Examining Environmental Footprints: Reusable and Disposable Incontinence Underpads

Healthcare providers are uniquely positioned to positively impact the caretaking of our planet.

Yet, according to the Yale School of Public Health, each year, the U.S. health sector produces nearly 10% of the nation’s greenhouse gas emissions – an increase of more than 30% within the last decade. Healthcare facilities are also the country’s second highest contributor of environmental waste. The healthcare industry produces more than 6,600 tons of solid waste every day, which adds up to over four billion pounds of waste annually.^[1] The tangible costs to dispose of healthcare organizations’ solid waste also continues to soar.

Traditional procurement processes for healthcare supplies consider elements like safety, efficiency, availability, price, and staff preference. However, clinicians and purchasing teams might be missing or unintentionally overlooking essential information about the full life cycle of a particular product – including the environmental impacts of its production, use, and ultimate disposal, as well as all of the associated costs.^[2]

Ensuring continuous quality improvements within healthcare systems must include strategic sustainability efforts and waste reduction strategies.

Sustainability and Incontinence Care

When it comes to incontinence care, preventive practices are essential for patient health and well-being. Every patient that is admitted into a hospital, rehabilitation facility, or long-term care setting is assessed for the risk of pressure injuries and the impact of incontinence. The stakes for ensuring quality incontinence care are high, and the frequent use of incontinence pads is required.

Understandably, nursing and clinical staff members are principally concerned about a patient’s skin breakdown, rather than potential over-use of an incontinence pad product. However, quality and sustainability are both significant factors to consider when deciding whether to use a reusable or disposable incontinence pad.

The Association of periOperative Registered Nurses (AORN) says in its Position Statement on Environmental Responsibility:

“All health care professionals have an ethical and professional responsibility to protect patients’ health through advocacy. Because human health is affected by and is dependent on the surrounding environment, health care professionals must actively work to incorporate best practices that mitigate negative environmental impact.” ^[3]

Over-reliance on disposable products can lead to unnecessary, increased environmental costs and negative, long-term effects.

Decarbonizing Health Care

A recent study published in the Journal of Nursing Care Quality aims to support clinicians’ knowledge to include environmental sustainability in decisions regarding patient care and reusable versus disposable incontinence underpads. A life cycle analysis was conducted, including soiling, reusable cycles before removal, supply chains, laundry use, and end-of-life environmental impact.

Results indicate that the selection of reusable underpads versus disposables reduced total natural resource energy consumption by 71%, greenhouse gas emissions by 61%, blue water consumption by 57%, and solid waste by 97%.

The full life cycle inventory of incontinence pads addressed in the article includes:

• The full supply chain from natural resources (oil, natural gas, ores, etc.) from the earth to the incontinence pad product (“known as cradle-to-grave”)
• The use and/or reuse of pads, which is in the healthcare setting and includes laundry and wastewater treatment for reusable pads
• The end-of-life disposition in which pads are managed when no longer functional

Here are some additional highlights:

• In the study’s survey of 13 large laundry systems, the average number of uses (laundry cycles) before a reusable incontinence pad is removed from service is 46. In comparison, disposable pads are disposed of after a single use.

• An important question regarding functionality of the incontinence pads is the frequency of pad changing. The study notes that “there is wide anecdotal evidence that on a per adjusted patient day basis more disposable pads are used than if these were reusable.” While additional research on relative use is needed and disposable pads have improved with the use of superabsorbent polymers, the number of disposable pad uses is estimated to be more than twice as high as the reusable pad uses.

• The number of uses per pad is also an interesting parameter because this determines both the number of pads and the accompanying packaging that must be manufactured (and ultimately, disposed of).

Effective incontinence care prioritizes patient dignity while minimizing moisture. Selecting reusable incontinence pad solutions in healthcare settings lowers environmental impact and is part of the solution to moving the healthcare industry along the path to greater sustainability.

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