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Hospital Waste Management in the Face of Ebola

  • As the current Ebola crises in West Africa continue to escalate, we’ve been fielding a lot of questions from clients concerned about medical waste management for Ebola patients.  Primarily, we’ve been hearing that hospital managers are unaware of official protocol, or simply do not know what to do with medical waste if their facility is, indeed, faced with an Ebola patient.

    Happily, Ebola in its present state is a fairly manageable pathogen.   Despite concerned speculation about the virus mutating into an airborne pathogen, Ebola as we know it now is only dangerous for humans through physical contact with infected body fluids.  And Ebola is not a very difficult organism to kill: It’s not very heat resistant, and often you can inactivate it using just normal disinfectants.

    On the other hand, Ebola is no laughing matter.  In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated.  It follows that Ebola must be treated at the highest level of containment, in accordance with CDC guidelines for Biosafety Level 4 containment.  The catch is that hospitals are not set up as laboratories; and hospital waste management will, necessarily, differ from laboratory waste management in accordance with hospital practice.

    In contrast to laboratory protocol which traditionally calls for hazardous waste to be treated immediately onsite, traditional medical waste collection practices are generally set up such that regulated medical waste from various parts of the hospital is commingled in one central area before being given to a contractor to be treated offsite.  If you have Ebola in your facility, you don’t want live Ebola being handled by your environmental, housekeeping, or waste services employees and commingled with other waste – because that would increase the potential for contact infection throughout the facility. Therefore, Ebola would have to be treated within the confines of the containment area around the isolated patient.

    The CDC has released “Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus”, which facility personnel can review for guidance.  Essentially, these are the protocols and information to be considered when dealing with Ebola:

    • PATHWAY TO INFECTION:  Any contact with body fluids of an infected patient. Person-to-person transmission occurs via close personal contact with an infected individual or their body fluids during the late stages of infection or after death. Nosocomial infections can occur through contact with infected body fluids due to the reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids. Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals.
    • CONTAINMENT REQUIREMENTS: Containment Level 4 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, and cultures.
    • PROTECTIVE CLOTHING: Personnel entering the area must either remove street clothing (including undergarments and jewelry) and change into dedicated laboratory clothing and shoes, or don full coverage protective clothing (i.e. completely covering all street clothing). Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Eye protection must be used where there is a known or potential risk of exposure to splashes.
    • LAB WASTE: Cultures and blood samples should be autoclaved in the lab. It is recommended that you minimize untreated, contaminated body fluid material in your normal red bag collection.
    • OTHER WASTE: Any other waste generated, whether it be solid or body fluids, would have to be decontaminated before being removed from the area.  Materials must be autoclaved or decontaminated using the disinfectants detailed below, prior to being released into the general waste stream.
    • SANITARY SEWERS: At the present time, CDC has not mandated decontamination of human waste excreted in bathroom facilities prior to release to sanitary sewers.  Toilets may be used in a normal fashion.
    • EBOLA INACTIVATION: Ebola virus is susceptible to sodium hypochlorite (BLEACH), lipid solvents, phenolic disinfectants, peracetic acid, methyl alcohol, ether, sodium deoxycholate, 2% glutaraldehyde, 0.25% Triton X-100, β-propiolactone, 3% acetic acid (pH 2.5), formaldehyde and paraformaldehyde, and detergents.  These disinfectants are very effective for decontamination. Furthermore, Ebola is not very heat resistant, and can be killed in 5 minutes at 212 degrees Farenheit.