A waste audit on different nebulization practices to treat respiratory conditions in the ICU

BACKGROUND: Aerosolized medications are frequently administered through nebulization to treat respiratory conditions. Vibrating mesh nebulizers (VMN) are preferred over junction emission technology (JET) nebulizers (JN) in providing effective treatment. They potentially differ in environmental impact due to differences in product and medicine waste. AIM: To quantify waste related to nebulization by JN and VMN to determine the most sustainable nebulization option in the ICU. METHODS: A waste audit was performed in the ICU of Erasmus University Medical Center, Rotterdam, The Netherlands. The functional unit was product waste per nebulization, cumulative waste generated by nebulization over nine days and product waste in one year. Waste of two JN and two VMN was quantified, including packaging and administration products. Nebulization was simulated to determine medication waste per nebulizer. Total amount of waste was calculated per nebulization and extrapolated for the year 2023. RESULTS: Overall, JN generated more waste than VMN. VMN in non-mechanically ventilated patients without tracheostomy generated more waste compared to JN on day one. Use beyond one day resulted in more waste for JN compared to VMN, related to product waste. Additionally, medication waste differed between JN (median of 0.60 mL) and VMN (median of 0.06 mL). Based on 2230 nebulizations in the ICU in 2023, JN produced 91,1 kg of waste and VMN produced 35,4 kg of waste. CONCLUSION: Nebulization with VMN generated less product and medication waste than JN in the ICU. VMN may therefore be a more sustainable option for treating acute respiratory conditions in the ICU.