Biomass Conversion and Biorefinery (2024) 14:1427–1442

https://doi.org/10.1007/s13399-022-02434-z

REVIEW ARTICLE

A comprehensive review of the application of plasma gasification

technology in circumventing the medical waste in a post-COVID-19
scenario
Rajneesh Kaushal1 · Rohit2 · Amit Kumar Dhaka3

Received: 17 November 2021 / Revised: 29 January 2022 / Accepted: 3 February 2022 / Published online: 10 February 2022
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022

Abstract
The recent COVID-19 pandemic, which has hit the world, is third in the last two decades. The safety and precaution measures
have led to the generation of a colossal pile of biomedical waste, including plastic waste, due to the usage of personal protec-
tive equipment kits and safety equipment that is not easily manageable. The environment and health and safety concerns for
humans require biomedical waste to be treated with an outstanding treatment process that can help humanity manage it by
adhering to strict environmental norms prescribed. The plasma gasification technology is the most beneficial and efficient
technology for treating biomedical waste. The byproducts generated can be utilized further as valuable inputs in other indus-
tries, thus strengthening the circular economy concept. In this research paper, the applicability of plasma gasification for the
treatment of biomedical waste in the present scenario has been reviewed. The feasibility and applicability of the technology
in handling biomedical waste have been reviewed via various research articles in this study. Also, further steps have been
suggested for the Indian scenario to make this technology commercially viable in the long run.

Keywords COVID-19 · Biomedical waste · Biomedical waste treatment methods · Plasma gasification · Efficiency ·
Synthesis gas

Abbreviations DC Direct current

BMW Biomedical waste FLW Food loss and waste
CAGR​ Compounded annual growth rate GHG Greenhouse gas
CPCB Central Pollution Control Board ICP Inductively coupled plasma
MSW Municipal solid waste
Highlights O&M Operation and maintenance
• COVID-19 pandemic reported 356 million cases globally with
a staggering rise in biomedical waste.
PG Plasma gasification
• India has recorded a rise of 200 tons per day of biomedical waste PPE Personal protective equipment
generation due to pandemics. RF Radiofrequency
• The share of plastic has increased in biomedical waste due to SUP Single-use plastics
masks, gloves, PPE kits, etc.
• Plasma gasification has emerged as an attractive and viable
UN United Nation
option to treat biomedical waste. UNEP United Nation Environment Programme
WHO World Health Organization
* Rajneesh Kaushal
rajneesh@nitkkr.ac.in
* Rohit 1 Introduction
rohit.iitb21@gmail.com
1
Department of Mechanical Engineering, NIT Kurukshetra, The rapid increase in population and ever-increasing zeal
Haryana, India of humankind to get more acculturate in an urban envi-
2
Environmental Science and Engineering Department, IIT, ronment has put more pressure on the available natural
Bombay, India resources throughout the world. These resources have
3
School of Renewable Energy and Efficiency, NIT accumulated in nature, going through different processes
Kurukshetra, Haryana, India and syntheses in millions of years. Human beings compete

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1428 Biomass Conversion and Biorefinery (2024) 14:1427–1442

with wildlife to get a more massive chunk and convert waste disposal in an unorganized way is an open invitation
these available raw resources to suitable usage. It has led to significant health risks and epidemics [11].
to the growing interaction between humans and animals, The biomedical waste (BMW) generation has observed
which are vectors of disease, viruses, and bacteria that a staggering rise during the past decades, mainly due to
were unknown to society to date. Humanity has exploited increased healthcare access to more populations [12]. Usage
the animals residing in their natural habitat in the wild and of disposable items like injections, syringes, sample con-
dismantled their habitats, making humans more vulnerable tainers, gloves, shields, and personal protective equipment
to zoonotic diseases [1]. (PPE) kits has been increased as a precaution against dis-
In the last two decades, the world has seen three pandemic eases like COVID-19, SARS, AIDS, EBOLA, hepatitis, and
outbreaks due to coronavirus. The first one was a severe tuberculosis.
acute respiratory syndrome, also termed SARS-CoV-1, in The biomedical waste is managed as per the BMW rules
2002. The second one was Middle East Respiratory Syn- notified by the Government of India in 2018. It reached a
drome, termed MERS-CoV in 2012. COVID-19 is the third value of 435.3 tons per day in 2015, translating approxi-
one in the series that emerged in 2019 [2]. Interconnection mately to 0.5–2 kg of waste per bed per day [13]. They are
between different countries of the world as a result of glo- recycled, reduced at source, put into landfills, or incinerated
balization and the capability of the COVID virus to spread under a properly controlled atmosphere. Souza et al. [14]
faster has led to the outbreak declared as a pandemic by the have studied the cost of medical waste disposal in India and
WHO in March 2020 [3]. found that it can vary from Rs. 7.7 per bed per day to Rs.
There has been a rapid increase in people residing in cit- 12.4 per bed per day, depending on the type of healthcare
ies. As per the UN study, 54% of the world’s population facility. The biomedical waste management market was set
resided in cities or urban areas [4]. India is catching pretty to reach $10.3 billion in 2018 for the USA itself, with a com-
fast, considering the urbanization of its population due to pounded annual growth rate (CAGR) of 4.9% [15].
fast economic growth. The transformation is primarily due to India is all set to generate around 775 tons per day of
shifting the economy from agriculture-based to industry and biomedical waste in 2022, with current levels being 551 tons
service-based economy. Around 31.16% of people resided per day. ASSOCHAM has estimated a CAGR of about 7%
in urban areas as per the 2011 survey [5], crossing the 69% at this level of waste generation. United Nation Environ-
mark by 2050 [6]. ment Programme (UNEP) study has estimated that due to
India is slowly proceeding towards a more urbanized the COVID pandemic, an increase of around 0.5 kg per bed
society, and resulting waste generation in India is observ- per day of BMW is expected [16]. China has experienced
ing a rapid climb. Municipal solid waste (MSW) generation a surge of 600% in medical waste generation, i.e., from 40
has increased from 31 million tons in 2001 to 62 million to 240 tons per day in Wuhan City only [17]. Asian capital
tons in 2015 in just 14 years, reaching 165 million tons by cities such as Kuala Lumpur, Bangkok, and Manila were
2030 [7]. India is ranked fifth in the list of countries with an poorly hit, and medical waste generation increased from 154
overall waste generation of approximately 0.12 million tons to 280 tons per day [18].
per day in 2016 and is set to increase by 5% every year [8]. Gasification is a process of thermochemical conversion of
India’s per capita MSW generation varies between 0.17 and biomass waste into combustible gas at high temperatures in
0.62 kg per person per day for small towns and big cities, the presence of the gasifying medium. Sharma and Kaushal
respectively [9]. [19] discussed the economic feasibility of gasification tech-
Indian cities face unplanned urbanization and are coupled nology for waste management in their research article. Gasi-
with expeditious population growth and a poor standard of fication is very flexible in terms of waste acceptance as it
living. Around 90% of MSW generated in India is either can proceed with a myriad of feedstock, and the output gas
non-attended or disposed of very poorly in an unscientific can be utilized for a range of applications. The gasification
way [10]. As per Municipal Solid Waste (Management and technology has a promising aspect as it can be helpful in
Handling) Rules, 2000 made by the Government of India, waste management, reducing GHG emissions and providing
municipal bodies are made responsible for proper collec- energy security. Plasma gasification of waste is a thermal
tion, segregation, and treatment of waste. Municipal bodies treatment in which temperatures as high as 10,000 K vapor-
in India have poor budgetary and technical support and lack ize the waste [20]. The resultant product is synthesis gas,
adequate infrastructure for sustainable waste disposal. The efficiently running compression ignition engines in various
persons engaged have poor coordination among themselves. applications. Plasma gasification technology provides a fea-
They lack proper training and guidance to build sustainable sible and environment-friendly solution for biomedical waste
strategies for appropriate waste disposal. Therefore, dump- treatment [21, 22].
ing waste in open mismanaged landfills outside the city Various authors have reported varying percentages of syn-
limits in low-lying areas is a ubiquitous sight. This type of thesis gas production during waste treatment using plasma

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Biomass Conversion and Biorefinery (2024) 14:1427–1442 1429

gasification (PG). Messerle et al. [23] have treated biomedi- ionization is used to distinguish between these two plasmas.
cal waste using air plasma and steam plasma gasification and The degree of ionization is the ratio of charged particles to
reported that synthesis gas ranging from 53.4 to 84.9 vol.% the total number of particles present in the plasma. Non-
could be produced. They have obtained a maximum yield at thermal plasma has a degree of ionization less than ­10−4.
a temperature less than 1600 K. A thermodynamic analysis The energy associated with plasma which is transferred
conducted on the treatment of BMW in a plasma gasifier to the target feedstock for heating and melting consists of
[22] has yielded syngas of the lower heating value 13 MJ/ the difference between convective heat given to the target
kg. The calorific value of syngas was almost double as what and radiative heat loss from the target to the surrounding.
we observed in conventional gasification yields. The gas tur- The net energy transferred to the feedstock, Qi, is given by
bine system coupled with the plasma gasifier in the above Eq. 1 [25].
study can offset more than half of the electricity required
Qi = hA Tp − Tsf − 𝜎𝜀 Tsf4 − Tw (1)
( ) ( )
for operating the gasifier. A cold gas efficiency of 78.61% is
observed in treating biomedical waste using PG [20]. The
where h is the convective heat transfer coefficient between
above study has established the possibility of utilizing PG
plasma and feedstock, A is the surface area of the plasma
for biomedical waste disposal and hydrogen production.
interaction with feedstock, Tsf is the feedstock surface tem-
The PG technology has been beneficial as it can
perature, Tw is the wall temperature of the reactor shell, σ is
strengthen the circular economy concepts in the waste dis-
the Stefan-Boltzmann constant, and Ɛ is the emissivity of
posal scenario [24]. There are very few studies depicting
the feedstock.
the application of plasma gasification of biomedical waste.
The plasma is generated in a particular instrument called
However, a comprehensive study after the COVID-19 pan-
a plasma torch. The plasma torches utilize electrical energy
demic to explore the applicability of plasma gasification
supplied to the gas passing through it at particular pressure
depicting all the aspects is needed, which has been explored
and temperature. The gas is excited due to its energy, and
in this work. Authors have gone through recent and previ-
electrons are separated from gaseous atoms. These gaseous
ously published articles to present the idea systematically.
electrons collide with atoms to ionize the gas. The plasma
The entire article has been organized into various sections
generation is initiated once the ionization reaches a threshold
and subsections to present the topic comprehensively. This
limit. The system resistance plays an essential role in raising
work will fulfill the quest of the scientific and research com-
plasma temperature [26].
munity to obtain structured information on PG of biomedical
Plasma production can be done by utilizing different
waste.
setups of plasma torches. Arc plasma (direct current (DC)
transferred and non-transferred), radiofrequency (RF),
microwave, and inductively coupled plasma torches are some
2 Plasma gasification
of the methods exploited for this purpose. DC-transferred
plasma torches have feedstock placed in the metal bath to
2.1 Plasma gasification background
work as counter electrodes, whereas DC-non-transferred
torches have counter electrodes positioned inside the torch
Plasma is an electrified gas that exists in ions and electrons
itself. Hybrid plasma setup consisting of arc plasma and RF
and becomes electrically conductive when the gas atoms
plasma sources is being considered for many applications,
are energized via electric current or by providing very high
including operating cost reduction and several added ben-
thermal energy. Plasma has several distinct characteristics
efits. Comparison between different methods is provided in
concerning gases. Gases are electrical insulators that do not
Table 1 for proper consideration of plasma torches.
respond to electric and magnetic fields, whereas plasma is
the opposite. Due to these characteristics, plasma qualifies
to be called the fourth state of matter. The plasma was ini-
2.2 Introduction to technology
tially utilized in Apollo space programs of NASA in the
1960s. The plasma was first used in a small-scale plant to
Plasma gasification technology is a high-temperature decom-
gasify municipal solid waste in Japan in the late 1990s. The
position of waste that converts the input feedstock into a
experiment successfully led to full-scale commercial plants
valuable combustible gas called synthesis gas. The reaction
in various countries. Plasma can be classified as thermal
takes place inside the reactor shell at a temperature as high
plasma or non-thermal plasma. Thermal plasma has elec-
as 3500–6500 °C [29, 30], utilizing the thermal energy of the
trons and heavier particles such as ions and neutrons in ther-
plasma. The waste decomposition proceeds at a very high
mal equilibrium with each other, that is, both of them are at
rate in the limited oxygen supply due to the high tempera-
the same temperature. Non-thermal plasma has electrons at
ture involved in the process. Plasma gasification can handle
a higher temperature than ions and neutrons. The degree of

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1430 Biomass Conversion and Biorefinery (2024) 14:1427–1442

Table 1  Comparison of different types of plasma setups (sources: [27, 28])

Parameters DC transferred DC non-transferred Radiofrequency Microwave

Temperature (K) 12,000–20,000 10,000–14,000 3000–8000 5273

Power input (kW) Up to 80 Up to 80 30 to 35 1
Electrode erosion Yes Yes No No
Electrode material Graphite, copper Graphite, brass, tungsten No electrode No electrode
Cooling method Required Not required Not required Not required
Plasma gas N2, Ar, ­CO2, air N2, Ar, air, ­CO2, ­H2O Ar, ­O2, ­H2 Ar, ­H2, ­N2
Input waste conductivity Required Not required Not required Not required
Thermal efficiency (%) 70–95 70–95 40–50 95–100
1 kW plasma source unit cost (USD) ~ 500 ~ 500 ~ 10,000 ~ 2000

hazardous and non-hazardous waste, making it suitable for scrubber for conditioning and cooling. After that, it enters
managing biomedical waste [29]. the cyclone separator for the removal of particulates. Test
Plasma gasification setup consists of a reactor shell cou- flare is provided to check the combustibility of syngas. Syn-
pled with a waste feeding system. The waste feeding system gas is utilized further for various applications after a stable
has a hopper for continuous waste supply and a shredder for and colorless flame is observed in the test flare setup. The
uniform particle size. The plasma torches are set up in the entire process can be optimized for reactor temperature,
reactor shell at different positions depending on the size of waste feeding rates, the power supplied to the setup, and the
the reactor shell. The feedstock waste enters into the reactor rate of slag elimination [33]. The gas constituents can be
shell via a waste feeding mechanism. Shredder provides for optimized to obtain syngas rich in combustible species like
uniform particle size for proper heat dispensation inside the carbon monoxide, hydrogen, and methane. The schematic
shell. The plasma torches situated inside the reactor shell sketch depicting the overall process of waste to energy using
are like a tubular setup that produces an electric arc. Torches plasma gasification is shown in Fig. 2.
have two electrodes separated from each other with passage Plasma gasification has the advantage that its high tem-
for gas in between them. The gas gets ionized with the flow perature can destroy any active ingredient compounds, radi-
of heavy electricity in between the two electrodes. This cals, and harmful radioactive materials apart from the ben-
results in the ionization of gas, resulting in plasma forma- efits of conventional gasification. The syngas produced has
tion. The heat is transferred from plasma to the waste feed- very low contaminants, but nanoparticles in the syngas can
stock inside the reactor shell. A temperature as high as 5500 be a problem [34]. The major demerit is that plasma gasifica-
°C is generated inside the reactor shells, mainly depending tion is an energy-intensive process. The average efficiency
on the power source. Plasma has the advantage of being for plasma gasification is 42%, which is very low compared
invariable with the feedstock type used, and it does not vary with convention gasification, in which efficiency can go as
with the supply of oxygen or air into the system. The feed- high as up to 72% [35].
stock is subjected to a very high temperature, which converts
into a combustible gas known as synthesis gas with carbon
monoxide, hydrogen, and methane as its main constituents. 3 Biomedical waste
The carbonaceous and volatile part of the feedstock is
gasified into syngas [31], while the inorganic compounds 3.1 Biomedical waste generation
and polymer are melted to form a glass-like structure called
a glass-like structure vitrified slag. The slag has various BMW is waste generated by medical practices like diag-
usages and contributes as raw materials for tiles, road con- nosis and treatment; research carried out on human and
struction, and landscaping. The metals cannot tolerate such animal samples; and medicinal composition and residues,
high heat, and they can be quickly recovered in molten form pharmaceutical products, and human and animal excre-
for further usage. The plasma gasification can be extremely tion [36]. Biomedical waste also includes various anatomi-
helpful for bulky waste as the volume reduction percentage cal waste like tissues of the body, blood samples, fluids
is very high in the range of 95% [32]. The plasma gasifica- of the human body, and pathological waste. Radioactive
tion setup is shown in Fig. 1. waste originating from cancer treatment; cytotoxic waste;
The gasifier reactor shell is attached with a slag removal microbiological cultures; used syringes, blades, instru-
system at the bottom to remove slag continuously. The ments, and lancets; and non-hazardous or general waste
syngas flows from the upper portion and enters the water like food items, glass, and ceramics are incorporated in

13
Biomass Conversion and Biorefinery (2024) 14:1427–1442 1431

Fig. 1  Plasma gasification setup. 1. Hopper. 2. Shredder. 3. Reactor/gasifier shell. 4. Water scrubber. 5. Cyclone separator. 6. Test flame. 7. Slag
removal system. 8. Electric supply. 9. Valve

Fig. 2  Schematic of plasma gasification

medical waste. Kalogiannidou et al. [37] have studied the The accumulated medical waste generated by a health-
composition of biomedical waste and reported that non- care unit depends on the type of disease, severity of disease
hazardous general waste comprises cardboard, plastics, and its contamination, degree of care provided, and waste
rubber, cloth, and synthetics. management practices being followed. The typical medical

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1432 Biomass Conversion and Biorefinery (2024) 14:1427–1442

waste generation rate varies for developed and developing standards is inadequate training and the low education level
countries and is in the range of 0.84–7 kg per bed per day of hospital staff.
[38]. The WHO has conducted a global study in 2011 and The Government of India notified the new Bio-Medical
found that 18–64% of healthcare units do not use appropriate Waste Management Rules on March 28, 2016, in compliance
disposal methods of biomedical waste. The Southeast Asian with Aarhus and Stockholm Convention. The new rules are
countries show a similar trend, with almost 56% of units much broader and clarified regarding waste categorization
lacking standard disposal mechanisms [39]. introducing color-coding. It mandates that only pretreatment
The biomedical waste generation varies according to the and segregation be done at the HCF level while proper dis-
tenure of stay of patients in hospitals and the capacity of posal and recycling will occur at Common Bio-Medical
hospitals. In 2018, out of total medical waste generated by Waste Treatment Facility [39].
healthcare facilities, around 85% of the waste was non-infec- A study was conducted with a modified WHO tool to
tious waste. Only 15% of the waste generated is classified as evaluate the waste management practices in Punjab, India.
hazardous waste. It was observed that developed countries The study found that the public sector has more compliance
have a more significant role in hazardous waste generation with 67.2% as against the private sector with 40.4%. Both
with a value of 0.5 kg per bed per day, while low-income sectors show 100% compliance at the secondary level [45].
countries generate only 0.2 kg per bed per day [40].
India generated around 619 tons per day of medical waste 3.2 Biomedical waste classification
in 2019, as per data available from the Government of India.
This translates to about 0.33 million tons of waste annually The biomedical waste is classified according to the various
from healthcare facilities. Out of this generated waste, 544 risks, i.e., physical, biological, chemical, and radiological.
tons per day of the waste is disposed of using different meth- It poses to the environment and people. Based on the above
ods, while 74 tons per day is released into the environment criteria, biomedical waste is categorized into non-hazardous
without proper treatment [41]. A similar study by Ramteke waste, i.e., general and hazardous waste. Healthcare waste
and Sahu [42] has found that almost 28% of total waste gen- that is mostly general, i.e., food, paper, leather, cloth, cotton,
erated is disposed of unscientifically in open areas. Manzoor gauge, and glass, which carries a shallow risk of spreading
and Sharma [43] have mentioned the effects of biomedical infection is termed as non-hazardous general waste. These
waste on human health and the environment. The composi- types of wastes are segregated with other general waste and
tion of medical waste in Indian scenario is shown in Fig. 3. are mostly treated without any procedure like municipal
The International Clinical Epidemiology Network con- solid waste treatment. The biomedical waste classification
ducted a comprehensive study to assess the situation of is represented in Fig. 4.
BMW management across various states in India for the The hazardous or infectious wastes are those wastes that
period 2009–2012 [44]. The situation was alarming as 82% can spread infection and have significant environmental
of primary healthcare facility (HCF) and 60% of second- and health risks associated with them. These types of waste
ary HCF do not have any credible biomedical waste man- require safe handling, disposal, and treatment as per the bio-
agement system. The tertiary HCF also does not show any medical rules notified by statutory bodies. These wastes con-
improvement, with 54.2% lacking the adequate disposal tain pathological microorganisms, which can spread disease
strategy. As per the study, the situation is much worse for after exposure. Needles, various syringes, lancets, scalpels,
rural areas than for urban areas, and the reason for such poor knives, test tubes, broken glass, human and animal cell cul-
tures, amniotic and other body fluids, saliva, blood samples,
and pathological waste are included in these wastes.
Hazardous waste further includes chemical waste, radio-
active waste, and cytotoxic waste. Chemical waste is the
waste that is generated mainly from pharmaceutical prepara-
tions. They are termed hazardous if they have one or more
of the following listed properties: toxic, corrosive, flamma-
ble, reactive, explosive, and oxidizing. Radioactive waste is
mainly generated by radioactive compounds used in onco-
logical treatment. They need to be handled carefully in spe-
cially designed lead containers. The cytotoxic waste is waste
with genotoxic properties, an example being cytotoxic drugs
used in oncological treatments.
As a global healthcare waste project, a study was done
Fig. 3  Composition of BMW in India (source: [43]) by the WHO has stated that out of total biomedical wastes

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Biomass Conversion and Biorefinery (2024) 14:1427–1442 1433

Fig. 4  Schematic classification

of biomedical waste

generated globally, 85% is general or non-hazardous waste precautions like wearing a mask, maintaining social distanc-
and only 10% accounts for infectious waste. Chemical and ing norms, sanitizers and sprays, and aggressive testing are
radioactive wastes account for 5% [46]. However, in India, suggested to contain the spread globally. The COVID-19
this value could be in the range of 15–35% due to poor seg- shows four stages of transmission, imported cases from other
regation at the source, leading to mixing infectious with countries in stage 1, local transmission in stage 2, commu-
general waste [38]. nity transmission being stage 3, and epidemic being stage
4 [48].
The survival of coronavirus saw a large-scale variation of
4 COVID‑19 pandemic ramifications 2 h to 9 days. The survival time of the virus on the surface
on biomedical waste depends on the type of surfaces like plastics, wood, and met-
als; the temperature and relative humidity of surroundings;
The world has seen the emergence of a new strain of corona- and the strain of the virus in circulation [46]. The survivabil-
virus emerging from Hubei Province, China. This new strain ity of coronavirus on the plastic surface is 6.8 h as against
has infected people with symptoms similar to pneumonia the paper, where it is just 3 h. Other surfaces like cloth (2
[47]. The coronavirus was the third outbreak after SARS- days) and stainless steel (5.6 h) show a great degree of vari-
CoV-1 in 2002 and MERS-CoV in 2012. WHO Director- ation depending upon several factors [49, 50]. The survival
General declared the outbreak a Public Health Emergency time of coronavirus is an essential factor in COVID-19 waste
of International Concern on January 30, 2020. The number management as it facilitates segregation and safe handling of
of cases has been reported to be 356 million worldwide as biomedical waste according to the requirement.
per data accessed within the WHO database on January 27, The COVID-19 pandemic has severely affected waste
2022. The spread of the virus is so alarming that almost management principles and supply chains globally. Wuhan
every country in this world is affected, with more than 5.6 City, the pandemic’s epicenter, experienced a 6-fold increase
million reported deaths. Southeast Asia reported more than in biomedical waste, 40 to 247 tons per day. Rural communi-
50 million cases, with a massive chunk of cases coming from ties in the UK saw a rise of 300% in waste [18]. Shanghai, a
India, with 40 million reported to date [46]. megacity in China with 3.3 tons per day, has reported 11.2
The main routes of coronavirus transmission are direct times increasing hazardous waste generation [51]. The State
contact and respiratory droplets from the mouth. Several Council of China has estimated an increase of 469 tons per

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1434 Biomass Conversion and Biorefinery (2024) 14:1427–1442

day of medical waste attributed to the corona pandemic [52]. primary source of FLW, increasing almost 12%. Online food
Prominent Southeast Asian cities also experienced a rise demand shot up by 80% during this period. It has increased
from 154 to 280 tons per day. These collectively contributed food and packing waste, including single-use plastics and
around 864 tons of BMW per day during the COVID-19 paper packaging [59].
outbreak [53]. Malaysia is observing an increase of 30% in The rise in demand for PPE can be seen from the fact
its clinical waste generation [54]. Iran is also observing an that China produced 110 million face masks in February
increase in infectious medical waste generation from 0.68 to 2020, an increase of around 450%. As of October 2020,
5 kg per bed per day [55]. South Korea has generated 2000 China has supplied almost 18 billion face masks and 1.7 bil-
tons of COVID waste until May 2020. The situation in the lion PPE [54]. N95 mask has seen a demand of 1.6 million
USA is more worrisome, with an increase from 2.5 million from the current requirement of 0.2 million [60]. The WHO
to 5 million tons per year [36]. has studied the monthly need for PPE and estimated that
The COVID-19 pandemic has similarly impacted India, healthcare workers would need 89 million masks, 76 million
increasing 140–350 tons of biomedical waste daily [57, 58]. gloves, 30 million gowns, and 1.6 million goggles during the
The impact of COVID-19 on biomedical waste generation COVID-19. A similar study for people in Italy has estimated
is depicted in Fig. 5. a need of 1 billion face masks and 0.5 billion gloves monthly
The inefficiencies of food supply chains during the [16, 61]. Benson et al. [56] have estimated that around 3.4
COVID-19 pandemic have created an unexpected shift in billion face masks and PPE kits are discarded daily. The
food access and food loss and waste (FLW). Food waste gen- region-wise distribution can be seen in Fig. 6. The single-use
erated from hospitals constitutes an integral part of BMW. face masks, gloves, boots, PPE kits, goggles, face shields,
During the lockdown period, households have been the etc., comprise mainly low-density polyethylene, polyvinyl

Fig. 5  Impact of COVID-19 on

biomedical waste generation 8000
(sources: [20, 22, 36, 41, 56])
7000

6000

5000
Tons/day

4000

3000

2000

1000

0
US China India Brazil World

Fig. 6  Estimated number of dis-

carded face masks region-wise 2000
Number of face mask

1500
(million)

1000

500

0
Asia Europe Africa Latin North Oceania
America America

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Biomass Conversion and Biorefinery (2024) 14:1427–1442 1435

chloride, polycarbonate, and other components, increasing collectors. All these will lead to the accumulation of bio-
the percentage of plastic content in biomedical waste [41]. medical plastic waste in the environment.
The UNEP has estimated an increase of 0.5 kg per bed per
day of plastic medical waste generation amid the COVID-
19 pandemic worldwide [16]. Even after the pandemic, this 5 Treatment methods
surge in demand for PPE like facemask and gloves is not
intended to decline and may record a CAGR of 20% until The biomedical waste treatment requires special handling,
2025 [36]. Plastic waste generation is on a steep incline, with transportation, and safe disposal strategies. The global
almost 1.6 million tons generated worldwide [62]. Hantoko healthcare waste project initiated in August 2008 was jointly
et al. [54] have estimated the total weight of discarded face- implemented by the WHO in cooperation with UNDP for
mask generated per day and found it to be 2331 tons per day seven selected countries including India. As per the study,
for India, only assuming a weight of 3 g for each discarded total BMW generation varies from 2 to 4 kg per bed per day.
facemask. Infectious waste constitutes a fraction of this waste with a
The COVID-19 pandemic has led to the prioritization of mere 0.2–0.4 kg per bed per day. The average bulk density
human health over environmental health, and waste manage- was found to be 100–200 kg per cubic meter [65]. Biomedi-
ment strategies are getting postponed or reversed in many cal waste collection in India is still developing as only 44%
countries globally. Hygiene and preventive concerns have of healthcare facilities have agreed to have a waste collec-
led to a significant increase in demand for food packaging. tion facility. Thirty-two percent of healthcare units dump
The ban of single-use plastics (SUP) has been delayed in their waste in dustbins provided by urban bodies [66]. Much
Newfoundland and Labrador provinces in Canada, New garbage is dumped openly in nearby landfills and thus could
York, Maine, Delaware, and others in the USA, UK, and not make up to the treatment facilities. Poor segregation of
Portugal. Several others like Massachusetts and New Hamp- hazardous waste is also an issue. The hazardous nature of
shire in the USA have either reintroduced it or banned reus- biomedical waste should be considered while selecting a
able amid COVID-19 concerns [61]. Waste management reliable and authentic waste treatment method. The infec-
practices in affected European countries like Italy which tious nature of this waste possesses not only human health
have been confined to infected persons are prohibited from concerns but also a significant risk to the environment as
segregating their waste [63]. China has also suspended envi- observed in the case of the COVID-19 pandemic.
ronmental standards for its small industries to expedite their Three approaches have been defined for BMW treatment,
recovery [50]. Indian municipalities were also at the receiv- i.e., an onsite treatment where healthcare facility treats its
ing end due to increased plastic waste amid the COVID-19 waste, cluster treatment where waste is treated in cluster
pandemic. Corburn et al. [64] have reported a rise in uncon- cater for the local area, and central treatment in which dedi-
trolled landfilling and burning of plastic waste in several cated treatment plants handle the BMW. Types and quantity
Indian municipalities. of waste, technological capabilities, treatment efficiency,
To contain COVID-19 transmission, countries have capacity, volume mass reduction, O&M requirement, skill
mostly resorted to a social distancing between individuals, requirement, and capital cost are factors that affect the selec-
quarantining, avoiding public gatherings, promoting work tion of treatment methods.
from home, closing education institutions and promoting Several studies have been conducted to evaluate the treat-
online classes, restricting visits to malls, restaurants, etc. ment options of biomedical waste. Incineration is widely
This measure has fostered a culture of online shopping utilized to dispose biomedical waste as it is safe and effec-
and food delivery among consumers. Food order delivery tive [67, 68]. Incineration is mainly used with no dearth of
from stores has shot up by almost 80% during this duration. investment and treats almost 59–60% of biomedical waste
South Korea has reported an increase of 92.5% and 44.5% in globally [12]. Chemical or steam disinfection is a preferable
online food orders and daily necessities. India, China, Italy, option for small waste disposal quantities [2].
and Germany have observed a 12–57% increase in online The WHO has mandated incineration for the disposal
shopping activities during the same duration. The USA has of PPE and other infectious waste made from plastics [50].
reported a 30% rise in online shopping. An online shopping However, medical waste incineration is a harmful method
firm, Amazon e-commerce services, has 26% year-on-year of waste disposal as it produces toxic compounds like poly-
sales in their first quarter [50]. Most packaging is done in chlorinated dibenzodioxins (PCDDs) and polychlorinated
single-use plastics like thin films and foams. The packag- dibenzofurans (PCDFs) at low temperatures, which are car-
ing in multi-layered plastics is also harmful as they pos- cinogenic. The various factors like low-temperature range,
sess very low recyclability due to polystyrene, low-density inappropriate residence time, the chlorine content in waste
polyethylene, etc. [41]. Most medicines cover use of single- feedstock, and de novo synthesis primarily respond to the
use plastics, tablets, capsule covers, containers, and sample dioxin and furan generations [69]. Apart from generating

13
1436 Biomass Conversion and Biorefinery (2024) 14:1427–1442

toxic gases like CO, ­CO2, ­SOx, ­NOx, and PM, it also pro- gasification technology for biomedical waste treatment is
duces polycyclic aromatic hydrocarbons that vary from 3377 quite beneficial as it provides a clean output of syngas, less
to 11,390 ng/Nm3 [70]. The pollution control devices are toxic emissions, slight char, and tar, and can disintegrate
used to contain the emission of these harmful gases within almost any medical compound present in the waste.
stringent statutory limits, which adds up to the incinerator
cost.
Autoclaving method using steam sterilization is the sec-
ond most preferred, with a 20–37% share [12]. Autoclav- 6 Plasma gasification of biomedical waste
ing is an environmentally friendly technology and converts
infectious waste into non-infectious ones. The main issue 6.1 Modeling of plasma gasification
with autoclaving is that it does not provide volume reduc-
tion. Thus, the output needs to be compressed and disposed Favas et al. [35] have utilized Aspen Plus to develop a
of in landfills, which consumes extra energy. Other waste plasma gasification model. The entire process is divided
disposal methods are microwave treatment, chemical dis- into four sections: inlet, drying of feedstock, pyrolysis,
infection, biological disinfection, landfilling, burning, and and gasification for simulation. The model was developed
plasma gasification, with less frequent usage and a combined to minimize the Gibbs free energy for calculating syngas
share of 4–5% [67]. constituents. Gibbs free energy at equilibrium for plasma
During recent years of development, plasma gasification gasification is defined by the following equation [35, 77].
of biomedical waste emerged as a promising technology for ( )
ni
the treatment of BMW [23, 71–74]. Wang et al. [2] have
∑N ∑N
(2)
t 0
G = n ΔGf ,i + n RT ln
i=1 i i=1 i
recommended the usage of plasma gasification for the treat- ntotal
ment of COVID-19 waste as the SARS-CoV-2 can spread
where Gt is Gibbs free energy of the system; ni and ntotal
quickly. This technology has combined the benefit of volume
are the number of moles of species i and the total number
reduction up to 95%, mass reduction of 90%, significant low
of moles of all species in the syngas, respectively; R is the
emissions, and residual inert [26, 36]. The plasma gasifica-
universal gas constant; and T is temperature. The super-
tion has shown higher efficiency in the treatment of BMW
script 0 denotes the standard thermodynamic property. Eq.
than conventional incineration, which makes it more suitable
(2) is solved for the values of ni for which the system’s total
and promising in its future applications [23].
Gibbs free energy is minimized. To minimize the Gibbs free
Plasma gasification has been compared with incinera-
energy, the Lagrange multiplier method given in Eq. (3) is
tion as it is an established and most widely used technol-
used [33, 78, 79].
ogy for treating biomedical waste in Table 2. The plasma

Table 2  Comparison of Parameters Incineration Plasma gasification Source

incinerator with plasma
gasification Operating parameters
Temperature (K) 1000–1500 Up to 3000 [36]
Stoichiometric ratio >1 <1 [75]
Sterilization efficacy High Very high [75]
Gross electrical efficiency (%) 18–26 Up to 31 [22, 76]
Volume reduction (%) 90 95 [22, 26]
Environmental parameters
PCDD/PCDF (μg/Nm3) < 0.0983 < 0.00925 [74]
­NOx (μg/Nm3) 40–100 150 [74]
­SOx (μg/Nm3) 40 26 [74]
HCl (μg/Nm3) 1–8 [74]
PM (μg/Nm3) 20 12.5 [74]
Economic cost (per ton)
Capital cost (million USD) 0.23 0.2 [74]
Operation cost (million USD/year) 0.016 0.017 [74]
Readiness level
Technology readiness level 9 8 [74]
Community readiness level 9 5 [74]

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Biomass Conversion and Biorefinery (2024) 14:1427–1442 1437

risen from 10 to 30% in the last decade [85]. The calorific

( )
𝜕L ni ∑m
= ΔG0f ,i + ni RT ln + 𝜆a
j=1 j ij
=0 (3) value of medical waste has been thus pushed higher, owing
𝜕ni ntotal
to the rise of plastic. The potential energy recovered per kg
where L and λj denote the Lagrange function and Lagrange of plastics is around 40 MJ/kg [17]. Studies have evaluated
multiplier in the equation, respectively, and aij is the atoms that the average calorific value of biomedical waste ranges
of jth element in a mole of ith species. Eq. (3) denotes the between 12.5 and 16.4 MJ/kg [86].
equilibrium equations for each specific species of the system. Plasma gasification technology has evolved with time and
Zitouni-Petrogianni and Voutsas [80] have modified a is seen as a promising technology to handle almost all types
mathematical model based on gasification to include the of medical waste. Owing to its high-temperature operation
thermodynamic analysis in the model. This model was at 3000 °C, it can kill all the microorganisms. Such high-
based on the model developed by Mountouris et al. [81] temperature operation is a good source of ultraviolet radia-
in their study. The modified model proves to be beneficial tion, which aids in killing the bacterial and viral loads in the
in predicting various concentrations of gases arising out of waste. Pharmaceutical ingredients are also destroyed in the
plasma gasifiers. The modified model was applied as a case process with no traces left [25]. Plasma gasification has been
study for a plasma gasification plant of 750 tons per day in utilized in eradicating cytotoxic medicines, which also offer
Greece. The model prediction is confirmed with the process high resistance to decomposition.
real-time data of the plant. Another model based on equi- Further reductions in emission in the form of dioxins,
librium-based gasification was developed on Aspen Plus. A benzopyrene, and furans are observed [87, 88]. The only
comparison between entrained flow and plasma gasification disadvantage with the technology is its heavy electrical
has been made. The results indicate that various gasification power usage in the range of hundreds of kW to a few MW.
characteristics like cold gas efficiency, synthesis gas compo- The syngas is produced as a byproduct in the whole pro-
sition, and heating value were better for plasma gasification cess of treatment of waste which has several usages. The
than entrained flow gasification [82]. most promising use of fuel is its utilization as an energy
A similar model was developed for municipal sludge to source [89]. The Fischer-Tropsch process is used to convert
hydrogen conversion utilizing plasma gasification coupled syngas to liquid fuel. The syngas can be utilized for gas
with chemical looping. The hydrogen production is signifi- turbine operation or as an input to fuel cells for electric-
cantly higher with plasma gasification than plasma gasifica- ity production. Other products like ammonia, methane, and
tion coupled with chemical looping [83]. The hydrogen is hydrogen can also produce syngas [23]. Various studies are
produced by utilizing microalgae in a plasma gasifier. Aspen being conducted to utilize compression ignition engines as
Plus simulation for the above study has obtained an optimal a fuel of the next generation. Increased mileage and reduced
value of steam-to-biomass ratio of 0.354 for raw microalgae operation cost of running such engines have been observed
[84]. by utilizing syngas [90].
Numerical investigations were carried out for gasification Plasma gasification is a relatively newer technology in
of medical waste in plasma reactor at different equivalence treating the medical waste field. The output of the plasma
ratio values. Three different waste samples of varying car- gasification process is a gas-like substance that can be used
bon contents were used, and gasification was carried out at as an input raw material in the construction and infrastruc-
equivalence ratios varying between 0.1 and 0.5. Maximum ture development industry. Scrap metals in the waste can be
hydrogen generation was observed at an equivalence ratio recycled as they are recovered in the molten form [74]. The
of 0.1 for all samples [20]. plasma gasification has a high temperature associated, which
breaks the complex structures in a simple form addressing
6.2 Plasma gasification treatment of biomedical the safety concerns to human health and the environment.
waste Syngas is generated as a byproduct in the whole process that
can substitute conventional fuels in compression ignition
A significant change has been observed in medical composi- engines [91]. The syngas obtained from plasma gasification
tion in recent times. COVID-19 pandemic has increased the is good quality and rich in hydrogen with low tar content
percentage of plastics and polymers in waste due to heavy [30, 92].
usage of PPE kits, face shield, gown, gloves, masks, dispos- A plasma gasification unit consists of several components
able bags, and other safety harnesses. Precautions against and systems used for its smooth functioning. A typical unit
diseases like AIDS, hepatitis, and Ebola also significantly has a waste feeding system; chamber of waste processing;
increase the number of plastics in medical waste. The solid residues handing system, which also helps remove
COVID-19 pandemic has severely increased plastic waste solid waste; synthesis gas management system; and moni-
generation, with almost 1.6 million tons of plastic generated toring and control [25]. The process flow can be depicted
every day globally [62]. Plastic content in medical waste has in Fig. 7.

13
1438 Biomass Conversion and Biorefinery (2024) 14:1427–1442

Electricity

Waste Gas Lime

Plasma Gasification
Chamber Scrubber Gas Stack

Metal Inert
Recovery Slag

Fig. 7  Plasma gasification process flow diagram

An experimental study with the treatment of medi- show that the concentration of syngas is not more than 54%
cal waste with fly ash has been carried out by varying the and 85% (volume percent). The heat of combustion for syn-
weight ratio to obtain minimal waste discharge along with a thesis gas produced in these two mediums is 3510 kJ/kg and
high-value end product. Feeding only medical waste in the 5664 kJ/kg, respectively. No harmful impurities are found
gasifier resulted in slag containing approximately 36% oxy- in the byproduct of plasma gasification as observed with
gen, 28.6% calcium, and 16% silicon. Co-treating it with fly X-ray analysis.
ash in the ratio of 2:1 shows a similar trend. Increasing the An experimental investigation on solid waste, which
fly ash by varying the ratio shows an increasing amount of included medical waste, reported the composition of carbon
transition metals in the slag. Treating the fly ash in a plasma monoxide (73.4%), hydrogen (6.2%), nitrogen (29.6%), and
gasifier obtained after co-treatment, also called secondary sulfur (0.8%) as volume percentage composition of synthesis
treatment, gives an enriched amount of heavy metals [93]. gas. The total concentration of syngas obtained is 69.6%
A very efficient method uses plasma generated by radi- (volume percentage). The experimental results obtained
ofrequency to treat medical and hazardous wastes and cryo- match accurately with the calculation done by Ustimenko
genic pretreatment. In cryogenic pretreatment method, all [95]. The electricity consumption varies with the medium
types of medical wastes are passed through liquid nitrogen used in plasma gasification, and it is calculated for unit con-
chamber and treating material becomes brittle, which is easy sumption basis to be around 1.92 kWh/kg for air gasification
to crush and all types of material in medical waste are con- and 2.44 kWh/kg for steam gasification.
verted into the same particle size 100 to 600 μm and crushed Zhovtyansky and Valinčius [96] have done an extensive
at a temperature of − 80 °C. Particle of similar size is easy study on plasma gasification of waste and concluded it to
to treat via RF plasma treatment method [94]. be a commercially viable alternative based on the ecologi-
The amount of synthesis gas obtained varies with the cal benefits it possesses and the total energy efficiency of
temperature in plasma gasifier. Tavares et al. [79] have sug- the system. Plasma gasification is highly efficient in treating
gested that plasma gasification is most favorable for syngas hazardous waste, with an efficiency of 99.9%. The overall
production at high temperatures. The maximum yield has flexibility of the systems, along with its acceptance of a
been observed at a temperature not more than 1300 °C as comprehensive range of waste, makes it an important tech-
per the calculations done by Messerle et al. [23]. A separate nology for research purposes. With every ton of solid waste
arrangement of plasma gasification in air and steam medium fed into the plasma gasifier, 900 kWh of electricity can be
has been made with bone tissue, and the results obtained produced [97].

13
Biomass Conversion and Biorefinery (2024) 14:1427–1442 1439

The efficiency of an internal combustion engine cou- 8 Future scope

pled with a plasma gasifier comes out to be 78.58%. The
electricity generation potential for the system has been There is further scope of studying the cost of technology
evaluated to be 31%, i.e., the setup produces 31% of the for treating biomedical waste in India as there is a dearth of
electricity required to be fed into a plasma gasifier. The work in this field. The different standards and design can be
payback period for the whole setup is calculated to be standardized to develop a low-cost alternative to the Indian
around 6 years which is quite impressive comparing the perspective. The effect of utilizing plasma gasification can
payback period for hydropower dams is around 20 years be studied for inactivation and residence time of microor-
[98]. ganisms. The technology has been confined to lab scale only
The feasibility of plasma gasification setup com- owing to its high cost and operational difficulties. The Indian
pared to incineration has been studied in Portugal. The waste is unsegregated and has a high moisture content. The
study covered a comprehensive evaluation and found real-time data can be assessed by utilizing the setup with
that plasma gasification is more beneficial considering general hospital waste on the field. This will help understand
health safety and environmental. Economic analysis over and evaluate the operating parameters at a much better scale.
20 years provided lower or similar costs for plasma gasi-
fication compared to incineration. The annual cash flow
was studied and found that plasma gasification is feasible Author contribution Conceptualization, proofreading, and reviewing
for a life span of 20 years. Plasma gasification requires were performed by Rajneesh Kaushal. Writing of the original draft was
performed by Rohit and Amit Kumar Dhaka. Writing with review and
a high initial investment, but annual revenue exceeds editing was performed by Rajneesh Kaushal and Rohit. Visualization
expenses [76]. was performed by Rohit and Amit Kumar Dhaka.

Declarations

7 Conclusion Conflict of interest The authors declare no competing interests.

The COVID-19 pandemic has thrown open a challenge for

medical waste management due to the enormous amount
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