Sustainable energy and water management in green hospitals: a narrative review

Hospitals consume substantial amounts of energy and water, while intensive care units (ICUs) have high resource demands because life-support equipment, monitoring systems and heating, ventilation and air conditioning operate continuously. This narrative review examines hospital and critical-care environmental impacts, sustainable energy and water management, healthcare workers’ knowledge and practices, and the use of Plan-Do-Study-Act (PDSA) cycles. Literature and guidance were identified through PubMed/MEDLINE, PubMed Central, Google Scholar, publisher databases and relevant health-agency and professional-society websites, and findings were synthesised thematically. The reviewed evidence identifies building energy, especially HVAC, and clinical consumables as major environmental hotspots. Water conservation must be planned alongside infection prevention and essential hygiene. Healthcare workers often express environmental concern but lack practical training, infrastructure and organisational support. Education combined with prompts, checklists, audit and feedback, local champions and leadership support is more likely to translate awareness into routine practice. The review also describes a 45-day quality-improvement project involving 80 staff members in ICUs at a hospital in Gurugram, India. Following two PDSA cycles, knowledge scores and observed practice adherence improved. In a descriptive comparison of one pre-intervention month with one post-intervention month, electricity use per occupied bed decreased by 17.7%, diesel use by 54.9% and water use per occupied bed-day by 11.25%. Because the project had no concurrent control group and compared only one month before and after the intervention, these changes cannot be attributed conclusively to the intervention. Longer time series, patient-safety balancing measures and transparent carbon accounting are needed to assess whether improvements are sustained.