**4. Discussion**

The majority of the studies were from LMICs, which shows that HCWM is more of a concern in LMICs [2–26,30]. In order to address the issue of HCWM, the 112 studies in this review used various methods ranging from case studies to systematic reviews. The studies are spread across different disciplines, with the largest number coming from the public health discipline, followed by environmental engineering, environmental health, environmental management, waste managemen<sup>t</sup> engineering, and lastly, community medicine. These findings show that HCW is a multidisciplinary issue [22,31] that has implications for the well-being of the people and the environment.

This review has also found that both HICs and LMICs use different terminologies to describe HCW, although the definition, categorization, and classification align with those provided by the WHO manual [2]. It is not clear why the use of nomenclature vary in countries, and yet, there is only one global manual. More so, the adverse consequences of the improper managemen<sup>t</sup> of HCW have been documented extensively [2,18–23], and using different nomenclatures to describe HCW is one of the factors contributing to the improper segregation practices of HCW among healthcare workers [4]. For example, a study in Botswana on HCWM current practices in healthcare facilities [16] found that the term 'clinical waste' is known to mean all of the waste that is generated from healthcare facilities. Due to this definition, most healthcare workers and the general public ended up not segregating HCW into non-hazardous and hazardous waste. The health workers disposed of all of the unsegregated HCW into red bags. The consequence of this practice was the unnecessary use and wasting of red bags, and the overloading of resources needed for the transportation and storage of HCW. Although this particular study cannot be generalized, more of such studies are ye<sup>t</sup> to be found. Varied nomenclatures could also cause confusion when it comes to developing HCWM policies by policy-makers, and can affect the practices of HCWM by healthcare workers who are generators and handlers of HCW. More importantly, a lesson learnt from Mbongwe's study is the need to have a standard nomenclature to describe, define, categorize, and classify HCW.

#### *Conclusion and Recommendations*

Considering that all of the nomenclatures that are used by various authors from HICs and LMICs are different, but align with those provided by the WHO manual, there is a need to adopt the terminology used by the manual. A uniform nomenclature could be beneficial for the healthcare workers who are HCW generators and handlers. A standard nomenclature could also be beneficial to policy-makers for designing HCWM policies that monitor appropriate HCWM practices.

#### **5. Strengths and Limitations**

The primary strength of this scoping review is its ability to answer all of the research questions with the use of transparent methods to conduct the review. Limitations to this scoping review are that only six databases were used to search for literature given the limited resources (at the University of KwaZulu-Natal). Furthermore, only 20 South African print media were used to identify search terms, because these were the only ones available at the time of the research. The search only used five key search terms (HCW, medical waste, clinical waste, biomedical waste, and hospital waste), because these are the most dominant terminologies found in the literature. Lastly, the review did not cover literature from 2016 onwards due to limited resources at the time of research.

#### **6. Areas for Future Research**

This scoping review did not explore the extent to which the WHO's guidelines have been adopted and implemented in practice by various countries. Such studies should be conducted to provide more insights into HCW and its management. More importantly, this review did not include literature from 2016 onwards. More studies should be conducted and include literature from 2016 onwards. This review did not explore search terms that are used in other media venues besides the ones from

the South African print media. Other studies should be conducted to include search terms from other media venues to help yield more insights into the study on HCWM.

**Supplementary Materials:** The following are available online at http://www.mdpi.com/2313-4321/3/4/51/s1, Table S1: Characteristics of newspaper covered in the analysis; Table S2: Table showing databases used in the study; Table S3: A list of all references analysed for the scoping review. Table S4: Coding framework used for the studies included in the scoping review.

**Funding:** This research received no external funding.

**Acknowledgments:** Lydia Hangulu (L.H.) would like to acknowledge the assistance provided by the Samantha Moodley (S.M.) for working as an assessor in the data collection phase. More importantly, Olagoke Akintola (O.A.) who supervised the research. The writing of the manuscript was supported by the postdoctoral fellowship gran<sup>t</sup> offered to Lydia Hangulu by the National Research Foundation (NRF) of South Africa. However, all views expressed in this manuscript are of the author and should and not necessarily to be attributed to NRF.

**Conflicts of Interest:** The author declares no conflict of interest.
