Medical Waste Management in the Age of Ebola

The tragic scenes of over 5000 fatalities and many more people infected with the Ebola virus in West Africa have also brought sadness and fear to the peoples this side of the Atlantic. The recent Ebola cases in Dallas, case especially the two healthcare workers who became infected has been the talk of the nation for weeks, and has presented a real problem for healthcare facilities who are or may have to treat Ebola cases.

Treating Ebola generates a lot of bio-hazardous waste and medical waste haulers are unable to transport it for disposal unless pre-sterilized since the DOT deems Ebola a Category A infectious agent, purchase meaning it is capable of killing people and animals, which leaves hospitals stuck without a way to dispose of the waste.

The CDC advice was that autoclaved Ebola medical waste is no longer infectious and so can be shipped by normal means.  However, most hospitals do not have autoclaves on-site designed for handling medical waste and with no means to ship it, some hospital administrators started looking around for sterilizers and saw the hospital already had some on-site, down in sterile processing. These thoughts caused much alarm in the sterile processing community, who envisioned packed red potentially leaking bio-hazard bags being piled up in sterile processing next to surgical supplies.

During the recent AAMI standards committee, there were several meetings to discuss a response to this question. The normally staid committee meetings were quite animated and AAMI put together a statement, which ChemDAQ supports, in conjunction with three other professional societies .

An AAMI press release provides the following statement:

AAMI, AORN, APIC, AST and IAHCSMM recommend that:

  1. Health care organizations should not circumvent established protocols for handling biohazardous medical waste.
  2. Biohazardous medical waste should not be brought into clean areas where processing reusable medical devices is performed.
  3. Biohazardous medical waste should not be inactivated in a sterilizer that is used for processing reusable medical devices.
  4. Sterilizers used to inactivate biohazardous medical waste should be designed and validated for that particular purpose.
  5. Organizations should work with infection preventionists and keep abreast of evolving professional and regulatory guidelines for handling biohazardous medical waste.

This statement recognizes that hazardous medical waste must not be brought into a clean area, for obvious reasons to avoid transmission of infection. Probably as important is the fact that medical device sterilizers are not validated for treating medical waste, and so even if the red waste bags were treated in a medical device sterilizer, there is no guarantee that the treatment would be effective. There are autoclaves on the market designed and validated for that purpose.

The question left unanswered for administrators is what to do with Ebola contaminated waste if they do not have a medical waste autoclave. The answer is probably the same as how should a hospital treat a highly infectious patient if they do not have an isolation room; i.e. the patient should not be treated there and should go to a facility that has the necessary equipment.

 

 

AAMI = Association for the Advancement of Medical Instrumentation

Aorn = Association of periOperative Registered Nurses

APIC = Association for Professionals in Infection Control and Epidemiology, Inc.

AST = Association of Surgical Technologists

IAHCSMM = International Association of Healthcare Central Service Materiel Management.