Versailles Hospital (78)
PUI deploys environmentally-friendly, cost-effective actions
Optimization of intervention kits, replacement of single-use outfits, alternatives to drugs that generate the most waste... at the PUI de Versailles, actions in favor of sustainable development are multiplying, with real economies of scale at the end of the day.
It's a fact that the healthcare sector pollutes. " But in France, since we have few or no binding regulations, the desire to do better must come from healthcare professionals ", say Marie Scius, a pharmacy intern, and Miriam Malliti, a pharmacist, who have taken the problem head-on and defined three priority areas for action: sustainable purchasing, waste reduction and improving quality of life.
Dumb as a post...
Sometimes all it takes is a sheet of paper and a pencil to achieve spectacular results. That's what happened, or nearly so, when Marie and Miriam set about composing surgical kits. "It's as simple as that. We drew up a table with the detailed composition of the kits on the left and 2 columns on the right: do you use this item during your procedures: yes/no. This led to discussions between professionals about whether they really needed it or could do without it. It was interesting because it also enabled us to review each other's practices, and bring them up to date. " The questionnaire was submitted not only to anesthetists and surgeons, but also to Ibodes (operating room nurses) and logisticians involved in supply.
In the end, 8 kits were scrutinized: epidural, ligamentoplasty, loco-regional anesthesia (LRA), coronary angiography, retina, combined cataract, episiotomy and intravitreal injection. Up to a quarter of the components - as much as 50% for the epidural kit - have been modified or deleted.
[ 8 kits under the microscope ]
Among the items modified, woven compresses were replaced by non-woven ones, intramuscular needles were replaced by subcutaneous ones, or when used as pumpers, by... pumpers. The items removed are varied: compresses, pancakes/dressings, metal objects such as Kocher forceps, cupules " and even a neurostimulation cable in the ALR kit! "
Thanks to this action, waste has been reduced from 11 to 52 kilos of waste per reference and per year. " That's around 160 kilos of waste avoided, with a financial gain despite inflation since we reduced the number of references. " The project took about a year to complete, but it did raise the teams' awareness of sustainable development issues.
good pui practices
Drawing on internal feedback (or that provided by other establishments) and the abundant documentation made available by professional bodies, Marie Scius detailed 6 key areas for advancing sustainable development in PUIs: purchasing drugs and medical devices, anaesthetic gases, sobriety in drug use, sustainable sterilization, waste and quality of life at work.
[ KIT STORAGE ]
Another project in Versailles is to order palboxes to store the kits. " These are gigantic cardboard boxes in pallet format ," explains Marie Scius. " The supplier assures us that it reduces cardboard waste by 50%, plastic waste by 30% and decarting time by 50%... and, of course, saves storage space. The Institut Gustave-Roussy in Villejuif has tested it and managed to reduce its packaging waste by 87%, as well as the equivalent of one month's warehouse staff time, so it's quite substantial. "
Effervescent tablets
Other waste reduction initiatives include the replacement of sodium bicarbonate mouthwash bottles with effervescent Bicarôme® tablets. " Historically, we used these ready-to-use bottles for patients hospitalized in our hemato-oncology departments to prevent mucositis. Except that these bottles have a very high waste tonnage. "
This has enabled us to divide the mass of waste by 40 and treatment costs by 10!
To make the switch to Bicarôme® effervescent tablets, the two employees are once again working on a questionnaire: one for patients, one for carers. " We evaluated intake, taste, convenience and so on. And we compared the economic and environmental impacts. "
[ REPLACING SODIUM BICARBONATE BOTTLES ]
In the end, patients and caregivers preferred tablets, not only for reasons of taste, but also for reasons of transport, storage and ecology. The replacement was validated for the prevention (but not treatment) of mucositis. " It has enabled us to divide the mass of waste by 40 and treatment costs by 10! And according to their estimates, if all the hospital's departments opted for Bicarôme®, waste would be reduced by around 120 kg/year (the equivalent of 2,700 bottles), saving €5,000.
Reduce injectables
Another priority is to reduce prescriptions for injectable drugs, which generate 90 times more waste than oral medication. " We organized an awareness campaign, first with the management committee, then with each new intern. We also created pop-ups that appear on doctors' screens at the time of prescription and at D+3, during re-evaluation. The message indicates that there is an oral alternative for this drug, and they are asked to justify the use of the intravenous route.
Around ten molecules - the most widely consumed in the hospital, with a bioavailability of over 90 between the intravenous and oral routes - are concerned: analgesics, PPIs, antibiotics, etc. "The project could not be evaluated due to a cyber attack on the hospital in 2022. The project could not be evaluated due to a cyber-attack on the hospital in 2022, but comparable studies are beginning to appear, notably on paracetamol, which show a 67% drop in the consumption ratio and emissions down from 180 kilos of CO 2 equivalent per month to 125. "
Good use sheets
Faced with a tight supply of pre-filled water bottles, Marie Scius and Miriam Malliti studied how to rationalize them to avoid shortages. A good-use sheet was sent to users, reminding them of the context of use, the correct indications for oxygen humidification - " for flow rates of less than 4 l/min, you don't necessarily need it " - and the precautions for use . - and precautions for use. Then, noting that volumes were still not falling, they drew out more incisive arguments on the controversial effectiveness of these bottles, the risk of microbiological contamination, their high cost and ecological impact... not to mention the effects on handling and storage. Message well received.
Reducing consumption of pre-filled water bottles
" After that, consumption dropped by 39%, saving €6,000/year and 540 kg of waste, with a positive impact on handling and storage space! Which tells us that sometimes tension (editor's note: in supply) is a good thing ," jokes Marie Scius.
The Green Apéro
To kick-start an ecological transition within the PUI itself, a working group called L'Apéro écolo was set up in 2023. " We've set up a suggestion box open to all. When it's full, at a working lunch, we unpack all the ideas and appoint people to implement them. "
This has led to a number of projects, including humorous advertising on lights and computers, changes to the packaging of certain medical devices, the introduction of reusable pyjamas in the chemotherapy reconstitution unit, and the replacement of paper bags with reusable dispensing bags. " The infectious risk prevention department has given us the go-ahead. Once the drugs have been unpacked, the departments have to place the sachets in bins. At first, they forgot to do this or lost the sachets. But now things are better. And the couriers who have been made aware of this operation are very involved," enthuses Miriam Malliti.
Several measures have also been adopted in favor of quality of life at work (QWL). " We organized a barter party in the spring, which was a great success. We also provided reusable crockery in the department and a book box in the break room. " Each time an idea is put into practice, a new leaf is added to the"tree of sustainable ideas" pinned to the wall.
" We also use indicators to see how far we've come and what remains to be done. We display them in the break room, so that everyone can see where they stand and how far we've come, as well as demonstrating the importance of a collaborative, proactive approach to progress ," says Marie Scius. Communication on projects is also vital between all healthcare players. " The more we have access to fact sheets, guides and feedback, the more we realize that many actions are accessible and require, in quotation marks, only time and investment. "
Since its launch, the Apéro écolo has never been empty. " Today, a third of the I.P.U., in fact almost half, take part in the meetings, with new recruits every time. It's a way of highlighting another facet of the pharmacist's profession and, who knows, of inspiring vocations.