**1. Introduction**

Healthcare activities such as operative and diagnostic procedures that involve administering injections, medications, drips, and surgery improve the health and quality of life of individuals [1]. However, the healthcare waste (HCW) that is generated during these healthcare activities could have adverse effects on both the people and the environment if it is poorly managed [2,3]. The literature regarding healthcare waste managemen<sup>t</sup> (HCWM) shows that large volumes of HCW is generated from healthcare facilities globally [4], and it is poorly managed, especially in low and middle-income countries (LMICs) [5]. The main factors attributed to poor HCWM practices in LMICs include: lack of financial investment and clear policies to manage HCW by most governments [3–6], low levels of knowledge by healthcare staff on how to handle HCW properly [7,8], poor segregation practices among healthcare workers [9], and inappropriate transport for transporting HCW, which is driven by untrained drivers who are also not registered to handle HCW [10]. More so, there are inadequate technologies for treating HCW [11–14]; as a result, HCW is often illegally dumped, openly burnt, and buried in poorly managed dumpsites [10–17].

Poor managemen<sup>t</sup> of HCW exposes healthcare workers, waste handlers, and the community members to toxins, injuries, and infections [2]. For example, in a study conducted in Tripoli,

Libya, it was found that exposure to HCW among waste handlers caused 5% of them to develop hepatitis B virus, and 0.3% had hepatitis C virus [18]. Exposure to HCW can cause tuberculosis (TB) infections [19], and damage the respiratory, nervous, and reproductive systems of the patients, family members, caregivers, and the public. HCW has mutagenic, teratogenic, and carcinogenic effects [20]. Exposure to HCW can also cause diseases such as diarrhea, leptospirosis, typhoid, cholera, and HIV [21]. The disposal of HCW into unprotected dumpsites promotes scavenging for reusable items for reselling. For example, one study in India revealed that, in almost 10% of the healthcare facilities in the country, more than 30% of the three to six billion injections that were administered every year were done with used equipment [22]. Similarly, in 2009, 240 people in the state of Gujarat in India contracted hepatitis B, because medical care was delivered with previously used syringes that were acquired through the black market [23].

While the environmental and health impacts of HCW have been well documented, having an operationalised nomenclature 'terminology' for HCW is important. The World Health Organization (WHO), in its global manual for healthcare waste management, provides guidelines for all of the issues relating to the proper managemen<sup>t</sup> of HCW from healthcare settings. The manual uses the nomenclature 'healthcare waste' to mean all of the waste that is generated as a result of healthcare activities, and further classifies HCW into non-hazardous and hazardous waste [2]. Despite having a global manual, different nomenclatures are used to describe HCW by various authors from high-income countries (HICs) and LMICs. For example, some have used 'medical waste' [10,12,18,19,21,23,24], 'biomedical waste' [1,3], 'hazardous waste' [20,25], 'hospital waste' [6,11,13], or 'yellow bag waste' [26,27]. Consequently, a study on HCWM practices in healthcare facilities in Botswana [16] found that the use of the nomenclature 'clinical waste' to mean HCW confused healthcare workers and the public. Both the healthcare workers and ordinary people correctly defined clinical waste as any waste from healthcare facilities, but failed to consider that HCW is further categorized as non-hazardous and hazardous waste. Failure to classify HCW into these categories resulted in the improper segregation of HCW [16]. In other contexts such as clinical practice, the consistence use of specific nomenclature in describing suicidal behavior is critical for case development among healthcare providers [28]. Furthermore, it is argued that consistent and specific nomenclature allows for appropriate diagnosis, treatment, and the subsequent creation of public policy [29]. Similarly, considering that HCWM practices involve cognitive behavior with a triadic relationship which involves peoples' perceptions, feelings, and actions, one can argue that using various nomenclatures to describe HCW could be confusing to waste generators and handlers, thereby affecting the HCWM practices. Despite having various nomenclatures to describe HCW, is not clear how they align with the definitions that are provided by the WHO's manual on HCWM. Furthermore, there is no scoping review that describes, defines, and characterizes HCW in comparison with the provisions made by the WHO manual.

This scoping review endeavors to determine the common nomenclatures for HCW from HICs and LMICs, including their definition, classification, and categorization in comparison to those provided by the WHO global manual for HCWM. This scoping review will answer three specific research questions: (1) What are the various nomenclatures that are used to describe HCW in HICs and LMICs? (2) To what extent do such nomenclatures align with the provisions made by the WHO manual on HCWM? (3) What are the gaps that exists in the literature? Findings of the review will add scientific knowledge to the body of literature on HCWM, and will help determine any inconsistencies that exist that will help make recommendations aimed at improving HCWM by healthcare workers and other policy implementers, especially in LMICs.
