# Life Cycle Assessment of Medical Waste Management: Case Study for Istanbul
## 2 Materials and Methods
### Life Cycle Assessment
#### 2.2.4 Waste Management Scenarios  
Scenario 0 (baseline scenario) represents the current medical waste management system in Istanbul. Waste segregation at the generation point and waste minimization were not considered. Of the total waste, 38% consists of medical waste, whereas the remaining 62% comprises municipal solid waste. Municipal solid waste is directly transferred to the landfill. Of the total medical waste, 38% is disposed of by incineration, while steam sterilization is applied to the remaining 62%. Medical waste converted into municipal waste after stream sterilization is transferred to the landfill. Electricity is generated after incineration and the production of landfill gas; therefore, energy is recovered. The flow scheme of scenario 0 is presented in Figure 3.  
In the flow scheme for the baseline scenario, the Waste Collection 1 and Waste Collection 2 processes represent waste collection from healthcare facilities on the European side and the Asian side, respectively. Municipal solid wastes among the collected waste are transported to ISTAC Odayeri and Komurcuoda landfill sites by Transport 1 and Transport 2, respectively. The landfill of MSW represents the landfill. Hazardous medical wastes are collected by the licensed vehicles of ISTAC and transported to the sterilization and incineration plants in Odayeri by Transport 3. Steam Treatment and Incineration represent the sterilization and incineration processes, respectively. The energy generated from incineration and landfill is represented by Electricity. The Diesel process, Natural Gas process, and Fuel Oil represent the fuel consumed during transportation, natural gas used in the steam sterilization process, and fuel used in the incineration process, respectively. Scenario 1 is created as the first alternative to the current medical waste management system in Istanbul, in which all of the hazardous waste generated from healthcare facilities is disposed of through incineration. Neither waste segregation nor waste minimization is assumed in this scenario. Of the total waste, 38% consists of medical waste, while the remaining 62% comprises municipal solid waste. In the context of this scenario, municipal solid waste is directly transferred to the landfill, whereas all medical waste is incinerated. Electricity is generated from incineration and the production of landfill gas; therefore, energy is recovered. The flow scheme of scenario 1 is displayed in Figure 4.  
Figure 3: Flow scheme for baseline scenario (scenario 0). In the second alternative scenario (Scenario 2), it is assumed that medical waste, except for pharmaceuticals, pressurized containers, and chemicals, is disposed of through steam sterilization. Waste including pharmaceuticals, pressurized containers, and chemicals is collected separately from the other wastes according to the Regulation on the Control of Medical Wastes and disposed of by incineration as per the Regulation on the Control of Hazardous Waste. Waste segregation at the generation point and waste minimization were not considered. Of the total waste, 38% includes hazardous medical waste, while the remaining 62% consists of non-hazardous municipal solid waste. Municipal solid waste is directly transferred to the landfill. Electricity is generated from the incineration process and the production of landfill gas; therefore, energy is recovered. The flow scheme of scenario 2 is shown in Figure 5.  
Scenario 3 is the first scenario comprising waste segregation at the generation point and waste minimization in medical waste management as an alternative to the baseline scenario. It is assumed that the medical waste ratio decreases to 15% from 32% by waste segregation and waste minimization in this scenario, so the ratio of municipal waste reaches  
Figure 4: Flow scheme for scenario 1. Figure 5: Flow scheme for scenario 2. 85%. In addition, it is assumed that the amount of medical waste generated is reduced with waste minimization, starting from the planning stage.