Ebola Waste: An Emerging Sustainability Issue

Janet Howard

October 15, 2014


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.Janet_brown

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 mosquitos 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.

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