Sustainable Cleaning Protocols in Healthcare Environments: Integrated Microbiological Assessment and Life Cycle Analysis

Healthcare cleaning services are essential for infection prevention but contribute significantly to the environmental footprint of hospital operations through the intensive use of chemicals, water, and energy. This study presents an integrated assessment of a conventional cleaning protocol (TT) and a CAM-compliant environmentally oriented protocol (GREEN, TG) in a real hospital setting (Bufalini Hospital, Cesena, Italy), combining microbiological monitoring with Life Cycle Assessment (LCA). Surface contamination was evaluated across different risk areas using standardized culture-based methods, while environmental impacts were quantified using a cradle-to-grave LCA approach, focusing on Global Warming Potential (GWP100). Both protocols achieved significant reductions in microbial load, with post-cleaning values consistently below established hygienic thresholds. No pathogenic indicator organisms were detected after cleaning, and the GREEN protocol demonstrated microbiological performance equivalent to or slightly better than the traditional system across all risk categories. LCA results revealed a substantial environmental advantage for the GREEN protocol, with a 43.7% reduction in carbon footprint (−273 g CO₂e m⁻² year⁻¹), corresponding to an annual saving of approximately 13.3 t CO₂e at the facility scale. These reductions were primarily driven by decreased chemical consumption, optimized dosing, and lower laundering temperatures. The findings demonstrate that environmentally sustainable cleaning strategies can maintain high standards of microbiological safety while significantly reducing environmental impacts. This integrated approach supports the adoption of CAM-compliant protocols in healthcare facilities and highlights the importance of combining infection control metrics with life-cycle environmental evaluation to inform sustainable procurement and hospital management practices.