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Article

Towards a Circular Solution for Healthcare Plastic Waste: Understanding the Legal, Operational, and Technological Landscape

by
Bharghav Ganesh
1,*,
Sayyed Shoaib-ul-Hasan
1,
Iliass Temsamani
1,2 and
Niloufar Salehi
1
1
Department of Production Engineering, KTH Royal Institute of Technology, Brinellvägen 68, SE-11428 Stockholm, Sweden
2
Siemens Digital Industries, Evenemangsgatan 21, SE-16979 Solna, Sweden
*
Author to whom correspondence should be addressed.
Recycling 2025, 10(1), 27; https://doi.org/10.3390/recycling10010027
Submission received: 30 December 2024 / Revised: 6 February 2025 / Accepted: 10 February 2025 / Published: 14 February 2025
(This article belongs to the Special Issue Challenges and Opportunities in Plastic Waste Management)
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Abstract

:
Plastic waste poses a critical challenge in the healthcare sector due to its predominant reliance on a linear “make-use-dispose” model, where plastics are typically incinerated or landfilled. This study examines Swedish healthcare waste management practices, encompassing Swedish and EU regulatory frameworks, hospital protocols, disinfection methods, and recycling processes. A key barrier to recycling healthcare plastic waste (HCPW) is the uncertainty surrounding effective decontamination. To overcome this, the paper proposes a circular solution involving on-site microwave-assisted disinfection and shredding, followed by chemical recycling through pyrolysis. This approach considers operational, legal, and technological landscapes and underscores the need for a multidisciplinary solution to enable the transition. This paper also presents a stakeholder collaboration and value capture matrix, identifying the shared value in collaboration among key stakeholders, including hospitals and healthcare service providers, on-site disinfection machine manufacturers, waste management firms, and chemical recycling companies, to advance recycling and foster a circular economy for HCPW.

1. Introduction

Plastics have revolutionized healthcare, becoming integral to the healthcare industry with numerous applications over the past 150 years [1]. The medical plastic market, valued at USD 25.6 billion, is projected to grow at a compounded annual growth rate of 10%, reaching USD 41.2 billion by 2028 [2]. In the US, healthcare facilities generate 5.9 million metric tons of waste annually, with plastics accounting for 1.7 million metric tons, or about 28% of the total waste [3]. With similar estimates, plastic waste in intensive care units constitutes approximately 30% of the waste stream [4].
Single-use plastics have become part of our daily lives, especially after the COVID-19 pandemic led to an increased demand for personal protective equipment (PPE) [5,6,7]. The most commonly used polymers in healthcare include polyurethane (PU), polypropylene (PP), polycarbonate (PC), low-density polyethylene (LDPE), polyvinyl chloride (PVC), and polystyrene (PS) [8,9]. Notably, most of these observed plastics are categorized as commodity plastics [10].
The linear “make-use-dispose” approach is prevalent in healthcare, particularly for single-use plastic consumables [11]. This linear approach, often leading to incineration or landfilling, currently dominates the healthcare industry [12], as represented in Figure 1. While healthcare experts advocate for a systemic shift towards a circular approach for consumables and plastic waste [3,13], the ineffective disposal of healthcare plastic waste (HCPW) hinders closing the material loop [14]. The large-scale consumption and the dependence on plastic consumables within the healthcare sector necessitate better management of plastic waste streams [15] and innovative and systemic solutions. Previously, different recycling technologies have been investigated for healthcare waste [16]. However, due to strict and evolving regulatory requirements [17,18], uncertainties about waste contamination, and operational challenges such as sorting and collection [19], only 9% of this waste is recycled [20,21]. Addressing these challenges requires identifying stakeholders to engage in cross-collaboration across the entire waste management system. Prior research highlights that effective recycling necessitates value chain thinking and cross-sectoral collaboration to improve waste collection, sorting, and treatment processes within a circular economy framework [22,23]. In this regard, the prior literature [23,24] emphasizes cross-sectoral collaboration and industrial partnerships among multiple stakeholders for creating a feasible solution for HCPW. To further their research, this paper examines Sweden’s current healthcare waste management practices, including regulations, hospital routines, disinfection processes, and recycling methods. Based on findings from the literature and interviews with key stakeholders, a circular solution for HCPW is identified. The study proposes utilizing on-site microwave disinfection techniques to convert HCPW into municipal solid waste (MSW), which can then be used as a feedstock for chemical recycling. Furthermore, the paper provides a collaboration and value capture matrix for different stakeholders including hospitals and healthcare service providers (HSP), on-site disinfection machine manufacturers, waste management companies, and chemical recycling companies.
This paper is structured as follows: Section 2 covers the methodology, Section 3 discusses healthcare waste themes from the literature and stakeholder insights gathered through on-site visits and interviews, Section 4 presents a circular solution for healthcare plastic waste, Section 5 identifies prospects and future challenges, and Section 6 concludes the study.

2. Research Methodology

2.1. Research Approach

This study aimed to understand the legal, operational, and technological landscape for creating a circular solution for HCPW in Sweden. This was achieved by examining the current healthcare waste management practices, including regulations, hospital routines, disinfection processes, and recycling methods. The research followed a two-phase approach to gather primary data:
Phase 1: A literature review was conducted to understand the legal, operational, and technological landscapes for waste management in the healthcare sector. Phase 1 focuses on an analysis of the EU regulation and Swedish national regulation for managing healthcare waste, operational routines for managing healthcare waste, and technological solutions for the disinfection and recycling of healthcare waste.
Phase 2: Semi-structured interviews and site visits were carried out with key stakeholders across identified sectors, including hospitals, waste management companies, manufacturers of on-site disinfection machines, and chemical recycling companies. These engagements provided insights into current practices, operational challenges, and stakeholder perspectives, complementing the literature review. This empirical component strengthens the study by contextualizing regulatory, operational, and technological aspects beyond what is available in the existing literature, ensuring a comprehensive foundation for the proposed circular solution.

2.2. Primary Data Collection

The primary data for this research was obtained through both analysis of the literature and semi-structured interviews with key stakeholders. The literature explored three main areas:
Technological feasibility for on-site disinfection: A thorough examination of the current state of the art in on-site disinfection technologies for healthcare plastic waste was conducted. This involved reviewing a wide range of technologies proposed and tested in research and assessing their readiness for practical application.
Recycling methods: The review investigated various recycling methodologies used for MSW and HCPW, considering the similarity in composition between the two types. This included a detailed evaluation of both experimental and theoretical evidence to assess the technical feasibility of recycling healthcare plastics.
Regulatory and legal frameworks: The literature review also included an analysis of Swedish regulations and healthcare and environmental laws to understand the compliance requirements. This examination covered the classification, disinfection, and conversion of healthcare plastics into MSW, highlighting the legal requirements for reclassifying materials post-disinfection to facilitate recycling within a circular economy framework.
Alongside the literature review, interviews with key stakeholders provided valuable insights into the operational challenges, technical feasibility, and willingness of various actors to adopt circular solutions. Table 1 summarizes the interviews and meetings held with different stakeholder groups, including healthcare consumable manufacturers, hospitals, waste management companies, on-site disinfection machine manufacturers, and chemical recycling companies.
On-site visits also served as a key component for primary data collection, which included a study visit to a large municipal hospital in Sweden and visits to on-site disinfection machine manufacturers. The visit to a large municipal hospital in Sweden was conducted to observe the current waste management practices related to HCPW. This included evaluating how waste is handled, stored, and prepared for disposal or recycling within the hospital environment.
Further, visits were made to three different on-site disinfection machine manufacturers. During these visits, vendors presented their disinfection solutions, offering demonstrations of their machine’s operational capabilities. Detailed discussions focused on the performance metrics of the technologies, including operational costs, throughput capacity, real estate footprint, and compliance with Swedish regulatory standards. A parametric comparison of machines was carried out to determine their feasibility for integration within the hospital environment.

2.3. Data Analysis

The data gathered from the literature review and stakeholder interviews were systematically analyzed to identify key challenges and opportunities in healthcare plastic waste management. This analysis involved categorizing the data based on common themes such as regulatory requirements, technical feasibility, and stakeholder roles. The synthesis process involved mapping out the relationships between stakeholders—hospitals, waste management firms, on-site disinfection machine manufacturers, and chemical recycling companies—and identifying how their roles could be aligned to create a circular solution. By systematically analyzing and synthesizing the collected data, the study proposes a circular solution for HCPW assessed as feasible from legal, operational, and technological perspectives.

3. Themes Relevant to Healthcare Plastic Waste Management

Three areas are considered pivotal for developing a circular solution for HCPW: (1) the legal and regulatory landscape in Sweden, (2) operational routines for the management of healthcare waste, and (3) technological solutions for disinfection and recycling processes.

3.1. Regulation for Managing Healthcare Waste in Sweden

In the European Union (EU), the Waste Framework Directive (2008/98/EC) determines the regulation of healthcare waste management, along with specific regulations on hazardous waste and incineration. This directive mandates hazardous waste, including healthcare waste, to be managed in a way that ensures the protection of human health and the environment [25]. The Directive on Hazardous Waste (91/689/EEC) provides a framework for the classification of hazardous waste. Within this directive, healthcare waste is classified as hazardous waste, while measures and practices for the efficient management of hazardous waste streams are provided [26]. The European List of Waste (2000/532/EC), establishes an EU-wide classification system for waste, including hazardous waste. Healthcare waste categories classified as hazardous in this list include infectious, cytotoxic, and chemical waste [27].
Once these wastes have been classified as hazardous waste, the regulation on the Shipment of Waste (1013/2006) governs the transboundary movements of hazardous waste, including healthcare waste, mandating compliance with notification procedures to ensure safe transport and treatment within and outside the EU [28]. Once these wastes are transported to incineration facilities, the directive on the Incineration of Wastes (2000/76/EC) regulates the incineration of hazardous waste to limit the environmental impact of incineration by setting limits on emissions from incineration plants [29].
The EU sets minimum standards for healthcare waste management through directives, but member states adapt these into their national laws, leading to differences in enforcement. To achieve circularity and recycling of HCPW in Sweden, it is crucial to understand the national regulations based on the EU framework.
In Sweden, healthcare waste management is governed by a comprehensive set of regulations and routines established by several authorities. These regulations are implemented and monitored by municipalities and regions, with the National Board of Health and Welfare (Socialstyrelsen) being a major stakeholder alongside other key agencies such as the Work Environment Agency (Arbetsmiljöverket) and the Swedish Environmental Protection Agency (Naturvårdsverket) [30,31]. Table 2 presents the Swedish regulation governing waste management in the healthcare sector.

3.2. Operational Routines for Handling Healthcare Waste

The term “healthcare waste” encompasses a variety of waste types generated within the healthcare sector, often referred to interchangeably as “hospital waste”, “medical waste”, “infectious waste”, or “clinical waste” [18]. In the literature, these terms frequently overlap, functioning as synonyms or subsets [17]. For clarity and consistency in this discussion, we will adopt the term “healthcare waste”. Understanding the origins and classification of healthcare waste is crucial, particularly given the absence of a universally accepted definition. Healthcare waste can be broadly categorized into two main types: clinical and non-clinical. Clinical waste is generated in settings such as clinics, operating theaters, maternity wards, emergency care units, intensive care units, isolation wards, pathology labs, research facilities, and laboratories [17,32]. This category includes infectious, pharmaceutical, sharps, pathological, cytotoxic, and radioactive waste [33].
Conversely, non-clinical waste arises from various support and administrative activities within healthcare settings, comprising materials such as mixed plastic waste, packaging, glass (both clear and colored), paper, and cardboard. The World Health Organization (WHO) estimates that only 15% of all healthcare waste is hazardous (clinical waste), while the remaining 85% consists of non-clinical waste, which is generally safe to manage [20]. Effective healthcare waste management typically follows a standardized three-step process: collection at the facility, transportation to the treatment site, and final treatment and disposal of the waste [34].
Collection: In this initial phase, hospitals and healthcare facilities implement upstream sorting of waste based on its characteristics and materials, utilizing color-coded bins to distinguish between different waste streams. However, due to the lack of a standardized approach, facilities often develop their own sorting and collection methods [35]. This inconsistency poses significant challenges in managing healthcare waste, particularly when personal protective equipment (PPE) becomes contaminated with bodily fluids. The absence of clear guidelines can result in misclassification of potentially infectious materials, leading to further complications in waste management [36,37].
Transportation: Healthcare facilities typically engage third-party waste management companies to oversee the collection and transport of waste streams, ensuring the implementation of appropriate disposal methods such as recycling, incineration, or landfilling. These companies manage both MSW and healthcare waste, often assuming responsibility for sorting and recycling collected materials. Many waste management firms possess infrastructure for extensive sorting and collection, facilitating the efficient processing of waste [38]. Advanced sorting techniques, such as spectroscopy, are frequently employed to identify and segregate plastics based on their monomer composition [39,40].
Final treatment and disposal: In developing countries, healthcare waste disposal predominantly relies on landfilling and incineration. However, these methods encounter significant challenges, such as inadequate infrastructure, leading to inefficient treatment and increased environmental risks, including air pollution and toxic emissions. In contrast, developed nations primarily utilize incineration while progressively adopting more sustainable practices [41]. Techniques like autoclaving, chemical treatments, and microwave technology are increasingly being implemented to neutralize infectious waste before disposal [42]. Furthermore, there is a growing emphasis on recycling non-hazardous waste, reducing the volume directed towards landfills and incinerators [43].
The healthcare waste management process observed at a large Swedish hospital necessitates effective upstream sorting throughout the facility, in line with established regulations for the safe handling of waste from both clinical and non-clinical activities. However, during the visit, it became apparent that the distinction between infectious and non-infectious waste relies on the experience and intuition of healthcare personnel. This lack of a standardized operating procedure can lead to inconsistencies in waste classification, potentially compromising safety.
However, the facility adheres to rigorous protocols for the collection of hazardous waste, such as radioactive and cytotoxic materials, demonstrating a commitment to compliance with national regulations governing hazardous waste management. Notably, strict protocols are in place for the disposal of sharps and other high-risk items, which are separated as biomedical and hazardous waste. The COVID-19 pandemic further complicated waste management practices, as all healthcare waste is treated as potentially infectious. This shift highlights the uncertainty surrounding contamination levels and has prompted the hospital to explore technologies for the safer handling of waste.
Waste management companies play a critical role in handling both MSW and healthcare waste, with established technologies for sorting and recycling at their centralized waste collection facility. The primary goal of the sorting process is to ensure proper recycling and promote a sustainable end-of-life solution for waste materials. These companies employ advanced sorting techniques, including spectroscopy, to identify and separate plastics, demonstrating a commitment to efficiency and sustainability. However, personnel at the waste management company revealed ongoing challenges in reliably distinguishing between infectious and non-infectious waste streams. This ambiguity often leads to these streams being directed toward waste-to-energy solutions, such as incineration, although the facility is currently utilizing advanced sorting technologies to enhance the identification of plastics for recycling.
These observations underline the essential link that waste management companies provide between hospitals and recycling companies. To ensure the safe transportation of waste streams and protect personnel, the disinfection and conversion of healthcare plastic waste to MSW are necessary steps.

3.3. Technological Solutions for Management of HCPW

Both hospitals and waste management companies seek on-site disinfection to ensure safer waste handling, due to the uncertainty of contaminated waste posing a risk of secondary infections. This uncertainty also hinders recycling. Therefore, understanding disinfection methods and recycling technologies is crucial.

3.3.1. Technologies for Disinfection of Healthcare Waste

Healthcare waste comprises a mix of hazardous and non-hazardous materials. While 85% of healthcare waste is typically non-hazardous, the remaining 15% includes materials that are infectious, radioactive, or chemically toxic, posing risks to health and safety [20,44]. To minimize infection risks and safeguard personnel, waste management companies treat all healthcare waste as potentially hazardous [45]. Addressing this challenge, Ilyas et al. investigated on-site disinfection methods to address these risks [16]. Table 3 presents a comparison of key on-site disinfection technologies—chemical disinfection, microwave sterilization, and on-site pyrolysis—summarizing their respective advantages and limitations. These technologies are compared to the conventional disinfection technology of autoclaving [10].
Autoclaves, a conventional method for on-site disinfection in healthcare, use high-temperature steam to eliminate pathogens effectively [10,55]. Newer methods, such as microwave-assisted disinfection, leverage moisture in waste to achieve high temperatures through microwave-induced molecular friction, offering up to 6Log10 (i.e., 99.9999%) disinfection with lower operational costs than autoclaves [56]. Chemical disinfection, another alternative, employs chemical agents to neutralize pathogens in healthcare waste. As a drawback, this method poses risks such as the inhalation of harmful chemicals and skin cancer to personnel, necessitating the use of PPE during manual operations [50,52,57]. On-site pyrolysis, gasification, and plasma-based treatment are prohibitively expensive unless implemented at scale.
Autoclaving remains the most common disinfection method, but emerging technologies like microwave-assisted disinfection, resistance heating, and chemical disinfection are gaining commercial traction. The sales manager at Company D highlighted significant sector-level growth in the adoption of on-site disinfection technologies within hospitals. This trend reflects an increasing willingness among healthcare facilities to invest in such technologies as a cost-effective solution, particularly in reducing the higher logistic expenses associated with hazardous waste transportation.
From the literature, the main technologies used for the on-site disinfection of healthcare waste are microwave-assisted disinfection, chemical disinfection, and steam sterilization via autoclaving. For this study, multiple visits were conducted to disinfection machine manufacturers to examine machine operations and perform a parametric comparison of their performance, specifically comparing these new technologies to autoclaving, the most widely implemented disinfection method. These visits helped identify state-of-the-art industry developments, linking them to the scientific literature. Data for parametric comparison was gathered through meetings, interviews, and product information provided by machine suppliers. Table 4 presents the parametric comparison of these machines, each utilizing different working principles.
Table 4 shows that microwave disinfection with shredding not only meets legal requirements for converting HCPW to MSW but also significantly reduces waste mass and volume, lowering transportation costs and operational demands.

3.3.2. Technologies for Recycling for Healthcare Plastic Waste

The recycling of plastics plays a crucial role in resource conservation and sustainability. It helps reduce the need for virgin materials [58]. Based on the literature, four main recycling strategies for plastics [59] are analyzed in Table 5, highlighting their advantages and limitations.
Upon reviewing the four recycling strategies for plastic waste while considering the compositional similarity of healthcare waste to MSW, tertiary or chemical recycling emerges as the most suitable process for further analysis [66,67]. Chemical recycling encompasses multiple technologies suitable for value recovery from mixed plastics. Among these, gasification, pyrolysis, and thermal cracking—both with and without catalysts—are the most commercially viable methods, possessing the highest technological readiness levels (TRL9) [66]. Pyrolysis, in particular, is identified as a promising waste-upcycling technology and the most effective value-recovery method [53,62,68,69]. This process involves the thermal degradation of organic material in an anaerobic environment, breaking down HCPW into high-value products such as pyrolytic oil, biochar, biogas, and other chemicals. These products can be further upcycled by hydrocracking into commercial fuels and polymers [70]. Pyrolytic oil, considered the most valuable product due to its high calorific value, can be processed into petrochemicals and petroleum products with properties comparable to those derived from crude oil [71,72]. Evidence-based studies for the conversion of HCPW into high-property bio-oils confirm the hypotheses for pyrolysis as a technologically feasible solution [69,73,74,75] with optimization efforts focused on enhancing process conditions and yields using HCPW as feedstock [76,77,78]. In summary, the physio-chemical characteristics of pyrolytic oil produced from the pyrolysis of medical plastic waste have similar properties to that of fossil fuels like diesel, gasoline, and naphtha [53,79]. Thus, thermochemical conversion processes such as pyrolysis can enhance circularity by transforming plastic waste into energy, value-added products, and resources [80].
Chemical recycling has emerged as a robust and validated technology for closing material loops in the management of end-of-life (EoL) plastics. This process is increasingly leveraged to convert MSW into high-value recyclates, sustainable aviation fuel (SAF), and valuable chemical intermediates such as pyrolysis oil. Among the various chemical recycling methodologies, pyrolysis has gained significant attention due to its efficacy in processing and acceptance of mixed plastic feedstocks.
Interviews with representatives from two leading companies in the chemical recycling sector reveal the adoption of catalytic pyrolysis, a process characterized by its enhanced tolerance for the heterogeneity of mixed plastic feedstocks. While the optimal feedstock composition is ideally devoid of polyvinyl chloride (PVC), the catalytic process—particularly when employing zeolites in an alkaline medium—effectively mitigates the formation of harmful byproducts, such as hydrochloric acid and polycyclic aromatic hydrocarbons. The process experts have indicated that the presence of minor amounts of PVC within the feedstock is permissible, without substantially compromising the process’s efficiency.
Moreover, it has been emphasized that a feedstock predominantly composed of polyolefins significantly enhances the success of the chemical recycling process. Additionally, the feedstock must be devoid of moisture and processed into either a shredded or agglomerated form to facilitate optimal pyrolysis. The microwave-assisted disinfection and upcycling of healthcare plastic waste yield a shredded feedstock with markedly reduced moisture content. Upon presenting the characteristics of this upcycled feedstock to the pyrolysis industry experts, they confirmed its compatibility with their process requirements. Hence, disinfected and upcycled healthcare plastic waste aligns with critical feedstock criteria, positioning it as a valuable resource for pyrolysis processes.

4. Proposal of a Circular Solution for Healthcare Plastic Waste

The proposed circular solution for HCPW combines operational, technological, and legal considerations to enable sustainable waste management. Operationally, it begins at hospitals, where on-site microwave-assisted disinfection neutralizes infection risks, ensuring that waste is safe for handling and reducing transportation complexities. Technologically, microwave-assisted disinfection achieves the regulatory 5-log10 sterilization requirement, thereby meeting the legal standards that allow treated HCPW to be classified as MSW. This classification enables subsequent handling, sorting, and supply to chemical recycling companies without the uncertainty surrounding potential infection risks, facilitating compliance with waste management regulations. For microwave-assisted disinfection with on-site shredding, small-scale and private clinics typically adopt Company D’s solution, while larger healthcare establishments, such as regional hospitals, prefer multiple units from Company E utilizing similar technology.
Pyrolysis as an end-of-life process is a technologically feasible method with established evidence for its global commercial adoption to produce valuable intermediates like pyrolysis oil [66]. Pyrolysis oil can also be used to produce renewable energy such as SAF and biodiesel, providing an alternative energy source or valuable circular plastics such as PP, LDPE, and HDPE by hydrocracking of pyrolysis oil [70,81], This promotes circularity within the sector. Figure 2 presents the proposed circular solution for HCPW.
In the present study, the authors build upon their prior work reported in [24], extending the initial framework by incorporating empirical insights from site visits and stakeholder interviews while offering a more comprehensive assessment of the legal, operational, and technological landscapes in implementing a circular solution for HCPW. Additionally, this work introduces a multi-stakeholder value capture model presented in Table 6, further emphasizing collaboration as a key enabler of circularity [23]. These advancements provide a more detailed and context-specific analysis, strengthening the practical applicability of the proposed solution.
However, the shift from a linear approach towards a circular solution requires the involvement of new stakeholders and the addition of operations. To support this transition, a multi-stakeholder collaboration analysis is conducted to identify the value captured through strategic partnerships and collaborations. This analysis highlights the alignment of individual stakeholder interests. Table 6 identifies key stakeholders and the shared value derived from their collaborations, illustrating the strategic coordination needed across the industry. The horizontal axis is numbered 1 to 4, while the vertical axis is labeled A to D, representing different stakeholders. For instance, cell A2 illustrates the value of collaboration between hospitals and healthcare service providers (horizontal axis) and on-site disinfection machine manufacturers (vertical axis). Cells along the diagonal (A1, B2, C3, D4) indicate that stakeholders cannot collaborate with themselves (N.A.).

5. Prospects and Future Challenges

Microwave disinfection, combined with shredding, serves as a valuable technology reducing the need for additional steps, such as grinding and drying for pyrolysis, which reduces additional steps thereby reducing operational costs to waste management companies [82]. The treated waste, composed of high-grade plastics from healthcare products, meets the requirements for chemical recycling feedstock, creating economic incentives for waste management companies through the aftermarket for upcycled plastics. In the European market, the resale value of plastics is approximately €450 per metric ton [83], further incentivizing the involvement of waste management companies. The on-site disinfection also benefits hospitals and healthcare service providers by reducing transportation costs and operational efforts due to the waste category of MSW and reductions in mass and volume.
Achieving circularity in plastic waste management requires collaboration across industries. Strategic partnerships between waste management companies and chemical recycling firms are key to securing high-quality feedstock and developing innovative solutions for end-of-life plastics. These alliances help waste management companies differentiate their services and increase the value of recycled plastics. Additionally, partnering with manufacturers of on-site disinfection machines adds further value. By integrating disinfection into their processes, waste management companies can offer comprehensive services to healthcare providers, ensuring regulatory compliance and reducing risks. This collaboration also helps lower waste volume and transportation costs. For on-site disinfection machine manufacturers, aligning their technology with broader waste management strategies enhances their appeal to healthcare facilities. Finally, for chemical recycling companies, under the EU’s Emissions Trading System, intermediate products such as pyrolysis oil qualify as recyclates [84,85], which facilitates incentives such as tax reductions to chemical recycling companies.
The emphasis on the circularity of HCPW not only promotes sustainability but also fosters strategic alliances that drive innovation across industries. Ultimately, these partnerships provide mutual value to all stakeholders while benefiting society by creating a sustainable pathway for recycling plastics from healthcare sources, which would otherwise be incinerated or landfilled.
Despite these prospects, challenges persist. The installation of on-site disinfection machinery requires additional space at hospitals that might not be planned in the original design of hospital operations. Additionally, these machines require ventilation due to the heat and fumes generated during operation, and existing hospital infrastructures may not support such expansions. While manufacturers are developing machines of various sizes to address space constraints, a challenge remains: customers primarily use these machines to reduce logistics costs and enhance safe waste handling, indicating a potential misalignment in the value proposition. Chemical recycling companies face another challenge, requiring larger quantities of feedstock from waste management companies. They emphasize the need for materials free from restricted substances such as metals and PVC that can reduce process yields. To achieve profitability, these companies prefer to procure plastic feedstock below market prices. Hence, collaboration and partnerships between waste management companies and chemical recycling companies set buy-sell agreements to ensure feedstock availability at a favorable price point for both stakeholders [86]. While microwave-assisted disinfection is essential for decontaminating plastic waste, it does not eliminate persistent organic contaminants. The prior literature indicates that pyrolysis can lead to the accumulation of PAHs, PCBs, and PCDD/Fs in its by-products, posing environmental and health risks. To mitigate this, high-temperature combustion of pyrolysis condensate is recommended to prevent hazardous accumulation in recycled materials [87].
While this study outlines significant prospects for implementing a circular solution for HCPW, addressing the identified challenges is crucial for realizing the full potential of these innovative solutions.

6. Conclusions

The management of plastics in the healthcare sector faces significant challenges due to the predominant reliance on a linear “make-use-dispose” model, where plastics are typically incinerated or landfilled, leading to environmental and health risks, including contamination and harmful emissions.
This study advances the technological landscape of HCPW recycling by proposing a circular solution that integrates on-site microwave-assisted disinfection with shredding, followed by chemical recycling leveraging pyrolysis. The adoption of on-site disinfection technology eliminates uncertainty regarding contamination, which has been a key operational barrier preventing the recovery of value from HCPW. By converting treated HCPW into MSW, this solution enhances waste handling efficiency, reduces logistical complexities, and ensures compliance with regulatory requirements, making it more accessible for further processing. Additionally, the integration of on-site treatment with chemical recycling serves a dual purpose—it prepares high-quality feedstock for chemical recycling companies while supporting advancements in pyrolysis as a scalable and efficient method for closing the material loop. Pyrolysis upcycles HCPW into valuable secondary raw materials, reducing reliance on virgin plastics and fostering a circular economy within the healthcare sector.
Through a synthesis of insights from the literature and stakeholder interviews, this study addresses key legal, operational, and technological barriers to achieving circularity in HCPW recycling. The proposed stakeholder collaboration and value capture matrix further underscores the importance of cross-sectoral partnerships, ensuring the successful adoption and scalability of the proposed circular model.
Future research should prioritize pilot implementation projects in collaboration with key stakeholders within the circular value chain. These pilots would evaluate the commercial viability, financial performance, waste collection strategies, feedstock preparation, logistics, and integration of the proposed system into existing waste management processes. While pilot projects serve as valuable indicators of feasibility, barriers and enablers, life-cycle assessment (LCA) and modeling, and simulation studies further enhance the assessment of environmental performance and financial viability. These approaches offer deeper insights into the scalability and functionality of the proposed circular solution compared to the present linear scenario. Such initiatives are essential for testing and refining the proposed circular solution, ensuring it is both scalable and sustainable, and setting a foundation for the broader adoption of circular economy principles in HCPW management.

Author Contributions

Conceptualization, B.G.; methodology, B.G.; validation, S.S.-u.-H., I.T. and N.S.; formal analysis, B.G.; investigation, B.G.; data curation, B.G.; writing—original draft preparation, B.G.; writing—review and editing, S.S.-u.-H., I.T. and N.S.; visualization, B.G.; supervision, S.S.-u.-H. and N.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Conflicts of Interest

Author Iliass Temsamani was employed by the company Siemens Digital Industries. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abbreviations

The following abbreviations are used in this manuscript:
EUEuropean Union
HCPWHealthcare plastic waste
PPEPersonal protective equipment
PUPolyurethane
PPPolypropylene
PCPolycarbonate
LDPELow-density polyethylene
PVCPoly-vinyl chloride
PSPolystyrene
MSWMunicipal solid waste
HSPsHealthcare service providers
PAHsPolycyclic aromatic hydrocarbons
PCBsPolychlorinated biphenyls
PCDD/FsPolychlorinated dibenzo-p-dioxin and dibenzofurans
LCALice-cycle assessment

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Recycling 10 00027 g001
Figure 1. Linear consumption of plastics in the healthcare sector—adapted from [24].
Figure 1. Linear consumption of plastics in the healthcare sector—adapted from [24].
Recycling 10 00027 g001
Recycling 10 00027 g002
Figure 2. Proposal of circular solution for plastics in the healthcare sector—adapted from [24].
Figure 2. Proposal of circular solution for plastics in the healthcare sector—adapted from [24].
Recycling 10 00027 g002
Table 1. Summary of interviews and on-site visits with key stakeholders.
Table 1. Summary of interviews and on-site visits with key stakeholders.
Stakeholder GroupSuccessive InterviewsNumber of
Attendees		Positions Held by IntervieweesSize of
Enterprise		On-Site Visit and Discussion
Hospital43Environmental Strategist, Environmental Coordinator, Environment ManagerLargeYes
Chemical Recycling Technology Provider-Company A43Process Manager, LCA Engineer, Process SpecialistLarge
Chemical Recycling Technology Provider-Company B12Procurement Engineer, Process ManagerLarge
Waste Management Logistics Company12Head of Hazardous Waste, Operations CoordinatorLarge
On-site Disinfection-Company C21Sales RepresentativeSME
On-site Disinfection-Company D32Sales Manager, Design EngineerSMEYes
On-site Disinfection-Company E12Sales Engineer, Director of SalesSMEYes
Licensor–Consultant11R&D Process Engineering Consultant SME
Healthcare Consumable Manufacturer43ESG Manager, Sustainability Director, Head of ESGLargeYes
Table 2. Regulations for managing healthcare waste in Sweden.
Table 2. Regulations for managing healthcare waste in Sweden.
RegulationsAim and Scope of the Regulation
Environmental Code—SFS 1998:808 The legal foundation for environmental protection, including waste management.
Waste Ordinance—SFS 2020:614 Specification of general waste management protocols.
Regulations for Contagious Waste—SOSFS 2005:26Dictates the handling, storage, and transportation of contagious waste.
Infection Risks—AFS 2018:4 Addresses infection control measures and categorizes infection risks based on four risk groups.
Transporting Waste—NFS 2005:3 Provides guidelines for the transportation of waste.
Reporting and Documenting Dangerous Waste—NFS 2020:5Mandates the reporting and documentation of hazardous waste.
Transport Regulation of Dangerous Waste—MSBFS 2020:9Governs the transportation of hazardous goods.
Waste for Landfill—SFS 2001:512Pertains to landfill waste management.
Table 3. Comparisons of healthcare waste management and disinfection process: Adapted from [16,46,47,48,49,50,51,52,53,54].
Table 3. Comparisons of healthcare waste management and disinfection process: Adapted from [16,46,47,48,49,50,51,52,53,54].
Disinfection TechnologyAbout the RrocessAdvantageLimitations
Autoclave—On-siteThe use of pressurized steam at high temperatures to sterilize healthcare plastic waste, ensuring the destruction of all microbial life.Good sterilization; technologically mature process; good efficiency. Produces toxic gasses; bad odor; cannot reduce volume of waste; increased mass and moisture in waste.
Chemical Disinfection—On-SiteThe use of chemical agents to destroy or deactivate pathogens in healthcare plastic waste, rendering it safe for disposal or recycling.High efficiency; high sterilization; broad sterilization spectrum; can destroy spores and fungi along with bacteria and viruses.High operational cost; cannot reduce volume of waste; increased mass and moisture in waste.
Microwave Disinfection—On-SiteThe application of microwave radiation to heat and disinfect HCPW, effectively killing pathogens through thermal effects.High efficiency; high sterilization; broad sterilization spectrum; can destroy most bacteria and viruses; low pollution; low operational cost; mass reduction; moisture reduction.Moderately high capital expenditure.
On-site Pyrolysis/Gasification and Other Valorization MethodsThe thermal decomposition of healthcare plastic waste in the absence or limited presence of oxygen to produce valuable by-products such as syngas, bio-oil, and char, while simultaneously eliminating pathogens.Reduction in mass and volume; generation of value-added products; high efficiency.Extremely high capital expenditure; requires pre-treatment and upcycling of plastic waste.
Table 4. Parametric comparison of on-site waste disinfection machines.
Table 4. Parametric comparison of on-site waste disinfection machines.
Disinfection TechnologyChemical Disinfection Microwave-Assisted
Disinfection 		Microwave and Resistance Disinfection Autoclave
Company Company C Company D Company E Current Method
Capacity per cycle (Kg)8 kg 10 kg–44 kg 75 kg–250 kg2.5 kg–88 kg
Working principleChemical agents (biocides) and shreddingMicrowave and shreddingMicrowave, electrical resistance, and shreddingPressurized steam
Cycle time15 min30 min60 min30 min
Cycle time per kg1.9 min/kgFrom 3 min/kg to 0.68 min/kgFrom 1.25 min/kg to 0.24 min/kgFrom 12 min/kg
Running cost per kg5.18 SEK per kg1.24 SEK per kg1 SEK per kg11.45 SEK per kg
Initial costLowLowHighLow
Energy per hourLow (3.9 kW/h)Low (3 Kw/h)High (20 kW/h)Medium (6 kW/h)
Energy per kg (small)0.49 kW/h0.3 kW/h0.27 kW/h2.4 kW/h
Weight reductionNoYes, approx. 20%Yes, approx. 20%No
Volume reductionYes 80%Yes, 80%Yes, 80%No
Sterilization levelHigh (also for spores)HighHigh High
Sterilization capacity6Log106Log106Log105Log10
ConsumablesYesNoNoNo
Water consumptionHighLowLowYes
Maintenance needsMedium (filters)LowLowYes
Regulations complianceMediumHighHighVery High
Automatic sorting (add-on)NoNoYesNo
Self-cleaningYesNoNoSemi-self-cleaning
Labor skill levelUnskilledUnskilledSemi-skilledSkilled
Table 5. Recycling methodology for plastic wastes adapted from [60,61,62,63,64,65,66].
Table 5. Recycling methodology for plastic wastes adapted from [60,61,62,63,64,65,66].
Recycling MethodDefinitionAdvantagesLimitations
Primary Recycling or Closed-Loop RecyclingReuse of plastic scraps to produce items with similar properties and characteristics to the original material. Most suitable for discarding waste within production processes; established process.Not suitable for contaminated, non-homogeneous, or mixed plastic streams;
Secondary Recycling or Mechanical RecyclingRecovery of plastics through mechanical processes that downgrade the recycled material, resulting in reduced quality.Less energy consumption; established process. mixed plastic cannot be used and requires extensive sorting; output of the process leads to loss in physical, chemical, and mechanical properties.
Tertiary Recycling or Chemical RecyclingRecovery and upcycling of plastics through thermochemical processes, breaking down polymers into monomers with quality recovery of the recycled material.Well-established processes; feedstock is mixed plastic with lower moisture content; output is usually upcycled into circular plastics having up to 100% of virgin plastic characteristics.Feedstock must not have moisture content; very expensive for small-scale setups.
Quatenary Recycling or Energy RecoveryEnergy recovery through incineration. Current method for value recovery through incineration of plastic waste; cheap process; established process.Toxic gas emissions; air pollution; smoke, ash, tar, and dust formation.
Table 6. Stakeholder collaboration value capture matrix.
Table 6. Stakeholder collaboration value capture matrix.
Hospital and HSP
(1)		On-Site Disinfection Machine Manufacturers
(2)		Waste Management Company
(3)		Chemical Recycling
Company
(4)
Hospitals
and HSP
(A)		N.A.
(1)
Reduced hazardous waste streams.
(2)
Reduction in mass and volume of waste.
(3)
MSW conversion reduces contamination risks.
(4)
Improved personnel safety in waste handling.
(1)
Access to a comprehensive waste management solution.
(2)
Strengthen brand and public image through sustainable waste recycling.
N.A.
On-site
Disinfection
Machine
Manufacturers
(B)
(1)
Hospitals and HSPs are primary customers.
(2)
Their feedback drives innovation and product adaptation.
(3)
Partnerships enable higher market penetration and enhanced brand visibility.
N.A.
(1)
Integrated disinfection and waste management streamline healthcare operations.
(2)
Position with broader waste management strategy increases value.
(3)
Set a valuable business-to-business customer for their machines, enhancing brand visibility.
N.A.
Waste
Management
Company
(C)
(1)
Rising demand for environmental solution creates opportunities in healthcare waste management.
(2)
Becoming a trusted partner strengthens market positioning.
(1)
Serving common HSP clients enables a more comprehensive service.
(2)
Added value and competitive advantage for complete waste management solutions.
(3)
Collaboration ensures regulatory compliance, and reduces legal risks.
(4)
Lower waste mass and volume reduces transportation cost and improves profitability.
(5)
Reduced contamination risk enhances staff safety.
N.A.
(1)
Support circular economy by supplying feedstock to recyclers.
(2)
Differentiate through advanced circular-waste-processing.
(3)
Green image by converting waste plastics into high-value products like circular plastics or renewable energy.
Chemical
Recycling
Company
(D)		N.A.N.A.
(1)
Partner with waste management companies for stable, high-quality feedstock.
(2)
Reliable supply balances demand, ensuring economic viability.
(3)
Collaborative R&D advances viable circular solutions for plastics.
N.A.
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MDPI and ACS Style

Ganesh, B.; Shoaib-ul-Hasan, S.; Temsamani, I.; Salehi, N. Towards a Circular Solution for Healthcare Plastic Waste: Understanding the Legal, Operational, and Technological Landscape. Recycling 2025, 10, 27. https://doi.org/10.3390/recycling10010027

AMA Style

Ganesh B, Shoaib-ul-Hasan S, Temsamani I, Salehi N. Towards a Circular Solution for Healthcare Plastic Waste: Understanding the Legal, Operational, and Technological Landscape. Recycling. 2025; 10(1):27. https://doi.org/10.3390/recycling10010027

Chicago/Turabian Style

Ganesh, Bharghav, Sayyed Shoaib-ul-Hasan, Iliass Temsamani, and Niloufar Salehi. 2025. "Towards a Circular Solution for Healthcare Plastic Waste: Understanding the Legal, Operational, and Technological Landscape" Recycling 10, no. 1: 27. https://doi.org/10.3390/recycling10010027

APA Style

Ganesh, B., Shoaib-ul-Hasan, S., Temsamani, I., & Salehi, N. (2025). Towards a Circular Solution for Healthcare Plastic Waste: Understanding the Legal, Operational, and Technological Landscape. Recycling, 10(1), 27. https://doi.org/10.3390/recycling10010027

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