Healthcare waste management in Istanbul: improving decision making

Turkey's accession to European Union requires compliance with the EU legislation.
Healthcare waste is one waste stream which will be affected by this accession.
Currently, in Turkey, especially in large provinces (such as Istanbul) there is an
increasing pressure on the government authorities to develop a sustainable approach
to healthcare waste management and integrate strategies aiming at pursuing
sustainable society. In this respect, the purpose of this research was to develop a
framework to support selection and planning of the future healthcare waste treatment
systems in Istanbul.
In this study, an Istanbul-scale system dynamics model was developed to estimate
future healthcare waste generation to 2040 and it was identified whether any of the
assumptions made, because of the data gaps, have any significant influence on the
outcomes of the model. The study found that more precise data are required on
treatment types (acute or chronic), patient episodes (inpatient and outpatient figures
in an age spectrum) and waste generation profiles (e.g. anatomic, genotoxic, sharps,
etc.) of healthcare institutions. The model also determined a high potential in
decreasing healthcare waste amounts (up to. 10,000tpa) through implementing
effective segregation along with a significant proportion of the healthcare waste
(77%) which being incinerated could, in principle, be treated through alternative
technologies.
The data generated by the model was used in the context of Multi-Criteria Decision
Analysis (MCDA) by identifying various criteria, measuring them and ranking their
relative importance from the point of key stakeholders via a questionnaire within
four future scenarios. It was found that autoclave/hydroclave technology option for
the treatment of healthcare waste suitable for alternative treatment (HCW SAT) and
then their disposal through landfilling with energy recovery has potential to be an
optimum option and these alternative treatment methods along with an efficient
healthcare waste segregation scheme should be given more attention by the
authorities in Istanbul. The methodology used in this project has been developed
based on the primary aim of the project which is to enable the decision makers in
Istanbul to gain an improved perception of the decision problem.