The use of disposable feeding bottles at the Erasmus MC Sophia Children’s Hospital is a major contributor to the environmental footprint of the entire paediatric department. Reusable feeding bottles are commercially available, but their introduction into the hospital is hindered by concerns about safety, hygiene, limitations in physical infrastructure and financial constraints.

This project combines a qualitative study investigating the journey of a feeding bottle from arriving as an empty product to its disposal as waste in the paediatric intensive care unit (PICU), with a quantitative waste audit. This audit revealed that annually, a minimum of 555 kilograms of feeding bottles are discarded from the PICU alone. The consistent use of accessory products, such as feeding teats or enteral feeding sets, further adds to this material waste. Based on this in-depth investigation of the current feeding practices and waste flows, ten sustainability hotspots were determined, leading to the development of eight explorative interventions to reduce the environmental footprint.

The designed mono-material feeding pouch reduces the material weight required to transport an equivalent amount of formula milk by 60% compared with conventional bottles. This saves more than 329 kilograms of plastic waste from the PICU annually. The smaller size of the feeding pouch decreases the generated volume of waste by two-thirds and requires 40% less transportation capacity to deliver.

Integration into the existing infrastructure of the hospital is ensured with the developed stackable preparation and transportation tray and the bedside pole holder, which supports both teat-based and enteral feeding for the proposed next generation of feeding containers.

The project also highlights the current use of sterile water, which more than doubles the disposed mass associated with feeding bottles, while being supported by potentially outdated guidelines. This topic is suggested as a key opportunity for immediate changes by the Sophia Children’s Hospital.

Introducing any new medical device is a complex challenge, and the development of this next generation of feeding containers and the necessary accessory products must be supported by a questioning of the established practices surrounding infant feeding. Reducing the environmental footprint of infant feeding at the Sophia Children’s Hospital, therefore, requires looking beyond the bottle to the wider system of feeding practices and hospital-wide processes and infrastructure.

The large environmental impact (EI) of healthcare is of growing concern, especially given the increasing negative health effects of environmental deterioration.1,2 Paediatric intensive care units (PICU) are major contributors to this EI, partly due to the use of consumables and electricity.3–5 Environmental hotspots in clinical pathways (CP) must be identified to guide practical and effective interventions to lower the EI.5,6 Life cycle assessment (LCA) is currently the golden standard for EI assessment. However, LCA is time-consuming and highly complex. Thus, execution of LCAs on a large scale to analyse full CPs is not feasible in healthcare settings. Furthermore, the required data are often not available. Financial costs may be used as a proxy (spend-based LCA), but their representativeness is questionable.6,7 Furthermore, the CPs of patients in the PICU differ highly and cannot be represented by a single standard CP. Therefore, this research aimed to develop a process-based framework for environmental hotspot identification that requires less time and expertise compared to LCA and accounts for differences between patients, using a case study of six PICU post-cardiac surgery patients. Modules were designed as building blocks to represent medical events in the CP with the flexibility to deal with interpatient variation. Associated consumable and electricity use were allocated to each module based on medical protocols and discussions with clinical staff. From this iterative process, a set of allocation rules was established. The material composition of each product was analysed and recorded in a database. Per module, the median frequency of occurrence was calculated in the patient cohort data. The carbon emissions (kg CO2-equivalent) associated with each module per occurrence were calculated based on impact factors from an open-source database.8 The total of each module was defined as the EI per module occurrence (in kg material and in kg CO2-equivalent) multiplied by the median module frequency. This research was a first step towards an accurate and flexible approach to environmental hotspot identification within CPs related to consumable weight and bedside electricity consumption. The modules and the data analysis algorithm can be reused and expanded for other CPs, saving time and effort in future analyses. The allocation rules ensure standardised allocation of consumables and electricity across the current modules and when new modules are added. Challenges in this approach lie in the availability of product information from manufacturers and reliable, open-source impact factors, especially for pharmaceuticals.