Sustainable Cooling in Viet Nam's Healthcare Facilities: Refrigerant Management, Energy Performance, and Safe Care

Sustainable Cooling in Viet Nam's Healthcare Facilities: Refrigerant Management, Energy Performance, and Safe Care

IMPLEMENTATION INSIGHTS · CLIMATE-RESILIENT HEALTHCARE

Last reviewed: October 27, 2026

Cooling is one of those hospital services that receives little attention when everything is working properly. Patients remain comfortable, clinical areas maintain appropriate environmental conditions, and temperature-sensitive medicines and supplies are stored safely. Behind these everyday activities are refrigeration and air-conditioning systems that may need to operate reliably around the clock.

Maintaining that reliability is becoming increasingly challenging. Higher temperatures can increase cooling demand, while aging equipment, refrigerant leakage, inefficient operation, and interruptions to electricity create additional environmental, financial, and operational pressures.

A hospital seeking to reduce electricity consumption may consider replacing older air-conditioning units, upgrading a central cooling system, improving maintenance, or adopting refrigerants with a lower climate impact. These decisions may appear primarily technical, but they can affect patient safety, infection prevention, staff working conditions, equipment performance, and the continued availability of essential healthcare services.

An energy-efficient system is not necessarily a safe or sustainable one. A refrigerant with lower global warming potential may offer environmental benefits while introducing technical or safety requirements that need careful management. Similarly, reducing cooling or ventilation without considering the needs of particular clinical areas may lower electricity consumption while creating unacceptable conditions for patient care.

For healthcare organizations in Viet Nam, sustainable cooling requires a balanced approach. Refrigerant management, energy performance, equipment reliability, and clinical safety need to be considered together, supported by appropriate technical expertise and an understanding of the legal requirements applicable to each facility.

The objective is to provide the cooling required for safe healthcare while reducing avoidable environmental impacts and maintaining reliable performance throughout the equipment's operating life.

Why Cooling Matters Beyond Thermal Comfort

Cooling serves different purposes within a healthcare facility, and those purposes should not be treated as interchangeable.

In many outpatient and administrative areas, air conditioning primarily supports acceptable indoor conditions for patients, visitors, and staff. In other spaces, temperature and humidity control contribute to the environmental conditions necessary for clinical procedures, diagnostic activities, equipment performance, or infection prevention.

Operating rooms, critical care areas, laboratories, imaging departments, sterile processing areas, and certain treatment spaces may have different technical requirements. Depending on their functions, these requirements can involve temperature, relative humidity, air filtration, airflow patterns, ventilation rates, and pressure relationships with adjacent areas.

Refrigeration serves another essential purpose. Medicines, vaccines, laboratory materials, and other temperature-sensitive healthcare products may require controlled storage conditions that ordinary comfort air conditioning cannot provide.

These distinctions matter when organizations consider energy-saving measures. An intervention suitable for an administrative office may be inappropriate for an operating room or another area with specialized environmental requirements. Similarly, a system that maintains a comfortable room temperature does not necessarily provide adequate ventilation, humidity control, or protection against airborne contaminants.

The World Health Organization's WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities, published in October 2020, and its subsequent Safe, Climate-Resilient and Environmentally Sustainable Health Care Facilities: An Overview, published in November 2024, recognize the importance of essential infrastructure, reliable energy services, and environmental conditions in delivering safe healthcare.

These publications offer an important perspective for cooling management. Environmental sustainability should be pursued alongside, rather than at the expense of, the conditions necessary for healthcare delivery.

In Viet Nam, local circumstances deserve particular attention. Hot and humid conditions in many regions can place significant demands on cooling and dehumidification systems. Coastal environments may accelerate corrosion of exposed equipment, while extreme weather and interruptions to external utilities can affect system reliability.

Cooling requirements also vary between facilities. A small outpatient clinic, a specialized treatment center, and a large hospital do not necessarily have the same equipment, clinical dependencies, or maintenance capabilities.

Understanding these differences is an essential starting point. Sustainable cooling cannot be achieved through a single technical solution applied indiscriminately across every building or department.

Understanding the Environmental Impact of Healthcare Cooling

Cooling systems can contribute to greenhouse gas emissions in two principal ways.

The first involves refrigerants. These substances circulate within refrigeration and air-conditioning systems to transfer heat. Some refrigerants have substantial global warming potential (GWP), meaning that their release into the atmosphere can contribute significantly to climate change.

The second involves the energy required to operate cooling equipment, including compressors, fans, pumps, controls, and associated systems. Where electricity generation produces greenhouse gas emissions, electricity consumed by cooling equipment contributes to the facility's energy-related climate impact.

Both pathways matter, but they require different management approaches.

Refrigerant-related emissions can be reduced through suitable equipment selection, leak prevention, competent servicing, refrigerant recovery, and responsible end-of-life management. Energy-related emissions can be reduced through efficient equipment, appropriate controls, maintenance, building improvements, and better alignment between cooling capacity and actual demand.

A hospital may replace an inefficient cooling system and reduce electricity consumption while continuing to use a refrigerant with substantial climate impact. Another facility may select a lower-GWP refrigerant but achieve limited overall environmental benefits if the equipment operates inefficiently or experiences repeated refrigerant losses.

This illustrates why refrigerant selection and energy performance should be evaluated together rather than as separate environmental initiatives.

The United Nations Environment Programme's Global Cooling Watch 2025: The Free Degrees, released in November 2025, examines growing global cooling demand and the importance of combining passive cooling, low-energy solutions, high-efficiency equipment, and refrigerant phase-down measures.

The Montreal Protocol Ozone Secretariat and UNEP's Cool Coalition further developed this approach through the Sustainable Cooling Policy Toolkit, introduced in January 2026. The toolkit considers policy measures across the cooling value chain, including equipment manufacturing, building design, operation, servicing, refrigerant management, and end-of-life treatment.

These international publications emphasize that sustainable cooling involves more than reducing electricity consumption or selecting a particular refrigerant. The performance of the complete system matters, including how it is maintained and what happens when equipment is replaced.

However, global estimates of cooling demand or emissions should not be interpreted as measurements of environmental performance at individual Vietnamese healthcare facilities.

An organization needs reliable information about its own equipment, refrigerants, energy consumption, and operating conditions before it can establish a credible improvement plan.

Refrigerant Management Starts With Understanding Existing Equipment

Healthcare organizations may operate cooling equipment acquired over many years, including central chillers, split air-conditioning units, variable refrigerant flow systems, cold rooms, specialized refrigerators, and other refrigeration equipment.

These systems may use different refrigerants and have different operating characteristics, maintenance requirements, environmental impacts, and expected service lives.

Without accurate equipment information, hospital managers may struggle to identify which systems present the greatest technical or environmental concerns.

An equipment inventory provides a practical starting point. Depending on the system, relevant information may include its location, manufacturer, model, installation date, refrigerant designation, specified refrigerant charge, maintenance history, and available operating performance data.

The organization should also understand which services depend on each system and what would happen if the equipment became unavailable.

This information may reveal concerns that are not immediately visible during normal operations. An older cooling unit may use a refrigerant subject to international phase-out measures. Another system may experience recurring refrigerant losses or frequent repairs, while equipment serving an essential clinical area may have limited maintenance documentation.

These findings can inform decisions about inspection, servicing, replacement planning, and the selection of qualified technical providers.

An inventory does not necessarily require an expensive digital platform. Existing asset management and maintenance records may provide a suitable foundation if the information is reliable and updated whenever relevant work is undertaken.

The aim is to establish a clearer understanding of what is installed, how it is maintained, and which assets need closer attention.

Why Refrigerant Leakage Deserves Attention

Refrigerant leakage may be difficult to recognize during routine hospital operations. Depending on the equipment and extent of leakage, a cooling system may continue operating even as its performance deteriorates.

Some leaks can contribute to reduced cooling capacity, increased electricity consumption, equipment damage, or eventual interruption of service. The consequences depend on the design and condition of the system, so these outcomes should not be assumed in every case.

The environmental implications also vary according to the refrigerant involved.

Hydrochlorofluorocarbons (HCFCs), including HCFC-22, have ozone-depleting potential and are controlled under the Montreal Protocol. Hydrofluorocarbons (HFCs) do not deplete the ozone layer, but many have substantial global warming potential. The Kigali Amendment to the Montreal Protocol establishes an international framework for phasing down HFC production and consumption.

Ozone depletion and climate impact are different environmental concerns, even though both are addressed within the international framework governing controlled substances.

Repeatedly adding refrigerant without adequately identifying and correcting the cause of leakage may increase operating costs and environmental losses. It may also conceal a problem with equipment reliability.

Where leakage is suspected, qualified technical assessment is necessary. Refrigeration systems involve pressure, electrical, chemical, and potentially flammability-related risks. Servicing and corrective work should therefore be undertaken by personnel with the appropriate technical competence and authorization.

Preventive maintenance, suitable leak detection, reliable service records, and timely repairs can support responsible refrigerant management.

Records of refrigerant additions, recovery, repairs, and other relevant activities may also help organizations identify recurring losses and evaluate whether corrective measures have been effective.

However, the quantity of refrigerant purchased or added during maintenance should not automatically be interpreted as a precise measurement of emissions. Reliable estimation depends on information about the system's original charge, maintenance circumstances, recovery records, and other relevant factors.

For healthcare organizations, refrigerant leakage is more than an environmental reporting concern. It may also indicate weaknesses in equipment maintenance, technical oversight, and the reliability of services that patients depend on.

Managing Refrigerants Throughout Their Life Cycle

Refrigerant management continues throughout the operating life of a cooling system.

Equipment may require repairs, relocation, modification, or replacement. Eventually, it reaches the end of its useful life. Each of these stages can create opportunities for refrigerant release if appropriate handling and recovery procedures are not followed.

In March 2026, the Montreal Protocol Ozone Secretariat published Introduction to Life Cycle Refrigerant Management, describing an integrated approach to limiting refrigerant use and emissions throughout the refrigerant life cycle.

Further briefings published in July 2026 examined the technical, policy, and financing aspects of life-cycle refrigerant management.

These publications reinforce an important point: choosing a refrigerant with lower climate impact is only one part of responsible management. What happens during servicing, recovery, transfer, recycling, reclamation, or final treatment also matters.

These activities have different technical meanings and legal implications. Recovery, recycling, reclamation, reuse, and destruction should not be treated as interchangeable or assumed to be appropriate for every refrigerant or circumstance.

In Viet Nam, the collection, transportation, storage, recycling, reuse, and treatment of controlled substances may be subject to specific environmental and technical requirements.

Healthcare organizations should understand the responsibilities associated with equipment ownership, operation, and decommissioning while ensuring that specialized activities are undertaken by appropriately qualified or authorized service providers where required.

Documentation can support this process. Depending on the circumstances, records of refrigerant recovery, transfer, storage, and final treatment may help establish how relevant activities were managed.

A maintenance contract does not automatically demonstrate that every environmental obligation has been fulfilled. Responsibilities need to be understood according to the services performed and applicable legal requirements.

Responsible procurement should also consider how equipment and refrigerants will eventually be managed at the end of their useful lives.

This is particularly relevant when selecting technologies that require specialized servicing or for which suitable refrigerant recovery and treatment arrangements may not be readily available.

Lower-GWP Refrigerants Still Require Careful Safety Assessment

The transition toward refrigerants with lower global warming potential is an important part of international cooling policy.

However, a refrigerant's environmental characteristics do not, by themselves, determine whether it is safe or suitable for a particular installation.

Refrigerants differ in operating pressure, thermodynamic properties, toxicity and flammability classifications, and compatibility with equipment components. These characteristics influence equipment design, installation, operation, maintenance, and the safeguards needed to manage potential hazards.

Some lower-GWP alternatives have different flammability characteristics from refrigerants commonly used in older systems. Others may require specialized equipment, pressure management, ventilation arrangements, leak detection, or additional protective measures.

The suitability of a refrigerant depends on the complete system, including equipment design, refrigerant charge, installation location, occupancy, manufacturer specifications, and applicable safety requirements.

ANSI/ASHRAE Standard 34-2024 provides internationally recognized refrigerant designations and safety classifications based on properties including toxicity and flammability.

ANSI/ASHRAE Standard 15-2024 addresses safety requirements for refrigeration systems within its defined scope. The two standards provide complementary technical references, although their scope and exclusions must be considered when applying them.

UNEP OzonAction's April 2026 publication, Update on New Refrigerants Designations and Safety Classifications, and the June 2026 UNEP-AREA Training Manual: Refrigerants Servicing and Good Practices further highlight the importance of technical competence when handling conventional and alternative refrigerants.

For healthcare organizations, the implication is that refrigerant selection should be based on the suitability of the complete installation rather than simply choosing the substance with the lowest GWP.

Replacing the refrigerant in existing equipment is not necessarily a straightforward substitution. A system designed for one refrigerant may be unsuitable for another because of differences in operating pressure, materials, controls, safety requirements, or other technical characteristics.

An inadequately assessed conversion could create equipment and safety risks.

Hospitals should therefore avoid refrigerant substitutions that have not been appropriately evaluated by qualified technical professionals.

Where replacement or conversion is being considered, the assessment should address manufacturer requirements, technical compatibility, safety standards, environmental obligations, and potential effects on healthcare operations.

Environmental improvements should be pursued through safe and technically appropriate solutions rather than assuming that a lower-GWP refrigerant is automatically the best choice for every application.

Improving Energy Performance Without Losing Control of Clinical Conditions

Improving cooling efficiency involves more than purchasing equipment with a higher efficiency rating.

A system's actual performance depends on its design, installation, controls, maintenance, building conditions, and the demands placed on it during operation.

A highly efficient system may deliver disappointing results if poorly maintained or incorrectly controlled. Conversely, an older system may benefit from targeted improvements that do not require immediate replacement.

Healthcare organizations can begin by examining available electricity records, equipment operating hours, maintenance history, and the relationship between cooling demand and clinical activity.

Larger facilities may benefit from submetering or building management system data that help distinguish cooling-related electricity consumption from other energy uses.

Comparisons nevertheless require care. Electricity consumption may increase because outdoor temperatures are higher, additional areas require cooling, or clinical services have expanded. A reduction in electricity use may indicate improved efficiency, but it could also reflect reduced activity or inadequate environmental control.

Energy performance should therefore be interpreted in relation to operating conditions and the services being delivered.

Appropriate measures may include equipment efficiency, electricity consumption over time, operating hours, and normalized performance indicators where reliable data are available.

Potential improvements may involve preventive maintenance, better controls, reducing unnecessary simultaneous cooling and reheating, improving insulation, and limiting avoidable heat gains.

The suitability of these measures depends on the building and its clinical functions.

For example, modifying cooling schedules in an administrative office may be reasonable when the space is unoccupied. The same approach may be inappropriate for an area requiring continuous environmental control.

Energy-saving decisions should therefore begin with a clear understanding of the conditions that must be maintained for safe healthcare.

The goal is not simply to reduce electricity expenditure. It is to improve the efficiency of cooling services while maintaining the performance required for their intended use.

Energy Savings Must Not Compromise Ventilation and Infection Prevention

Cooling and ventilation are closely connected in many healthcare facilities, but they perform different functions.

Cooling controls temperature and, depending on the system, may also contribute to humidity management. Ventilation and air handling can support outdoor air supply, filtration, contaminant removal, airflow patterns, and pressure relationships between spaces.

A room may feel comfortable while its ventilation is inadequate for the activities taking place. Likewise, reducing fan operation or changing airflow to save energy may affect ventilation performance even when room temperature remains acceptable.

These distinctions are particularly important in clinical areas with specialized environmental requirements.

ANSI/ASHRAE/ASHE Standard 170-2025, Ventilation of Health Care Facilities, establishes ventilation design requirements within its defined scope. These address matters including airflow, outdoor air supply, temperature, humidity, and other environmental conditions relevant to different healthcare spaces.

ASHRAE/ASHE Guideline 43-2025, Operations Guideline for Ventilation of Health Care Facilities, provides complementary recommendations for operating and maintaining healthcare heating, ventilation, and air-conditioning systems.

The distinction between the two documents matters. Standard 170 establishes technical requirements within its scope, while Guideline 43 provides operational recommendations. Neither document should automatically be treated as a universally binding legal requirement for every healthcare facility in Viet Nam.

Their applicability depends on relevant Vietnamese regulations, adopted technical standards, project specifications, contractual requirements, and institutional circumstances.

These references are particularly useful when organizations consider changes to ventilation rates, pressure relationships, humidity controls, equipment operating schedules, or other environmental conditions.

Some energy-saving strategies may be appropriate in certain spaces when supported by technical assessment and permitted by applicable requirements. Others could compromise infection prevention or clinical safety.

In operating rooms, isolation areas, and other specialized healthcare spaces, changes to ventilation arrangements may require coordinated review involving engineering, infection prevention, clinical, and facility management professionals.

The objective is to improve energy performance without compromising the environmental conditions necessary for safe care.

Lower electricity consumption is not a meaningful success if it is achieved by creating unacceptable risks for patients or healthcare workers.

Protecting Medicines, Vaccines, and Other Temperature-Sensitive Products

Not all healthcare cooling involves controlling room temperature.

Refrigeration is essential for many medicines, vaccines, laboratory materials, and other temperature-sensitive products. Safe storage depends on maintaining the conditions appropriate to each product.

These requirements vary. Some products require refrigeration, others require freezing or specialized storage conditions, and certain products may have specific handling requirements based on approved instructions and stability evidence.

For many routinely refrigerated vaccines, the established storage range is between +2°C and +8°C. However, this range should not be treated as a universal requirement for every vaccine, medicine, or biological product.

Applicable product-specific requirements must take precedence.

WHO's Immunization Devices Performance, Quality and Safety (IMD-PQS) program provides technical specifications and assessment procedures for immunization equipment, including refrigerators and freezers.

The program recognizes the importance of selecting refrigeration technology according to actual operating conditions, including ambient temperature, electricity reliability, storage capacity, and the ability to maintain appropriate vaccine storage temperatures.

This is relevant when healthcare organizations consider replacing older refrigerators with more energy-efficient models.

An energy-efficient unit should not be selected solely because it consumes less electricity if it cannot reliably maintain the conditions required for the products being stored.

Reliable refrigeration may also depend on suitable temperature monitoring, alarms, maintenance arrangements, backup capacity, and defined responses to temperature excursions.

The organization should understand who is responsible for reviewing temperature records, responding to alarms, and assessing the implications of storage conditions outside the permitted range.

Where a temperature excursion occurs, appropriately authorized professionals should determine the implications for affected products according to applicable requirements and product-specific information.

An environmental or energy-saving objective should never independently justify releasing potentially compromised products for clinical use.

Sustainable cold chain management therefore involves more than the efficiency of refrigeration equipment. It includes reliable temperature control, monitoring, maintenance, and the professional processes necessary to protect product integrity.

Reducing Cooling Demand Through Better Building Performance

The efficiency of a cooling system is strongly influenced by the building in which it operates.

Excessive solar heat gain, inadequate insulation, uncontrolled air infiltration, and unsuitable building arrangements can increase the amount of cooling required.

Where technically appropriate, building improvements may reduce demand before additional mechanical cooling capacity is considered.

Potential measures include shading, solar-control glazing, roof and wall insulation, and other approaches that limit unnecessary heat gains.

These measures can be particularly relevant when healthcare facilities are being designed, expanded, or substantially renovated.

However, passive or low-energy cooling should not be treated as a universal substitute for mechanical air conditioning in healthcare.

Opening windows, increasing natural airflow, or introducing fans may be inappropriate in spaces requiring controlled ventilation, filtration, pressure relationships, infection prevention, or specialized environmental conditions.

High humidity can also create additional challenges. A cooling approach that reduces electricity consumption but fails to manage moisture adequately may create conditions that require further technical attention.

Nonclinical areas may offer greater flexibility, although interventions still need to consider thermal comfort, indoor air quality, security, and operating requirements.

The appropriate approach depends on the function of the space and the risks associated with changing environmental conditions.

Reducing unnecessary cooling demand can support energy efficiency and long-term affordability, but the conditions required for safe healthcare must remain the starting point.

Reliable Cooling Is Part of Safe Healthcare Operations

An efficient cooling system may still present significant operational risks if it cannot maintain essential functions during equipment failure, extreme heat, or interruptions to electricity.

Healthcare organizations should understand which services depend on cooling and the consequences of losing that service.

The temporary loss of comfort cooling in an administrative area is not equivalent to the loss of environmental control in a critical clinical space or refrigeration used for temperature-sensitive healthcare products.

These differences should inform maintenance priorities, contingency arrangements, and investment decisions.

Some systems may require technical redundancy or backup capacity, while others may benefit from improved preventive maintenance, earlier detection of deteriorating performance, or stronger arrangements for technical support.

Backup electricity may contribute to continuity, but the presence of a generator does not establish that every essential cooling system will remain operational during a power interruption.

The actual capacity and configuration of electrical systems, equipment dependencies, and operating requirements need appropriate technical verification.

Major maintenance and equipment replacement can also create temporary risks. Work affecting essential cooling may require changes to normal operations, making coordination with relevant clinical and technical departments important.

For healthcare organizations, reliability should be defined according to the consequences of failure rather than an assumption that every cooling unit has the same operational importance.

This distinction helps direct attention and resources toward the systems that matter most for patient safety and essential services.

Making Procurement and Maintenance Decisions More Responsible

Cooling equipment is often evaluated through purchase price, technical specifications, and supplier quotations. These factors matter, but they do not necessarily provide a complete picture of long-term value.

A lower purchase price may be offset by higher energy consumption, frequent repairs, recurring refrigerant losses, or difficulty obtaining replacement components.

A technically advanced system may also become difficult to maintain if appropriately trained personnel or reliable service providers are not available.

Healthcare organizations should therefore consider lifecycle costs, technical suitability, energy performance, refrigerant characteristics, and maintainability together.

For important systems, supplier responsibilities, warranty conditions, documentation, staff training, maintenance support, and spare parts availability may influence long-term performance.

End-of-life refrigerant management and equipment disposal should also be considered where relevant.

The choice between maintaining, repairing, upgrading, or replacing equipment is not always straightforward. An older system may remain suitable when maintained correctly, while another may warrant replacement because of persistent failures, poor efficiency, refrigerant availability, or changing regulatory requirements.

International refrigerant phase-down measures do not necessarily mean that every existing system must be replaced immediately. Requirements applicable to particular substances, equipment, and activities need to be assessed under the relevant legal provisions and transitional arrangements.

Procurement decisions must also respect the organization's legal and financial responsibilities.

Public healthcare facilities may be subject to particular procurement, public asset management, investment, and approval requirements. Private organizations may have different governance arrangements but remain subject to applicable corporate, technical, environmental, and safety obligations.

Environmental sustainability does not remove these requirements.

A responsible procurement decision should explain why the equipment is suitable for its intended healthcare function, what resources will be needed to operate and maintain it, and how the organization will verify that it performs as expected.

The Vietnamese Policy and Legal Context

Viet Nam has developed a regulatory framework addressing ozone layer protection, controlled greenhouse gases, energy efficiency, building performance, and the safety of technical installations.

These frameworks are relevant to sustainable cooling, although their applicability depends on the equipment, activities, institution, and legal circumstances involved.

Environmental Protection and Refrigerant Management

The Law on Environmental Protection No. 72/2020/QH14, effective January 1, 2022, as amended, provides an overarching legal foundation. Article 92 addresses ozone layer protection, including the management of controlled substances and relevant requirements concerning their collection, recycling, reuse, and treatment.

Government Decree No. 06/2022/ND-CP provides detailed provisions on greenhouse gas emissions reduction and ozone layer protection.

The Decree was subsequently amended by Government Decree No. 119/2025/ND-CP, effective August 1, 2025, and Government Decree No. 83/2026/ND-CP, effective March 23, 2026.

These instruments form part of the current regulatory framework governing controlled substances and relevant management and administrative requirements.

Ministry of Natural Resources and Environment Circular No. 01/2022/TT-BTNMT provides implementing provisions related to climate change response. It was amended by Ministry of Agriculture and Environment Circular No. 08/2025/TT-BNNMT, effective August 1, 2025.

The relevant provisions address activities involving controlled substances, including applicable management, registration, reporting, and other requirements.

Their applicability should be assessed carefully.

A hospital that owns or operates refrigeration equipment does not necessarily have the same legal obligations as a refrigerant importer, manufacturer, recovery operator, or treatment facility.

The requirements depend on the regulated substance, activities undertaken, relevant equipment characteristics, and the organization's legal role.

An important technical regulation is QCVN 76:2023/BTNMT, issued through Circular No. 20/2023/TT-BTNMT and effective May 30, 2024.

The regulation addresses the collection, transportation, storage, recycling, reuse, and treatment of controlled substances. It is particularly relevant where refrigerants are recovered, transferred, stored, or managed during servicing or equipment decommissioning.

Organizations undertaking such activities must consider the technical and documentation requirements applicable to their roles.

At the national policy level, Prime Minister's Decision No. 496/QD-TTg, dated June 11, 2024, issued the National Plan on the Management and Phase-Out of Ozone-Depleting Substances and Controlled Greenhouse Gases.

The Plan supports Viet Nam's implementation of its international commitments under the Montreal Protocol and Kigali Amendment, including the transition toward substances and technologies with lower environmental impacts.

These policies should not be interpreted as requiring every healthcare facility to immediately replace all existing refrigeration equipment. Obligations and transition arrangements need to be examined according to the equipment and activities involved.

Energy Efficiency and Building Requirements

Energy efficiency is governed by a separate legal framework.

The Law on Economical and Efficient Use of Energy No. 50/2010/QH12 was amended by Law No. 77/2025/QH15, effective January 1, 2026.

Government Decree No. 30/2026/ND-CP, effective January 21, 2026, provides implementing provisions concerning energy management, energy audits, major energy users, energy-efficient equipment, and related matters.

The obligations applicable to a healthcare facility depend on its classification, energy consumption, institutional characteristics, and other relevant conditions.

Ministry of Industry and Trade Circular No. 64/2026/TT-BCT, issued on September 30, 2026, addresses energy-efficiency planning and reporting, energy management models, and energy audits.

As of October 27, 2026, this Circular has been issued but has not yet taken effect. Its effective date is November 20, 2026, when it is scheduled to replace Circular No. 25/2020/TT-BCT.

The new Circular includes provisions concerning energy management and reporting for designated major energy users and certain public-budget-funded agencies and units meeting specified electricity consumption conditions.

These requirements should be considered according to the institution's actual classification and circumstances rather than assumed to apply identically to every healthcare facility.

Building energy efficiency requirements also need attention.

As of October 27, 2026, QCVN 09:2017/BXD remains the applicable national technical regulation on energy-efficient buildings within its scope.

On July 30, 2026, the Ministry of Construction issued Circular No. 61/2026/TT-BXD, introducing QCVN 04-3:2026/BXD, the National Technical Regulation on Civil Construction Works, Part 3: Energy-Efficient Buildings.

The new regulation is scheduled to take effect on February 1, 2027, replacing QCVN 09:2017/BXD from that date.

Its scope includes specified new construction and renovation activities involving buildings with a total floor area of at least 2,500 square meters, including hospitals.

The regulation addresses matters such as building envelopes, ventilation and air-conditioning systems, lighting, and other relevant building energy systems.

However, its applicability depends on the characteristics of the building and project. Circular No. 61/2026/TT-BXD also contains transitional provisions relevant to certain projects approved or submitted for appraisal before the regulation takes effect.

Consequently, the new regulation should be considered in forward-looking project planning without being incorrectly presented as already effective in October 2026.

Healthcare and Fire Safety Responsibilities

Healthcare responsibilities remain central to cooling-related decisions.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective January 1, 2024, as amended where applicable, provides the overarching legal framework for healthcare activities and professional responsibilities.

The Law on Fire Prevention, Firefighting and Rescue No. 55/2024/QH15, effective July 1, 2025, is also relevant where cooling installations, refrigerants, or associated equipment introduce fire and related safety considerations.

The actual requirements depend on the equipment, refrigerant characteristics, installation conditions, building type, and activities involved.

International technical standards, including those developed by ASHRAE, may provide useful professional references. Their legal status in Viet Nam depends on whether and how they are incorporated into applicable national regulations, adopted project specifications, contracts, or other binding arrangements.

No single international publication or Vietnamese legal instrument provides a complete answer for every cooling system in every healthcare facility.

Organizations should therefore establish the requirements applicable to their circumstances and seek appropriately qualified professional advice when specialized assessment, technical approval, or regulatory compliance determination is necessary.

Measuring Sustainable Cooling Performance

Healthcare organizations need reliable evidence to understand whether cooling improvements are delivering their intended results.

Different objectives require different measures.

Energy performance may be assessed using electricity consumption, operating hours, equipment performance data, and appropriate comparisons across relevant periods.

However, changes in electricity use should be interpreted in relation to weather, clinical activity, operating conditions, and other factors that may influence cooling demand.

Refrigerant management requires different information. Equipment records, maintenance findings, refrigerant additions, documented recovery, identified leaks, and corrective actions can help organizations understand how refrigerant-related risks are being managed.

Where suitable evidence is available, refrigerant-related greenhouse gas emissions may be estimated using the quantity of refrigerant released and an appropriate global warming potential factor.

These estimates require transparent assumptions. Refrigerant quantities purchased, stored, recovered, or added during servicing should not automatically be treated as verified emissions.

Healthcare reliability requires additional measures.

For clinically important systems, organizations may consider documented functional performance, service interruptions, maintenance findings, temperature excursions, and whether required environmental conditions were maintained.

An energy-saving project should not be described as successful solely because electricity consumption decreased if its effects on healthcare environmental conditions have not been considered.

Similarly, the absence of an incident does not necessarily prove that a system would perform adequately under every future extreme condition.

Where sufficient information and expertise are available, environmental assessment may consider both refrigerant-related and energy-related emissions over the system's expected life.

However, complex calculations are not always necessary for initial improvement planning.

A smaller healthcare facility may benefit more from reliable equipment records, consistent maintenance documentation, and a few meaningful indicators than from an elaborate assessment based on incomplete data.

The purpose of measurement is to identify problems, support better decisions, and demonstrate whether improvements have delivered practical value.

Sustainable cooling should ultimately be evaluated through its environmental performance, energy efficiency, technical reliability, and contribution to safe healthcare operations.

What Climate & Health Vietnam Can Contribute

For Climate & Health Vietnam (CHVN), sustainable cooling is a relevant area for evidence synthesis, professional education, and implementation-oriented learning.

The subject brings together climate change mitigation, healthcare resilience, environmental management, patient safety, facility operations, and responsible use of resources.

CHVN can contribute by examining credible international guidance, explaining the differences between refrigerant management and energy efficiency, and helping healthcare professionals understand why cooling decisions must account for clinical requirements.

An important area of professional learning is how healthcare organizations can consider refrigerant characteristics, lifecycle management, maintenance arrangements, operating costs, and environmental performance without overlooking equipment safety or continuity of essential services.

Another is understanding how international cooling initiatives and technical standards relate to Viet Nam's evolving legal and regulatory framework.

Evidence summaries and case-based discussions may help healthcare managers, quality and patient safety professionals, engineers, environmental specialists, and other stakeholders recognize practical considerations, potential opportunities, and the limitations of particular approaches.

Where appropriate, CHVN may facilitate professional dialogue and knowledge-sharing collaboration with qualified academic institutions, healthcare organizations, technical experts, and other relevant partners.

Such activities should remain within CHVN's actual expertise, institutional capacity, professional scope, and applicable legal requirements.

CHVN does not present its educational resources as official regulatory guidance or imply endorsement by WHO, UNEP, ASHRAE, or other international organizations.

It does not claim authority to approve refrigerant substitutions, certify cooling equipment, undertake regulated refrigerant recovery or treatment, issue engineering approvals, or determine legal compliance.

Where specialized refrigeration design, installation, maintenance, refrigerant handling, environmental assessment, energy auditing, or safety evaluation is required, appropriately qualified and authorized professionals or organizations should be involved.

CHVN's role is to make credible evidence accessible, explain its relevance to healthcare in Viet Nam, and encourage informed professional learning and responsible collaboration.

Toward Cooling That Protects Both Health and the Climate

Healthcare organizations need reliable cooling to provide safe and effective care. At the same time, the technologies used to deliver that cooling consume energy, depend on refrigerants with different environmental impacts, and create continuing operational responsibilities.

Sustainable cooling requires attention to these factors throughout the equipment's life.

Replacing an older system may be appropriate in some circumstances, but new technology alone does not guarantee improved environmental performance or healthcare reliability. Refrigerant management, maintenance, technical suitability, and competent operational oversight remain essential.

For healthcare organizations in Viet Nam, a practical starting point is to understand their existing equipment, the refrigerants it uses, the services it supports, and the costs and risks associated with its operation.

That information can help identify where maintenance should be improved, which systems warrant further technical assessment, and where investments in efficiency or lower-climate-impact technologies may be justified.

Some facilities may need major upgrades. Others may achieve meaningful improvements through more consistent maintenance, better controls, reduced unnecessary cooling demand, or stronger refrigerant recovery arrangements.

The appropriate approach will depend on the organization, its infrastructure, and the services it provides.

What matters is that environmental improvements are pursued without compromising necessary temperature control, ventilation, infection prevention, product storage, or essential service continuity.

Sustainable cooling in healthcare is not simply about using less electricity or switching to a different refrigerant. It is about providing the right cooling, maintaining it safely, managing its environmental impact responsibly, and protecting the patients and healthcare services that depend on it.

Selected References and Policy Context

International Guidance and Evidence

World Health Organization. WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. October 12, 2020.

World Health Organization. Operational Framework for Building Climate Resilient and Low Carbon Health Systems. November 9, 2023.

World Health Organization. Safe, Climate-Resilient and Environmentally Sustainable Health Care Facilities: An Overview. November 3, 2024.

World Health Organization. Measuring Greenhouse Gas Emissions in Health Systems. December 22, 2025.

World Health Organization. Indicators of Climate Resilience and GHG Emissions in Health Systems. March 11, 2026.

United Nations Environment Programme. Global Cooling Watch 2025: The Free Degrees. November 2025.

Montreal Protocol Ozone Secretariat and UNEP Cool Coalition. Sustainable Cooling Policy Toolkit. January 23, 2026.

Montreal Protocol Ozone Secretariat. Introduction to Life Cycle Refrigerant Management. March 2026.

Montreal Protocol Ozone Secretariat. Deep Dive Into Life-Cycle Refrigerant Management. July 30, 2026.

Montreal Protocol Ozone Secretariat. Policies for Life-Cycle Refrigerant Management. July 30, 2026.

Montreal Protocol Ozone Secretariat. Financing Life-Cycle Refrigerant Management. July 30, 2026.

UNEP OzonAction. Update on New Refrigerants Designations and Safety Classifications. April 2026.

UNEP OzonAction and European Association of Refrigeration, Air Conditioning and Heat Pump Contractors. UNEP-AREA Training Manual: Refrigerants Servicing and Good Practices. June 2026.

ANSI/ASHRAE Standard 15-2024. Safety Standard for Refrigeration Systems.

ANSI/ASHRAE Standard 34-2024. Designation and Safety Classification of Refrigerants.

ANSI/ASHRAE/ASHE Standard 170-2025. Ventilation of Health Care Facilities.

ASHRAE/ASHE Guideline 43-2025. Operations Guideline for Ventilation of Health Care Facilities.

World Health Organization. Immunization Devices Performance, Quality and Safety (IMD-PQS) Programme: E003 Refrigerators and Freezers.

Viet Nam Policy and Regulatory Context

National Assembly. Law on Environmental Protection No. 72/2020/QH14, effective January 1, 2022, as amended.

Government of Viet Nam. Decree No. 06/2022/ND-CP, dated January 7, 2022, concerning greenhouse gas emissions reduction and ozone layer protection, as amended.

Government of Viet Nam. Decree No. 119/2025/ND-CP, dated June 9, 2025, amending Decree No. 06/2022/ND-CP, effective August 1, 2025.

Government of Viet Nam. Decree No. 83/2026/ND-CP, dated March 23, 2026, further amending Decree No. 06/2022/ND-CP, effective March 23, 2026.

Ministry of Natural Resources and Environment. Circular No. 01/2022/TT-BTNMT, dated January 7, 2022, concerning the implementation of provisions of the Law on Environmental Protection relating to climate change response, as amended.

Ministry of Agriculture and Environment. Circular No. 08/2025/TT-BNNMT, dated June 17, 2025, amending Circular No. 01/2022/TT-BTNMT, effective August 1, 2025.

Ministry of Natural Resources and Environment. Circular No. 20/2023/TT-BTNMT, dated November 30, 2023, issuing QCVN 76:2023/BTNMT on the collection, transportation, storage, recycling, reuse, and treatment of controlled substances, effective May 30, 2024.

Prime Minister of Viet Nam. Decision No. 496/QD-TTg, dated June 11, 2024, issuing the National Plan on the Management and Phase-Out of Ozone-Depleting Substances and Controlled Greenhouse Gases.

National Assembly. Law on Economical and Efficient Use of Energy No. 50/2010/QH12, effective January 1, 2011, as amended.

National Assembly. Law No. 77/2025/QH15, dated June 18, 2025, amending the Law on Economical and Efficient Use of Energy, effective January 1, 2026.

Government of Viet Nam. Decree No. 30/2026/ND-CP, dated January 21, 2026, detailing selected provisions and implementation measures of the legislation on economical and efficient use of energy, effective January 21, 2026.

Ministry of Industry and Trade. Circular No. 25/2020/TT-BCT, dated September 29, 2020, concerning energy-efficiency planning, reporting, and energy audits, remaining applicable within its scope until replaced.

Ministry of Industry and Trade. Circular No. 64/2026/TT-BCT, dated September 30, 2026, concerning energy-efficiency planning and reporting, energy management, and energy audits, scheduled to take effect November 20, 2026.

Ministry of Construction. Circular No. 15/2017/TT-BXD, dated December 28, 2017, issuing QCVN 09:2017/BXD on Energy-Efficient Buildings.

Ministry of Construction. Circular No. 61/2026/TT-BXD, dated July 30, 2026, issuing QCVN 04-3:2026/BXD on Civil Construction Works, Part 3: Energy-Efficient Buildings, scheduled to take effect February 1, 2027, subject to applicable transitional provisions.

National Assembly. Law on Medical Examination and Treatment No. 15/2023/QH15, effective January 1, 2024, as amended where applicable.

National Assembly. Law on Fire Prevention, Firefighting and Rescue No. 55/2024/QH15, effective July 1, 2025.

Professional scope: This article is intended for professional education, evidence synthesis, and knowledge sharing. It does not constitute engineering design, refrigeration or air-conditioning installation instructions, refrigerant handling or substitution guidance for a specific system, an energy audit, legal advice, an environmental compliance assessment, fire safety approval, equipment certification, procurement advice, or individualized clinical guidance. References to international standards, technologies, refrigerants, and performance measures are for educational purposes and do not establish mandatory requirements unless applicable under the relevant legal or contractual framework. Climate & Health Vietnam does not claim authority to approve engineering modifications, certify equipment or personnel, perform regulated refrigerant recovery or treatment, determine statutory reporting obligations, or issue accreditation or certification criteria. References to WHO, UNEP, ASHRAE, and other organizations do not imply their endorsement of CHVN or its activities. Healthcare organizations should evaluate cooling-related decisions according to their actual clinical requirements, technical circumstances, applicable Vietnamese laws, manufacturer instructions, and advice from appropriately qualified and authorized engineering, environmental, safety, infection prevention, and healthcare professionals.