Sustainability interventions in nursing wards
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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.
Intervention
Clean bladder catheterization with the no-touch technique instead of sterile bladder catheterization.
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 during bladder catheterization. Want to know more about the environmental impact? See the bottom of this page for more information.
Current situation
Sterile catheterization with 2 sterile gloves, 2 sterile gauzes, 100 ml sterile water from a 500 ml bottle, cellular mat
- 1 sterile catheterization = 0.4 kg CO2-eq
New situation
Clean catheterization with 2 non-sterile gloves, 2 non-sterile gauzes, 100 ml tap water, towel
- 1 clean catheterization = 0.2 kg CO2-eq
-46% CO2
The impact of sterile bladder catheterisation depends on how often the 500ml bottle is used. Do you throw away the bottle after 1 time? Then this provides 0.9 kg of CO2-eq and saves up to 80% compared to clean bladder catheterization!
Performing 100 bladder catheterizations cleanly instead of sterile saves at least
20
kg CO2-eq
and is equivalent to driving 103 km
When is it implemented?
This intervention is implemented when each nursing unit in the hospital uses the clean catheterization guideline and the kg of CO2-equivalent has been calculated.
How is this measured?
Determine the number of bladder catheterizations per year using purchasing data for insertion sets or individual catheters (when sets are not used). Analyze the purchasing data from the previous year and calculate how many insertion sets or catheters were purchased over the course of a year for the nursing units. Fill in the environmental impact calculation tool. This tool can be found in the MS Teams channel if your hospital participates in the Greening healthcare together program.
If not all nursing units have adopted the new method, follow the "measuring intervention with purchasing data" procedure.
Resources
click here for the Radboudumc infographic where they implemented this intervention and saved 2151 kg of waste per year.
click here for a display from the Green OR about the difference in materials between clean catheterization and sterile catheterization.
click here for an information poster published by V&VN.
click here for the bladder catheterization guideline, module 2 insertion.
Footnotes
- Samenwerkingsverband Richtlijnen Infectiepreventie. (Juli 2024). Richtlijn Blaaskatheterisatie.
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.
Nursing practice
Reusable non-sterile suture removal set
Sutures can be removed with sterile disposable materials such as gauze, cotton swabs, tweezers, and scissors or a stitch cutter. The tweezers and scissors do not need to be sterile and can be replaced by clean, reusable ones that are cleaned and disinfected. This means the final sterilisation step is omitted after cleaning and disinfection. Mechanical cleaning (thermal disinfection) is preferred over manual cleaning.
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.
Nursing practice
Replacing IV lines every seven days
IV lines, the part of the infusion system that remains outside the body and connects to the intravenous catheter, are currently replaced every four days to prevent infections. Research shows that replacing IV systems every seven days does not increase the risk of infection. This saves materials and time for nurses.
