Medical and healthcare waste generation, storage, treatment and disposal: a systematic scoping review of risks to occupational and public health

Systems to safely store, handle, treat and dispose of medical (healthcare) waste are well developed in the 21st century. Yet, across many parts of the Global South (low-income and middle-income countries) such systems, resources and knowhow are lacking; to the extent that medical waste could pose a serious threat to the health, safety and lives of millions of healthcare workers and waste handlers who frequently interact with this category of materials. We present here a novel scope and dimension to investigating specifically the risks and hazards to people who come into contact with medical waste, focusing on activity types and established medical practice. A systematic scoping review of evidence (PRISMA-Scr) was used to critically analyze, compare and summarize data. Prevalent combinations of hazards, exposure and risk are semi-quantitatively scored and ranked. Our results signpost three core topics posing a major risk to human health: (1) Open, uncontrolled burning and rudimentary incineration of medical waste by waste handlers who have to make difficult choices between burning or discarding on land (e.g. in dumpsites) from where it risks pathogen infection; (2) A small but non-negligible trade in reused medical equipment (e.g. hypodermic needles), proliferated by a cohort of waste reclamation specialists (sub-group of waste pickers); and (3) The mismanagement of medical sharps at the point of generation, handling and storage in the Global North and South. A combination of immediate action and further research are recommended to address and inform on these topics which threaten the health and mortality of millions.