Purpose This study evaluated strategies to achieve carbon neutrality in hospitals within the South Western Sydney Local Health District (SWSLHD), focusing on recycling and renewable energy initiatives localised at Campbelltown Hospital and globally, to highlight specific and innovative approaches to sustainability. Methodology A comprehensive literature review was conducted, analyzing operational data from SWSLHD and global hospital sustainability efforts. The review emphasized waste reduction, recycling programs and renewable energy integration, identifying challenges and cost-effective solutions through comparisons with successful case studies worldwide. Results SWSLHD achieved a 28% carbon footprint reduction from 2017–2018 through economically viable strategies, particularly in a perioperative setting. The "Gloves Off" initiative, targeting a reduction of 47 million disposable gloves annually, and the "Bluey Reduction" campaign, saving 1.5 million absorbent pads, are projected to save $2.3 million and $350,000 respectively. Reduced desflurane gas use and 5% lower nitrous oxide emissions were further achieved. Planned programs include ‘Clinical Waste Segregation Education’, ‘Compression Sleeve Recycling’, e-discharge summaries reducing paper waste by 50% ($1.17 million saved annually), and transition to reusable theatre equipment. Globally, well-funded recycling practices, renewable energy integration, and improvements to heating, ventilation and air conditioning infrastructure demonstrate the greatest potential for impact. Conclusion These initiatives demonstrate SWSLHD’s commitment to sustainability and highlights the importance of innovation and investment in achieving carbon neutrality in healthcare systems globally.