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EbolaStates’ waste disposal laws limit hospitals’ Ebola-related disposal options

Published 21 October 2014

As U.S. hospitals prepare their staff for the possibility of admitting Ebola patients, many are concerned with the laws governing the disposal of Ebola-contaminated medical waste. Protective gloves, gowns, masks, medical instruments, bed linens, cups, plates, tissues, towels, and even pillowcases used on a single Ebola patient treated in a U.S. hospital will generate roughly eight 55-gallon barrels of medical waste each day. The CDC recommends autoclaving or incinerating the waste as a way to destroy the microbes, but California and at least seven other states prohibit burning infected waste.

As U.S. hospitals prepare their staff for the possibility of admitting Ebola patients, many are concerned with the laws governing the disposal of Ebola-contaminated medical waste. “We fully expect that it’s coming our way,” Jennifer Bayer, spokeswoman for the Hospital Association of Southern California, said of the virus. “Not to create any sort of scare, but just given the makeup of our population and the hub that we are, it’s very likely.”

Protective gloves, gowns, masks, medical instruments, bed linens, cups, plates, tissues, towels, and even pillowcases used on a single Ebola patient treated in a U.S. hospital will generate roughly eight 55-gallon barrels of medical waste each day. The Centers for Disease Control and Prevention (CDC) recommends autoclaving or incinerating the waste as a way to destroy the microbes, but California and at least seven other states prohibit burning infected waste. “These are some pretty big issues and they need some quick attention,” said Bayer.

The restrictions on burning medical waste means that California hospitals may have to transport any Ebola-contaminated waste to another state via roads and highways- a prospect that worries some environmental advocates. Under federal transportation guidelines, Ebola medical waste would be considered a Class A infectious substance, capable of causing death or permanent disability, and would require approval from state transportation officials. “Storage, transportation and disposal of this waste will be a major problem,” California Hospital Association president C. Duane Dauner warned Senator Barbara Boxer (D-California) in a letter.

Governing reports that CDC director Dr. Thomas Frieden has recommended autoclaving to deal with Ebola waste, but according to Dr. Thomas Ksiazek, a professor in the department of microbiology and immunology at the University of Texas Medical Branch, “most hospitals don’t use it for most disposable items. They’re quite happy to bag them up and send them to a regular medical disposal company.”

Allen Hershkowitz, a senior scientist at the Natural Resources Defense Council, notes that incineration is a simple and effective means for treating deadly medical waste but most states banned the practice years ago because many materials that did not need to be incinerated were being sent to combustors and were emitting dangerous pollutants. Hershkowitz believes an exception should be made for Ebola medical waste. “There’s no pollutant that’s going to come out of a waste incinerator that’s more dangerous than the Ebola virus,” Hershkowitz said. “When you’re dealing with pathogenic and biological hazards, sometimes the safest thing to do is combustion.”

The St. Louis branch of Stericycle Inc., the nation’s largest medical waste disposal company, recently agreed to dispose of Ebola-contaminated waste from Texas, but last week, Missouri Attorney General Chris Koster asked a St. Louis Circuit judge to grant a temporary restraining order against the transaction, citing the company’s numerous violations of mishandling infectious wastes and that treating the waste could potentially infect workers.