Results

Forty-two individuals (33 HEs, 7 IPC Directors, and 2 IPs) from unique institutions completed the survey, resulting in a response rate of 45%. There were no incomplete responses. Thirty (71.4%) were from academic medical centers, 5 (11.9%) were from VA medical centers and 7 (16.7%) were from community hospitals. Six (14.3%) participants were from institutions with >1000 beds, 15 (35.7%) from institutions with 500–1000 beds, 19 (45.2%) from institutions with 100–500 beds and 2 (4.8%) from institutions with <100 beds.

Over half of participants correctly estimated the amount of waste and carbon emissions produced annually by the US healthcare system. Conversely, 42.9% considered environmental sustainability concerns either important or very important in IPC decision-making. The majority (47.6%) considered the issue moderately important, 9.5% slightly important and none considered it unimportant.

Fifteen (35.7%) respondents had an environmental sustainability committee at their institution and of these, 8 had an established relationship between the committee and the IPC department. The most common techniques to promote sustainability amongst institutions were water/energy conservation (59.5%), reusable PPE (52.4%) and Leadership in Energy and Environmental Design (LEED) certification (47.6%) (Figure 1). Highlighting the current challenges in incorporating sustainability in IPC, 18 (42.9%) reported use of single-use disposable flexible scopes (ie, endoscopes, bronchoscopes), 17 (40.5%) reported donating gently used, expired or unused medical supplies, and 10 (23.8%) reported use of “greener” chemicals for low-level environmental disinfection, while 5 (11.9%) still reported use of ethylene oxide (ETO) as part of sterilization efforts.

Figure 1.

Current institutional practices, and policies respondents would support in the future, related to sustainability in infection prevention and control. ^aRespondent would support elimination of ethylene oxide use. ^bRespondent would support elimination of single-use, disposable endoscopes.

When asked which efforts they would support at their institutions to promote environmental sustainability, 28.6% of participants would eliminate the use of single-use endoscopes and instead rely on high level disinfection/sterilization and one third would avoid use of ETO for sterilization (Figure 1). Thirty-two respondents (76.2%) would promote donation of gently used, expired or unused medical supplies, 69% would use “greener” chemicals for low-level environmental disinfection, 50% would implement water conservation (ie, low flow aerators) or energy conservation measures (ie, motion sense lighting), 42.9% would purchase reusable PPE and 31.0% would pursue LEED certification. Other suggested mechanisms included optimizing use of PPE for transmission-based precautions, including discontinuing contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant Enterococcus (VRE), management of single-use items for patients on contact precautions, moving to virtual meetings to reduce travel-related emissions, and recycling food matter from the cafeteria.

In deciding whether to support environmental sustainability measures, key considerations participants articulated were patient safety concerns, knowledge about effectiveness and costs, and garnering administrative support, as well as buy-in from other departments. A salient theme amongst responses was the concern for transmission of infections, including multi-drug resistant organisms (MDROs), associated with re-using instruments, in particular, endoscopes. Other factors included impacts on work flow/personnel time, Instructions For Use (IFU) by manufacturers supporting use of agents other than ETO, regulatory risk and liability associated with reusable devices and PPE, infrastructure (eg, for reusable gowns), resources for distributing gently used, expired or unused items, and issues related to ageing physical plants. Selected illustrative free-text responses are displayed in Table 1. See supplementary tables S1 – S3 for all free text answers.

Table 1.

Selected participant quotes on key considerations in supporting environmentally sustainable measures in infection prevention and control