Mixed-Methods Assessment of Hazardous Healthcare Waste Management in Türkiye, 2016–2024
Abstract
Background: Hazardous healthcare waste is an escalating environmental and public health concern, requiring robust and traceable management systems. Evidence from Türkiye remains limited. This study evaluates hazardous healthcare waste managed by an interim storage facility and explores management challenges.
Methods: A mixed-methods study was conducted. Quantitative data included hazardous waste records (2016–2024) from a facility in Bursa providing nationwide services. Waste amounts were analyzed by institution type, level of care, region, year, and waste code using descriptive statistics and trend analysis. Qualitative data were obtained through semi-structured interviews with 14 stakeholders (managers, engineers, workers). Data were analyzed using thematic analysis.
Results: A total of 12,409 tons of hazardous healthcare waste were collected; 78% originated from public institutions. Most waste came from Istanbul, Bursa, and Izmir, with the Marmara region accounting for 48%. Waste volumes increased over time. Secondary and tertiary care facilities generated 51% and 47% of waste, respectively. The most common types were contaminated packaging (54%), hazardous chemicals (28%), and cytotoxic/cytostatic drugs (13%). Participants reported deficiencies in segregation, classification, packaging, and labeling, along with regional disparities, workforce shortages, training gaps, logistical constraints, and weak enforcement. Improper mixing of waste streams was frequently noted.
Conclusions: Hazardous healthcare waste has increased substantially, mainly from higher-level public institutions. Systemic challenges persist, particularly in segregation and labeling processes. Strengthening training, regulation, monitoring, and digital tracking, alongside regionalized management approaches, is essential for sustainable hazardous waste management. Addressing these gaps is critical to reducing environmental risks and advancing sustainable healthcare systems.
Key messages: • Hazardous healthcare waste is rising in Türkiye, while system gaps in segregation, training, and enforcement increase environmental and health risks.
• Strengthening workforce capacity, regulation, and monitoring systems is essential for safe, sustainable hazardous waste management in healthcare.
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BibTeX
@article{ayvaz2026mixedmethods,
title = {{Mixed-Methods Assessment of Hazardous Healthcare Waste Management in Türkiye, 2016–2024}},
author = {I Ayvaz and NE Lüleci},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.065},
url = {https://doi.org/10.1093/eurpub/ckag169.065},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Mixed-Methods Assessment of Hazardous Healthcare Waste Management in Türkiye, 2016–2024
AU - I Ayvaz
AU - NE Lüleci
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.065
UR - https://doi.org/10.1093/eurpub/ckag169.065
AB - Background: Hazardous healthcare waste is an escalating environmental and public health concern, requiring robust and traceable management systems. Evidence from Türkiye remains limited. This study evaluates hazardous healthcare waste managed by an interim storage facility and explores management challenges. Methods: A mixed-methods study was conducted. Quantitative data included hazardous waste records (2016–2024) from a facility in Bursa providing nationwide services. Waste amounts were analyzed by institution type, level of care, region, year, and waste code using descriptive statistics and trend analysis. Qualitative data were obtained through semi-structured interviews with 14 stakeholders (managers, engineers, workers). Data were analyzed using thematic analysis. Results: A total of 12,409 tons of hazardous healthcare waste were collected; 78% originated from public institutions. Most waste came from Istanbul, Bursa, and Izmir, with the Marmara region accounting for 48%. Waste volumes increased over time. Secondary and tertiary care facilities generated 51% and 47% of waste, respectively. The most common types were contaminated packaging (54%), hazardous chemicals (28%), and cytotoxic/cytostatic drugs (13%). Participants reported deficiencies in segregation, classification, packaging, and labeling, along with regional disparities, workforce shortages, training gaps, logistical constraints, and weak enforcement. Improper mixing of waste streams was frequently noted. Conclusions: Hazardous healthcare waste has increased substantially, mainly from higher-level public institutions. Systemic challenges persist, particularly in segregation and labeling processes. Strengthening training, regulation, monitoring, and digital tracking, alongside regionalized management approaches, is essential for sustainable hazardous waste management. Addressing these gaps is critical to reducing environmental risks and advancing sustainable healthcare systems. Key messages: • Hazardous healthcare waste is rising in Türkiye, while system gaps in segregation, training, and enforcement increase environmental and health risks. • Strengthening workforce capacity, regulation, and monitoring systems is essential for safe, sustainable hazardous waste management in healthcare.
SN - 1101-1262
SN - 1464-360X
ER -