Table 2 Evaluation of conceptual, technical and semantic aspects between the Brazilian Portuguese version of the health-care waste management tool - rapid assessment tool (HCWM-RAT) and its original English version

[…] improper management of wastes generated in health care facilities causes direct health impacts on the community, the personnel working in health care facilities, and on the environment. In addition, pollution due to inadequate treatment of waste can cause indirect health effects to the community.

[…] o gerenciamento inadequado dos resíduos gerados pelos Estabelecimentos de Saúde (ES) pode provocar impactos diretos na saúde da coletividade, dos profissionais que trabalham nos ES e no ambiente. Ademais, a poluição oriunda do tratamento inadequado dos resíduos pode causar efeitos indiretos na saúde da coletividade.

The translation “na saúde da coletividade” (on the community), instead of the literal word, “da comunidade” was used because in Brazil the term “community” has the sense of a limited geographical area, inhabited by an indigent population (often referred to as a “favela” or a slum).

An example of such a plan can be found at the following address: www.healthcarewaste.org

Para auxiliar a implantação do Plano de Gerenciamento de Resíduos de Serviços de Saúde (PGRSS), foi elaborado o Manual de Gerenciamento de Resíduos de Serviços de Saúde, lançado pela Anvisa, que igualmente disponibiliza outras orientações relevantes que podem ser encontradas na página do Órgão: www.anvisa.gov.br.

Here, it is stated that the Brazilian Health Surveillance Agency (Anvisa) has developed a handbook to help implement the Health-care Waste Management Plan (HCWMP). The professional is invited to access the electronic page of the Agency, where other guidelines are also offered.

Incineration - The controlled burning of solid, liquid or gaseous wastes to produce gases and residues containing little or no combustible material.

Incineração - Queima controlada de materiais em temperaturas acima de 800 °C, na presença de oxigênio, sendo os produtos finais desta queima, quando completa: dióxido de carbono, vapor d'água e cinzas

As suggested by the experts, the definition given by current Brazilian regulations was maintained: As stated by the Ministry of Environment, incineration is any process that applies temperatures above 800 °C, in the presence of oxygen, generating carbon dioxide, water vapor and ashes. A consensus was attained that this is not derived from the meaning given by the original version.

Pharmaceutical waste - Consisting of/or containing pharmaceuticals. [Includes: pharmaceuticals expired, no longer needed; their containers, items contaminated by or containing pharmaceuticals (bottles, boxes…)].

Resíduo químico-farmacêutico - Consiste de/ou contém produtos farmacêuticos, incluindo medicamentos (com validade vencida ou não mais necessários) e seus recipientes quando contaminados. Regulamentados como uma subcategoria do Grupo B (Resolução RDC ANVISA n° 306/04 e CONAMA n° 358/05) são aqueles caracterizados nos itens 11.11 e 11.12 da RDC Anvisa n° 306/04

As suggested by the target professionals (from the field test) and the experts, the terminology given by the Brazilian regulations and requirements was adopted. in Brazil, pharmaceutical wastes constitute a sub-category in the Group B (Chemical Residues) (Anvisa 306/04 and Conama358/05). Therefore, besides describing the sub-category, the item indicates regulations and their requirements for identifying medicines that are subject to special control. It is understood that this does not derive from the meaning (waste and classification) given by the original version.

Radioactive health-care waste - Consisting of/or containing radioactive substances. [Includes: unused liquids from radiotherapy or laboratory research; contaminated glassware, packages or absorbent paper; urine and excreta from patients treated or pre-tested with unsealed radionuclides; sealed sources].

Rejeito radioativo - materiais resultantes de atividades humanas que contenham radionuclídeos (não selados) em quantidades superiores aos limites de isenção especificados nas normas da Comissão Nacional de Energia Nuclear (CNEN) e para os quais a reutilização é imprópria ou não prevista.

The translation that expresses the concept accepted and adopted by the Brazilian National Nuclear Energy Commission (Cnen) was maintained. The term “waste” is translated as a “Rejeito” (reject) (something that cannot be reused or recycled), instead of waste (something that can be reused, recycled or transformed - for energy). The radioactive reject is described as resulting from activities that use any kind of radionuclide (unsealed) above the amounts considered as improper for reuse by CNEN.

Recycling - A term embracing the recovery and reuse of scrap or waste material for manufacturing or other purposes.

Reciclagem - Processo de transformação dos resíduos sólidos que envolve a alteração de suas propriedades físicas, físico-químicas ou biológicas, com vistas à transformação em insumos ou novos produtos.

The definition given by the current regulations (as mentioned above) was maintained. Recycling was described as a biological, chemical or physical transformation process, resulting in new products or raw materials (“cradle to grave” or “cradle to cradle”). It is understood that this encompasses the term and meaning given by the original version.

Risk - Probability that a hazard will cause harm and the severity of that harm.

Risco à saúde - probabilidade da ocorrência de efeitos adversos à saúde, decorrentes da exposição humana a agentes físicos, químicos, de acidente (especialmente relacionados aos perfurocortantes) e biológicos

Risk is described as the probability of the occurrence of adverse effects to health, resulting from human exposure to physical, chemical or biological agents. In the case of health care wastes, sharp objects are particularly important.

Safety (sharps) box - A puncture proof/liquid proof container designed to hold used sharps safely during disposal and destruction.

Recipientes para acondicionamento de perfurocortantes - recipientes rígidos, resistentes à punctura, ruptura e vazamento, com tampa e devidamente identificados, atendendo aos parâmetros referenciados na norma NBR 13853:1997 da Associação Brasileira de Normas Técnicas (ABNT-NBR)

This item describes the characteristics of the safety boxes for sharps (perfurocortantes). It is warned that the box has to be resistant to perforation, disruption and leaks, and should have a cap and identification. It also has to display conformity to the Brazilian Standards (ABNT-NBR 13853:1997).

Sharps - Sharps are a subcategory of infectious health care waste and include objects that are sharp and can cause injuries.[Includes: syringe needles, scalpels, infusion sets, knives, blades, broken glass].

Perfurocortantes - Materiais perfurocortantes ou escarificantes, tais como: Lâminas de barbear, agulhas, escalpes, ampolas de vidro, brocas, limas endodônticas, pontas diamantadas, lâminas de bisturi, lancetas; tubos capilares; micropipetas; lâminas e lamínulas; espátulas; e todos os utensílios de vidro quebrados no laboratório (pipetas, tubos de coleta sanguínea e placas de Petri) e outros similares

In Brazil, sharps are categorized as Group E - Perfurocortantes (Anvisa n° 306/04 and Conama n° 358/05). In the regulations, sharps are described as materials or objects with sharp edges, sharp tips or rigid snags able to produce cuts or to perforate human skin. Sharps can be razor blades, needles, scalpels, shattered glassware, lancets, capillary tubes, micropipettes, microscope slides, cover slips, spatulas, or odontological instruments.

Waste management - All the activities - administrative and operational - involved in the handling, treatment, conditioning, storage, transportation and disposal of waste.

Gerenciamento de resíduos - Constitui-se em um conjunto de procedimentos de gestão, planejados e implementados a partir de bases científicas e técnicas, normativas e legais, com o objetivo de minimizar a produção de resíduos e proporcionar aos resíduos gerados, um encaminhamento seguro, de forma eficiente, visando à proteção dos trabalhadores, a preservação da saúde pública, dos recursos naturais e do meio ambiente

The current Brazilian regulatory definition was maintained. Waste management is described as a group of management procedures, scientifically supported, based on legal regulations and standards, aiming to reduce these byproducts and give them an adequate and safe fate.

It is further explained that the aim of waste management is to protect workers and to preserve public health, natural resources and the environment.