Sustainable IPC solutions in healthcare: Balancing efficacy, economy, and environmental responsibility

In today’s world, where environmental challenges loom large, the healthcare industry stands at a critical juncture. The use of consumables combined with the need to prevent infections in healthcare facilities has led to a surge in the use of infection prevention and control (IPC) products. However, there is a growing concern about the environmental impact of these indispensable measures.

IPC measures remain necessary in healthcare settings, where it saves and improves lives. Yet, as we endeavour to safeguard patients, aged care residents, healthcare workers and the community, striking a balance between efficacy, economic viability, and environmental responsibility is vital.

To provide context, consider that every 40 seconds, a new patient acquires a healthcare-associated infection (HAI).¹ These infections not only pose a significant risk to human health but also impose substantial economic and environmental costs. For each HAI, an additional 18.1 bed days² and 2,262kg of CO2 emissions³ are incurred, highlighting the multifaceted nature of these challenges.

Achieving sustainability in business relies on a delicate balance between these three pillars:

• Economic: This involves the efficient and responsible utilisation of resources, ultimately leading to longterm profitability and business viability
• Environmental: The focus is on reducing waste, minimising carbon footprints, and maximising energy efficiency, all of which contribute to mitigating negative environmental impacts such as pollution and global warming
• Social: Initiatives related to employee safety, wellness, diversity, inclusion and equal access to healthcare play a pivotal role in creating healthier communities that can sustain themselves, aligning with the social dimension of sustainability

The shift towards sustainable disinfection

Chlorine-based disinfectants are often used in healthcare, which have raised environmental concerns due to the generation of harmful ecotoxic by-products (Parveen et al. 2022).⁴ The adverse effects of these disinfectants have been extensively documented; dating back to 1999, where the EPA recognised all forms of chlorine as highly corrosive and toxic.⁵

Specifically, Parveen et al. (2022) research found that chlorine-based disinfectants have a detrimental impact on both human health and the environment. These negative effects encompass respiratory problems, contamination of wastewater, disruption of soil and aquatic ecosystems, and bioaccumulation within the food chain. Consequently, the healthcare industry is increasingly exploring environmentally sustainable alternatives such as those that breakdown to nonharmful by-products like peracetic acid.⁴

Balancing efficacy and environmental responsibility

Healthcare facilities encounter substantial challenges in striking the right balance between effective disinfection and environmental considerations. When evaluating a disinfectant wipe, it is essential to look at the organisms the wipe is effective against and the contact time.

The wipe should be effective against clinically relevant organisms found in the healthcare environment, such as MRSA, VRE, CRE and Norovirus, but it is important to ensure these claims have been approved by the TGA. TGA-approved claims are likely to be stated on the ARTG certificate and ensure the quality of the test method and the laboratory used.

It is also essential to assess the contact time used in the test method. Many disinfectant efficacy tests have a standard contact time of 60 minutes. For this to replicate real use, the surface would need to stay wet for 60 minutes, but a surface dries in minutes.

Efficacy tests should be evaluated to ensure:

• Testing has been conducted at ISO 17025 or GMP-accredited laboratories
• Test methodologies utilise realistic contact times — shorter than it takes for the surface to dry
• Tests are conducted in dirty conditions; TGA requires disinfectants tested in clean conditions to have the surface cleaned prior to disinfecting
• Tests are conducted using the liquid that is extracted from the wipes
• A standardised test method is used, such as an EN, ASTM or TGO 54 method

It is also important to understand that when cleaning and disinfecting, the technique used is crucial to ensure the removal and killing of bioburden and harmful microorganisms.

Navigating regulatory and industry initiatives

Government regulations and industry initiatives play a pivotal role in promoting sustainable disinfection practices. In late 2023, the Australian Government introduced the National Health and Climate Strategy, which outlines key priorities aimed at guiding efforts to reduce greenhouse gas emissions within the Australian health system.⁶

Cost-benefit analysis of sustainability

The shift towards sustainable disinfection practices in healthcare facilities can bring about unexpected cost benefits while simultaneously reducing the carbon footprint linked to HAIs. For example, when contemplating the adoption of biodegradable detergent-and-disinfectant wipes, it’s essential to examine factors like surface area coverage per wipe and coverage per pack. This analysis will help provide valuable insights into the economic feasibility of making the transition.

The future of sustainable disinfection

The escalating global awareness of economic, environmental, and social concerns in healthcare is likely to drive an increasing demand for sustainable practices in healthcare, pushing the industry towards continued improvement in this vital area of healthcare operations. Based on this, the outlook suggests that healthcare can play a pivotal role in reducing its environmental footprint, enhancing economic viability, and maintaining the highest standards of care, safety, and social well-being.

References

<sub>1. Guest JF, Keating T, Gould D, et al. Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England. BMJ Open 2020;10:e033367. doi: 10.1136/bmjopen-2019-033367.
2. https:// Australian Commission on Safety and Quality in Health Care. (2018a). Hospital-Acquired Complication (pp. 1–35).
3. Carbon Cost of 1 HCAI. Data on File.
4. Parveen, N., Chowdhury, S., & Goel, S. (2022), Environmental impacts of the widespread use of chlorine-based disinfectants during the COVID-19 pandemic. Environmental Science and Pollution Research, 29(57):85742- 85760. doi: 10.1007/s11356-021-18316-2. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC8799444.
5. EPA. (1999). Wastewater Technology Fact Sheet Chlorine Disinfection [Review of Wastewater Technology Fact Sheet Chlorine Disinfection]. https://www3.Epa.gov/Npdes/Pubs/Chlo.pdf.
6. Commonwealth of Australia | Department of Health and Aged Care. (2023). National Health and Climate Strategy [Review of National Health and Climate Strategy]. https://www.health.gov.au/Resources/Collections/National- Health-And-Climate-Strategy-Resources-Collection?Language=En.</sub>

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