1 Introduction

Healthcare heavily relies on medical products, a significant portion of which is composed of plastics, including polyethylene (PE), polypropylene (PP), polyvinyl chloride (PVC), polystyrene (PS), and polycarbonate (PC), accounting for 70% of the mass of medical devices [1]. These materials have played a transformative role in the medical industry, offering cost-effectiveness, easy processing, and sterilization capabilities [2, 3]. However, the widespread use of plastics in healthcare has unintended consequences, leading to a substantial environmental impact as burning fossil fuels, such as oil, converts carbon to carbon dioxide, a potent greenhouse gas that absorbs infrared radiation, leading to global warming, making the manufacture of plastics a major contributor to climate change, primarily through the release of heat-trapping greenhouse gases [4]. The World Health Organization has estimated that 4.9 million deaths (8.3 percent of total mortality worldwide) are attributable to environmental exposure to toxic chemicals [5]. Between 400,000 and 1 million lives are lost yearly in low- and middle-income countries (LMICs) due to mismanaged waste [2]. The global plastic waste generation has surged, and this could potentially exacerbate the existing plastic pollution challenges created by over 10 million tonnes of plastic that have been estimated to threaten the health of our environments and our global oceans [6]. In the United States, healthcare facilities produce 14,000 tons of plastic waste daily, and up to 25% of that waste is in plastic packaging and other products [7]. Traditional disposal methods, such as landfills or incineration [8], have raised concerns due to poorly designed incinerators and improper landfill disposal. Even recycling, touted as a potential solution, faces challenges, with low recycling rates contributing to the growing plastic waste crisis [3, 9, 10]. Improper plastic disposal methods release harmful environmental pollutants, posing severe health risks to populations. Dioxins, furans, and hydrogen chloride are pollutants affecting soil, groundwater, and air quality [11,12,13]. Medical plastic waste disposal's environmental and health ramifications have become a public concern, necessitating urgent attention [3]. Recycling medical plastics has been proposed as a sustainable approach, but challenges, including public perception of infectiousness and the quality of recovered materials, must be addressed [14, 15]. The complexity of medical plastic waste streams requires specialized processing for a sustainable and circular waste management approach [1, 16, 17]. Despite the revolutionary impact of medical plastics on healthcare [2], their environmental consequences and waste management challenges demand urgent attention. The study explored the medical plastic waste generation and recyclability conditions of medical plastic waste to address the global challenge of medical plastic pollution in Ghana and other low and medium-income countries.

1.1 The situation in Ghana

Research in Ghana reveals that the segregation of medical waste is not consistently practiced; however, open burning and dumping are common disposal methods [18]. Inadequate segregation in healthcare facilities in Kumasi, Ghana, leads to hazardous healthcare waste exceeding recommended thresholds, highlighting the absence of a proper Healthcare Waste Management framework [19]. Incineration remains the primary method of treatment in Ghanaian hospitals, raising environmental concerns [20]. Incineration of plastics releases CO2, a greenhouse gas that adversely affects the ozone layer and contributes to global warming. These previous studies have focused on general health care waste, its management heddles, and its method of treatment; however, to the best of our knowledge, no research has been done on the recycling of medical plastic waste in Ghana. This study aims to bridge this research gap by providing an analysis of the conditions of recycling medical plastic waste at two major healthcare facilities in Ghana: the Kwame Nkrumah University of Science and Technology (KNUST) Hospital and the Komfo Anokye Teaching Hospital (KATH).

1.2 Rationale of the study

The objectives of this work are to determine the source, composition, and volume of recyclable medical plastic products. The outcome will be used to determine which medical product to select for recycling to ascertain the possibility of medical-to-medical recycling. It will serve as a model groundwork scalable to other healthcare facilities in Ghana and other low- and middle-income countries facing similar medical plastic waste management challenges.

2 Material and method

Aside from its administration and OPD, the KNUST hospital comprises 13 other units where medical plastics are used. These units are OTMC (Osei Tutu Medical Complex), the eye clinic, the public health units, dental, X-ray, pharmacy, theater, children, male & female wards, maternity, emergency, and infectious disease units (IDU). The KATH provides health services through various directorates, namely Accident and Emergency, Anesthesia, Child Health, Diagnostics, Domestics, Emergency Medicine, Public Health, Medicine, Obstetrics and Gynecology (O&G), Oncology, Oral Health, Psychiatry, Surgery and Trauma, Eye, Ear, Nose and Throat (EENT).

The first step was to identify the medical plastic consumables through a literature review and supplement it with visits to the stores of the two Hospitals earmarked for the study, mainly the Komfo Anokye Teaching Hospital (KATH) and the KNUST hospital, all in Kumasi, Ghana. Interviews were conducted, and observations were made on handling medical plastics at the hospitals. The interview questions posed included how waste is collected from various units, who collects them, how often, what is used to collect them both within and out of the hospital, and how the general waste is disposed of. Questions were also asked about the sources of products. The recyclability was determined using three methods: The Multi-Criteria Decision Analysis (MCDA), volume analysis, and material testing.

2.1 Multi-criteria decision analysis

A multi-criteria decision analysis (MCDA) was used to rank these products according to the most recyclable. This method was used because it provides a systematic and structured approach for evaluating multiple criteria simultaneously, as it helps reduce subjective biases and preferences by providing a transparent and objective framework for decision-making. It also allows the involvement of other stakeholders or experts in the field of the scope of the research, i.e., nurses, medical doctors, and health workers.

2.1.1 Description of the MCDA method

It consists of first setting the main goal, which in this case is the recyclability of the products. Secondly, determine the criteria: polymer type, multi-polymer, ease of disassembly, level of contamination, volume, and ease of cleaning, as seen in Table 1. The significance of these criteria is as follows:

  1. i.

    Polymer type: products made from recyclable polymers can be reprocessed easily into new materials without a substantial loss of their essential properties.

  2. ii.

    Multi-polymer: products with different polymer compositions make sorting and separating very challenging for recycling. The recyclability of such products depends on the feasibility of separating and processing each material individually.

  3. iii.

    Ease of disassembly: products that are easy to disassemble are more likely to be recycled efficiently because an easy disassembly process requires less cost, and effort (energy) for recycling.

  4. iv.

    Level of contamination: products that have a low risk of encountering blood, urine, and fecal matter are easy to recycle.

  5. v.

    Volume: every recycler needs a high volume of raw material to practically work therefore high volume contributes significantly to the recycling stream, making it financially viable.

  6. vi.

    Ease of cleaning: clean materials are more likely to meet recycling quality standards as they reduce the risk of contamination.

Table 1 Pair comparison analysis table
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Thirdly, knowing the options available, the weight assigned to each criterion was determined through another method called the pair comparison analysis as exhibited in Table 1. The various options were ranked through a Likert scale of 1 to 5 as illustrated in Table 4 according to how well they satisfy each criterion.

2.2 Mass of products

The various medical plastic devices at the stores were weighed using the Mettler Toledo Model weighing scale with model number PM34-K (Delta Range) and readability of fine range/coarse range: 0.1 g/1 g. This quantitative data collection was taken from February to April 2023.

2.3 Ethical clearance

The Komfo Anokye Teaching Hospital Institutional Review Board issued ethics approval for the study with reference number KATH IRB/AP/009/23. The KNUST Hospital also approved the study.

3 Results

The data were obtained in document form in Excel format (2021&2022) for all medical products for KATH and Goods Revenue Voucher (GRV) books for the year 2022 at KNUST.

The results from the interviews revealed that janitors collect the waste 3 times a day from 3 main bins (black, yellow, and red), and sharps containers are collected separately and sent to the incinerators. Black, yellow, and red polythene plastics were used to transport the waste to a waste disposal site designated by the hospital. The municipal waste trucks picked them up and sent them to Kumasi landfill. The hospitals acquire their products through private tendering and donations. According to some staff interviewed, most of these donations often do not cover the most important medical products the hospitals need for their activities.

It was observed that medical plastic products like IV bags are handled by the pharmacy departments of the two hospitals. The hospitals do not have typical data on medical plastic waste since no real study has been done in this area. KATH however has all products entered in Excel but no emphasis was laid on medical plastic consumables, due to this reason the data was cleaned to extract that of the medical plastic consumables for year 2021 and year 2022.

3.1 Medical plastic products

For the IV bags, the scope of the research covers only plastic (container), not the content (fluid) therefore the data in this work speaks to only empty IV bags. Owing to this there was no monetary value attached to IV bags as was seen in Tables 2 and 3. The primary data obtained at the Stores were yearly consumption quantities and price lists of the various medical plastic products. The total weight (kg) was calculated by multiplying quantity by the weight of their corresponding virgin medical plastics from the stores, while the item described value in Ghana cedi (GHS) was the product of the unit price of each medical device and their quantity per year.

Table 2 List of medical plastic products for 2022 at KATH
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Table 3 List of medical plastic products for 2022 at KNUST hospital
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A total number of 51 medical plastic products (Table 2) and 33 products (Table 3) were obtained from the data collected at KATH and KNUST Hospital respectively.

3.2 Waste generation

The KNUST hospital has an average of 98 beds capacity and an average occupancy rate of 47.4%. The Komfo Anokye Teaching Hospital has an average bed complement of 889 and an average percentage bed occupancy of 65.89% for 2021 and 2022.

The following formula gives the mass of waste generated per patient per day:

$$\frac{mass\;of\;waste\;generated\;per\;patient\;per\;day}{{bed\;capacity \times occupancy\;rate \times 365}}.$$

The total weight of medical plastics recorded at KNUST Hospital amounted to 8254.835 kg for 2022. KATH recorded a total of 90,044.21 kg and 93,023.6766 kg in 2022 and 2021 respectively. The mass of waste per patient per day at KNUST was 0.486 kg/bed/day and that of KATH was 0.428 kg/bed/day.

Figure 1 named composition of medical plastic waste consumables for 2022 at KATH showed an overview of the medical plastic items described in Table 2 in terms of weight. The highest-ranked product was Examination gloves weighing 45,625 tons/year representing 57% of the medical plastic consumables. The syringes (second) swept 13% with a weight of about 10,660 tons/year and followed closely by IV bags and surgical gloves weighing 8868 tons/year and 6447 tons/year respectively. The infusion set came fifth, weighing 2233 tons/year.

Fig. 1
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Composition of medical plastic waste consumables for 2022 at KATH

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Figure 2 shows the product composition of medical plastic consumables for 2022 at KNUST Hospital. The major component of the products was examination gloves (64%). The composition of gloves at KNUST Hospital is higher than its homologous number at KATH because the number of products at the University Hospital is small compared to that of KATH. Syringes and IV bags have 11% and 7% composition respectively.

Fig. 2
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Composition of medical plastic waste consumables for 2022 at KNUST Hospital

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3.3 Recyclability

3.3.1 Exclusion criteria

Products that are made up of natural rubber or latex, silicon, and foley catheters are excluded because they are thermoset materials which means they do not soften or melt upon heating and lose their mechanical properties when they go through recycling. Thermosetting polymers undergo a curing process during manufacturing, leading to the formation of cross-linked structures that make these medical plastic products acquire properties that hinder their recyclability. They are excluded from the scope of this study because the study focused on traditional recycling processing (mechanical recycling) which cannot handle natural rubber or latex, silicon, and foley catheters. According to a joint document owned by the Ministry of Health and Ministry of Environment Science Technology and Innovation titled National Guidelines for Health Care Waste Management in Ghana (Sect. 2.2: Classification of Health Care Waste) written in [21], laborastory ware/cultures, and products in contact with blood, urine, or fecal matter are infectious or highly infectious.

3.3.2 Multi-criteria decision analysis (MCDA)

Table 4 shows how well each option satisfies the various criteria. The results of the exclusion criteria gave six (6) medical plastic consumables namely infusion set, IV bags, non-breathable mask, Nebulizer mask, Oxygen nasal cannula, and syringes. The results of the MCDA saw IV bags, syringes and infusion set with scores (4.1), (3.88), and 3.54 respectively as the most recyclable products (see Table 5).

Table 4 Ranking options on how well it satisfies the criteria
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Table 5 Ranking of the most recyclable products
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3.3.3 Volume analysis for medical plastic products

Knowing the volume or the weight helps the researcher to plan the recycling process. Table 6 shows the weights of the various medical plastic products generated at KATH (2022&2021) and 2022 for KNUST Hospital obtained through the exclusion criteria and MCDA.

Table 6 Weight of recyclable products
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Syringes constitute an average of 42% of the total weight of the potentially recyclable medical plastic waste, while IV bag has an average of 32% of the total weight, and infusion set or giving set occupies the third position with an average of 10% of the total weight. It was observed that these three (3) products, namely syringe, IV bag, and infusion make up 84% of the total volume of products considered. This information is vital to help plan for the recycling facilities and optimize the process and will also help in targeting the products to be considered for recycling since the recycling facility will need constant raw materials for continuous production.

3.3.4 Material testing

Another important step leading to obtaining quality recovered and recycled materials is knowing the types of polymer or properties of materials to recycle. Samples of IV bags, syringes, and infusion sets were tested using Bruker FT-IR spectrometer to determine their functional groups to establish the polymer composition of the products. The FT-IR test was used instead of other tests because this study seeks to identify the full complement of various functional groups present in the polymer due to its sensitivity.

3.3.4.1 FT-IR results and interpretations

IV bags  Figure 3 shows the results on the main body of the flexible IV bag, which is made up of Polycarbonate (PC) and neck Polyethylene Terephthalate (PET), as shown in Supplementary Fig. 1. The main functional group shown by the (Infra-red) IR spectrum of Fig. 3 is the CH3 bond characterized by the wave number 2958.22–2857.53 cm−1, C=O characterized by the wave number 1720.83 cm−1 and C–O characterized by 1199.30 cm−1 which is Polycarbonate (PC). Polyethylene terephthalate (PET) polymeric materials are O–H stretch, C=C stretch, and C–O stretch. The IR peaks at 1767.63 and 1256.17 cm−1 (Supplementary Fig. 1) correspond to C=O and C–O bonds respectively. Another peak observed at 1503.91 cm−1 appears due to the C=C stretching in aromatic ring carbon. The broadband in the 3320.19 to 3000 cm−1 region is attributed to the asymmetric vibration of the hydroxyl (O–H) groups.

Fig. 3
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Flexible IV bag (main body)

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Bottle type IV indicates a Polyethylene (PE) polymer chain as the spectra of alkanes are dominated by the C–H stretching and bending peaks from the methyl and methylene groups. In the spectrum exhibited in Supplementary Fig. 2, there are two peaks between 3000 and 2850, confirming there are CH3 and CH2 groups present. The methyl group umbrella mode is at 1377 as expected.

Syringe  The barrel of the syringe is Polypropylene (PP) because the major functional group present is CH3 stretching from 3000 to 2850 cm−1 as indicated on the IR spectrum and CH2 umbrella mode at 1455.66–1375.76 cm−1 (Supplementary Fig. 3). The plunger of the syringe whose spectrum is shown in Supplementary Fig. 4, however, is PE.

Infusion set (tubing, spike, drip chamber and roller clamp) The results of the FT-IR test on the sampled infusion set revealed that the spike is polystyrene (PS) characterized by a benzene ring and C=C functional group. The wave numbers for these groups on the IR spectrum shown in Supplementary Fig. 5 are 3100–2850 cm−1 and 1602.10 cm−1 for C=C and benzene rings respectively. It also has CH3 stretching at 3000–2850 cm−1. The roller clamp or V—track controller is PE while the solution filter chamber has the following major functional groups namely H–H stretch, CH3 stretch, C=O stretch, and C–O stretch proving it is a polyurethane (PU), which is thermoplastic polyurethane (TPU). The tubing is made up of PC polymer type. These polymer types namely PP, PC, PET, PE, TPU (thermoplastic polyurethane), and PS are recyclable and help group together materials with similar melting points to be sorted together for an efficient recycling processing [14, 22,23,24].

4 Discussions

The measure of waste per patient per day is a very important index in understanding the environmental impact of healthcare facilities. The study found 0.486 kg/bed/day and 0.428 kg/bed/day for KNUST and KATH respectively. Which is almost similar for the two hospitals.The United Nations environmental program [25] interview article titled “Health care waste: what to do with it?” confirms that “an assessment of waste generation rate data from around the world shows that about 0.5 kg per bed per day is produced in hospitals. However, this figure, and the underlying composition of the waste, varies enormously depending on local context, with higher-income countries generating far higher levels of waste and plastic”. The figures obtained from the study are consistent with United Nations figures since Ghana also belongs to low and medium-income countries.

The study identified specific medical plastic products that are highly recyclable within healthcare settings. Infusion sets, syringes, and IV bags are highlighted as key candidates for recycling. These products are typically composed of polymers like PC, PET, PP, PS, PE, and TPU [14, 22,23,24], all of which are recognized as recyclable materials. This finding presents an opportunity to implement targeted collection and recycling programs for these items and indeed enhance the sorting process by so doing reducing the overall environmental impact of healthcare waste.

The material testing revealed that the polymer for the barrel is different from the plunger. This information is relevant to sorting opportunities before recycling since mixed polymer recycling will change the characterization of the recyclate. It is also relevant to decide which product to recycle. The annual weight of Infusion sets, syringes, and IV bags in Sect. 3 (Tables 2 and 3) revealed that KATH generates 56 kg/day while KNUST Hospital generates 5 kg/day of potential recyclable medical plastic waste for a fully fledge collection scheme These figures provide insight into the scale of waste management operations at these facilities. KATH, being a larger hospital, generates a substantially higher volume of recyclable medical plastic waste. This information is invaluable for planning and optimizing recycling efforts, logistics, and infrastructure. Introducing a new recycling initiative, especially for a specific waste stream like medical plastics, requires a deep understanding of local dynamics. This information is vital for designing an effective and sustainable recycling program. Ensuring the quality of recycled materials is crucial for market acceptance and long-term viability.

The exclusion of natural rubber or latex, silicon, and foley catheters from the scope of this work placed some limitations on the range of materials that can be effectively processed through conventional recycling methods. Looking at the data, excluding thermoset materials means missing out on a huge portion of the overall medical plastic waste stream therefore limiting the potential volume of the recycled materials which, if possible, will increase the hospitals’ revenue as huge volumes of waste could be sold to recycling companies. This situation however suggests two issues very relevant for research: on one hand how to handle and dispose of non-recyclable thermoset medical waste immediately and on the other to explore alternative methods of handling thermoset medical plastic waste through research initiatives to find a sustainable and environmentally friendly solution to the medical plastic waste management menace.

There were a few challenges that are worth addressing namely, the documentations on certification documents which show the polymer types of the various medical plastic products not readily available, due to firstly the lack of awareness on medical plastic recycling and secondly the fact that the hospitals classify these products as standard products, so they do not ask for the type of polymer the products are made up of. It was also difficult to get information from local manufacturers. The study recommends that hospitals should make available the manufacturers’ certification documents that clearly show the polymer types of the various products. Regulatory bodies should make a policy asking manufacturers and suppliers to stamp or emboss the respective resin identification codes on the medical products as is done in the case of other non-medical plastics in the country. This calls for stakeholder collaboration, and evidence-based policy development in addressing the complexities of healthcare waste management. The scope of this work did not include PVC because its recycling releases dangerous chemicals. Even though it can be recycled in some developed countries it cannot be done in Ghana for now. Furthermore, some countries may have developed the technology to completely kill germs from confirmed infectious medical plastics, but this is beyond the scope of this work.in this study the focus was on two hospitals in Ghana however the scalability of the research findings extends beyond the Ghanaian healthcare system, offering valuable lessons for improving medical plastic waste management infrastructure and policy frameworks in other sub-Saharan African countries. Policymakers can leverage on the findings to develop evidence-based strategies for promoting sustainable waste management practices. Future research may focus on creating training programs targeting healthcare workers, patients, and the public to raise awareness about the importance of proper medical plastic waste segregation, recycling practices, and environmental stewardship. Research may also delve into performing a life cycle assessment of recycling the products to evaluate their environmental impact.

5 Conclusion

In Ghana, where challenges related to infrastructure, resource availability, and waste management differ significantly from those in more developed regions, medical plastic waste poses a pressing challenge to the environment and health. The total weight of medical plastics generated at KNUST Hospital was about 8 tons while KATH recorded approximately 90 tons per annum. This information could help recyclers, policymakers, and researchers to plan, implement, and optimize target recycling programs. The rate of medical plastic waste generation at KNUST and KATH was 0.486 kg/bed/day and 0.428 kg/bed/day respectively. The measured waste per patient per day figures underscore the importance of understanding local contextual factors and waste management practices in evaluating waste generation. The absence of dedicated segregation and recycling efforts for medical plastic waste presents a critical area for improvement. Medical waste management policies should promote the segregation of recyclable medical plastic waste. Medical personnel should be trained and incentivized by hospital administrators and recyclers to ensure efficient waste segregation.

The study proposed adopting policy measures to enhance documentation standards, product labeling requirements, and recycling practices, to contribute to a broader effort to promote sustainable healthcare waste management practices. There were a few challenges and limitations, namely data accessibility constraints and regulatory issues that may be improved by crafting tailored medical plastic waste management policies in collaboration with hospital administrators and policymakers. Areas for future research directions may focus on, exploring innovative ways to recycle medical plastic waste, exploring strategies for ensuring the safe handling and processing of medical plastic waste, and fostering international collaboration with global research institutions, industry stakeholders, and international organizations. This in turn will help to leverage best practices, innovative technologies, and funding opportunities for advancing sustainable waste management practices on a global scale.