Copyright ©The Author(s) 2023.
World J Crit Care Med. Sep 9, 2023; 12(4): 217-225
Published online Sep 9, 2023. doi: 10.5492/wjccm.v12.i4.217
Table 1 Clinical practices which may aid in reducing the environmental impact of intensive care unit
Clinical practices
ReduceAvoid 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
ReuseChoose reusable equipment over single-use disposal ones
Consider single-use device reprocessing
Extend product lifespans through repairing and upgrading equipment as much as possible
RecycleRecycle used fluid bags and non-sharps
Table 2 Published environmental sustainability efforts done in intensive care unit
ReduceRedesign pharmaceutical doses and packaging; install waste containers for non-recyclables and chemical wastes; educate staffDecreased solid waste generation by 39% (13.7 to 8.4 kg/patient/d)Furukawa et al[47], 2016
ReduceFour-step action plan: (1) Audit local practice; (2) develop clinical guideline for rational ordering; (3) educate stakeholders; and (4) measure impact through re-auditComparing July-December 2017 vs July-December 2018 in a 58-bed ICU, number of ABG tests decreased by 31.3%, saving A$770000, 100 L of blood, and reducing emissions of 1038 kg CO2e (akin to driving 6782 km in an average Australian car). Inappropriate ABG testing decreased by 47.3%, and the number of inappropriate tests per bed-day decreased by 71%, without worsening patient mortalityWalsh et al[48], 2020
ReduceRelocating in-room disposable equipment to supply carts situated outside the patient rooms, while using small baskets for basic admissions with expected short lengths of stay. Additionally, instead of refilling all items to quota, daily room restocking was customized based on nursing requirementsA Canadian ICU with 16 beds implemented a strategy to reduce the amount of unused equipment waste, resulting in a large 80% decrease. This reduction translated to an approximate annual saving of Can$110000Yu et al[49], 2021
RecycleRecycling program in ICUAn Australian ICU produced 540 kg total waste/week in 2008, which reduced to 505 kg after introducing a recycling program in 2013, with 14% of the total waste being recycledMcGain et al[50], 2009; Kubicki et al[51], 2015