove dirt and pathogens or spores that are insensitive to alcohol [2]. Why disinfecting is more resource-efficient than washing and scrubbing PRACTICE