JMIR Publications

ABSTRACT

Background:

Operating rooms (ORs) are among the most resource-intensive clinical environments in modern hospitals. They consume large volumes of energy and water, depend heavily on single-use supplies, generate complex waste streams, and emit potent greenhouse gases through inhalational anesthesia. Because perioperative nurses coordinate workflows, prepare supplies, maintain sterile practice, and monitor adherence to protocols across the surgical pathway, they are strategically positioned to translate sustainability evidence into daily OR practice.

Objective:

This narrative review synthesizes current evidence on environmentally sustainable OR practice and proposes a nurse-led framework for green OR stewardship that integrates environmental responsibility with patient safety, infection prevention, and operational efficiency.

Methods:

Literature published between January 2013 and June 2026 was reviewed across PubMed, CINAHL, Scopus, Web of Science, professional society guidance, and policy documents. Search concepts included green operating room, sustainable surgery, perioperative nursing, carbon footprint, operating room waste, low-flow anesthesia, reusable surgical textiles, sustainable procurement, and HVAC energy conservation. Evidence was synthesized thematically into domains relevant to perioperative nursing leadership.

Results:

Seven actionable domains were identified: waste segregation and reduction; energy-efficient HVAC, lighting, and equipment management; sustainable procurement and supply-chain stewardship; anesthesia-related emissions reduction; safe adoption of reusable textiles and reprocessed devices; water conservation and hand-antisepsis optimization; and staff education, governance, and behavioral implementation. Across the literature, OR sustainability interventions are consistently associated with reduced regulated waste, lower energy and supply expenditure, and reduced carbon emissions when implemented with multidisciplinary governance and infection prevention oversight. Strongly supported measures include eliminating desflurane where clinically appropriate, minimizing fresh gas flows, reducing redundant tray and custom-pack items, improving waste segregation, using HVAC setback strategies for unoccupied rooms, and adopting reusable or reprocessed products when safety and performance are equivalent.

Conclusions:

Green OR practice should be regarded as a patient-safety-aligned quality improvement priority rather than an optional environmental activity. Perioperative nurses can lead this transformation by establishing baseline audits, engaging multidisciplinary stakeholders, safeguarding infection-control standards, embedding sustainability metrics into quality dashboards, and sustaining behavioral change through education and feedback. Future research should prioritize standardized carbon accounting, multicenter implementation studies, cost-effectiveness analyses, and nursing competency frameworks for climate-smart perioperative care.