Environmental footprint of hospital care: Review of evidence and current trends

Abstract

Introduction: Hospitals contribute 4-5 % of global greenhouse gas emissions, creating a paradox between their health preservation mission and environmental impact. This study examines current evidence on hospital environmental footprint and mitigation strategies. Methodology: Narrative review of 30 studies selected from multiple academic databases with complementary Elicit analysis, prioritizing methodological quality and geographic diversity. Results: Environmental impact varies considerably across hospital services. Operating theaters show highest emissions (up to 814 kg CO₂e per procedure), where anesthetic gases represent 44.7 % of impact and disposable materials 78 %. Imaging departments generate 0.5-17.5 kg CO₂e per study. Poor waste management produces 441 kg daily biocontaminated waste, while 992 pharmaceuticals contaminate environmental matrices globally. During COVID-19, environmental indices increased 17.2 %. Regionally, Latin America faces supply chain challenges, while Europe focuses on optimizing transportation and materials. Conclusions: Hospital sustainability is technically feasible and economically beneficial. Most promising interventions include local sourcing, safe material reuse, anesthetic optimization, and comprehensive environmental management systems. Transformation requires recognizing environmental health as an essential component of care quality—not as restriction, but as natural evolution of medical excellence.