Reducing hospital-provided plastic water bottle use in an intensive care unit: Environmental, economical, and behavioural outcomes of a sustainability initiative.

INTRODUCTION: The Australian healthcare system generates substantial quantities of plastic waste annually, with hospital-provided water bottles (HPWBs) representing a potentially modifiable source of nonclinical, single-use plastic consumption. Evidence regarding pragmatic, low-cost strategies to reduce HPWB use in Australian healthcare settings remains limited. This study evaluated the environmental, financial, and behavioural impact of a multifaceted intervention designed to reduce HPWB utilisation.

METHODS: A quality improvement study was conducted in a regional Australian intensive care unit. The intervention comprised optimisation of ordering practices, relocation of HPWB supplies to patient-designated areas, and education of staff and visitors regarding the environmental, financial, and health implications of single-use plastics. Economic and environmental impacts were assessed through procurement audits over two 3-month periods before and after intervention. Repeated spot audits evaluated behavioural changes. Staff attitudes and hydration experiences were assessed using questionnaires completed by 66 multiprofessional respondents before intervention and 53 respondents after intervention. The primary outcome of interest was change in cost associated with HPWB procurement.

RESULTS: Following implementation, HPWB procurement decreased from 972 to 72 bottles over a 3-month period, representing a 92.7% reduction in procurement costs ($903.96 vs $66.00 AUD), a 30-kg decrement in plastic waste generation, and a decreased carbon footprint associated with materials alone of 134.7 kg CO2e. Secondary outcomes were assessed through spot audits and questionnaires. Spot audits demonstrated reduced storage of HPWBs outside patient-designated areas (14 bottles vs one bottle) and reduced use within staff areas (four vs two bottles). Questionnaire results did not demonstrate a significant difference in self-reported hydration following intervention (mean difference: -0.1, p = 0.327; Cohen's d = -0.11). A modest behavioural effect with a trend towards reduced HPWB use was observed (mean difference: 0.4, p = 0.091; Cohen's d = 0.32). Perceptions regarding the primary contributors to HPWB use changed significantly following intervention (χ2 = 16.61, p = 0.011), with respondents increasingly identifying patients rather than visitors as the predominant users.

CONCLUSION: This low-cost intervention was associated with substantial reductions in costs associated with HPWB procurement, plastic waste generation, and carbon footprint without adversely affecting staff-reported hydration. These findings suggest that simple behavioural and system-based interventions may represent a scalable approach to reducing single-use plastics and supporting sustainable healthcare delivery.