British Medical Journal (The BMJ)Towards Net Zero: Critical Care

The ICU multidisciplinary team must address environmental sustainability challenges as ICUs produce much more greenhouse gas emissions and solid waste per bed day than an acute care ward.

The authors offer an extensive survey of contributors to the carbon footprint in ICUs in the West. They show the areas with highest carbon impact and offer suggestions in each for reducing the same. They demonstrate how the ICU is a carbon hotspot in the hospital. Not just because it is always active, but also for a number of other contributing factors.

Key Points:

• Carbon hotspots within the ICU include energy use (particularly HVAC), pharmaceuticals, and medical equipment
• Many different actions can be taken to decrease the environmental footprint of critical care.
• An individual clinician should consider the balance between the most impactful intervention and taking an action that is feasibly within their control, which may not be the largest carbon footprint.
• Focus on avoiding, reducing, reusing, and recycling without compromising safe, quality care
• Everyone on the team can engage in researching and rethinking how ICUs can be more sustainable.

Select Details and Recommendations:

• Prevent unnecessary admissions and readmissions.
• Optimize length of stay.
• Use evidence-based medicine to avoid unnecessary therapies
  • One US study based in five academic hospitals found that 6.7% of all assessed patient days ineffective or futile.
• Reusable items are rarely used in ICUs in higher income countries.
  • Reusables are mostly more economical.
  • Reusables become more ecologically favorable with renewable electric source
• Recycle more.
  • Per one study, the average US ICU recycles about 15% of waste – but another 15% of potential recycling was missed.

Did You Know?
The healthcare sector is responsible for 4-5% of global greenhouse gas emissions; if it were a country, it would be the fifth highest emitter on the planet!