A study at Vancouver General Hospital (VGH) found that over 60 per cent of patients received IV antimicrobials even when oral administration was feasible. The unnecessary use of IV antimicrobials contributes to medical waste, higher carbon emissions, and increased hospital costs, without offering additional clinical benefits over oral alternatives.
For patients, the switch to oral antimicrobials reduces the need for IV lines, which can be uncomfortable, restrict mobility, and increase infection risk. Patients on oral antimicrobials can often be discharged earlier, allowing for recovery at home without IV-related complications.
The health-care system also benefits. Preparing and administering IV medications takes significant time from pharmacy and nursing staff. Transitioning to oral antimicrobials streamlines workflow, improves efficiency and frees up resources for more urgent clinical needs.
The project was initiated and led by Dr. Rosanne Thalakada, Clinical Pharmacy Specialist, ASPIRES, and Dr. Shaqil Peermohamed, Regional Medical Director, ASPIRES. ASPIRES is the Antimicrobial Stewardship Program – Innovation, Research, Education, and Safety.
The beauty in this initiative is that it’s a simple switch and in many instances actually improves patient outcomes while reducing waste,” shared Rosanne. “It’s truly a win-win.”
Environmental and financial impact
Beyond patient care, there are strong environmental and financial incentives. IV medications generate substantially more greenhouse gas emissions than oral alternatives, with estimates suggesting about a 100 fold or higher increase for IV highly bioavailable antimicrobials.
The study at VGH projected that reducing unnecessary IV antimicrobial use could save approximately $61,000 per year and cut carbon emissions by approximately six million grams of CO₂-equivalent annually—comparable to driving approximately 29,000 km in a gas-powered car (the study is ongoing and any updates will be published when available).
Promoting the change
To encourage awareness about this beneficial change, clinically known as IV-to-PO switch, ASPIRES commissioned an art piece made from medical waste, by local artist Pete Clarkson, which captured a lot of positive attention.
The art piece has been a real conversation piece,” said Shaqil. “We’re hoping that it can broaden the impact of this work and inspire other similar initiatives.”
ASPIRES has also presented at rounds, developed an infographic and launched an IV-to-PO switch guideline on Firstline, an antimicrobial stewardship application that is easily accessible at point-of-care across VCH and a primary source for local and tailored guidance.
Hospitals can support IV-to-PO conversion through:
- Prescriber education,
- Optimization in the electronic health record system,
- Pharmacist led IV-to-PO conversion programs, and
- Integrating daily IV-to-PO assessments into medical rounds.
This shift enhances patient care, reduces workload, and contributes to a sustainable health-care system, demonstrating how planetary health considerations align with better clinical outcomes.
Learn more about the project and the leads at Antimicrobial stewardship for patients and planet – CASCADES Canada.
