Water Recycling in Public Hospitals of Markazi Province of Iran Using the TOPSIS Multi-Criteria Decision-Making Method: Identification and Prioritization of Strategies

Background. Given the water scarcity crisis and high water consumption in hospitals, it is crucial to identify and prioritize water recycling strategies in these facilities. This study aimed to identify the most appropriate water recycling strategies and prioritize them based on multiple criteria. Methods. This descriptive–analytical study was conducted in the Spring of 2025, involving eight selected public hospitals with high water consumption in Markazi Province. Initially, through literature review, field visits, and semi-structured interviews with 17 experts in hospital water and wastewater management, potential recycling strategies and relevant evaluation criteria were identified. Qualitative data were analyzed using content analysis in MAXQDA 2022. In the quantitative phase, the criteria were weighted using the Shannon entropy method, and the alternatives were prioritized using the TOPSIS multi-criteria decision-making model. All calculations were performed using Microsoft Excel. Results. Findings showed that recycling dialysis wastewater (score: 0.87), rainwater harvesting (score: 0.78), and recycling medical equipment wash water (score: 0.75) were the top three prioritized options. The economic criterion, with a weight of 0.35, was identified as the most influential factor in the decision-making process. Conclusion. The results indicated that the prioritization of water recycling strategies in hospitals is influenced by a combination of economic, technical, environmental, and operational criteria. The TOPSIS model identified dialysis wastewater recycling as the most favorable option. Therefore, it is recommended to implement a pilot project for recycling dialysis wastewater, develop localized guidelines for hospital water recycling systems, and provide specialized training for hospital personnel.