Ebola-Associated Waste Management

• Waste generated in the care of patients with known or suspected EVD is subject to procedures set forth by local, state and Federal regulations. Basic principles for spills of blood and other potentially infectious materials are outlined in the US Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen standard, 29 CFR 1910.1030. See https://www.osha.gov/SLTC/bloodbornepathogens/index.html.
• Waste contaminated (or suspected to be contaminated) with Ebola virus is a Category A infectious substance regulated as a hazardous material under the U.S. Department of Transportation’s (DOT’s) Hazardous Materials Regulations (HMR; 49 C.F.R., Parts 171-180). Requirements in the HMR apply to any material DOT determines is capable of posing an unreasonable risk to health, safety, and property when transported in commerce¹. For off-site commercial transport of Ebola-associated waste, strict compliance with the HMR is required. For more information on the HMR requirements see http://phmsa.dot.gov/hazmat/transporting-infectious-substances.
  • If a person requires a variance to the HMR, that person must apply for a Special Permit under 49 CFR § 107.105. DOT may grant a special permit if the applicant can demonstrate that an alternative packaging will achieve a safety level that is: (1) at least equal to the safety level required under the HMR, or (2) consistent with the public interest if a required safety level does not exist. See http://www.phmsa.dot.gov/hazmat/permits-approvals/special-permits. DOT granted multiple special permits authorizing the transportation in commerce of certain Ebola-associated waste. See http://phmsa.dot.gov/hazmat/packaging-of-ebola-contaminated-waste.
  • Ebola-associated waste that has been appropriately incinerated, autoclaved, or otherwise inactivated is not infectious, does not pose a health risk, and is not considered to be regulated medical waste or a hazardous material under Federal law. Therefore, such waste is no longer considered a Category A infectious substance and is not subject to the requirements of the HMR.
• The inactivation or incineration of Ebola-associated waste within a hospital system may be subject to state, local and OSHA regulations.
  • Onsite inactivation
    • Ebola-associated waste may be inactivated through the use of appropriate autoclaves. Other methods of inactivation (e.g., chemical inactivation) have not been standardized and would need to consider worker safety issues, as well as the potential for triggering other Federal safety regulations.
  • Onsite incineration
    • Ebola-associated waste may be incinerated. The products of incineration (i.e., the ash) can be transported and disposed of in accordance with state and local regulations and standard protocols for hospital waste disposal.
• Ebola-associated waste disposal is subject to state and local regulations. See http://www.epa.gov/waste/nonhaz/industrial/medical/programs.htm. Ebola-associated waste that has been appropriately inactivated or incinerated is not infectious and is not considered to be regulated medical waste or a hazardous material under Federal law.

Relevant CDC guidance is available at:

http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html

http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html

http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html

For questions on CDC guidance, please contact 1-800-CDC-INFO (1-800-232-4636).

Relevant DOT guidance is available at

http://phmsa.dot.gov/portal/site/PHMSA/menuitem.6f23687cf7b00b0f22e4c6962d9c8789/?vgnextoid=4d1800e36b978410VgnVCM100000d2c97898RCRD&vgnextchannel=d248724dd7d6c010VgnVCM10000080e8a8c0RCRD&vgnextfmt=print

http://www.phmsa.dot.gov/pv_obj_cache/pv_obj_id_E7AFD0A1C5DBDDE54BCAAA0A80F9D6898FF50400/filename/suspected_ebola_patient_packaging_guidance_final.pdf

http://phmsa.dot.gov/hazmat/question-and-answer

For questions on DOT guidance or the HMR requirements, please contact DOT’s Pipeline and Hazardous Materials Safety Administration’s (PHMSA’s) Hazardous Materials Information Center at 1-800-467-4922, 9:00 am-5:00 pm Eastern Standard Time.

Relevant OSHA guidance is available at

https://www.osha.gov/SLTC/ebola/index.html.

For questions on OSHA guidance, please contact 1-800-321-OSHA (6742).

¹ The HMR applies to interstate, intrastate, and foreign commerce.