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Hospital administrators are continually tasked with balancing high-quality patient care, tight budgets, and stringent regulatory requirements—all while maintaining a safe, reliable environment for patients and staff. Now, with climate change emerging as a significant public health threat, another critical responsibility has come into focus: reducing the carbon footprint of their facilities.

The need for uninterrupted energy, around-the-clock operations, and resource-heavy processes makes decarbonization a particularly daunting challenge for hospitals. For many hospital leaders, the pressure to act is growing alongside concerns about how to balance sustainability efforts with the day-to-day realities of running a healthcare facility.

Fortunately, there are wins in decarbonization beyond meeting sustainability goals, including energy savings and operational efficiency.

What’s the scale of the issue?

North America contributes the most to the global healthcare climate footprint, with the U.S. ranking first at 546 million metric tons of CO2e, followed by Canada at ninth and Mexico at eleventh. These figures are unsurprising given the scale of healthcare systems in these countries and the inherently energy-intensive nature of hospitals.

Where are the carbon emissions coming from (and what can be done about them)?

Most of the essential functions of hospitals are heavily reliant on energy consumption from carbon sources. Understanding the primary sources of these emissions is key to identifying opportunities to reduce the environmental impact of healthcare facilities. Below are the main contributors to hospital carbon footprints:

1. Heating, ventilation, and air conditioning (HVAC)

The challenge: Hospitals require extensive heating, ventilation, and air conditioning (HVAC) systems to maintain the controlled environments essential for patient safety and infection control. The constant need for climate control—especially in areas like operating rooms, intensive care units, and laboratories—leads to high levels of energy consumption, and much of that energy is still generated from fossil fuels. HVAC typically accounts for the largest share of energy use in a hospital.

Solutions: Replacing outdated HVAC systems with energy-efficient models and incorporating heat recovery systems can significantly cut energy consumption. Retrofitting older buildings with better insulation, energy-efficient windows, and automatic shading helps reduce energy losses. Advanced building management systems can optimize heating and cooling while providing real-time alerts to address inefficiencies. Additionally, hospitals can plan a transition to renewable energy sources like geothermal for climate control.

2. Lighting and medical equipment

The challenge: From hallways and patient rooms to operating theaters and diagnostic suites, lighting is essential in every part of a hospital. However, many older facilities still rely on inefficient lighting systems, which contribute to unnecessary energy use. Beyond lighting, medical equipment creates a substantial electrical load. Devices such as diagnostic imaging machines, life support systems, and sterilization equipment require large amounts of electricity and often run continuously. Even less frequently considered equipment, such as commercial kitchen appliances and laundry machines, operate under the same 24/7 demand. The lifespan, efficiency, and energy sources powering this high-demand equipment play a significant role in shaping a hospital’s overall carbon footprint.

Solutions: Hospitals can switch to LED lighting and use smart lighting controls to reduce energy waste. More efficient medical equipment can help lower electricity demand, but the costs associated make this less practical for immediate widespread implementation in existing facilities. However, hospitals can start with a facility condition assessment that results in a plan to replace older equipment as it reaches the end of its lifecycle with energy-efficient alternatives. Additionally, hospitals can optimize the use of non-clinical equipment, such as kitchen and laundry machinery, by investing in energy-efficient models and implementing off-peak operation schedules where possible. Finally, many hospitals are introducing power generation onsite through solar, solid oxide fuel cells, and other supplements to the grid. Learn more about the role of microgrid technology for hospitals.

3. Medical gases

The challenge: Medical gases such as nitrous oxide and desflurane that are commonly used in anesthesia contribute significantly to a hospital’s overall emissions. These gases, especially when released into the atmosphere, act as potent greenhouse gases, with global warming potentials (GWP) far higher than carbon dioxide. Nitrous oxide, for instance, has a GWP nearly 300 times that of CO2.

Solutions: Hospitals can reduce the environmental impact of medical gases by switching to lower-GWP anesthetics, implementing gas capture and recycling systems, and optimizing anesthetic delivery systems to minimize excess emissions and leaks. Regular maintenance and calibration of gas delivery systems can ensure efficient use, reducing the waste of high-impact gases like nitrous oxide.

4. Energy used to heat water

Given the need for sterilization, sanitation, and general patient care, the water demand in hospitals is immense, and the energy required to pump, heat, and treat water is significant. Hospitals often rely on large-scale water heating systems, which consume substantial quantities of energy and contribute to their carbon footprint.

Solutions: To reduce this impact, many hospitals are transitioning from conventional gas boilers and steam sterilizers to fully electric systems—often called “electrification.” Electric boilers and sterilizers can be powered by renewable energy sources such as hydropower, solar, and wind when green energy is available. Advancements in energy-efficient water heating technologies, such as heat pumps and cogeneration systems, offer additional ways to optimize water heating while further minimizing energy use.

Big picture strategy for hospitals who want to decarbonize

While upgrading equipment and systems is a critical component of decarbonizing hospitals, a broader, more strategic approach is necessary to achieve long-term sustainability goals. Beyond replacing outdated infrastructure, hospitals can implement advanced planning, energy modeling, and more comprehensive solutions that address efficiency and carbon reduction throughout the lifecycle of operations from design to daily management.

1. Data-driven energy management

Hospitals can adopt data-driven energy management systems to monitor real-time energy use, track performance against sustainability goals, and identify inefficiencies. These systems leverage data analytics to detect anomalies in energy consumption and help facility managers make informed decisions and prioritize energy-saving initiatives.

Energy modeling plays a key role in helping hospitals understand their current energy use and future needs. By simulating energy consumption patterns, hospitals can pinpoint inefficiencies and determine where the most impactful reductions can be achieved supporting a phased approach to transitioning from fossil fuels to renewable energy sources. This strategic planning ensures that decarbonization aligns with both long-term operational goals and capital budgets, allowing for a structured, cost-effective path to sustainability.

2. Retro-commissioning of mechanical systems post-occupancy

Retro-commissioning (or RCx) is a systematic process for fine-tuning building systems to restore optimal operation. Whereas commissioning (Cx) typically involves the evaluation of new systems to ensure that operation is in line with the original design intent, retro-commissioning focuses on existing systems after several years of operation. During the normal course of business, it’s common for multiple uncoordinated changes to be triggered by construction projects, repairs, and maintenance (or lack thereof). This can inadvertently lead to inefficient and ineffective building system operation. RCx finds and addresses these gaps in performance.

3. Purchasing green energy

Hospitals can make substantial progress in decarbonization by purchasing green energy from renewable sources such as wind, solar, or hydroelectric power. Many energy providers now offer green power agreements, allowing hospitals to source some or all their electricity from renewable sources. This strategy helps hospitals reduce their carbon footprint without requiring immediate on-site renewable energy installations, offering a quick and scalable solution that’s particularly appealing for facilities looking to make immediate sustainability gains. In some parts of North America, utility power companies already supply through decarbonized sources, such as hydropower in British Columbia or wind energy in Texas.

4. Early sustainability planning for new construction

For new construction and major renovation projects, consulting engineers specializing in sustainable strategies can have a major impact on reducing costs in mechanical, electrical, and plumbing (MEP) systems. This involves space and utility planning and integrating energy-efficient designs from the outset, such as right-sizing HVAC systems, optimizing ventilation, and integrating energy-efficient solutions. Early engagement also improves lead time for equipment selection. By embedding sustainability into the MEP design process, hospitals can ensure that their new facilities are built with decarbonization goals in mind from day one while also protecting the project from expensive change orders and achieving the efficiencies of a holistic approach.

5. Staff education and stakeholder engagement

One often overlooked but highly effective strategy is staff education and engagement in decarbonization efforts. By fully communicating the “why” behind sustainability initiatives and involving staff in planning, hospitals can foster a culture of responsibility and long-term commitment to environmental goals. This includes training maintenance teams on new technologies and approaches, as their understanding and proactive management can lead to significant operational improvements. Engaging all stakeholders—from leadership to on-the-ground staff—ensures that sustainability becomes a shared priority across the organization.

How Salas O’Brien can help

Salas O’Brien works with hospitals across North America to solve challenging problems—including navigating the complexities of decarbonization. Our experts provide a range of services from detailed energy modeling and commissioning to MEP design and sustainability planning for new construction and renovations. Reach out to one of our experts below to talk about the challenges you are trying to solve.

For media inquiries on this article, reach out to Stacy Lake, Director of Corporate Communications