The Universal Green Hospital Framework: A Narrative Blueprint for Eliminating PVC and DEHP, Reducing Medical Waste, and Advancing Sustainable Nursing-Led Healthcare Transformation

Background: Healthcare systems face increasing pressure to integrate environmental sustainability without compromising patient safety or clinical efficiency. While global models such as WHO’s green health initiatives and Net-Zero frameworks offer high-level policy direction, they often lack operational pathways for frontline implementation, especially in eliminating harmful materials like PVC and DEHP, reducing medical waste, and fostering therapeutic environments. Aim: To develop a universal, nursing-led Green Hospital framework (UGHF) that integrates environmental sustainability, patient safety, and healthcare quality into a scalable, evidence-based model applicable across diverse healthcare contexts. Design: A narrative review design was employed, synthesizing multidisciplinary evidence from peer-reviewed literature, WHO technical reports, governmental guidelines, and documented case studies. A structured evidence mapping and extraction matrix - validated by senior nursing quality experts - categorized interventions into thematic domains including PVC/DEHP elimination, waste reduction, energy and water efficiency, safe radioactive waste disposal, therapeutic environment creation, and staff engagement. Setting: This study was entirely desk-based, drawing on documented case examples from acute care hospitals, oncology and pediatric centers, nuclear medicine units, and primary care facilities implementing sustainable practices. Participants: No human subjects were involved; the review synthesized data from previously published literature and policy documents meeting predefined inclusion criteria. Method: Evidence was extracted, thematically categorized, and comparatively analyzed to identify best practices, barriers, and facilitators. Performance indicators, governance structures, and a risk assessment matrix were integrated into the final framework to ensure accountability and scalability. Results: The UGHF uniquely embeds sustainability into core clinical operations through nursing-led, stepwise implementation. Comparative analysis demonstrated that the framework bridges policy-level sustainability goals with operational feasibility, addressing gaps in existing global models. Key features include a 90-day quick-start checklist, measurable KPIs (e.g., 15% annual plastic waste reduction, 100% adoption of PVC/DEHP-free alternatives by 2030), and governance-compatible policy integration pathways. The framework’s modular design enables adaptation across both high-resource and resource-limited hospitals. Conclusion: The UGHF offers a replicable, patient-centered model that harmonizes environmental, clinical, and operational priorities. By positioning nurses as sustainability champions, it ensures cultural transformation, regulatory compliance, and measurable progress toward green healthcare goals. Recommendations: Hospitals should adopt the UGHF as a strategic blueprint, integrating its performance indicators into quality improvement programs, accreditation processes, and procurement policies. Future research should evaluate real-world implementation outcomes across different healthcare systems and economic settings.