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Healthcare waste is a rampant issue in Australian hospitals. The operating room (OR) contributes disproportionately to total hospital waste. There has been considerable research in the literature concentrating on strategies to improve OR and hospital waste accumulation, in an attempt to provide guidance and direction on how to reduce the healthcare ecological footprint. We reviewed the literature for leading greening initiatives currently utilised in the OR in Australia and internationally. This narrative literature review focuses on the trend of OR greening initiatives over the last 25 years, comparing different innovative approaches, the successes and setbacks, and the financial implications of initiatives. A variety of measures that hospital management, surgeons, anaesthetists, nurses and other healthcare personnel can take to reduce the ecological footprint of their healthcare facility are outlined. Greening initiatives include reducing, recycling, reusing, rethinking and researching, as well as novel technology and smarter architectural design. We also evaluated the barriers to improving waste management, which include lack of leadership, misconceptions among staff, and an overall resistance to change. In conclusion, in a world where greenhouse gas emissions cause unprecedented climate change and landfill space is finite, it is incumbent upon hospitals to help reduce the environmental impact of their facility. Reducing pollution and greenhouse gas emissions would moderate the incidence of human disease, save money for the healthcare system and society as a whole, and contribute to a safer and healthier world we all would like to live in.