Abstract / Summary
Abstract Healthcare-associated infections (HAIs) impose a substantial burden in low- and middle-income countries, and inadequate medical waste management is an underexamined contributor. This study investigated medical waste management practices across seven hospitals in Lagos, Nigeria, and assessed the potential of circular economy approaches to simultaneously reduce infection risk and improve resource efficiency. A convergent parallel mixed-methods study was conducted across seven purposively selected hospitals in Lagos State between January 2022 and December 2023, combining structured surveys (n = 336 healthcare workers; 87.5% response rate), semi-structured interviews (n = 21 key informants), and systematic direct observation of waste-handling practices. Chi-square tests with Cramér’s V effect sizes examined associations between professional category, training, and waste-management knowledge and practice. The seven facilities operated 1245 beds and generated 215.56 kg of waste daily (0.181 kg/bed/day), comprising approximately 70% general and 30% infectious waste; improper segregation contaminated the entire waste stream, eliminating recycling potential. Professional category was strongly associated with waste-categorisation knowledge (χ² = 1344.0, df = 20, p < 0.001, Cramér’s V = 0.89), with sanitation workers showing the lowest knowledge despite the highest occupational exposure. Only 61.0% of respondents agreed that segregation should occur at the point of generation, 58.1% correctly identified the colour-coding system, and only 42.3% had received formal training. Only 57% of facilities had adequate waste storage, and collection intervals routinely exceeded WHO recommendations. Inadequate medical waste management is a significant, underrecognised contributor to HAI risk in this setting. Integrating circular economy principles - waste minimisation, source segregation, safe recycling, and formalisation of waste-handling work - with infection prevention and control could simultaneously reduce transmission risk and yield an estimated 15–20% in cost savings. Seven policy interventions are proposed, spanning national legislation, mandatory segregation, appropriate treatment technology, formal recycling with worker protections, continuous training, stronger enforcement, and community engagement.