Systematic Study of Risk-Based Medical Waste Management in Teaching Hospitals
Keywords:
Teaching Hospital; Medical Waste Management; Risk-Based Management; FMEA.Abstract
Background: Teaching hospitals are highly complex due to the integration of service, education, and research functions, resulting in a larger and more varied volume of hazardous medical waste. A risk-based management approach is crucial to mitigate occupational health impacts and environmental pollution. Objective: This systematic review aims to analyze risk-based medical waste management practices, operational indicators that determine waste generation, and control strategies in teaching hospitals. Methods: This study used the Systematic Literature Review (SLR) method following the PRISMA protocol. Article searches were conducted in Scopus, ScienceDirect, and Taylor & Francis databases for publications from 2021–2026, resulting in 9 primary articles for synthesis. Results: Risk analysis based on Failure Mode and Effects Analysis (FMEA) showed that the waste transfer stage and direct exposure to body fluids were critical points with the highest risks. In the laboratory area, risks were dominated by chemical and ergonomic hazards. Medical waste generation was strongly correlated with hospital operational indicators such as Bed Occupancy Rate (BOR), Bed Turnover Rate (BTOR), duration of hospitalization, and infection rates (HAIs). For final treatment, incineration is the optimal choice based on a multi-criteria decision-making (MCDM) for large capacities, while a combination of chemical disinfection and pyrolysis offers the most environmentally friendly option based on a Life Cycle Assessment (LCA). Human factors, particularly training frequency, have been shown to be a key predictor of staff sorting compliance. Conclusion: Medical waste management in teaching hospitals requires an integrated management system that combines periodic risk assessments, sustainable treatment technologies, and continuous staff training.
References
ALMashaqbeh, S., & ALKhamisi, Y. N. (2023). Healthcare waste hazards assessment using EWGM-FMEA: Case study in Oman. Cogent Engineering, 10(1). https://doi.org/10.1080/23311916.2023.2185951
Alshammari, W., Alhussain, H., & Rizk, N. M. (2021). Risk management assessments and recommendations among students, staffs, and health care workers in educational biomedical laboratories. Risk Management and Healthcare Policy, 14, 185–198. https://doi.org/10.2147/RMHP.S278162
Çetin, E., Hussein, A., & Güneş-Durak, S. (2025). Advancing Sustainable Medical Waste Management: A Case Study on Waste Generation and Classification in a University Hospital Microbiology Laboratory. Sustainability (Switzerland), 17(10). https://doi.org/10.3390/su17104325
Chen, C., Chen, J., Fang, R., Ye, F., Yang, Z., Wang, Z., Shi, F., & Tan, W. (2021). What medical waste management system may cope With COVID-19 pandemic: Lessons from Wuhan. Resources, Conservation and Recycling, 170, 105600. https://doi.org/10.1016/j.resconrec.2021.105600
Dadashi, T., Hosseinpoor, S., & Mohammadi, A. (2024). A comprehensive protocol for evaluating health, safety, and environmental risks of hospital solid waste through FMEA technique. MethodsX, 12(March), 102760. https://doi.org/10.1016/j.mex.2024.102760
Devebakan, N., Gasim, N., Durmus, A., & Babashova, S. (2025). Bayesian Model Averaging and Augmented Autoregressive Distributed Lag Approach for modeling hospital waste amount. Evidence from Dokuz Eylul University hospital in Turkiye. Cleaner Waste Systems, 11(January), 100302. https://doi.org/10.1016/j.clwas.2025.100302
Edi Kurnawan, Farida Yuliaty, Vip Paramarta, & Kosasih. (2025). INTEGRATED RISK MANAGEMENT IN HOSPITAL MANAGEMENT STRATEGY. MORFAI JOURNAL. https://doi.org/10.54443/morfai.v5i1.2518
Ghaffari, M., Hupponen, M., & Horttanainen, M. (2026). Life cycle assessment of the healthcare plastic waste management in Finland, a case study: HUS Meilahti hospital area. Waste Management, 218(April), 115528. https://doi.org/10.1016/j.wasman.2026.115528
Janik-Karpinska, E., Brancaleoni, R., Niemcewicz, M., Wojtas, W., Foco, M., Podogrocki, M., & Bijak, M. (2023). Healthcare Waste—A Serious Problem for Global Health. Healthcare, 11(2), 242. https://doi.org/10.3390/healthcare11020242
Kalan, O., Antmen, Z. F., & Akbaba, S. (2025). Selection of Medical Waste Disposal Method for a University Hospital Using Hybrid Multi-Criteria Decision-Making Methods: A Case Study in Adana Province, Turkey. Sustainability (Switzerland), 17(24). https://doi.org/10.3390/su172411378
Kaposi, A., Nagy, A., Gomori, G., & Kocsis, D. (2024). Analysis of healthcare waste and factors affecting the amount of hazardous healthcare waste in a university hospital. Journal of Material Cycles and Waste Management, 26(2), 1169–1180. https://doi.org/10.1007/s10163-024-01890-1
Khalid, S., Haq, N., Sabiha, Z. ul A., Latif, A., Khan, M. A., Iqbal, J., & Yousaf, N. (2021). Current practices of waste management in teaching hospitals and presence of incinerators in densely populated areas. BMC Public Health. https://doi.org/10.1186/s12889-021-11389-1
Laupe Rado, M. Y., Amir, R., Herlina, H., Haniarti, H., & Thasim, S. (2025). Evaluasi Kepatuhan terhadap Regulasi Pengelolaan Limbah Medis Berbahaya dan Beracun (B3) di Rumah Sakit dr. Hasri Ainun Habibie Parepare. Sulolipu: Media Komunikasi Sivitas Akademika Dan Masyarakat, 25(2), 384–391. https://doi.org/10.32382/sulo.v25i2.1749
Maalouf, A., & Agamuthu, P. (2023). Waste management evolution in the last five decades in developing countries – A review. Waste Management & Research: The Journal for a Sustainable Circular Economy, 41(9), 1420–1434. https://doi.org/10.1177/0734242X231160099
Ramadan, B. S., Rosmalina, R. T., -, S., -, M., Khair, H., Rachman, I., & Matsumoto, T. (2023). Potential Risks of Open Waste Burning at the Household Level: A Case Study of Semarang, Indonesia. Aerosol and Air Quality Research, 23(5), 220412. https://doi.org/10.4209/aaqr.220412
Ramadi, D., Barlian, E., Yuniarti, E., & Handayuni, L. (2025). Analisis Timbulan Limbah Medis Padat Di Rumah Sakit X Kota Padang. Human Care Journal, 10(1), 7–16. https://sinta.kemdikbud.go.id/journals/profile/5436
Sanito, R. C., Mujiyanti, D. R., You, S.-J., & Wang, Y.-F. (2024). A review on medical waste treatment in COVID-19 pandemics: Technologies, managements and future strategies. Journal of the Air & Waste Management Association, 74(2), 72–99. https://doi.org/10.1080/10962247.2023.2282011
Slutzman, J. E., Bockius, H., Gordon, I. O., Greene, H. C., Hsu, S., Huang, Y., Lam, M. H., Roberts, T., & Thiel, C. L. (2023). Waste audits in healthcare: A systematic review and description of best practices. Waste Management & Research: The Journal for a Sustainable Circular Economy, 41(1), 3–17. https://doi.org/10.1177/0734242X221101531
Susilawati, Ramadhanu, S., Nayla, I., Anggita, V. P., Jawahir, A., & Sintia, P. (2025). Penilaian Aspek Lingkungan terhadap Kegiatan Pengelolaan Limbah Medis dan Non Medis di Puskesmas X Kota Medan. Jurnal Kolaboratif Sains, 8(9), 6056–6063. https://doi.org/10.56338/jks.v8i9.8733
WHO. (2024). Health-care waste. Fact-Sheets. https://www.who.int/news-room/fact-sheets/detail/health-care-waste
Yang, T., Du, Y., Sun, M., Meng, J., & Li, Y. (2024). Risk Management for Whole-Process Safe Disposal of Medical Waste: Progress and Challenges. Risk Management and Healthcare Policy, Volume 17, 1503–1522. https://doi.org/10.2147/RMHP.S464268
Yeoh, S., Bourdamis, Y., Saker, A., Marano, N., Maundrell, L., Ramamurthy, P., & Sharma, D. (2024). An Investigation Into Contaminated Waste Composition in a University Dental Clinic: Opportunities for Sustainability in Dentistry. Clinical and Experimental Dental Research, 10(6), 1–9. https://doi.org/10.1002/cre2.70015
