A single Ebola patient treated at a U.S. hospital will generate eight 55-gallon barrels of medical waste each day.
Protective gloves, gowns, masks and booties are donned and doffed by all who approach the patient’s bedside and then lost. Disposable medical tools, packaging, bed linens, cups, plates, tissues, towels, pillowcases and anything which is used to clean up after the individual has to be thrown away.
Even curtains, privacy screens and mattresses eventually must be treated as contaminated medical waste and disposed of.
Dealing with this collection of pathogen-filled debris without triggering new infections is a legal and logistical challenge for every U.S. hospital now preparing for a potential visit by the virus.
In California and other states, it is a much worse waste-management nightmare.
While the U.S. Centers for Disease Control and Prevention recommends autoclaving (a kind of sterilizing) or incinerating the waste as a surefire means of destroying the microbes, burning waste is effectively prohibited in California, also banned in several different states.
“Storage, transport and disposal of this waste is going to be a significant problem,” California Hospital Association President C. Duane Dauner warned Sen. Barbara Boxer, D-Calif., in a letter last week.
Even some countries that normally permit incineration are throwing up barriers to Ebola waste.
In Missouri, the state attorney general has sought to bar Ebola-contaminated debris from a St. Louis incinerator operated by Stericycle Inc., the nation’s largest medical waste disposal company.
because of restrictions on burning, California hospital representatives say their only option seems to be trucking the waste over public highways and incinerating it in a different state — a prospect which makes some environmental advocates uneasy.
Rules for transport
Under national transportation guidelines, the material would be designated a Class A infectious substance, or one that is capable of causing death or permanent disability, and might require special approval from the Department of Transportation, hospital representatives state.
“These are some pretty big issues and they need some quick attention,” said Jennifer Bayer, spokeswoman for the Hospital Association of Southern California.
“We fully expect that it’s coming our way,” Bayer said of this virus. “Not to create any type of scare, but only given the makeup of our population and the hub we are. It’s very likely.”
The Ebola virus is essentially a string of genetic material wrapped in a protein coat. It can’t survive a 1,500-degree scorching within an incinerator, or the prolonged, pressurized steam of an autoclave. “It’s killed by bleach, by autoclaving, by an assortment of chemicals.”
But, CDC guidelines note that”chemical inactivation” has yet to be standardized and could trigger worker safety regulations.
Getting ready
California health officials recently tried to reassure residents that the nation’s private and public hospitals were up to the task and were actively training for the potential arrival of Ebola.
“Ebola doesn’t pose a substantial public health risk to California communities at the present time,” said Dr. Gil Chavez, an epidemiologist and deputy director at the California Department of Public Health. “Let me tell you why: Current scientific evidence specifies that individuals can’t get Ebola through the air, water or food. … The Ebola virus doesn’t survive more than a few hours on impervious surfaces.”
It was unclear whether California officials viewed the waste issue as a potential problem.
Although one-third of the nation’s private hospitals and”a few” of its public hospitals reported to Boxer’s office that there would be problems complying with the CDC’s incineration recommendation, and many others, a state public health official told reporters he wasn’t aware of any conflicts.
Dr. David Perrott, chief medical officer for the California Hospital Association, said there was also confusion about whether infected human waste could be flushed down the toilet.
“Here’s what we’ve heard from the CDC: It’s OK,” Perrott said. “But then we’ve heard from some sources, that perhaps we need to fix it and then flush it down the toilet or you have to consult local authorities. It sounds maybe a bit gross, but there is a real question about what to do with that waste.”
Dr. Thomas Ksiazek, a professor of microbiology and immunology of the University of Texas Medical Branch, has said he believes there has been a lot of overreaction about Ebola medical waste.
“There are different ways to deal with the waste; autoclaving would be chief among them,” Ksiazek said. “The problem is, most hospitals do not use it for most disposable items. They’re quite happy to bag them up and send them to a normal medical disposal firm.”
But Allen Hershkowitz, a senior scientist at the Natural Resources Defense Council, said incineration is easy and effective, and must be available to hospitals to help remove the mountain of waste.
Hershkowitz said states began to crack down on medical waste incineration years back because materials that didn’t have to be burned were being sent to combustors and were emitting harmful pollutants.
“There is no pollutant that’s likely to come out of a waste incinerator that’s more harmful than the Ebola virus,” Hershkowitz said. “When you are dealing with pathogenic and biological hazards, sometimes the safest thing to do is combustion.”
Hershkowitz said states began to crack down on medical waste incineration years ago because materials that didn’t need to be burned were being sent to combustors and were emitting dangerous pollutants.
In this case of Ebola medical waste, he said California should reconsider its restrictions.
“There’s no pollutant that’s going to come out of a waste incinerator that’s more dangerous than the Ebola virus,” Hershkowitz said. “When you’re dealing with pathogenic and biological hazards, sometimes the safest thing to do is combustion.”
by: http://www.sfgate.com/news/article/Another-challenge-disposing-of-waste-5909413.php