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Published on

22/7/2025

Waste management for healthcare facilities

Waste management in healthcare facilities is an area of increasing complexity and constant evolution, guided by demanding regulations and an increasingly marked environmental awareness.

Waste management in healthcare facilities: a strategic and regulatory issue

Waste management in healthcare and medico-social facilities is an issue of considerable complexity and strategic importance, rigorously framed by French legislation. Far from being limited to simple disposal, this management encompasses a series of fundamental principles aimed at protecting human health and the environment, while promoting the adoption of a circular economy approach. Healthcare professionals, whether working in care facilities, in-home hospitalization, or in private practice, generate a significant volume of waste of very diverse natures. Among these, some present major risks, whether infectious, chemical, toxic, radioactive, or mechanical. A thorough understanding and strict application of the regulations in force are therefore imperative to control these risks at all stages of the disposal chain, from initial production to final treatment. The purpose of this article is to offer an exhaustive exploration of the legal obligations, the specificities of the different waste streams, the responsibilities incumbent on the actors concerned, and the sanctions incurred in the event of non-compliance, in order to provide a clear and complete vision of the challenges of waste management in the healthcare sector.

The legal framework and fundamental principles of waste management

Waste management within healthcare and medico-social facilities is intrinsically governed by a set of strict legislative and regulatory provisions, the pillars of which are the Environment Code and the Public Health Code. In accordance with Article L541-1 of the Environment Code, waste is defined as "any substance or object, or more generally any movable property, which the holder discards or intends or is required to discard." This fundamental definition serves as a starting point for all the obligations incumbent on producers and holders of waste.

The main guiding principles and the hierarchy of treatment methods Facilities are required to organize the management of their waste in accordance with a hierarchy of treatment methods clearly established by law. This hierarchy, detailed in particular by Article L541-1 II. 2° of the Environment Code, must guide every decision regarding waste management:

Prevention of waste generation: This approach is the top priority. It aims to reduce the amount of waste produced or to limit its harmful effects at the source. For healthcare facilities, this can translate into optimizing practices, using durable materials, or reducing packaging.
Preparation for reuse: This step involves preparing products for identical reuse before they are considered waste. This is an essential component of waste prevention, such as donating unused medical equipment or uneaten meals.
Recycling: This process involves transforming waste into new substances, materials, or products. Sorting at the source is essential to enable the recycling of different flows.
Any other recovery, including energy recovery: When recycling is not technically or economically viable, this step involves recovering energy from waste, for example, via incineration with energy recovery.
Elimination: Representing the last resort, elimination only concerns ultimate waste, that is, waste for which no form of recovery is possible.

Fundamental Environmental and Health ObligationsBeyond this hierarchy, hospitals must organize their waste management in such a way as to limit the transport of waste, thus promoting a principle of proximity that is essential for reducing the carbon footprint and the risks associated with logistics. More importantly, this management must imperatively comply with the principles of protecting human health and the environment. This implies constant vigilance to:

Do not create risks for ecosystems, whether it be water, air, soil, fauna, or flora. Any failure could have disastrous environmental and health consequences.
Do not cause noise or olfactory nuisances, which can impact the quality of life of residents and staff.
Do not harm landscapes and protected sites, thus preserving natural and cultural heritage.
Do not cause degradation of places of particular interest, such as classified sites, natural monuments, and natural areas of ecological, faunal, or floral interest.

These requirements apply universally to all healthcare and medico-social facilities. They are already in effect, and non-compliance can lead to numerous administrative or criminal penalties. Defective waste management, such as illegal dumping or the use of an unapproved organization for treatment, can be severely penalized, with penalties of up to four years' imprisonment and a €150,000 fine. These fundamental principles are fully in line with a comprehensive approach to ecological planning of the healthcare system, aimed at reducing its environmental impact and strengthening its resilience to climate challenges and resource scarcity.

Traceability: an imperative for transparent management

Waste traceability is a crucial component of the legal framework for its management within healthcare and medico-social facilities. It constitutes a guarantee of continuous monitoring, from the moment the waste is produced until its final disposal, thus ensuring rigorous compliance with all regulatory requirements.

Obligations for Maintaining a Chronological RegisterLegislation requires hospitals to maintain and retain a chronological register of the traceability of their waste for at least three years. This traceability obligation does not apply to waste that is collected directly by the public service. For hazardous waste and POP (Persistent Organic Pollutants) waste, Article R541-43 of the French Environment Code specifies that hospital operators are required to keep a detailed register. This register must record the production, shipment, reception, and treatment of this waste, as well as the products and materials resulting from its recovery. The retention of this register is mandatory for a minimum period of three years.

The fundamental role of Waste Tracking Forms (WTF)For all hazardous waste, the issuance of a Waste Tracking Form (WTF) is mandatory for each collection. This document is of paramount importance for tracking all disposal operations and must be systematically made available to the administrative authorities. The WTF must contain a multitude of precise and detailed information, including the waste code, the quantity (actual or estimated in tons), the origin of the waste (address, SIRET), the prior acceptance certificate number, a clear description of the operation, the number of packages per type of packaging, the total number of packages, the address of the collection site, and the possible mention of the presence of POP waste. When issued by the producing hospital, additional information concerning the issuer of the form, the nature, packaging and quantity of the waste, its precise origin, as well as the destination facility (with details if an eco-organization or a trader/broker is involved) must also be provided.

Dematerialization and the advent of the Trackdéchets platform: The regulations have evolved significantly to make the dematerialization of the WTSDF (Waste Tracking Slip for Hazardous Waste) and the traceability register mandatory for certain categories of waste. The Trackdéchets platform is the central and essential digital tool for this mandatory declaration. It allows for the simplified and secure declaration of the tracking of hazardous waste, asbestos, end-of-life vehicles, and refrigerant fluids at each collection. For waste containing asbestos, the WTSDF can be issued by the project owner (the hospital), the company carrying out the work, the waste disposal center, or the holder, with the requirement to specify information relating to the seal numbers, the consistency and packaging of the waste, as well as the work operations carried out. Regarding refrigerant fluids, since January 1, 2023, the issuer can be the holder or the operator who collects, and they must specify information relating to the containers. The electronic transmission of this data via Trackdéchets, if carried out within seven days of the production or dispatch of the waste, exempts the hospital from the obligation to keep and maintain a paper register, as the data is then directly accessible and consultable via the "national waste register". The obligation to dematerialize WTSDFs for healthcare waste with a risk of infection (DASRIA) was being defined in 2023, signaling a progressive extension of this practice. Article R1335-4 of the Public Health Code also specifies the establishment of monitoring documents for DASRIA.

Responsibility and penalties related to traceabilityThe responsibility of the establishment, as the producer or holder of waste, extends continuously until the final disposal or recovery of the waste, even in cases where the waste is transferred to a third party for processing purposes. It is the producer's responsibility to ensure that the person or entity to whom the waste is handed over is duly authorized and qualified to handle it. Failure to comply with traceability obligations is punishable by sanctions. For example, a fine of €750 is provided for if the waste traceability register is not kept or if the establishment refuses to make it available to the administrative authorities during an inspection. More generally, any violation of the obligations to keep a register, to transmit information, or the refusal to present the BSDDs to authorized agents, constitutes a 4th class offense.

Source sorting and the "8 streams": at the heart of obligations

Source sorting is a fundamental component of waste management within healthcare facilities. It requires the separation of different types of waste from their point of production, in order to allow for their appropriate treatment or recovery. This obligation is reinforced and systematized by the implementation of the concept of waste "streams".

Evolution of mandatory sorting "streams"Regulations require establishments to sort their waste at a minimum according to specific categories, called "streams." Initially based on five streams, this obligation has gradually expanded to include more materials:

The historical « 5 streams »: These are the basic categories that establishments are required to sort separately. They include paper/cardboard, metal, plastic, glass and wood. This obligation has been in effect for waste producers and holders since July 1, 2016. Compliance with these streams allows for better recovery and more efficient recycling of materials.
The « 7 streams »: In addition to the five previous streams, mineral fractions and plaster are added, specifically in the event of construction, renovation or demolition work. This extension aims to more effectively manage building waste, which is often bulky and specific.
The « 8 streams »: From January 1, 2025, textiles will be added to this list, bringing the total number of mandatory sorting streams to eight. This change aims to strengthen the recovery of textiles, including uniforms, bed linen, and other used textile products from hospitals.

It is important to note that in practice, biodegradable waste, food oils and hazardous waste are also considered as additional mandatory streams, even if they are not explicitly included in the designation "8 streams" as presented by the main source. They have their own specific sorting and management regulations.

Mandatory Separate Collection for Users and StaffBeyond internal sorting, hospitals have a crucial obligation to provide the public and their staff with separate collection systems for certain specific waste. This concerns paper, cardboard, steel, aluminum, plastics, and biowaste. This measure is essential to encourage the participation of all stakeholders present in the hospital in the sorting process. This obligation applies to all public and private health and medico-social hospitals whose total waste volume totals at least 1,100 liters per week, all waste combined. Articles D543-278 and D543-281 of the French Environment Code confirm that compliance with this rule validates the obligation of separate collection for waste generated by the public.

Sorting is crucial not only for environmental reasons, but also for economic and safety considerations. It makes it possible to identify hazardous waste (HW) from non-hazardous waste (NHW), avoiding potentially risky mixtures, ensuring the safety of people (care staff, disposal agents) and complying with hygiene rules. In addition, rigorous sorting makes it possible to control the economic impact of the elimination of healthcare risk waste, which is often costly.

Annual characterization report and sorting certificates Hospitals are also required to produce an annual waste characterization report as well as a certificate of mandatory sorting. These documents are of paramount importance to attest to compliance with sorting obligations and are required for the admission of waste into storage facilities. Producers must demonstrate that the waste transported to non-hazardous waste storage facilities is indeed non-recoverable, justifying this characterization through this annual report, which can be delegated to the facility operator or a competent laboratory.

Penalties for non-compliance with sortingFailure to comply with the 8-stream waste sorting obligations may result in significant administrative penalties, up to €150,000 in fines. In addition, general mismanagement of waste, including practices such as illegal dumping or the use of unapproved organizations for treatment, is punishable by imprisonment of up to four years and a fine of €150,000. These measures underscore the critical importance that regulations place on source sorting to ensure compliance and environmental protection.

Waste from healthcare activities involving infectious and similar risks (DASRIA): very specific management requirements

Waste from infectious and related healthcare activities (DASRIA) is a particularly sensitive category of waste, due to the risks it may present: infectious, chemical, toxic, radioactive or mechanical. Their management is therefore subject to extremely rigorous regulations, with the overriding aim of protecting patients, healthcare staff, collection agents and the environment as a whole.

Definition and characterization of HCWRIAsAccording to Article R.1335-1 of the Public Health Code, healthcare activity waste is defined as "waste from diagnostic, monitoring and preventive, curative or palliative treatment activities in the fields of human and veterinary medicine." Specifically considered as HCWRIAs are those that:

Present an infectious risk: They contain viable micro-organisms or their toxins, which there is good reason to believe can cause disease in humans or other living organisms, due to their nature, quantity or metabolism.
Even in the absence of infectious risk, specific categories are relevant. :
- Sharps and cutting materials intended for disposal, whether or not they have been in contact with a biological product (e.g., needles, scalpels, blades, syringes with integrated needles).
- Blood products for therapeutic use that are incompletely used or have reached their expiration date.
- Human anatomical waste corresponding to non-easily identifiable human fragments (unlike Human Anatomical Parts or HAPs, which are easily identifiable and have a separate disposal channel, often via cremation).

Furthermore, waste from teaching, research, industrial production in human and veterinary medicine, thanatopraxy, cosmetic surgery, tattooing by skin breakage, and clinical or non-clinical trials on cosmetic and tattooing products are also comparable to healthcare risk waste if they meet the aforementioned characteristics. The High Council for Public Health (HCSP) has provided crucial clarifications on the characterization of infectious risk. Waste is considered to be at infectious risk if it comes from a proven infectious focus with clinical signs or if it is heavily impregnated with blood, secretions or excretions, with a risk of leakage. This characterization, carried out by the healthcare professional, is based on a clinical assessment and/or a microbiological diagnosis. In case of doubt or practical impossibility of characterizing the risk, the waste must imperatively be classified as healthcare risk waste. The caregiver is also considered to be the main assessor of infectious risk according to the recommendations of the CLIN (Committee for the Fight against Nosocomial Infections).

Stringent DASRI management proceduresDASRI management is subject to very strict rules at each stage of their life cycle:

Source sorting: It is imperative that healthcare risk waste (HRW) be sorted immediately at the point of production and separated from all other waste. Under no circumstances should they be mixed with other waste to avoid contamination or additional risk.
Conditioning and packaging: This waste must be placed in specific containers and stored under controlled conditions. Collection must be carried out in single-use packaging, complying with NF standards, identifiable by their dominant yellow color and a biological hazard pictogram. This packaging must be adapted to the type, size, and volume of waste, and allow for provisional and then definitive closure before removal. Specific standards exist for various types of packaging: plastic bags (NF X 30-501), cardboard boxes with bags (NF X 30-507), plastic drums and jerrycans (NF EN ISO 23 907 and NF X 30-511), boxes and mini-collectors for sharps (NF EN ISO 23 907 and NF X 30-511), and liquid waste (NF X 30-506). Each package must identify the waste producer and bear the words "Healthcare activity waste with infectious risks".
Storage : The maximum storage time for DASRI (potentially infectious healthcare waste) is strictly regulated by the decree of September 7, 1999, and varies according to the quantity produced:
- Quantity over 100 kg/week: 72 hours.
- Quantity between 15 kg/month and 100 kg/week: 7 days.
- Quantity between 5 kg/month and 15 kg/month: 1 month.
- Quantity less than or equal to 5 kg/month: 3 months (with an exception of 3 months for perforating DASRIA only), including storage, any regrouping, transport and final treatment. Storage facilities must be dedicated, equipped with water supply and drainage, clearly identified, secure (protection against deterioration, theft, bad weather, heat and animals), ventilated, lit and equipped with washable floors and walls. It is strictly forbidden to compact, pack or freeze DASRIA.
Traceability: Complete traceability of healthcare risk waste (DASRIA) must be ensured until its final treatment. Article R1335-4 of the Public Health Code requires the establishment of monitoring documents at each stage of disposal.
Transport: The transport of healthcare risk waste (DASRIA) is subject to the regulations on dangerous goods, in particular the ADR Agreement and the TMD decree of May 29, 2009. A safety advisor for the transport of dangerous goods (CSTMD) is mandatory for hospitals that ship more than 333 kg of healthcare risk waste (DASRIA) per shipment. This advisor is responsible for ensuring the safety of the transport, handling, storage, and packaging of these dangerous goods.
Final treatment: The only two methods of disposal of healthcare risk waste (DASRIA) authorized by the Public Health Code are incineration and pretreatment by disinfection. Pretreatment by disinfection, carried out by specific devices (called standardizers), makes the waste compatible with the household waste stream. Under certain regulatory conditions, this pretreated waste can even be directed to a material recovery and recycling stream. However, composting is explicitly excluded for healthcare risk waste (DASRIA) due to its characteristics and origin. The decree of April 20, 2017, governs the procedures for the approval and use of pretreatment by disinfection devices.

Responsibility and sanctionsAny person who produces healthcare waste is required to ensure its disposal. This obligation rests directly with the healthcare facility, the legal entity on whose behalf a healthcare professional carries out his activity, or, in other cases, the natural person who professionally carries out the waste-producing activity. Disposal may be entrusted to a qualified third party by means of a written agreement.Failure to sort and collect DASRIA can lead to heavy administrative penalties, which can amount to fines of up to €150,000. In addition, poor general waste management, including illegal dumping or the use of an unapproved organization, is punishable by four years' imprisonment and a €150,000 fine.

A national guide to the disposal of DASRIA, the 2009 version of which is currently being updated (with a new edition scheduled for 2025), aims to harmonize sorting practices on a national scale to better meet climate challenges, while guaranteeing the protection of professionals and the public throughout the chain. This revision is the fruit of a collaborative effort involving the Direction Générale de la Santé (DGS), the Direction Générale de l'Offre de Soins (DGOS), waste collection and treatment professionals, hospital federations, learned societies and regional health agencies.

Other hazardous waste: identification and dedicated channels

Beyond Healthcare Activity Waste with Infectious Risks and Similar (DASRIA), healthcare facilities generate a variety of other categories of hazardous waste. This waste requires specific and rigorous management due to its intrinsic properties, such as toxicity, flammability, corrosivity, or radioactivity. Its presence is indicated by an asterisk in the list of classified waste, and it must be sorted and treated accordingly.

Definition and typology of hazardous waste (excluding HCWRIAs)Hazardous waste is defined by the possession of one or more hazard properties. It is imperative that hospitals sort this waste at the source and separate it from any other non-hazardous waste. Among the types of hazardous waste frequently encountered in the hospital environment, apart from HCWRIAs, are:

Hazardous chemical waste (HCW): This category encompasses a wide range of substances and products. These include certain professional cleaning products, hydrocarbon-based products, various paints, adhesion, sealing and repair products, coating products, special maintenance and protection products, common chemical products (such as acids or bases), solvents and thinners, biocidal and phytosanitary household products, as well as inks and printing cartridges. The handling and storage of these wastes are strictly regulated by specific regulations, including the Labor Code and European regulations CLP (Classification, Labelling and Packaging) and REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals). It is essential to limit the quantities of these products stored, to clearly identify any reconstituted product (indicating its name, hazard pictogram and hazard statements), and to store them in secure premises. These premises must be equipped with retention tanks, adequate ventilation, separation of incompatible chemical products, and appropriate fire safety devices.
Unused medications (UM) and cytotoxic drugs: Unused medications, including certain specific products such as dental amalgam waste, batteries, and printer cartridges, are classified as hazardous waste. Anti-cancer drugs, for example, although they can be packaged and collected mixed with DASRIA, are subject to specific provisions and decrees for their management. UMs reported by households are generally taken care of by the Cyclamed eco-organization, and discussions are underway to extend the activity of this eco-organization to similar waste produced by healthcare facilities.
Waste electrical and electronic equipment (WEEE or D3E): This broad category includes lamps, bulbs (excluding filament lamps), neon lights, screens, monitors, photovoltaic panels, assisted pedaling cycles, scooters, as well as all small and large electrical and electronic equipment. WEEE frequently contains hazardous components and substances (such as accumulators, printed circuit boards or cathode ray tubes). However, they also have a high recycling potential for materials such as plastic and metals. Their management is governed by articles R543-172 et seq. of the Environment Code. Batteries and accumulators, although part of WEEE, have specific regulations and collection channels.
Dental amalgams: The disposal of amalgam waste from dental offices is a legal obligation and must be done through specific channels. The installation of amalgam separators is required to prevent the discharge of residues into the wastewater system.
Radioactive waste: Although they are not the subject of a dedicated and detailed section in the sources provided, hazardous waste with radioactive risks is mentioned as a specific management channel. It is specified that for radioactive waste that also falls under the DASRIA or anatomical parts regime, only the provisions of the Public Health Code apply to them.
Technical oils: To be distinguished from used cooking oils, used mineral or synthetic oils (from engines, turbines, hydraulic systems, gears, etc.) must be collected separately from other waste. A removal slip must be issued for each collection, and rigorous traceability is mandatory for this sector.

Management requirements for all hazardous wasteFor all of these categories of hazardous waste, it is imperative that they are packaged/contained and, in some cases, specifically and clearly labeled. They must also be subject to appropriate and separate collection which ensures that they are not mixed with other treatment streams, in order to prevent any risk of cross-contamination or danger. Their handling often requires the use of appropriate personal (PPE) and collective (CPE) protective equipment for the safety of personnel.

SanctionsFailure to comply with the sorting and management procedures for hazardous waste is severely penalized. It may result in administrative penalties of up to €150,000 in fines. In addition, general mismanagement of waste, such as illegal dumping or the use of an unapproved organization, is punishable by four years' imprisonment and a €150,000 fine. These penalties underscore the seriousness of the risks associated with such waste and the critical importance of compliant and secure management.

Food waste and used cooking oils: recovery and environmental issues

The management of biowaste and used cooking oils (UCO) represents a major strategic component in the approach to reducing and valorizing waste within healthcare facilities, particularly those equipped with collective restaurants. These channels, constantly adapted by regulations, aim to promote the circular economy by transforming these waste streams into valuable resources.

Regulatory Obligations Relating to BiowasteLegislation on biowaste has undergone significant changes. Since January 1, 2023, entities producing or holding more than 5 tons of biowaste per year are subject to the obligation to ensure its separate collection for recovery. This obligation has been extended to all producers and holders of biowaste, including private and public hospitals, from December 31, 2023.

Food waste is broadly defined, including "non-hazardous biodegradable garden or park waste, food and kitchen waste from households, offices, restaurants, wholesalers, canteens, caterers or retail stores, and comparable waste from food processing plants."

Canteens, regardless of the quantity of biowaste they produce, are specifically required to organize their source separation and recovery. Three main methods of recovery are permitted by the regulations:

On-site composting: Hospitals have the option of installing a local composting system, subject to certain conditions. This option is possible if the volume of biowaste treated on site does not exceed 1 ton per week. This promotes local management and reduces transport needs.
Collection by an external provider: Using an accredited professional specializing in the collection and processing of biowaste is a common solution for hospitals. The provider then ensures the transport of biowaste to methanization or industrial composting facilities.
Donation to an approved animal association: A less conventional but encouraged option for valorizing bio-waste is donating it to an approved animal association. This approach must be submitted to the departmental directorate for employment, labor, solidarity, and population protection (DDETSPP) for approval.

Furthermore, as part of an effort to combat food waste, collective restaurants that produce more than 3,000 meals per day are required to enter into an agreement to donate consumable products with one or more associations authorized to provide food aid. This measure allows for the redistribution of still-consumable food surpluses, thus preventing their transformation into waste.

Management of used cooking oils (UCO)In parallel with bio-waste, used cooking oils (UCO) are subject to specific regulations. Collective restaurants that generate more than 60 liters of cooking oil per year are required to collect them separately for recovery. Although used oils are classified as hazardous waste, they have a separate management channel from other technical oils, often managed via eco-organizations.

Burning ban and deconditioning requirements: Burning of biowaste is generally prohibited, except in cases of exceptional prefectural derogation. A crucial point of the regulation is the obligation to decondition biowaste when it is contained in non-compostable, non-methanizable, or non-biodegradable packaging, before its recovery. However, some exceptions are provided: collection bags made of paper, cardboard, or even plastic that meet the EN13432 standard or equivalent, as well as certain coffee capsules, paper coffee filters, and tea bags, may be collected jointly with biowaste. A tolerance for plastic bags compliant with the EN13432 standard is maintained until December 31, 2024, for prior markets.

Applicable sanctionsFailure to comply with the obligations relating to the management of biowaste and used cooking oils may result in significant administrative penalties, up to €150,000 in fines. In addition, general mismanagement of waste, such as illegal dumping or the use of an unapproved organization, is punishable by four years' imprisonment and a €150,000 fine. These penalties underscore the importance given to these sectors in the ecological transition and the reduction of the environmental footprint of healthcare facilities.

Waste management from construction work and the fight against single-use plastics.

Healthcare facilities face two other major and distinct challenges in waste management: on the one hand, the significant volumes generated by the construction, renovation, or demolition of their infrastructures, and on the other hand, the increasing imperative to drastically reduce the use of single-use plastics. Both areas are subject to specific regulations, all aimed at minimizing their environmental impact.

Construction waste When undertaking demolition or major renovation projects, healthcare facilities are subject to specific obligations regarding the management of the resulting waste.

Prior and mandatory diagnosis: Before the start of work, the hospital must imperatively carry out a diagnosis of its waste management. This diagnosis, provided for by Article L126-34 of the Construction and Housing Code, must be established by competent persons. Its main objective is to determine the most appropriate methods of reuse or recovery for the products, materials and waste considered, specifically identifying suitable recycling channels. This allows for upstream planning of waste management to maximize its recovery.
Mandatory information in quotes: Construction companies responsible for work (construction, renovation, demolition, and even gardening) are required to include detailed information in their quotes regarding the methods of removal and management of waste produced. This includes the costs associated with this management and the facilities planned for their treatment. This requirement aims to ensure transparency and adequate planning of waste management from the contractual phase.
Delivery of a waste tracking form: Once the work has been carried out, the company must provide the hospital with a waste tracking form. This document is essential for tracking building waste and ensuring compliance with its disposal.

In the event of failure by construction companies to comply with the obligations mentioned in the quotes, financial penalties of €3,000 to €15,000 in fines may be applied.

Eliminating single-use plastic waste: Healthcare facilities are also key players in the fight against plastic pollution, with clear guidelines to significantly reduce the use of single-use plastics.

Prohibition of plastic utensils and free water bottles: It is now mandatory for hospitals to eliminate the use of plastic utensils such as cutlery, plates, cups, and their lids. Similarly, the free distribution of plastic water bottles is prohibited. Failure to comply with this latter prohibition may result in a fine of €450.
Provision of water fountains: To compensate for the ban on disposable water bottles, hospitals must plan to install at least one water fountain on their premises. The number of fountains required is proportional to the structure's capacity, with a recommendation of one fountain for 300 people accommodated (excluding staff). The absence of these fountains may be penalized by a fine of €1,500.
Reusable or recyclable containers for takeout: Community restaurants are now required to offer reusable containers (glass, ceramic, stainless steel, etc.) or those made from recyclable materials for all takeout sales.
Specific restrictions in certain sensitive departments: The departments of pediatrics, obstetrics, maternity, maternal and child protection (PMI), as well as local perinatal centers, must imperatively cease the use of plastic food containers (including biodegradable, bio-sourced, compostable, varnished plastics, or those with sealing layers) for cooking, reheating and serving meals. Derogations may exist in specific cases.
Reusable dishes for meals consumed on site: For restaurants with the capacity to accommodate at least 20 people simultaneously, it is mandatory to replace disposable dishes with reusable alternatives for all meals consumed on site.

These measures, which are already in effect, are part of a comprehensive approach to reducing resource consumption and promoting reuse. They actively contribute to preventing waste generation and protecting the environment, in line with the fundamental principles of waste management.

Responsibilities, penalties and the key role of EPR systems and prevention

Waste management in healthcare facilities is underpinned by a fundamental legal principle: the extended responsibility of the producer or holder, which extends from the waste production phase to its final disposal. This principle is reinforced by a system of rigorous sanctions in the event of non-compliance and is complemented by the growing role of Extended Producer Responsibility (EPR) schemes and waste prevention initiatives.

Responsibility of the waste producer/holderThe Environment Code, via its Article L541-2, clearly states that the producer or holder of waste is fully responsible for its management until its final disposal or recovery. This responsibility is inalienable and remains effective even when the waste is transferred to a third party for processing purposes. It is therefore the producer's responsibility to ensure, in a diligent manner, that the person or organization to whom he hands over the waste is duly authorized and competent to handle it. This obligation of responsibility applies specifically to healthcare waste (HCW), as stipulated in Article R1335-2 of the Public Health Code. Waste-producing entities, whether they are healthcare facilities, educational or research institutions, industrial establishments, legal entities on whose behalf a healthcare professional practices, or natural persons professionally engaged in waste-producing activities, are all subject to this disposal obligation.

Penalties for non-compliance: Failure to comply with the rules established for waste management can result in very heavy administrative and criminal penalties.

Criminal penalties: Imprisonment and substantial fines are provided for serious offenses. For example, the abandonment of waste, the transfer of waste to an unauthorized facility, or the illegal transfer of waste without prior notification or consent of the competent authorities (French or foreign) may be punishable by two years' imprisonment and a fine of €75,000 (Articles L541-46 and 48 of the French Environmental Code). These provisions also extend to managers who have failed to meet their obligations and have allowed these rules to be disregarded. The safety advisor for the transport of dangerous goods may be liable to a penalty of up to 1 year's imprisonment and a fine of €30,000.
Administrative penalties :
- Non-compliance with the sorting of waste from the "8 streams": a fine of up to €150,000.
- Non-compliance with the sorting of hazardous waste (excluding DASRIA): a fine of up to €150,000.
- Non-compliance with the sorting and collection of DASRIA: a fine of up to €150,000.
- Non-compliance with the management of biowaste and used cooking oils: a fine of up to €150,000.
- Failure to keep a waste traceability register or refusal to make it available to the authorities: a fine of €750.
- Free distribution of plastic bottles: a fine of €450.
- Absence of mandatory water fountains: a fine of €1,500.
- Failure to comply with the obligations stipulated in the quote for construction companies regarding the management of construction waste: a fine ranging from €3,000 to €15,000.

These sanctions, most of which are already in effect, demonstrate the increased vigilance of the authorities and the critical importance given to rigorous and compliant waste management in the healthcare sector.

Extended Producer Responsibility (EPR) schemes EPR schemes are essential organizational mechanisms for the prevention and management of certain types of waste. They are based on the fundamental principle that producers, importers, and distributors of products are held responsible for the management of waste resulting from these products and must contribute to it, including financially. This mechanism is implemented through eco-organizations, which are private law, non-profit structures created by the producers themselves. The latter pay an "eco-contribution" to these organizations, often passed on to the consumer (indicated by "including eco-tax."). In exchange for this contribution, the eco-organizations are responsible for organizing the collection and treatment of the waste concerned. Using an eco-organization not only makes it possible to better recover the waste, but also to avoid paying a second time for its disposal, as the cost has already been integrated into the initial purchase price of the product. Many EPR schemes directly concern healthcare facilities, particularly for:

Household packaging
Papers
Waste electrical and electronic equipment (WEEE), for which eco-organizations such as Ecologic, Ecosystem, Screlec, Corepile, and Soren (for photovoltaic panels) are approved.
Furniture elements (DEA), with Eco-mobilier and Valdelia as eco-organizations.
Textiles
Batteries and accumulators, managed by organizations such as Corepile and Screlec.
The chemical products (DDS), managed by EcoDDS and Ecosystem.
Tires and end-of-life vehicles
The products or construction materials from the building sector
Mineral or synthetic oils, for which Cyclevia is the dedicated eco-organization.
Packaging used by catering professionals (mandatory since January 1, 2023).
Single-use healthcare textiles (mandatory as of January 1, 2024).

It should be noted that, while unused medicines for human use (UMU) reported by households are covered by Cyclamed, discussions are underway to extend this activity to UMU generated by healthcare facilities.

Waste prevention and the importance of donationBeyond sorting and treatment, preventing waste generation is the first and most fundamental objective in the waste management hierarchy. This prevention includes crucial initiatives such as donation, which prevents still-usable products from becoming waste.

The donation of uneaten meals: Article L541-15-5 of the French Environment Code formally prohibits rendering unsold food that is still edible unfit for consumption. Large operators in collective catering, defined as those preparing more than 3,000 meals per day, are even subject to the obligation to conclude a food donation agreement with one or more authorized associations. However, specific food categories, particularly those of animal origin, may be excluded from donation for reasons of health risk, unless the establishment's health control plan explicitly authorizes their donation and they are properly packaged and labeled with their expiration date.
The donation of medical equipment: Healthcare facilities have the legal possibility to transfer medical equipment free of charge to associations or social and solidarity economy structures. These entities have the mission of reconditioning this equipment, thus developing activities of preparation for reuse and re-employment. A decree is being drafted to specify the terms of application of this measure. Initiatives such as the "Bon coin du CHU", a winner of the FHF TES 2022 Award for its platform for the exchange of equipment and furniture, perfectly illustrate how these donations can promote the circular economy and significantly reduce the volume of waste.

These proactive approaches are essential for waste management that goes beyond simple disposal, seeking to valorize resources and reduce waste production at source.

Conclusion:

Waste management in healthcare facilities is an area of increasing complexity and constant evolution, guided by demanding regulations and an increasingly marked environmental awareness. From the fundamental principles of prevention and valorization to rigorous traceability, including sorting at source and specific management of each waste stream, each step is crucial to guarantee the protection of public health and the environment.

Obligations to sort the "8 streams", the meticulous management of Waste from Healthcare Activities involving Infectious Risks (DASRIA), other hazardous waste, bio-waste and single-use plastics, as well as compliance for waste from construction projects, illustrate the diversity and scale of the challenges faced by facilities on a daily basis. The dematerialization of tracking slips via platforms such as Trackdéchets simplifies and secures traceability, while the development of Extended Producer Responsibility (EPR) channels and donation initiatives encourages a more circular and resilient economy.

The producer's responsibility is paramount at each stage of the waste lifecycle, and failure to comply with these rules may result in severe penalties, both administrative and criminal. Ultimately, proactive, informed, and rigorously compliant waste management is not only a legal obligation for healthcare facilities; it is an essential component of their overall performance, institutional image, and active contribution to a more sustainable future. Continuous updates to guidelines and regulations demonstrate the authorities' ongoing commitment to refining practices for an ever more positive impact and better protection of ecosystems and human health.