The overuse and inappropriate use of antimicrobials have led to environmental waste and drug shortages. This challenges the ecological and economical sustainability of our healthcare system and worsens antimicrobial resistance.

Antimicrobial stewardship programs (ASP) commonly consider the cost of drug acquisition but may be failing to recognize the hidden costs of multi-dose intravenous regimens including additional nursing administration time, tubing and fluids, and potentially increased hospital length of stay. They also rarely consider the environmental impact of medical waste creation and disposal, which contributes to the global antimicrobial resistance crisis. These costs are harder to calculate but crucial to a comprehensive assessment of a medication’s total impact. In this invited commentary, we provide an example of a stewardship evaluation at our institution focused on changing from meropenem (MER) to ertapenem (ETP) for infections caused by extended-spectrum beta-lactamase producing organisms. We found that despite an increase in acquisition costs, changing from MER to ETP is associated with overall savings and decreased waste production. A secondary analysis suggests that stay length may also be improved with this substitution.

We present a holistic approach to antimicrobial stewardship that considers the total cost of an antimicrobial. By broadening their view to include hidden costs and secondary effects, ASPs can further demonstrate their value to the healthcare system, reduce resistance, and improve their environmental impact.

The pace and trajectory of global and local environmental changes are jeopardizing our health in numerous ways, among them exacerbating the risk of disease emergence and spread in both the community and the healthcare setting via healthcare-associated infections (HAIs). Factors such as climate change, widespread land alteration, and biodiversity loss underlie changing human–animal–environment interactions that drive disease vectors, pathogen spillover, and cross-species transmission of zoonoses. Climate change–associated extreme weather events also threaten critical healthcare infrastructure, infection prevention and control (IPC) efforts, and treatment continuity, adding to stress to strained systems and creating new areas of vulnerability. These dynamics increase the likelihood of developing antimicrobial resistance (AMR), vulnerability to HAIs, and high-consequence hospital-based disease transmission. Using a One Health approach to both human and animal health systems, we can become climate smart by re-examining impacts on and relationships with the environment. We can then work collaboratively to reduce and respond to the growing threat and burden of infectious diseases.

The climate crisis calls for urgent action from every level of the US healthcare sector, starting with an acknowledgment of our own outsized contribution to greenhouse gas emissions (at least 8.5% of carbon emissions). As the climate continues to become warmer and wetter, the medical establishment must deal with increasing rates of pulmonary and cardiovascular diseases, heat-related illness, and emerging infectious diseases among many other health harms. Additionally, extreme weather events are causing healthcare delivery breakdown due to physical infrastructure damage, slowed supply chains, and workforce burden. Pathways for healthcare systems to meet these challenges are emerging. They entail significant measures to mitigate our carbon footprint, embrace shared and equity-driven governance, develop new metrics of accountability, and build more resilience into our care delivery processes. We call upon SHEA to play a unique leadership role in the fight for sustainable, equitable, and efficient health care in a rapidly changing climate that immediately threatens human well-being.

Climate change and pollution harm the public. The healthcare industry disproportionately contributes to greenhouse gas emissions. Infection diseases professionals including infection preventionists and antimicrobial stewards are uniquely positioned to mitigate the environmental impact of our daily practices. We highlight 10 actionable steps that infectious disease professionals can incorporate into daily practices, thereby mitigating the impact of climate change.

In this survey of infection prevention and control (IPC) professionals, we gauged knowledge, attitudes and institutional practices related to environmental sustainability and IPC. Overall, IPC professionals have not yet universally adopted measures to promote environmental sustainability. More research is needed around environmentally sustainable efforts that preserve patient safety in IPC.