Sustainability innovation
Somerset Trust cuts carbon footprint in testing for UTI
Pee-in-Pot (PiP) is a sustainable innovation developed by Somerset NHS Foundation Trust to facilitate midstream urine collection. In this article, the team behind the innovation share their insights.
Urinary tract infections (UTIs) are a significant cause of morbidity and mortality among patients and represent a considerable proportion of hospital admissions, with an increasing burden noted in high-income countries. UTIs can severely impact patient’s quality of life and impose substantial costs on healthcare systems. Urine microscopy, culture and sensitivity (MC&S) testing is routinely performed for UTI management, antenatal care and preoperative screening for urological surgery. Despite the critical need for reliable testing, practices surrounding midstream urine (MSU) specimen collection vary greatly leading to potential inaccuracies and inefficient practices that generate unnecessary waste and expense.
The problem There is marked variability in MSU collection processes, with a lack of standardisation across practice and consumable use. Processes are often unnecessarily complex and involve many single-use plastic items. Additionally non-compliant methods such as grey pulp and non-sterile specimen collection remain common. As most NHS and Independent Healthcare Providers outline objectives within their Green Plans to reduce single-use plastics, our aim was to address this issue by minimising
the use of such items in this routine pathway, as identified by our consultant urologist and clinical sustainability lead.
Background to the project Developing environmentally sustainable approaches to the delivery of routine clinical care is imperative, as healthcare transitions to net zero practices in response to the climate crisis. Single-use plastic products contribute significantly to healthcare’s greenhouse gas emissions making reduction in their use a priority. Transitioning to lower carbon products should involve questioning the necessity of environmentally harmful practices that have evolved in the absence of evidence. Where evidence is lacking but there is a potential opportunity to introduce more sustainable alternatives in clinical care, we should investigate these possibilities. Excessive use of sterile plastic equipment stands out as an area warranting this type of enquiry. The Pee-in-Pot (PiP) developed by Somerset NHS Foundation Trust (SFT) has been
Despite the critical need for reliable testing practices surrounding midstream urine (MSU) specimen collection vary greatly leading to potential inaccuracies and inefficient practices that generate unnecessary waste and expense.
purposefully designed to address several prominent issues. These are the high observed clinical practice variation in urine testing, the associated high costs, and the substantial plastic waste and carbon footprint associated with current MSU testing techniques. The unique shape and design of the PiP provides a single-item solution for collection, dipstick testing, and decanting of exactly 10mL of urine into a 10mL boric acid container for laboratory testing. Its composition from bamboo-derived cellulose pulp (Thermofibre®) makes it a more sustainable alternative to plastic, storing biogenic carbon from the atmosphere and undergoing disposal by maceration and flushing rather than incineration. Its clean but non- sterile composition enhances manufacturing, packaging and distribution efficiency. Local pilot studies and observations of
routine local practice where clean pulp was being routinely used to collect MSU samples has indicated that this material could provide non-inferior microscopy and culture results. Preliminary testing of the PiP in clinical areas has gained favourable feedback from patients and staff with no clear difference in urine culture results observed. This favourable early pilot work led to the PiP receiving Small Business Research and Innovation (SBRI) Healthcare funding to undertake conclusive microbiological evaluation, and to scale production and rollout of the product across the NHS through an NHS-industry partnership between Somerset
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