Table 3 Inclusion of terms, acronyms and assessment requirements: conceptual, technical and semantic evaluation

Resíduos similares ao RSU - Resíduos que se supõe não apresentam risco biológico, químico, de acidente com perfurocortantes ou físico (relativos aos rejeitos radioativos), à saúde ou ao meio ambiente, podendo ser equiparados aos resíduos domiciliares

According to the experts, the term “domestic waste” applied in the original version does not exist in the Brazilian regulation, but the closest applicable term is “similar to urban waste” (RSU), These residues do not present any significant risk to human health or the environment.

Célula especial de RSS - Consiste na disposição dos RSS em locais que observem os critérios mínimos estabelecidos pela Resolução do Conselho Nacional de Meio Ambiente, n°. 358/2005

Existing conditions for final HCW disposal in some regions of Brazil. A special cell for the disposal of HCW is a location for the destination of wastes, following the criteria established in the Conama n° 358/05 Act.

Armazenamento temporário (interno) - Consiste na guarda temporária dos recipientes contendo os resíduos já acondicionados, em local próximo aos pontos de geração, visando agilizar a coleta dentro do estabelecimento e otimizar o deslocamento entre os pontos geradores e o ponto destinado à apresentação para coleta externa

This term is given by the Brazilian regulations (Anvisa n° 306/04) and adopted requirements. Internal temporary storage is a site abutting the location of residue generation, where the residues are transitorily stored in labeled containers. This is a restricted area that aims to facilitate the collection and its transportation to the final destination.

Transporte interno - Consiste no traslado dos resíduos dos pontos de geração até local destinado ao armazenamento temporário ou armazenamento externo com a finalidade de apresentação para a coleta

This term is in accordance with the Brazilian regulations. Internal transportation is the collection of residues within the unit and its routing to internal temporary storage (see previous item).

Destinação final - Processo decisório no manejo de resíduos que inclui as etapas de tratamento e disposição final.

The term “destination” encompasses the decision making about the handling of HCW, its treatment and final destination, or recycling and reuse where applicable (in agreement with the specialists and target professionals – the HCW management staff).

IBGE - Instituto Brasileiro de Geografia e Estatística; SNIC - Sistema Nacional de Informações das Cidades; CNES - Cadastro Nacional de Estabelecimentos de Saúde; CCIH - Comissão de Controle de Infecção Hospitalar; SESMT - Serviço Especializado em Engenharia de Segurança e Medicina do Trabalho;

IBGE, SNIS and CNES refer to Brazilian databases that must be consulted in order to answer certain items: Criterion 1 – Geographical and Demographic Situation and Criterion 2 – Health-Care Facilities (HCF). Both criteria concern the “location and characterization of HCF”. IBGE is the main demographic information provider, because it is responsible for the Brazilian Census, gathering social, economic and administrative data; SNIS gathers information on management of water services and solid residue; CNES is responsible for quantitative information on the HCF, respective locations/addresses, data on available infra-structure, type of health services provided, specialized health services, inpatient beds and health professionals; CCIH is composed of a team of graduated health professionals, formally designated for hospital infection control; SESMT is regulated by a Brazilian Standard for the prevention of occupational accidents and diseases. Depending on the size of the unit and the number of employees, the SESMT team must be composed of one labor-safety physician, one labor-safety nurse, one labor-safety nurse technician, one labor-safety engineer and one labor-safety technician.

Não possui conhecimento algum sobre os riscos oferecidos pelos RSS às pessoas que os manuseiam: Inexistente = 0.

Sabe que os resíduos oferecem riscos, todavia não sabe esclacer como ou o porquê: Crítico (baixo) = 1.

Possui conhecimento contido na opção 1 e sabe que precisa, por exemplo, usar EPI/EPC, mas não o porquê e/ou se este é adequado: Insuficiente = 2.

Possui conhecimento contido na opção 2 e compreende a adequação e importância de práticas de prevenção de riscos: Satisfatório = 3.

Possui conhecimento contido na opção 3 e sabe como reagir frente à situação de risco ou acidente (tipo reativo): Bom = 4.

Possui conhecimento contido na opção 4, mas também sabe como prevenir e é capaz de orientar quanto às práticas de manejo frente aos riscos oferecidos pelos RSS (tipo pró-ativo): Excelente = 5

No criteria have been attributed for [Q] in the original version – Item 304 (staff for HCW awareness: awareness of risks of person(s) handling HCW?). Instead of literal translation, the term “conhecimento” (awareness) was applied because regulations in Brazil enforce HCW generators to promote a continuous education program for the staff managing wastes. Thus, the following criteria have been created for the Brazilian version:

“nonexistent = 0” – The staff has no knowledge about any of the risks presented by HCW;

“critical (low) = 1” – The staff knows that waste presents risks, but cannot explain how or why;

‘Insufficient - 2’- The staff has the knowledge contained in option 1 and knows the need, for example, for wearing individual or collective protective equipment (EPI or EPC), but they do not know the reason why or whether is it adequate;

“satisfactory - 3” - The staff has the knowledge contained in option 2 and understands the adequacy and importance of risk-prevention options;

“good - 4” - The staff has the knowledge contained in option 3 and knows how to react when facing a risk/accident situation (reactive type);

“excellent - 5” - The staff has the knowledge contained in option 4, and also cares about prevention and is capable of guiding others in practices for managing the risks presented by HCW (pro-active type)