While many hospitals voluntarily undertake environmental initiatives, their efforts often fail due to the lack of an established and sustainable environmental management system (EMS), which uses proven business management practices to integrate environmental concerns into an organization's activities, products, and services. The Kentucky Pollution Prevention Center created this May 2005 guide to help health care facilities implement EMSs that minimize the environmental impacts of medical waste incineration, persistent bioaccumulative toxins (PBTs), and hazardous material use and disposal. The guide was compiled with input from the U.S. Environmental Protection Agency and hospital administrators from across the country.