Environmental and Microbiological Performance of a CAM-Compliant Green Cleaning Protocol in a Private Healthcare Facility: Integrated Surface Hygiene Assessment and Life Cycle Assessment at Domus Nova Hospital, Ravenna, Italy

Healthcare cleaning services are essential for infection prevention and control, but they also contribute to the carbon footprint of healthcare facilities through recurrent consumption of detergents, disinfectants, textiles, water, energy, and transport-related resources. This sequential, non-randomized, single-facility evaluation compared a traditional cleaning protocol with a Green protocol oriented to the Italian Minimum Environmental Criteria (Criteri Ambientali Minimi, CAM) for cleaning services at Domus Nova Hospital, a private accredited healthcare facility in Ravenna, Italy. A risk-based microbiological monitoring plan was applied to low-, medium-, and medium-high-risk areas, prioritizing high-touch surfaces and using RODAC contact plates and sterile swabs. In parallel, a comparative Life Cycle Assessment was conducted in accordance with ISO 14040, ISO 14044, and ISO 14067 principles, using Global Warming Potential over 100 years as the main impact indicator and the functional unit of one square meter of cleaned hospital surface maintained for one year. The two protocols were assessed during different monitoring periods of unequal duration; therefore, the study was interpreted as a whole-system operational comparison rather than as a randomized trial or formal equivalence/non-inferiority assessment. After cleaning, all 64 observations obtained under the Green protocol met the adopted surface-hygiene acceptability criteria, compared with 55 of 64 observations under the Traditional protocol. No predefined target pathogenic indicators were recovered from post-cleaning samples under the applied culture conditions. From a climate-impact perspective, the Green protocol reduced the carbon footprint by 39.0%, corresponding to an avoided impact of 450 g CO2e m−2 year−1 and 2663.5 kg CO2e year−1 at the facility scale. The main climate-related benefits were associated with the combined effect of textile-system redesign, lower energy consumption, optimized product use, and reduced operator transport. These findings support the use of integrated surface-hygiene indicators and life-cycle metrics to inform healthcare cleaning procurement, while highlighting that the results concern culture-based surface contamination indicators from a single facility and do not directly assess infection transmission or patient outcomes.