Sustainability in the ICU

Is sustainability In the ICU possible? 

Sustainability in the ICU is possible. Although the ICU is inherently wasteful in terms of energy and medical waste, we can create a more sustainable and safe work environment for patients and workers by researching and implementing environmentally conscious practices. I currently work In a brand new state-of-the-art ICU. Not only do we have the most up-to-date equipment, but the hospital openly brags about how sustainable and energy efficient the new ICU Is. But how true are these claims? Koch and Schulz (2021), In an article published In Intensive Care Medicine, expanded upon the various ways in which the ICU Is unsustainable but simultaneously provided a plethora of ways In which hospitals can combat them on the unit. Using these points, I will be assessing and evaluating the various factors In which my work environment Is both sustainable and unsustainable and making my best determination as to how truly sustainable the new ICU Is. 

1. Energy Efficiency: The ICU will never not be an energy-dependent environment. Life-sustaining equipment, such as ventilators, monitors, and IV pumps, requires a lot of energy. Although many are battery-powered, Keeping all equipment plugged In at all times remains policy. In addition, lighting Is frequently changed and adjusted based on both patient and worker preferences.  My unit has purchased brand-new CRRT machines that run at optimum energy levels to promote energy efficiency. We also have pump audits, In which the charge nurse rounds and finds pumps that are being used at minimal capacity. Each pump can use up to 4 channels, and If any can be taken off a pump and put on just one, we will. Unfortunately, we are still behind in cost analysis from current unit energy cost, and previous unit energy costs are unavailable. I am very curious to see the improvement in energy efficiency. That being said, using energy-efficient equipment and promoting energy-saving practices, such as turning off unused equipment, can help reduce energy usage and associated greenhouse gas emissions.

2. Waste Management: Proper waste management is crucial in the ICU. More than other units, we are dealing with hazardous bodily fluids, contaminants, plastics, and other waste. My hospital only has three disposal methods—trash, biohazard, and sharps. We also lack support staff and a large soiled utility room. This has led to trash being overfilled and dirty linens remaining in bags in the rooms. These often create unpleasant smells in both patient rooms and on the unit itself. Our biohazard disposal Is also very small. In fact, It Is the size of a small trash bin. Because these materials are hazardous, overfilling can be dangerous and lead to both spills and accidental contact by waste management personnel. To improve our waste management efficiency, the unit should start by implementing recycling programs for materials like plastics, glass, and paper, Increasing the size of soiled utility rooms, and creating safer disposal methods for potentially Infectious materials.

3. Water Conservation: Efficient use of water is essential for sustainability. Encouraging staff to follow water conservation practices, such as using water-saving devices and reporting leaks promptly, can help minimize water waste in the ICU. One Issue In the ICU we have Is not that we have a large number of sinks, but rather every hour, the sinks will randomly turn on and run for 20 seconds. Although there Is no data on the amount of water being used, 20 seconds of running water every hour calculates to 8 minutes a day of wasted water. Multiply this by the number of sinks and the number of days In a year, and the amount of water wasted from that alone will be staggering. 

4. Single-Use Item Reduction: Single-use items, such as gloves, gowns, and masks, are necessary for infection control in the ICU. However, efforts can be made to reduce their usage when possible. Although staff should feel safe, using these items correctly at the right time is essential. For instance, gowns should only be worn under contact precautions, masks should be worn under droplet precautions, and gloves should be worn when handling patients, hazardous materials, or certain cleaning agents. Staff education on minimizing unnecessary usage can help reduce the overall waste generated. In contrast, something my hospital has done that has benefited sustainability is single-use, pre-filled medications. These medications, often pain medication and steroids, come in pre-filled luer-lock syringes that eliminate vail and needle waste all at once. This not only saves the hospital money but reduces the chance of needle-sticks. 

5. Medication and Supply Management: Unfortunately, my unit does poorly managing pharmaceutical waste. The most important aspect of this problem is the method of disposal. Oftentimes, because the staff is busy, excess or waste drugs are disposed of inappropriately In the trash bins Instead of a neutralizing drug buster at the pyxis station. This has led to multiple Instances of direct exposure to hazardous medications, such as fentanyl. Nurses understand the importance of proper drug disposal. In fact, a study conducted by Yale University found that "95.2% of nurses (N=99/104) believed that appropriate waste disposal is important to “protect the environment health.” The survey also asked about the top reason that contributes to improper waste disposal practices, and 56.7% of nurses (N=59/104) believed that the “lack of knowledge about waste segregation” is the top reason for improper disposal practices. Nurses were also asked about reasons that contributed to avoidable waste, and 37.5% of nurses (N=39/104) indicated that “the order for medication that is less than the available package size” is the top reason contributing to avoidable waste." ( Wasim, 2019). The unit may find more staff adherence to this policy If more drug-buster stations are made available.