From carbon cost to climate care: Greening our intensive care units

Table 3 The 5Rs of sustainability in the intensive care unit: Practical applications and clinical benefits

Principle	ICU application	Clinical benefit
Replace/avoid	Avoid non-evidence-based tests (e.g., routine daily imaging or laboratory panels). Replace high-impact therapies where appropriate[31,35,37,44]	Prevents overtreatment. Reduces iatrogenic harm and patient discomfort. Lowers cognitive load
Reduce	Optimise medication preparation and overfill. Minimise overstocking, reduce unnecessary energy use and room entries[28,31,35,44]	Improves efficiency without compromising readiness. Reduces error risk and staff workload
Reuse	Use durable gowns and linens, metal instruments, reusable laryngoscope blades, reprocessable bronchoscopes[19,27,31,35,44]	Lowers waste and cost while maintaining infection-control safety and procedural reliability
Recycle	Segregate clean packaging, plastics, PVC items. Reduce red-bag waste through improved classification[15,16,18,31,35]	Reduces hazardous-waste costs, improves compliance. Engages frontline staff
Rethink	Re-evaluate routines, adopt tele-ICU and digital workflows, redesign care environments and infrastructure[31,35,44,52]	Enhances patient comfort, staff wellbeing, system resilience and innovation

Adapted from published intensive care unit sustainability consensus guidance and health-system decarbonisation frameworks. ICU: Intensive care unit; PVC: Polyvinyl chloride.