Development of a Novel Carbon Emissions Estimation Tool for Disposable Waste Associated With Antimicrobial Packaging, Preparation, and Administration in the Hospital Setting.

Background: Addressing climate change is one of the most pressing needs of society. The One Health approach recognizes the importance of antimicrobials at the intersection between humans, animals, and the environment and advocates for mitigation of antimicrobial overuse, primarily as a means of preventing antimicrobial resistance. Antimicrobial use additionally contributes to climate change through consumption of single-use disposable products used for packaging, drug preparation, and intravenous drug administration, which in turn generates greenhouse gas (GHG) emissions when disposed. Methods: We estimated the GHG emissions associated with intravenous antimicrobials given in the hospital setting, initially performing the data collection in a large academic hospital in Cleveland, Ohio, and validating the data in another large academic hospital in Salt Lake City, Utah. For each antimicrobial agent, we identified all disposable packaging, preparation, and administration materials. Materials were weighed and classified by type, and total GHG emissions measured in carbon dioxide equivalents were calculated using emission factors defined by the U.S. Environmental Protection Agency. Results: Results were summarized in tables listing GHG emissions per dose per antimicrobial agent, and a calculator tool was created in spreadsheet format to accommodate antimicrobial use data collected by hospital antimicrobial stewardship programs. Conclusions: We developed a novel tool for estimating GHG emissions associated with single-use waste generated from IV antimicrobial packaging, preparation, and administration in the hospital setting. This tool can be used by antimicrobial stewardship programs to assess their institutions' GHG emissions and provide another stewardship value measure quantifying avoided GHG emissions with antimicrobial optimization strategies.