Background:
The healthcare sector has a great impact on environment and climate, being responsible for 2% of industrial waste. Disposable diapers create around 800 to 1000 kilos of waste per child over the entire nappy period. Therefore, the Eco Care-project was launched to focus on sustainable childbirth by implementation reusable diapers on maternity wards.

Aims and Objectives:
(1) To investigate knowledge, attitude and practice of healthcare providers (HCP) in Flanders regarding sustainability in personal/professional life and reusable diapers. (2) To implement reusable diapers on a maternity ward.

Method:
We use a cross-sectional study with online survey among Flemish HCP in childcare (n=185). Descriptive statistics and χ2 tests were applied for data-analysis (SPSS with P<0.05 as significant). A circular value chain (framework of Wiek, 2011) and business case analysis was performed. The use of reusable diapers is currently piloted on a maternity service with an online survey among parents.

Results:
Respondents have sufficient knowledge about sustainable living (75%), consider sustainability important in their professional life (78%), are well informed about reusable diapers (73%) and show a high willingness to use (77%). Most childcare settings use disposable diapers (62%), only 8% exclusively reusable ones. The most important stimulator and barrier was resp. environmental impact (70%) and lack of usability (46%). Stakeholders are maternity, prenatal consultation, infection prevention, communication, logistics/waste department, laundry service, diapers producer, government, etc. We developed a roadbook and an information video for parents, followed by a pilot study. This study showed a positive attitude towards reusable diapers among parents, who mentioned workload and insufficient knowledge as most important barriers and rental and laundry services as facilitators.

Conclusions:
This is a unique project on the implementation of reusable diapers on maternity ward, thereby introducing a more sustainable childbirth care and highlighting the need to raise awareness and knowledge on sustainable care among HCP. This requires a proper translation of sustainability policies into practice, but also healthcare education.