Health Care Waste Management Improvement Interventions Specifications and Results: A Systematic Review and Meta-Analysis

  • Ali Ashtari Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
  • Jafar Sadegh Tabrizi Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
  • Ramin Rezapour Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
  • Mohammad Rashidian Maleki Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
  • Saber Azami-Aghdash Mail 1. School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran 2. Iranian Center of Excellence in Health Management, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
Health care waste management, Systematic review, Meta-analysis, Critical analysis, Interventions


Background: Given   the   importance   of   proper   management   of   Health   Care   Waste   Management (HCWM), comprehensive information on interventions in this field is necessary. Therefore, we aimed to systematically review and meta-analysis of characteristics and results of interventions in the field of HCWM.

Methods: The required data were gathered through searching the keywords such as waste management, biomedical waste, hospitals waste, health care waste, infectious waste, medical waste, Waste Disposal Facilities, Garbage, Waste Disposal Facilities, Hazardous Waste Sites in PubMed, Scopus, EMBASE, Google scholar, Cochrane library, Science Direct, web of knowledge, SID and MagIran and hand searching in journals, reference by reference, and search in Gray literatures between 2000 and 2019. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis.

Results: Twenty-seven interventions were evaluated. Most of the studies were conducted after 2010, in the form of pre and post study, without control group, and in hospital. Interventions were divided into two categories: educational interventions (19 studies) and multifaceted managerial interventions (8 studies). The most studied outcome (in 11 studies) was KAP (knowledge, attitude and practice). The mean standard difference of interventions on KAP was estimated 3.04 (2.54–3.54) which was significant statistically (P<0.05). Also, interventions were considerably effective in improving the indicators of waste production amount, waste management costs and overall waste management performance.

Conclusion: Despite positive effect of interventions, due to the methodological deficiencies of published studies and high heterogeneity in results of studies, caution should be exercised in interpreting and using the results of the studies.


1. Windfeld ES, Brooks MS (2015). Medical waste management - A review, J Environ Manage. 163:98-108.
2. Eker HH, Bilgili MS, Sekman E, et al (2010). Evaluation of the regulation changes in medical waste management in Turkey. Waste Manag Res, 28(11):1034-8.
3. Al-Momani H, Obaidat M, Khazaleh A, et al (2019). Review of medical waste management in Jordanian health care organisations. Br J Healthc Manag, 25(8):1-8.
4. Eren E, Tuzkaya UR (2019). Occupational health and safety-oriented medical waste management: A case study of Istanbul. Waste Manag Res, 37(9):876-884.
5. Gao Q, Shi Y, Mo D, et al (2018). Medical waste management in three areas of rural China. PLoS One, 13(7):e0200889.
6. Olaniyi FC, Ogola JS, Tshitangano TG (2019). Efficiency of Health Care Risk Waste Management in Rural Healthcare Facilities of South Africa: An Assessment of Selected Facilities in Vhembe District, Limpopo Province. Int J Environ Res Public Health, 16(12):2199.
7. Acharya A, Gokhale VA, Joshi D (2014). Impact of biomedical waste on city environment: Case study of Pune, India. J Appl Chem,6(6):21-7.
8. Bdour A, Altrabsheh B, Hadadin N, et al (2007). Assessment of medical wastes management practice: a case study of the northern part of Jordan. Waste Manag, 27(6):746-59.
9. Chaerul M, Tanaka M, Shekdar AV (2008). A system dynamics approach for hospital waste management. Waste Manag, 28(2):442-9.
10. Yizengaw E, Getahun T, Geta M, et al (2018). Sero-prevalence of hepatitis B virus infection and associated factors among health care workers and medical waste handlers in primary hospitals of North-west Ethiopia. BMC Res Notes, 11(1):437.
11. Babanyara Y, Ibrahim D, Garba T, et al (2013). Poor Medical Waste Management (MWM) practices and its risks to human health and the environment: a literature review. Int J Environ Ealth Sci Eng, 11(7):1-8.
12. Mastorakis NE, Bulucea CA, Oprea TA, et al (2010). Environmental and health risks associated with biomedical waste management. Develop Energy Environ Economics, 2010:287-94.
13. Ali M, Wang W, Chaudhry N, et al (2017). Hospital waste management in developing countries: A mini review. Waste Manag Res, 35(6):581-92.
14. Bai VR, Vanitha G, Zainal Ariff AR (2013). Effective hospital waste classification to overcome occupational health issues and reduce waste disposal cost. Infect Control Hosp Epidemiol, 34(11):1234-1235.
15. Kwikiriza S, Stewart AG, Mutahunga B, et al (2019).A Whole Systems Approach to Hospital Waste Management in Rural Uganda. Front Public Health,7:136.
16. Motta O, Zarrella I, Cucciniello R, et al (2018). A new strategy to control the proliferation of microorganisms in solid hospital waste and the diffusion of nosocomial infections. Infez Med,26(3):210-215.
17. S Khan K, Kunz R, Kleijnen J, et al. Systematic reviews to support evidence-based medicine. Mazurek Melnyk B, editor2011.
18. Moher D, Liberati A, Tetzlaff J, et al (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097.
19. National Heart Lung and Blood Institute. Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group [National Heart Lung and Blood Institute web site] 2019. [Accessed october 23]. .
20. Askarian M, Heidarpoor P, Assadian O (2010). A total quality management approach to healthcare waste management in Namazi Hospital, Iran. Waste Manag, 30(11):2321-6.
21. Martin DM, Yanez N, Treggiari MM (2017). An initiative to optimize waste streams in the operating room: Recycling in the operating room (RECOR) project. AANA J, 85(2):108-12.
22. Mokuolu O, Akindele R, Olawumi H (2016). Development of improved solid hospital waste management practices in a Nigerian Tertiary Hospital. Nigerian J Technol, 35(3):674.
23. Mosquera M, Andrés-Prado MJ, Rodríguez-Caravaca G, et al (2014).Evaluation of an education and training intervention to reduce health care waste in a tertiary hospital in Spain. Am J Infect Control, 42(8):894-7.
24. Perrego K (2017).Improving Staff Knowledge of Perioperative Regulated-Waste Management. AORN J, 105(1):85-91.
25. Johnson KM, González ML, Dueñas L, et al (2013). Improving waste segregation while reducing costs in a tertiary-care hospital in a lower–middle-income country in Central America. Waste Manag Res, 31(7):733-8.
26. Aboelnour A, Abuelela MH (2019). Increase adherence to waste management policy at healthcare facility in Egypt. Bulletin of the National Research Centre, 43(1):29.
27. Tabrizi JS, Saadati M, Heydari M, et al (2018). Medical waste management improvement in community health centers: an interventional study in Iran. Prim Health Care Res Dev, 20:1-6.
28. Stonemetz J, Pham JC, Necochea AJ, et al (2011). Reduction of regulated medical waste using lean sigma results in financial gains for hospital. Anesthesiol Clin, 29(1):145-52.
29. Almuneef M, Memish ZA (2003).Effective medical waste management: it can be done. Am J Infect Control, 31(3):188-92.
30. Gielar A, Helios-Rybicka E (2013). Enviromental impact of a hospital waste incineration plant in Krakow (Poland). Waste Manag Res, 31(7):722-8.
31. Rao PH (2008).Report: Hospital waste management--awareness and practices: a study of three states in India. Waste Manag Res, 26(3):297-303.
32. Eleyan D, Al-Khatib IA, Garfield J (2013).System dynamics model for hospital waste characterization and generation in developing countries. Waste Manag Res, 31(10):986-95.
33. Townend WK, Cheeseman CR (2005). Guidelines for the evaluation and assessment of the sustainable use of resources and of wastes management at healthcare facilities. Waste Manag Res, 23(5):398-408.
34. Kühling J-G, Pieper U (2012). Management of healthcare waste: developments in Southeast Asia in the twenty-first century. Waste Manag Res, 30:100-4.
35. Ho CC, Liao CJ (2011).The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste. Waste Manag, 31(12):2631-7.
36. Reza Sabour M, Mohamedifard A, Kamalan H (2007). A mathematical model to predict the composition and generation of hospital wastes in Iran. Waste Manag, 27(4):584-7.
37. Tsakona M, Anagnostopoulou E, Gidarakos E (2007). Hospital waste management and toxicity evaluation: A case study. Waste Manag, 27(7):912-20.
38. Nemathaga F, Maringa S, Chimuka L (2008). Hospital solid waste management practices in Limpopo Province, South Africa: A case study of two hospitals. Waste Manag, 28(7):1236-45.
39. Alves SB, e Souza ACS, Tipple AFV, et al (2014). The reality of waste management in primary health care units in Brazil. Waste Manag Res. 32:40-7.
40. Saadati M, Azami-Aghdash S, Rezapour R (2020). Medical Waste Management in Community Health Centers: Different Experience From East Azerbaijan Province, Iran. Int Q Community Health Educ, 40(2):159-60.
41. Tabrizi JS, Rezapour R, Saadati M, et al (2018). Medical waste management in community health centers. Iran J Public Health, 47(2):286-291.
42. Win E, Saw Y, Oo K, et al (2019). Healthcare waste management at primary health centres in Mon State, Myanmar: The comparisons between hospital and non-hospital type primary health centres. Nagoya J Med Sci, 81:81-91.
43. Sadeghi H, Fazlzadeh M, Hazrati S, et al (2012). Survey of waste management practices at health centers of Ardebil City. J Health, 2(4):17-27.
44. Organization WH (2005).Management of solid health-care waste at primary health-care centres: A decision-making guide.
45. Himmelstein DU, Woolhandler S, Wolfe SM (2004). Administrative waste in the US health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings. Int J Health Serv, 34(1):79-86.
46. Rashidian A, Alinia C, Majdzadeh R (2015). Cost-effectiveness analysis of health care waste treatment facilities in iran hospitals; a provider perspective. Iran J Public Health, 44(3):352-60.
47. Lee BK, Ellenbecker MJ, Moure-Ersaso R (2004). Alternatives for treatment and disposal cost reduction of regulated medical wastes. Waste Manag, 24(2):143-51.
48. Vaccari M, Tudor T, Perteghella A (2018). Costs associated with the management of waste from healthcare facilities: An analysis at national and site level. Waste Manag Res, 36(1):39-47.
49. Soares SR, Finotti AR, Prudêncio da Silva V, et al (2013). Applications of life cycle assessment and cost analysis in health care waste management. Waste Manag, 33(1):175-83.
50. D'Souza BC, Seetharam AM, Chandrasekaran V, et al (2017). Comparative analysis of cost of biomedical waste management across varying bed strengths in rural India. Int J Healthc Manag, 11(1):1-6.
How to Cite
Ashtari A, Tabrizi JS, Rezapour R, Rashidian Maleki M, Azami-Aghdash S. Health Care Waste Management Improvement Interventions Specifications and Results: A Systematic Review and Meta-Analysis. Iran J Public Health. 49(9):1611-1621.
Review Article(s)