What does sustainable development mean, and how is it relevant to the control of infection? To answer the first part of that question: for any process to be sustainable it simply means that it can be sustained, or continued, indefinitely. To put it another way, the process must not destroy the resources needed to continue the process. And it only takes a moment’s thought to realise that the resources for all human-driven processes are totally dependent on the planet we all share.
As I write this article, we are approaching Earth Day on 22nd April. Earth Day is an annual international event which has occurred since 1970, with the aim of demonstrating support for protecting the environment. The truth is that, looking back over those 55 years, we have not done very well at protecting it.
Since 1970, wildlife populations have dropped by 73%, according to the Zoological Society of London’s Living Planet Report 20241. Habitat degradation and loss, caused by humans, together with human overexploitation of natural resources, are given as the primary reasons for this. This can be contextualised by the Global Footprint Network in Geneva, which reports2 that in 1970 we were annually consuming about one Earth’s worth of ecological resources (e.g. crops, livestock and fish products, soil, timber and other forest products). They now calculate that has risen to 1.7 Earths. That means that, by about the end of July each year, we use up what the Earth can produce in 12 months. That clearly cannot continue forever! We are damaging the Earth’s ability to sustain us as a species and that is obviously, by definition, not sustainable.
A related way in which we are causing that damage is the amount of carbon dioxide (CO2) we are putting into the atmosphere. Essentially, CO2 is a waste product from a lot of human activity and though the planet is great at absorbing it, it can only deal with so much (even less as we reduce the amount of vegetation on the planet). As data from NASA3 show, CO2 has varied naturally between about 180 and 300 parts per million (ppm) over the last 800,000 years – with the lower periods corresponding with ice ages and the intervening years being the interglacial periods. The same data show that the level of CO2exceeded 300ppm, for the first time in human history, in 1911 and that it has continued to rise at an unprecedented rate since then. The level is now monitored daily by the US National Oceanic and Atmospheric Administration and their data show4 that the level has exceeded 430ppm in 2025, so it is now more than 40% higher than it was for the entirety of the existence of our species before the 20th century.
Why does the level of CO2 matter? The planet is in a constant balancing act between the sun heating it up, and the coldness of space surrounding it causing it to cool. CO2 tips that balance by slowing down the heat leaving the planet. The more CO2 , the slower the heat leaves and the warmer we get. And the numbers are huge! Richard Allan, Professor of Climate Science at the University of Reading, has calculated5 that at the beginning of 2023, Earth was heating at a rate equivalent to all 8 billion people alive each using 60 kettles to boil up the ocean. That comes with consequences!
Not least among the consequences are those for human health. The Centers for Disease Control (CDC) in the USA describes6 how the changing climate will impact on every aspect of human health: communicable diseases (including vector, food and waterborne diseases), non-communicable diseases, physical injuries and mental health. It will also exacerbate wealth inequalities, and we know from COVID that wealth and health inequalities are very closely linked.
Health Care Without Harm published a report7 in 2019 which calculated healthcare’s own carbon footprint globally. That footprint is not small either, it is more than twice that of the aviation industry, sitting at around 4.5% of global emissions. We are creating our own patients, effectively.
This is where the link with infection control is critical, and thus where infection control practitioners can really have an impact. How much of what is done in healthcare, and the way it is done (e.g. the products used, the waste generated, the way things are decontaminated) is driven by a perception of a risk of infection? A huge proportion, I would say. But how often is real infection control expertise, rather than ritual or dogma, what drives the response to that risk? I think that perhaps we would all argue, not often enough!
With infection control practitioner’s expertise, and our experience of assessing and balancing risks (where we need to start including the risk to the planet), we can be the ones identifying where change can happen, where we can reduce what we use, and where we can move to reusable versions or products, thus reducing our carbon footprint and our use of the planet’s resources.
Below are just a few examples of projects I am aware of, led by infection control practitioners I have met:
- Trials of reusable incontinence products in care home settings
- Reducing the use of couch roll
- Reducing the frequency of routine sheet changing in hospital
- Cannulation reduction
- Reducing unnecessary glove use
- Rationalising when skin prep is needed for venepuncture
- Patching chairs and couches rather than condemning them
- Optimising waste streams
- Trialling reusable curtains
- Implementing reusable theatre hats, gowns and drapes
- Moving to less toxic disinfectants
- Moving to less toxic hand sanitisers
- Trials of reusable aprons
- Trials of reusable anaesthetic masks
There are many, many more!
At my own hospital we recently produced a report8 looking at the practicalities of implementing some of the above, and we are very happy for anything in that report to be used by any other team.
We are key stakeholders in so much of healthcare, and thus we can either be barriers or enablers when change is required. Change has never been needed more, or more urgently, than it is now. So, if you have not already, seek out your organisation’s sustainability lead if you have one, talk to your clinical teams about how they can make their practice more sustainable, and be the change agent that allows that to happen.
A final tip if wondering where to start: have a look in your bins! What is taking up most space? Could it be used less? Is there a reusable alternative? We have never seen a net-zero healthcare system before, so there is no road map for this. It will need ideas from everybody: ground up, top down, and everyone in between.
If not you, who? If not now, when?
References
1- Zoological Society of London. Living Planet Report 2024 [internet]. Available from : https://livingplanet.panda.org/en-GB/ (Accessed 2025 Apr 14).
2- Global Footprint Network. Earth Overshoot Day 2024 [internet]. Available from : https://www.footprintnetwork.org/2024/07/21/earth_overshoot_day_2024/ (Accessed 2025 Apr 14).
3- National Aeronautics and Space Administration (NASA). Carbon Dioxide | Vital Signs – Climate Change [internet]. Available from : https://climate.nasa.gov/vital-signs/carbon-dioxide/?intent=111 (Accessed 2025 Apr 14).
4- National Oceanic and Atmospheric Administration (NOAA). Trends in Atmospheric Carbon Dioxide [internet]. Available from : https://gml.noaa.gov/ccgg/trends/monthly.html (Accessed 2025 Apr 14).
5- Allan R. Reconciling Earth’s growing energy imbalance with ocean warming. In : Weather and Climate at Reading [blog]. University of Reading ; 2025. Available from : https://blogs.reading.ac.uk/weather-and-climate-at-reading/2025/reconciling-earths-growing-energy-imbalance-with-ocean-warming/ (Accessed 2025 Apr 14).
6- Centers for Disease Control and Prevention (CDC). Effects of Climate Change on Health [internet]. Available from : https://www.cdc.gov/climate-health/php/effects/index.html (Accessed 2025 Apr 14).
7- Health Care Without Harm. Health Care’s Climate Footprint. Bruxelles: Health Care Without Harm; 2019. 48 p. Available from : https://global.noharm.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf (Accessed 2025 Apr 14).
8- Great Western Hospitals NHS Foundation Trust. Infection Prevention & Control and Sustainability [internet]. Swindon (GB): Great Western Hospitals NHS Foundation Trust; 2024. Available from : https://www.gwh.nhs.uk/media/aakj2uqq/1-gwh-ipc-sustainability-report-v1-0-digital-spreads.pdf (Accessed 2025 Apr 14).