The Washington Times: U.S. hospitals unprepared to deal with Ebola waste

By Kelly Riddell - The Washington Times - Thursday, October 2, 2014

The nation's hospitals may be unprepared to deal with the waste caused by Ebola patients, according to U.S. health officials, making it difficult for them to care for patients safely and prevent the spread of the disease.

At issue is whether waste management companies can pick up and carry Ebola-soiled waste without special training and packaging by people with hazardous materials training.

At Atlanta's Emory University, where the first two U.S. Ebola patients were treated in August after contracting the disease in West Africa, as many as 40 bags of waste were generated each day, which placed a huge burden on the hospital's waste disposal system, Emory's Dr. Aneesh Mehta told colleagues at a medical meeting in September. The comments were first reported by Reuters.

The hospital's waste hauler, Stericycle, initially refused to handle the material created by Emory's Ebola patients, making the hospital wait for six days with waste piling up, before the Centers for Disease Control and Prevention stepped in and brokered an emergency deal with the company.

Stericycle did not respond to requests for comment.

Patients stricken with Ebola commonly suffer from heavy vomiting, diarrhea and sometimes bleeding through the eyes and ears, which creates a large amount of infected material and an urgent need for quick and proper disposal of the soiled linens and medical paraphernalia. Ebola spreads through human secretions such as vomit, blood, sweat and urine.

Waste management companies say the appreciate the extra burden Ebola presents.

"The National Waste and Recycling Association and its members are working with the CDC and the U.S. Department of Transportation to resolve issues affecting the management of medical waste material from the Ebola patients," said Thom Metzger, spokesman for the Washington-based association.

"We are confident that the health care waste industry that we represent is capable of safely managing this material in a manner that is protective of public health and safety; however, we are bound to operate within the law, and current federal regulations effectively restrict transportation of this material," Mr. Metzger said. "We are awaiting approval and comprehensive guidance from the federal agencies."

The CDC did not respond to requests for comment. The Department of Transportation — which oversees waste carriers — is working closely with the parties involved to "address the safe transportation of Ebola-contaminated medical waste," said Gordon "Joe" Delcambre, a spokesman for the agency.

The DOT classifies Ebola as a "Category A agent," one that is potentially life-threatening and requires special packaging and discard methods. The CDC, however, allows for the containment of Ebola-infected materials to be stored in leak-proof containers, categorizing it "regulated medical waste" that can be hauled by nonspecialized waste management companies.

In Emory's case, the hospital sent its staff to raid the local Home Depot for 32-gallon rubber waste-containers with lids so they could store the Ebola waste while a transportation deal was being brokered, Reuters reported.

While U.S. hospitals may be clinically prepared to deal with Ebola, this regulatory glitch may catch many hospitals off guard, lessening their ability to treat the disease, according to Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University.

"Treating Ebola patients represents an occupational health and safety risk," Dr. Macgregor-Skinner said. "Ebola patients create an enormous amount of waste that is deemed category A — highly infectious, able to kill people, with no vaccine — and now you want a private company to say, 'Yeah, we'll take that waste, no problem!' That's not going to happen. We don't have the logistics organized."

Hospitals and waste management companies also have to be concerned that Ebola waste isn't used for nefarious reasons, and have biosecurity procedures in place to guarantee the waste stays in the hospital, and waste management system is tightly controlled, he said. So far, no such systems are in place in many U.S. hospitals.

"We have a long way to go — we are nowhere near ready yet," Dr. Macgregor-Skinner said.

Part of the solution brokered with Emory and Stericycle by the CDC was to bring in one of the university's jumbo sterilizers, dubbed an "autoclave." An autoclave uses pressurized steam to help sanitize Ebola's infectious agents. The sanitized waste was then handed to Stericycle for the company to incinerate. Many hospitals don't have autoclaves or incinerators on-site, or if they do, they haven't been used in so long that many times they don't know whether they're operational or not, Dr. Macgregor-Skinner said.

Waste management may prove to be an obstacle at Texas Health Presbyterian Hospital in Dallas, which is now treating the first Ebola patient to be diagnosed on U.S. soil. Calls to the hospital on how they're managing their waste weren't immediately returned. It is unknown whether the hospital has either an incinerator or an autoclave to deal with the patient's waste.