Sustainable management of hospital waste in Iran: A review of evidence, implementation challenges, decontamination methods, and circular economy pathways

Abstract

Waste from healthcare activities, especially its hazardous part, including infectious waste, sharps, chemicals, and pharmaceuticals, is considered one of the most important waste streams in terms of health, occupational, and environmental consequences. Improper management of these wastes can increase the risk of occupational exposure, the spread of pathogens, environmental pollution, and management costs. This study aimed to review the available scientific evidence on the status of hospital waste management in Iran, focusing on source segregation, collection and transportation, decontamination, final disposal, economic costs, environmental consequences, and the capacity to apply circular economy principles. This review was conducted using reliable international sources, World Health Organization (WHO) documents, and research and review studies conducted in Iran, and the studies were analyzed based on waste generation, segregation status, decontamination technologies, management costs, and environmental impacts. Evidence indicates significant heterogeneity in waste management performance among healthcare centers and different regions of Iran. In Tehran hospitals, only 5.6% of centers were at an excellent level in the overall waste management assessment, while 13.9% and 3.5% were classified as poor and very poor, respectively. Also, in Tabriz, 38.9% of the autoclaves examined had operational problems, and about 55.6% of the samples tested with biological indicators had positive results. In 43 Tehran hospitals, the total waste generation was reported to be 4.42 ± 2.77 kg per active bed per day, and the average cost of hazardous waste treatment was about $0.3 per kg. Overall, improving hospital waste management in Iran requires an integrated approach based on effective segregation, continuous training, quality control of decontamination technologies, and economic and environmental monitoring and evaluation. The transition from the traditional disposal approach to production reduction, resource recovery, life cycle assessment, and circular economy can play an important role in increasing the sustainability of the healthcare waste management system.