Volume 14, Issue 2 (6-2026)
jmsthums 2026, 14(2): 88-106 |
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Souri A, Mansouri N, Mahmoudkhani R, Haji Seyed Mirzahosseini S A. Developing a model for evaluating and selecting sustainable technologies for healthcare waste treatment and disposal. jmsthums 2026; 14 (2) :88-106
URL: http://jms.thums.ac.ir/article-1-1570-en.html
URL: http://jms.thums.ac.ir/article-1-1570-en.html
Abouzar Souri1 
, Nabiollah Mansouri *1 , Rouhallah Mahmoudkhani2 , Seyed Alireza Haji Seyed Mirzahosseini1
, Nabiollah Mansouri *1 , Rouhallah Mahmoudkhani2 , Seyed Alireza Haji Seyed Mirzahosseini1
1- Department of Environmental Engineering, SR.C., Islamic Azad University, Tehran, Iran
2- Department of Environmental Health Engineering, Faculty of Health, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
2- Department of Environmental Health Engineering, Faculty of Health, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
Abstract: (14 Views)
Background & Aim: Various technologies are available for the treatment and disposal of hazardous healthcare waste, which may pose risks to human health and the environment. Selecting the most appropriate technology is a complex decision-making process involving multiple criteria. This study aimed to identify and prioritize the criteria influencing the selection of healthcare waste treatment and disposal technologies.
Methods: This descriptive-analytical study began with a comprehensive literature review to identify factors influencing the selection of healthcare waste treatment and disposal technologies. These factors were subsequently screened and evaluated through a multi-round Delphi process involving 25 experts. Subcriteria were retained if they met both predefined acceptance criteria: a mean score of at least 3 and an agreement level exceeding 70%. The relative weights of the accepted criteria and subcriteria were then determined by 12 specialists using the Analytic Hierarchy Process (AHP) and Expert Choice software.
Results: Four main criteria and 37 subcriteria were identified through three rounds of expert consultation. The overall mean score for the subcriteria was 4.04, with a mean agreement level of 93.3%. The subcriteria were distributed across four domains: technical (17), health and environmental (14), economic (4), and social and legal (2). Based on the AHP results, health and environmental considerations received the highest weight (0.564), followed by technical (0.218), social and legal (0.136), and economic criteria (0.082). Among the subcriteria, compliance with standards and regulations received the highest weight (0.116), whereas ease of operation, reduction in waste weight and volume, and diversity of system capacity collectively had the lowest reported weight (0.005). Cronbach’s alpha coefficient was 0.92, and the inconsistency ratio for the criteria was 0.00076.
Conclusion: The proposed model, comprising four main criteria and 37 subcriteria, provides a structured framework for evaluating and selecting sustainable technologies for healthcare waste treatment and disposal. The prioritization of health and environmental considerations, followed by technical factors, highlights the importance of protecting human health and the environment while ensuring the technical suitability of waste management technologiesaste.
Methods: This descriptive-analytical study began with a comprehensive literature review to identify factors influencing the selection of healthcare waste treatment and disposal technologies. These factors were subsequently screened and evaluated through a multi-round Delphi process involving 25 experts. Subcriteria were retained if they met both predefined acceptance criteria: a mean score of at least 3 and an agreement level exceeding 70%. The relative weights of the accepted criteria and subcriteria were then determined by 12 specialists using the Analytic Hierarchy Process (AHP) and Expert Choice software.
Results: Four main criteria and 37 subcriteria were identified through three rounds of expert consultation. The overall mean score for the subcriteria was 4.04, with a mean agreement level of 93.3%. The subcriteria were distributed across four domains: technical (17), health and environmental (14), economic (4), and social and legal (2). Based on the AHP results, health and environmental considerations received the highest weight (0.564), followed by technical (0.218), social and legal (0.136), and economic criteria (0.082). Among the subcriteria, compliance with standards and regulations received the highest weight (0.116), whereas ease of operation, reduction in waste weight and volume, and diversity of system capacity collectively had the lowest reported weight (0.005). Cronbach’s alpha coefficient was 0.92, and the inconsistency ratio for the criteria was 0.00076.
Conclusion: The proposed model, comprising four main criteria and 37 subcriteria, provides a structured framework for evaluating and selecting sustainable technologies for healthcare waste treatment and disposal. The prioritization of health and environmental considerations, followed by technical factors, highlights the importance of protecting human health and the environment while ensuring the technical suitability of waste management technologiesaste.
Type of Study: Research |
Subject:
Special
Received: 2026/03/1 | Accepted: 2026/06/4 | Published: 2026/10/19
Received: 2026/03/1 | Accepted: 2026/06/4 | Published: 2026/10/19
References
1. Mishra AR, Mardani A, Rani P, Zavadskas EK. A novel EDAS approach on intuitionistic fuzzy set for assessment of health-care waste disposal technology using new parametric divergence measures. Journal of Cleaner Production. 2020;272:122807. [DOI:10.1016/j.jclepro.2020.122807]
2. Chartier Y. Safe management of wastes from health-care activities. 2nd ed. Geneva: World Health Organization; 2014.
3. Yang T, Du Y, Sun M, Meng J, Li Y. Risk management for whole-process safe disposal of medical waste: progress and challenges. Risk Management and Healthcare Policy. 2024;17:1503-22. [DOI:10.2147/RMHP.S464268]
4. Purnomo CW, Kurniawan W, Aziz M. Technological review on thermochemical conversion of COVID-19-related medical wastes. Resources, Conservation and Recycling. 2021;167:105429. [DOI:10.1016/j.resconrec.2021.105429]
5. Sanito RC, Mujiyanti DR, You S-J, Wang Y-F. A review on medical waste treatment in COVID-19 pandemics: technologies, managements and future strategies. Journal of the Air & Waste Management Association. 2024;74(2):72-99. [DOI:10.1080/10962247.2023.2282011]
6. World Health Organization. Global analysis of healthcare waste in the context of COVID-19: status, impacts and recommendations. Geneva: World Health Organization; 2022.
7. Citaristi I. United Nations Environment Programme-UNEP. In: The Europa directory of international organizations 2022. London: Routledge; 2022. p. 193-9. [DOI:10.4324/9781003292548-46]
8. Giakoumakis G, Politi D, Sidiras D. Medical waste treatment technologies for energy, fuels, and materials production: A review. Energies. 2021;14(23):8065. [DOI:10.3390/en14238065]
9. Mazzei HG, Specchia S. Latest insights on technologies for the treatment of solid medical waste: A review. Journal of Environmental Chemical Engineering. 2023;11(2):109309. [DOI:10.1016/j.jece.2023.109309]
10. Liu H-C, You J-X, Lu C, Chen Y-Z. Evaluating health-care waste treatment technologies using a hybrid multi-criteria decision making model. Renewable and Sustainable Energy Reviews. 2015;41:932-42. [DOI:10.1016/j.rser.2014.08.061]
11. Hong J, Zhan S, Yu Z, Hong J, Qi C. Life-cycle environmental and economic assessment of medical waste treatment. Journal of Cleaner Production. 2018;174:65-73. [DOI:10.1016/j.jclepro.2017.10.206]
12. Voudrias E. Technology selection for infectious medical waste treatment using the analytic hierarchy process. Journal of the Air & Waste Management Association. 2016;66(7):663-72. [DOI:10.1080/10962247.2016.1162226]
13. Schifano J, Niederberger M. How Delphi studies in the health sciences find consensus: a scoping review. Scientific Reports. 2025;14(1):14. [DOI:10.1186/s13643-024-02738-3]
14. Jonidi Jafari A, Rabbani D, Bagheri Arani S, Zarei E, Hosami Arani M. Environmental health management during the Muharram and Safar mourning ceremonies based on the analytic hierarchy process. Iranian Journal of Health and Environment. 2024;16(4):687-706.
15. Amin Tahmasebi H, Nasirzadeh H. Selecting the best waste disposal method in health using combined method of fuzzy analytical hierarchy process and fuzzy weighted aggregated sum product assessment. Payavard Salamat. 2022;15(6):541-50.
16. Manupati VK, Ramkumar M, Baba V, Agarwal A. Selection of the best healthcare waste disposal techniques during and post COVID-19 pandemic era. Journal of Cleaner Production. 2021;281:125175. [DOI:10.1016/j.jclepro.2020.125175]
17. Narayanamoorthy S, Annapoorani V, Kang D, Baleanu D, Jeon J, Kureethara JV, et al. A novel assessment of bio-medical waste disposal methods using integrating weighting approach and hesitant fuzzy MOOSRA. Journal of Cleaner Production. 2020;275:122587. [DOI:10.1016/j.jclepro.2020.122587]
18. Torkashvand J, Farzadkia M, Jonidi Jafari A, Heidari M, Ghalkhanbaz A. Comparison and prioritization of the different disinfection methods of infectious waste. Journal of Research in Environmental Health. 2019;5(3):194-204.
19. Salimian S, Mousavi SM. The selection of healthcare waste treatment technologies by a multi-criteria group decision-making method with intuitionistic fuzzy sets. Journal of Industrial and Systems Engineering. 2022;14(1):205-20.
20. Nabizadeh R, Mahvi AH, Khazaei M, Zamanzadeh M, Yari AR, Jafari AJ, et al. A fuzzy multi-criteria decision making approach for evaluating the health-care waste treatment alternatives. Environmental Engineering and Management Journal. 2018;17(12):2795-805. [DOI:10.30638/eemj.2018.279]
21. Azad F, Mirzaebrahim Tehrani M, Jozi SA, Miri Lavasani SM. Effective criteria for the location of safe assembly points: a comprehensive review and Delphi study. Journal of Neyshabur University of Medical Sciences. 2023;11(2):46-60.
22. Beheshtinia MA, Jafari Kahoo S, Fathi M. Prioritizing healthcare waste disposal methods considering environmental health using an enhanced multi-criteria decision-making method. Environmental Pollutants and Bioavailability. 2023;35(1):2218568. [DOI:10.1080/26395940.2023.2218568]
23. Al-Qutaish RE. Delphi method: a comprehensive literature review. International Journal of Software Engineering. 2025;12(1):1-15.
24. Krishankumar R, Mishra AR, Rani P, Zavadskas EK, Ravichandran KS, Kar S. A new decision model with integrated approach for healthcare waste treatment technology selection with generalized orthopair fuzzy information. Information Sciences. 2022;610:1010-28. [DOI:10.1016/j.ins.2022.08.022]
25. Ozturk M, Akkurt T, Özkan A, Günkaya Z, Banar M. Utilization of multi criteria decision making techniques for the determination of the optimal healthcare waste management method. Environmental Research and Technology. 2026;9(3):478-91. [DOI:10.35208/ert.1644012]
26. Nabizadeh R, Gholami M, Pasalari H, Yegane BM, Farzadkia M, Asgharnia H, et al. Hospital wastes management in Mazandaran Province with emphasis on genotoxic waste management. Iranian Journal of Health and Environment. 2019;12(3):351-64.
27. Ali M, Wang W, Chaudhry N, Geng Y. Hospital waste management in developing countries: A mini review. Waste Management & Research. 2017;35(6):581-92. [DOI:10.1177/0734242X17691344]
28. Di Bella V, Ali M, Vaccari M. Constraints to healthcare waste treatment in low-income countries-a case study from Somaliland. Waste Management & Research. 2012;30(6):572-5. [DOI:10.1177/0734242X11427943]
29. Nematollahi H, Tuysserkani M, Nematollahi A. Medical waste management in the modern healthcare era: a comprehensive review of technologies, environmental impact, and sustainable practices. Results in Engineering. 2025;28:107210. [DOI:10.1016/j.rineng.2025.107210]
30. Skrinjar I, Vucic K, Puljak L. Sample size and consensus methods used in Delphi studies are heterogeneous: meta-research study. Journal of Clinical Epidemiology. 2026;195:112262. [DOI:10.1016/j.jclinepi.2026.112262]
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