Sustainability interventions in nursing wards
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.
Intervention
Maintain a maintenance IV (NaCl flow) at 2 ml/hour to keep a central or peripheral line accessible, instead of 5 ml/hour.
Environmental impact
Measured in CO₂ emissions, based on the reduction in the number of NaCl 0.9% infusion bags used.
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.
When is it implemented?
This intervention is considered implemented when a 2ml/hour infusion rate is used on the nursing units of the hospital.
How is this measured?
The effect of this intervention at the hospital level cannot be reliably determined based on variations in purchasing data for NaCl 0.9% infusion bags.
Analyze the existing protocol to assess implementation at the hospital level. Check whether an infusion rate of 2ml/hour is listed as the standard and observe whether the protocol is followed in practice. This can be done using the pharmacy administration records, if available and reliable. If this is not recorded, a measurement* can be done on the nursing units by determining the number of patients with a maintenance infusion per time unit.
At the department level, the number of maintenance infusions can be estimated based on a maintenance infusion measurement*. This allows for the calculation of the number of infusion bags (volumes of 50, 100, 250, or 500 ml) used for a maintenance infusion. The environmental impact of this can be calculated using the environmental impact calculation tool**.
Resources
Click here for an example from the practical issues discussed by Medisch Contact.
Click here for the recommendation from the Groene IC, section ‘lower pump settings’.
Click here for the recommendation from the working group of the Dutch Association of Hospital Pharmacists in appendix 2, measure 3. This recommendation was made in November 2024 during the infusion fluid availability issue.
Footnotes
* Maintenance infusion measurement template follows
** The environmental impact calculation tool follows
Resultaten
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View our other interventions
Nursing practice
Containers made from recycled plastic for specific hospital waste
Nursing units produce large amounts of waste, including specific hospital waste (SHW). Nurses collect this waste in separate SHW containers, also known as WIVA containers, identifiable by their blue bins with yellow lids. A more sustainable alternative made from recycled plastic has been developed, recognisable by its grey colour.
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.
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.
