SynthesisInternational journal for quality in health care : journal of the International Society for Quality in Health Care2026
Medical waste management within the Green Hospital approach: a systematic review of direct, contextual, and transferable evidence.
Synthesis in International journal for quality in health care : journal of the International Society for Quality in Health Care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundMedical waste management is a central pillar of the Green Hospital approach, yet evidence on effective strategies and system-level barriers remains fragmented. This systematic review synthesizes direct medical-waste-management evidence together with healthcare-sustainability and transferable waste-system evidence relevant to the Green Hospital framework.
methodsWe conducted a systematic review in accordance with PRISMA 2020. The review protocol was registered in PROSPERO (CRD420251168204). Six bibliographic databases and one grey-literature source were searched for original empirical, intervention, case-study, modelling, and optimization studies published online between 1 January 2020 and 27 August 2025 that examined medical waste management or provided clearly relevant healthcare-sustainability or transferable waste-system evidence. Two reviewers independently screened records, extracted data, and appraised methodological quality using design-appropriate criteria: the Mixed Methods Appraisal Tool for empirical studies and an adapted model-appraisal framework for modelling, optimization, framework-development, and technology-evaluation studies.
resultsOf the 21 included studies, 15 provided direct medical-waste-management evidence, five provided healthcare-sustainability or planetary-health contextual evidence, and one provided transferable waste-system evidence. Behavioural compliance, education, or segregation was addressed in 11 studies (52%); workflow or operational optimization in four studies (19%); digital or decision-support systems in five studies (24%); environmental or economic assessment, modelling, circularity, or resource recovery in 10 studies (48%); and systemic or organizational barriers in seven studies (33%). Studies could contribute to more than one synthesis theme; therefore, these categories were not mutually exclusive.
conclusionSustainable medical waste management within the Green Hospital framework requires an integrated socio-technical strategy combining behavioural reinforcement, operational improvement, decision-support technologies, environmental and economic assessment, and enabling governance. These findings can be interpreted through a Human Factors and Ergonomics (HFE) lens, although formal HFE interventions were not consistently evaluated in the included studies.
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