Disposing of Medical Waste: Ebola & Other Deadly Diseases

DISPOSING OF MEDICAL/ WASTE: MEDICAL WAS EBOLA & OTHERS STATISTICS ON MEDICAL WASTE COST OF DISPOSAL CURRENTLY $2-$2.5 BILLION 2017: PROJECTED COSTS= $3.2 BILLION WASTE TYPES REGULATED MEDICAL WASTE HEALTH CARE GENERAL WASTE (NON-HAZARDOUS) 15% 85% Infectious: Items contaminated by bodily fluids (bandages, cultures, disposable surgical tools, linens, samples, swabs) or pathological waste (body parts, organs, tissue) Cardboard, disposable paper products, food waste, plastic (IV bags, tubing, syringes), sterile blue wrap, Tyvek sheets, x-rays, etc. Chemical Hazards: Disinfectants, mercury, pharmaceutical drugs, solvents Physical Hazards: Sharps (glassware, lancets, needles, syringes, scalpels) Radioactive: Nuclear byproducts from cancer treatments, toxic waste WAYS HOSPITALS DISPOSE OF BIOHAZARD WASTE AUTOCLAVING : steam sterilization within a pressurized chamber > Accounts for 90-95% of biohazard disposal > 2013: 34 incinerators in U.S. • Purpose: Reduce waste's mass, volume, danger of spreading infection • Mobile units (e.g., MediBurn or MedClean) used especially for pharma- ceutical and pathological waste • Stationary units for high volume: San-l-Pak (compactor included), Mark-Costello (vacuum + shredder), Redbag Solutions (filter for liquids vs solids) • Issues: Possibility of airborne pathogens [mercury + dioxin], pollution, smoke, financial cost • Combined with: shredding (to reduce mass of sterilized waste up to 85%), tumbling (maximum exposure of pathogens), compacting, and ozone sterilization (reduces need for hazardous chemicals) THERMAL OR MICROWAVE SYSTEMS CHEMICAL DEEP LANDFILL TREATMENT/DISINFECTION BURIAL - reduces/destroys threat of infection - buries sharps in tear-resistant container • Pathogen-killing heat: shredded and mois- tened waste to 95-250 degrees Centigrade > Destroys and reduces waste at 545 - 1,000+ degrees Centigrade minus oxygen • Bleaching method: Pour Clorox in waste receptacle; use 1/10 spray solution to wipe down surfaces Formaldehyde: cleans and disinfects equip- ment + waste • Soaking: Douse waste with sodium hypochlo- rite, peracetic acid, or ammonia STATISTICS ON EBOLA 2014: Number of Infected per WHO (as of 01/03/15) These numbers of infected are from the West African countries: Guinea, Liberia, and Sierra Leone 20,656 13,151 8,153 CONFIRMED OR SUSPECTED CASES CONFIRMED BY LAB DEATHS HOW EBOLA SPREADS NOT VIA AIR WATER FOOD EBOLA SPREADS BY DIRECT CONTACT WITH BODILY FLUIDS OR CONTAMINATED NEEDLES whudeakoadundnd SPECIFIC EBOLA CHALLENGES: WASTE CREATION NEBRASKA AFP NEBRASKA BIOCONTAINMENT UNIT > One patient creates 465 cubic feet of solid waste > Total Pounds: over 1,100 > Content: mostly protective gear > Additional: 4-8 daily bags of linens, towels, scrubs • Content sterilization: 75% full, taped, wiped with bleach, transported for sterilization within hospital • Bag transport: Sterilized contents placed in biohazard bag, disposed as Category B waste • One patient creates nine liters of liquid waste: bleeding from eyes + ears, diarrhea, hemorrhage, vomiting TREATMENT COSTS EXTRA STEPS TO TAKE IN THE U.S. > Three-week stay for one patient = 1,000 pounds of hazardous waste • Ebola virus creates 30-40 times the amount of waste created by other illnesses/viruses > Infectious Ebola waste costs $1,000 per • Sterilization: waste in toilet bowl + one cup bleach or disinfectant for 15 minutes (2.5 times longer than regular liquid waste) Showers: on shower stall floor, sprinkle three tablespoons granulated chlorine (for swimming pools) pre- shower, then one cup bleach post- shower: wipe down surfaces with bleach spray solution barrel EBOLA WASTE DISPOSAL CHALLENGES LEGAL > Off-site transport: Ebola waste (Category A) requires DOT special permits unless autoclaved or incinerated • Transport: Temperature-controlled + plan for spills/emergencies Protect against hijacking to use infected material as bioweapon Options: room temperature, refrigerated, frozen, in liquid nitrogen • Chemical inactivation: OSHA sets the standard and regulates enforcement • Containment: Category A waste placed in watertight triple bags, in watertight hard containers LOGISTICAL IDENTIFICATION INCINERATION Takes 72 hours post-symptoms to Potentially toxic ashes could affect groundwater by leaching Potentially harmful gas: dioxin (linked detect virus Common symptoms pre-bleeding: diarrhea, severe headache, vomiting Labs: cultures and amplifications don't work unless sample includes blood to birth defects, cancer, immune system disorders) U.S. Environmental Protection Agency: identifies medical waste as third biggest source of airborne dioxin ACTIVITY Virus stays active up to six days AUTOCLAVE Inactivates microorganisms and steam cleans equipment Breakdowns leads to regional airborne or waterborne pollutants or poisoning (e.g. reactions to improperly disposed pharmaceuticals - antibiotics, or cyto- toxic waste) WASTE TYPE HOSPITAL AFTER DEATH Needs proper containment and disposal capabilities Infectious disease unit/section found in top-tier hospitals Can treat patients in "high-level isolation" Can process/sterilize waste effectively (most hospitals used to Category B waste, do not have incinerators OR autoclaves) Training: Doctors and nurses don't have 4-6 weeks to learn biosafety on infectious Involves liquids, solids, linens First U.S. Ebola victim generated 140 55-gallon drums of waste from one apartment where he stayed temporarily waste (FUTURE) SOLUTIONS FOR EBOLA WASTE DISPOSAL Increase Use of Killing Agents San-l-Pak > Heat: UV rays or sunlight > Microwave: gamma rays > Autoclaves: 30-minute autoclave cycles at 121 degrees Centigrade > Incinerators: Install at large hospital sites > Portable medical waste treatment unit > Company will increase • production Levels: current = 40-60 annually • sterilization + compaction units (90% of units) • weight Capacity: currently 87-230 pounds > Replaces need for off-site commercial incinerators (none in California) > Reduces off-site costs from 30 cents (incineration) to 8 cents per pound Sources http://www.latimes.com/science/la-sci-ebola-waste-disposal-20141020-story.html http://www.foxnews.com/health/2014/10/02/us-nears-solution-for-safe-disposal-ebola-medical-waste/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633376/ (Isfahan study) http://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.html http://www.ajicjournal.org/pb/assets/raw/Health%20Advance/journals/ymic/YMIC_3269 pdf http://www.nytimes.com/2014/10/18/us/waste-from-ebola-poses-challenge-to-hospitals.html?_r=0 http://www.bccresearch.com/pressroom/env/arket-medical-waste- treatment-containment-management-disposal-reach-nearly-$32-billion-2017 http://articles.aberdeennews.com/2012-06-07/news/32107680_1_medical-waste-solid-waste-biological-waste http://medassureservices.com/blog/category/medical-waste-disposal/ http://noharm.org/lib/downloads/other/1641_Kaplan_can_sustainable_hosps_bend_cost_curve_ib.pdf http://file.scirp.org/Html/3-6701673_25649.htm (used in section 2) http://www.hfmmagazine.com/display/HFM-news- article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2014/July/marketplace-regulated-medical-waste http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HameHealthandConsumer/ConsumerProducts/Sharps/ http://www.washingtonpost.com/blogs/wonkblog/wp/2014/10/03/wonkbook-the-policy-implications-of-americas-ebolo-response/ http://phmsa.dot.gov/hazmat/phmsa-provides-guidance-for-transporting-ebola-contaminated-items http://www.intechopen.com/books/current-topics-in-public- health/health-care-waste-management-public-health-benefits-and-the-need-for-effective-environmental-regulat http://www.amhmagazine.com/article.php?article_id=990 www.uth.edu/dotAsset/819ed3c5-fb34-4cf5-a8a0-6c847c5c9fb8.ukn http://cdph.ca.gov/programs/cder/Pages/Ebola.aspx http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html http://www.columbiaclub.org/wp-content/uploads/IOM-2014-Ebola-Workshop_in_Brief_FINAL.pdf http://www.goldenstatenewspapers.com/tracy_press/news/weapon- to-battle-ebola-made-in-tracy/article_93bf760a-608b-11e4-a0d4-43186031ac9.html EKU Online