Table 1 Summary of included studies
Title; Author | Country, year | Income-level* | Summary of study design | Type of precaution studied | Main findings | Variable used to quantify environmental impact |
|---|---|---|---|---|---|---|
Characteristics of the medical waste generated at the Jordanian hospitals Abu-Qdais et al. [19] | Jordan, 2006 | Lower middle | Cross-sectional study Weighing, sorting of waste and surveys were conducted in 5 hospitals in Jordan | Standard precaution | The weighted mean infectious medical waste by the hospitals covered by the survey is 0·61 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Statistical analysis and characteristics of hospital medical waste under novel Coronavirus outbreak Abu-Qdais et al. [20] | Jordan, 2020 | Upper middle | Cross-sectional study The composition of medical waste generated was analysed during the COVID-19 pandemic in a major tertiary care hospital in Jordan | Standard precaution | The mean amount of infectious medical waste generated from coronavirus treatment was 3·95 kg/bed/day, which are more than tenfold higher than the average generation rate of 0·41 kg/bed/day before the pandemic | Mass of infectious waste (kg/bed/day) |
Estimation of COVID-19 generated medical waste in the Kingdom of Bahrain Al-Omran et al. [21]†| Bahrain, 2021 | High | Cross-sectional study The amount of PPE waste generated during COVID-19 among healthcare facilities in the Kingdom of Bahrain was studied. PPE waste generation per healthcare worker (HCW) per day was estimated | Contact precaution | PPEs used by medical staff in 5 healthcare facilities was 2·62 kg/HCW/day | Mass of PPE waste (kg/HCW/day) |
Clinical laboratory waste management in Shiraz, Iran Askarian et al. [22] | Iran, 2012 | Upper middle | Cross-sectional study Waste across 109 clinical laboratories were collated over a period of 1 month | Standard precaution | Infectious waste amounted to 0.4 ± 0.35 kg/patient/day across the 109 laboratories | Mass of infectious waste (kg/patient/day) |
Characterization and management of solid medical wastes in the Federal Capital Territory, Abuja Nigeria Bassey et al. [23] | Nigeria, 2006 | Low | Cross-sectional study Management of solid medical wastes in five selected hospitals was studied | Standard precaution | The mean infectious waste produced was 0·35 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Qualitative and quantitative evaluation of medical waste products in Côte d'Ivoire Bitty et al. [24]†| Ivory Coast, 2013 | Lower middle | Cross-sectional study Medical waste across both the public and private healthcare systems were monitored | Standard precaution | Taking the total proportion of infectious waste to be 59.39% of total medical waste as reported by the authors, the national average of infectious waste is estimated at 0.37 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Medical waste production at hospitals and associated factors Cheng et al. [25] | Taiwan, 2008 | High | Cross-sectional study This study was conducted to evaluate the quantities of medical waste generated of 150 healthcare establishments in Taiwan | Standard precaution | Mean infectious waste generated by type of medical establishment Medical centres: 0.60Â kg/bed/day Regional hospitals: 0.44Â kg/bed/day Local hospitals: 0.88Â kg/bed/day Clinics and others: 0.19Â kg/bed/day | Mass of infectious waste (kg/bed/day) |
Thinking green: Modelling respirator reuse strategies to reduce cost and waste Chu et al. [26]†| USA, 2021 | High | Cost-analysis study The authors assumed a model with universal masking of all healthcare workers across 6 months of the COVID-19 pandemic. Waste generated per patient was estimated by dividing the total amount of waste by the total number of hospitalised patients with COVID-19 during the first 6 months of the pandemic. Multiple respirator strategies were analysed | Airborne precaution | Assuming 6 months to be 182.5 days, the estimated environmental impact of N95 respirators with various strategies are outlined 1 per patient encounter: 1.16 kg/patient/day 1 per day: 0.515 kg/patient/day Ultraviolet germicidal irradiation (UVGI) decontaminated 3 M 1860 N95 respirators: 0.257 kg/patient/day H2O2 decontaminated 3 M 1860 N95 respirators: 0.180 kg/patient/day Reusable respirator and disposable filters: 0.217 kg/patient/day Reusable respirator and decontaminated filters: 0.022 kg/patient/day 1 surgical mask per day: 0.386 kg/patient/day | Mass of N95/respirator waste (kg/patient/day) |
Medical waste management in Ibadan, Nigeria: Obstacles and prospects Coker et al. [27] | Nigeria, 2008 | Lower middle | Cross-sectional study 52 healthcare facilities in Ibadan, Nigeria were studied, of which only 1 was a tertiary care hospital | Standard precaution | In the tertiary hospital, the mean amount of infectious waste produced was 20·1 kg/day | Mass of infectious waste (kg/day) |
Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011 Debere et al. [28] | Ethiopia, 2011 | Low | Cross-sectional study 6 hospitals in Addis Ababa in Ethiopia was recruited to assess the health care waste generation rate and its management system across a period of two months | Standard precaution | The amount of infectious waste generated varied from 0·037 to 0·116 kg/patient/day | Mass of infectious waste (kg/patient/day) |
The safety of non-incineration waste disposal devices in four hospitals of Tehran Farshad et al. [29] | Iran, 2014 | Upper middle | Cross-sectional study The concentration of volatile organic compounds (VOCs) emitted from four non-incinerator waste disposal methods were analysed in four hospitals across a 10-week period | Standard precaution | Among 40 VOCs tested, benzene, toluene, ethyl benzene, and xylene, collectively BTEX, were detected. Mean concentration of VOCs produced Autoclave without shredder:1.78 ppm Dry-heat system: 5.47 ppm Autoclave with shredder: 9.3 ppm Hydroclave: 5.5 ppm | Concentration of VOCs (ppm) |
Before/after intervention study to determine impact on life-cycle carbon footprint of converting from single-use to reusable sharps containers in 40 UK NHS trusts Grimmond et al. [30] | UK, 2020 | High | Life-cycle assessment Across 40 acute care hospitals in the UK, the carbon footprint of utilising single-use sharps containers and reusable sharps containers were compared across a 12Â month period | Standard precaution | The use of single-use sharps containers produced 3896.4 tonnes of CO2 across the 12-month period, compared to 628.9 tonnes of CO2 after switching to reusable containers, a 83.9% decrease. This further eliminated incineration of 900.8 tonnes of plastic and 132.5 tonnes of cardboard | Metric tonnes carbon dioxide equivalent (MTCO2e) |
Variations in Hospital Waste Quantities and Generation Rates Hamoda et al. [31]†| Kuwait, 2005 | High | Cross-sectional study The authors quantified waste generation from the 2 largest hospitals in Kuwait | Standard precaution | The mean infectious waste produced was 1·04 kg/bed/day and 1·09 kg/bed/day for Amiri Hospital & Mubarak Hospital respectively | Mass of infectious waste (kg/bed/day) |
Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh Hassan et al. [32] | Bangladesh, 2008 | Low | Cross-sectional study Health care establishments in Dhaka City, amounting to 2884 beds, were surveyed on waste production and management | Standard precaution | DMCH, BMCH and General Hospitals produced 0·29, 0·24 and 0·22 kg/bed/day of infectious waste respectively | Mass of infectious waste (kg/bed/day) |
Characteristics and management of infectious industrial waste in Taiwan Huang et al. [33] | Taiwan, 2008 | High | Cross-sectional study Data from Taiwan’s Department of Health and EPA were retrieved to survey the production of infectious waste | Standard precaution | Assuming a bed-occupancy of 100% and a total number of 95,810 beds across Taiwan’s general hospitals, infectious waste was 2.5 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Sustainability and shared smart and mutual green growth (SSaM-GG) in Korean medical waste management Koo et al. [34] | South Korea, 2015 | High | Life-cycle assessment Four available treatment systems of medical waste (incineration, incineration with heat recovery, steam sterilisation, and microwave disinfection) were studied to treat infectious waste prior to disposal. A functional unit of 1,000Â kg of regulated medical waste (RMW) was chosen | Standard precaution | Incineration: 1213Â kg-CO2/t Incineration with heat recovery: 455Â kg-CO2/t Steam sterilisation: 490Â kg-CO2/t Microwave disinfection: 99Â kg-CO2/t | Mass of CO2 emission per ton of waste (kg-CO2/t) |
Auditing an intensive care unit recycling program Kubicki et al. [35]†| Australia, 2013 | High | Cross-sectional study The weight and proportion of ICU waste and recyclables were studied across 7 non-consecutive days in a 11-bed ICU | Standard precaution | Mean infectious waste produced was 1.78 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Characteristics of Medical Waste in Taiwan Kuo et al. [36] | Taiwan, 1998 | High | Cross-sectional study Twenty-eight public hospitals in Taiwan were surveyed and records on general and infectious waste production were kept for one year | Standard precaution | The mean infectious waste produced was 0·39 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Analyses of the recycling potential of medical plastic wastes Lee et al. [37]†| USA, 2002 | High | Cross-sectional study Site visits to five typical city hospitals were conducted. Plastic waste was physically examined, and data regarding each hospital’s waste stream and disposal was conducted | Standard precaution | The mean amount of infectious waste produced was 1·49 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Healthcare waste management status in Lagos State, Nigeria: a case study from selected healthcare facilities in Ikorodu and Lagos metropolis Longe et al. [38] | Nigeria, 2011 | Lower middle | Cross-sectional study 20 healthcare institutions comprising of diagnostic centres, clinics, health centres, and hospitals (both public and private) were visited across 12 weeks | Standard precaution | We excluded the four diagnostic centres because information on bed number was not available. Across the rest of the 16 sites totalling 1,243 beds, the mean amount of infectious waste was 0.22 kg/bed//day | Mass of infectious waste (kg/bed/day) |
Medical Waste Management: A Case Study of the Souss-Massa-Drâa Region, Morocco Mbarki et al. [39]†| Morocco, 2013 | Lower middle | Cross-sectional study The authors conducted a study regarding medical waste generation, separation, collection, storage, transportation, and disposal across seven hospitals | Standard precaution | The mean infectious waste produced was 0·16 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Influence of COVID-19 on the 10-year carbon footprint of the Nagoya University Hospital and medical research centre Morooka et al. [40] | Japan, 2020 | High | Longitudinal study Data on electricity, gas, and water usage, pharmaceutical and medical supply costs, and waste amounts were recorded for Nagoya University Hospital from April 2010 to March 2021. The effect of the COVID-19 pandemic on the carbon footprint was then compared for three types of emission sources | Standard precaution | Total emission from infectious medical waste: 2019 (Pre-COVID): 114,470Â kg-CO2/ year 2020 (COVID):147,620Â kg-CO2/ year | Mass of CO2 emission per year (kg-CO2/ year) |
Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview Pandey et al. [41] | India, 2016 | Lower middle | Cross-sectional study The observational study was carried out over a period of five months in Chhatrapati Shivaji Subharti Hospital, Meerut | Standard precaution | The mean infectious waste generated was 0·34 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Assessment and selection of the best treatment alternative for infectious waste by modified Sustainability Assessment of Technologies methodology Rafiee et al. [42] | Iran, 2016 | Upper middle | Cross-sectional study Across a period of three months, infectious waste generated in the Iman Khomeini hospital complex was measured | Standard precaution | The mean amount of infectious waste produced was 1·15 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Assessment and selection of the best treatment alternative for infectious waste by Sustainability Assessment of Technologies (SAT) methodology Rahmani et al. [43] | Iran, 2020 | Lower middle | Cross-sectional study Four hospitals in Ardabil formed the setting of this study, with in-person and field visits performed. Mass of waste generated was tabulated | Standard precaution | The mean amount of infectious waste produced was amounted to 2·42 kg/bed/day | Mass of infectious waste (kg/bed/day) |
The carbon footprint of waste streams in a UK hospital Rizan et al. [44] | UK, 2020 | High | Cross-sectional study The carbon footprint of different waste streams based on disposal methods in 3 UK hospitals were measured | Standard precaution | Decontamination of hospital waste, including electricity, gas/oil, and water supplies 338Â kg CO2e/t Infectious waste Autoclave decontamination: 569Â kg CO2e/t Clinical, sharps, anatomical and medicinal waste High temperature incineration: 1074Â kg CO2e/t | Mass of CO2 emission per ton of waste (kg-CO2/t) |
Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic Rizan et al. [45] | UK, 2021 | High | Life-cycle assessment The environmental impact of commonly used PPE were individually assessed. The impact was then extrapolated to health and social care services in England during the COVID-19 pandemic across a 6-month period. Besides global warming potential, other metrics including ionising radiation, water consumption, and marine, air, and land pollution were analysed | Contact precaution | Carbon footprint of individual PPE items: Single-use gown: 905Â g CO2e Face shield: 231Â g CO2e Cup fit FFP respirator: 125Â g CO2e Duckbill FFP respirator: 76Â g CO2e Apron: 65Â g CO2e Glove: 26Â g CO2e Surgical mask (type IIR): 20Â g CO2e Surgical mask (type II): 13Â g CO2e Total 6Â month carbon footprint of all PPE items: 106,477,990Â kg CO2e | Mass of CO2 emission (g CO2e) |
Healthcare waste generation and management practice in government health centers of Addis Ababa, Ethiopia Tadesse et al. [46] | Ethiopia, 2014 | Low | Cross-sectional study Ten health centres were chosen, with seven consecutive days of waste collection performed. Total waste/day was measured using a weighing scale. On site visits and interviews were also conducted | Standard precaution | The mean amount of infectious waste was 2·29 kg/day | Mass of infectious waste (kg/day) |
The challenge of medical waste management: a case study in northwest Iran-Tabriz Taghipour et al. [47] | Iran, 2009 | Upper middle | Cross-sectional study The amount of infectious waste produced in 10 of the 25 active hospitals in Tabriz (Iran’s fourth largest city) were collated. Further observations and figures regarding the disposal of waste was made | Standard precaution | The mean amount of infectious waste produced across the ten hospitals was 1·04 kg/bed/day | Mass of infectious waste (kg/bed/day) |
Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives Vozzola et al. [48] | USA, 2021 | High | Life-cycle assessment The environmental impact of reusable and disposable isolation gowns were compared on the basis of energy consumption, greenhouse gas emissions, blue water consumption and solid waste generation | Contact precaution | Metrics are presented per 1,000 uses Reusable vs disposable Global warming potential: 218 vs 310Â kg CO2eq Natural resource energy: 3,712 vs 5,150Â MJ Blue water: 43.8 vs 74.6Â kg Solid waste at hospital site: 0.4 vs 63.4Â kg | Mass of CO2 emission (kg CO2eq) Natural resource energy (MJ) Blue water (kg) Mass of waste (kg) |