The safe handling and in-hospital management of waste generated through the care of patients with Ebola is based on three main principles.
Safe containment and packaging of waste should be performed as close as possible to the point of generation. Staff should avoid opening containers to manipulate the waste after primary containment.
Limit the number of personnel entering the Ebola patient care area and those handling generated waste before and after primary containment.
Always use appropriate personal protective equipment (PPE) and procedures for handling waste until onsite inactivation or transport away from the hospital for offsite inactivation.
Preparing a Waste Management Plan as Part of Ebola Patient Care
Comply with your State and local regulations for handling, storage, treatment, and disposal of Ebola-associated waste.
Determine whether Ebola-associated waste will be inactivated onsite at the hospital or transported offsite for inactivation.
Identify a dedicated waste management team with specific training on standardized procedures for waste handling, including wearing appropriate PPE, and protocols for safely bagging and packaging waste, storing waste, and transporting packaged waste.
Onsite inactivation: Ebola-associated waste may be inactivated through incineration or by autoclaving using properly maintained equipment with appropriate biological indicators.
Offsite inactivation: Comply with regulations for packaging, transport and disposal of Ebola-associated waste.
When selecting emergency department triage areas for the evaluation of patients with possible Ebola, a designated area should be identified for waste storage pending a determination of whether the patient has Ebola or not. The storage space should meet all applicable fire codes and principles of maintaining a clutter-free, safe environment.
Waste bags should never be over-filled. Bags should be closed when two thirds full.
If stored within the patient room, all filled solid waste bags and sharps containers should undergo primary closure procedures as outlined below.
If stored outside the patient room, all filled solid waste bags and sharps containers should undergo both primary and secondary closure, and be removed as outlined below.
Be sure healthcare personnel and environmental services staff handling waste are trained to wear recommended PPE (same used for patient care) and follow appropriate putting on and taking off procedures. Use the OSHA PPE Selection Matrix for Occupational Exposure to Ebola Virus [PDF – 3 pages] to guide selection of appropriate PPE for environmental services and waste collection workers handling, transporting, and disposing of waste.
Handling and primary packaging of waste should occur in the patient room and the area where PPE is removed and be performed by the primary healthcare workers (i.e., doctors and nurses) wearing PPE as designated in the guidance for hospitals.
Supplies for Hand Hygiene, Cleaning and Disinfection, and Packaging Waste
Select a hospital grade disinfectant available as wipe, spray, pull-top, or refill bottles (depending on application) with a label claim for one of the non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect hospital environmental surfaces.
Disposable cleaning cloths
Alcohol-based hand rub (ABHR) that is at least 60% alcohol
Rigid outer receptacle that conforms to U.S. DOT HMR requirements for transport of Category A DOT waste provided by approved waste vendor
Waste should be packaged with an installed liner provided by the waste vendor.
Absorbent material sufficient to absorb potential free liquid (if any) should be placed in the bottom of the rigid outer packaging or the liner of the fiberboard outer packaging.
Primary Packaging of Medical Waste in Patient’s Room
Procedures for management of solid waste generated during Ebola patient care are outlined in CDC’s Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus. Examples of solid waste include medical equipment, sharps, linens, privacy curtains, and used healthcare products (such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, used PPE [gowns, masks, gloves, goggles, face shields, respirators, booties, etc.] or byproducts of cleaning).
All placement of receptacles (including sharps containers) and primary packaging by double-bagging of waste should occur in the patient’s room and be performed by the primary healthcare workers (i.e., doctors and nurses) wearing PPE as designated in the guidance for U.S. Emergency Departments and Hospitals.
Line appropriate-sized waste containers with a leak-proof biohazard bag.
Place non-sharps solid waste in the biohazard bag. Bags should not be filled beyond two thirds full to allow safe closure.
Carefully place sharps waste in appropriate disposable sharps container and close the container. Containers should not be filled beyond two thirds full to allow safe closure.
Prepare filled bags and sharps containers for onsite inactivation (step 5) or offsite inactivation/incineration (step 6).
Prior to closure of bag and sharps container, prepare waste for onsite autoclaving:
Non-sharps waste: if required by the validated procedures, add a sufficient volume of water to primary bag.
Sharps waste: if required by the validated procedures, add sufficient volume of water.
For offsite inactivation, no liquid should be added.
Place closed sharps containers in a biohazard bag.
Close the bag with a method that will not tear or puncture the bag (e.g., tying the neck of bag with a goose-neck knot) and will ensure no leaks.
The healthcare workers (i.e., doctors and nurses) caring for the patient and wearing PPE as designated in the guidance for hospitals should spray or wipe the outside surfaces of double-bagged waste with an EPA-registered hospital disinfectant immediately before removing waste from the room.
Upon removing the double-bagged waste from the patient’s room, the healthcare worker should place the double-bagged waste in a designated transport cart (for onsite inactivation or a rigid outer receptacle (with absorbent material and liner as described above, for offsite inactivation).
The designated container should be located at the periphery of the area for taking off PPE so that removal from the area is efficient and does not create a risk of recontamination of the outer container.
Before removal from the area, the healthcare workers wearing appropriate PPE should close the liner (either by zip tie or similar means of closure as specified by the manufacturer of the packaging), and close the outer lid and packaging. Disinfect the entire exterior surface of the container with an EPA-registered hospital disinfectant (wipe or spray).
Primary handling of liquid waste should occur in the patient’s room and be performed by the primary healthcare workers (i.e., doctors and nurses) wearing recommended PPE as designated in the guidance for hospitals.
Pour waste, avoiding splashing by pouring from a low level, into the toilet.
Spills should be managed by the doctors and nurses caring for the Ebola patient and by wearing recommended PPE as designated in the guidance for hospitals.
Isolate the area of the spill; do not let other individuals access the area until disinfection is completed.
Place absorbent material on the spill (a solidifier agent can be used). Pour the EPA-registered disinfectant over the spill and allow sufficient contact time (according to manufacturer’s instructions for treating spills).
Use disposable absorbent towels to remove bulk spill material. Dispose of the towels in a biohazard bag as specified above.
