Stericycle, DOT and CDC help hospitals prepare for Ebola waste
How do hospitals prepare for the potential Ebola virus 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. While this waste stream may not become an issue for most hospitals, preparedness is key.
Special process for waste disposal
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 continue to work together to evaluate the process and prepare to address additional Ebola-related waste needs. At present, each incident is 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 likely will be required from the Department of Transportation to remove the Category A infections waste (PDF), a different category from traditional infectious material (Category B).
The CDC reports that Ebola requires standard, contact and droplet precautions. It is spread by contact with one or more of the following: infected animals; blood or body fluids (including urine, saliva, sweat, feces, vomit, breast milk and semen) of a person sick with Ebola or objects (such as needles and syringes) contaminated with the virus.
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 bush meat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (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 other parenteral means. It 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 (six 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. 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 (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 such as 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, including reusable linens.
Sustainability and infection control
Sustainability teams, led by infection control, work together to educate new and existing employees, develop posters, strategically place waste bins and monitor waste 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.