Management of liquid pharmaceutical residues in the intensive care unit: an ancillary analysis of the multicenter observational GAME-OVER study.

BACKGROUND: Liquid pharmaceutical residues (LPR) released into the environment are micropollutants that may exert toxic effects on wildlife. Appropriate LPR management therefore represents a pollution hotspot in healthcare facilities, although data on their management by healthcare providers are scarce. The primary endpoint was to investigate whether nurses' knowledge of their workplace enabled them to appropriately dispose of LPR in the intensive care unit (ICU). METHODS: As part of the one-day multicenter observational prospective GAME-OVER study, which enrolled 81 French ICUs a day of choice between November 2022 and March 2023, an ancillary survey was conducted in nurses working in the ICU on the study day. The multiple-choice survey aimed to assess practices regarding LPR and medical waste (MW) management. Based on the submitted responses and the non-hazardous MW disposal route in each facility, LPR disposal route was either considered 'appropriate', 'wrong' or 'appropriate but optimizable'. RESULTS: Among the 988 nurses working on the study day, 823 (83%) completed the survey. Overall, 374 registered nurses (44%) chose an improper LPR disposal route in their survey responses. Among the 801 nurses who reported disposing of syringes containing LPR, 253 (32%) chose a wrong LPR disposal route. Moreover, 214 nurses declared emptying syringes containing LPR before disposal, of which 155 (72%) did not use the appropriate LPR pathway, leading to theoretical environmental contamination. Importantly, 359 (44%) nurses were not aware of which non-hazardous MW disposal pathway was used in their facility, namely by incineration (65%), or burial (33%), partly explaining improper LPR management. CONCLUSIONS: This study demonstrated that knowledge on LPR management among registered nurses in French ICUs was limited, leading to theoretical environmental contamination. IMPLICATIONS FOR CLINICAL PRACTICE: This study highlights the need to provide specialized training on LPR management for healthcare providers, which may help decreasing pharmaceutical environmental contamination by implementing ecodesign of healthcare in the ICU. TRIAL REGISTRATION: NCT05553054.