Implementation of green nursing practices in perioperative care: impact on safety, efficiency, and sustainability

Background Perioperative care is resource-intensive and contributes substantially to healthcare waste, creating a need for sustainability strategies that preserve patient safety and operational performance. This study evaluated whether a structured green nursing intervention was associated with improvements in environmental sustainability, perioperative efficiency, patient-safety compliance, and nurses' knowledge, attitudes, and practices (KAP). Methods A single-center quasi-experimental pretest–posttest study was conducted among 120 perioperative nurses recruited using stratified random sampling from Xiangyang Central Hospital. The structured intervention incorporated waste segregation and minimization, responsible use of reusable materials, digital documentation, and energy-conservation practices. Outcomes were assessed using structured questionnaires, standardized observational procedures, and operational and environmental records. Pre–post differences were evaluated using appropriate paired analyses, with statistical significance set at p < 0.05. Results Waste generation decreased from 2.45 ± 0.60 to 1.62 ± 0.48 kg/case (mean change, −0.83 kg/case; p < 0.001), while procedure duration decreased from 92.3 ± 15.2 to 84.7 ± 13.6 min ( p = 0.002). Cost per surgical case decreased from 520 ± 110 to 465 ± 95 ( p = 0.010), and patient-safety compliance increased from 78.5% to 91.2% ( p < 0.001). Knowledge, attitude, and practice scores increased from 12.4 to 18.7, 3.1 to 4.2, and 2.9 to 4.0, respectively (all p < 0.001). Recycling increased from 18.5% to 41.3%, whereas the energy-use proxy decreased by 17.2%. Conclusion Structured green nursing practices were associated with concurrent improvements in environmental performance, operational efficiency, patient-safety compliance, and nurses' KAP. These findings support integrating nursing-led sustainability strategies into perioperative practice while warranting confirmation through controlled, longer-term studies.