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
Nursing practice
Using the same infusion sets on every ward
When hospital departments use different IV systems, IV lines may need to be replaced when a patient is transferred because the systems are not compatible. This leads to unnecessary waste, takes additional time, and can cause discomfort for the patient. A single, standardised IV system prevents this.
General resources
Reducing glove use
Nurses use large quantities of non-sterile gloves during patient care. There are three situations where gloves are required: 1) when caring for patients in isolation 2) when there is a risk of contact with mucous membranes or bodily fluids 3) when preparing certain medications. Wearing gloves as a standard practice is not recommended1. Due to the high consumption rates in hospitals, gloves have a considerable environmental impact2.
Nursing practice
Reducing maintenance IV flow rate
A maintenance IV with NaCl 0.9% at a flow rate of 5 ml/hour is often used to keep the IV line open for patients not receiving intravenous medication. Reducing the pump rate to 2 ml/hour lowers NaCl 0.9% use, allowing for smaller infusion bags or less frequent bag replacement. This is more sustainable and reduces material consumption.
