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Ebola Waste: An Emerging Sustainability Issue

By Janet Howard, Director, Facility Engagement, Practice Greenhealth

For health care sustainability managers, there’s an emerging waste stream to consider—waste from the Ebola virus. How do hospitals prepare for this potential waste stream with science-based decision-making and start off with a best management approach to this waste? While this is an emerging topic with evolving practices, the most important resource is The Center for Disease Control and Prevention web page for interim guidance on the best approaches for protective equipment, segregation, storage, packaging and removal of this Category A infectious material. And while this waste stream may not become an issue for most hospitals, preparedness is key.

Stericycle, a member of Practice Greenhealth, began working with the CDC and the Department of Transportation in August when the first Ebola case entered the United States.  As a result of the collaboration, DOT released a special permit process along with requirements for proper segregation, containment, packaging and removal of this Category A infectious waste to address the needs of Dallas Presbyterian Hospital while maintaining overall public safety. Stericycle, DOT and CDC are continuing to work together to evaluate the process and prepare to address additional Ebola related waste needs.  At present, each incident is being addressed on a case-by-case basis.

To prepare for waste disposal, hospital staffers should work with their waste hauler for specific packaging procedures and ensure appropriate supplies are on-hand in the hospital and that their hauler is prepared to manage waste removal and disposal. Additional special permits will likely be required from the Department of Transportation to remove the Category A infectious waste, which is a different category than traditional infectious material (which is Category B). The waste is defined by the Department of Transportation as a Category A infectious substance.

The CDC reports that Ebola is spread the following ways and requires standard, contact and droplet precaution:

  • Blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola.
  • Objects (like needles and syringes) that have been contaminated with the virus
  • Infected animals.
  • Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitoes or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.

According to the CDC site providing guidance for clinicians, the Ebola virus enters the patient through mucous membranes, breaks in the skin, or parenterally and infects many cell types, including monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells and epithelial cells. The incubation period may be related to the infection route (e.g., 6 days for injection versus 10 days for contact). Ebola virus migrates from the initial infection site to regional lymph nodes and subsequently to the liver, spleen and adrenal gland.

The CDC reports on the details regarding personal protective equipment (PPE).  For waste collection, environmental services staff are recommended to wear at a minimum, disposable gloves, gown (fluid resistant/ impermeable), eye protection (goggles or face shield), and face mask to protect against direct skin and mucous membrane exposure of cleaning chemicals, contamination, and splashes or spatters during environmental cleaning and disinfection activities.

Additional barriers (e.g., leg covers, shoe covers) should be used as needed. If reusable heavy-duty gloves are used for cleaning and disinfecting, they should be disinfected and kept in the room or anteroom. Be sure staff is instructed in the proper use of personal protective equipment including safe removal to prevent contaminating themselves or others in the process, and that contaminated equipment is disposed of appropriately (included in the Category A waste collection). Any mattresses or pillows that are not covered with an impermeable plastic covering should be treated as Category A infectious waste, as well.

Check the CDC website frequently for any updates. The CDC also recommends that any room with a patient on isolation for the Ebola virus should be free of cloth materials like carpeting, curtains or furniture. EPA-registered, hospital disinfectants with a label claim for a non-enveloped virus shall be used on all surfaces and all waste should be collected as Category A regulated medical waste (RMW), including reusable linens.  

Sustainability teams, led by infection control, work together to educate new and existing employees, develop posters, strategically place waste bins and monitor segregation practices. According to the Practice Greenhealth Sustainability Benchmark Report, award-winning hospitals average a 9 percent regulated medical waste generation with top performers at a 2.3 percent compared to total waste.  With waste fees at least five times more than for solid waste, it’s worth the effort, saving anywhere from tens of thousands to hundreds of thousands of dollars per year in waste removal and treatment fees.

This update is informational only and not a regulatory guidance document. All policies should be included in the Joint Commission (or other accreditation) Hazardous Material and Waste Management Plan.  For more information, contact the facility’s waste hauler to prepare for a Category A infectious material removal needs.  Ask them if they are approved by the Department of Transportationto remove Category A infectious waste.  Refer to the Center for Disease Control and Preventionfor the latest on Ebola virus and proper management protocol. 

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