Limited mitigation potential of downstream waste management: A facility-level life cycle assessment of hospital PPE systems

Healthcare systems generate substantial volumes of plastic-rich waste, with single-use personal protective equipment (PPE) accounting for an increasingly large share. While healthcare waste management has received significant attention, the real-world mitigation potential of downstream interventions remains insufficiently quantified. This study presents a facility-level life cycle assessment (LCA) of hospital PPE waste management based on multi-year operational data (2019–2023) from a Hungarian hospital. Using a cradle-to-grave system boundary with defined upstream exclusions and the ReCiPe 2016 Midpoint (H) method, environmental impacts were evaluated across alternative end-of-life (EoL) routing and waste segregation scenarios under real operating conditions. Results show that impacts are primarily driven by upstream material production and consumption, with PPE throughput directly determining system-level burdens. Across all scenarios, human and freshwater toxicity dominate the environmental profile, exceeding climate-related impacts. Scenario analysis indicates that even under optimized conditions, downstream interventions—such as improved segregation and alternative EoL routing—provide limited mitigation within the studied system, reducing the combined normalized score for human and freshwater toxicity by <7%. These findings highlight a structural constraint in healthcare waste systems, where mitigation potential is inherently limited downstream relative to upstream drivers. While segregation remains an important operational parameter, effective mitigation requires prioritizing upstream strategies, such as demand reduction, material substitution, and procurement-based interventions.