Improving environmental sustainability of intensive care units: A mini-review

Table 2 Published environmental sustainability efforts done in intensive care unit

Category	Method	Outcome	Ref.
Reduce	Redesign pharmaceutical doses and packaging; install waste containers for non-recyclables and chemical wastes; educate staff	Decreased solid waste generation by 39% (13.7 to 8.4 kg/patient/d)	Furukawa et al[47], 2016
Reduce	Four-step action plan: (1) Audit local practice; (2) develop clinical guideline for rational ordering; (3) educate stakeholders; and (4) measure impact through re-audit	Comparing 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 mortality	Walsh et al[48], 2020
Reduce	Relocating 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 requirements	A 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$110000	Yu et al[49], 2021
Recycle	Recycling program in ICU	An 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 recycled	McGain et al[50], 2009; Kubicki et al[51], 2015

ABG: Arterial blood gas; ICU: Intensive care unit.