LB036 - TURNING THE TAP: A SUSTAINABLE SHIFT IN ENTERAL PRACTICE
LB036
TURNING THE TAP: A SUSTAINABLE SHIFT IN ENTERAL PRACTICE
J. Jackson1,*
1Dietetics, St Georges University Hospitals NHS Foundation Trust, London, United Kingdom
Rationale: Healthcare significantly contributes to climate change, with critical care being one of the sector’s largest sources of carbon emissions (Carrandi et al., 2024). In 2020, the NHS became the world’s first health system to commit to reaching net-zero emissions (NHS England, 2020).
This QI project aimed to reduce the use and disposal costs of sterile water bottles in the Adult Critical Care Directorate (ACCD) (approx 60 beds) and wider hospital setting (approx 1300 beds), by challenging the routine use of sterile water for enteral feeding, promoting tap water as a safe, cost-effective alternative, thereby lowering financial and environmental waste.
Methods: An ICU “Green Team,” comprising a Consultant, Matron, Nurse, and Dietitian, met to discuss the project aims and identify key stakeholders to drive changes to the local nutrition support policy.
Usage data was obtained from Drug Usage Summary Reports generated by CareFlow Medicines Management. The annual number, cost and weight of sterile water bottles used by the Trust was broken down into inpatient wards (including ACCD), non- inpatient and paediatric wards (e.g. , PICU, Endoscopy, Theatres, Outpatient and Outpatient clinics) and ACCD only. Inpatient ward areas were distinguished from non-inpatient ward areas as not all sterile water used across the Trust was for enteral feeding flushes. Data was collected for 2023 and 2024 (pre-intervention) and an average was calculated. This was then compared to usage figures for 2025 (post intervention). Figures for 2025 were calculated based on actual figures (Jan to May 2025) and scaled up to give an annual estimate. Disposal costs were calculated for ACCD only as it was known that this area was disposing of the sterile water bottles via the infectious waste stream.
The Trust’s Adult Nutrition Support Policy was reviewed in line with the evidence base and updated. In addition recycling points were set up across the ACCD with education on the benefits of recycling.
Results: Following the intervention, there was a substantial reduction in the use of sterile water bottles, associated costs, weight of waste generated, and disposal costs across all areas
At the Trust level, the number of sterile water bottles used fell from 59,997 to 13,665, representing a 77.2% reduction. This was accompanied by a corresponding decrease in cost, dropping from £65,996.70 to £15,032.16. Similarly, the weight of waste reduced from 10.0 to 2.28 tonnes.
In the inpatient wards (including ACCD), the number of bottles used decreased from 31,161 to 7,588, a 75.6% reduction. The cost fell from £34,277.10 to £8,347.68, and the waste weight declined from 5.2 to 1.27 tonnes—also a 75.6% reduction.
The ACCD area, in particular, showed the most dramatic changes. Bottle usage fell from 14,454 to just 720, a 95.0% reduction. Costs dropped from £15,899.40 to £792.00. Waste weight decreased from 2.0 to 0.1 tonnes (94.0% reduction), and the disposal cost reduced from £1,010.52 to £8.42, equating to a 99.2% reduction.
These findings clearly demonstrate the significant impact of the intervention in reducing both environmental burden and financial expenditure across all areas assessed.
Conclusion: This quality improvement initiative demonstrates that reviewing and updating clinical policies—particularly those lacking a strong evidence base—can deliver meaningful environmental and financial benefits without compromising patient care. The reduction in sterile water bottle usage not only contributed to significant cost savings but also aligned with the NHS's commitment to achieving net-zero emissions (NHS England. (2020). By engaging key stakeholders and using real-world data to inform decision-making, the project serves as a scalable and replicable model for other critical care units and healthcare settings seeking to implement sustainable, evidence-based practices.
References: Carrandi, A., Nguyen, C., Tse, W.C., Taylor, C., McGain, F., Thompson, K., Hensher, M., McAlister, S., & Higgins, A.M. (2024). How environmental impact is considered in economic evaluations of critical care: A scoping review. Intensive Care Medicine, 50(1), 36–45. https://doi.org/10.1007/s00134-023-07274-7
NHS England. (2020). Delivering a ‘net zero’ national health service. https://www.england.nhs.uk/greenernhs/publication/net-zero-delivery-plan/
Disclosure of Interest: None declared