Comparative life cycle assessment of biomedical waste management strategies: a focus on carbon footprint during covid-19 eras

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Muhammad, Sukalpaa Chaki, N.A. Mande, A. A. Lawan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9572309/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The COVID-19 pandemic significantly increased biomedical waste (BMW), particularly plastic-based personal protective equipment (PPE), raising environmental concerns. This study applies life cycle assessment (LCA) in line with International Organization for Standardization (ISO 14040/14044) to compare incineration and non-incineration waste treatment methods. A cradle-to-grave approach with a functional unit of 1 tonne of BMW was used. Data from literature and the Eco invent database supported inventory analysis, while impacts were assessed using the ILCD 2011 Midpoint+ method. Results show incineration produces significantly higher CO₂-equivalent emissions due to combustion of plastic-rich waste, whereas non-incineration methods such as autoclaving generate lower emissions but may lead to long-term landfill impacts. Despite environmental drawbacks, incineration remains essential for hazardous waste treatment. The study highlights the need for integrated, low-carbon waste management strategies that balance environmental sustainability with public health safety. Biomedical waste (BMW) COVID-19 Life Cycle Assessment (LCA) Incineration Carbon footprint CO₂-equivalent emissions. 1. INTRODUCTION The COVID-19 pandemic didn’t just strain healthcare systems it also created a massive surge in biomedical waste (BMW), turning it into a significant environmental and public health challenge. With the extensive use of personal protective equipment (PPE), including masks, gloves, face shields, and single-use medical supplies caused an unprecedented increase in the generation of healthcare waste. In extreme cases, up to 145 times more healthcare waste was generated than in pre-pandemic times, and each infected patient produced 3.4 kg of BMW per day, which was a significant portion of waste requiring special treatment because of its contagiousness (Dihan et al., 2023; Rizan et al., 2021; Kuppusamy et al., 2022). Billions of single-use PPEs were thrown away each day throughout the world, and the streams of plastic-based waste grew significantly, being dominated by such polymers like polypropylene and polyethylene (Benson et al., 2021; Das et al., 2021; Singh et al., 2021) while these materials are critical in infection control, they presented a two-fold challenge, including short-term hazards related to pathogen transmission and the long-term environmental impact due to their persistence and carbon-intensive lifecycle. The environmental implications of these waste are directly related to its physicochemical nature. The PPE is composed of plastic that is characterized by high calorific value, thus, making it a good thermochemical treatment material but at the same time a large source of greenhouse gas (GHG) emissions during combustion. England as an example, Life cycle analysis of PPE to health and social care services resulted in an estimated over 106,000 tonnes of CO 2 -equivalent emissions over six months, emphasizing the magnitude of the carbon footprint in responses to the pandemic measure (Rizan et al., 2021). beyong the immediate emissions, the production processes upstream, transportation, and disposal downstream are also linked to the overall environmental impact, which justifies the need for system-wide evaluation methods. Due to the contagious threat, incineration has become the prevailing BMW method of treatment in the pandemic. An effective pathogen destruction and rapid volume reduction are ensured by high-temperature combustion, which makes it operationally appealing in case of an emergency (Ilyas et al., 2020; Kuppusamy et al., 2022). Nevertheless, this dependence on incineration poses a major trade-off on the environment. Mechanically, the oxidation of carbon-based polymers produces large amounts of CO2, and the incomplete combustion and existence of halogenated compounds may produce toxic emissions of dioxins, furans, particulate matter and heavy metals. There are empirical studies that have reported increased emissions of NOₓ, SOₓ, and trace metals, with cadmium identified as one of the significant carcinogenic risks in the Indian (Thind et al., 2021). Thermochemical conversion pathways are always in the top category in terms of global warming potential (GWP) compared to other treatment methods, especially without energy recovery systems (Purnomo et al., 2021; Sanito et al., 2023). Despite its environmental burden, incineration remains widely adopted due to infrastructural constraints and the limited scalability of alternative technologies. Autoclaving, microwave disinfection, and chemical treatments offer lower direct emissions but are often restricted to specific waste categories and require subsequent disposal steps, frequently involving landfilling. Comparative assessments reveal important trade-offs: while landfilling of untreated or inadequately treated BMW leads to high impacts across multiple categories, including GWP and ecotoxicity, incineration—especially without energy recovery—remains carbon-intensive (Kumar et al., 2020; Deepak et al., 2022). More nuanced findings emerge from integrated system analyses. For instance, co-incineration with municipal solid waste or in cement kilns can offset fossil fuel use through energy recovery, thereby reducing net carbon emissions relative to standalone incineration (Zhao et al., 2021; Parida et al., 2022). Similarly, microwave or steam sterilization combined with energy-recovery incineration of residuals has been shown to achieve lower normalized environmental impacts across multiple categories (Dihan et al., 2023; Zhao et al., 2021). However, these findings also reveal inconsistencies and context dependency. Some studies indicate that incineration with energy recovery can outperform autoclave–landfill systems in terms of overall GWP, while others highlight the superior environmental performance of non-thermal treatments when evaluated across broader impact categories (Kılıç & Kuzu, 2021; Deepak et al., 2022). These discrepancies arise from variations in system boundaries, waste composition, energy mixes, and technological efficiencies. Notably, many existing studies are based on pre-pandemic conditions or simplified scenarios that do not fully capture the unique characteristics of COVID-19 waste streams, such as the dominance of plastic PPE, disrupted recycling systems, and increased transportation distances. Consequently, a critical research gap persists in the form of limited comprehensive, comparative life cycle assessments conducted under actual pandemic conditions. While methodological frameworks such as ReCiPe2016 and CML-IA have been applied to evaluate BMW systems, their application to COVID-specific scenarios remains relatively sparse, particularly in low- and middle-income countries where infrastructural limitations and waste management practices differ significantly (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023). Existing studies often focus on isolated treatment options rather than integrated systems, thereby overlooking potential synergies between technologies and the role of circular economy strategies such as reuse, recycling, and energy recovery. Addressing this gap requires a systematic and mechanistically grounded comparison of BMW management strategies that accounts for both direct and indirect emissions across the entire lifecycle. In this context, the present study employs life cycle assessment to quantify and compare the carbon footprint of incineration and alternative treatment methods during the COVID-19 era. By integrating data on waste composition, energy use, and treatment efficiencies, the study aims to elucidate the key drivers of environmental impact and identify more sustainable management pathways. Ultimately, such analysis is essential for informing policy decisions that balance infection control imperatives with long-term environmental sustainability, particularly in the face of future public health emergencies. 2. RELATED WORK / LITERATURE REVIEW Life cycle assessment (LCA) has become the dominant methodological framework for evaluating the environmental performance of medical and biomedical waste management systems, largely due to its ability to capture impacts across the entire waste lifecycle. Grounded in the ISO 14040/14044 standards, LCA systematically integrates goal and scope definition, inventory analysis, impact assessment, and interpretation to quantify emissions and resource flows from waste generation to final disposal (Zhao et al., 2009; Astrup et al., 2015; Zhao et al., 2021). In the context of healthcare waste, this framework enables the inclusion of multiple impact categories—such as global warming potential (GWP), human toxicity, eutrophication, and resource depletion—thereby providing a multidimensional understanding of environmental burdens (Ali et al., 2016; Deepak et al., 2022; Mushtaq et al., 2022; Nematollahi et al., 2024). Methodological variations, including the use of ReCiPe2016, CML-IA, and region-specific databases, further influence the characterization of impacts, often leading to differences in absolute results while preserving relative trends among treatment options (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023; Zheng et al., 2025). A critical strength of LCA in this domain lies in its ability to account for system-level interactions, particularly substitution credits arising from energy recovery or material recycling, which can significantly offset direct emissions from treatment processes. Pre-COVID LCA studies provide a well-established baseline for understanding the environmental trade-offs among biomedical waste treatment technologies. Incineration has traditionally been favored for its capacity to achieve complete pathogen destruction and substantial volume reduction; however, its environmental performance is highly contingent on operational efficiency and energy recovery. Comparative assessments consistently demonstrate that incineration without energy recovery exhibits one of the highest GWP values due to direct CO₂ emissions from the combustion of carbon-rich materials, particularly plastics (Zhao et al., 2009; Deepak et al., 2022). Mechanistically, the oxidation of hydrocarbons generates CO₂ as a primary product, while incomplete combustion and the presence of halogenated compounds can lead to secondary pollutants such as dioxins and heavy metals. In contrast, incineration systems integrated with energy recovery can partially mitigate these impacts by displacing fossil fuel-based electricity or heat, thereby reducing net emissions (Zhao et al., 2009; Ghodrat et al., 2017). Autoclaving, based on steam sterilization under controlled temperature and pressure, offers a non-combustion alternative that avoids direct emission of combustion-related pollutants. However, its environmental advantage is often offset by the need for subsequent landfilling of sterilized waste, which introduces additional burdens such as methane emissions and long-term leachate generation. Empirical comparisons reveal that autoclaving may outperform poorly operated incinerators in both environmental and operational terms, yet it remains unsuitable for certain waste categories, including anatomical and pharmaceutical waste (Ferdowsi et al., 2013). Landfilling, when used as a primary disposal route, is generally associated with the highest environmental impacts across multiple categories, particularly when methane capture systems are absent or inefficient (Ali et al., 2016; Deepak et al., 2022). These findings collectively highlight that environmental performance is not determined by a single treatment stage but by the interaction between treatment technology, waste composition, and downstream management pathways. The COVID-19 pandemic introduced a disruptive shift in these established dynamics by dramatically increasing both the volume and plastic content of biomedical waste. Studies conducted during the pandemic consistently report a surge in PPE-related waste, with single-use plastics such as masks and gloves becoming dominant contributors to waste streams and associated carbon footprints (Benson et al., 2021; Rizan et al., 2021; Türkmen, 2021; Dihan et al., 2023). This compositional shift has significant mechanistic implications for LCA outcomes. The high polymer content increases the calorific value of waste, thereby intensifying CO₂ emissions during incineration, while also amplifying upstream emissions from raw material extraction and manufacturing. At the same time, the urgency of infection control led to a widespread reliance on incineration, often bypassing segregation and recycling pathways that could otherwise reduce environmental impacts. Recent COVID-specific LCA studies provide important, though still limited, insights into these dynamics. A comparative assessment of emergency disposal scenarios in China demonstrated that co-incineration of medical waste with municipal solid waste, when coupled with energy recovery, yielded the lowest overall environmental impacts among evaluated options, largely due to the offset of fossil energy use (Zhao et al., 2021). Similarly, country-scale analyses in Bangladesh and other regions suggest that integrated systems combining microwave or steam sterilization with subsequent energy-recovery incineration can achieve lower normalized impacts across multiple categories (Dihan et al., 2023; Nabavi-Pelesaraei et al., 2022). However, these findings are not universally consistent. In some contexts, the benefits of energy recovery are offset by inefficiencies in infrastructure, variability in waste composition, and increased transportation requirements, particularly in centralized systems. Moreover, PPE-focused LCAs reveal that upstream processes—such as material production and supply chain logistics—can dominate total carbon footprints, sometimes exceeding the impacts of disposal itself (Rizan et al., 2021; Andeobu et al., 2022). This divergence in findings underscores a critical limitation in the current literature: the lack of standardized, pandemic-specific comparative analyses that evaluate multiple treatment pathways under consistent system boundaries and realistic waste compositions (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023; Zhao et al., 2021). While many studies quantify the environmental impacts of individual technologies or specific waste streams, relatively few provide direct, side-by-side comparisons of incineration, autoclaving, landfilling, and recycling within a unified LCA framework tailored to COVID-19 conditions (Türkmen, 2021; Andeobu et al., 2022; Rizan et al., 2021). Furthermore, existing analyses often treat treatment technologies in isolation, neglecting the potential benefits of integrated systems that combine sterilization, energy recovery, and material recycling (Deepak et al., 2022; Dihan et al., 2023). Consequently, a significant research gap persists in the form of limited comprehensive assessments that explicitly link pandemic-induced changes in waste composition—particularly the dominance of plastic PPE—to comparative carbon emissions across alternative management strategies (Benson et al., 2021; Dihan et al., 2023; Zhao et al., 2021). Addressing this gap requires a more holistic and mechanistically informed application of LCA that incorporates dynamic waste characteristics, operational constraints, and circular economy interventions (Nabavi-Pelesaraei et al., 2022; Deepak et al., 2022). Such an approach is essential for resolving the apparent contradictions in existing findings and for identifying robust, low-carbon strategies for biomedical waste management in both emergency and non-emergency contexts. 3. METHODOLOGY 3.1 Goal and Scope Definition This study employs a life cycle assessment (LCA) framework to evaluate and compare biomedical waste (BMW) management strategies during the COVID-19 era, with a primary focus on carbon footprint and associated environmental impacts. The methodology is aligned with the standards of the International Organization for Standardization (ISO 14040/14044), ensuring a systematic and transparent assessment of environmental burdens across the life cycle. The objective is to compare incineration and non-incineration technologies—including autoclaving and landfill-linked systems—under pandemic-specific conditions characterized by increased waste volume and altered composition. A cradle-to-grave system boundary is adopted, encompassing raw material extraction, PPE manufacturing, transportation, waste collection, treatment, and final disposal. This approach captures both direct emissions (e.g., combustion-related CO₂) and indirect emissions associated with energy use and upstream production processes. The inclusion of PPE-dominated waste streams reflects COVID-19 conditions, where plastic-rich materials significantly influence environmental outcomes (Kumar et al., 2020; Dihan et al., 2023). The system also considers multiple waste categories, including infectious, cytotoxic, and anatomical waste, which require different treatment intensities and thus contribute variably to total emissions (Zhao et al., 2021; Ye et al., 2022). 3.2 Functional Unit The functional unit (FU) is defined as the treatment and disposal of 1 tonne (1000 kg) of biomedical waste with representative COVID-19 composition. This ensures comparability across treatment scenarios and aligns with established LCA practices in biomedical waste studies (Zhao et al., 2009; Ji et al., 2023). PPE body coveralls are used as a proxy for dominant waste streams due to their high generation rates during the pandemic. Based on average weights, the FU corresponds to approximately 4000 disposable coveralls (0.250 kg each) or 2710 reusable coveralls (0.369 kg each). This scaling enables the quantification of environmental burdens per unit mass while capturing the influence of material composition, particularly the high fossil carbon content of plastics, which is a key driver of emissions in thermal treatment processes (Nabavi‐Pelesaraei et al., 2022; Kumar et al., 2020). 3.3 Life Cycle Inventory (LCI) The life cycle inventory (LCI) compiles all material and energy inputs, emissions, and waste flows associated with each stage of the system. Data are sourced from peer-reviewed literature and the Ecoinvent database to ensure methodological consistency and data reliability. The inventory includes electricity and fuel consumption, transportation distances, and emissions from treatment processes. Energy inputs are modeled based on grid electricity and fuel combustion, linking energy consumption to indirect CO₂ emissions. Transportation impacts are quantified through fuel use and associated emissions, which are particularly relevant in centralized waste management systems (Dihan et al., 2023; Ji et al., 2023). For PPE production, upstream processes such as polymer synthesis and textile manufacturing are included, as these contribute significantly to total life cycle emissions (Kumar et al., 2020). Treatment processes are modeled based on their underlying mechanisms. Incineration is represented as a high-temperature oxidation process in which carbon-rich waste is converted to CO₂, with additional emissions from auxiliary fuel use and process inefficiencies (Deepak et al., 2022; Rezaee et al., 2024). Non-incineration technologies such as autoclaving are modeled as steam-based sterilization processes, where emissions are primarily indirect and driven by energy consumption rather than chemical transformation (Zhao et al., 2009; Dihan et al., 2023). Landfill processes are included to account for downstream impacts, particularly methane generation from anaerobic degradation and leachate formation (Zhao et al., 2009; Zheng et al., 2025). 3.4 Impact Assessment Method The life cycle impact assessment (LCIA) is conducted using the ILCD 2011 Midpoint+ method, which converts inventory flows into environmental impact indicators using established characterization factors. The primary focus is on climate change, expressed as CO₂-equivalent emissions, capturing contributions from fossil carbon oxidation, energy consumption, and transportation. Additional impact categories, including acidification and human toxicity, are also evaluated to provide a comprehensive environmental profile. These categories are particularly relevant in biomedical waste management, where emissions from incineration contribute to air pollution and potential health risks (Çetin et al., 2025; Cho et al., 2024). The inclusion of multiple impact categories ensures that trade-offs between climate impact and other environmental effects are adequately captured, as highlighted in previous LCA studies (Deepak et al., 2022; Dihan et al., 2023). 3.5 Tools Used The modeling and analysis are performed using openLCA, an open-source LCA platform that enables integration of inventory datasets, impact assessment methods, and scenario modeling. The software supports a structured workflow aligned with ISO standards, facilitating goal definition, inventory analysis, impact assessment, and interpretation within a unified environment. OpenLCA allows for detailed process-based modeling of biomedical waste systems, enabling the representation of complex interactions between material flows, energy use, and emissions. It also supports sensitivity and scenario analyses, which are critical for evaluating the variability introduced by COVID-19 conditions, including increased waste volume and shifts in treatment practices (Zhao et al., 2021; Ji et al., 2023). This computational framework ensures robustness and reproducibility of results while providing actionable insights for sustainable biomedical waste management. 4. RESULTS AND DISCUSSION 4.1 Carbon Emission Results The carbon footprint of biomedical waste (BMW) management systems was quantified using life cycle assessment (LCA), with emissions expressed as CO₂-equivalent (CO₂-eq) based on global warming potential (GWP) factors defined by the Intergovernmental Panel on Climate Change. This approach integrates emissions of CO₂, CH₄, and N₂O into a unified metric, capturing both direct thermochemical emissions and indirect energy-related contributions. The results from this study demonstrate that incineration consistently exhibits higher carbon emissions compared to non-incineration pathways. For PPE waste, incineration generated 3.402 kg CO₂-eq, approximately double that of non-incineration (1.701 kg CO₂-eq). A more pronounced difference is observed for cytotoxic waste, where incineration resulted in 2202.29 kg CO₂-eq compared to 660.53 kg CO₂-eq under non-incineration. These findings indicate that emission intensity is strongly dependent on both waste composition and treatment technology. Table 4.1 Carbon Emissions from Incineration-Based Treatment Waste Category Emissions (kg CO₂-eq) PPE (mask, gloves, gowns, etc.) 3.402 Anatomical Waste 0.282 Cytotoxic Waste 2202.29 Table 4.2 Carbon Emissions from Non-Incineration Treatment Waste Category Emissions (kg CO₂-eq) PPE (mask, gloves, gowns, etc.) 1.701 Cytotoxic Waste 660.53 These results are consistent with several LCA studies reporting higher GWP for incineration-based systems, particularly under COVID-19 conditions where plastic-rich waste dominates (Kumar et al., 2020; Mushtaq et al., 2022; Çetin et al., 2025). However, the magnitude of emissions varies across studies due to differences in system boundaries, energy recovery assumptions, and waste composition. 4.2 Comparative Analysis The increased emissions of incineration can be attributed to its thermochemical processes. High-temperature oxidation of carbonaceous substances, in which polymers in PPE, e.g., polypropylene, are directly transformed into CO 2, is known as incineration. This operation in itself generates large amounts of greenhouse gases because of the fossil carbon content of plastics, which is escalated during the COVID-19 pandemic (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023). Moreover, fuel auxiliaries, which are necessary to sustain combustion temperatures, also lead to a higher level of emissions (Deepak et al., 2022; Rezaee et al., 2024). Non-incineration methods, on the contrary, like autoclaving are based on the principle of steam sterilization, and the emissions are mainly indirect, in connection with electricity use instead of the oxidation of chemicals. This explains the lower CO₂-eq values observed in this study. Comparable patterns have been observed in comparative LCAs, with incineration scenarios having a greater GWP than landfill-associated or sterilization-based options (Kumar et al., 2020; Cho et al., 2024). Nevertheless, the relative performance is not always uniform. In other studies, it is documented that with energy recovery, incineration could have lower life cycle emissions compared to landfill, because it avoids the use of fossil energy (Zhao et al., 2009; Ji et al., 2023; Ding et al., 2025). This emphasizes the role of systems configuration in the derivation of environmental results. The excessively large emission rates of the cytotoxic waste in the present study also indicate the necessity of intensive thermal destruction, which raises the consumption of fuel and emission factors as compared to other types of waste. 4.3 Environmental Trade-offs The findings highlight a critical trade off between the effects of the environment and biosafety when managing biomedical waste. Although incineration has a bigger carbon footprint, it offers total destruction of pathogens and toxic substances and is therefore essential in high-risk waste streams in case of a pandemic. This is in line with the earlier research which highlights incineration as an essential measure to guarantee infection control and minimize epidemiological risks (Zhao et al., 2021; Ye et al., 2022). Environmentally speaking, though, incinerating materials causes climate change, acidity, and human toxicity because of the release of CO₂, NO 8, SO 2 and trace pollutants (Çetin et al., 2025; Cho et al., 2024). Conversely, non-incineration routes or landfill-based systems have lower short term emissions but long term environmental costs. The anaerobic landfill formation of methane is a significant contributor to delayed GWP, and in the long term, it can outgass CO2 unless gas collection systems are highly efficient (Dihan et al., 2023; Zhao et al., 2009). Moreover, disposal in landfills is linked to the appearance of leached, microplastic, and heavy metal, which add to ecotoxicity and groundwater pollution (Zheng et al., 2025; Çetin et al., 2025). These results imply that although non-incineration might seem to be desirable in the context of a short-term reduction in carbon emission, its general environmental performance is heavily reliant on the downstream management approach. A more balanced solution is provided through integrated systems. It has been shown that a combination of sterilization, recycling, and energy-recovery incineration can lessen the overall environmental impact of single-technology strategies (Deepak et al., 2022; Mushtaq et al., 2022). These systems reduce emissions but retain biosafety, and a systems-level approach to waste management is essential. 4.4 COVID-19 Impact Its thermochemical processes can be blamed to the increased emissions of incineration. High-temperature oxidation of carbonaceous substances, in which polymers in PPE, e.g., polypropylene, are directly transformed into CO 2, is known as incineration. Such an operation by itself produces huge quantities of greenhouse gases due to the fossil carbon content of plastics, which is exacerbated during the COVID-19 pandemic (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023). Additionally, fuel auxiliaries, which are needed to maintain combustion temperatures, also cause an increased amount of emissions (Deepak et al., 2022; Rezaee et al., 2024). Non-incineration methods, on the contrary, like autoclaving are based on the principle of steam sterilization, and the emissions are mainly indirect, in connection with electricity use instead of the oxidation of chemicals. This is the reason why the CO 2-eq values were lower in this study. Similar trends can be seen in comparative LCAs whereby incineration scenarios have a higher GWP than landfill-related or sterilization-related alternatives (Kumar et al., 2020; Cho et al., 2024). However, the relative performance is not necessarily consistent. In other studies, it is documented that with energy recovery, incineration could have lower life cycle emissions compared to landfill, because it avoids the use of fossil energy (Zhao et al., 2009; Ji et al., 2023; Ding et al., 2025). This underlines the importance of systems configuration in derivation of environmental results. The very high levels of emission of the cytotoxic waste in the current study also suggest the need of intensive thermal destruction, which increases the use of fuel and emission factors in comparison to other forms of waste. 4.3 Environmental Trade-offs The results reveal an essential trade off of the impact of the environment and biosafety in managing biomedical waste. Even though incineration has a greater carbon footprint, it provides complete elimination of pathogens and toxic substances and hence necessary in high-risk waste streams in the event of a pandemic. This is in line with the earlier research which highlights incineration as an essential measure to guarantee infection control and minimize epidemiological risks (Zhao et al., 2021; Ye et al., 2022). Environmentally speaking, though, incinerating materials causes climate change, acidity, and human toxicity because of the release of CO₂, NO 8, SO 2 and trace pollutants (Çetin et al., 2025; Cho et al., 2024). On the other hand, non-incineration pathways or landfill-based systems are less emitting in the short run, but costly in the long run to the environment. Anaerobic landfill formation of methane is an important contributor to slowed down GWP and in the long-term, this can outgass CO2 unless the gas collection systems are highly efficient (Dihan et al., 2023; Zhao et al., 2009). Besides, landfill disposal is associated with the emergence of leached, microplastic, and heavy metal that contribute to ecotoxicity and groundwater contamination (Zheng et al., 2025; Çetin et al., 2025). The implication of these findings is that non-incineration may appear to be a desirable option in the situation of a temporary decrease in carbon emissions, but its overall environmental performance depends greatly upon the downstream management strategy. A more balanced solution is offered with integrated systems. It is revealed that a hybrid of sterilization, recycling, and energy-recovery incineration can reduce the overall impact of single-technology strategies on the environment (Deepak et al., 2022; Mushtaq et al., 2022). Such systems minimize emissions yet preserve biosafety and a systems-level waste management approach is a necessity. References Ali, M., Wang, W., Chaudhry, N., & Geng, Y. (2016). Hospital waste management in developing countries: A mini review. 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Medical waste management during COVID-19: Environmental impact assessment. PLoS ONE , 17(3), e0259207. You, S., Sonne, C., & Ok, Y. S. (2020). COVID-19’s unsustainable waste management. Science , 368(6498), 1438. Zhao, W., van der Voet, E., Huppes, G., & Zhang, Y. (2009). Comparative life cycle assessments of incineration and non-incineration treatments for medical waste. International Journal of Life Cycle Assessment , 14, 114–121. Zhao, H., Liu, H., Wei, G., Wang, H., Zhu, Y., Zhang, R., & Yang, Y. (2021). Comparative LCA of emergency medical waste disposal during COVID-19. Waste Management , 126, 388–399. Zheng, X., Zhong, S., Alam, O., Hossen, S., & Du, D. (2025). Microplastics and heavy metals emissions from healthcare waste management. Waste Management , 204, 114932. Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9572309","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":632170306,"identity":"81ae40c2-aac3-4d84-b2bd-ea7590cb2473","order_by":0,"name":"A.T. 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Lawan","email":"","orcid":"","institution":"Sharda University","correspondingAuthor":false,"prefix":"","firstName":"A.","middleName":"A.","lastName":"Lawan","suffix":""}],"badges":[],"createdAt":"2026-04-30 05:29:52","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-9572309/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9572309/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108492330,"identity":"27cb6c1a-176d-492b-8dc4-d5405f9ca6ff","added_by":"auto","created_at":"2026-05-05 09:57:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":206308,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9572309/v1/7da063ae-2cc2-48b4-b9a1-8392131808ba.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eComparative life cycle assessment of biomedical waste management strategies: a focus on carbon footprint during covid-19 eras\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eThe COVID-19 pandemic didn\u0026rsquo;t just strain healthcare systems it also created a massive surge in biomedical waste (BMW), turning it into a significant environmental and public health challenge. With the extensive use of personal protective equipment (PPE), including masks, gloves, face shields, and single-use medical supplies caused an unprecedented increase in the generation of healthcare waste. In extreme cases, up to 145 times more healthcare waste was generated than in pre-pandemic times, and each infected patient produced 3.4 kg of BMW per day, which was a significant portion of waste requiring special treatment because of its contagiousness (Dihan et al., 2023; Rizan et al., 2021; Kuppusamy et al., 2022). Billions of single-use PPEs were thrown away each day throughout the world, and the streams of plastic-based waste grew significantly, being dominated by such polymers like polypropylene and polyethylene (Benson et al., 2021; Das et al., 2021; Singh et al., 2021) while these materials are critical in infection control, they presented a two-fold challenge, including short-term hazards related to pathogen transmission and the long-term environmental impact due to their persistence and carbon-intensive lifecycle.\u003c/p\u003e\n\u003cp\u003eThe environmental implications of these waste are directly related to its physicochemical nature. The PPE is composed of plastic that is characterized by high calorific value, thus, making it a good thermochemical treatment material but at the same time a large source of greenhouse gas (GHG) emissions during combustion. England as an example, Life cycle analysis of PPE to health and social care services resulted in an estimated over 106,000 tonnes of CO 2 -equivalent emissions over six months, emphasizing the magnitude of the carbon footprint in responses to the pandemic measure (Rizan et al., 2021). beyong the immediate emissions, the production processes upstream, transportation, and disposal downstream are also linked to the overall environmental impact, which justifies the need for system-wide evaluation methods.\u003c/p\u003e\n\u003cp\u003eDue to the contagious threat, incineration has become the prevailing BMW method of treatment in the pandemic. An effective pathogen destruction and rapid volume reduction are ensured by high-temperature combustion, which makes it operationally appealing in case of an emergency (Ilyas et al., 2020; Kuppusamy et al., 2022). Nevertheless, this dependence on incineration poses a major trade-off on the environment. Mechanically, the oxidation of carbon-based polymers produces large amounts of CO2, and the incomplete combustion and existence of halogenated compounds may produce toxic emissions of dioxins, furans, particulate matter and heavy metals. There are empirical studies that have reported increased emissions of NOₓ, SOₓ, and trace metals, with cadmium identified as one of the significant carcinogenic risks in the Indian (Thind et al., 2021). Thermochemical conversion pathways are always in the top category in terms of global warming potential (GWP) compared to other treatment methods, especially without energy recovery systems (Purnomo et al., 2021; Sanito et al., 2023).\u003c/p\u003e\n\u003cp\u003eDespite its environmental burden, incineration remains widely adopted due to infrastructural constraints and the limited scalability of alternative technologies. Autoclaving, microwave disinfection, and chemical treatments offer lower direct emissions but are often restricted to specific waste categories and require subsequent disposal steps, frequently involving landfilling. Comparative assessments reveal important trade-offs: while landfilling of untreated or inadequately treated BMW leads to high impacts across multiple categories, including GWP and ecotoxicity, incineration\u0026mdash;especially without energy recovery\u0026mdash;remains carbon-intensive (Kumar et al., 2020; Deepak et al., 2022). More nuanced findings emerge from integrated system analyses. For instance, co-incineration with municipal solid waste or in cement kilns can offset fossil fuel use through energy recovery, thereby reducing net carbon emissions relative to standalone incineration (Zhao et al., 2021; Parida et al., 2022). Similarly, microwave or steam sterilization combined with energy-recovery incineration of residuals has been shown to achieve lower normalized environmental impacts across multiple categories (Dihan et al., 2023; Zhao et al., 2021).\u003c/p\u003e\n\u003cp\u003eHowever, these findings also reveal inconsistencies and context dependency. Some studies indicate that incineration with energy recovery can outperform autoclave\u0026ndash;landfill systems in terms of overall GWP, while others highlight the superior environmental performance of non-thermal treatments when evaluated across broader impact categories (Kılı\u0026ccedil; \u0026amp; Kuzu, 2021; Deepak et al., 2022). These discrepancies arise from variations in system boundaries, waste composition, energy mixes, and technological efficiencies. Notably, many existing studies are based on pre-pandemic conditions or simplified scenarios that do not fully capture the unique characteristics of COVID-19 waste streams, such as the dominance of plastic PPE, disrupted recycling systems, and increased transportation distances.\u003c/p\u003e\n\u003cp\u003eConsequently, a critical research gap persists in the form of limited comprehensive, comparative life cycle assessments conducted under actual pandemic conditions. While methodological frameworks such as ReCiPe2016 and CML-IA have been applied to evaluate BMW systems, their application to COVID-specific scenarios remains relatively sparse, particularly in low- and middle-income countries where infrastructural limitations and waste management practices differ significantly (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023). Existing studies often focus on isolated treatment options rather than integrated systems, thereby overlooking potential synergies between technologies and the role of circular economy strategies such as reuse, recycling, and energy recovery.\u003c/p\u003e\n\u003cp\u003eAddressing this gap requires a systematic and mechanistically grounded comparison of BMW management strategies that accounts for both direct and indirect emissions across the entire lifecycle. In this context, the present study employs life cycle assessment to quantify and compare the carbon footprint of incineration and alternative treatment methods during the COVID-19 era. By integrating data on waste composition, energy use, and treatment efficiencies, the study aims to elucidate the key drivers of environmental impact and identify more sustainable management pathways. Ultimately, such analysis is essential for informing policy decisions that balance infection control imperatives with long-term environmental sustainability, particularly in the face of future public health emergencies.\u003c/p\u003e"},{"header":"2. RELATED WORK / LITERATURE REVIEW","content":"\u003cp\u003eLife cycle assessment (LCA) has become the dominant methodological framework for evaluating the environmental performance of medical and biomedical waste management systems, largely due to its ability to capture impacts across the entire waste lifecycle. Grounded in the ISO 14040/14044 standards, LCA systematically integrates goal and scope definition, inventory analysis, impact assessment, and interpretation to quantify emissions and resource flows from waste generation to final disposal (Zhao et al., 2009; Astrup et al., 2015; Zhao et al., 2021). In the context of healthcare waste, this framework enables the inclusion of multiple impact categories\u0026mdash;such as global warming potential (GWP), human toxicity, eutrophication, and resource depletion\u0026mdash;thereby providing a multidimensional understanding of environmental burdens (Ali et al., 2016; Deepak et al., 2022; Mushtaq et al., 2022; Nematollahi et al., 2024). Methodological variations, including the use of ReCiPe2016, CML-IA, and region-specific databases, further influence the characterization of impacts, often leading to differences in absolute results while preserving relative trends among treatment options (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023; Zheng et al., 2025). A critical strength of LCA in this domain lies in its ability to account for system-level interactions, particularly substitution credits arising from energy recovery or material recycling, which can significantly offset direct emissions from treatment processes.\u003c/p\u003e\n\u003cp\u003ePre-COVID LCA studies provide a well-established baseline for understanding the environmental trade-offs among biomedical waste treatment technologies. Incineration has traditionally been favored for its capacity to achieve complete pathogen destruction and substantial volume reduction; however, its environmental performance is highly contingent on operational efficiency and energy recovery. Comparative assessments consistently demonstrate that incineration without energy recovery exhibits one of the highest GWP values due to direct CO₂ emissions from the combustion of carbon-rich materials, particularly plastics (Zhao et al., 2009; Deepak et al., 2022). Mechanistically, the oxidation of hydrocarbons generates CO₂ as a primary product, while incomplete combustion and the presence of halogenated compounds can lead to secondary pollutants such as dioxins and heavy metals. In contrast, incineration systems integrated with energy recovery can partially mitigate these impacts by displacing fossil fuel-based electricity or heat, thereby reducing net emissions (Zhao et al., 2009; Ghodrat et al., 2017).\u003c/p\u003e\n\u003cp\u003eAutoclaving, based on steam sterilization under controlled temperature and pressure, offers a non-combustion alternative that avoids direct emission of combustion-related pollutants. However, its environmental advantage is often offset by the need for subsequent landfilling of sterilized waste, which introduces additional burdens such as methane emissions and long-term leachate generation. Empirical comparisons reveal that autoclaving may outperform poorly operated incinerators in both environmental and operational terms, yet it remains unsuitable for certain waste categories, including anatomical and pharmaceutical waste (Ferdowsi et al., 2013). Landfilling, when used as a primary disposal route, is generally associated with the highest environmental impacts across multiple categories, particularly when methane capture systems are absent or inefficient (Ali et al., 2016; Deepak et al., 2022). These findings collectively highlight that environmental performance is not determined by a single treatment stage but by the interaction between treatment technology, waste composition, and downstream management pathways.\u003c/p\u003e\n\u003cp\u003eThe COVID-19 pandemic introduced a disruptive shift in these established dynamics by dramatically increasing both the volume and plastic content of biomedical waste. Studies conducted during the pandemic consistently report a surge in PPE-related waste, with single-use plastics such as masks and gloves becoming dominant contributors to waste streams and associated carbon footprints (Benson et al., 2021; Rizan et al., 2021; T\u0026uuml;rkmen, 2021; Dihan et al., 2023). This compositional shift has significant mechanistic implications for LCA outcomes. The high polymer content increases the calorific value of waste, thereby intensifying CO₂ emissions during incineration, while also amplifying upstream emissions from raw material extraction and manufacturing. At the same time, the urgency of infection control led to a widespread reliance on incineration, often bypassing segregation and recycling pathways that could otherwise reduce environmental impacts.\u003c/p\u003e\n\u003cp\u003eRecent COVID-specific LCA studies provide important, though still limited, insights into these dynamics. A comparative assessment of emergency disposal scenarios in China demonstrated that co-incineration of medical waste with municipal solid waste, when coupled with energy recovery, yielded the lowest overall environmental impacts among evaluated options, largely due to the offset of fossil energy use (Zhao et al., 2021). Similarly, country-scale analyses in Bangladesh and other regions suggest that integrated systems combining microwave or steam sterilization with subsequent energy-recovery incineration can achieve lower normalized impacts across multiple categories (Dihan et al., 2023; Nabavi-Pelesaraei et al., 2022). However, these findings are not universally consistent. In some contexts, the benefits of energy recovery are offset by inefficiencies in infrastructure, variability in waste composition, and increased transportation requirements, particularly in centralized systems. Moreover, PPE-focused LCAs reveal that upstream processes\u0026mdash;such as material production and supply chain logistics\u0026mdash;can dominate total carbon footprints, sometimes exceeding the impacts of disposal itself (Rizan et al., 2021; Andeobu et al., 2022).\u003c/p\u003e\n\u003cp\u003eThis divergence in findings underscores a critical limitation in the current literature: the lack of standardized, pandemic-specific comparative analyses that evaluate multiple treatment pathways under consistent system boundaries and realistic waste compositions (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023; Zhao et al., 2021). While many studies quantify the environmental impacts of individual technologies or specific waste streams, relatively few provide direct, side-by-side comparisons of incineration, autoclaving, landfilling, and recycling within a unified LCA framework tailored to COVID-19 conditions (T\u0026uuml;rkmen, 2021; Andeobu et al., 2022; Rizan et al., 2021). Furthermore, existing analyses often treat treatment technologies in isolation, neglecting the potential benefits of integrated systems that combine sterilization, energy recovery, and material recycling (Deepak et al., 2022; Dihan et al., 2023).\u003c/p\u003e\n\u003cp\u003eConsequently, a significant research gap persists in the form of limited comprehensive assessments that explicitly link pandemic-induced changes in waste composition\u0026mdash;particularly the dominance of plastic PPE\u0026mdash;to comparative carbon emissions across alternative management strategies (Benson et al., 2021; Dihan et al., 2023; Zhao et al., 2021). Addressing this gap requires a more holistic and mechanistically informed application of LCA that incorporates dynamic waste characteristics, operational constraints, and circular economy interventions (Nabavi-Pelesaraei et al., 2022; Deepak et al., 2022). Such an approach is essential for resolving the apparent contradictions in existing findings and for identifying robust, low-carbon strategies for biomedical waste management in both emergency and non-emergency contexts.\u003c/p\u003e"},{"header":"3. METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003e3.1 Goal and Scope Definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employs a life cycle assessment (LCA) framework to evaluate and compare biomedical waste (BMW) management strategies during the COVID-19 era, with a primary focus on carbon footprint and associated environmental impacts. The methodology is aligned with the standards of the International Organization for Standardization (ISO 14040/14044), ensuring a systematic and transparent assessment of environmental burdens across the life cycle. The objective is to compare incineration and non-incineration technologies\u0026mdash;including autoclaving and landfill-linked systems\u0026mdash;under pandemic-specific conditions characterized by increased waste volume and altered composition.\u003c/p\u003e\n\u003cp\u003eA cradle-to-grave system boundary is adopted, encompassing raw material extraction, PPE manufacturing, transportation, waste collection, treatment, and final disposal. This approach captures both direct emissions (e.g., combustion-related CO₂) and indirect emissions associated with energy use and upstream production processes. The inclusion of PPE-dominated waste streams reflects COVID-19 conditions, where plastic-rich materials significantly influence environmental outcomes (Kumar et al., 2020; Dihan et al., 2023). The system also considers multiple waste categories, including infectious, cytotoxic, and anatomical waste, which require different treatment intensities and thus contribute variably to total emissions (Zhao et al., 2021; Ye et al., 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Functional Unit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe functional unit (FU) is defined as the treatment and disposal of 1 tonne (1000 kg) of biomedical waste with representative COVID-19 composition. This ensures comparability across treatment scenarios and aligns with established LCA practices in biomedical waste studies (Zhao et al., 2009; Ji et al., 2023). PPE body coveralls are used as a proxy for dominant waste streams due to their high generation rates during the pandemic.\u003c/p\u003e\n\u003cp\u003eBased on average weights, the FU corresponds to approximately 4000 disposable coveralls (0.250 kg each) or 2710 reusable coveralls (0.369 kg each). This scaling enables the quantification of environmental burdens per unit mass while capturing the influence of material composition, particularly the high fossil carbon content of plastics, which is a key driver of emissions in thermal treatment processes (Nabavi‐Pelesaraei et al., 2022; Kumar et al., 2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Life Cycle Inventory (LCI)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe life cycle inventory (LCI) compiles all material and energy inputs, emissions, and waste flows associated with each stage of the system. Data are sourced from peer-reviewed literature and the Ecoinvent database to ensure methodological consistency and data reliability. The inventory includes electricity and fuel consumption, transportation distances, and emissions from treatment processes.\u003c/p\u003e\n\u003cp\u003eEnergy inputs are modeled based on grid electricity and fuel combustion, linking energy consumption to indirect CO₂ emissions. Transportation impacts are quantified through fuel use and associated emissions, which are particularly relevant in centralized waste management systems (Dihan et al., 2023; Ji et al., 2023). For PPE production, upstream processes such as polymer synthesis and textile manufacturing are included, as these contribute significantly to total life cycle emissions (Kumar et al., 2020).\u003c/p\u003e\n\u003cp\u003eTreatment processes are modeled based on their underlying mechanisms. Incineration is represented as a high-temperature oxidation process in which carbon-rich waste is converted to CO₂, with additional emissions from auxiliary fuel use and process inefficiencies (Deepak et al., 2022; Rezaee et al., 2024). Non-incineration technologies such as autoclaving are modeled as steam-based sterilization processes, where emissions are primarily indirect and driven by energy consumption rather than chemical transformation (Zhao et al., 2009; Dihan et al., 2023). Landfill processes are included to account for downstream impacts, particularly methane generation from anaerobic degradation and leachate formation (Zhao et al., 2009; Zheng et al., 2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Impact Assessment Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe life cycle impact assessment (LCIA) is conducted using the ILCD 2011 Midpoint+ method, which converts inventory flows into environmental impact indicators using established characterization factors. The primary focus is on climate change, expressed as CO₂-equivalent emissions, capturing contributions from fossil carbon oxidation, energy consumption, and transportation.\u003c/p\u003e\n\u003cp\u003eAdditional impact categories, including acidification and human toxicity, are also evaluated to provide a comprehensive environmental profile. These categories are particularly relevant in biomedical waste management, where emissions from incineration contribute to air pollution and potential health risks (\u0026Ccedil;etin et al., 2025; Cho et al., 2024). The inclusion of multiple impact categories ensures that trade-offs between climate impact and other environmental effects are adequately captured, as highlighted in previous LCA studies (Deepak et al., 2022; Dihan et al., 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Tools Used\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe modeling and analysis are performed using openLCA, an open-source LCA platform that enables integration of inventory datasets, impact assessment methods, and scenario modeling. The software supports a structured workflow aligned with ISO standards, facilitating goal definition, inventory analysis, impact assessment, and interpretation within a unified environment.\u003c/p\u003e\n\u003cp\u003eOpenLCA allows for detailed process-based modeling of biomedical waste systems, enabling the representation of complex interactions between material flows, energy use, and emissions. It also supports sensitivity and scenario analyses, which are critical for evaluating the variability introduced by COVID-19 conditions, including increased waste volume and shifts in treatment practices (Zhao et al., 2021; Ji et al., 2023). This computational framework ensures robustness and reproducibility of results while providing actionable insights for sustainable biomedical waste management.\u003c/p\u003e"},{"header":"4. RESULTS AND DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003e4.1 Carbon Emission Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe carbon footprint of biomedical waste (BMW) management systems was quantified using life cycle assessment (LCA), with emissions expressed as CO₂-equivalent (CO₂-eq) based on global warming potential (GWP) factors defined by the Intergovernmental Panel on Climate Change. This approach integrates emissions of CO₂, CH₄, and N₂O into a unified metric, capturing both direct thermochemical emissions and indirect energy-related contributions.\u003c/p\u003e\n\u003cp\u003eThe results from this study demonstrate that incineration consistently exhibits higher carbon emissions compared to non-incineration pathways. For PPE waste, incineration generated 3.402 kg CO₂-eq, approximately double that of non-incineration (1.701 kg CO₂-eq). A more pronounced difference is observed for cytotoxic waste, where incineration resulted in 2202.29 kg CO₂-eq compared to 660.53 kg CO₂-eq under non-incineration. These findings indicate that emission intensity is strongly dependent on both waste composition and treatment technology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.1 Carbon Emissions from Incineration-Based Treatment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWaste Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEmissions (kg CO₂-eq)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePPE (mask, gloves, gowns, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAnatomical Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCytotoxic Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2202.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.2 Carbon Emissions from Non-Incineration Treatment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWaste Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEmissions (kg CO₂-eq)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePPE (mask, gloves, gowns, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCytotoxic Waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e660.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThese results are consistent with several LCA studies reporting higher GWP for incineration-based systems, particularly under COVID-19 conditions where plastic-rich waste dominates (Kumar et al., 2020; Mushtaq et al., 2022; \u0026Ccedil;etin et al., 2025). However, the magnitude of emissions varies across studies due to differences in system boundaries, energy recovery assumptions, and waste composition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Comparative Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe increased emissions of incineration can be attributed to its thermochemical processes. High-temperature oxidation of carbonaceous substances, in which polymers in PPE, e.g., polypropylene, are directly transformed into CO 2, is known as incineration. This operation in itself generates large amounts of greenhouse gases because of the fossil carbon content of plastics, which is escalated during the COVID-19 pandemic (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023). Moreover, fuel auxiliaries, which are necessary to sustain combustion temperatures, also lead to a higher level of emissions (Deepak et al., 2022; Rezaee et al., 2024).\u003c/p\u003e\n\u003cp\u003eNon-incineration methods, on the contrary, like autoclaving are based on the principle of steam sterilization, and the emissions are mainly indirect, in connection with electricity use instead of the oxidation of chemicals. This explains the lower CO₂-eq values observed in this study. Comparable patterns have been observed in comparative LCAs, with incineration scenarios having a greater GWP than landfill-associated or sterilization-based options (Kumar et al., 2020; Cho et al., 2024).\u003c/p\u003e\n\u003cp\u003eNevertheless, the relative performance is not always uniform. In other studies, it is documented that with energy recovery, incineration could have lower life cycle emissions compared to landfill, because it avoids the use of fossil energy (Zhao et al., 2009; Ji et al., 2023; Ding et al., 2025). This emphasizes the role of systems configuration in the derivation of environmental results. The excessively large emission rates of the cytotoxic waste in the present study also indicate the necessity of intensive thermal destruction, which raises the consumption of fuel and emission factors as compared to other types of waste.\u003c/p\u003e\n\u003cp\u003e4.3 Environmental Trade-offs\u003c/p\u003e\n\u003cp\u003eThe findings highlight a critical trade off between the effects of the environment and biosafety when managing biomedical waste. Although incineration has a bigger carbon footprint, it offers total destruction of pathogens and toxic substances and is therefore essential in high-risk waste streams in case of a pandemic. This is in line with the earlier research which highlights incineration as an essential measure to guarantee infection control and minimize epidemiological risks (Zhao et al., 2021; Ye et al., 2022).\u003c/p\u003e\n\u003cp\u003eEnvironmentally speaking, though, incinerating materials causes climate change, acidity, and human toxicity because of the release of CO₂, NO 8, SO 2 and trace pollutants (\u0026Ccedil;etin et al., 2025; Cho et al., 2024). Conversely, non-incineration routes or landfill-based systems have lower short term emissions but long term environmental costs. The anaerobic landfill formation of methane is a significant contributor to delayed GWP, and in the long term, it can outgass CO2 unless gas collection systems are highly efficient (Dihan et al., 2023; Zhao et al., 2009).\u003c/p\u003e\n\u003cp\u003eMoreover, disposal in landfills is linked to the appearance of leached, microplastic, and heavy metal, which add to ecotoxicity and groundwater pollution (Zheng et al., 2025; \u0026Ccedil;etin et al., 2025). These results imply that although non-incineration might seem to be desirable in the context of a short-term reduction in carbon emission, its general environmental performance is heavily reliant on the downstream management approach.\u003c/p\u003e\n\u003cp\u003eA more balanced solution is provided through integrated systems. It has been shown that a combination of sterilization, recycling, and energy-recovery incineration can lessen the overall environmental impact of single-technology strategies (Deepak et al., 2022; Mushtaq et al., 2022). These systems reduce emissions but retain biosafety, and a systems-level approach to waste management is essential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 COVID-19 Impact\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIts thermochemical processes can be blamed to the increased emissions of incineration. High-temperature oxidation of carbonaceous substances, in which polymers in PPE, e.g., polypropylene, are directly transformed into CO 2, is known as incineration. Such an operation by itself produces huge quantities of greenhouse gases due to the fossil carbon content of plastics, which is exacerbated during the COVID-19 pandemic (Nabavi-Pelesaraei et al., 2022; Dihan et al., 2023). Additionally, fuel auxiliaries, which are needed to maintain combustion temperatures, also cause an increased amount of emissions (Deepak et al., 2022; Rezaee et al., 2024).\u003c/p\u003e\n\u003cp\u003eNon-incineration methods, on the contrary, like autoclaving are based on the principle of steam sterilization, and the emissions are mainly indirect, in connection with electricity use instead of the oxidation of chemicals. This is the reason why the CO 2-eq values were lower in this study. Similar trends can be seen in comparative LCAs whereby incineration scenarios have a higher GWP than landfill-related or sterilization-related alternatives (Kumar et al., 2020; Cho et al., 2024).\u003c/p\u003e\n\u003cp\u003eHowever, the relative performance is not necessarily consistent. In other studies, it is documented that with energy recovery, incineration could have lower life cycle emissions compared to landfill, because it avoids the use of fossil energy (Zhao et al., 2009; Ji et al., 2023; Ding et al., 2025). This underlines the importance of systems configuration in derivation of environmental results. The very high levels of emission of the cytotoxic waste in the current study also suggest the need of intensive thermal destruction, which increases the use of fuel and emission factors in comparison to other forms of waste.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Environmental Trade-offs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results reveal an essential trade off of the impact of the environment and biosafety in managing biomedical waste. Even though incineration has a greater carbon footprint, it provides complete elimination of pathogens and toxic substances and hence necessary in high-risk waste streams in the event of a pandemic. This is in line with the earlier research which highlights incineration as an essential measure to guarantee infection control and minimize epidemiological risks (Zhao et al., 2021; Ye et al., 2022).\u003c/p\u003e\n\u003cp\u003eEnvironmentally speaking, though, incinerating materials causes climate change, acidity, and human toxicity because of the release of CO₂, NO 8, SO 2 and trace pollutants (\u0026Ccedil;etin et al., 2025; Cho et al., 2024). On the other hand, non-incineration pathways or landfill-based systems are less emitting in the short run, but costly in the long run to the environment. Anaerobic landfill formation of methane is an important contributor to slowed down GWP and in the long-term, this can outgass CO2 unless the gas collection systems are highly efficient (Dihan et al., 2023; Zhao et al., 2009).\u003c/p\u003e\n\u003cp\u003eBesides, landfill disposal is associated with the emergence of leached, microplastic, and heavy metal that contribute to ecotoxicity and groundwater contamination (Zheng et al., 2025; \u0026Ccedil;etin et al., 2025). The implication of these findings is that non-incineration may appear to be a desirable option in the situation of a temporary decrease in carbon emissions, but its overall environmental performance depends greatly upon the downstream management strategy.\u003c/p\u003e\n\u003cp\u003eA more balanced solution is offered with integrated systems. It is revealed that a hybrid of sterilization, recycling, and energy-recovery incineration can reduce the overall impact of single-technology strategies on the environment (Deepak et al., 2022; Mushtaq et al., 2022). Such systems minimize emissions yet preserve biosafety and a systems-level waste management approach is a necessity.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAli, M., Wang, W., Chaudhry, N., \u0026amp; Geng, Y. (2016). Hospital waste management in developing countries: A mini review. \u003cem\u003eWaste Management \u0026amp; Research\u003c/em\u003e, 34(6), 581\u0026ndash;592.\u003c/li\u003e\n\u003cli\u003eAndeobu, L., Wibowo, S., \u0026amp; Grandhi, S. (2022). Medical waste from COVID-19 pandemic: Trends, risks and management strategies. \u003cem\u003eEnvironmental Research\u003c/em\u003e, 212, 113427.\u003c/li\u003e\n\u003cli\u003eAstrup, T. F., Tonini, D., Turconi, R., \u0026amp; Boldrin, A. (2015). 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Microplastics and heavy metals emissions from healthcare waste management. \u003cem\u003eWaste Management\u003c/em\u003e, 204, 114932.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Sharda University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Biomedical waste (BMW), COVID-19, Life Cycle Assessment (LCA), Incineration, Carbon footprint, CO₂-equivalent emissions.","lastPublishedDoi":"10.21203/rs.3.rs-9572309/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9572309/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eThe COVID-19 pandemic significantly increased biomedical waste (BMW), particularly plastic-based personal protective equipment (PPE), raising environmental concerns. This study applies life cycle assessment (LCA) in line with International Organization for Standardization (ISO 14040/14044) to compare incineration and non-incineration waste treatment methods. A cradle-to-grave approach with a functional unit of 1 tonne of BMW was used. Data from literature and the Eco invent database supported inventory analysis, while impacts were assessed using the ILCD 2011 Midpoint+ method. Results show incineration produces significantly higher CO₂-equivalent emissions due to combustion of plastic-rich waste, whereas non-incineration methods such as autoclaving generate lower emissions but may lead to long-term landfill impacts. Despite environmental drawbacks, incineration remains essential for hazardous waste treatment. The study highlights the need for integrated, low-carbon waste management strategies that balance environmental sustainability with public health safety.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Comparative life cycle assessment of biomedical waste management strategies: a focus on carbon footprint during covid-19 eras","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 05:14:28","doi":"10.21203/rs.3.rs-9572309/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52466102-e450-4c06-bec9-8aebf750e29b","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T05:14:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 05:14:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9572309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9572309","identity":"rs-9572309","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}