Écoresponsabilité des médicaments intraveineux au quartier opératoire : Étude avant-après de l'impact de mesures de réduction du gaspillage médicamenteux

Details

Supervisors

Dubois, Philippe E ; Charlot, Salomé

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

enIntroduction: Intravenous drug waste in operating rooms (ORs) contributes substantially to the environmental footprint and healthcare expenditure of surgical care. While previous studies have mainly quantified drug wastage, evidence on the effectiveness of waste-reduction interventions remains limited. This study aims to identify, implement, and evaluate eco-responsible strategies to reduce intravenous drug waste while ensuring clinical feasibility, microbiological safety, regulatory compliance, and cost-effectiveness. Methods: A prospective before-and-after interventional study was conducted in the surgery department of a Belgian hospital. Among 168 intravenous medications, ten were selected according to predefined criteria including frequency of use, waste potential, and environmental and economic impact. Drug consumption and wastage were prospectively recorded during two collection periods using standardized case-report forms. Based on these findings and a literature review, eco-responsible optimization strategies were developed and implemented considering microbiological, regulatory, organizational, and clinical feasibility. Medication waste, carbon footprint (gCO₂-éq), and costs were compared before and after implementation using appropriate statistical analyses. Results: A total of 114 baseline and 93 post-intervention datasets were analyzed. Four eco-responsible interventions were implemented. Replacing propofol 1% with propofol 2% reduced the median number of vials used per procedure from two to one (p = 0,013) and significantly decreased the associated carbon footprint (1317 vs. 986 gCO₂-éq/procedure; p = 0,020). Preparing two 5mL lidocaine syringes from a single 10mL vial reduced the median discarded volume from 4,1 to 0,87 mL per procedure (p < 0.001), with a corresponding reduction in waste-related carbon emissions (189 vs. 36 gCO₂-éq/procedure; p < 0,001). Introducing 2g cefazolin vials significantly reduced the carbon footprint of surgical antibiotic prophylaxis (2528 vs. 1888 gCO₂-éq/procedure; p < 0,001). Intravenous-to-oral paracetamol substitution was implemented but insufficiently adopted for meaningful evaluation. Conclusions: Simple modifications in drug packaging and preparation practices significantly reduced medication waste, carbon emissions, and resource utilization without compromising clinical practice. Eco-responsible optimization of intravenous medication management represents a pragmatic, scalable strategy to improve the environmental sustainability of perioperative care.