A Multicentre Questionnaire Based Knowledge, Attitude, Practice Study on “Green ICU” Amongst Intensivists and ICU Nurses in India

INTRODUCTION: The worldwide carbon footprint of the healthcare industry is thought to be as high as 5%. The bulk of greenhouse gas (GHG) emissions in healthcare sector comes from the ICUs(1). The importance of sustainable healthcare practices has been highlighted by the World Health Organization (WHO), which has urged member countries to develop and implement strategies to facilitate sustainability in healthcare. Global efforts, mostly led by Europe and Oceania, to reduce the substantial environmental impact of ICUs are on the rise.(2) However, there is significant dearth of data from Indian ICUs in terms of the initiatives taken for increasing sustainability in ICUs. OBJECTIVES: 1. To elucidate the existing knowledge and attitude on the concept of “Green ICU”amongst intensivists and ICU nursing professionals. 2. To identify the prevalent practices in ICUs at the bed side which are compatible with “Green ICU” concept. MATERIALS AND METHODS: A close ended multiple choice questionnaire was circulated across the study population via Google Forms and the data collected was analyzed using SPSS software after approval of Institutional Ethical Committee. This questionnaire was formulated in keeping with Sustainability in ICU toolkit from the ANZICS 2020 e-conference(3). A score of 0–5 was considered as poor knowledge, 6–10 as average, 11–15 as good and above 15 as excellent. RESULTS: A total of 139 study subjects participated in our study, out of which 101 were males and 38 females. Baseline demographics of the study participants were as follows: Only 40.3% of the study participants were aware of the concept of “Green ICU” whereas 43.2% of participants declared no knowledge of the above concept and 16.5% were not sure of the extent of their knowledge. A staggering 85.6% of the study participants had never attended any formal training/workshop/CME on “Green ICU”. Knowledge aspect was judged on 8 bedside applicable questions, Attitude aspect was judged on 6 questions and Practice aspect was judged on a set of 15 questions. “Practice” aspect of Green ICU 41.7% of the participants had “Good” knowledge and 33.8% had “Excellent ” knowledge, however when Practice aspect was considered 57.6% had “Good ” practices and only 30.9% had excellent practices. We also calculated the impact of experience in ICU on the knowledge/ Attitude/Practice score. Although Knowledge score did not have co relation with experience in ICU, however “good “practice scores was more with experience in ICU. DISCUSSIONS/CONCLUSIONS: The ANZICS 2020 NZ ASM and Australian Quality and Safety committee sustainability e-conference served as the benchmark for sustainability in ICU toolkit. This toolkit compiles concepts and activities that we may use locally.(3) Similarly, guidelines by National Centre for Disease Control, Government of India in February 2023, also advocates the use of green procurement, energy efficient process in ICU.(4) It is crucial to recognize the importance of promoting sustainability in day to day ICU practices. Our study gives insight into the existing knowledge and attitude and prevalent practices in ICUs in India. Our study surprisingly showed that though nearly 85% of the participants lacked any formal training however 88.5% had practices that were aligned with sustainability in ICU which probably arises from heterogeneity of the ICUs prevalent in India ranging from well equipped ones to resource limited settings. Our study paves way for further research in this direction.