Medical waste management within the Green Hospital approach: a systematic review of direct, contextual, and transferable evidence.

BACKGROUND

Medical 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.

METHODS

We 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.

RESULTS

Of 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.

CONCLUSION

Sustainable 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.