Few issues have garnered the attention, or generated the much concern among the general public, as the Ebola patients in the United States. When the first Ebola patient showed up at the hospital in Texas, reaction was extreme. And, every aspect of the disease has received magnified scrutiny, including its waste. If not handled properly, waste generated in the course of treatment for an Ebola patient may pose a risk to workers. This article outlines the critical controls and procedures used by hospitals and the healthcare waste companies to manage that risk.
According to the Centers for Disease Control and Prevention (CDC), the Ebola virus is transmitted through direct contact with blood or other bodily fluids of a person who is ill (exhibiting symptoms) with the Ebola virus disease. The Ebola virus can be present in aerosolized particles (liquid droplets sprayed into the air) of the bodily fluids mentioned. But there is no scientific evidence that the Ebola virus is an airborne infectious disease, meaning that the virus does not remain suspended in the air for an extended period of time or persist in a dry environment.
Protection from the Ebola virus starts with following the Occupational Safety & Health Administration’s (OSHA) Bloodborne Pathogen Standard, using Universal Precaustions and following Regulated Medical Waste (RMW) Regulations, all of which have been in place for decades. Under Universal Precautions, all blood and other potentially infectious material (OPIM) are considered infectious. According to the OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030, appropriate Engineering Controls, Administrative Controls and Personal Protective Equipment (PPE) should be utilized to reduce or eliminate exposure to employees reasonably expected to come in contact with blood or OPIM in the course of their work. Training to the OSHA standards, company protocols and applicable regulatory permits is required. Protocols and procedures should be reviewed regularly to ensure accuracy and effectiveness.
Employees can be vulnerable to some of the same fear exhibited by the general public. Educating employees on appropriate protocols and reviewing procedures prior to ever handling Ebola contaminated waste will instill confidence and trust.
Waste Characterization and Standard Infection Control
The Department of Transportation (DOT) regulates the movement of regulated medical waste. Some regulated medical waste that is potentially fatal, such as Ebola, is classified as Category A waste, which requires more robust packaging than normal regulated medical waste. If Ebola contaminated waste is to be transported from the hospital to an off-site treatment facility, it must be packaged as Category A waste according to the DOT’s guidelines.
Other recommendations for infection control include:
- Limit the number of workers who handle the waste to a minimum.
- Keep Category A waste separated from other Regulated Medical Waste.
- Understand and practice proper donning (putting on) and doffing (taking off) of required PPE.
- Notify your supervisor immediately in the event you may have been exposed to blood or other potentially infectious material.
Point of Origin Waste Management
It is important to develop a plan. Part of that plan should be to: Identify the complete custody chain for waste handling, collection, transportation and disposal before the waste is generated. Create back-up plans at each step in the process and ensure that the process is sustainable over time. The volume of waste generated will likely be more than can be anticipated. Emory University and the University of Nebraska experienced 15 to16 95-gallon containers of waste per day for each patient. According to the transportation requirements, the waste should be double bagged with the exterior of each bag disinfected after sealing. The bags should be put into a rigid, leak-proof outer container and labelled appropriately.
If practical, consider on-site autoclaving of waste using an appropriate autoclave to reduce the risk prior to packing, transportation and disposal. If an on-site autoclave is utilized, the Ebola virus will have been inactivated meaning that the waste material is generally not regulated as medical waste any longer.
Collection and Transportation
- Appropriately packaged Ebola contaminated waste is not considered to pose a significantly higher risk of exposure than any other potentially infectious RMW.
- Properly label containers and follow DOT Hazardous Materials Regulations
- Do not use forklifts or other equipment capable of damaging the waste containers.
- Place waste sealed containers as low as possible on hand trucks, dollies, carts and in trucks to reduce the risk of tipping or falling. Secure containers within trucks and trailers to prevent damage in transit.
- Never handle leaking containers or containers visibly contaminated with blood or other potentially infectious materials without proper protection, possibly including enhanced Personal Protective Equipment (PPE).
Waste Treatment and Processing
- Depending on their job tasks, workers involved with processing appropriately packaged Ebola contaminated waste are not considered to be at a significantly higher risk of exposure to the Ebola virus than any other potentially infectious material they would handle on a daily basis.
- Workers exposed to waste prior to it being completely treated and decontaminated (e.g, workers opening waste containers or loading autoclaves or incinerators), are at a higher risk for exposure than workers handling treated waste products (e.g., Incinerator ash, autoclaved material, point of origin autoclave waste).
- Conduct a risk assessment to determine potential points of exposure and appropriate controls.
- Do not shred contaminated waste. Shredding can create bio-aerosols capable of spreading the virus.
- Avoid using pressurized water or air for cleaning. High pressure sprays can create bio-aerosols capable of spreading the virus.
Final Disposal of Treated Waste
Ebola contaminated waste that has been properly disinfected using autoclaving, incineration, a combination of these or other general accepted methods employed for other infectious RMW is not considered to be infectious. As such, treated waste can be disposed of following the normal protocols used by a permitted facility under the jurisdiction of the state where it is located.
The Regulated Medical Waste industry in the United States has, for many years, worked daily with infectious substances in a professional and responsible manner. Ebola presents a new challenge, but one the industry is prepared to meet. NW&RA staff members continue to coordinate Ebola-waste handling, transportation and treatment issues with our Healthcare Waste Institute members and representatives from government agencies to ensure that industry input is being heard as important protocols are being developed and implemented. For more information, we have developed an Ebola resource page on our website (http://wasterecycling.org/ebola).
John Haudenshield is the safety director for the National Waste & Recycling Association and may be reached at (540) 589-2975 or JHaudenshield@wasterecycling.org.
Anne Germain is director of waste and recycling technology for the National Waste & Recycling Association and may be reached at (202) 364-3724 or AGermain@wasterecycling.org.