A Review of the Applicability of Current Green Practices in Healthcare Facilities

Document Type : Review Article


1 Medical Physics Service, Portuguese Oncology Institute of Porto, Porto, Portugal

2 Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, Msida, Malta

3 Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland

4 Department of Electroradiology, University of Medical Science, Poznan, Poland

5 Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK

6 Radiography Department, Faculty of Health Sciences, University of Malta, Msida, Malta

7 Medical Physics and Radiobiology Group, Research Center (IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal


Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare.

We conducted a scoping review guided by the Arksey and O’Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022.

Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book.

Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.


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  • Receive Date: 16 November 2021
  • Revise Date: 29 November 2022
  • Accept Date: 19 April 2023
  • First Publish Date: 07 May 2023