Sustainability interventions in nursing wards
Nursing practice
Wound care irrigation with tapwater
For acute wounds (traumatic or surgical), irrigation using a female catheter filled with lukewarm tap water is recommended instead of NaCl 0.9%. This increases patient comfort and reduces material use, as a new sterile NaCl 0.9% bottle or sterile collection tray is no longer needed every 24 hours.
Intervention
Use tap water to cleanse traumatic and/or surgical wounds instead of 0.9% NaCl.
Exclusions:
- Rinse in the shower and rinse with a vacuum system, as this is a different application than wound rinsing with a female catheter.
- Wound treatments that have been ruled out in consultation with your own hospital's wound consultant, such as open fascial wounds or wounds where the depth and structure are unclear and rinse fluid may not run back properly.
Implementation approach
Look at the approach for implementing a different method in nursing practice and consult the step-by-step guide for more information on setting goals, implementation, and evaluation.
Environmental impact
Measured in CO2-emissions due to less use of (environmentally harmful) materials in wound care. Want to know more about the environmental impact? See the bottom of this page for more information.
Current situation
Wound rinse* with 0.9% NaCl from a 500 ml bottle and sterile tray
- Rinse a wound once with NaCl = 0.80 kg CO2-eq
New situation
Wound washing* with tap water and renal pelvis pulp
- Rinse a wound once with tap water = 0.07 kg CO2-eq
-91% CO2
The environmental impact of a wound wash with NaCl is approximately 11 times higher than a wound rinse with tap water.
* Assuming 116 ml of rinse fluid (fill a 60cc syringe approximately twice)
Rinsing a wound 100 times with tap water instead of NaCl saves
73
kg CO2-eq
and is equivalent to driving 374 km
When is it implemented?
This intervention is considered implemented when rinsing with tap water becomes the standard option for wound care on nursing units, unless this is not possible.
How is this measured?
The effect of this intervention on a hospital level cannot be reliably established based on the variation in purchasing data, such as the number of NaCl 0.9% 500ml bottles. Therefore, analyze existing wound care protocols to assess the implementation at the hospital level. Check if rinsing with tap water is listed as the standard. Keep in mind that protocols do not always reflect the daily practices of wound care; clinical experience and expertise also play an important role.
At the department level, the number of wound rinses can be estimated based on protocols and practices for specific patient groups. The environmental impact of this can be calculated using the environmental impact tool. This tool can be found in the MS Teams channel if your hospital participates in the Greening healthcare together program. However, this calclation on department level is not mandatory for the program.
Resources
- V&VN (May 2023). 'Beter Doen' recommendations (n = 369) | Hospital list
View our other interventions
General resources
Paper medication cup
Medication is often administered several times a day in plastic cups, which generates a large amount of waste. Paper medication cups suitable for liquids (containing less than 5% plastic) offer a more sustainable alternative. In some cases, however, a plastic cup remains necessary, for example when crushing medication.
Verpleegkundig handelen
Non-sterile bladder catheter insertion
Since July 2024, bladder catheterisation may be performed using the new ‘no-touch technique’. In this method, non-sterile gloves are used, and the genital area is cleaned with tap water. This more sustainable approach requires fewer sterile materials and saves time, as the procedure can be performed by a single nurse. With this intervention, nurses put the new guideline into practice.
ADL
Reducing linen use
Linen is used for many different purposes. Reducing linen use is not only better for the environment but also benefits patients by helping to prevent pressure ulcers. The do-not-do recommendations1 advises: “Avoid or limit unnecessary layers underneath the patient, such as linen, positioning materials, cellulose mats, incontinence materials, clothing, and bedding.”
Nursing practice
Containers made from recycled plastic for specific hospital waste
Nursing wards produce a lot of waste, including specific hospital waste (SZA). Nurses collect this waste in separate SZA tanks, also known as Wiva barrels, recognisable by the blue barrel with a yellow lid. A more sustainable alternative made from recycled plastic, recognisable by its grey colour, has been developed.
