Society for Healthcare Epidemiology of America supports environmental stewardship and sustainability while protecting patients and healthcare personnel position statement of the SHEA Board.
Dec 26, 2025DOI: 10.1017/ash.2025.10262EditorialASHE
Written by: David J WeberPriya NoriRajalakshmi AnanthanarayananCarolee EstelleJesse T JacobJennie H KwonLisa L MaragakisRekha MurthyAnn-Christine NyquistCatherine PassarettiLisa SaimanErica S ShenoyJulia E SzymczakThomas R Talbot
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Dr. Priya Nori
General ID · MMC
JJ
Dr. Jesse Jacob
General ID · Emory University
Antibiotic and diagnostic stewardship
There is a clear synergy between climate change, AMR, and their magnified impacts on the world’s most vulnerable populations.7 Achieving target reductions for global warming and AMR are interlinked goals of the United Nations global agenda.Antimicrobial stewardship (AS) is an extension of frontline patient care and directly affects individual and population-level outcomes. Interventions to reduce excess antibiotic days of therapy, including shorter antibiotic courses, earlier de-escalation of broad-spectrum agents or intravenous (IV) to oral (PO) switch, can reduce plastic waste associated with IV administrations and have a positive and direct impact on reducing healthcare-associated carbon emissions.8 Moreover, measures to improve diagnostic stewardship by avoiding unnecessary diagnostic testing or leveraging reflexive testing have downstream positive impacts on reducing plastic waste and energy consumption while improving patient outcomes. Therefore, all stewardship programs should implement and scale up proven interventions like de-escalation/cessation, IV to PO switch, and diagnostic stewardship to reduce healthcare utilization and waste and improve patient outcomes. Stewardship programs should also track cost from excess antimicrobial use as quality measures of programmatic success. Nelson et al reported that a switch from frequently dosed meropenem to once daily ertapenem for extended spectrum β-lactamase (ESBL) bloodstream infections resulted in comprehensive cost savings (drug costs, IV tubing, saline, vials, etc.), decreased nursing time, a 66% reduction in waste, and a mean length of stay reduction of >3 days.9 To assist stewardship programs with their sustainability efforts, carbon emission reductions can also be tracked. A novel carbon emissions estimation tool has been developed for disposable waste associated with antimicrobial packaging, preparation, and administration in the hospital setting.10 Numerous successes of the stewardship community demonstrate that we can achieve optimal patient outcomes from infectious diseases while also implementing safe and sustainable practices (Table 1).Table 1.Noteworthy healthcare sustainability-focused interventions and studiesInterventionOutcome/detailsAntimicrobial stewardshipChakravorty et al quantified emissions from excess days of IV antibiotics in patients eligible for PO antibiotics (per institutional IV to PO switch protocol). 17An estimated 9,694 IV days of therapy could have been saved, amounting to 2,049 kg of solid waste, or 0.353 metric tons of CO2 equivalents, 904 miles driven, 40 gallons of gasoline consumed, or 389 pounds of coal burned.Spivak et al measured greenhouse gas emissions from unnecessary outpatient antibiotic prescriptions.813,580,000 estimated unnecessary prescriptions in the United States approximating 993,906 miles driven in a gas-powered carHojat et al led a multi-society effort to develop a calculator to compare carbon emissions of various IV or PO antimicrobial regimens.18Antibiotic Waste CalculatorIn 2023, the “Sustainabil-ID” interest group of pediatric and adult infectious diseases providers was established to promote sustainability interventions in ID. 18,19Member Spotlight: Preeti Jaggi and Shreya Doshi—Pediatric Infectious Diseases SocietyLalakea et al implemented an educational intervention on hand hygiene, appropriate glove use, and environmental impacts to reduce non-sterile glove overuse in surgical specialty outpatient clinics.11An average of 4719 gloves saved per month with a total savings of 56,628 gloves, 180.2 kg of waste and $3,003.17 per year, with projected 1472–1767 kg reduction in CO emissions, equivalent to 3766–4519 miles driven in a gas-powered car.Pearl et al conducted a SHEA Research Network survey of hospital epidemiologists, IPC directors, and infection preventionists on knowledge, attitudes, and institutional practices related to environmental sustainability and IPC.20Most respondents supported or had in place sustainable measures like donation ofgently used or unused medical supplies, pursuit of LEED green buildings certification, water/energy conservation, reusable PPE, and “greener” chemicals for low-level disinfectionGreene et al developed a conflict-based pragmatic approach to reducing single-use plastics in healthcare, which can be applied to AS, and IPC-based interventions, among others.21“No conflict”—immediately implementable“Context-dependent”—requires further exploration“Value conflict”—too high risk/too many safety concernsNote. ID, infectious disease; IPC, infection prevention and control; IV, intravenous; LEED, leadership in energy and environmental design; PO, orally administered.
Infection prevention and control
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Noteworthy healthcare sustainability-focused interventions and studies
Note. ID, infectious disease; IPC, infection prevention and control; IV, intravenous; LEED, leadership in energy and environmental design; PO, orally administered.
Healthcare epidemiology and infection prevention and control
Disposable gloves are the highest-volume single-use product used in healthcare.11 Therefore, Infection Prevention and Control (IPC) programs should continue to recommend their use only when indicated to protect healthcare personnel or patients. For example, the Centers for Disease Control and Prevention (CDC) notes that Occupational Safety and Health Administration “regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patient’s body fluids.”12 Exploring conversion from disposable to reusable isolation gowns, when feasible and acceptable, can reduce energy consumption, greenhouse gas emissions, and solid waste generation.13 Finally, IPC programs can continue to promote the disposal of healthcare waste in the appropriate receptacle, given that biohazardous waste generates more greenhouse gas emissions due to the high energy required for autoclaving or incineration.14
However, measures designed to improve healthcare sustainability must be balanced with risks of communicable disease transmission in healthcare settings. Examples of interventions designed to mitigate the effects of climate change or improve sustainability reported as leading to healthcare-associated infections have included use of electronic faucets in an intensive care unit15 and the installation of a low-flow recirculated hot water system in a new hospital.16 When evaluating competing methods of protecting healthcare personnel or patients, facilities must consider the impact of each alternative. For example, when considering the use of disposable versus reusable endoscopes (ie, bronchoscopes and gastrointestinal endoscopes), consider the following: (1) multiple outbreaks have been reported of multidrug-resistant gram-negative bacilli transmitted by reusable endoscopes despite high-level disinfection that adhered to the manufacturer’s instructions for use, (2) current technology has not validated a method of low-temperature sterilization or high-level disinfection that can guarantee a pathogen-free duodenoscope, and (3) use of a sterile disposable duodenoscope is a proven safe and effective method of endoscopy.
SHEA recommends that IPC and AS programs prioritize sustainability while assessing benefits and potential risks of new products, or new policies and procedures (Table 1). Importantly, IPC and AS experts should examine whether implementation of sustainable strategies could have unintended harms related to the risk of healthcare-associated infections and pathogen transmission within the healthcare setting and develop potential strategies to mitigate such risks.
In summary, the SHEA Board of Trustees commends infection prevention and AS professionals who seek to implement rational, sustainable practices to reduce healthcare’s carbon emissions and improve patient outcomes. SHEA members should be “at the table” for high-level discussions on sustainability-based decisions that may affect our mission of safe healthcare for all. Likewise, SHEA members should promote proven IPC and stewardship interventions which can also reduce costs and excess plastic waste. We can identify opportunities to promote sustainability in our daily work while prioritizing patient and healthcare personnel safety.
JJ
Dr. Jesse Jacob
Infectious Disease · General Infectious DiseaseEmory Universityjessej
