Improving environmental sustainability of intensive care units: A mini-review

Table 1 Clinical practices which may aid in reducing the environmental impact of intensive care unit

Category	Clinical practices
Reduce	Avoid unnecessary ICU admissions through accurate triage
	Avoid futile care
	Avoid overdiagnosis
	Avoid over-investigation and routine testing
	Avoid overtreatment
	Avoid overuse of supplemental oxygen
	Avoid routine prophylaxis (e.g., proton pump inhibitors, thromboprophylaxis) for low-risk patients
	Change central venous catheter infusion sets not earlier than 7 d
	Manage supply chain to reduce unused medical waste
	Replace intravenous drug use with oral alternatives
	Avoid unnecessary vehicular transport by utilizing telepresence
	Reduce facility energy consumption for heating, ventilation, and air conditioning, by setting a moderate room temperature
	Improve first-pass success of procedures through better training
	Decarbonize energy sources by using natural rather than artificial lighting
	Reduce paper printouts and forms
	Minimize plastic use
	Reduce healthcare-associated infections and iatrogenic complications
	Stock fewer items inside patient rooms and keep them in supply carts outside patient rooms
	Replace inhalational anaesthetics with total intravenous anaesthesia
	Replace hydrofluorocarbon-containing metered dose inhaler with mesh nebulizer
Reuse	Choose reusable equipment over single-use disposal ones
	Consider single-use device reprocessing
	Extend product lifespans through repairing and upgrading equipment as much as possible
Recycle	Recycle used fluid bags and non-sharps

ICU: Intensive care unit.