Development, content validation, and pilot application of an instrument for assessing healthcare waste management performance in hospital care

Healthcare waste management directly impacts patient safety, occupational health, and healthcare quality. Despite regulatory frameworks, healthcare institutions frequently encounter operational barriers due to unstandardized practices, insufficient continuous training, and limited managerial diagnostic tools. This study aimed to develop, content-validate, and pilot-test the Healthcare Waste Management Assessment Instrument (IAGRAS) as a decision-support tool for hospital governance and quality improvement. A mixed-methods study was conducted at a tertiary-level accredited hospital in Brazil. IAGRAS was structured around seven key performance indicators using an ipsative scoring system adapted from the Competing Values Framework. Content validity was evaluated by an expert panel using the Content Validity Index (CVI). A pilot application was performed with 50 nursing and hygiene professionals. Data were analyzed using descriptive statistics, the D'Agostino test, Coefficient of Variation, and sector-specific performance mapping using BioEstat 5.0. Expert evaluation confirmed 100% agreement, yielding a CVI of 1 across all seven indicators. Pilot data demonstrated normal distribution (p>0.05). The overall performance mean reached 36% for the 'High Degree' knowledge category. Significant sector variations were identified: the Surgical Center (50%) and Hygiene/Cleaning department (43%) achieved the highest compliance scores, whereas the 4th-floor (26%) and 5th-floor (27%) surgical wards revealed major knowledge gaps regarding waste management plans, transport logistics, and regulatory standards. High Coefficients of Variation (up to 79.7%) highlighted substantial perceptual heterogeneity among staff. IAGRAS proved to be a content-valid and feasible diagnostic instrument for identifying operational bottlenecks and guiding targeted educational and administrative interventions in hospital settings. Its integration into routine institutional audits can strengthen hospital governance, biosafety culture, and care quality.