Poorly managed hospital waste represents a real and persistent threat to public health (1). Its danger is not limited to its visual appearance; it originates from highly contaminated medical areas and often carries pathogenic microorganisms capable of causing serious or even fatal infections in exposed individuals. This risk concerns healthcare workers as well as those responsible for collection, not to mention populations living near sites of inappropriate disposal or treatment (2).

Indeed, all germs capable of causing human disease can be present in this waste. Therefore, its handling requires absolute vigilance. Medical personnel, particularly those involved in waste management, must apply strict protocols to limit the risk of cross-contamination. At this level, training, protective equipment, and compliance with standards are fundamental (3, 4).

Waste sorting and collection are the first and crucial steps in any safe management strategy. Each hospital department and each treatment room must have a dedicated collection system. Waste must be immediately packaged in suitable containers and then safely transported to a centralized collection point, where a hospital hygiene service is in place. This is where the role of collection agents becomes essential (3, 5).

Sharp objects, such as used needles, scalpels, or syringes, are among the most hazardous waste. They must be disposed of immediately upon use in rigid, puncture-resistant, hermetically sealed safety boxes, specially designed to prevent any risk of accidents or illicit recycling (6, 7).

The temporary storage of medical waste also meets specific standards. It must be done in large, hermetically sealed containers, protected from insects, rodents, stray animals, and unauthorized persons. When prolonged storage is necessary, these containers must be refrigerated to limit the decomposition of biological materials and microbial growth. Sealing is essential to prevent any leakage of contaminated liquids. Finally, waste must be packaged in waterproof, non-reusable bags, suitable for humidity, and hung in specific supports. In some cases, these bags are themselves inserted into plastic or metal containers to increase security. This double packaging limits risks during transport and guarantees more efficient disposal in treatment units, where they exist (8, 9).

In public hospitals, as well as in some private clinics, it is still common to find medical waste, including that classified as hazardous or infectious, collected without prior sorting and stored in a single depot, sometimes within hospital grounds. It remains piled up there for several days, without proper treatment, often within reach of scavengers, children, or stray animals. This direct exposure increases the risk of cross-contamination and reveals the shortcomings of a system that remains poorly structured (10, 11).

This waste is not harmless. They include sharp objects, equipment contaminated with bodily fluids, pharmaceutical residues, and highly toxic chemicals. Their careless handling, their transport without scientific supervision, their burial on the ground, or their mixing with household waste in landfills are all dangerous practices still observed in certain regions. Worse still, this waste is sometimes recovered in parallel circuits for reuse or fraudulent recycling, particularly syringes and needles, which represent a major risk of disease transmission (12, 13).

According to the latest report from the World Health Organization (WHO, 2026), nearly 15% of waste produced by healthcare facilities worldwide is considered hazardous, including infectious and pharmaceutical waste. In Morocco, the National Environmental Regulatory Agency (ANRE, 2025) reports that more than 60% of hospitals lack a comprehensive medical waste management system, exposing staff and patients to biological and chemical risks. This situation underscores the importance of assessing the knowledge, attitudes, and practices (KAP) of hospital staff to identify gaps and propose improvement measures tailored to the national context. A simple needlestick accident with an infected needle is enough to transmit these viruses, with respective contamination probabilities of 30% for hepatitis B, 1.8% for hepatitis C, and 0.3% for HIV.

In Morocco, healthcare facilities generate approximately 38,000 tons of medical waste each year, of which nearly 12,000 tons are considered hazardous. This high proportion considerably complicates its treatment, especially since few facilities have suitable facilities such as modern incinerators, disinfection stations, or secure collection systems. In some areas, these facilities are simply nonexistent or out of service (14).

Hospital waste management in Morocco is a growing concern among healthcare professionals, environmental stakeholders, and citizens. While hospitals' mission is to provide care, they can also, paradoxically, become sources of serious health risks when they fail to ensure the safe and controlled disposal of their medical waste. Numerous publications, field studies, and official investigations now confirm that the conditions for treating this waste are far from satisfactory in many facilities across the Kingdom (8, 15).

The consequences extend far beyond hospitals. The uncontrolled disposal of medical waste leads to air pollution (particularly during wild burning), soil and groundwater contamination, and increases the circulation of toxic waste in informal channels. This phenomenon primarily affects the most vulnerable populations, who are poorly informed about the associated health risks. The low level of health education, the absence of reliable epidemiological data, and the lack of specific training for hospital staff further exacerbate the problem (16, 17).

These dysfunctions call for an urgent response from health authorities. The implementation of hospital waste management policies, accompanied by adequate funding, staff training, and awareness campaigns, is essential to prevent health and environmental risks. The study aimed to assess the knowledge, attitudes, and practices (KAP) of healthcare staff regarding MPW management at El Idrissi Hospital in Kenitra, as well as their perception of the associated risks.

Medical waste includes all waste produced in healthcare facilities. This medical waste does not all have the same origin and does not all pose the same risk to occupational health, public health, and the environment. The current study aimed to assess the knowledge, attitudes, and practices (KAP) of healthcare staff regarding MPW management at El Idrissi Hospital in Kenitra, as well as their perception of the associated risks.

A significant portion of this waste (between 75% and 90% of the total amount of medical waste) is produced by the administrative and hospitality activities of these facilities; this waste is considered household waste and is disposed of through the regular household waste stream. However, hazardous medical waste must follow a specific disposal process, being separated from other waste from the moment of production and packaged in appropriate containers to comply with hygiene regulations and ensure the safety of individuals (patients, healthcare staff, and personnel responsible for sorting, collecting, or disposing of waste). Thus, efforts are being made to prevent accidents that may occur throughout the entire waste disposal chain (production and sorting, packaging, collection, storage, removal, transport, treatment and disposal) (3, 18).

The descriptive analysis of the participants reveals a predominantly female population (67.6%), reflecting the typical composition of staff in healthcare facilities in Morocco, where nursing and paramedical professions are largely dominated by women. This female predominance could influence perceptions and attitudes regarding the management of medical records, as several studies have shown that female healthcare workers often adopt more cautious behaviors in terms of occupational risk prevention (19–21).

Regarding age, the majority of participants were young to middle-aged: 41.2% were under 35 years old and 36.8% were between 35 and 45 years old. The mean age (37.9 ± 10.4 years) indicates a relatively experienced but still actively working population. This distribution is interesting because the literature shows that knowledge of medical record management tends to increase with experience, while practices can be improved with more frequent continuing education among younger professionals (22, 23).

The diversity of the staff represented (16.2% physicians, 39.7% nurses, 2.9% nursing assistants, and 41.2% other professionals) enriches the analysis of institutional practices. The high proportion of nurses, the main actors in the sorting and handling of medical records, is an asset for evaluating existing procedures but also makes the internal organization particularly dependent on their training and workload. The 41.2% belonging to the “Other” category suggest the varied involvement of non-clinical profiles in daily practices, which raises the question of standardization and interprofessional harmonization of procedures.

The average administrative seniority of 12.9 ± 9.2 years, with nearly half of the staff having less than 10 years of experience, shows that the team is relatively stable but still in a phase of operational learning. The low proportion of staff with over 30 years of service (5.9%) suggests likely staff turnover or structural renewal. Experience is a key factor in mastering the protocols for managing electronic health records, more health staff often have a better understanding of the risks, but not always of current standards. Seniority within the department (8.5 ± 7.3 years), lower than administrative seniority, reflects significant internal mobility. Over 64.7% of participants had been in their current department for less than 10 years. This mobility can have a dual impact: positive, by facilitating adaptation to different care environments and exposing healthcare professionals to various protocols; negative, because frequent turnover can limit in-depth mastery of EHR-specific procedures within a particular department, especially in the absence of standardized and regular training (24–26).

The distribution of experience within the department shows that nearly two-thirds of the staff (65%) have less than 10 years of service, while only 2% have more than 30 years. This high proportion of relatively new healthcare professionals may explain some variations in knowledge and practices related to medical waste management, as experience often influences the mastery of procedures.

The results show that knowledge of the medical waste management process is strongly linked to institutional awareness-raising activities, including posters, meetings, and training days, which aligns with the findings of several recent studies. Indeed, research conducted in Morocco and elsewhere has demonstrated that continuing education and the posting of procedures significantly improve knowledge levels and compliance with hospital waste sorting (8, 27). The lack of a significant association with the media as a source of awareness confirms the findings of recent research indicating that media campaigns are generally less effective than direct on-site interventions in changing healthcare practices (28). Furthermore, the highly significant association between reported knowledge and mastery of sorting (waste categories, infectious medical waste color code, fill limits) is consistent with the observations of Dunbar et al. (29), who emphasize that understanding technical standards is a major determinant of compliance (29).

The current study show that training on medical and pharmaceutical waste (MPW) management is strongly associated with improved practices, including knowledge of color coding, systematic sorting, and separation of hazardous waste, which is consistent with the findings of recent studies. Several studies conducted in North Africa and other middle-income countries have indeed shown that structured training significantly improves compliance with MPW management protocols and reduces sorting errors (30, 31). The very high proportion of trained healthcare workers reporting knowledge and application of waste sorting and separation (between 68% and 91%) confirms the positive impact of continuing education, as also reported by Bannour et al. (27), who emphasize that interactive training increases staff engagement and vigilance (27).

The significant association between knowledge of medical waste categories and reported practices (sorting, source separation, recognition of the code/color system) aligns with the observations of several researchers who found that a clear understanding of waste categories is an essential prerequisite for the correct implementation of sorting procedures (32, 33). Also, the fact that over 88% of participants familiar with medical waste categories attested to the existence of a waste coding system in their facility reinforces the findings of Abdesalam et al. (34), who indicated that the availability of a clear organizational system, combined with adequate training, is a key determinant for the safe and compliant management of hospital waste (34).

The results indicate that the majority of healthcare professionals acknowledge the existence of a medical waste management plan (66.2%) and a dedicated person in charge within their department (73.3%), which aligns with international recommendations emphasizing the importance of structured governance to ensure the safe management of hospital waste. Recent studies have indeed shown that the presence of formalized procedures and a clearly identified person in charge significantly improves compliance with sorting protocols and reduces the risks of occupational exposure (35, 36). The significant association observed between knowledge of the procedure and the existence of a person in charge confirms this organizational link. However, despite this apparent structure, only 57.8% of participants felt they had sufficient equipment, a finding frequently reported in similar studies conducted in Africa and Asia, where a lack of material resources is one of the main obstacles to the effective management of medical waste (2, 15, 37). This discrepancy between organizational framework and material availability underscores the need for logistical support to ensure the optimal implementation of medical waste management standards.

The results reveal that healthcare workers' behavior regarding the management of medical waste is generally consistent with recommended best practices, as evidenced by the high proportion of participants reporting systematic waste sorting and adherence to operational procedures. The high rates of good practices, carrying bags and containers to the bedside (73.7%), regular monitoring of medical waste management within the ward (73.3%), immediate replacement of collected containers (81.6%), and regular collection (89.5%) are consistent with the findings of recent studies highlighting that ongoing training and the presence of clear protocols significantly improve healthcare staff behavior (15, 27). The highly significant statistical association between sorting practices and several behavioral dimensions confirms that healthcare workers with good technical skills more frequently adopt compliant behaviors, which aligns with the study of Zhang et al. showing that sorting skills are a major predictor of adherence to safety measures (38). The high proportion of staff reporting that collection agents comply with container closure rules (71.1%) also aligns with the study conducted by herzing et al. (39), who emphasize the importance of inter-departmental coordination to reduce exposure risks (39). Thus, these results indicate a positive trend in behavioral practices, even though the literature reminds us that vigilance must remain constant to prevent accidents related to biomedical waste.

Healthcare staff attitudes toward the management of medical waste are strongly influenced by three key factors: workload, insufficient equipment, and lack of training. The highly significant associations observed confirm what several recent studies have highlighted: workload overload reduces healthcare workers' vigilance and increases the likelihood of improper handling of biomedical waste (4, 39). Similarly, insufficient equipment particularly the lack of suitable containers, coded bags, or personal protective equipment is recognized as a major obstacle to compliance with best practices (27, 33).These results confirm that improving staff attitudes requires an integrated approach combining increased material resources, reduced workload, and targeted ongoing training.

This study has several limitations that should be highlighted. Its cross-sectional design does not allow for the establishment of causal relationships between staff knowledge, attitudes, and practices regarding the management of electronic health records (EHRs). Since the data are self-reported, they may be influenced by social desirability bias or recall bias, especially as no direct observation of actual practices was conducted to validate participants' statements. Furthermore, the survey was carried out in a single hospital, limiting the generalizability of the results to other contexts or healthcare facilities. Finally, the lack of a qualitative approach and the failure to consider the organizational specificities of each department may have masked significant variations in EHR management.

The results of this study suggest several avenues for improving the management of medical and pharmaceutical waste:

Ongoing staff training: Implementing regular awareness and practical training programs, tailored to each department, could reduce the gap between knowledge and practice.

The study conducted at El Idrissi Hospital in Kenitra reveals generally satisfactory levels of knowledge and practices regarding the management of medical and pharmaceutical waste, but also highlights significant gaps related to training, workload, and insufficient equipment. The significant associations observed between knowledge, behaviors, and certain organizational factors underscore the importance of continuous capacity building for staff, the availability of equipment, and the strict application of institutional procedures. While these results cannot be generalized to all healthcare facilities in the country, they constitute an important indicator of the need to improve the governance of medical and pharmaceutical waste, implement more regular audits, and promote a safety culture within hospitals. Future studies incorporating direct observation and a multicenter approach will strengthen the validity of the findings and better guide national interventions in medical and pharmaceutical waste management.

This study highlights persistent gaps in medical waste management at El Idrissi Hospital. Strengthening staff skills, improving internal organization, and regularly updating protocols are essential to ensure the safe management of hospital waste and reduce risks to healthcare workers, patients, and the environment.