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Background:
Systematic Review

Unveiling the Symbiosis of Environmental Sustainability and Infection Control in Health Care Settings: A Systematic Review

by
Reem F. Alruwaili
1,*,
Nourah Alsadaan
2,
Abeer Nuwayfi Alruwaili
2 and
Afrah Ghazi Alrumayh
3
1
Department of Public Health Nursing, College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
2
Department of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
3
Department of Maternity and Child Health Nursing, College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
*
Author to whom correspondence should be addressed.
Sustainability 2023, 15(22), 15728; https://doi.org/10.3390/su152215728
Submission received: 5 October 2023 / Revised: 28 October 2023 / Accepted: 3 November 2023 / Published: 8 November 2023
(This article belongs to the Special Issue Public Health and Healthcare Services Technologies and Development in Post-COVID 19 Era)
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Abstract

:
This systematic review explores the intricate relationship between environmental sustainability and infection control in healthcare. A comprehensive examination of twelve selected studies reveals key themes, including the pivotal role of leadership in motivating sustainable practices within healthcare facilities and the integration of sustainable design strategies for effective infection prevention and control. The review emphasizes the significance of strong leadership in driving a culture of environmental responsibility, fostering staff engagement, and ensuring the success of sustainability initiatives. Sustainable design strategies, such as energy-efficient building practices and eco-friendly materials, emerge as essential components of both environmental sustainability and infection control. By creating synergy between these objectives, healthcare facilities can simultaneously reduce their environmental footprint and enhance patient safety. This study underscores the importance of leadership commitment and sustainable design in shaping the future of healthcare toward a more environmentally responsible and infection-resistant paradigm.

1. Introduction

The healthcare sector is undeniably essential for promoting public health and well-being, but it is also associated with significant environmental and public health challenges. Healthcare facilities are characterized by resource-intensive operations, substantial waste generation, and energy-intensive practices [1]. Simultaneously, the sector grapples with the persistent threat of healthcare-associated infections (HAIs), which pose substantial risks to patients, healthcare workers, and public health systems [2,3].
Environmental sustainability in healthcare is an emerging priority driven by the recognition that healthcare systems, while serving to heal and protect, also contribute to ecological degradation and climate change [4,5] The environmental footprint of healthcare facilities encompasses factors such as energy consumption, water use, waste generation, and the procurement of materials and supplies [6]. These factors collectively contribute to greenhouse gas emissions, air and water pollution, and resource depletion [7].
Efforts to promote environmental sustainability in healthcare have gained momentum in recent years. Healthcare organizations and institutions worldwide have committed to reducing their environmental impact by adopting sustainable practices [8,9]. These initiatives aim to mitigate climate change, conserve natural resources, and minimize harm to ecosystems, aligning healthcare with broader global sustainability goals [10].
Infection control is a critical aspect of healthcare, with a profound impact on patient safety and the overall effectiveness of healthcare systems [11]. HAIs are infections that patients acquire while receiving medical treatment in healthcare facilities, and HAIs represent a significant public health concern. HAIs can lead to extended hospital stays, increased healthcare costs, complications, and, in severe cases, patient mortality [12].
Infection control measures within healthcare settings encompass rigorous hand hygiene, proper sterilization and disinfection, the appropriate use of personal protective equipment (PPE), and adherence to isolation protocols [13]. These measures are essential for preventing the transmission of infectious agents, including bacteria, viruses, and fungi, among patients and healthcare workers [14].
The confluence of environmental sustainability and infection control represents an evolving paradigm within healthcare. It recognizes that healthcare facilities can simultaneously combat infectious diseases and reduce their environmental impact [15]. This dual-focus approach has given rise to innovative strategies and practices that foster the alignment of these seemingly disparate goals [16].
For instance, environmentally friendly cleaning products and procedures are not only effective at preventing infections but also reduce the environmental footprint of healthcare facilities [17]. Likewise, sustainable architectural designs that enhance natural ventilation and lighting can contribute to improved infection control outcomes. Evidence-based policies that promote efficient resource utilization support both infection prevention and sustainability by reducing waste and resource consumption [18].
Research by Heather Baid in “Satisficing for sustainability in critical care practice” (2019) highlights how healthcare facilities can adopt sustainable design strategies to reduce their environmental footprint [19]. Sustainable architectural designs that enhance natural ventilation, optimize lighting, and promote energy efficiency not only conserve resources but also contribute to infection control. These designs create environments that are conducive to patient well-being and recovery while reducing the risk of infection spread [20].
Moreover, studies, such as the one by Aliabadi et al. (2011), emphasize that sustainable architectural features can enhance infection control. Proper ventilation systems and layouts can help minimize airborne transmission of pathogens, critical for preventing the spread of infectious diseases within healthcare facilities [21].
Infection control and sustainability align in the use of innovative cleaning practices. Research led by Costa et al. (2018) explores the use of probiotics, specifically Lactobacillus GG, in infection prevention among patients with hematologic malignancies [22]. The study demonstrates that probiotics can reduce the incidence of gastrointestinal infections, suggesting their potential in infection control within healthcare settings. This not only benefits patient health but also aligns with sustainable practices by reducing the need for aggressive chemical disinfectants.
In addition, investigations into environmentally friendly cleaning products underscore their role in improving indoor air quality and reducing chemical pollution. By utilizing biodegradable and non-toxic cleaning agents, healthcare facilities can enhance the safety of both patients and healthcare workers while minimizing their environmental impact [23,24].
The review by Morgan (2009) emphasizes the critical role of surveillance systems in infection control. These systems collect and analyze data related to infections, aiding in early detection, source identification, and resource allocation. Morgan informs evidence-based policies, providing healthcare facilities with the data-driven insights needed to enhance both infection control and sustainability [25].
With healthcare costs soaring, the strain on economies and individuals is significant. In the United States alone, healthcare expenses accounted for approximately 17.7% of the GDP in 2019, projected to rise further [26]. Simultaneously, the environmental impact of the healthcare industry is substantial, contributing to vast amounts of medical waste and emissions. The sector’s carbon footprint, estimated at 4.4% of global net emissions, underscores the urgency for sustainable practices in healthcare to mitigate environmental damage [27]. Moreover, while access to healthcare remains a persistent issue globally, with nearly half of the world’s population lacking essential healthcare services, the threat of antibiotic resistance continues to grow [28]. Antibiotic-resistant infections affect millions annually, leading to increased healthcare costs, longer hospital stays, and thousands of deaths each year [29].
This systematic review seeks to delve into the dynamic interplay between environmental sustainability and infection control within healthcare systems. By synthesizing existing research and insights, it aims to provide a comprehensive understanding of how sustainable practices intersect with, enhance, and transform infection control strategies. The review also seeks to identify opportunities and challenges in the integration of sustainability principles into healthcare practices, ultimately aiming to guide the development of resilient, patient-centric healthcare systems that are both environmentally responsible and effective in safeguarding public health. Through this exploration, we hope to contribute to the growing body of knowledge that informs policymakers, healthcare professionals, and researchers on the path towards a sustainable and infection-resistant future in healthcare.

2. Materials and Methods

2.1. Search Strategy and Selection Criteria

This systematic review adheres to the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [30]. The research protocol was crafted following the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement [31] and was registered with PROSPERO (CRD42023470075).
An extensive systematic search strategy was conducted. The search was performed on various databases including but not limited to Embase.com, Medline ALL (Ovid), Web of Science Core Collection, Cochrane Central Register of Controlled Trials (Wiley), and Google Scholar (last search conducted on 25 July 2023). The search strategy employed a combination of terms related to environmental sustainability, infection control, and healthcare settings. Additionally, the references of the selected articles were manually reviewed to ensure comprehensiveness.
Following the removal of duplicates, eligibility screening was independently carried out by two reviewers (R.F.A. and N.A.) based on the title and abstract, and subsequently on the full text. Inclusion criteria encompassed studies focusing on the symbiotic relationship between environmental sustainability practices and infection control within healthcare settings. We included interventions or observational studies that compare initiatives related to environmental sustainability and infection control in healthcare settings. Exclusion criteria comprised case–control studies, case series, case reports, or opinion reports. Any discrepancies during the screening process were reconciled through discussion between the reviewers.

2.2. Data Extraction

The primary focus of this review is to examine the correlation between environmental sustainability initiatives and infection control measures within healthcare settings. The main outcome of interest includes the impact on infection rates, resource utilization, waste management, and patient outcomes attributed to the implementation of environmentally sustainable practices.
Data extraction was conducted independently by R.F.A., N.A., and A.N.A., emphasizing relevant information from the included studies such as study characteristics, intervention details, and outcome measures. The authors of the selected studies were contacted to provide additional or missing data pertinent to this review. Any potential overlap or duplicity in patient cohorts between studies was assessed and reconciled in consultation with the respective study authors.
In the initial search of the databases, a total of 3501 papers were found. After removing duplicates, 488 papers were screened based on their title and abstract, with 219 being excluded. Of the remaining 184 papers, 12 were ultimately selected for the full-text review. The PRISMA flow diagram is explained in Figure 1.

2.3. Risk of Bias Assessment

Two reviewers (R.F.A., A.G.A.) independently assessed the methodological quality and risk of bias of all eligible studies. We evaluated all studies as an independent observational cohort by using a modified version using ROBVIS2, which was developed during the Evidence Synthesis Hackathon. This web app is built on the robvis R package [32]. Discrepancies in the assessment were resolved through consensus.

2.4. Data Analysis

Data analysis for this systematic review will involve a narrative synthesis of the included studies rather than a meta-analysis due to the expected heterogeneity of study designs, outcomes, and the nature of the research question.
Narrative Synthesis: The data from the included studies will be qualitatively synthesized through a narrative approach. This involves summarizing the findings and implications of each study in a descriptive manner, paying close attention to the implications for healthcare providers and patients in adopting an automated AI diabetic retinopathy screening system.
Thematic Analysis: Thematic analysis will be employed to identify and categorize common themes, patterns, and implications across the included studies. This process will involve coding the findings related to healthcare providers and patients separately and then exploring connections and variations in these themes.

3. Results

3.1. The Quality Assessment

Among the twelve studies analyzed [33,34,35,36,37,38,39,40,41,42,43,44], in the risk of bias assessment of the included studies, varying degrees of bias risk are observed, reflecting the diversity of study designs (Figure 2). Several studies, such as Lee et al. (2022), Isunju et al. (2022), and Saadeh et al. (2022) [41,42,43], demonstrate some concerns related to the randomization process, indicating potential selection bias. However, these studies generally exhibit low risk in other domains, including any deviation from intended intervention, missing outcome data, measurement of the outcome, and selection of reported results. Meanwhile, retrospective studies like Emmanuel et al. (2021) inherently exhibit some concerns regarding randomization but generally show low risk across other bias domains [38]. Overall, the studies tend to present a moderate risk of bias, with notable exceptions like Leistner et al. (2023), a cluster-randomized controlled crossover trial, which exhibits a low risk of bias due to its well-controlled design [36], and qualitative studies like Lesan et al. (2021), which, within the context of qualitative research, demonstrate a low to moderate risk of bias [39]. These assessments inform the interpretation of study findings within the systematic review.

3.2. Main Outcomes

The extraction Table 1 provides a comprehensive overview of the key details of each included study in our systematic review, offering valuable insights into their study designs, objectives, sample sizes, and main outcome.
Firstly, the studies emphasize the crucial role of healthcare management and leadership in driving sustainability initiatives. Lee et al. (2022) [41] and Emmanuel et al. (2021) [38] highlight how top management can motivate employees and integrate sustainable design strategies to enhance infection control. Leadership perspectives, as explored by Hegarty et al. (2019) [37], can guide systematic approaches to implementation despite the complexities involved in sustainability and infection control.
Several studies underscore the significance of robust infection prevention and control (IPC) programs, especially in the context of emerging infectious diseases like COVID-19. Saadeh et al. (2022) [43] and Gomes et al. (2022) [35] emphasize the need for improvements in IPC, including water, sanitation, and hygiene (WASH) practices, to protect both patients and healthcare workers. Furthermore, Talaat et al. (2016) [34] and Hamam et al. (2021) [40] highlight the importance of surveillance systems in understanding infection patterns and guiding effective IPC strategies.
The studies recognize the intrinsic link between sustainable healthcare environments and infection control. Emmanuel et al. (2021) [38] and Leistner et al. (2023) [36] explore the potential of sustainable design strategies, such as probiotic cleaning and environmentally friendly practices, in reducing healthcare-associated infections (HAIs). Lesan et al. (2021) [39] delves into the layout and configuration of healthcare spaces, demonstrating how proper zoning and patient separation can significantly impact infection control during pandemics.
Anicetus et al. (2022) [44] and Karltun et al. (2012) [33] emphasize the need for evidence-based policies, efficient programs, and effective resource utilization to ensure sustainability and infection control within healthcare facilities.
Also, the studies offer several key findings that have meaningful implications for understanding and advancing the integration of sustainability and infection control in healthcare.
  • Saadeh et al. and Gomes et al.’s emphasis on strengthening IPC programs implies that investments in core infection control capabilities, like WASH infrastructure and training, are imperative for healthcare resilience [35,43].
  • Findings on sustainable design strategies indicate facilities should incorporate green building practices into planning and operations to simultaneously reduce environmental impact and infection risks [36,38].
  • The importance of leadership underscored by Lee et al. and Emmanuel et al. highlights that motivating sustainability initiatives requires culture change driven from the top down. This suggests healthcare organizations must prioritize leadership training and development around sustainability [38,41].
  • Anicetus et al. and Karltun et al.’s focus on resource management highlights the need for data-driven policies and efficient allocation to balance infection control and sustainability [33,44].
  • Studies on surveillance systems demonstrate the value of leveraging data insights to guide improvements in both sustainability and IPC outcomes [34,40].
  • Research on healthcare spatial configuration indicates meticulous zoning and layout planning is essential to optimize pandemic preparedness and response [39].

4. Discussion

The intersection of environmental sustainability and infection control in healthcare represents a multifaceted challenge with far-reaching implications for both patient care and global ecological well-being. The collection of studies included in this systematic review offers a nuanced perspective on this complex relationship and highlights several key themes and findings.

4.1. Infection Prevention and Control (IPC) Programs: The Cornerstone of Healthcare Sustainability

IPC measures, such as stringent hand hygiene practices, surface disinfection protocols, and isolation strategies, significantly contribute to the reduction in healthcare-associated infections (HAIs) [15]. These practices form the cornerstone not just for safeguarding patients and healthcare workers but also for their pivotal role in sustainability efforts, reducing the environmental impacts tied to healthcare-associated infections [15]. The mitigation of HAIs has a profound effect on overall sustainability by diminishing the burden of these infections and subsequently lessening their environmental impact [45].
During the COVID-19 pandemic, the urgent need for rigorous IPC measures became abundantly clear due to the highly transmissible nature of the SARS-CoV-2 virus [46]. These measures, ranging from strict adherence to hand hygiene, proper use of personal protective equipment (PPE), stringent isolation and quarantine protocols, to intensified cleaning and disinfection practices, were imperative not only in containing the spread of the pandemic but also in preserving the functionality of healthcare systems and conserving essential resources [13]. The implementation of these measures not only played a crucial role in managing the crisis but also significantly reduced the environmental footprint associated with the pandemic [47].
The profound impact of the COVID-19 crisis underscores how rigorous IPC measures are not only vital for public health but also integral in reducing healthcare-associated infections [48]. By lessening the burden of infections within healthcare settings, these measures align with broader sustainability initiatives, emphasizing the need for continued emphasis on IPC strategies in healthcare practices. Consequently, by preventing infections, these measures contribute to the reduction in medical waste, the use of resources, and overall environmental impact, which is vital for sustainable healthcare practices in the long term [49].

4.2. Sustainable Design Strategies for Infection Control

Sustainable design strategies for infection control represent a comprehensive and integral approach in establishing healthier and safer indoor environments across various settings, encompassing buildings and public spaces [50]. These strategies address the dual goal of mitigating the spread of diseases and prioritizing environmentally conscious practices. By amalgamating various tactics, these strategies contribute to a paradigm where infection control measures harmonize with sustainable principles, acknowledging the need for a holistic approach in design and functionality [51].
One crucial aspect of these strategies pertains to ensuring superior air quality and effective ventilation systems within structures. Natural ventilation systems stand out as a fundamental element, significantly enhancing indoor air quality by reducing the concentration of pathogens [52]. The incorporation of high-efficiency particulate air (HEPA) filters and adherence to green building standards like LEED serve to further improve air quality while concurrently minimizing energy consumption, thereby fostering a healthier and more sustainable indoor environment [53].
The choice of materials employed in construction and design fundamentally contributes to infection control measures. Integrating recyclable materials that possess antimicrobial properties not only aids in mitigating the spread of pathogens but also ensures sustainability [54]. Materials such as copper, specific wood types, and antimicrobial paints play a vital role in creating a safer and eco-friendly environment, underscoring the significance of material selection in sustainable design strategies for infection control [55].
The integration of daylight and biophilic design elements represents another cornerstone in this approach. Natural light not only positively impacts the ambiance of a space but also carries disinfecting properties [56]. Biophilic design, incorporating indoor plants and natural elements, not only enhances mental well-being but also functions as a natural defense against bacteria, reducing stress and aiding in the process of recovery [57].
Integrating green roofs and permeable surfaces serves a dual purpose in managing stormwater and minimizing the risk of waterborne infections, highlighting the importance of environmentally harmonious design in infection control [58]. Furthermore, the integration of technology, such as UV-C disinfection systems, touchless interfaces, and antimicrobial coatings, assumes a pivotal role in reducing the transmission of pathogens while maintaining sustainability, reflecting the synergy between innovation and ecological consciousness [59]. Enhanced ventilation may be a key element in limiting the spread of infections. If the ventilation system is properly designed and kept clean to preserve the correct pressure among the functional units, it can be effective in removing airborne infectious agents [60].

4.3. Leadership and Management in Driving Sustainability Initiatives

Effective leadership commitment emerges as essential for motivating and integrating environmental sustainability initiatives in healthcare. As Lee et al. and Emmanuel et al. demonstrate, leadership involvement at the administrative level is key for driving adoption of sustainable practices, overcoming barriers, and fostering a culture shift [38,41]. Their study underscores that sustainable practices in healthcare settings often require a culture shift that begins at the top, with strong leadership driving change. Furthermore, Emmanuel et al. (2021) discusses how sustainable design strategies, such as low energy consumption and reduced carbon emissions, are essential for infection prevention and control [38]. Effective leadership can integrate these strategies into the facility’s design and operations, addressing both environmental and infection control objectives. Emmanuel et al. (2021) delves into the critical role of sustainable design strategies in infection prevention and control. Sustainable design strategies encompass a range of environmentally responsible practices, including energy-efficient building design, reduced carbon emissions, and eco-friendly construction materials [38]. These strategies not only reduce the environmental footprint of healthcare facilities but also have a direct impact on infection control.
Energy-efficient HVAC systems and building materials can contribute to better indoor air quality, which is essential for preventing the spread of airborne infections [61]. Additionally, reduced energy consumption can free up resources for other critical aspects of infection control, such as adequate staffing, personal protective equipment (PPE), and hygiene supplies [62].
The integration of sustainable design strategies into healthcare facility planning and operations requires effective leadership [63]. Leaders must champion these strategies and ensure that incorporated it into the facility’s design, construction, and ongoing maintenance [64]. This alignment between sustainability and infection control objectives demonstrates how strong leadership can bridge the gap between environmental responsibility and patient safety [65].

4.4. Evidence-Based Policies and Efficient Resource Utilization

In the context of infection prevention and control (IPC), the emphasis on evidence-based policies cannot be overstated. These policies provide a solid foundation for healthcare facilities to implement effective IPC measures and environmentally sustainable practices [66]. Their significance lies in their proven effectiveness, adaptability to changing circumstances, and resource efficiency. Evidence-based policies rely on scientific research and data, ensuring that healthcare facilities allocate their budget and personnel efficiently, ultimately prioritizing patient safety by reducing the risk of healthcare-associated infections (HAIs) and fostering a culture of continuous improvement in healthcare [67].
Efficient resource utilization is equally critical in the context of sustainability and infection control [68]. Healthcare facilities must pay meticulous attention to resource management for several reasons. Proper waste management, including segregation, recycling, and disposal, is essential to prevent environmental contamination and reduce infection risks [69]. Efficient resource allocation ensures that resources, whether personnel, medical supplies, or equipment, are distributed where needed most, optimizing patient care and infection control [70]. Moreover, energy and water conservation are crucial to reduce the carbon footprint and ensure the availability of essential resources for infection control measures like hand hygiene [71]. Sustainable procurement practices, such as selecting products with minimal environmental impact, are part of this effort. By integrating evidence-based policies and efficient resource utilization, healthcare facilities can achieve sustainable healthcare practices that prioritize infection control while minimizing their environmental impact, ultimately benefiting both patient health and the planet’s well-being [72,73].

4.5. Surveillance Systems for Infection Control

The intertwining of environmental sustainability and surveillance systems for infection control presents a crucial nexus in our pursuit of a healthier future. Environmental sustainability, encompassing responsible resource management and biodiversity preservation, is pivotal for long-term ecological balance and human well-being [74]. Renewable energy, resource conservation, sustainable agriculture, biodiversity protection, and efficient waste management collectively contribute to mitigating environmental degradation and fostering a balanced ecosystem [75].
In parallel, surveillance systems for infection control serve as a cornerstone in public health, facilitating early detection, response, and monitoring of diseases. These systems not only help identify outbreaks but also monitor environmental factors like water quality, air pollution, and climate changes that significantly influence disease transmission. Their role in preventative measures, research, and planning is vital in informing targeted interventions and policy decisions [76].
The confluence of these realms manifests through various avenues. Surveillance systems leverage environmental monitoring to predict and prevent disease outbreaks, considering the influence of environmental changes on public health. Additionally, they aid in assessing how environmental sustainability practices impact disease transmission. The use of advanced technologies further enhances these systems, fostering a comprehensive understanding of the interplay between environmental factors and public health [77].
Therefore, the integration of environmental sustainability and surveillance systems is pivotal. By intertwining these facets, we can craft more effective strategies for disease control and environmental preservation. Understanding the connections between a healthy environment and disease transmission facilitates the development of holistic approaches that safeguard both human health and the planet’s well-being [78].

4.6. The Healthcare Environment Configuration

The integration of environmental sustainability, often referred to as the Healthcare Environment Configuration, is gaining momentum as a pivotal aspect of responsible healthcare facility management [79]. This approach involves a comprehensive set of practices designed to minimize the environmental footprint of healthcare operations while fostering a healthier, more sustainable environment. Key strategies include a focus on energy efficiency through the adoption of LED lighting, efficient HVAC systems, and a shift toward renewable energy sources [80]. These efforts significantly reduce energy consumption and carbon emissions, aligning with global sustainability goals [81].
Waste management stands as another critical pillar, given the substantial volume of waste generated by healthcare facilities [82]. Proper segregation, recycling, and responsible disposal methods for hazardous medical waste are essential in curbing the environmental impact. Implementing recycling programs and strategies to reduce waste, along with the adoption of eco-friendly materials, plays a vital role in this initiative [83].
Efforts to conserve water play a pivotal role, given the high water usage in healthcare facilities [84]. Practices such as installing water-saving fixtures, water recycling for non-potable purposes, and optimizing water usage go a long way in reducing water consumption and wastewater discharge, contributing to sustainable operations [85].
The design and construction of healthcare facilities also hold substantial potential for environmental sustainability. Adhering to green building principles involving the use of eco-friendly materials, maximizing natural lighting, and incorporating nature in healing environments can create more sustainable structures while promoting patient well-being [86,87].

5. Limitations and Future Directions and Conclusions

While the reviewed studies offer valuable insights into the intersection of environmental sustainability and infection control in healthcare, it is important to acknowledge some limitations. The studies encompass a range of methodologies, including quasi-experimental, cross-sectional, and qualitative designs, each with its own inherent biases and limitations. Several studies had relatively small sample sizes, such as Saadeh et al.’s assessment of just 23 hospitals, which limits the generalizability of findings [43]. Many studies also relied on self-reported data from surveys or interviews, which can introduce response bias.
Furthermore, few studies directly measured environmental outcomes, such as energy use or emissions, to quantify the effect of interventions. Most focused on indirect sustainable or infection control indicators. Additionally, the predominantly observational study designs are vulnerable to confounding factors.
Future research with more robust experimental designs, larger sample sizes, objective environmental impact data, and longitudinal follow-up could provide stronger evidence. Cost-effectiveness analyses of different sustainability strategies and their infection prevention impacts could also inform decision making. Exploring the sustainability–infection control nexus in more geographic settings and clinical contexts would boost generalizability.
Additionally, studies could examine the role of emerging technologies like AI and automation in balancing sustainability and infection prevention. Research is also needed on sustainability training and leadership development interventions and their organizational impacts. In summary, while the current literature offers a meaningful foundation, addressing methodological limitations and research gaps could further strengthen the knowledge base guiding sustainable and infection-resilient healthcare systems.
This systematic review elucidates the complex interrelationship between environmental sustainability and infection control in healthcare systems. The findings contribute significantly to understanding how healthcare facilities can holistically integrate sustainability principles into infection prevention efforts.
Practical implications emerge for healthcare leaders, policymakers, and practitioners seeking to apply these insights. Strong leadership commitment and impactful organizational culture shifts are essential to drive sustainability agendas. Investments into robust IPC capabilities and staff training are imperative, alongside the incorporation of green design features and efficient resource management. Meticulous spatial configuration and patient zoning optimize infection containment.
Moving forward, healthcare must leverage these synergies through systems-level strategies that account for the multifaceted aspects of balancing infection resilience and environmental responsibility. Policy and managerial efforts should be guided by evidence-based models that illuminate this symbiosis. Sustainability must become integral to healthcare’s central mission of healing and protecting human health.

Author Contributions

Conceptualization, R.F.A. and N.A.; methodology, R.F.A.; software, R.F.A.; validation, R.F.A., N.A., A.N.A. and A.G.A.; formal analysis, R.F.A.; investigation, R.F.A.; resources, A.G.A.; data curation, R.F.A.; writing—original draft preparation, R.F.A.; writing—review and editing, R.F.A., N.A., A.N.A. and A.G.A.; visualization, R.F.A.; supervision, N.A. and A.N.A.; project administration, R.F.A. All authors have read and agreed to the published version of the manuscript.

Funding

This work was funded by the deanship of scientific research of Jouf University through the fast-track research funding program.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Molero, A.; Calabrò, M.; Vignes, M.; Gouget, B.; Gruson, D. Sustainability in Healthcare: Perspectives and Reflections Regarding Laboratory Medicine. Ann. Lab. Med. 2021, 41, 139–144. [Google Scholar] [CrossRef]
  2. Alamer, A.; Alharbi, F.; Aldhilan, A.; Almushayti, Z.; Alghofaily, K.; Elbehiry, A.; Abalkhail, A. Healthcare-Associated Infections (HAIs): Challenges and Measures Taken by the Radiology Department to Control Infection Transmission. Vaccines 2022, 10, 2060. [Google Scholar] [CrossRef] [PubMed]
  3. Alharbi, N.S.; Alhaji, J.H.; Qattan, M.Y. Toward Sustainable Environmental Management of Healthcare Waste: A Holistic Perspective. Sustainability 2021, 13, 5280. [Google Scholar] [CrossRef]
  4. Ossebaard, H.C.; Lachman, P. Climate Change, Environmental Sustainability and Health Care Quality. Int. J. Qual. Health Care 2021, 33, mzaa036. [Google Scholar] [CrossRef] [PubMed]
  5. Abrams, E.M.; Singer, A.G.; Shaker, M.; Greenhawt, M. What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care. J. Allergy Clin. Immunol. Pract. 2021, 9, 608–612. [Google Scholar] [CrossRef]
  6. Lenzen, M.; Malik, A.; Li, M.; Fry, J.; Weisz, H.; Pichler, P.-P.; Chaves, L.S.M.; Capon, A.; Pencheon, D. The Environmental Footprint of Health Care: A Global Assessment. Lancet Planet. Health 2020, 4, e271–e279. [Google Scholar] [CrossRef]
  7. Prasad, P.A.; Joshi, D.; Lighter, J.; Agins, J.; Allen, R.; Collins, M.; Pena, F.; Velletri, J.; Thiel, C. Environmental Footprint of Regular and Intensive Inpatient Care in a Large US Hospital. Int. J. Life Cycle Assess. 2022, 27, 38–49. [Google Scholar] [CrossRef]
  8. Pereno, A.; Eriksson, D. A Multi-Stakeholder Perspective on Sustainable Healthcare: From 2030 Onwards. Futures 2020, 122, 102605. [Google Scholar] [CrossRef]
  9. Mostepaniuk, A.; Akalin, T.; Parish, M.R. Practices Pursuing the Sustainability of A Healthcare Organization: A Systematic Review. Sustainability 2023, 15, 2353. [Google Scholar] [CrossRef]
  10. Velenturf, A.P.M.; Purnell, P. Principles for a Sustainable Circular Economy. Sustain. Prod. Consum. 2021, 27, 1437–1457. [Google Scholar] [CrossRef]
  11. Alhumaid, S.; Al Mutair, A.; Al Alawi, Z.; Alsuliman, M.; Ahmed, G.Y.; Rabaan, A.A.; Al-Tawfiq, J.A.; Al-Omari, A. Knowledge of Infection Prevention and Control among Healthcare Workers and Factors Influencing Compliance: A Systematic Review. Antimicrob. Resist. Infect. Control 2021, 10, 86. [Google Scholar] [CrossRef] [PubMed]
  12. Haque, M.; Sartelli, M.; McKimm, J.; Abu Bakar, M. Bin Health Care-Associated Infections – an Overview. Infect. Drug Resist. 2018, 11, 2321–2333. [Google Scholar] [CrossRef] [PubMed]
  13. Jara, B.J. Infection Prevention in the Era of COVID-19: 2021 Basic Procedure Review. J. Nucl. Med. Technol. 2021, 49, 126–131. [Google Scholar] [CrossRef] [PubMed]
  14. Abstracts from the 5th International Conference on Prevention & Infection Control (ICPIC 2019). Antimicrob. Resist. Infect. Control 2019, 8, 148. [CrossRef]
  15. Haque, M.; McKimm, J.; Sartelli, M.; Dhingra, S.; Labricciosa, F.M.; Islam, S.; Jahan, D.; Nusrat, T.; Chowdhury, T.S.; Coccolini, F.; et al. Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview. Risk Manag. Healthc. Policy 2020, 13, 1765–1780. [Google Scholar] [CrossRef]
  16. Friedrich, A.W. Control of Hospital Acquired Infections and Antimicrobial Resistance in Europe: The Way to Go. Wiener Med. Wochenschr. 2019, 169, 25–30. [Google Scholar] [CrossRef]
  17. Doll, M.; Stevens, M.; Bearman, G. Environmental Cleaning and Disinfection of Patient Areas. Int. J. Infect. Dis. 2018, 67, 52–57. [Google Scholar] [CrossRef]
  18. Emmanuel, U.; Osondu, E.D.; Kalu, K.C. Architectural Design Strategies for Infection Prevention and Control (IPC) in Health-Care Facilities: Towards Curbing the Spread of COVID-19. J. Environ. Health Sci. Eng. 2020, 18, 1699–1707. [Google Scholar] [CrossRef]
  19. Baid, H. Satisficing for Sustainability in Critical Care Practice: A Constructivist Grounded Theory. Ph.D. Thesis, University of Brighton, Brighton, UK, 2019; p. 291. [Google Scholar]
  20. Ismaeil, E.M.H.; Sobaih, A.E.E. High-Performance Glazing for Enhancing Sustainable Environment in Arid Region’s Healthcare Projects. Buildings 2023, 13, 1243. [Google Scholar] [CrossRef]
  21. Aliabadi, A.A.; Rogak, S.N.; Bartlett, K.H.; Green, S.I. Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities. Adv. Prev. Med. 2011, 2011, 124064. [Google Scholar] [CrossRef]
  22. Costa, R.L.; Moreira, J.; Lorenzo, A.; Lamas, C.C. Infectious Complications Following Probiotic Ingestion: A Potentially Underestimated Problem? A Systematic Review of Reports and Case Series. BMC Complement. Altern. Med. 2018, 18, 329. [Google Scholar] [CrossRef]
  23. Gola, M.; Settimo, G.; Capolongo, S. Indoor Air Quality in Inpatient Environments: A Systematic Review on Factors That Influence Chemical Pollution in Inpatient Wards. J. Healthc. Eng. 2019, 2019, 8358306. [Google Scholar] [CrossRef]
  24. Carslaw, N.; Shaw, D. Modification of Cleaning Product Formulations Could Improve Indoor Air Quality. Indoor Air 2022, 32, e13021. [Google Scholar] [CrossRef] [PubMed]
  25. Morgan, O.W.; Pinner, R.W. Surveillance of Infectious Diseases. In Encyclopedia of Microbiology; Elsevier: Amsterdam, The Netherlands, 2009; pp. 759–774. [Google Scholar]
  26. Galvani, A.P.; Parpia, A.S.; Foster, E.M.; Singer, B.H.; Fitzpatrick, M.C. Improving the Prognosis of Health Care in the USA. Lancet 2020, 395, 524–533. [Google Scholar] [CrossRef]
  27. Sijm-Eeken, M.; Jaspers, M.; Peute, L. Identifying Environmental Impact Factors for Sustainable Healthcare: A Scoping Review. Int. J. Environ. Res. Public Health 2023, 20, 6747. [Google Scholar] [CrossRef]
  28. Dadgostar, P. Antimicrobial Resistance: Implications and Costs. Infect. Drug Resist. 2019, 12, 3903–3910. [Google Scholar] [CrossRef]
  29. Murray, C.J.L.; Ikuta, K.S.; Sharara, F.; Swetschinski, L.; Robles Aguilar, G.; Gray, A.; Han, C.; Bisignano, C.; Rao, P.; Wool, E.; et al. Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. Lancet 2022, 399, 629–655. [Google Scholar] [CrossRef]
  30. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
  31. Shamseer, L.; Moher, D.; Clarke, M.; Ghersi, D.; Liberati, A.; Petticrew, M.; Shekelle, P.; Stewart, L.A. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: Elaboration and Explanation. BMJ 2015, 349, g7647. [Google Scholar] [CrossRef] [PubMed]
  32. McGuinness, L.A.; Higgins, J.P.T. Risk-of-bias VISualization (Robvis): An R Package and Shiny Web App for Visualizing Risk-of-bias Assessments. Res. Synth. Methods 2021, 12, 55–61. [Google Scholar] [CrossRef] [PubMed]
  33. Karltun, A. Developing a Sustainable Infection Control Program in Health Care. In Proceedings of the 6th NOVO Symposium on Sustainable Health Care: Continuous Improvement of Processes and Systems, Stockholm, Sweden, 25–26 November 2012. [Google Scholar]
  34. Talaat, M.; El-Shokry, M.; El-Kholy, J.; Ismail, G.; Kotb, S.; Hafez, S.; Attia, E.; Lessa, F.C. National Surveillance of Health Care–Associated Infections in Egypt: Developing a Sustainable Program in a Resource-Limited Country. Am. J. Infect. Control 2016, 44, 1296–1301. [Google Scholar] [CrossRef]
  35. Gomes, D.J.; Hazim, C.; Safstrom, J.; Herzig, C.; Luvsansharav, U.; Dennison, C.; Ahmed, Y.; Wesangula, E.; Hokororo, J.; Amone, J.; et al. Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa. Emerg. Infect. Dis. 2022, 28, S255–S261. [Google Scholar] [CrossRef] [PubMed]
  36. Leistner, R.; Kohlmorgen, B.; Brodzinski, A.; Schwab, F.; Lemke, E.; Zakonsky, G.; Gastmeier, P. Environmental Cleaning to Prevent Hospital-Acquired Infections on Non-Intensive Care Units: A Pragmatic, Single-Centre, Cluster Randomized Controlled, Crossover Trial Comparing Soap-Based, Disinfection and Probiotic Cleaning. eClinicalMedicine 2023, 59, 101958. [Google Scholar] [CrossRef]
  37. Hegarty, J.; Murphy, S.; Creedon, S.; Wills, T.; Savage, E.; Barry, F.; Smiddy, M.; Coffey, A.; Burton, A.; O’Brien, D.; et al. Leadership Perspective on the Implementation of Guidelines on Healthcare-Associated Infections. BMJ Lead. 2019, 3, 43–51. [Google Scholar] [CrossRef]
  38. Emmanuel, U.; Eze, D.O.; Kalu, K.C.; Haliru, A.A. Environmental Sustainability for Infection Prevention and Control (IPC) in Healthcare Facilities. In Proceedings of the 4th International Conference of Contemporary Affairs in Architecture and Urbanism (ICCAUA-2021), Virtual, 20–21 May 2021; Alanya Hamdullah Emin Paşa University: Alanya, Türkiye, 2021; pp. 677–686. [Google Scholar]
  39. Lesan, M.; Khozaei, F.; Kim, M.J.; Shahidi Nejad, M. Identifying Health Care Environment Contradictions in Terms of Infection Control during a Pandemic with a Focus on Health Workers’ Experience. Sustainability 2021, 13, 9964. [Google Scholar] [CrossRef]
  40. Hamam, S.; Sakr, A.; Zahran, W.; El Kholy, R.; Kasemy, Z.; Ibrahem, R.; Sakr, M.; Younis, F. Health Care-Associated Infections at an Egyptian Tertiary Care Hospital: A 2-Year Prospective Study. Menoufia Med. J. 2021, 34, 514. [Google Scholar] [CrossRef]
  41. Lee, S.M.; Lee, D. Developing Green Healthcare Activities in the Total Quality Management Framework. Int. J. Environ. Res. Public Health 2022, 19, 6504. [Google Scholar] [CrossRef]
  42. Isunju, J.B.; Ssekamatte, T.; Wanyenze, R.; Mselle, J.S.; Wafula, S.T.; Kansiime, W.K.; Bateganya, N.L.; Nalugya, A.; Wagaba, B.; Denny, L.; et al. Analysis of Management Systems for Sustainability of Infection Prevention and Control, and Water Sanitation and Hygiene in Healthcare Facilities in the Greater Kampala Area, Uganda. PLoS Water 2022, 1, e0000021. [Google Scholar] [CrossRef]
  43. Saadeh, R.; Khader, Y.; Alyahya, M.; Al-Samawi, M.; Allouh, M.Z. Water, Sanitation, and Hygiene and Infection Prevention and Control in Jordanian Hospitals in the Context of COVID-19: A National Assessment. Risk Manag. Healthc. Policy 2022, 15, 571–582. [Google Scholar] [CrossRef]
  44. Anicetus, H.; Manyele, S.; Habtu, M.; Kiyunge, A.; Saria, J.; Njee, R.; Thadei, L.; Massa, K.; Saguti, G.E.; Yoti, Z. Assessment of Environmental Cleaning Practices and the Impacts on Infection Prevention and Control in Selected Hospitals in Tanzania. J. Environ. Prot. 2022, 13, 698–715. [Google Scholar] [CrossRef]
  45. Peters, A.; Schmid, M.N.; Parneix, P.; Lebowitz, D.; de Kraker, M.; Sauser, J.; Zingg, W.; Pittet, D. Impact of Environmental Hygiene Interventions on Healthcare-Associated Infections and Patient Colonization: A Systematic Review. Antimicrob. Resist. Infect. Control 2022, 11, 38. [Google Scholar] [CrossRef] [PubMed]
  46. Shbaklo, N.; Lupia, T.; De Rosa, F.G.; Corcione, S. Infection Control in the Era of COVID-19: A Narrative Review. Antibiotics 2021, 10, 1244. [Google Scholar] [CrossRef] [PubMed]
  47. Rume, T.; Islam, S.M.D.-U. Environmental Effects of COVID-19 Pandemic and Potential Strategies of Sustainability. Heliyon 2020, 6, e04965. [Google Scholar] [CrossRef] [PubMed]
  48. Tomczyk, S.; Taylor, A.; Brown, A.; de Kraker, M.E.A.; El-Saed, A.; Alshamrani, M.; Hendriksen, R.S.; Jacob, M.; Löfmark, S.; Perovic, O.; et al. Impact of the COVID-19 Pandemic on the Surveillance, Prevention and Control of Antimicrobial Resistance: A Global Survey. J. Antimicrob. Chemother. 2021, 76, 3045–3058. [Google Scholar] [CrossRef]
  49. Storr, J.; Twyman, A.; Zingg, W.; Damani, N.; Kilpatrick, C.; Reilly, J.; Price, L.; Egger, M.; Grayson, M.L.; Kelley, E.; et al. Core Components for Effective Infection Prevention and Control Programmes: New WHO Evidence-Based Recommendations. Antimicrob. Resist. Infect. Control 2017, 6, 6. [Google Scholar] [CrossRef]
  50. Salonen, N.; Ahonen, M.; Sirén, K.; Mäkinen, R.; Anttila, V.-J.; Kivisaari, M.; Salonen, K.; Pelto-Huikko, A.; Latva, M. Methods for Infection Prevention in the Built Environment—A Mini-Review. Front. Built Environ. 2023, 9, 1212920. [Google Scholar] [CrossRef]
  51. Çakmakçı, R.; Salık, M.A.; Çakmakçı, S. Assessment and Principles of Environmentally Sustainable Food and Agriculture Systems. Agriculture 2023, 13, 1073. [Google Scholar] [CrossRef]
  52. Lipinski, T.; Ahmad, D.; Serey, N.; Jouhara, H. Review of Ventilation Strategies to Reduce the Risk of Disease Transmission in High Occupancy Buildings. Int. J. Thermofluids 2020, 7–8, 100045. [Google Scholar] [CrossRef]
  53. Berardi, U. Sustainability Assessment in the Construction Sector: Rating Systems and Rated Buildings. Sustain. Dev. 2012, 20, 411–424. [Google Scholar] [CrossRef]
  54. Karim, N.; Afroj, S.; Lloyd, K.; Oaten, L.C.; Andreeva, D.V.; Carr, C.; Farmery, A.D.; Kim, I.-D.; Novoselov, K.S. Sustainable Personal Protective Clothing for Healthcare Applications: A Review. ACS Nano 2020, 14, 12313–12340. [Google Scholar] [CrossRef]
  55. Shah, K.W.; Huseien, G.F. Inorganic Nanomaterials for Fighting Surface and Airborne Pathogens and Viruses. Nano Express 2020, 1, 032003. [Google Scholar] [CrossRef]
  56. Ferrante, T.; Villani, T. Pre-Occupancy Evaluation in Hospital Rooms for Efficient Use of Natural Light—Improved Proposals. Buildings 2022, 12, 2145. [Google Scholar] [CrossRef]
  57. Tekin, B.H.; Corcoran, R.; Gutiérrez, R.U. A Systematic Review and Conceptual Framework of Biophilic Design Parameters in Clinical Environments. HERD Health Environ. Res. Des. J. 2023, 16, 233–250. [Google Scholar] [CrossRef]
  58. Jones, L.; Anderson, S.; Læssøe, J.; Banzhaf, E.; Jensen, A.; Bird, D.N.; Miller, J.; Hutchins, M.G.; Yang, J.; Garrett, J.; et al. A Typology for Urban Green Infrastructure to Guide Multifunctional Planning of Nature-Based Solutions. Nat. Based Solut. 2022, 2, 100041. [Google Scholar] [CrossRef]
  59. Yong, L.X.; Calautit, J.K. A Comprehensive Review on the Integration of Antimicrobial Technologies onto Various Surfaces of the Built Environment. Sustainability 2023, 15, 3394. [Google Scholar] [CrossRef]
  60. Gola, M.; Caggiano, G.; de Giglio, O.; Napoli, C.; Diella, G.; Carlucci, M.; Carpagnano, L.F.; D’Alessandro, D.; Joppolo, C.M.; Capolongo, S.; et al. SARS-CoV-2 Indoor Contamination: Considerations on Anti-COVID-19 Management of Ventilation Systems, and Finishing Materials in Healthcare Facilities. Ann. Ig. Med. Prev. Comunita 2021, 33, 381–392. [Google Scholar]
  61. Elsaid, A.M.; Ahmed, M.S. Indoor Air Quality Strategies for Air-Conditioning and Ventilation Systems with the Spread of the Global Coronavirus (COVID-19) Epidemic: Improvements and Recommendations. Environ. Res. 2021, 199, 111314. [Google Scholar] [CrossRef]
  62. Moghadam, T.T.; Ochoa Morales, C.E.; Lopez Zambrano, M.J.; Bruton, K.; O’Sullivan, D.T.J. Energy Efficient Ventilation and Indoor Air Quality in the Context of COVID-19—A Systematic Review. Renew. Sustain. Energy Rev. 2023, 182, 113356. [Google Scholar] [CrossRef]
  63. Abid, G.; Contreras, F.; Rank, S.; Ilyas, S. Sustainable Leadership and Wellbeing of Healthcare Personnel: A Sequential Mediation Model of Procedural Knowledge and Compassion. Front. Psychol. 2023, 13, 1039456. [Google Scholar] [CrossRef]
  64. Taylor, F.R. When West Meets East: Is It Time for Headache Medicine to Complement “Convention” With Alternative Practices? Headache J. Head Face Pain 2011, 51, 1051–1054. [Google Scholar] [CrossRef]
  65. Hughes, R.G. Section VI: Tools for Quality Improvement and Patient Safety. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses; 2008; pp. 1–39. Available online: https://www.ncbi.nlm.nih.gov/books/NBK2682/?report=reader (accessed on 2 November 2023).
  66. Magadze, T.A.; Nkhwashu, T.E.; Moloko, S.M.; Chetty, D. The Impediments of Implementing Infection Prevention Control in Public Hospitals: Nurses’ Perspectives. Health SA Gesondheid 2022, 27, 2033. [Google Scholar] [CrossRef]
  67. Mosadeghrad, A.M. Factors Influencing Healthcare Service Quality. Int. J. Health Policy Manag. 2014, 3, 77–89. [Google Scholar] [CrossRef] [PubMed]
  68. Telfah, S.; Chau, K.Y.; Tran, T.K.; Bui, A.T.; Tai, N.T.; Phan, T.T.H. Role of Financial Markets and Natural Resource Utilization in Green Economic Recovery: Evidence from Selected Developing Economies. Resour. Policy 2023, 83, 103761. [Google Scholar] [CrossRef]
  69. Ashtari, A.; Sadegh Tabrizi, J.; Rezapour, R.; Rashidian Maleki, M.; Azami-Aghdash, S. Health Care Waste Management Improvement Interventions Specifications and Results: A Systematic Review and MetaAnalysis. Iran. J. Public Health 2020, 49, 1611–1621. [Google Scholar] [CrossRef] [PubMed]
  70. Fattahi, M.; Keyvanshokooh, E.; Kannan, D.; Govindan, K. Resource Planning Strategies for Healthcare Systems during a Pandemic. Eur. J. Oper. Res. 2023, 304, 192–206. [Google Scholar] [CrossRef]
  71. Mathur, P. Hand Hygiene: Back to the Basics of Infection Control. Indian J. Med. Res. 2011, 134, 611. [Google Scholar] [CrossRef]
  72. Soares, A.L.; Buttigieg, S.C.; Bak, B.; McFadden, S.; Hughes, C.; McClure, P.; Couto, J.G.; Bravo, I. A Review of the Applicability of Current Green Practices in Healthcare Facilities. Int. J. Health Policy Manag. 2023, 12, 6947. [Google Scholar] [CrossRef]
  73. Osborne, S.R.; Piper, D.; Alston, L.V.; Bolton, K.A.; Whelan, J.; Reeve, E.; Wong Shee, A.; Browne, J.; Walker, T.; Versace, V.L.; et al. Beyond the Black Stump: Rapid Reviews of Health Research Issues Affecting Regional, Rural and Remote Australia. Med. J. Aust. 2020, 213, S3–S32.e1. [Google Scholar] [CrossRef]
  74. Choy, Y.K. Sustainable development: The nexus of environmental sustainability, values, and ethics. Eur. J. Sustain. Dev. 2017, 6, 308–324. [Google Scholar] [CrossRef]
  75. Chu, E.W.; Karr, J.R. Environmental Impact: Concept, Consequences, Measurement. In Reference Module in Life Sciences; Elsevier: Amsterdam, The Netherlands, 2017. [Google Scholar]
  76. Davis, J.R.; Lederberg, J. Public Health Systems and Emerging Infections: Assessing the Capabilities of the Public and Private Sectors; National Academy Press: Washington, DC, USA, 2000; ISBN 0309068290. [Google Scholar]
  77. Hess, J.; Boodram, L.-L.G.; Paz, S.; Stewart Ibarra, A.M.; Wasserheit, J.N.; Lowe, R. Strengthening the Global Response to Climate Change and Infectious Disease Threats. BMJ 2020, 371, m3081. [Google Scholar] [CrossRef]
  78. Herrero, M.; Hugas, M.; Lele, U.; Wirakartakusumah, A.; Torero, M. A Shift to Healthy and Sustainable Consumption Patterns. In Science and Innovations for Food Systems Transformation; Springer International Publishing: Cham, Switzerland, 2023; pp. 59–85. [Google Scholar]
  79. Mehra, R.; Sharma, M.K. Measures of Sustainability in Healthcare. Sustain. Anal. Model. 2021, 1, 100001. [Google Scholar] [CrossRef]
  80. Nascimento, G.; Araujo, C.A.S.; Alves, L.A. Corporate Sustainability Practices in Accredited Brazilian Hospitals: A Degree-of-Maturity Assessment of the Environmental Dimension. Rev. Adm. 2017, 52, 26–35. [Google Scholar] [CrossRef]
  81. Bathish, M.A.; Lee, D.R.; Czerwinski, M.A.; Marsack, J.E. A Survey of Sustainability Efforts in Healthcare Simulation and Clinical Learning. Clin. Simul. Nurs. 2022, 69, 1–6. [Google Scholar] [CrossRef]
  82. Khan, B.A.; Khan, A.A.; Ahmed, H.; Shaikh, S.S.; Peng, Z.; Cheng, L. A Study on Small Clinics Waste Management Practice, Rules, Staff Knowledge, and Motivating Factor in a Rapidly Urbanizing Area. Int. J. Environ. Res. Public Health 2019, 16, 4044. [Google Scholar] [CrossRef] [PubMed]
  83. Abubakar, I.R.; Maniruzzaman, K.M.; Dano, U.L.; AlShihri, F.S.; AlShammari, M.S.; Ahmed, S.M.S.; Al-Gehlani, W.A.G.; Alrawaf, T.I. Environmental Sustainability Impacts of Solid Waste Management Practices in the Global South. Int. J. Environ. Res. Public Health 2022, 19, 12717. [Google Scholar] [CrossRef] [PubMed]
  84. van der Heijden, S.; Cassivi, A.; Mayer, A.; Sandholz, S. Water Supply Emergency Preparedness and Response in Health Care Facilities: A Systematic Review on International Evidence. Front. Public Health 2022, 10, 1035212. [Google Scholar] [CrossRef]
  85. Silva, J.A. Wastewater Treatment and Reuse for Sustainable Water Resources Management: A Systematic Literature Review. Sustainability 2023, 15, 10940. [Google Scholar] [CrossRef]
  86. Danilov, A.; Benuzh, A.; Yeye, O.; Compaore, S.; Rud, N. Design of Healthcare Structures by Green Standards. E3S Web Conf. 2020, 164, 05002. [Google Scholar] [CrossRef]
  87. Alhmoud, S.H.; Çağnan, Ç.; Arcan, E.F. Improving Interior Environmental Quality Using Sustainable Design in Jordanian Hospital Bedrooms. Eur. J. Sustain. Dev. 2020, 9, 443. [Google Scholar] [CrossRef]
Sustainability 15 15728 g001
Figure 1. PRISMA flow diagram.
Figure 1. PRISMA flow diagram.
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Figure 2. Summary of risk of bias [33,34,35,36,37,38,39,40,41,42,43,44].
Figure 2. Summary of risk of bias [33,34,35,36,37,38,39,40,41,42,43,44].
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Table 1. The extraction table of the included articles.
Table 1. The extraction table of the included articles.
Author and YearStudy DesignTitleSample Aim of the Study Main Outcomes
Lee et al. (2022) [41]Quasi-experimental Study“Developing Green Healthcare Activities in the Total Quality Management Framework”261 employees at general hospitals in South KoreaExamines the effectiveness of green healthcare activities in hospitals based on the total quality management (TQM) framework.The results of the study revealed that the role of top management is essential for the successful implementation of green healthcare activities through motivating employees for their active participation in the program, providing continuous education and training on the importance of environmental sustainability, and diligently monitoring the progress at the organization level.
Isunju. et al. (2022) [42]Cross-sectional Study“Analysis of management systems for sustainability of infection prevention and control, and water sanitation and hygiene in healthcare facilities in the Greater Kampala Area, Uganda”60 public health centers The study examines the challenges and variations in managing water, sanitation, and hygiene (WASH) and infection prevention and control (IPC) services in healthcare facilities in the Greater Kampala Metropolitan Area, Uganda, with a focus on improving sustainability.Insufficient budgets for WASH infrastructure maintenance and deficiencies in management systems for WASH and IPC in healthcare facilities in the Greater Kampala Metropolitan Area pose challenges to sustainability, but recognizing high-performing staff and implementing IPC guidelines, offices, and committees, along with improved monitoring and accountability, can contribute to sustaining recommended practices.
Saadeh et al. (2022) [43]A national assessment“Water, Sanitation, and Hygiene and Infection Prevention and Control in Jordanian Hospitals in the Context of COVID-19: A National Assessment”23 Jordanian hospitals.Identifies areas that need improvement in Jordanian health centers regarding infection prevention and control (IPC) programs; water, sanitation, and hygiene (WASH) services; and other protective measures, especially in the context of coronavirus disease (COVID-19).There is scope for improvement in many WASH/IPC aspects, and urgent actions should be taken, especially to fill the gaps in COVID-19 precautionary measures.
Emmanuel et al. (2021) [38]Retrospective analysis “Environmental Sustainability for Infection Prevention and Control (IPC) in Healthcare Facilities”-Identifies the
nexus between a sustainable built environment and infection control in healthcare facilities with the view of
developing guidelines and highlighting the role of architecture in curbing the pandemic.		Sustainable design strategies play a significant role in infection prevention and control and could as well be a panacea for curbing the spread of coronavirus, especially in healthcare facilities. A sustainable environment for hospitals or healthcare facilities, apart from low energy and carbon emission, needs to integrate design strategies to confront the impact of healthcare associated infections.
Anicetus et al. (2022) [44]National and regional survey “Assessment of Environmental Cleaning Practices and the Impacts on Infection Prevention and Control in Selected Hospitals in Tanzania”26 regions of TanzaniaAscertains the environmental cleanliness condition of the healthcare facilities at all levels.Handling of healthcare wastes is not practiced to expectations, and there is a need to strengthen the situation. The findings provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources.
Leistner et al. (2023) [36]Cluster-randomized controlled crossover trial“Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-center, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning”18 non-ICU wards in the university hospital of Berlin, GermanyExamines the effect of three different surface-cleaning strategies on the incidence of HAIs.Routine surface disinfection proved not superior to soap-based or probiotic cleaning in terms of HAI prevention. Thus, probiotic cleaning could be an interesting alternative, especially in terms of environmental protection.
Karltun et al. (2012) [33]Observational study “Developing a sustainable infection control program in health care”One urology unit Examines the challenges and efforts related to developing a sustainable infection control program in a healthcare setting, particularly within the context of the Strama initiative in Sweden.The Strama group’s efforts to establish uniform practices, develop treatment guidelines, address challenges in obtaining feedback, and work on implementing an E-portal for clinical data, with a focus on improving infection control practices in healthcare, although specific quantitative or qualitative results are not detailed in the provided passage.
Gomes et al. (2022) [35]Cross-sectional study “Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa”Four target countries: Tanzania, Ethiopia, Kenya, and UgandaPresents an overview of the key strategies used to strengthen infection prevention and control (IPC) practices in healthcare facilities in East African countries (Tanzania, Ethiopia, Kenya, and Uganda) during the COVID-19 pandemic, with a focus on CDC-supported capacity-building initiatives and lessons learned from their implementation.Outlines the strategies employed by the US Centers for Disease Control and Prevention (CDC) to rapidly strengthen infection prevention and control (IPC) practices in healthcare facilities in East African countries, including Tanzania, Ethiopia, Kenya, and Uganda, in response to the COVID-19 pandemic, emphasizing tailored approaches and a cross-country learning network to enhance IPC.
Lesan et al. (2021) [39]Qualitative study“Identifying Health Care Environment Contradictions in Terms of Infection Control during a Pandemic with a Focus on Health Workers’ Experience”Four hospitals and a series of online semi-structured interviews with 162 health care staff.Examines the experiences of health workers with hospital spaces during the COVID-19 pandemic. Identifying the difficulties they face, the present study attempts to shed light on the role of the health care layout configuration in combating pandemicsSpace configuration and the hospitalization of patients, layout and circulation of the environment, operation services such as indoor environment conditions, maintenance of health care system, and organizational support for health care staff were the most critical factors affecting infection control in health care environments. The initial zoning and separation of patients were the most effective methods of controlling infection. Hospitals with clustered plan layouts were found to be the most effective buildings for the zoning of COVID-19 patients during the pandemic and for infection control.
Talaat et al. (2016) [34]Surveillance study“National surveillance of health care–associated infections in Egypt: Developing a sustainable program in a resource-limited country”91 ICUs in 28 hospitalsDescribes the process of developing a national HAI surveillance program and the magnitude of HAI rates in Egypt.Implementation of a sustainable surveillance system in a resource-limited country was possible following a stepwise approach with continuous evaluation. Enhancing infection prevention and control programs should be an infection control priority in Egypt.
Hamam et al. (2021) [40]Prospective study“Health care-associated infections at an Egyptian tertiary care hospital: a 2-year prospective study”13 ICUs in four tertiary care university hospitalsThe incidence and patterns of HAIs and their relation to the length of hospital stay and underlying patient clinical status in tertiary care hospitals based on the surveillance system of Center for Disease Control and Prevention.The surveillance system for HAIs is a cornerstone in the IPC activities to obtain a holistic idea about the hospital infection pattern, its sources and relations to different devices, and antimicrobial resistance patterns. So, efforts should be made to maintain a robust infection control awareness strategy and a sustainable surveillance system to guard against the alarming problem of HAI.
Hegarty et al. (2019) [37]Mixed methods“Leadership perspective on the implementation of guidelines on healthcare-associated infections”Qualitative individual interviews (n = 16) and quantitative surveys (n = 51)Explores the implementation of National Clinical Guidelines pertaining to methicillin-resistant Staphylococcus aureus and Clostridium difficile from the leadership angle.Guidelines are complex interventions in complex organizations, perhaps leadership could help overcome the challenges posed by this complexity. Leadership may allow a systematic approach to all aspects of implementation despite the variety of challenges faced at different stages of implementation and sustainability of uptake of guidelines over time.
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Alruwaili, R.F.; Alsadaan, N.; Alruwaili, A.N.; Alrumayh, A.G. Unveiling the Symbiosis of Environmental Sustainability and Infection Control in Health Care Settings: A Systematic Review. Sustainability 2023, 15, 15728. https://doi.org/10.3390/su152215728

AMA Style

Alruwaili RF, Alsadaan N, Alruwaili AN, Alrumayh AG. Unveiling the Symbiosis of Environmental Sustainability and Infection Control in Health Care Settings: A Systematic Review. Sustainability. 2023; 15(22):15728. https://doi.org/10.3390/su152215728

Chicago/Turabian Style

Alruwaili, Reem F., Nourah Alsadaan, Abeer Nuwayfi Alruwaili, and Afrah Ghazi Alrumayh. 2023. "Unveiling the Symbiosis of Environmental Sustainability and Infection Control in Health Care Settings: A Systematic Review" Sustainability 15, no. 22: 15728. https://doi.org/10.3390/su152215728

APA Style

Alruwaili, R. F., Alsadaan, N., Alruwaili, A. N., & Alrumayh, A. G. (2023). Unveiling the Symbiosis of Environmental Sustainability and Infection Control in Health Care Settings: A Systematic Review. Sustainability, 15(22), 15728. https://doi.org/10.3390/su152215728

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