Environmental sustainability in laboratory medicine: implementation and evaluation of Green Lab strategies in a university hospital laboratory

Background. Clinical laboratories have a substantial environmental footprint due to high energy demand, temperature-controlled storage, extensive use of reagents and single-use consumables, water consumption and healthcare-waste generation. Although laboratory-specific sustainability frameworks are increasingly available, evidence on their structured implementation in complex hospital laboratories and integration into quality-management systems remains limited. Objectives. To describe and evaluate a multidimensional Green Lab programme implemented in a university hospital clinical laboratory and assess its progressive integration into an ISO 15189-oriented quality-management framework. Methods. A single-centre, multiphase implementation study was conducted at the Laboratory Medicine Unit of the University Hospital of Padova between 2023 and 2026. Activities included cold-storage assessment and optimisation, participation in the International Laboratory Freezer Challenge, and mapping and polymer characterisation of selected single-use plastic-waste streams by FT-IR spectroscopy and differential scanning calorimetry. Sustainability performance was evaluated through a sector-based audit using 39 EFLM-derived items across eight diagnostic sectors, followed by assessment using the official EFLM Green and Sustainable Laboratories certification framework. Additional activities included staff engagement, Green Lab governance and communication tools, consolidation of activities into an integrated project and quality plan, and mapping against eight processes of the existing ISO 15189-oriented quality-management system. Analyses were descriptive. Results. The cold-storage inventory included 74 refrigerators and freezers and identified opportunities for equipment rationalisation, inventory management, maintenance and storage optimisation. The Freezer Challenge generated a programme-derived estimated energy saving of 131 kWh/day. Plastic-waste mapping identified approximately 4.5 tonnes/year of selected single-use plastic streams; polymer characterisation showed heterogeneous mono- and multi-polymer composition and identified an HDPE-rich non-infectious fraction as a candidate for recovery-feasibility assessment. The sector-based audit yielded an overall study-defined Green Laboratory Sustainability Score of 67.7%, with substantial variation across sectors and sustainability domains. The subsequent EFLM assessment identified established practices, ongoing activities and unresolved gaps in hazardous chemicals, energy, waste and water management, including requirements dependent on institutional infrastructure and centralised processes. Staff engagement showed favourable appraisal of directly actionable sustainable behaviours but highlighted infrastructural and organisational barriers. Mapping against the quality-management system showed heterogeneous levels of sustainability integration across the eight assessed processes, from project-level implementation to prospective system-level integration. Conclusions. A multidimensional Green Lab programme can be implemented in a complex university hospital laboratory by combining environmental assessment, operational interventions, structured evaluation, staff participation and organisational development. The EFLM framework provides laboratory-specific criteria for sustainability assessment, while an ISO 15189-oriented quality-management system offers an organisational structure for documenting, risk-assessing, monitoring and reviewing sustainability activities. This programme established a baseline and infrastructure for continual improvement. Future development should focus on longitudinal environmental indicators monitored alongside quality and safety indicators to ensure that environmental improvements do not compromise laboratory performance.