Contribution of hospitals and clinical services to global warming: a scoping systematic review

This Scoping Review aims to conduct an up-to-date and comprehensive search of the scope of existing studies on how hospitals and clinical services contribute to global warming.

Data sources: PubMed, Scopus and Embase. Selection criteria: Studies published from January 2000 to December 2024, in all languages and of any design type. Exclusion criteria: Secondary studies. Guidelines or recommendations. Letters or comments without new data. Studies of hospital products carried out in non-hospital environments. Outpatient units. Publications comparing hospital activities with extra-hospital services that differ only by transport. Primary outcome measure. The contribution to climate change of hospitals and clinical services, through their processes and activities. Data extraction and analysis. Three authors independently selected the articles according to the study objectives. If there were differences, these were resolved through discussion. The same method was applied for data extraction.

The literature search yielded 905 results, excluding duplicates. 184 studies were included in the scoping review. The studies were grouped into the following areas: anesthetic technique, medical devices, surgical procedures, other clinical activities, waste management, support units, and hospitals. A description is also made of the hospital processes involved in the generation of greenhouse gas emissions, such as incineration, laundry, among others. The most numerous publications were related to anesthesiology, devices and operating room. 13.6% of the studies are either experimental or quasi-experimental. Thirteen studies incorporated economic aspects, mainly description of costs. We did not find any studies that carried out a sustainability analysis, in terms of the relationship between costs, emissions and clinical effectiveness.

In conclusion, this study provided a comprehensive overview of hospitals' contribution to greenhouse gas emissions and other environmental impacts. We did not find any studies that carried out a sustainability analysis, in terms of the relationship between costs, emissions and clinical effectiveness. Research that incorporates economic aspects and sustainability studies is necessary for the implementation of effective actions.