IFC requires that this document is made available through the World Bank InfoShop and to the locally affected community no less than 30 days prior to project consideration by the IFC Board of Directors. The Summary of Project Information (SPI) also provides details of where the ERS has been made available to the locally affected community. The SPI must be sent to World Bank InfoShop no less than 30 days prior to project consideration by the IFC Board of Directors.

This is a Category B project according to IFC’s Procedure for Environmental and Social Review of Projects because a limited number of specific environmental and social impacts may result that can be avoided or mitigated by adhering to generally recognized performance standards, guidelines or design criteria. The review of this project consisted of appraising technical and environmental /social information submitted by the project sponsor. The following potential environment, health and safety and social impacts of the projects were analyzed. - Site selection, acquisition, development and permitting; - Quality and sustainability of potable water supply; - Handling and disposal of hazardous and non-hazardous health care waste; - Liquid effluent management; - Air emissions; - Adequacy of disinfection and sterilization programs; - Occupational health and safety and implementation of good hospital management practices and employee training programs to prevent nosocomial diseases; - Life and fire safety in the design, construction and outfitting of new and existing facilities; and - Systematic management of quality, environmental issues, and occupational health and safety.

The sponsor has presented plans to address these impacts to ensure that the proposed project will upon implementation of the specific agreed measures, comply with the environmental and social requirements, host country laws and regulations and the World Bank/IFC environment and social policies and the environmental, health and safety guidelines. Information about how these potential impacts will be addressed by the sponsor/project is summarized in the paragraphs that follow. Further information is provided in the attached Corrective Action Plan (CAP). - Site selection, acquisition, development and permitting. Centro Medico Puerta de Hierro (CMPDH) purchased four parcels of land constituting approximately 12 ha that house the ambulatory surgery center and the hospital. These parcels were purchased from a local real estate firm that was authorized to offer these parcels in a corporate subdivision (Fraccionamiento Plaza Corporativa Zapopan) in Zapopan, Jalisco state through a sales contract. The properties are fully paid with no current mortgages or other encumbrances. The subdivision was designed and constructed for this type of development. No environmental impact study or similar development document was required by local authorities. All required sanitary authority permits for construction and operation have been granted. - Quality and sustainability of potable water supply. The local municipal system for potable water and sewerage services (SIAPA) provides potable water for general hospital use. SIAPA water is chlorinated as it fills the storage tanks and the storage tank is cleaned periodically. Water for specialized equipment such as hemodialysis units and autoclaves is subjected to further treatment including deionization, filtration and ultraviolet sterilization. CMPDH will implement a water monitoring program to ensure that internal water treatment schemes are adequate for the quality of water provided by SIAPA in accordance with the attached corrective action plan (CAP). - Handling and disposal of hazardous and non-hazardous health care waste. CMPDH conducts internal segregation of health care wastes and all biological, infectious and hazardous health care waste is collected and stored temporarily for pickup, treatment and disposal by a Secretary of Environment and Natural Resources (SEMARNAT) licensed service company, Environmental Communication and Design. Non hazardous waste is collected on a daily basis by another contractor for disposal in a municipal landfill. - Liquid effluent management. CMPDH liquid waste is discharged under permit to the municipal system operated by SIAPA. - Air emissions. Electric power for the hospital is provided by the grid (CFE). CMPDH has an emergency power generation system to supply critical hospital equipment and areas. CMPDH is evaluating the feasibility of utilization of emergency generating capacity to cover peak demand periods. These diesel –fired generators are not operated more than 500 hours/year. Boilers for hot water and steam are electric. - Adequacy of disinfection and sterilization programs. CMPDH has instituted a disinfection and sterilization program consistent with local regulatory requirements and international best practice. General use and invasive procedures equipment is sterilized in accordance with these guidelines and with the nature of the material. CMPDH uses ethylene oxide, steam, formaldehyde, and solutions of acetic acid and glutaraldehyde among other techniques for equipment sterilization. Precleaning, sterilization and disinfection procedures are overseen by graduate nursing staff. - Occupational health and safety and implementation of good hospital management practices and employee training programs to prevent nosocomial diseases. CMPDH has developed an occupational health and safety program consistent with the requirements of the Occupational Health and Safety Administration of the USA and with international guidance on the prevention of nosocomial (hospital acquired) infections. There are extensive employee training programs in place with an emphasis on the hazards associated with hazardous health care waste accumulation and management and other particularly hazardous operations within the hospital. Other employee training and development seminars focus on prevention of cross contamination and disease transmission. Accident and unplanned events statistics are collected and analyzed to elucidate required changes in operations and to further reduce lost time accidents and accident severities. - Life and fire safety in the design, construction and outfitting of new and existing facilities. The design currently does not comply with IFC Life and Fire Safety guidelines. Structural steel has not been coated with fire protection material; the office tower of the hospital building has only one fire stair and no sprinkler system. The designers will add both fire protection spray to the steel structure of the tower and a full sprinkler system to the tower and all offices; ensure that one fire stair is fire isolated at each level; mechanically pressurize the single fire stair from the tower to prevent smoke entering the stair during an emergency. Independent certification by a qualified professional that these measures will bring the facility into compliance with IFC guideline requirements will be required in accordance with the attached corrective action plan (CAP). - Systematic management of quality, environmental issues, and occupational health and safety. CMPDH will implement a systematic approach to management of internal affairs, environmental and occupational health and safety in accordance with the attached CAP. Additionally the hospital will seek certification of the management system to ensure adequate integration throughout hospital operations.

The following supporting documents provide further details of environmental and/or social issues: Corrective Action Plan.

Accordingly, IFC concludes that the proposed project will meet the applicable World Bank/IFC environment and social policies and the environmental, health and safety guidelines upon successful implementation of the agreed mitigation measures.

IFC will evaluate the project's compliance with the applicable environmental and social requirements during the lifetime of the project by reviewing the annual monitoring reports (AMRs) prepared for the project covering: - the status of implementation of all measures contained in the Corrective Action Plan and - ongoing performance of project-specific environmental, health and safety activities as reflected in the results of periodic and quantitative sampling and measuring programs. Periodic site supervision visits will also be conducted.