Experts have warned that conflicting U.S. regulations over how
such waste should be transported could make it very difficult for
U.S. hospitals to safely care for patients with Ebola, a messy
disease that causes diarrhea, vomiting and in some cases, bleeding
from the eyes and ears.
Safely handling such waste presents a dual challenge for regulators,
who want to both prevent the accidental spread of the deadly disease
and avert any deliberate attempts to use it as a bioweapon.
Most U.S. hospitals are not equipped with incinerators or large
sterilizers called autoclaves that could accommodate the large
amounts of soiled linens, contaminated syringes and virus-spattered
protective gear generated from the care of an Ebola patient, said
Dr. Jeffrey Duchin, chair of the Infectious Diseases Society of
America's Public Health Committee.
Sterilizing Ebola waste before it is transported is important not
only to protect waste haulers but to guard against someone using the
waste "for nefarious purposes," said Sean Kaufman, president of
Behavioral-Based Improvement Solutions, an Atlanta-based biosafety
firm. "It's not just a safety issue," he said.
The matter, which was first reported by Reuters last month, may pose
a significant challenge for Texas Health Presbyterian Hospital in
Dallas, which is now treating the first Ebola patient to be
diagnosed on U.S. soil.
Duchin said he is not aware of whether the hospital has its own
incinerator or large autoclave, but if it does not, "they are going
to have to find a temporary solution for managing infectious waste.
That puts the hospital in a very difficult situation."
Cynthia Quarterman, administrator of the U.S. Department of
Transportation's Pipeline and Hazardous Material Safety
Administration, which oversees dangerous shipments, said her agency
is "working on how we can clarify even further for hospitals, for
the public, what the appropriate transportation should be."
Another official said that news could come within days.
The issue centers on guidance over handling Ebola-contaminated
waste. The U.S. Centers for Disease Control and Prevention advises
hospitals to treat items infected with the Ebola virus in leak-proof
containers and discard them as they would other biohazards that fall
into the category of "regulated medical waste."
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But the DOT deems Ebola a Category A infectious agent, meaning it is
capable of killing people and animals, and not "regulated medical
waste," a category in which pathogens are not capable of causing
Waste management contractors who normally handle hazardous hospital
waste say they cannot legally haul the material, which leaves
hospitals stuck without a way to dispose of the waste.
Already the issue has created problems. When Emory University
Hospital in Atlanta was preparing to care for two U.S. missionaries
infected with Ebola in West Africa in its high-security
biocontainment unit, their waste hauler, Stericycle, initially
refused to handle it.
Bags of Ebola waste quickly began piling up until the hospital
worked out the issues with the help of the U.S. Centers for Disease
Control and Prevention.
CDC spokesman Tom Skinner said the waste management problem has not
been resolved yet, but he has said previously that the CDC is
meeting with officials at the DOT to resolve the matter.
Duchin said he has heard that the discussion "has been elevated at
the fed to decision makers who can solve the problem."
A DOT official said the CDC and DOT will likely issue joint guidance
by next week.
(Reporting by Patrick Rucker and Julie Steenhuysen; Editing by Lisa
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