Rising human and environmental risks from hazardous medical waste

The authors identify the most exposed groups as frontline clinical staff, waste handlers, laundry and cleaning crews, transport and landfill workers, and residents living near disposal sites. Home-based care also contributes to the problem through unsafe disposal of sharps and leftover medicines. These patterns point to the need for strong governance, well-trained staff at every step of the waste chain, and universal standards for segregation and safe disposal.

Healthcare workers and communities face escalating risks from poorly managed medical waste, warns a new review published in the Journal of Xenobiotics. The team’s findings spotlight the urgent need for better prevention, training, and safer treatment technologies to reduce harm from the growing volume of healthcare waste worldwide.

The study, titled “Healthcare Waste Toxicity: From Human Exposure to Toxic Mechanisms and Management Strategies,” examines how exposure to healthcare waste (HCW) causes harm, through which toxic pathways these harms unfold, and what practical management measures can curb the threat. The authors stress that weak governance and outdated handling practices are allowing long-recognized hazards to persist and worsen.

Rising burden of hazardous healthcare waste

While only about 15 percent of HCW is classified as hazardous, it carries disproportionate risks to people and the environment. This fraction includes infectious, pathological, sharps, pharmaceutical and cytotoxic, chemical, and radioactive wastes. The review shows that generation rates vary widely between countries and healthcare settings, and were driven up sharply during the COVID-19 pandemic, straining systems that were already under pressure.

The authors identify the most exposed groups as frontline clinical staff, waste handlers, laundry and cleaning crews, transport and landfill workers, and residents living near disposal sites. Home-based care also contributes to the problem through unsafe disposal of sharps and leftover medicines. These patterns point to the need for strong governance, well-trained staff at every step of the waste chain, and universal standards for segregation and safe disposal.

The review links HCW-related disease risks directly to shortcomings in segregation and treatment. It emphasizes that prevention and minimization of waste must be the first line of defense, followed by strict separation of hazardous streams at the point of generation.

Human exposure and toxic pathways

The authors outline the major exposure routes and toxic mechanisms tied to different HCW categories. Sharps and infectious waste are singled out for causing needle-stick injuries that can transmit serious blood-borne infections such as HIV, hepatitis B, and hepatitis C. Hollow-bore needles are particularly high-risk.

Pharmaceutical and cytotoxic waste can induce acute organ toxicity and, over the long term, genotoxic, carcinogenic, and reproductive effects. The improper disposal of antibiotics contributes to the spread of antimicrobial resistance.

Chemical waste, including mercury from medical devices, silver from imaging solutions, chlorine-based disinfectants, formaldehyde, and even obsolete pesticides, can cause neurotoxicity, endocrine disruption, respiratory and skin injuries, and cancer.

For radioactive waste, the impact depends on dose and exposure time, with risks ranging from mild tissue damage to life-threatening injuries and elevated cancer incidence.

The study also highlights risks from management-related failures. Inadequate incineration can release persistent organic pollutants such as dioxins and furans, as well as toxic metals. Poorly designed landfills can leach hazardous chemicals into soil and groundwater, posing long-term risks to surrounding populations.

Strategies for reducing risks and strengthening management

The review proposes a clear management hierarchy, prioritizing waste prevention and minimization, followed by segregation at source, and then deployment of treatment technologies tailored to each waste stream.

For infectious waste, the authors recommend non-combustion thermal technologies such as steam sterilization and microwave treatment, which are effective and limit the release of harmful byproducts. High-temperature treatment is still necessary for pathological and cytotoxic wastes, while immobilization methods remain key for radioactive residues. Chemical and radiation-based disinfection approaches should be carefully managed to minimize secondary hazards.

The study calls for dedicated healthcare waste management teams, routine staff training, proper labeling, and continuous oversight throughout the entire process, from generation to final disposal. It also notes that evidence gaps persist in understanding how combined exposures affect human health and in evaluating the real-world performance of emerging thermal and radiation treatment methods.

The authors argue that countries must invest in both technology and governance reforms to protect workers, nearby communities, and the environment. They underscore that without coordinated policies, the growing complexity of healthcare delivery, coupled with aging populations and increasing reliance on home-based care, will heighten the risks.