Disposal of Household Healthcare Waste: A Cross-Sectional Analysis from Türkiye

Abstract

Aim:

The aim of this study is to identify the types and disposal methods of household healthcare waste (HHW) in Türkiye.

Methods:

This cross-sectional study was carried out between December 15, 2023, and March 15, 2024. A structured survey was administered to 1243 patients or accompanying relatives who received outpatient care or were discharged from a tertiary healthcare institution in Türkiye, ensuring only one respondent per household. Descriptive statistical methods including frequencies, percentages, means, standard deviations, and minimum–maximum values were used to analyze the data.

Results:

The most common pharmaceutical HHWs in the past year were: 89.1% tablets, 56.5% syrups, 52.5% ointments, and 33.6% drops. The most common infectious HHW was 25% blood-contaminated dressing waste. The most common sharps HHWs were 20.7% blood glucose measurement needles/kits, 19.4% syringes, and 11.3% broken light bulbs. 43.1% of participants reported disposing of infectious HHWs, 37% of sharps HHWs, and 67.6% of pharmaceutical HHWs in household waste.

Conclusion:

Findings highlight substantial gaps and challenges in HHW disposal practices in Türkiye. A significant proportion of HHWs is disposed of together with household waste, and most individuals lack adequate information regarding safe disposal methods. These results underscore the urgent need for legislative frameworks and public education initiatives to improve HHW management, protect public health, and promote environmental sustainability.

What is already known on this topic?

• Household healthcare waste (HHW), including pharmaceuticals, sharps, and infectious materials, poses serious risks to public health and the environment if not properly managed.

• In many countries, including Türkiye, HHWs are often disposed of with general household waste due to the absence of specific disposal guidelines or public awareness.

• Previous studies indicate that improper disposal of medical waste can lead to infections, injuries, and environmental contamination.

What this study adds on this topic?

• This study provides the first large-scale cross-sectional data on HHW types and disposal methods in Türkiye.

• It reveals that over two-thirds of pharmaceutical HHWs and more than one-third of sharps and infectious HHWs are discarded in regular household trash.

• This study provides an evidence-based foundation for the development of a national action plan for the safe management of HHW in Türkiye, highlighting the urgent need for regulatory frameworks, clearer municipal responsibilities, and enhanced public awareness.

Introduction

Household healthcare waste (HHW) refers to medical or potentially infectious waste generated in homes, including items such as used syringes, dressings, expired medications, and contaminated materials. The World Health Organization (WHO) defines waste generated as a result of healthcare activities, such as syringes, contaminated dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices, and radioactive materials, as healthcare waste (WHO, 2024). In addition, synonymous terms such as medical waste, biomedical waste, clinical waste, and health facility waste are also used in the literature to refer to healthcare waste. According to the WHO, approximately 85% of healthcare waste is considered nonhazardous, while the remaining 15% consists of infectious and hazardous waste. Hazardous healthcare waste may include pathogenic microorganisms, radioactive materials, toxic chemicals, pharmaceutical components, and sharps (WHO, 2024). In developed countries, an average of 0.5 kg of hazardous healthcare waste is produced per hospital bed per day, whereas in low-income countries, this amount is approximately 0.2 kg. However, in low-income countries, healthcare waste is often collected without being separated into hazardous and nonhazardous categories, which results in an overestimation of the actual amount of hazardous waste (WHO, 2024). With the advancement of medical technologies and the improvement of health standards, the amount of healthcare waste worldwide has been increasing every year. A similar rise has been observed in Türkiye, where the amount of healthcare waste sent to waste treatment facilities for disposal was recorded as 130,401 tons in 2022 (Republic of Turkey Ministry of Environment, 2022).

Healthcare institutions are the largest producers of healthcare waste. Medical waste is generated in facilities that provide healthcare services, such as hospitals, laboratories, veterinary clinics, research centers, and nursing homes (WHO, 2024). However, the generation of healthcare waste is not limited to healthcare institutions. Factors such as an aging population, advancements in medical technologies, the shift from inpatient to outpatient treatment for chronic diseases, reduced hospital stays, and the increasing prevalence of home healthcare services have led to the generation of significant amounts of healthcare waste outside of healthcare facilities. Particularly, the COVID-19 pandemic has contributed to an increase in the production of medical waste and contaminated personal protective equipment, as well as the classification of household waste generated by quarantined individuals as COVID waste. This situation has placed a considerable burden on the medical waste management systems, particularly in countries with transitional economies. (Sharma et al., 2020; Singh et al., 2020a; Singh et al., 2020b). During the pandemic, home isolation and quarantine measures led to the rapid accumulation of potential COVID waste in domestic environments. This situation has posed serious environmental and public health risks regarding the management of healthcare waste in households (Household Healthcare Waste, HHW) and has become an issue requiring urgent improvements (Hangulu and Akintola, 2017; Ilyas et al., 2020; Manzoor and Sharma, 2019; Peng et al., 2020; Sarkodie and Owusu, 2020; Silva et al., 2022a; Silva et al., 2022b; Singh et al., 2020a; Singh et al., 2020b; Zikhathile and Atagana, 2018). During this process, while there is relatively more comprehensive knowledge and control mechanisms regarding the management of medical waste in healthcare institutions, it has been highlighted that there are significant uncertainties and gaps in the management of HHW (Sarkodie and Owusu, 2020; Silva et al., 2022a; Silva et al., 2022b; Singh et al., 2020a; Singh et al., 2020b). Moreover, the uncertainty regarding how to manage HHW in many developed and developing countries, along with the inclusion of these wastes in municipal solid waste systems, leading to environmental pollution, constitutes a significant issue (Hangulu & Akintola, 2017; Ilyas et al., 2020; Silva et al., 2022a; Silva et al., 2022b; Zikhathile & Atagana, 2018).

Ineffective management of medical waste can lead to the spread of infectious agents, genotoxic effects, the dispersion of toxic chemicals or pharmaceuticals into the environment, and injuries caused by sharps. It is well known that such waste poses significant risks to environmental and public health (Cao et al., 2019; Essandoh et al., 2015; Manzoor and Sharma, 2019; Miyazaki et al., 2007; Padmanabhan & Barik, 2019; WHO, 2024). In Türkiye, regulations regarding the management and disposal of medical waste were established with the publication of the Medical Waste Control Regulation in 2017 (Official Gazette of the Republic of Turkey, 2017). However, this regulation only covers medical waste generated in healthcare institutions, and there are no provisions for the disposal of HHW. This creates a significant gap in how HHWs should be managed and disposed of. Additionally, the lack of publications related to the disposal of HHWs contributes to the neglect of their management. No national-level data on public awareness regarding the disposal of HHW could be identified in Türkiye; existing studies appear to focus predominantly on assessing healthcare workers’ knowledge, attitudes, and/or practices related to medical waste management.

This study aims to comprehensively examine the types and disposal methods of HHW generated in Türkiye. The findings are expected to contribute to the academic literature on HHW management and guide strategic planning for the development of waste management policies.

Resarch Questions

The research questions are as follows:

• What is the level of public awareness regarding HHW management?

• What disposal methods are applied for infectious HHWs?

• What disposal methods are applied for pharmaceutical HHWs?

• What disposal methods are applied for sharps HHWs?

Methods

Study Design

The present study was conducted using a cross-sectional design.

Sample

This study was conducted between December 15, 2023, and March 15, 2024. The study population consisted of 1243 patients or their relatives who were examined in outpatient clinics, received outpatient treatment, or were discharged from a tertiary healthcare facility in Tekirdağ, Türkiye, during the specified period (with only one representative per family). No sampling was conducted, and all individuals aged 18 and over, who had no mental, physical, or sensory (visual, auditory) impairments, or their family members from the institutions where the study was carried out were invited to participate. The minimum required sample size was calculated using Cochran’s formula (n = Z²pq/L²) with a 95% confidence level (Z = 1.96), an assumed prevalence of 0.50 (P = .50; q = 1−p), and a margin of error of 5% (L = 0.05). The minimum required sample size was 384. However, to increase representativeness, reduce sampling error, and account for non-response, data were collected from all eligible individuals during the study period, resulting in a final sample of 1243 participants. The study was conducted in Tekirdağ, a province located in the northwest of Türkiye with a population of 1 167 059, which is considered a major city. The hospital where the study was conducted is a 430-bed tertiary healthcare facility affiliated with a university, operating with 1275 academic and administrative staff. The study was conducted in a single province (Tekirdağ), which limits the generalizability of the findings to the broader population of Türkiye. Therefore, the results should be interpreted with caution when extrapolated to other regions.

Data Collection Tools

Household Healthcare Waste Identification Form: The form was developed by the researchers after reviewing the relevant literature (Hangulu & Akintola, 2017; Rogowska & Zimmermann, 2022; Silva et al., 2022a; WHO, 2024). The form consisted of 34 items organized into 3 sections: (1) awareness of HHW management, (2) household health-related characteristics (e.g., presence of a chronic illness, receiving home care services), and (3) disposal practices for infectious, sharps, and pharmaceutical waste.

Data Collection

After obtaining the necessary ethical committee approval and institutional permissions, data were collected through face-to-face administration of the survey by trained researchers. Individuals who met the inclusion criteria were approached in the relevant outpatient and inpatient units, informed in detail about the purpose, scope, and procedures of the study, and invited to participate. For participants who were unable to complete the form independently due to health-related limitations, the survey was administered to a first-degree caregiver. In these cases, the researchers provided a clear verbal explanation of each item to ensure comprehension and accurate reporting. Throughout the data collection process, researchers offered clarification when needed to minimize misinterpretation. Completion of the HHW Identification Form took approximately 10 minutes for both participants and caregivers. This study used ChatGPT (OpenAI) to assist with the translation of the manuscript from Turkish to English during manuscript preparation. The authors reviewed and approved the translated text and take full responsibility for the final version of the manuscript.

Data Analysis

The statistical analyses of the data obtained in the study were performed using SPSS 21.0 software (IBM Corp.; Armonk, NY, USA) . Continuous variables are calculated using mean, standard deviation, minimum, and maximum values, while categorical variables are expressed as frequencies and percentages.

Ethical Considerations

All participants in the study signed a written informed consent form in accordance with the Declaration of Helsinki. The study protocol was approved by the Non-Interventional Clinical Research Ethics Committee of the Faculty of Medicine, Tekirdağ Namık Kemal University (Date: November 28, 2023; Protocol number: 2023.189.11.03). Institutional permission from the hospital administration was obtained prior to data collection.

Results

The participants reported an average of 3.93 ± 1.65 people in their households, with 58.7% indicating that their family income was equivalent to their expenses, 78.6% stating that there were no healthcare professionals in their families, and 69.7% mentioning that they had not received information regarding HHW management. Additionally, 50.9% of the participants reported having a family member with a chronic illness, 6% indicated that they received home care services, and 8.6% reported having a family member in need of care (Table 1).

Table 1.

Family Characteristics of Participants (N=1243)

		n	%
Household income	Income less than expenses	282	22.7
	Income equal to expenses	730	58.7
	Income more than expenses	211	17
Healthcare professional in the family	Yes	258	20.8
	No	977	78.6
Information on HHW management	Receives	376	30.2
	Does not receive	867	69.7
Family member with chronic illness	Yes	633	50.9
	No	610	49.1
Family member receiving home care services	Yes	75	6
	No	1168	94
Family member in need of care	Yes	107	8.6
	No	1136	91.4
Number of people in the household (mean ± SD)	3.93 ± 1.65

In the past year, 25% of the participants reported the presence of blood-contaminated dressing waste (16.45 ± 42.47 items/year), 8.6% reported gloves contaminated with blood (20.81 ± 38.94 items/year), 6.4% reported serum sets (6.78 ± 11.45 items/year), and 17.7% reported other infectious HHWs (61.53 ± 183.76 items/year) generated in their homes. Regarding the distribution of sharps HHWs produced in their homes, 20.7% of the participants reported the presence of blood glucose measurement needles and kits (140.10 ± 247.94 items/year), 19.4% reported syringes (15.11 ± 38.32 items/year), and 11.3% reported broken medication ampoules (11.34 ± 14.74 items/year). Additionally, 89.1% of participants reported the presence of tablets (20.12 ± 20.37 items/year), 56.5% reported syrups (7.42 ± 48.73 items/year), 52.5% reported ointments (6.75 ± 47.82 items/year), 33.6% reported drops (7.59 ± 63.38 items/year), 15.4% reported ampoule medications (21.65 ± 107.68 items/year), and 10% reported nebulizer or inhalation medications (19.36 ± 108.09 items/year) as pharmaceutical HHWs generated in their homes. Some waste categories showed high standard deviations (e.g., 16.45 ± 42.47; 21.65 ± 107.68), indicating substantial variability among households. This heterogeneity is expected, as certain types of HHW (particularly sharps and pharmaceutical waste) are produced in large quantities by a small subgroup of individuals with chronic illnesses or intensive home care needs, while the majority produce none. These values therefore reflect the presence of naturally occurring outliers rather than measurement error (Table 2).

Table 2.

Distribution of Medical Wastes Generated in Participants’ Homes (N=1243)

Medical Waste Type		n	%	Annual Mean ± SD
Infectious	Blood-contaminated dressing waste	314	25.3	16.45 ± 42.47
	Gloves contaminated with blood	107	8.6	20.81 ± 38.94
	Dialysis waste	30	2.4	51.33 ± 85.45
	Colostomy care set	29	2.3	198.5 ± 355.39
	Urine bag-catheter	35	2.8	7.67 ± 4.04
	Enteral feeding bag	25	2	2
	Serum set	79	6.4	6.78 ± 11.45
	Patient incontinence pad	43	3.5	241.56 ± 643.82
	Oxygen mask	62	5	3.79 ± 3.32
	Other	220	17.7	61.53 ± 183.76
Sharps	Syringe	241	19.4	15.11 ± 38.32
	Blood glucose measurement needle and kit	257	20.7	140.10 ± 247.94
	Broken medication ampoule	141	11.3	11.34 ± 14.74
Pharmaceutical	Tablet	1108	89.1	20.12 ± 20.37
	Syrup	702	56.5	7.42 ± 48.73
	Ampoule medication	191	15.4	21.65 ± 107.68
	Ointment	653	52.5	6.75 ± 47.82
	Drops	418	33.6	7.59 ± 63.38
	Suppository	93	7.5	4.29 ± 4.58
	Nebulizer-inhalation medication	124	10	19.36 ± 108.09

Among the participants, 43.1% reported disposing of infectious HHW in household waste, 3.5% reported taking it to the municipal waste collection center or hospital, and 2.8% reported giving it to the pharmacy. Regarding sharps HHW, 37% of participants reported disposing of it in household waste, 2.9% took it to the hospital, and 1.8% gave it to the pharmacy. For pharmaceutical HHW, 67.6% of participants reported disposing of it in household waste, 7.5% gave it to the pharmacy, 5.3% took it to the hospital, and 3.6% handed it over to the municipal waste collection center (Table 3).

Table 3.

Distribution of Disposal Methods for Household Healthcare Waste Generated by Participants (N=1243)

	Infectious Waste		Sharps Waste		Pharmaceutical Waste
Disposal method	n	%	n	%	n	%
Throwing in household waste	536	43.1	460	37.0	840	67.6
Pouring down the sink or toilet	18	1.4	9	0.7	27	2.2
Incineration	4	0.3	3	0.2	3	0.2
Giving to the municipality’s medical waste collection and transportation unit	43	3.5	38	3.1	45	3.6
Burying in the ground	3	0.2	4	0.3	1	0.1
Giving to the pharmacy	35	2.8	22	1.8	93	7.5
Giving to the hospital	44	3.5	36	2.9	66	5.3
Never discarded/disposed of	93	7.5	103	8.3	89	7.2

Discussion

The inadequate disposal of HHWs can have serious adverse effects on public health by contributing to the spread of infections, the development of antimicrobial resistance, and environmental pollution (Manzoor & Sharma, 2019). In this context, the proper disposal of HHWs is of critical importance in preventing negative health outcomes. In Türkiye, this study, which addresses the family-based management and disposal of HHW with a large sample group, is considered one of the few studies in the existing literature on this topic.

One of the key findings of the study is that the most commonly produced HHWs in the past year were, in order, pharmaceuticals (pills, syrups, ointments, drops), infected waste (blood-contaminated dressings), and sharp and piercing medical waste (blood glucose measurement needles and kits, syringes, and ampoules). Determining the type and quantity of HHWs is crucial for effective waste management planning. The first step in the efficient management of medical waste is source reduction (minimizing waste generation) and appropriate segregation at the source (UNEP, 2020; Singh et al., 2020b; WHO, 2020). The excessive production of pharmaceutical HHWs and the fact that the majority of them are disposed of in household waste is particularly noteworthy. The management of such waste should primarily focus on strategies aimed at minimizing waste generation. Reasons such as changes in dosage, substitution of medication, patient death, incomplete treatment, inappropriate use of medication, discontinuation of treatment due to side effects, or the expiration of the medication result in unused drugs, leading to the generation of pharmaceutical HHWs (Hassali & Shakeel, 2020; Singleton et al., 2014). Rogowska & Zimmermann (2022) note that the easy accessibility and affordability of over-the-counter medications have promoted the global increase in the consumption of non-prescription drugs. In this context, to prevent excessive medication use, particularly the overuse of over-the-counter drugs, and to develop an effective system for the collection of unused or expired medications, could significantly contribute to reducing the amount of pharmaceutical HHWs (Rogowska & Zimmermann, 2022). The effectiveness of interventions in this area is directly related to raising public awareness about the methods of disposal of medications after their use (Rogowska & Zimmermann, 2022). Another significant waste is sharp and piercing HHW. The study highlights that 40.01% of participants produce used syringes and glucose measurement needles and kits at home, and 37% dispose of them in household trash. This is concerning in terms of the potential risks it poses to public health. Improper disposal of sharp and piercing HHWs increases the risk of injury among family members, waste handlers, waste collectors, children, and animals. Such injuries not only lead to physical trauma but also significantly elevate the risk of spreading infectious diseases (Janik-Karpinska et al., 2023; Miyazaki et al., 2007).

Another significant finding of the current study is that the vast majority of HHWs are disposed of with household waste. The study reveals that only a small portion of HHWs (7.5% or less) is handed over to pharmacies, hospitals, or municipal waste collection centers. This finding indicates that while medical waste produced in hospitals and clinics in Türkiye is managed as industrial waste, a significant portion of HHWs is included in municipal solid waste and managed accordingly. Similar results have been reported in several other studies (Hangulu & Akintola, 2017; Silva et. al., 2022a; Silva et al., 2022b; Rogowska & Zimmermann, 2022; Zikhathile & Atagana, 2018). Sönmez, Nazik & Andi (2018) also reported in their study that 84.1% of caregivers in a city in Türkiye dispose of HHWs together with household waste. Rogowska & Zimmermann (2022), in their review article examining 48 studies published between 2012 and 2021 in various countries, found that the primary method used for drug disposal is typically disposal with household waste or discharge into the sewage system. Furthermore, they noted that even in countries with legal systems or programs for the return of excess medications, this disposal practice remains prevalent, and the effectiveness of these systems is insufficient (Rogowska & Zimmermann, 2022). The disposal of medical waste in household trash without separation and treatment can lead to the contamination of natural resources such as soil, surface water, and groundwater, as harmful microorganisms, chemicals, and medications leach into these environments (WHO, 2024). Poorly managed medical waste can pose long-term and undesirable risks to public health and present serious threats to the environment (Manzoor & Sharma, 2019; Miyazaki et al., 2007). In this regard, it is emphasized that effective waste management principles should be developed and implemented to minimize the potential harm of medical waste (Janik-Karpinska et al., 2023; WHO, 2024). The timely collection of HHWs, disposal processes, and the creation of public awareness are critically important roles for local authorities. In Türkiye, some local governments have taken significant steps by establishing collection units for the disposal of HHWs. However, the study results indicate that the public has not sufficiently embraced municipal practices regarding community-based HHW management, and improvements are needed to enhance their effectiveness.

The proper management of HHWs is also dependent on public awareness and active participation (WHO, 2024). In the current study, it was found that 70% of participants had not received any information about the management of HHWs. This finding also suggests that the insufficient level of knowledge regarding HHW management is reflected in the participants’ practices. In a study by Stokes et al. (2020), it was observed that patients who were provided with a disposal kit and an instructional booklet for opioids after surgery began to dispose of these medications correctly. The research highlights the importance of education provided by healthcare professionals and awareness campaigns in this process. In particular, efforts to raise public awareness about HHW management could play a key role in reducing both environmental and public health risks.

Study Limitations

This study has certain limitations. The data were self-reported, which may introduce recall or reporting bias. The research was conducted in a single province, which limits the generalizability of the findings to the broader population of Türkiye. Additionally, some forms were completed by caregivers instead of patients, which may have affected the accuracy of responses.

Conclusion and Recommendations

The findings of this study demonstrate significant gaps in the management and disposal of HHW in the studied region of Türkiye. A substantial proportion of infectious, sharps, and pharmaceutical HHW is still discarded with household waste, and the majority of the population has never received information on proper disposal practices. These results highlight an urgent need for structured, sustainable, and multisectoral interventions to improve public awareness and strengthen HHW management practices.

Public awareness activities should be implemented regularly, at least annually, by primary healthcare centers, municipalities, family physicians, and nurses. These programs should use standardized educational materials and prioritize households that generate higher-risk waste, such as sharps and infectious materials. Local governments should expand and promote community-based HHW collection systems, including designated drop-off points in pharmacies and scheduled mobile collection units. Additionally, national strategic plans should clearly define the roles of key stakeholders (e.g., Ministry of Health, Ministry of Environment, municipalities, and pharmacies) and establish standardized procedures for segregation, collection, and disposal of HHW.

Efforts aimed at source reduction such as pharmacy-based return programs for unused medications and public campaigns addressing rational drug use—should be strengthened. Increasing the visibility and accessibility of municipal HHW collection centers through digital tools, public announcements, and community-level outreach may also enhance participation. Overall, improving HHW management will require coordinated action across sectors, sustained public education, and well-defined national policies to protect both public health and environmental safety. Future studies should incorporate analytical designs to examine factors influencing HHW disposal behaviors and to explore potential causal relationships.

Funding Statement

The authors declared that this study has received no financial support.

Data Availability Statement:

The data that support the findings of this study are available on request from the corresponding author.