Quality-Improvement Approaches to Biomedical Waste Management in Tertiary Hospitals: Global Evidence, Challenges and Future Directions

Abstract

Introduction: Biomedical waste management (BMW) remains a critical challenge for health systems globally, particularly in low and middle-income countries (LMICs) where rapid patient turnover, high waste volumes, limited infrastructure and inconsistent compliance increase risks to healthcare workers (HCWs), patients and the environment. Tertiary-care hospitals generate complex waste streams and require robust monitoring, training and quality-improvement (QI) systems to ensure safe and sustainable practices. Despite well-established frameworks such as WHO guidelines and India’s Biomedical Waste Management (BMW) Rules 2016 and amendments, significant gaps persist in segregation, transport, storage, occupational safety and treatment processes.

 Methods: A narrative review was conducted using PubMed, Scopus, Web of Science and Google Scholar (2010-2025). Search terms included “biomedical waste”, “healthcare waste”, “segregation”, “quality improvement”, “PDSA”, “training”, and “occupational safety”. Human studies, hospital-based investigations and QI interventions published in English were included. Data were synthesised thematically across regulatory frameworks, segregation practices, transport and storage systems, treatment technologies, KAP assessments, occupational hazards, digital monitoring tools and QI models.

 Results: Across regions, segregation accuracy, PPE compliance, NSI rates and waste-generation indicators remain suboptimal, especially in LMIC tertiary hospitals. Studies consistently demonstrate poor KAP among newly recruited, contractual and housekeeping staff. Training interventions whether structured workshops, refresher modules or digital learning produce measurable improvements in segregation compliance, PPE adherence and risk perception. QI strategies, including Plan–Do–Study–Act (PDSA) cycles, Lean redesign of waste workflows, audit feedback loops and barcoding-based digital tracking, significantly strengthen waste-management performance. Persistent challenges include infrastructural gaps, inadequate storage, irregular transport routes, lack of supervision, behavioural barriers, and inconsistent enforcement at facility and state levels. Emerging innovations such as RFID tracking, AI-driven monitoring, and green treatment technologies offer promising future directions.

Conclusions: Studies demonstrates that improving BMW requires an integrated approach combining continuous training, QI-driven system redesign, regular monitoring and digital traceability. Tertiary-care hospitals given their complexity, high waste loads and diverse workforce must prioritise structured training, standardised audits, leadership engagement and technology-enabled tracking to enhance safety, compliance and environmental performance. Sustainable improvements are most likely when BMW is embedded within broader infection prevention and control (IPC) and hospital quality frameworks.