Healthcare systems face wasteful practices due to the misconception of unlimited supplies. (Barbariol & Baid, 2023) In ICUs, unused supplies are frequently discarded after patients are discharged. As the highest-consuming unit, the ICU generates a significant amount of medical waste. This waste management project explores strategies to reduce the ICU's carbon footprint by minimizing waste, optimizing supply usage and promoting sustainable practices. Addressing these inefficiencies can enhance environmental responsibility while maintaining high-quality patient care.
Why Sustainability in Critical Care Nursing Matters
"The Hippocratic oath to First do no harm guides physician practice, yet healthcare itself pollutes and harms public health. If global healthcare were a country, it would be the fifth largest carbon emitter on the planet." (McGain et al., 2020, p.681) Healthcare is in juxtaposition with the promotion of better health. Although healthcare professionals promote prevention, early detection and treatment, our actions are also harming the planet and thereby harming the population.
A neuro ICU at our hospital conducted a waste audit and found that in just 24 hours, the unit totaled over 90 kg of waste. Annually, the ICU averaged 32,400 kg of waste. (Corbin et al., 2022) Although progress may be gradual, starting with one unit at a time can significantly reduce environmental impact and contribute to a healthier planet and population.
Green ICU Team: Building a Culture of Environmental Responsibility
As a bedside nurse, I find that after report, extra time is spent organizing the supply room to note the supplies on hand in case I need them later. Supplies are scattered all around the patient's room — on sinks, couches, tables and even outside — leading to excessive waste generation when patients leave. It is unfortunate to see unused and unopened supplies get discarded once a patient moves out of their room. Housekeepers express frustration over discarded supplies, and the supply chain notes the ICU's high usage compared to other units. The Green ICU project aims to reduce the ICU's carbon footprint by minimizing medical waste. Beyond the cost savings, Green ICU represents a global commitment to sustainable practices.
Strategies to Reduce Supply Waste in the ICU
To measure sustainability, data was collected before and after the intervention by auditing supplies removed from patients' rooms after discharge, excluding isolation rooms. Audits were conducted on a weekly basis, separating items that could or could not be returned to par on an Excel spreadsheet. The team collaborated with infection control, quality and supply management departments, forming a multidisciplinary team to determine the criteria to return supplies to par. Those items that could be returned to par were cleaned with disinfectant wipes and checked for expiration dates. Data was collected in three phases: eight weeks of pre-intervention data, four weeks of intervention and 12 weeks of post-intervention data.
Forming the Green Team
Green ICU focused on four key areas. First, a Green Team was formed, comprising patient care assistants (PCAs) and nurses from both day and night shifts. Meetings were held to collaborate and brainstorm ideas to address excess supply usage and waste generation in the ICU. Forming a team is crucial for gathering input, making recommendations and ensuring the sustainability of interventions. The purpose of creating a green team is to have a group of healthcare providers or champions who are motivated to promote health in the critical care unit. (Trent et al., 2023)
Optimizing Bedside Supply Carts
Second, supply carts were customized. The ICU uses carts as servers for commonly used medical supplies, so nurses have them close by. ICU carts in our hospital were readily available outside patients' rooms but were not used appropriately. As a background note, PCAs were responsible for restocking servers, but the results were inconsistent because it was difficult to restock while working on the floor. Frequently, nurses went to the supply room, because the servers did not have all the components needed to complete their tasks. The servers also posed an infection control risk, as nurses would often come out with dirty gloves to grab something quick for the patient. Following a survey, 11 out of 15 servers were removed from the hallway. Two servers were designated for open-heart patients, and two remained for the rooms farthest away from the supply room. Servers were labeled for easy access and restocked weekly by PCAs after in-service training.Using a Color-Coded Supply System/Designated Area
One key strategy is a color-coded labeling system. This simple, but highly effective tool helps raise cost awareness and promote mindful use of resources. For the project, each supply item was identified and labeled based on price. Green was the least expensive with a price range of $0-$2.99. Yellow was moderate, with a price range of $3-$15 and red was the most expensive at more than $15. Stickers were placed on each supply item to promote mindful usage.
Creating Designated Supply Areas
Finally, designated supply areas were created. Unused items were placed on a desk outside the supply room. Instead of nurses taking supplies into the room and adding them to the waste, supplies were set outside for later use. If the supply was not needed by the end of the shift, nurses returned it to the supply room. Necessary supplies in the room were stored in a clear bin visible through the window. Nurses can go to one area in the room for supplies instead of multiple areas. This process reduces the number of extra supplies brought into the room. Furthermore, all hygiene items are stored on top of the bedside stand. Usually, staff bring patient care items for each cleaning rather than checking the room to see if there are extras. For example, sometimes there are several tubes of zinc paste, 10 comfort glides and packets of wipes in the patient's room. These extra items add up and, unfortunately, go to waste. By having all hygiene supplies in one area, staff know where to look and don't bring in extra unnecessary supplies.
Educating Nurses on Sustainable Practices
The ICU staff were educated after the interventions via huddles, staff meetings, emails and shared governance. A posterboard presentation was given, and a team-building relay race was conducted during a staff meeting. Each group received a big bag of supplies (originally separated for return during the audit process). The team was divided between the day shift and the night shift. The team who returned the most supplies won a prize.
Outcomes: Reducing ICU Medical Waste and Costs
The Green ICU initiative successfully achieved supply cost savings through effective waste reduction efforts. Before the intervention, $5,094.15 worth of supplies was wasted; of that amount, $2,680.21 was returned to par. After implementation, $2,197.02 was wasted and $930.03 was returned, leading to a 56.9% reduction in supply waste from December 2023 to May 2024. These interventions have proven essential in lowering healthcare costs and promoting sustainability. Our project focuses on improving existing practices rather than introducing an entirely new system.
Next Steps: Expanding ICU Sustainability Practices
The next phase of the project focuses on reprocessing patient care items such as pulse oximetry, disposable EKG leads and sequential compression device (SCD) sleeves. The unit had a recycling bin in the soiled utility room, but it was unused because staff preferred to not take extra steps to dispose of the items. To address this issue, Medline provided bins for each patient room that were installed by the Green Team. Staff education was conducted through huddles, shared governance and staff meetings. Medline data confirms increased collection rates, further advancing the ICU's sustainability efforts.
I acknowledge and thank the following: Givenchy Victorio, BSN, RNIII, CCRN; Durga Basnet, MSN, RN, CNN; Pinky Shani, PhD, MSN, RN, NE-BC, and the ICU Green Team
What is your organization doing to reduce its ICU carbon footprint?
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