Background: The pharmaceutical industry is estimated to have a larger environmental footprint than the automotive industry. Discarded and unused doses of pharmaceuticals generate financial waste and pollution, and exacerbate antibiotic shortages. The antibiotic daptomycin is dispensed in standard-sized single-use vials and dosed based on patient weight. Residual daptomycin in the vial after dose preparation must be disposed of and cannot be used for another patient. We hypothesized that daptomycin dosing nomogram use would reduce daptomycin waste, environmental impact, and financial costs. Methods: We performed a retrospective chart review quantifying daptomycin waste, defined as disposed of unused daptomycin, at Harbor-UCLA Medical Center, a 400-bed Level 1 Trauma Center, from 1/1/2023 to 12/31/2023. We then adjusted dosing using a daptomycin dosing nomogram. We modeled the difference in daptomycin waste (mg of daptomycin disposed of unused), pharmaceutical waste (weight of excess daptomycin vials required due to wasted antibiotic), and cost between the two dosing strategies. Our model assumed a daptomycin vial weight of 16.8g and cost of $30 per 500mg daptomycin vial. We conservatively estimated pharmaceutical waste as waste only from daptomycin vials, ignoring all other supplies and materials necessary to prepare daptomycin. Results: During the 1 year time period at our Medical Center, 138,882mg daptomycin was wasted. This level of daptomycin waste equates 4671g excess pharmaceutical waste and $8332 spent on unused, discarded daptomycin. In our model, we found that nomogram implementation would have reduced mean monthly daptomycin waste from 11,002mg to 1387mg (p<0.001). This reduction would have decreased the proportion of daptomycin wasted from a mean of 19% to 3% of all consumed daptomycin (Figure 1). Nomogram use would also have saved $7333 and averted 4111g of pharmaceutical waste in 2023. Conclusion: A daptomycin dosing nomogram would have prevented 122,322mg of daptomycin from being wasted and saved over $7000 at a 400 bed Medical Center over one year. Given the 4111 g of pharmaceutical waste is a conservative estimate, and ignores waste from other supplies/materials as well as upstream waste and emissions from daptomycin manufacturing, the overall generated environmental impact prevented by nomogram use is likely significantly higher. Our findings demonstrate that intentionally designed dosing strategies aimed at reducing drug waste can save hospital costs and reduce the environmental footprint of clinical care. When implemented at large health systems these strategies are likely to result in substantial cost savings and reduction in the negative environmental impact associated with pharmaceuticals.

The overuse and inappropriate use of antimicrobials have led to environmental waste and drug shortages. This challenges the ecological and economical sustainability of our healthcare system and worsens antimicrobial resistance.

Antimicrobial stewardship programs (ASP) commonly consider the cost of drug acquisition but may be failing to recognize the hidden costs of multi-dose intravenous regimens including additional nursing administration time, tubing and fluids, and potentially increased hospital length of stay. They also rarely consider the environmental impact of medical waste creation and disposal, which contributes to the global antimicrobial resistance crisis. These costs are harder to calculate but crucial to a comprehensive assessment of a medication’s total impact. In this invited commentary, we provide an example of a stewardship evaluation at our institution focused on changing from meropenem (MER) to ertapenem (ETP) for infections caused by extended-spectrum beta-lactamase producing organisms. We found that despite an increase in acquisition costs, changing from MER to ETP is associated with overall savings and decreased waste production. A secondary analysis suggests that stay length may also be improved with this substitution.

We present a holistic approach to antimicrobial stewardship that considers the total cost of an antimicrobial. By broadening their view to include hidden costs and secondary effects, ASPs can further demonstrate their value to the healthcare system, reduce resistance, and improve their environmental impact.

Pediatric medications inflate healthcare-associated plastic waste because many are given as liquid suspensions due to a need for weight-based dosing. While chewable tablet formulations and stair-step dosing recommendations are available, they are underutilized. We demonstrate the potential of small changes to medication administration to decrease plastic waste.

In this manuscript, we highlight current literature on environmental hygiene techniques to combat reservoirs of antibiotic resistant organisms in the healthcare environment. We discuss several topics for each strategy, including mechanism of action, assessment of effectiveness based on studies, cost, and real-world translatability. The techniques and topics summarized here are not inclusive of all available environmental hygiene techniques but highlight some of the more popular and investigated strategies. We focus on the following: Ultraviolet radiation, hydrogen peroxide vapor, copper-coated surfaces, phages, interventions involving sinks, and educational initiatives.

Non-sterile gloves (NSG) are essential for reducing transmission of pathogens and for protecting patients and staff. Their overconsumption can lead not only to an increased risk of cross-contamination but also increased plastic waste and downstream environmental effects. Glove reduction campaigns worldwide have safely and successfully reduced their inappropriate use and associated waste. In this multidisciplinary commentary, we discuss the sweeping public health and environmental consequences of NSG overuse and strategies to implement a successful glove stewardship campaign.

The pace and trajectory of global and local environmental changes are jeopardizing our health in numerous ways, among them exacerbating the risk of disease emergence and spread in both the community and the healthcare setting via healthcare-associated infections (HAIs). Factors such as climate change, widespread land alteration, and biodiversity loss underlie changing human–animal–environment interactions that drive disease vectors, pathogen spillover, and cross-species transmission of zoonoses. Climate change–associated extreme weather events also threaten critical healthcare infrastructure, infection prevention and control (IPC) efforts, and treatment continuity, adding to stress to strained systems and creating new areas of vulnerability. These dynamics increase the likelihood of developing antimicrobial resistance (AMR), vulnerability to HAIs, and high-consequence hospital-based disease transmission. Using a One Health approach to both human and animal health systems, we can become climate smart by re-examining impacts on and relationships with the environment. We can then work collaboratively to reduce and respond to the growing threat and burden of infectious diseases.

We assessed healthcare workers’ knowledge, attitudes, and practices around disposable personal protective equipment (PPE) use. We observed that healthcare workers are interested in sustainable policies and identified areas for policy changes to reduce PPE waste.

Introduction: The healthcare sector contributes significantly to global greenhouse gas (GHG) emissions, accounting for 8.5% of the total emissions in the United States alone. Infection control practices designed to prevent disease transmission contribute to this substantial carbon footprint. These practices, which include enhanced ventilation requirements, extensive sterilization processes, and laundry services, inherently increase energy consumption and GHG emissions. The approach to making healthcare more sustainable has been multipronged, including initiatives to reduce waste and energy use. We explored environmental cleaning practices and the energy use associated with ultraviolent (UV) light disinfection. Methods: A retrospective analysis was conducted on the energy consumption of three different UV light disinfection machines used at Stanford Health Care from September 2023 to August 2024. Annual run time data was obtained from vendor-provided logs, and energy use was calculated using the equipment wattage specifications provided with each machine. Results: We found that UV light disinfection utilized approximately 7,300 kWh constituting less than 1% of Stanford Health Care total energy use for the period. This energy consumption equates to the charge required for 3.5 round trips from San Francisco to New York City in an electric vehicle. Discussion: UV light has been widely used in healthcare over the last decade. Recent data suggests that there may be no additional benefit to UV light disinfection when other enhanced cleaning methods, such as sporicidal cleaners, are utilized. Therefore, using UV light in addition to sporicidal cleaners may be redundant. Infection prevention practices often incorporate redundancies given the dependence on human behavior and the high consequences of practice failures. As the healthcare industry continues to work towards reducing greenhouse gas emissions it will be important to consider all energy reductions and any redundancies in practices. In the future, a life cycle analysis could be conducted to compare UV light disinfection and sporicidal cleaning methods to evaluate each practice’s impact on sustainability efforts. Our evaluation showed that UV light disinfection results in modest energy usage reductions. However, as the healthcare industry continues to work towards reducing greenhouse gas emissions it will be important to consider all energy reductions and any redundancies in practices.

Single-use surgical equipment is a standard strategy to reduce the risk of pathogen transmission in the operative room. However, this practice is associated with a great environmental impact. Reusable surgical tools represent an opportunity to reduce this impact, with many studies showing a 50% or greater reduction in carbon emissions by switching to reusable alternatives. While the safety of reusable equipment depends on strict sterilization protocols, the risk of infection is minimal when guidelines are followed. To advance sustainability in healthcare, we must balance infection prevention priorities, operational challenges, and the environmental considerations.

The climate crisis calls for urgent action from every level of the US healthcare sector, starting with an acknowledgment of our own outsized contribution to greenhouse gas emissions (at least 8.5% of carbon emissions). As the climate continues to become warmer and wetter, the medical establishment must deal with increasing rates of pulmonary and cardiovascular diseases, heat-related illness, and emerging infectious diseases among many other health harms. Additionally, extreme weather events are causing healthcare delivery breakdown due to physical infrastructure damage, slowed supply chains, and workforce burden. Pathways for healthcare systems to meet these challenges are emerging. They entail significant measures to mitigate our carbon footprint, embrace shared and equity-driven governance, develop new metrics of accountability, and build more resilience into our care delivery processes. We call upon SHEA to play a unique leadership role in the fight for sustainable, equitable, and efficient health care in a rapidly changing climate that immediately threatens human well-being.

Climate change and pollution harm the public. The healthcare industry disproportionately contributes to greenhouse gas emissions. Infection diseases professionals including infection preventionists and antimicrobial stewards are uniquely positioned to mitigate the environmental impact of our daily practices. We highlight 10 actionable steps that infectious disease professionals can incorporate into daily practices, thereby mitigating the impact of climate change.

In this survey of infection prevention and control (IPC) professionals, we gauged knowledge, attitudes and institutional practices related to environmental sustainability and IPC. Overall, IPC professionals have not yet universally adopted measures to promote environmental sustainability. More research is needed around environmentally sustainable efforts that preserve patient safety in IPC.

Stewardship is not only about appropriate antibiotic prescribing, but also improving the utilization of resources. While multiple treatment regimens are endorsed for chorioamnionitis, some produce significantly more plastic waste than others. Ampicillin with gentamicin ± clindamycin, and vancomycin with gentamicin both create more plastic waste compared to regimens like cefoxitin, piperacillin/tazobactam, or ertapenem.