Safe Handling, Treatment, Transport and Disposal of Ebola-contaminated Waste

Ebola is spread primarily through direct contact with the blood or other body fluids of a person who is ill with Ebola, and from contact with objects contaminated with the Ebola virus. Waste generated from caring for or cleaning up after an Ebola patient may pose a risk to workers if it is not handled safely or treated and disposed of properly.

Safe handling, treatment, transport and disposal of waste that is suspected or known to be contaminated with the Ebola virus begins at the point the waste is generated (also known as the point of origin) and continues through final disposal. Waste may be generated at the point of origin during activities such as:

• Using and discarding sharps, dressings and other supplies while caring for a patient with suspected or confirmed Ebola
• Discarding supplies used for clinical laboratory testing of samples from a patient with suspected or confirmed Ebola
• Cleaning hospital rooms, ambulances, airplanes, other vehicles, airports, other transportation facilities, residences or other areas with suspected or confirmed Ebola-virus contamination
• Removing and discarding disposable personal protective equipment (PPE) after working in an environment with suspected or confirmed Ebola-virus contamination

Personal Protective Equipment

The Occupational Safety and Health Administration (OSHA) Personal Protective Equipment (PPE) Standard requires employers to assess the workplace to determine what hazards are present, and then choose the appropriate PPE to protect workers. Employers must select PPE that will protect workers against the Ebola virus and other hazards to which they may be exposed.

Workers with different job tasks may have very different exposures and require different PPE, such as those who load waste containers onto trucks compared to those who empty containers onto processing lines. Workers must wear PPE to help minimize exposure to the virus via mucous membranes and broken skin or through inhalation of bio-aerosols. Examples of PPE that may be needed during waste handling, treatment, transport and disposal include:

• Goggles or face shields
• Nitrile gloves (consider using double gloves and/or puncture-resistant gloves for extra protection)
• Aprons and fluid-resistant or impermeable gowns or coveralls
• Facemasks that cover the nose and mouth
• Dedicated washable shoes with protective shoe coverings
• N95 respirators, powered air purifying respirators (PAPRs) or other respiratory protection devices

Training, practice and observation of workers in correct donning and doffing of PPE are important infection control measures. Workers should put on PPE in a way that minimizes the risk of skin and mucous membrane contact with potentially infectious materials and remove PPE in a way that avoids self-contamination. This includes decontaminating PPE before and between removal steps. The order of PPE removal may vary depending on the type of PPE a worker uses, the nature of the work tasks being performed, and which devices or garments are contaminated, among other factors.

Waste Management Steps at Point of Origin

Take these steps at the point of origin to minimize the creation of solid and liquid wastes.

• Identify a complete chain for waste handling, collection, treatment, transport and disposal before the waste is generated. Ensure that waste, including incinerator ash or other completely treated materials, has a final place for disposition.
• Create a waste management plan and secure necessary contracts and permits ahead of time in order to help avoid potential exposure hazards, security risks and storage problems. Pre-identify waste management facilities prior to waste generation—waste management facilities may have their own requirements that may need to be considered.
• Place materials in double, leak-proof bags, and store in a rigid, leak-proof container to reduce the risk of worker exposure. If waste will ultimately be transported, follow U.S. Department of Transportation (DOT) guidance for packaging from the outset to minimize repackaging or additional handling. This guidance can be found at phmsa.dot.gov/hazmat/packaging-of-ebola-contaminated-waste.
• Follow manufacturer instructions on product labels and Safety Data Sheets for Environmental Protection Agency (EPA)-registered disinfectants when selecting PPE.
• Use a puncture-proof container for sharps. Go to www.cdc.gov/niosh/docs/97-111 for more information.
• Mark and label outer packaging according to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens standard (29 CFR 1910.1030) and DOT general marking requirements for nonbulk packaging (49 CFR 172.301).
• Ensure that the outsides of waste containers are not contaminated. Use administrative controls and work practices to avoid contaminating a container when placing waste into it.
• Implement protocols for effectively decontaminating the outside of bags that go into containers and the containers themselves in situations where they come into contact with potentially infectious waste.
• If a porous container (e.g., a corrugated cardboard box) becomes contaminated, place it into another container. Disinfect the outsides of waste bags with an EPA-registered disinfectant that meets Centers for Disease Control and Prevention (CDC) criteria by wiping or spraying the bags with an appropriate disinfectant. Follow manufacturer instructions on product labels for concentration, application method and contact time for the specific disinfectant.
• If practicable, consider autoclaving waste on-site, using an appropriate autoclave before it is packaged and sent out of a facility for disposal. Porous materials may require multiple autoclave cycles to ensure sufficient penetration of heat and steam. This approach may be more effective than just using a longer cycle.

Collecting and Transporting Waste

Following stringent packaging protocols, including decontaminating waste containers at the point of origin, may reduce the risk of exposure to the Ebola virus and other infectious agents for workers involved in collecting packaged waste. The following are additional methods you should train your employees to follow when collecting and transporting Ebola waste:

• Place containers of waste as low as possible on dollies, hand trucks or carts, and in trucks or other transport vehicles to prevent toppling and spillage. Secure containers, especially stacked ones, within vehicles using suitable straps or tie-downs.
• Use proper protections, including additional or more protective PPE, if handling waste containers with visible contamination from blood, body fluids or other potentially infectious or unknown material. Employers may consider additional or more protective PPE for waste collection and transport workers if they determine another or more serious hazard(s) exists.

Processing Waste in a Treatment/Disposal Facility

Workers who are exposed to waste before it is completely treated and decontaminated, including when opening containers to load waste onto processing lines or into autoclaves or incinerators, may be at higher risk for exposure to the Ebola virus and other infectious agents than workers who handling waste products that have already been treated (for example, incinerator ash or waste that was already appropriately autoclaved at its point of origin). Waste that has been properly treated and decontaminated is no longer infectious but should still be handled carefully.

• Place containers of waste as low as possible on dollies, hand trucks or carts, and when stacking to prevent toppling and spillage. Secure stacked containers using suitable shelves, straps or other equipment.
• Employers must consider increasing levels of PPE for waste processing and treatment/disposal workers if they determine that a more serious hazard exists.

Do Not Shred Contaminated Waste

Do not use waste management processes that involve shredding incoming waste materials that have suspected or confirmed Ebola-virus contamination. This is because shredding, particularly with equipment that is not closed and ventilated out of the work area, may result in the generation of bio-aerosols (aerosolized droplets containing infectious particles that can be inhaled). Shredders may become clogged or jammed by atypical, porous waste materials (linens, carpet, curtains or other textiles) that must be discarded when decontamination is not possible.

If a shredder is used and it becomes clogged, do not enter the machine to resolve a jam. If a worker must do so, always ensure that the machine is powered off and follow proper lockout/tagout procedures for controlling hazardous energy. Ensure that the worker has proper PPE to protect against all health and safety hazards that are possible from the waste and the machinery, including bloodborne pathogens and other infectious diseases, and mechanical, electrical and other physical hazards of the equipment.

Safer Waste Processing Techniques

When processing waste, select techniques that minimize potential worker exposure to the Ebola virus or other pathogens. These techniques may include:

• Incinerating entire, unopened waste containers in incinerators to eliminate exposures associated with handling and opening containers.
• If using autoclave or rotoclave equipment, develop, validate and regularly test protocols using biological and nonbiological indicators to ensure that the autoclave temperature and pressure are maintained for enough time to kill all organisms throughout the waste content, and that heat/steam can penetrate packaging and any porous materials.
• Conduct weekly (or more frequent) testing with biological or nonbiological indicators to ensure that autoclave equipment is functioning properly.

Do not use open burning techniques, which could expose workers and other individuals to harmful air contaminants. Do not shred contaminated waste.

Final Disposal of Treated Waste

Waste that has been properly treated and disinfected using thermal/heat treatment, autoclaving, incineration, or a combination of these or other generally accepted methods is not considered to be infectious.
Depending on state regulations, such waste can safely be disposed of following the protocols normally used by a facility under the jurisdiction of the state where it is located. As with any solid waste, other applicable disposal requirements should be considered (for example, if noninfectious materials such as toxic metals are present in regulated amounts).

Use Appropriate Respiratory Protection

In instances where workers may be exposed to bio-aerosols, such as using high-pressure air or water for cleaning areas suspected or known to contain Ebola virus, additional respiratory protection is needed. In these cases, medically qualified workers must use, at a minimum, a NIOSH-approved, fit-tested N95 respirator.

Infection Control for All Waste Workers

Infection control starts with limiting the number of workers who handle waste to essential staff. For example, instruct and train health care workers generating waste during care of an Ebola patient to properly package the waste instead of requiring an environmental services or waste collection worker to also handle the waste. Other practices you should train your workers to follow are:

• Whenever gloves are removed or changed, wash hands with soap and water or use alcohol-based hand rubs if soap and water are unavailable. Always wash with soap and water if hands are visibly soiled.
• Avoid touching the face or other exposed parts of the body while wearing gloves or before washing/sanitizing bare hands.
• Change clothing and shower as soon as possible if work clothing becomes soiled. Discard soiled work clothing with other Ebola-contaminated waste.
• Consider wearing dedicated, washable footwear while on the job.
• Notify a supervisor immediately if exposed to potentially infectious material or waste on the job, including on work clothing, exposed skin or through mucous membranes (e.g., eyes, nose, mouth).

Source: OSHA