From ICU to Hospital-Wide: Implementing a Recycling Programme in a Latin American Tertiary Care Hospital

Healthcare systems contribute approximately 4.4% of global greenhouse gas emissions, with intensive care units (ICUs) generating disproportionately high waste volumes. While professional organisations have published sustainability guidelines, limited documentation exists from middle-income settings, particularly in Latin America where resource constraints present unique implementation challenges.

To analyse the implementation process and outcomes of a nurse-led hospital-wide recycling programme initiated in the intensive care unit of a Latin American tertiary-care hospital.

Single-case study following Yin's methodology examining programme implementation from 2019 to 2023. Data collection included institutional documentation review, quantitative analysis of recycling volumes and direct observations of operational practices across multiple hospital departments.

The programme established recycling protocols while maintaining infection control standards. Total recycled materials increased from 44 994 kg in 2019 (3% of total waste) to a peak of 102 579 kg in 2021, with subsequent decline to 48 279 kg in 2023. Despite this decline, recycling rates remained above baseline (4.7%-5.8% vs. 0.2% pre-implementation). Material distribution showed organic waste (59.1%) and paper/cardboard (36.4%) as primary components. Key implementation challenges included space constraints, staff engagement variability and absence of standardised frameworks, addressed through protocol adaptation, education programmes and waste collection optimisation.

This case study suggests that implementing comprehensive recycling programmes in middle-income healthcare settings may be feasible despite resource limitations when protocols are adapted to local contexts and clinical leadership is leveraged.

This study describes how ICU nurses can lead institutional sustainability initiatives in resource-constrained settings. The findings provide practical insights for developing environmental policies in Latin American healthcare systems, highlighting the importance of early protocol formalisation and realistic expectations about programme sustainability.