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 Waste management companies are refusing to haul away the soiled
sheets and virus-spattered protective gear associated with treating
the disease, citing federal guidelines that require Ebola-related
waste to be handled in special packaging by people with hazardous
materials training, infectious disease and biosafety experts told
Reuters.
Many U.S. hospitals are unaware of the regulatory snafu, which
experts say could threaten their ability to treat any person who
develops Ebola in the U.S. after coming from an infected region. It
can take as long as 21 days to develop Ebola symptoms after
exposure.
The issue created problems for Emory University Hospital in Atlanta,
the first institution to care for Ebola patients here. As Emory was
treating two U.S. missionaries who were evacuated from West Africa
in August, their waste hauler, Stericycle, initially refused to
handle it. Stericycle declined comment.
Ebola symptoms can include copious amounts of vomiting and
diarrhoea, and nurses and doctors at Emory donned full hazmat suits
to protect themselves. Bags of waste quickly began to pile up.
"At its peak, we were up to 40 bags a day of medical waste, which
took a huge tax on our waste management system," Emory's Dr. Aneesh
Mehta told colleagues at a medical meeting earlier this month.
Emory sent staff to Home Depot to buy as many 32-gallon rubber waste
containers with lids that they could get their hands on. Emory kept
the waste in a special containment area for six days until its
Atlanta neighbor, the U.S. Centers for Disease Control and
Prevention, helped broker an agreement with Stericycle.
While U.S. hospitals may be prepared clinically to care for a
patient with Ebola, Emory's experience shows that logistically they
are far from ready, biosafety experts said.
"Our waste management obstacles and the logistics we had to put in
place were amazing," Patricia Olinger, director of environmental
health and safety at Emory, said in an interview.
NOT IF, BUT WHEN
The worst Ebola outbreak on record is now projected to infect as
many as 20,000 people in West Africa by November, while U.S.
officials have said that number could rise above 550,000 by
mid-January without an international intervention to contain its
spread. Experts say it is only a matter of time before at least some
infected patients are diagnosed in U.S. hospitals, most likely
walking into the emergency department seeking treatment.
Already there have been several scares. As of Sept. 8, as many as 10
patients have been tested by U.S. hospitals for suspected Ebola
cases, Dr. Barbara Knust, team leader for the CDC's Ebola response,
said at a medical meeting this month. All tested negative.
The CDC has issued detailed guidelines on how hospitals can care for
such patients, but their recommendations for handling Ebola waste
differs from the U.S. Department of Transportation, which regulates
the transportation of infectious waste.
CDC advises hospitals to place Ebola-infected items in leak-proof
containers and discard them as they would other biohazards that fall
into the category of "regulated medical waste." According to DOT
guidelines, items in this category can't be in a form that can cause
human harm. The DOT classifies Ebola as a Category A agent, or one
that is potentially life-threatening.
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DOT regulations say transporting Category A items requires special
packaging and hazmat training.
CDC spokesman Tom Skinner said the agency isn't aware of any
packaging that is approved for handling Ebola waste. As a result,
conventional waste management contractors believe they can't legally
haul Ebola waste, said Thomas Metzger, communication director for
the National Waste & Recycling Association trade group.
A TEMPORARY FIX
Part of Emory's solution was to bring in one of the university's
large-capacity sterilizers called an autoclave, which uses
pressurized steam to neutralize infectious agents, before handing
the waste off to its disposal contractor for incineration.
Few hospitals have the ability to autoclave medical waste from Ebola
patients on site.
"For this reason, it would be very difficult for a hospital to agree
to care for Ebola cases - this desperately needs a fix," said Dr
Jeffrey Duchin, chair of the Infectious Diseases Society of
America's Public Health Committee.
Dr. Gavin Macgregor-Skinner, an expert on public health preparedness
at Pennsylvania State University, said there's "no way in the world"
that U.S. hospitals are ready to treat patients with highly
infectious diseases like Ebola.
"Where they come undone every time is the management of their liquid
and solid waste," said Macgregor-Skinner, who recently trained
healthcare workers in Nigeria on behalf of the Elizabeth R. Griffin
Research Foundation.
Skinner said the CDC is working with DOT to resolve the issue. He
said the CDC views its disposal guidelines as appropriate, and that
they have been proven to prevent infection in the handling of waste
from HIV, hepatitis, and tuberculosis patients.
Joe Delcambre, a spokesman for DOT's Pipeline and Hazardous
Materials Safety Administration, could not say whether requiring
hospitals to first sterilize Ebola waste would resolve the issue for
waste haulers. He did confirm that DOT is meeting with CDC.
Metzger said his members are also meeting with officials from the
DOT, the CDC and the Environmental Protection Agency to sort out the
issue.
Until the matter is resolved, however, "We're bound by those
regulations," he said.
(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and
John Pickering)
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