Medical waste ash (MWA), a byproduct of the incineration of biomedical waste, poses environmental risks if not properly treated. As a potential supplementary cementitious material, MWA offers both environmental and engineering advantages by enabling waste valorization and reducing reliance on conventional cement. However, the differences in its physical, chemical, and microstructural properties, together with variations in pre-treatment and incorporation methods, have led to inconsistent performance across construction applications. This review systematically studies the recent research (2020–2024) in upcycling MWA in construction materials including asphalt mixtures, mortar, and concrete focusing on its effects on key performance indicators such as compressive strength, sorptivity, and heavy metal leaching. Optimal replacement levels, typically ranging from 5% to 15%, are summarized to achieve a best mechanical performance. Comparative results show that properly treated MWA can increase the 28-day compressive strength of concrete up to 65 MPa. This review aims to provide a strategic framework for the application of MWA in the construction industry to promote cleaner production and sustainable waste management solutions by incorporating MWA into construction materials.
PasupathiPSindhuSPonnushaBS, et al.Biomedical waste management for health care industry. Int J Biol Med Res2011; 2: 472–486.
2.
KhobragadeDS. Health care waste: avoiding hazards to living and non living environment by efficient management. Fortune J Health Sci2019; 2: 14–29.
3.
RaoSRanyalRBhatiaS, et al.Biomedical waste management: an infrastructural survey of hospitals. Med J Armed Forces India2004; 60: 379–382.
4.
ChartierY, Emmanue J and Pieper U, et al. Safe management of wastes from health-care activities (2nd ed.). Geneva, Switzerland: World Health Organization, 2014.
5.
RamtekeSSahuBL. Novel coronavirus disease 2019 (COVID-19) pandemic: considerations for the biomedical waste sector in India. Case Stud Chem Environ Eng2020; 2: 100029.
6.
TiwariAVKaduPA. Biomedical waste management practices in India-a review. Int J Curr Eng Technol2013; 3: 2030–2033.
7.
World HealthOrganization. Safe management of bio-medical sharps waste in India: a report on alternative treatment and non-burn disposal practices. New Delhi, India: WHO Regional Office for South-East Asia, 2005.
ParidaVKSikarwarDMajumderA, et al.An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19. J Environ Manag2022; 308: 114609.
10.
RahmanMMBodrud-DozaMGriffithsMD, et al.Biomedical waste amid COVID-19: perspectives from Bangladesh. Lancet Glob Health2020; 8: e1262.
11.
LiuFLiuH-QWeiG-X, et al.Characteristics and treatment methods of medical waste incinerator fly ash: a review. Processes2018; 6: 73.
12.
VavvaCLymperopoulouTMagoulasK, et al.Chemical stabilization of fly ash from medical waste incinerators. Environ Process2020; 7: 421–441.
13.
DouXRenFNguyenMQ, et al.Review of MSWI bottom ash utilization from perspectives of collective characterization, treatment and existing application. Renewable Sustainable Energy Rev2017; 79: 24–38.
14.
ManjunathBDi MareMOuellet-PlamondonCM, et al.Exploring the potential use of incinerated biomedical waste ash as an eco-friendly solution in concrete composites: a review. Constr Build Mater2023; 387: 131595.
15.
TufailMKhalidS. Heavy metal pollution from medical waste incineration at Islamabad and Rawalpindi, Pakistan. Microchem J2008; 90: 77–81.
16.
TsakalouCPapamarkouSTsakiridisP, et al.Characterization and leachability evaluation of medical wastes incineration fly and bottom ashes and their vitrification outgrowths. J Environ Chem Eng2018; 6: 367–376.
17.
GhazaliEJohariMAMFauziMA, et al.An overview of characterisation, utilisation, and leachate analysis of clinical waste incineration ash. Int J Environ Res2022; 16: 69.
18.
LinJYongCLZhangF, et al.Sorted municipal solid waste ash as cement substitute: a study on paper ash and food waste ash. Case Stud Constr Mater2024; 20: e03329.
19.
Genc TokgozDDOzerkanNGAntonySJ. Untreated municipal solid waste incineration ashes for cement replacement. J Eng Res2023; 11: 34–39.
20.
KaurHSiddiqueRRajorA. Influence of incinerated biomedical waste ash on the properties of concrete. Constr Build Mater2019; 226: 428–441.
21.
AbabnehAAl-RousanRGharaibehW, et al.Recycling of pre-treated medical waste fly ash in mortar mixtures. J Mater Cycles Waste Manage2020; 22: 207–220.
22.
Al-RawasAAHagoAWTahaR, et al.Use of incinerator ash as a replacement for cement and sand in cement mortars. Build Environ2005; 40: 1261–1266.
23.
AhmedTChowdhuryRRahmanM. Stablization of medical waste incineration fly ash in cement mortar matrix. Bangladesh J Sci Ind Res2020; 55: 131–138.
24.
OyebisiSAlomayriT. Cement-based concrete modified with Vitellaria Paradoxa ash: a lifecycle assessment. Constr Build Mater2022; 342: 127906.
25.
Terán-CuadradoGTahirFNurdiawatiA, et al.Current and potential materials for the low-carbon cement production: life cycle assessment perspective. J Build Eng2024; 96: 110528.
26.
SalkinIFKennedyM. Review of health impacts from microbiological hazards in health-care wastes. Geneva: WHO, 2004.
27.
World HealthOrganization. Safe management of wastes from health-care activities: a summary. Geneva, Switzerland: World Health Organization, 2017.
28.
JangY-CLeeCYoonO-S, et al.Medical waste management in Korea. J Environ Manag2006; 80: 107–115.
29.
Sunayana, SinghDKalawapudiK, et al.Geotechnical and chemical engineering properties for incinerated ash and mixtures. In: Environmental Geotechnology: Proceedings of EGRWSE 20182019, pp.247–254. Springer.
30.
Ramesh KumarAVaidyaANSinghI, et al.Leaching characteristics and hazard evaluation of bottom ash generated from common biomedical waste incinerators. J Environ Sci Health A2021; 56: 1069–1079.
31.
DebrahJKDinisMAP. Chemical characteristics of bottom ash from biomedical waste incinerators in Ghana. Environ Monit Assess2023; 195: 68.
32.
JaberSKAljawadAAPopE, et al.The use of bottom ash and fly ash from medical incinerators as road construction material. Sci Bull Univ Politeh Buchar2022; 84: 43–54.
OguntayoDOgundipeOAladegboyeO, et al.Performance evaluation of hospital waste ash-modified asphalt mixtures. Adv Civ Eng2023; 2023: 6880766.
35.
RamuluGShankarS. Performance assessment of geopolymer stabilized aggregate pavement bases with incorporation of biomedical waste incinerated ash. Innov Infrastruct Solut2024; 9: 81.
36.
Suresh KumarAMuthukannanMArunkumarK, et al.Utilisation of waste glass powder to improve the performance of hazardous incinerated biomedical waste ash geopolymer concrete. Innov Infrastruct Solut2022; 7: 93.
37.
NatarajaMChakravarthyHGNShivaprasadR, et al.Self-compacting concrete incorporating incinerated biomedical waste ash: a performance assessment. J Eng Appl Sci2023; 70: 22.
38.
GirmaMAsterayB. Fresh, mechanical, and microstructural properties investigation on the combined effect of biomedical waste incinerator ash and bagasse ash for high-strength concrete. Adv Mater Sci Eng2022; 2022: 5685372.
39.
KatareKNSamaiyaNKIyerMurthyY. Strength and durability properties of concrete using incinerated biomedical waste ash. Environ Eng Res2023; 28: 220024.
40.
Rishi and Aggarwal V. Experimental investigation of geopolymer concrete along with biomedical and bone China waste at different molarities of sodium hydroxide. Multiscale Multidiscip Model Exp Des2023; 6: 277–289.
41.
FilipponiPPolettiniAPomiR, et al.Physical and mechanical properties of cement-based products containing incineration bottom ash. Waste Manage2003; 23: 145–156.
42.
PiastaWZarzyckiB. The effect of cement paste volume and w/c ratio on shrinkage strain, water absorption and compressive strength of high performance concrete. Constr Build Mater2017; 140: 395–402.
43.
KovlerKRousselN. Properties of fresh and hardened concrete. Cem Concr Res2011; 41: 775–792.
44.
XiaoRJiangXZhangM, et al.Analytical investigation of phase assemblages of alkali-activated materials in CaO-SiO2-Al2O3 systems: the management of reaction products and designing of precursors. Mater Des2020; 194: 108975.
45.
IqbalMSBuxQAliA, et al.Experimental analysis of concrete with partial cement replacement using incinerated hospital waste ash. Budownictwo I Architektura2024; 23: 115–127.
46.
KumarASMuthukannanMArunkumarK, et al.Development of eco-friendly geopolymer concrete by utilizing hazardous industrial waste materials. Mater Today Proc2022; 66: 2215–2225.
47.
MatalkahF. Recycling of hazardous medical waste ash toward cleaner utilization in concrete mixtures. J Cleaner Prod2023; 400: 136736.
48.
BapatJD. Mineral Admixtures in Cement and Concrete. CRC press, 2012.
49.
SongQSuJNieJ, et al.The occurrence of MgO and its influence on properties of clinker and cement: a review. Constr Build Mater2021; 293: 123494.
50.
Abu BakarBRamadhansyahPMegat AzmiM. Effect of rice husk ash fineness on the chemical and physical properties of concrete. Mag Concr Res2011; 63: 313–320.
51.
KaurHSiddiqueRRajorA. Effect of bacteria on strength properties and toxicity of incinerated biomedical waste ash concrete. Environ Technol2023; 44: 1705–1729.
52.
ChowdhuryRAl BiruniMTAfiaA, et al.Medical waste incineration fly ash as a mineral filler in dense bituminous course in flexible pavements. Materials (Basel)2023; 16: 5612.
53.
SirajSAl-MarzouqiAHIqbalMZ, et al.Impact of micro silica filler particle size on mechanical properties of polymeric based composite material. Polymers (Basel)2022; 14: 4830.
54.
WuZKhayatKHShiC, et al.Mechanisms underlying the strength enhancement of UHPC modified with nano-SiO2 and nano-CaCO3. Cem Concr Compos2021; 119: 103992.
55.
FarhanKZJohariMAMDemirboğaR. Assessment of important parameters involved in the synthesis of geopolymer composites: a review. Constr Build Mater2020; 264: 120276.
56.
ThivesLPGhisiE. Asphalt mixtures emission and energy consumption: a review. Renewable Sustainable Energy Rev2017; 72: 473–484.
57.
LiYHaoPZhangM. Fabrication, characterization and assessment of the capsules containing rejuvenator for improving the self-healing performance of asphalt materials: a review. J Cleaner Prod2021; 287: 125079.
58.
HassanHMZWuKHuangW, et al.Study on the influence of aggregate strength and shape on the performance of asphalt mixture. Constr Build Mater2021; 294: 123599.
59.
SunL. Structural behavior of asphalt pavements: Intergrated analysis and design of conventional and heavy duty asphalt pavement. Oxford, UK: Butterworth-Heinemann, 2016.
60.
AlsheyabMAKhasawnehMAAbualiaA, et al.A critical review of fatigue cracking in asphalt concrete pavement: a challenge to pavement durability. Innov Infrastruct Solut2024; 9: 86.
61.
ChenYXuSTebaldiG, et al.Role of mineral filler in asphalt mixture. Road Materials and Pavement Design2022; 23: 247–286.
62.
ChoudharyJKumarBGuptaA. Utilization of solid waste materials as alternative fillers in asphalt mixes: a review. Constr Build Mater2020; 234: 117271.
63.
MukhtarNHasanMRMGhazaliMFHM, et al.Influence of concentration and packing of filler particles on the stiffening effect and shearing behaviour of asphalt mastic. Constr Build Mater2021; 295: 123660.
64.
EisaMBasiounyMYoussefA. Effect of using various waste materials as mineral filler on the properties of asphalt mix. Innov Infrastruct Solut2018; 3: 27.
65.
FuSKwonEELeeJ. Upcycling steel slag into construction materials. Constr Build Mater2024; 444: 137882.
66.
Al-MistarehiBWKhadaywiTSHusseinAK. Investigating the effects on creep and fatigue behavior of asphalt mixtures with recycled materials as fillers. J King Saud Univ Eng Sci2021; 33: 355–363.
67.
TahirAMAl-HadidyA. Recycling the residue of medical waste incineration as a filler in asphalt paving mixtures. J Mater Civ Eng2023; 35: 06023006.
68.
Diaz-LoyaIJuengerMSerajS, et al.Extending supplementary cementitious material resources: reclaimed and remediated fly ash and natural pozzolans. Cem Concr Compos2019; 101: 44–51.
69.
VietDBChanW-PPhuaZ-H, et al.The use of fly ashes from waste-to-energy processes as mineral CO2 sequesters and supplementary cementitious materials. J Hazard Mater2020; 398: 122906.
70.
ZhangDShaoY. Early age carbonation curing for precast reinforced concretes. Constr Build Mater2016; 113: 134–143.
71.
RostamiVShaoYBoydAJ, et al.Microstructure of cement paste subject to early carbonation curing. Cem Concr Res2012; 42: 186–193.
72.
RamgopalLGandhimathiRDhipanaravindS, et al.An investigation of the bio-medical waste ash on cement mortar bricks. Mater Today Proc2024; 103: 463–468.
73.
FuSLeeJ. Recycling of ceramic tile waste into construction materials. Developments in the Built Environment2024; 18: 100431.
74.
SinghHYTKMishraAK, et al.Harnessing the foundation of biomedical waste management for fostering public health: strategies and policies for a clean and safer environment. Discover Applied Sciences2024; 6: 89.
75.
ChanW-PRenFDouX, et al.A large-scale field trial experiment to derive effective release of heavy metals from incineration bottom ashes during construction in land reclamation. Sci Total Environ2018; 637-638: 182–190.
76.
YinKLiPChanWP, et al.Characteristics of heavy metals leaching from MSWI fly ashes in sequential scrubbing processes. J Mater Cycles Waste Manag2018; 20: 604–613.
77.
YinKDouXChanW-P, et al.Comparative leaching characteristics of fly/bottom ashes from municipal solid waste incineration under various environmental stresses. J Mater Cycles Waste Manag2020; 22: 46–55.
78.
ZhuKWangLLiaoL, et al.Study on synthesis of CSH gel and its immobilization of heavy metals. Crystals (Basel)2024; 14: 64.
79.
KrólMFlorekPMarzecM, et al.Structural studies of calcium silicate hydrate modified with heavy metal cations. Spectrochim Acta, Part A2024; 321: 124681.
