Public hospital waste segregation practices : a scoping review

Abstract

Healthcare waste segregation (HCWS) is a cornerstone of effective healthcare waste management (HCWM), ensuring the safe handling, disposal, and minimisation of environmental and health risks. This dissertation implemented a scoping review methodology to investigate HCWS practices in public hospital settings providing tertiary care. It focused on mapping segregation methods, guideline adherence, environmental impacts, and the research methodologies employed in the included studies. The review included 10 studies conducted across diverse contexts, primarily in lower-middle and upper-middle-income countries, where HCWM challenges are often most acute. The findings revealed significant variability in segregation practices, influenced by infrastructure, training, and adherence to international and national guidelines. While some hospitals demonstrated high compliance with colour-coded systems and effective waste stream separation, others struggled due to resource limitations and inconsistent enforcement of policies. Improper segregation was linked to increased hazardous waste volumes, pollution, and occupational risks such as needle-stick injuries. Conversely, best practices, including segregating at the point of waste generation, compliance monitoring and efficient training, were associated with improved segregation outcomes. Methodologically, the reviewed studies utilised a mix of quantitative, qualitative, and mixed-method approaches, with field observations, questionnaires, and interviews being the most common data collection tools. However, the reliance on cross-sectional designs and the limited application of longitudinal studies constrained the ability to evaluate long-term segregation impacts. This review highlights the need for standardised HCWM guidelines, enhanced training programmes, and infrastructural investments to address identified challenges. Future research should explore innovative monitoring technologies and expand the scope to include diverse healthcare settings. Finally, the evidence this dissertation provides is actionable insights for improving HCWS practices globally, contributing to safer healthcare environments and sustainable waste management.