Sustainable Healthcare Practices: A Practical Guide for Hospitals in India

Sustainable healthcare practices are the steps a hospital takes to cut its use of energy, water and materials, produce less waste and pollution, and stay financially sound, without compromising patient safety. For hospitals in India this is now part of compliance as well as good management: the Bio-Medical Waste Management Rules, 2016 set legal duties for waste, and NABH’s 6th edition hospital standards, effective 1 January 2025, add a standard on sustainability. This guide covers what to do in each area, from electricity and water to anaesthetic gases and digital records, and how to get started.

What sustainability means for a hospital

NABH frames sustainability in three parts: environmental, social and economic. In day-to-day hospital terms, that means:

• Environmental: using less electricity, diesel and water, generating less waste, and handling biomedical waste, chemicals and wastewater safely.
• Social: staff well-being, safe working conditions and the hospital’s responsibilities to the community around it.
• Economic: keeping the hospital financially viable so it can keep delivering care.

The three often support each other. An LED retrofit or a fixed leak lowers the monthly bill, good segregation keeps the hospital compliant and protects housekeeping staff, and a building that keeps power and water running through a heatwave or flood protects patients when they most need care.

What NABH’s 6th edition expects

The foreword to the 6th edition says: “The integration of sustainable measures within these accreditation standards in its latest edition reflects a forward-thinking and responsible approach towards healthcare delivery.”

The main requirement sits in the Responsibility of Management chapter. Standard ROM.3 says that “those responsible for governance ensure sustainability in hospitals by addressing environmental, social and economic factors from long term well-being of healthcare system and community.” Its seven objective elements are:

Commitment elements are assessed at the final assessment, Achievement elements during surveillance and Excellence elements at re-accreditation. Other chapters back this up: FMS.2 asks that facilities operate in a planned manner and promote environment-friendly measures, and IPC.4.d, a Core element, requires biomedical waste to be handled appropriately and safely. Our overview of the NABH 6th edition standards covers the other chapters.

Energy efficiency

Hospitals run around the clock, so even small savings add up. The Ministry of Health’s Guidelines for Green and Climate Resilient Healthcare Facilities (National Centre for Disease Control, February 2023) cover these steps:

1. Audit first. Carry out an energy audit and sub-meter the big loads, such as air conditioning, chillers, sterilisation, laundry, kitchen and imaging, so you know where the units go.
2. Fix habits and maintenance. A switch-off policy for unused areas and equipment, regular walk rounds, and maintenance of HVAC, refrigeration and pumps.
3. Replace inefficient equipment. LED lighting, occupancy sensors in rooms that are not always in use, and star-labelled equipment from the Bureau of Energy Efficiency (BEE).
4. Add renewable energy. Rooftop solar panels for critical loads and solar water heating.

Track consumption per occupied bed or per patient-day so that growth in patient numbers does not hide improvements. Our article on hospital maintenance management covers how a planned maintenance programme supports this.

Water and wastewater

Water is used for cleaning, laundry, kitchens, sterilisation, dialysis and air conditioning. Under NABH, potable water and electricity must be available round the clock (FMS.2.d, a Core element), so conservation is also about resilience. Practical steps:

• Run a water audit and repair leaks, including dripping taps and running cisterns.
• Fit low-flow taps, sensor-operated taps and urinals, and dual-flush cisterns.
• Harvest rainwater from roofs where local conditions allow.
• Run a sewage treatment plant (STP) properly and reuse treated water for flushing or gardening where permitted.
• Consider reusing reject water from reverse-osmosis plants for non-potable uses.

Wastewater is also regulated. The Bio-Medical Waste Management Rules require hospitals to segregate liquid chemical waste at source, pre-treat or neutralise it before it mixes with other effluent, and treat and dispose of liquid waste in line with the Water (Prevention and Control of Pollution) Act, 1974.

Biomedical and general waste

The Bio-Medical Waste Management Rules, 2016, notified by the Ministry of Environment, Forest and Climate Change on 28 March 2016 and amended several times since, apply to every hospital, clinic, laboratory and blood bank. The State Pollution Control Board or Pollution Control Committee enforces them, and every generator needs its authorisation, however little waste it produces. The duties with the biggest environmental effect are:

• Segregation at source into the colour-coded categories, so untreated biomedical waste never mixes with other waste.
• No chlorinated plastics: chlorinated plastic bags (excluding blood bags) and gloves had to be phased out by 27 March 2019.
• Recycling after treatment: plastics and glass recovered from treated biomedical waste may only go to authorised or registered recyclers.
• Pre-treatment on site of laboratory and microbiological waste, blood samples and blood bags.
• Training and records: training at induction and at least once a year, a daily register, an annual report to the pollution control board by 30 June, and records kept for five years.

Our biomedical waste management guide covers the colour categories and treatment methods in detail.

According to the World Health Organization, about 85% of the waste generated by health care is general, non-hazardous waste. That is where reduction is easiest, and a waste audit shows where segregation fails and where general waste can be cut. Other legal requirements apply here too:

• General waste must be handled under the relevant waste management rules, and treated biomedical waste must never go out with municipal solid waste.
• Identified single-use plastic items, such as plastic cutlery, plates, cups and straws, have been banned since 1 July 2022 under the Plastic Waste Management (Amendment) Rules, 2021. This matters for canteens and events.
• Under the E-Waste (Management) Rules, 2022, any organisation that uses 1,000 or more units of listed electrical and electronic equipment in a financial year must hand its e-waste only to a registered producer, refurbisher or recycler.
• Replacing mercury thermometers and blood pressure instruments with digital or aneroid ones removes the risk of mercury spills, and any mercury waste must be handled under the applicable rules.

Green buildings and retrofits

Design decisions lock in energy and water use for decades, so sustainability is cheapest to build in at the planning stage. In India, the Indian Green Building Council’s IGBC Green Healthcare Facilities rating system covers facilities from sub-centres and primary health centres to private hospitals and medical institutions. It assesses six areas: site selection and planning, water conservation, energy efficiency, building materials and resources, indoor environmental quality, and sanitisation and hygiene. Ratings run from Certified through Silver and Gold to Platinum. GRIHA is another Indian green building rating that hospitals can use.

For existing buildings, the government guidelines suggest natural ventilation in non-critical areas, better glazing, landscaping and green procurement. Clinical areas come first: operation theatres, ICUs and isolation rooms need their controlled ventilation, so energy measures must never weaken infection control. Fire and structural safety under the National Building Code also apply to any retrofit.

Sustainable procurement

What a hospital buys shapes its energy use, waste and running costs for years, which is why NABH lists sustainable procurement as an Excellence element (ROM.3.e). Useful criteria for purchase decisions:

• Compare the lifetime cost, including energy, water, consumables and disposal, not only the purchase price.
• Prefer BEE star-labelled appliances and energy-efficient medical equipment.
• Choose reusable instruments, linen, gowns and drapes where your sterilisation and laundry capacity can process them safely.
• Ask suppliers about take-back of packaging and end-of-life equipment.
• Specify mercury-free devices and avoid chlorinated plastics.
• Buy locally where quality and price are comparable.

Anaesthetic gases and clinical practice

Some environmental impacts come from clinical care itself. Inhaled anaesthetics are released into the atmosphere, and they differ widely: desflurane has the highest global warming potential of the anaesthetic gases, and NHS England decommissioned it from routine use by early 2024 in favour of lower-carbon alternatives. Nitrous oxide is also a greenhouse gas.

Clinical choices stay with anaesthetists, but a department can agree a policy on:

• preferring lower-impact agents and regional techniques where they are clinically appropriate;
• using low fresh-gas flows;
• checking piped nitrous oxide and medical gas systems for leaks.

Beyond the theatre, cutting unnecessary tests, imaging and admissions saves resources as well as money.

Digital records and telemedicine

Electronic records, digital reports and online appointment systems reduce paper, printing and storage space. Teleconsultation for suitable follow-ups saves patients a journey to the hospital. See our guides to how electronic health records improve patient care and digital patient engagement tools. Digital systems have a footprint of their own, though: servers and devices use power, and old hardware becomes e-waste that should go to registered recyclers.

Staff, transport and the community

Sustainability only works if staff carry it out. Include energy saving and waste segregation in induction and refresher training, give each department a named champion, and share the results so people see the effect of their effort. NABH also asks hospitals to encourage staff to use common or public transport (ROM.3.f) and to promote staff well-being (ROM.3.d). Our guide to the role of human resources in healthcare covers training and well-being in more detail.

How to start a sustainability programme

1. Give it an owner. Name a senior lead and a small committee from engineering, housekeeping, procurement, nursing, infection control and finance. It can work alongside the biomedical waste committee.
2. Set a baseline. Collect 12 months of electricity, diesel and water bills and waste quantities by category from the biomedical waste register.
3. Take the quick wins. A switch-off policy, LED lighting, leak repairs and segregation audits cost little, and their savings can help fund larger projects.
4. Plan capital projects. Solar panels, efficient chillers and STP water reuse need a business case with a payback period.
5. Write it into policy. Add sustainability criteria to the procurement policy and an ESG programme to the governance documents NABH will review under ROM.3.
6. Measure and report. Install sub-meters early, review the indicators below at management meetings and share progress with staff.

Frequently Asked Questions