## 4 Discussion  
In this study, the average amount of biomedical waste generated per hospital bed was calculated as 1.19 kg.bed\({}^{-1}\).day\({}^{-1}\). In one study, [PERSON] and [PERSON] [24] reported biomedical waste amounts varying between 0.84 and 5.8 kg.bed\({}^{-1}\).day\({}^{-1}\). [PERSON] [25] found at five Jordanian hospitals that the average daily biomedical waste generation rates varied between 0.29 and 1.36 kg.bed\({}^{-1}\).day\({}^{-1}\). In a similar study conducted at Italian hospitals, the biomedical waste generation rates varied between 0.2 and 3.5 kg.bed\({}^{-1}\).day\({}^{-1}\)[26]. Figure 4: Amounts of GHG emissions from different fuels for biomedical waste collection, transport and treatment between 2009 and 2019. Figure 3: The amounts of greenhouse gases (GHG) versus the global warming factor (GWF) generated during the transportation and treatment of biomedical waste from 2009 to 2019. Daily routine bioindicator tests have shown that the removal rates for _Bacillus stearothermophilus_ were always higher than 6 log\({}_{10}\) in this study. Sterilization effectiveness varies with many parameters that affect the heat transfer and vapor penetration, such as waste contents, waste density, moisture content, and container types [27; 28]. In order to prevent any damage on the shredder, it was ensured in this study that the incoming waste was always free of metal objects. Sterilization efficiency is usually observed by giving a level of assurance at 10\({}^{-3}\) or 10\({}^{-6}\), which indicates that there is a chance in thousands and millions, respectively. Essentially, this means that at least 3 or 6 log\({}_{10}\) pathogen reductions should be maintained. This level of reduction is usually possible because steam sterilization autoclaves are generally operated at minimum standards (121 \({}^{\circ}\)C for 30 min or 134 \({}^{\circ}\)C for 5 min) [8; 10]. The steam autoclave in this study performed at a contact time of 45 min, a temperature of 150 \({}^{\circ}\)C, and at a steam pressure of 5 bar. However, some studies claim that these parameters are not sufficient for the complete sterilization of all biomedical waste types [28; 29]. For instance, the inclusion of a grinding system before sterilization allows better sterilization due to a larger waste surface area for steam. Shredding transforms waste into an unrecognizable form and provides a volume reduction of up to 80% [7]. The shredder system achieved approximately 70 to 80% volume reduction throughout this study. It should be noted, however, that the use of integrated shredders and autoclaves can cause repeated failures and high maintenance costs [30; 31; 32]. As stated by the World Health Organization (WHO), in order to select the best biomedical waste treatment technology, they must pose minimal human health impact, minimal environmental impact, and must be cost-effective and easily implemented [33]. The advantages and disadvantages of five biomedical treatment technologies are summarized as follows [34]: 1--Landfilling: it is one of the oldest methods for biomedical waste disposal in undeveloped countries. However, biomedical waste landfilling includes some serious disadvantages such as the contamination of soil and water, the spreading of pathogens, and high GHG emissions. The only advantage of the landfilling of biomedical waste is the low cost and easy operation; 2--Sterilization: this process is preferred in several applications because it offers many advantages such as excellent efficiency, short treatment times, lower cost, minimum GHG emissions and air pollutants, environment-friendly technology, and the availability of wide range of autoclave sizes. However, sterilization has some disadvantages, such as the odor problem, unsuitability for hazardous and pathological wastes, and shredder requirement; 3--Incineration: the incineration of biomedical waste is suitable for all waste types, provides a high volume reduction, has a potential for energy recovery, and provides complete sterilization.