Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;49(1):65-74.
doi: 10.1007/s00134-022-06940-6. Epub 2022 Dec 8.

Circular material flow in the intensive care unit-environmental effects and identification of hotspots

Nicole Hunfeld  1   2 , Jan Carel Diehl  3 , Maarten Timmermann  4 , Pieter van Exter  5 , Joris Bouwens  5 , Savanna Browne-Wilkinson  5 , Nine de Planque  6 , Diederik Gommers  7
Affiliations

Circular material flow in the intensive care unit-environmental effects and identification of hotspots

Nicole Hunfeld et al. Intensive Care Med. 2023 Jan.

Abstract

Purpose: The healthcare sector is responsible for 6-7% of CO2 emissions. The intensive care unit (ICU) contributes to these CO2 emissions and a shift from a linear system to a circular system is needed. The aim of our research was to perform a material flow analysis (MFA) in an academic ICU. Secondary aims were to obtain information and numbers on mass, carbon footprint, agricultural land occupation and water usage and to determine so-called "environmental hotspots" in the ICU.

Methods: A material flow analysis was performed over the year 2019, followed by an environmental footprint analysis of materials and environmental hotspot identification.

Results: 2839 patients were admitted to our ICU in 2019. The average length of stay was 4.6 days. Our MFA showed a material mass inflow of 247,000 kg in 2019 for intensive care, of which 50,000 kg is incinerated as (hazardous) hospital waste. The environmental impact per patient resulted in 17 kg of mass, 12 kg CO2 eq, 300 L of water usage and 4 m2 of agricultural land occupation per day. Five hotspots were identified: non-sterile gloves, isolation gowns, bed liners, surgical masks and syringes (including packaging).

Conclusion: This is the first material flow analysis that identified environmental risks and its magnitude in the intensive care unit.

Keywords: Circular economy; Environmental hotspots; Intensive care unit; Material flow analysis; Sustainability.

PubMed Disclaimer

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Material flow analysis of the intensive care; material groups are shown on the left. The flow continues towards products and leaves the ICU with the outflow on the right side. SZA = hospital waste
Fig. 2
Fig. 2
Weight distribution of different material types in percentages. Medicines are excluded from the figure because of their large impact (65% of total mass)
Fig. 3
Fig. 3
Ratio packing per product group in percentage weight of products and their packaging
Fig. 4
Fig. 4
Individual products per patient per day
Fig. 5
Fig. 5
Estimated contribution of products or product groups with the highest mass and highest environmental impact. The mass of the medicines itself is excluded. Sterile water shown in this figure is used as a nebulizer (1 L bags) in the mechanical ventilation circuit. Its CO2 emission is relatively small: 0.000438766 CO2-eq/kg
See this image and copyright information in PMC

References

    1. Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med. 2019;380:263–273. doi: 10.1056/NEJMra1807873. - DOI - PubMed
    1. Ebi KL, Ogden NH, Semenza JC, Woodward A. Detecting and attributing health burdens to climate change. Environ Health Perspect. 2017;125:1–8. doi: 10.1289/EHP1509. - DOI - PMC - PubMed
    1. Mitchell D, Heaviside C, Vardoulakis S, Huntingford C, Masato G, Guillod BP, Frumhoff P, Bowery A, Wallom D, Allen M. Attributing human mortality during extreme heat waves to anthropogenic climate change. Environ Res Lett. 2016;11:074006. doi: 10.1088/1748-9326/11/7/074006. - DOI
    1. Atwoli L, Baqui AH, Benfield T, Bosurgi R, Godlee F, Hancocks S, Horton R, Laybourn-Langton L, Monteiro CA, Norman I, Patrick K, Praities N, Olde Rikkert MGM, Rubin EJ, Sahni P, Smith R, Talley NJ, Turale S, Vázquez D. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. BMJ. 2021;374:n1734. doi: 10.1136/bmj.n1734. - DOI - PMC - PubMed
    1. Pörtner HO, Roberts DC, Adams H, Adler C, Aldunce P, Ali E, Begum RA, Betts R, Kerr RB, Biesbroek R (2022) Climate Change 2022 Impacts, Adaptation and Vulnerability; Working Group II Contribution to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_FinalD.... Accessed 27 June 2022

LinkOut - more resources