Sustainability and waste reduction in clinical laboratories

Hospitals are major generators of waste, producing an estimated 5.9 million tons of solid waste annually in the United States alone. This burden contributes to environmental pollution, rising operational costs, and downstream health impacts. While operating rooms, food services, and imaging departments have received increasing scrutiny as waste-intensive sectors, clinical laboratories, despite their high energy use, dependence on single-use plastics, and central role in every diagnostic decision, remain comparatively understudied in sustainability research. In this review, we argue that integrating environmental impact into laboratory practice represents the next evolution of quality in laboratory medicine. We propose a workflow-based framework to evaluate waste generation across the full testing continuum, including test ordering, specimen collection, transport, analysis, post-analytical practices, procurement, and accreditation. Drawing on current evidence, case studies, and emerging sustainability programs, we identify practical intervention points and critical knowledge gaps, including the lack of standardized environmental metrics such as waste-per-test, energy-per-test and water-per-test. By treating environmental performance as measurable, comparable and improvable, clinical laboratories can help lead healthcare's broader transition toward high-value, environmentally responsible care while maintaining diagnostic quality and patient-centered care.