Sustainable Management of Medical Waste in Surgical Units: Operational Challenges and Policy Perspectives

Surgical wards constitute a significant contributor to global medical waste (MW), accounting for over one-third of total healthcare sector trash. Medical interventions produce hazardous, infectious, and potentially toxic byproducts, making effective MW management crucial, especially where current mechanisms are insufficient. Substantial disparities persist between high-income and low- and middle-income countries regarding MW infrastructure, enforcement, and adoption of safe, sustainable treatment technologies. Proper segregation, recycling, treatment, and disposal are key to protecting public health, environmental integrity, and promoting healthcare sustainability. Waste treatment technologies divide into thermal and physico-chemical processes, requiring thorough evaluation of advantages, disadvantages, and suitability for each waste type. This narrative review updates MW knowledge by synthesizing data from scientific literature, institutional documents, and regulatory sources. Key quantitative data indicate operating rooms generate up to 30% of total hospital waste, with recyclable materials representing over 40% of that volume. Improper segregation rates remain high, and incineration remains dominant despite sustainability concerns. The Romanian case study highlights progressive EU alignment, enforcing standardized MW classification, color-coded segregation, and specialized disposal protocols in surgical wards. Despite legal compliance, Romania is advancing incrementally, with systematic audits, digital tracking, and national outcome-based evaluations yet to be fully established. The Plastic Surgery Unit at Oradea County Emergency Clinical Hospital demonstrates good protocol adherence; however, strengthening data feedback mechanisms would enhance hospital-wide performance optimization and strategic waste reduction. Training and monitoring represent important areas for continued development. Coordinated professional engagement, modernized infrastructure, and enforceable audits are identified as critical priorities for improving MW handling in surgical environments. Future research should emphasize management innovation, evidence-based policy formulation, and a systematic strategy to achieve sustainable MW.