-
https://repository.netecweb.org/files/original/b74f66c4123a196e2884bd6e0a856ef6.pdf
bf049bbc0b95fcbbd62d528fd9e414f0
PDF Text
Text
Ambulance Operations: High Consequence
Infectious Disease Waste Management
NETEC MODEL GUIDANCE
NETEC EMS WORKGROUP
LEAD AUTHOR: S. Lane
EFFECTIVE DATE2/5/2024
LAST REVISED DATE: 2/5/2024
PURPOSE
This Model Guidance outlines the procedure for management of waste resulting from
transport and care of a patient suspected or confirmed to have a high consequence infectious
disease.
SCOPE
This Model Guidance applies to all EMS personnel involved in the transport and management
of a patient suspected or confirmed to have a high consequence infectious disease.
Ambulance Operations: High Consequence Infectious Disease Waste Management
1
�PROCEDURE
While transporting patients with a suspected or confirmed high consequence infectious
disease (HCID), the waste generated may be considered to contain Category A infectious
substances and would be considered Category A waste. Category A waste in an untreated
form is capable of causing permanent disability or life-threatening or fatal disease in
otherwise healthy humans or animals upon exposure1.
Not all patients with a confirmed HCID will lead to the generation of Category A waste. A few
examples of Category A agents are viral hemorrhagic fevers (such as Ebola Virus Disease,
Marburg Virus Disease, and Lassa Fever) and Clade 1 Mpox (monkeypox, Congo Basin clade).
Waste generated from the care of a patient confirmed to be infected with a Category A agent
will be disposed of as Category A waste. The waste generated from the care of a patient
suspected to be infected with a Category A agent should be treated as Category A waste for
disposal or storage until a diagnosis is confirmed.
1. Consider pre-planning conversations with receiving facilities to determine disposition
of waste generated during transport. This includes waste from confirmed or suspected
HCID cases.
2. If transferring suspected or confirmed regulated Category A hazardous waste at a
destination facility, ensure there is a plan in place for that waste and any additional
waste generated during the cleaning process. All waste generated during the transfer
of a patient suspected or confirmed to be infected with a Category A agent should be
considered Category A waste until determined otherwise. This includes PPE,
ambulance drapes, disinfectant wipes, and any additional disposables.
3. Place all waste in biohazard bags for disposal. All bags will be closed with a gooseneck
knot2, and the outer surface disinfected with an EPA-registered hospital disinfectant
according to directions on the label. All waste is double-bagged and exterior surfaces
disinfected. Biohazard bags may be inserted into autoclave bags provided by the
receiving facility.
4. Containers of liquid waste should be either solidified per EMS agency protocol or
solidified and/or treated at the receiving facility per receiving facility plans. Consider
any patient belongings, which are typically bagged, labeled, and transported with the
patient in the patient compartment, to be contaminated. Consider bagging valuables
separately for potential recovery.
Ambulance Operations: High Consequence Infectious Disease Waste Management
2
�5. Dispose of all waste according to EMS agency/service protocols as well as local and
federal guidance1 and regulations for Category A infectious substances. Best practice
may be to consider transferring waste to the receiving healthcare facility for
disposition.
REFERENCES
1. Planning Guidance for Handling Category A Solid Waste.
https://www.phmsa.dot.gov/transporting-infectious-substances/planning-guidancehandling-category-solid-waste
2. Are You Preparing Suspected Ebola – Contaminated Waste For Transportation?
https://repository.netecweb.org/items/show/303
3. ASPR TRACIE (2023) EMS Infectious Disease Playbook p.76 (PDF).
https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf
4. CDC. (2016). Example: Standard Operating Procedure (SOP) for Decontamination of an
Ambulance that has Transported a Person Under Investigation or Patient with
Confirmed Ebola. Page 2 (PDF).
https://www.cdc.gov/vhf/ebola/pdf/ambulance-decontamination.pdf
5. U.S. Department of Health and Human Services and U.S Department of
Transportation. (n.d.). Guidance for Developing a Plan for Interfacility Transport of
Persons Under Investigation or Confirmed Patients with Ebola Virus Disease in the
United States. p.24 (PDF). https://www.cdc.gov/vhf/ebola/pdf/interfacility-transport.pdf
6. US Department of Transportation (2022) Managing Solid Waste Contaminated with a
Category A Infectious Substance (PDF).
https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/202206/Cat%20A%20Waste%20Planning%20Guidance_Final_2022_06.pdf
7. Isakov, A., Miles, W., Gibbs, S., et al. (2015). Transport and Management of Patients
with Confirmed Ebola Virus Disease. Annals of Emergency Medicine. 66(3):297-305.
Page 302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115304/
NETEC Model Guidance
National Emerging Special Pathogens Training and Education Center
Website: www.netec.org Assistance: info@netec.org
3
�
Dublin Core
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
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Title
A name given to the resource
EMS Ambulance Operations High Consequence Infectious Disease Waste Management
Description
An account of the resource
PURPOSE: This Model Guidance outlines the procedure for management of waste resulting from transport and care of a patient suspected or confirmed to have a high consequence infectious disease.<br />SCOPE: This Model Guidance applies to all EMS personnel involved in the transport and management of a patient suspected or confirmed to have a high consequence infectious disease.<br /><br />This is from the series of Model Guidance documents. Find all the resources in the series below.<br />
<ol>
<li><a href="https://repository.netecweb.org/items/show/1800" title="EMS Ambulance Cleaning and Disinfection">EMS Ambulance Cleaning and Disinfection</a></li>
<li><a href="https://repository.netecweb.org/items/show/1801" title="EMS Ambulance Modification Procedure">EMS Ambulance Modification Procedure</a></li>
<li><a href="https://repository.netecweb.org/items/show/1802" title="EMS Ambulance Operations High Consequence Infectious Disease Waste Management">EMS Ambulance Operations High Consequence Infectious Disease Waste Management</a></li>
<li><a href="https://repository.netecweb.org/items/show/1803" title="EMS Biohazard Spill">EMS Biohazard Spill</a></li>
<li><a href="https://repository.netecweb.org/items/show/1804" title="EMS PPE Breach: High Consequence Infectious Disease Patient Transport">EMS PPE Breach: High Consequence Infectious Disease Patient Transport</a></li>
<li><a href="https://repository.netecweb.org/items/show/1805" title="EMS Provider Down Procedure">EMS Provider Down Procedure</a></li>
<li><a href="https://repository.netecweb.org/items/show/1806" title="EMS Model PPE Donning and Doffing Procedure for Confirmed or Suspected VHF Case with Active Bleeding, Vomiting, or Diarrhea">Model PPE Donning and Doffing Procedure for Confirmed or Suspected VHF Case with Active Bleeding, Vomiting, or Diarrhea</a></li>
<li><a href="https://repository.netecweb.org/items/show/1807" title="EMS Model PPE Donning and Doffing Procedure for Confirmed or Suspected VHF Case without Active Bleeding, Vomiting, or Diarrhea">Model PPE Donning and Doffing Procedure for Suspected VHF Case without Active Bleeding, Vomiting, or Diarrhea</a></li>
</ol>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2024-02-05
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-02-05
Subject
The topic of the resource
Emergency Medical Services
Identifier
An unambiguous reference to the resource within a given context
Emergency Medical Services
EMS
Guidance Document
High Consequence Infectious Disease (HCID)
R-EMS
Standard Operating Procedure (SOP)
Waste
Waste Management
-
Dublin Core
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Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.epa.gov/rcra/medical-waste
Dublin Core
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Title
A name given to the resource
Medical Waste
Subject
The topic of the resource
Waste Management
Description
An account of the resource
Medical waste is a subset of wastes generated at health care facilities, such as hospitals, physicians' offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories. Generally, medical waste is healthcare waste that that may be contaminated by blood, body fluids or other potentially infectious materials and is often referred to as regulated medical waste.
Creator
An entity primarily responsible for making the resource
EPA
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-05-03
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-05-03
Relation
A related resource
Y - D0.1WM/D0.2WM Qualtrics # 1104
R-WM
Waste
Waste Management
-
https://repository.netecweb.org/files/original/30505a8841bef4345c5063b9810d5e5a.png
91376fc99b4affc0f1bbe029e3f2be6d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2021/07/21/monkeypox-waste-management/
Dublin Core
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Title
A name given to the resource
Waste Management from Patients Being Treated for Mpox Virus
Subject
The topic of the resource
Waste Management
Description
An account of the resource
The United States recently had a case of Mpox virus diagnosed in a patient in Dallas County, Texas. Organizations in the U.S. now preparing for the potential need to handle patients under investigation or patients with the Mpox virus must also consider both the solid and liquid waste associated with such patients. It is also important to develop a communications strategy to alleviate concerns from the general public associated with both the solid and liquid waste.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-07-21
Contributor
An entity responsible for making contributions to the resource
2022-11-14 by Trish / General IPC asset review (marked for archive - but can't as it's a blog post) - tagging 'Archived'. Note from IPC: "More recent waste management post for mpx (resource 1673)"
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
No review 'archived'
Archived
Blog
Category A
Mpox
R-IPC
Special Pathogens
Waste
Waste Management
-
https://repository.netecweb.org/files/original/9f602ae774a5278c8836503bc36faa45.png
700012660d4898bcf6c588d95d719479
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
Objectives
<table>
<tbody>
<tr>
<td>UN 2814:</td>
<td></td>
</tr>
<tr>
<td>Infectious substances affecting humans and animals</td>
<td>Bacillus anthracis (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Brucella abortus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Brucella melitensis (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Brucella suis (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Burkholderia mallei—Pseudomonas mallei—Glanders (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Burkholderia pseudomallei—Pseudomonas pseudomallei (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Chlamydia psittaci—avian strains (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Clostridium botulinum (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Coccidioides immitis (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Coxiella burnetti (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Crimean-Congo hemorrhagic fever virus</td>
</tr>
<tr>
<td> </td>
<td>Dengue virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Eastern equine encephalitis virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Escherichia coli, verotoxigenic (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Ebola virus</td>
</tr>
<tr>
<td> </td>
<td>Flexal virus</td>
</tr>
<tr>
<td> </td>
<td>Francisella tularensis (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Guanarito virus</td>
</tr>
<tr>
<td> </td>
<td>Hantaan virus</td>
</tr>
<tr>
<td> </td>
<td>Hantaviruses causing hemorrhagic fever with renal syndrome</td>
</tr>
<tr>
<td> </td>
<td>Hendra virus</td>
</tr>
<tr>
<td> </td>
<td>Herpes B virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Human immunodeficiency virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Highly pathogenic avian influenza virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Japanese Encephalitis virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Junin virus</td>
</tr>
<tr>
<td> </td>
<td>Kyasanur forest disease virus</td>
</tr>
<tr>
<td> </td>
<td>Lassa virus</td>
</tr>
<tr>
<td> </td>
<td>Machupo virus</td>
</tr>
<tr>
<td> </td>
<td>Marburg virus</td>
</tr>
<tr>
<td> </td>
<td>Monkeypox virus</td>
</tr>
<tr>
<td> </td>
<td>Mycobacterium tuberculosis (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Nipah virus</td>
</tr>
<tr>
<td> </td>
<td>Omsk hemorrhagic fever virus</td>
</tr>
<tr>
<td> </td>
<td>Poliovirus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Rabies and other lyssaviruses (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Rickettsia prowazekii (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Rickettsia rickettsia (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Rift Valley fever virus</td>
</tr>
<tr>
<td> </td>
<td>Russian spring-summer encephalitis virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Sabia virus</td>
</tr>
<tr>
<td> </td>
<td>Shigella dysenteriae type I (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Tick-borne encephalitis virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Variola virus</td>
</tr>
<tr>
<td> </td>
<td>Venezuelan equine encephalitis virus</td>
</tr>
<tr>
<td> </td>
<td>Vesicular stomatitis virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>West Nile virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Yellow fever virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Yersinia pestis (cultures only)</td>
</tr>
<tr>
<td>UN 2900:</td>
<td>African swine fever virus (cultures only)</td>
</tr>
<tr>
<td>Infectious substances affecting animals only</td>
<td>Avian paramyxovirus Type 1—Velogenic Newcastle disease virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Classical swine fever virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Foot and mouth disease virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Lumpy skin disease virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Mycoplasma mycoides—Contagious bovine pleuropneumonia (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Peste des petits ruminants virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Rinderpest virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Sheep-pox virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Goatpox virus (cultures only)</td>
</tr>
<tr>
<td> </td>
<td>Swine vesicular disease virus (cultures only)</td>
</tr>
</tbody>
</table>
URL
https://www.federalregister.gov/documents/2005/05/19/05-9717/hazardous-materials-infectious-substances-harmonization-with-the-united-nations-recommendations
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hazardous Materials: Infectious Substances; Harmonization With the United Nations Recommendations
Subject
The topic of the resource
Waste Management
Description
An account of the resource
The requirements adopted for the UN Recommendations establish a two-tiered classification system for Division 6.2 materials—Category A and Category B. A Category A infectious substance poses a higher degree of risk than a Category B infectious substance. A Category A material is an infectious substance that is transported in a form that is capable of causing permanent disability or life-threatening or fatal disease to otherwise healthy humans or animals when exposure to it occurs. An exposure occurs when an infectious substance is released outside of its protective packaging, resulting in physical contact with humans or animals. Category A infectious substances are assigned to UN 2814 (for substances that cause disease in humans or in both humans and animals) or UN 2900 (for substances that cause disease in animals only). The following are examples of Category A infectious substances. Please note this list is not all inclusive and is provided only as guidance (https://www.federalregister.gov/d/05-9717/p-26).
<div>https://www.federalregister.gov/d/05-9717/p-26</div>
<div>https://www.federalregister.gov/d/05-9717/p-26</div>
<br /><br />This page includes a list of micro-organisms that are considered to create Category A waste, including Ebola, Monkeypox,
Creator
An entity primarily responsible for making the resource
the Pipeline and Hazardous Materials Safety Administration
Date
A point or period of time associated with an event in the lifecycle of the resource
2005-05-19
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 204, original # 2
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Category A
Ebola
Guanarito virus
Mpox
Nipah (NiV)
R-IPC
Special Pathogens
Viral Hemorrhagic Fever
Waste
-
https://repository.netecweb.org/files/original/18ca4e51cf87772e23b6306a5e5658fb.pdf
1ade3cedb2a616b3fce36bcf2dd35896
PDF Text
Text
PROCEDURE TITLE: Terminal Cleaning in the SCDU
APPLICABLE FACILITIES:
☐EHC
☐EDH
☐EHH
☒EUH
☐EUHM ☐EUHS
EFFECTIVE DATE: 05/21/2021
☐EHI
☐EHN
☐EJCH
☐ELTAC
☐ESJH
☐EUOSH ☐EWWH ☐RJV-ERH ☐RJV-ESOP ☐TEC/ESA
ORIGINATION DATE: 3/1/2002
SCOPE:
The SCDU follows a defined set of protocols for activation of the Unit. Because the SCDU must be
prepared for a wide range of infectious agents, plans exist to respond as appropriate based on the
agent and clinical presentation of the patient. Consideration must be given to appropriate safe
transport into the Unit, as well as the safe delivery of care for patients while in the Unit.
PURPOSE:
To establish a process to eliminate infectious pathogens from a room previously occupied by a
patient with a serious communicable disease.
PROCEDURE:
Contaminated Durable and Non-disposable Equipment:
1. In the patient room, the patient’s nurse should preliminarily cleanse the contaminated equipment
with disinfectant designated by the hospital.
2. Both the patient room and the anteroom nurse are to create disinfectant mats* with disposable
pads and diluted ammonia quaternary solution mixture (1 part quaternary solution to 2 parts
water) until pads are adequately soaked. Pads are placed from the patient’s doorway to the
storage destination. Micro-Chem Plus is currently uses, if another hospital approved disinfectant is
used, verify appropriate ratios with Infection Control and Prevention Department and the
Environmental Health and Safety Office.
3. The patient room nurse will then roll and/or hand off the preliminary cleaned equipment to the
anteroom nurse, where he/she will clean equipment again with approved disinfectant with
designated PPE per waste management protocol.
4. Cover equipment with a plastic bag and label as dirty until further decontamination with vaporized
hydrogen peroxide at a future time.
5. Patient room nurse will roll/hand off equipment to the resource nurse outside of the anteroom.
Equipment will be stored in a designated dirty storage area. The resource nurse will wear
designated PPE per waste management protocol.
6. The resource nurse outside of the room doffs PPE per SOP protocol. Anteroom nurse removes
PAPR Hood and sets aside.
Terminal Cleaning in the SCDU
1 of 4
�7. Equipment is stored in the designated area until terminally cleaned using vaporized hydrogen
peroxide.
Patient Room and Anteroom Decontamination:
1. Upon notification of imminent discharge the Unit Program Director or Medical Director will alert the
administrator on-call for EUH. The administrator will be responsible for alerting the Vaporized
Hydrogen Peroxide contractor of the imminent need for terminal decontamination of the area.
2. All designated personnel must be trained on infection control principles, PPE use and proper
decontamination procedures. Selection and use of PPE will comply with hospital, SCDU and CDC
infection control guidance.
3. All personnel involved in the terminal cleaning of the patient care suite, including the handling of
contaminated waste, equipment, materials and/or subcontractors involved in those procedures will
be monitored according to the Occupational Injury Management Protocol for the SCDU.
4. All disinfectants will be EPA registered for non-enveloped viruses.
5. Patient personal belongings stay in the room until after verification of decontamination by the
contractor. Prior to discharge, have the patient sign the “Waiver of Liability”, attached in the
Discharge Protocol Procedure. The original copy of the signed waiver will be maintained by EUH
administration with one copy given to the patient and one copy to the contractor.
6. One nurse is dedicated to the patient room, one to the anteroom and one as waste management
resource outside the patient care suite.
7. Remove all disposable waste and linens from the patient room and then anteroom per SCDU
Waste Management Protocol.
8. Disinfect all reusable equipment in the patient room and anteroom per SCDU Management of
Contaminated Equipment Intended for Disposal/Repair/Maintenance.
9. In the patient room spot clean the ceiling with any visible contamination using disinfectant and
mop.
10. In both the patient room(s) and anteroom clean the walls and surfaces, including toilet, bathroom
and all patient belongings, using disinfectant. Open cabinets and drawers and clean the inside
and outside surfaces. All rooms and surfaces associated with patient care will be treated
regardless of the amount of visible contamination observed or the time passed since the patient
left the area. Patient belongings will be stored in the patient room closet for decontamination by
the Vaporized Hydrogen Peroxide contractor. Collect all wipes and cleaning supplies as waste.
11. Mop the floors once with disinfectant, starting from the areas likely to be least contaminated and
ending in the areas of most contamination.
12. Doff booties per protocol and don a new pair.
Terminal Cleaning in the SCDU
2 of 4
�13. Return to the last mopped area and mop the floor a second time, moving from that point to the
doffing area.
14. With door open, the anteroom nurse will hold open a red bio-hazard bag, place all waste in red
bio-hazard bags.
15. Patient room nurse will doff per protocol, placing all PPE in the red bio-hazard bag being held by
anteroom nurse. After doffing the coverall, the patient room nurse will keep coverall on the
chemical pad. With PAPR and inner gloves remaining, the patient room nurse will place the
coverall and chemical pad in the red bio-hazard bag that the anteroom nurse continues to hold.
a. Complete doffing per protocol.
16. While the patient room nurse showers, the anteroom nurse will perform waste management with
assistance from the resource nurse.
17. The anteroom nurse will mop, beginning at the door of the patient room and moving to the
anteroom door towards the hallway. While wearing high level PPE, the resource nurse will hold
open a red bio-hazard bag; all remaining waste will be placed in that bag.
18. After the patient room nurse exits the shower and the bio-containment suite, the anteroom nurse
will doff per protocol while the resource nurse holds open a red bio-hazard bag.
19. The anteroom nurse will observe the resource nurse doff and place all waste in the same red biohazard bag. Waste is disposed of per waste management protocol.
Terminal Cleaning with Vaporized Hydrogen Peroxide:
1. A team analysis of the area to be decontaminated will be conducted by both Emory University
Hospital administration and the contractor.
2. The contractor will set-up decontamination equipment in the determined areas wearing
appropriate PPE.
3. The contractor will place the biological and chemical indicators in area.
4. The contractor will decontaminate the area utilizing vaporized hydrogen peroxide. The process
usually takes 3-6 hours depending on the area.
5. After decontamination is complete the contractor will check the chemical indicators to determine if
the areas were exposed to the vaporized hydrogen peroxide and a visual confirmation of a 6 log
kill.
6. The contractor will collect the biological indicators and incubate according to CDC
recommendations.
7. The contractor will label each biological indicator according to the location.
Terminal Cleaning in the SCDU
3 of 4
�8. The contractor will remove all equipment from the area.
9. The contractor will analyze the biological indicators at 12, 24, 48 and 72 hours to determine if the
decontamination was successful.
10. If a positive biological indicator is detected another decontamination will be necessary.
11. If a 6 log kill is confirmed a report is generated and an all clear, give to Emory personnel.
12. Upon confirmation of decontamination the contractor will issue a certificate of decontamination to
EUH administration for their records.
RELATED DOCUMENTS AND LINKS:
Waste Management in the SCDU
De-escalation of Care and Room Transfer
DEFINITIONS:
N/A
REFERENCES AND SOURCES OF EVIDENCE:
“Compatibility of Hydrogen Peroxide Vapor Room Decontamination with Physiological Monitors”.
Author(s): John M. Boyce, MD; Nancy L. Havill, MT, CIC; Vincent Cianci; Gary Flanagan. Source:
Infection Control and Hospital Epidemiology, Vol. 35, No. 1 (January 2014), pp. 92-93 Published by:
The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America
Stable URL: http://www.jstor.org/stable/10.1086/674388.
“Compatibility of Material and Electronic Equipment with Hydrogen Peroxide and Chlorine Dioxide
Fumigation” Assessment and Evaluation Report. Author: Shawn P. Ryan, PhD, Source: The United
States Environmental Protection Agency, Office of Research and Development’s National Homeland
Security Research Center, EPA/600/R-10/169 (December 2010), www.epa.gov/ord
Hydrogen Peroxide Vapor Decontamination in a Patient Room Using Feline Calicivirus and Murine
Norovirus as Surrogate Markers for Human Norovirus. Authors: Torsten Holmdahl, Mats Waldera,
Nathalie Uzcáteguia, Inga Odenholta, Peter Lanbecka, Patrik Medstranda and Anders Widella.
Source: Infection Control & Hospital Epidemiology / FirstView Article / February 2016, pp 1 - 6, DOI:
10.1017/ice.2016.15, Published online: 10 February 2016
Terminal Cleaning in the SCDU
4 of 4
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Procedure Title: Terminal Cleaning in the SCDU
Subject
The topic of the resource
Infection Control
Description
An account of the resource
SCOPE:<br />The SCDU follows a defined set of protocols for activation of the Unit. Because the SCDU must be prepared for a wide range of infectious agents, plans exist to respond as appropriate based on the agent and clinical presentation of the patient. Consideration must be given to appropriate safe transport into the Unit, as well as the safe delivery of care for patients while in the Unit.<br /><br />PURPOSE:<br />To establish a process to eliminate infectious pathogens from a room previously occupied by a patient with a serious communicable disease.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-05-21
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC - check with Britton - "needs reviewing/updating"
2023-01-18 - Joanna - got new version from Sharon - updated.
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 217, original # 8a
Y - D0.1IC/D0.2IC Qualtrics # 218, original # 9
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Infection Prevention and Control
Procedure
Protocol
R-IPC
Standard Operating Procedure (SOP)
Terminal Clean
Waste
Waste Management
-
https://repository.netecweb.org/files/original/c71b8bc8c516b6e42a01d9d22fda28db.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/vhf/ebola/clinicians/cleaning/handling-waste.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Procedures for Safe Handling and Management of Ebola-Associated Waste
Subject
The topic of the resource
Waste Management
Description
An account of the resource
<p><strong>Who this if for</strong>: Hospital infection control, occupational health systems, and facility medical waste managers and personnel</p>
<p><strong>What this is for</strong>: To provide detailed step by step procedures for use with the CDC guidance on <a href="https://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/waste-management.html">Ebola-Associated Waste Management</a>.</p>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-10-20
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC - marked needs review - checked CDC - page is updated
2024-03-27 Waste never returned – bump to next review
Relation
A related resource
Y
Y - D0.1PI/D0.2PI Qualtrics # 123, original # 11
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a
Y - D0.1WM/D0.2WM Qualtrics # 1106
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-08-10
Ebola
Infection Prevention and Control
Physical Infrastructure
R-WM
Standard Operating Procedure (SOP)
Viral Hemorrhagic Fever
Waste
Waste Management
-
https://repository.netecweb.org/files/original/7cc5c14094799b74298210150878a02f.pdf
f8d13bc244c8f19e31a2e49e55a5e555
PDF Text
Text
COVID-19 Waste Container Use
Medical waste or trash generated in the patient care room
during the care of patients infected with COVID-19
Index
Page 1 -
In patient-care room waste container preparation
Page 2 -
In patient-care room waste container in use
Page 3 -
In patient-care room waste container bag closure: Overhand knot
Page 4 -
In patient-care room waste container bag closure: Gooseneck knot
In Patient-care Room Waste Container Preparation
Preparing the Waste Container with a New Bag
ü
Primary packaging of waste should take place
where the waste is generated by staff wearing
appropriate PPE
ü
Waste containers should be lined with a
leak-proof bag of appropriate thickness
ü
Bags should be large enough to overlap the
edge of the waste container
ü
Bags should be placed into the waste container
without creating an air pocket under the bag
Prior to starting, don clean gloves or perform hand/glove hygiene
*Waste generated during the care of COVID-19 patients is Category B infectious substance waste and should be managed according to standard waste processes
Page 1
�COVID-19 Waste Container Use
In Patient-care Room Waste Container in Use
Best practices
ü
ü
ü
ü
ü
ü
ü
Waste container bags should be strong enough to contain the contents without risk of rupture
Make sure to have extra bags in the patient’s room, this will avoid having to leave the room for supplies
Place waste containers close to the area where tasks will be performed
Do not allow waste containers to become more than two-thirds full to allow for safe closure
Do not place waste containers where they can become a tripping hazard
Do not place sharps in the bag
ü Glove box corners can tear bags when disposed of in the waste container
Gently place trash into the container
ü Never compress the contents in the waste container, because that action can cause the upward dispersal of particles
ü Never throw or toss anything into the waste container, as this can cause the upward dispersal of particles and there is
potential to miss the waste container
Page 2
�COVID-19 Waste Container Use
In Patient-care Room Waste Container Bag Closure: Overhand knot
Important: Do not let gown touch the floor
Tying an Overhand Knot
1
Grab the opposite corners of the bag
2
Raise corners above the bag
3
Twist the corners
4-5
1
2
3
4
5
6
7
8
9
10
Continue to twist the corners a few
more times
6
Stand up to continue the twisting process
7
Tighten the twisted material to facilitate
a well-formed loop
8
Create a loop with the tightly twisted
section of the bag
9
Thread the loop with the working end of
the twisted bag
10
Important: Do not position head over the bag’s opening
Tighten the knot
Page 3
�COVID-19 Waste Container Use
In Patient-care Room Waste Container Bag Closure: Gooseneck knot
Important: Do not let gown touch the floor
Tying a Gooseneck Knot
1
Grab the opposite corners of the bag
2
Raise corners above the bag
3
Twist the corners
4-5
Important: Do not position head over the bag’s opening
1
2
3
4
6
7
8
9
5
Continue to twist the corners a few
more times
6
Stand up to continue the twisting process
7
Tighten the twisted material to facilitate
a well-formed loop
8
Create a loop with the tightly twisted
section of the bag
9
Secure the loop with a long swatch of
strong adhesive tape
(For example, masking tape)
Closeup
view of secured
gooseneck knot
Page 4
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Waste Container Use
Subject
The topic of the resource
Waste Management
Description
An account of the resource
A PDF flyer infographic illustrating how to handle a waste container inside the patient care room. Including: waste container preparation, waste container in use, waste container closure (two techniques).
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-29
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (old? no replacement?)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
No review "archived"
2019-nCoV
Archived
Coronavirus
COVID-19
R-IPC
Waste
Waste Management
-
https://repository.netecweb.org/files/original/b5bf6d6d74f6c3b867097722cd6fda12.pdf
132319ea27659a927ddc974958d45952
PDF Text
Text
AMBULATORY CLEANING PROTOCOL
Cleaning room after suspected COVID-19 patient
Did
Patient
have mask on
no
entire time?
yes
Room to remain vacant
after patient leaves for
1 hour prior to cleaning.
Don PPE:
Gloves & Mask
Don PPE:
Gloves Only
Do not lean on surfaces until clean
Do not lean on surfaces until clean
Clean high touch surfaces with approved disinfectant*
High Touch Surface Areas:
High Touch Surface Areas:
• Door knobs
• Blood Pressure cuff
• Exam table
• Otoscope
• Cabinet handles
• Sink faucet handle
• Keyboard
• Countertop
• Computer mouse
• Thermometer
• Patient Chair
Your clinic may have additional high touch surfaces
based on your clinical setting or layout (i.e. I.V.
Pumps)
*Approved Cleaning Agents include:
1. Clorox Healthcare Hydrogen peroxide
or Bleach Wipes
2. PDI Wipes: Purple top, gray top, and
yellow/gold top
Observe kill time on
the label of the wipe
container
Trash should be disposed
of as you normally would
Emory Infection Prevention on call:
1. EHConnec PIC #94428
2. 404‐686‐5500 enter 94428 followed by #
Version 1.0 Emory University, created by Visual Medical Education. Updated March 26, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Objectives
Emory's protocol for cleaning room after suspected COVID-19 patient.
URL
https://med.emory.edu/ppe
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Emory VME
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COVID-19 Ambulatory PPE Resources: Cleaning
Subject
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Infection Control
Description
An account of the resource
COVID-19 Ambulatory ACE / DICE Printable PDFs.
These one-page PDF's depict Emory's use of PPE for protection against COVID-19 in the ambulatory setting. Created by Emory's Visual Medical Education team.
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Emory
Date
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2020-04-03
Contributor
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2022-12-07 general asset review - IPC (change R-PPE)
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q2)
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2024-12-10
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PPE
2019-nCoV
Cleaning
Coronavirus
COVID-19
Disinfection
Gloves
Mask
Masks
R-PPE
Waste
-
https://repository.netecweb.org/files/original/29a6370a36005cd3f6f5fea1f7197316.pdf
185732e348fba09230c80d5f155d164e
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Text
Are you preparing suspected Ebolacontaminated waste for transportation?
Ebola contaminated waste is considered a Category A infectious substance and must be doubled bagged and
placed in a rigid outer packaging prior to transportation.
Packaging Requirements:
You must use packaging meeting the requirements for a Division 6.2 Category A material (49 CFR 173.196) or
Special Permit DOT-SP 16279.
Packaging Preparation:
1
PROPERLY CLOSED
SHARPS CONTAINER
Bag the waste
• Put contaminated waste into a leakproof
primary receptacle
• Use authorized container for sharps
• Wrap sharp edges to prevent puncturing of the
plastic bag
• Close the packaging in accordance with closure
instructions
• If following a DOT-SP, spray exterior surface
with EPA-registered disinfectant that is
recommended by the CDC for use against the
Ebola virus
2
Double bag
• Place primary receptacle into a leakproof
secondary packaging with the closure facing
upward
• Include absorbent material sufficient to absorb
the entire contents of all primary receptacles
• Close the packaging in accordance with closure
instructions
• If following a DOT-SP, spray exterior surface
with disinfectant
3
LINER
Put contaminated waste in outer packaging
• Put primary receptacle and secondary
packaging in rigid outer packaging
• Close the packaging in accordance with closure
instructions
• If following a DOT-SP, spray exterior surface
with disinfectant
For more information on transporting infectious substances, please visit
PHMSA’s website:
https://www.phmsa.dot.gov/transporting-infectious-substances/
transporting-infectious-substances-overview
or contact the Hazmat Info Center: 1-800-467-4922
PHH50-0000-0000
�
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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URL
https://www.phmsa.dot.gov/transporting-infectious-substances/ebola-contaminated-waste-transportation-poster
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Are you preparing suspected Ebola contaminated waste for transportation?
Subject
The topic of the resource
Waste Management
Description
An account of the resource
Ebola Contaminated Waste for Transportation Poster
Creator
An entity primarily responsible for making the resource
United States Department of Transportation (DOT): Pipeline and Hazardous Materials Safety Administration (PHMSA)
Date
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2022-10-13
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2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q1)
Coverage
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2024-09-10
Identifier
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Infection Prevention and Control
Category A
Ebola
Infection Prevention and Control
R-IPC
Waste
Waste Management
-
https://repository.netecweb.org/files/original/01a0d83bed6d724e89456c3975050d7f.pdf
54c755ae9908e3cef66e989a6732fc03
PDF Text
Text
Managing Solid Waste Contaminated with a Category A
Infectious Substance (August 2019)
Summary of Key Points and Significant Changes
KEY POINTS
•
A Category A infectious substance is a material known or reasonably expected to contain a
pathogen that is in a form capable of causing permanent disability or life-threatening or fatal
disease in otherwise healthy humans or animals who are exposed to it, consistent with
international classification (United Nations [UN] 2814).
•
Infectious waste, including materials contaminated with Category A infectious substances, can be
managed safely.
•
Leadership within healthcare facilities; laboratories; state, local, tribal, and/or territorial (SLTT)
governments; waste management companies; and other entities that may or will need to manage
Category A waste should ensure their organizations have plans to address the entire waste
lifecycle, from initial generation of the infectious waste to final disposition of any treated
byproducts (residuals).
•
Hospital care of a person infected with certain pathogens classified as a Category A infectious
substance, particularly Ebola or another hemorrhagic fever virus (HFV), can result in large
volumes of potentially infectious waste, especially for diseases associated with severe illness and
lengthy hospital stays.
•
Outside of hospitals, people infected with certain pathogens classified as Category A infectious
substances, such as Ebola and other HFVs, may contaminate their homes, vehicles in which they
travel, and other environments before they are hospitalized. Category A waste may also originate
from laboratories (e.g., research, clinical) that work with Category A pathogens, particularly
when they intentionally cultivate these pathogens. Housing, care, and post-mortem management
of animals infected with certain Category A pathogens also results in Category A waste.
•
Every effort should be made to minimize the amount of Category A waste generated. Category A
waste should be physically separated, if practical, from other solid waste at the point of origin.
Similar considerations should be made for separating Category A waste from other, noninfectious hazardous materials.
•
Throughout the waste lifecycle, employers must protect workers from occupational exposure to
pathogens, chemicals, other hazardous materials, and other hazards that could cause injury and
illness.
•
The U.S. Department of Transportation (DOT)/Pipeline and Hazardous Materials Safety
Administration (PHMSA) regulates movement and certain other aspects related to management
of Category A infectious substances, including waste that is known or suspected to be
1
�Managing Solid Waste Contaminated with a Category A Infectious Substance – Key Points & Significant Changes
contaminated with them, through its Hazardous Materials Regulations (HMR). Additional federal
and SLTT laws and regulations may apply to various aspects of waste management.
•
Typically, the safest and best options for treating Category A waste so that it is no longer
infectious—a process known as “inactivation”—are implemented on-site, where the waste is
generated. Common inactivation methods include autoclaving and incineration. However, in
specific circumstances where those options are not available, alternative treatment methods,
including chemical disinfection and alkaline hydrolysis digesters, may also be appropriate.
•
When waste cannot be treated on-site, it must be sent off-site to special facilities typically
operated by commercial waste management companies. These facilities, regulated and permitted
by SLTT authorities, primarily use autoclaves and incinerators to treat waste on a larger scale
than what most hospitals, laboratories, and other entities are capable of doing on-site.
•
Before offering it for transportation, individuals and entities responsible for generating infectious
waste must classify it appropriately, including as Category A waste when required.
•
Individuals and entities must classify waste as hazardous waste when required under Resource
Conservation and Recovery Act (RCRA) requirements. These are set and enforced by the U.S.
Environmental Protection Agency (EPA) or by states/territories authorized to implement the
RCRA hazardous waste program in lieu of EPA.
•
Category A waste may be safely transported off-site for inactivation in packaging meeting HMR
requirements or the alternative packaging requirements of a DOT special permit. The HMR also
require that waste transporters comply with certain labeling and paperwork requirements.
Properly classifying (i.e., as Category A) and packaging waste begins at its point of origin.
•
Management of waste that contains both a Category A infectious substance and certain other
materials, such as those that are radioactive, must comply with regulations applicable to all
substances in the waste. Such instances would need to be addressed on a case-by-case basis and
may require issuance of a special permit to address the unique combination of potentially
hazardous materials.
•
Waste that has been inactivated through an effective treatment method, along with any materials
left over after treatment (i.e., residuals), is no longer infectious, poses no risk of infection, and is
not considered to be regulated medical waste (RMW) or a hazardous material (unless other types
of regulated hazardous materials are present) under federal or SLTT laws and regulations. Such
waste is no longer considered a Category A infectious substance subject to the HMR.
•
Residuals, such as incinerator ash, must be evaluated to determine if the residual is still
hazardous. Even though materials that have been properly incinerated are no longer infectious,
ash may be categorized as hazardous waste due to its ability to concentrate certain toxic
substances (e.g., metals) that may have been present in the original waste or in other waste
incinerated at the same time.
•
Residuals must be transported and disposed of in accordance with SLTT requirements and
standard protocols for their disposal. Disposal options may vary depending on whether residuals
contain hazardous materials.
2
�Managing Solid Waste Contaminated with a Category A Infectious Substance – Key Points & Significant Changes
•
At all stages of waste management, all involved parties should ensure effective communication
with one another about the nature and content of the waste to help ensure safe, effective
management of waste all the way to ultimate disposal.
SIGNIFICANT CHANGES
This section summarizes significant changes in the August 2019 guidance compared to the January 2017
interim version. The August 2019 version:
•
Updates the main guidance and most appendices to cover Category A infectious substances
generally. Ebola-specific information is now in Appendix F (Pathogen-Specific Information).
•
Restructures the main planning guidance around information and responsibilities for entities or
individuals involved in various steps throughout the typical waste lifecycle, including during
waste generation, transportation, treatment and disposal. The new structure also addresses roles
and responsibilities of the United States Federal government and SLTT agencies and discusses
overarching planning considerations and worker safety and health concerns relevant across the
steps of the waste lifecycle.
•
Expands the scope of the guidance to address additional potential sources of Category A waste
associated with patient treatment beyond that which is generated during the management of
patients in hospitals. Such sources include laboratories where infectious substances are handled
for clinical or diagnostic purposes of infectious patients and residences where infectious patients
have lived.
•
Includes a robust glossary of terms to clarify waste-specific terminology and other key words
used throughout the document, as well as a complete listing of acronyms.
•
Adds discussion of alternative Category A waste treatment options, including chemical
disinfection and alkaline hydrolysis digestion (i.e., tissue digestion), in situations in which
autoclaving or incineration are not feasible.
•
Expands discussion on compliance with the complex regulatory framework that may apply during
various Category A waste management activities, including as a result of DOT, U.S. Department
of Labor (DOL)/Occupational Safety and Health Administration (OSHA), U.S. Department of
Health and Human Services (HHS), and U.S. Department of Agriculture (USDA) requirements.
•
Discusses additional requirements for specific modes of transportation.
•
Cross-references the list of UN 2814, Infectious Substances Affecting Humans, with the federal
Select Agents lists, including for animal and plant pathogens, in an expanded Appendix B
(Infectious Agent Categorization).
•
Combines the former Appendix C (Decision Matrix for Waste Treatment) and Appendix D
(Decision Tree for Treatment and Disposal of Category A Infectious Substances) into a single
decision tool, now in Appendix C (Decision Matrix for Waste Treatment). The decision tool also
addresses management of Category A waste resulting from terrorism or other incidents over
which the Federal Bureau of Investigation (FBI) maintains jurisdiction.
•
Simplifies and streamlines the questions and answers in Appendix D (Questions and Answers).
3
�
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
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Title
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Managing Solid Waste Contaminated with a Category A Infectious Substance: Summary of Key Points and Significant Changes
Subject
The topic of the resource
Waste Management
Description
An account of the resource
<ul>
<li>This document summarizes <a href="/items/show/540" title="Guide">a full guide</a>., which has been updated on June 10, 2022. The full guide supersedes an interim version, previously published on January 19, 2017 and that on August, 2019.</li>
<li>This document does not create new requirements, nor does it remove the obligation to comply with all applicable federal, state, local, tribal, and territorial laws and regulations.</li>
<li>See <a href="/items/show/540" title="Full Guide" target="_blank" rel="noreferrer noopener">the full guide</a>, which has been updated on June 10, 2022.</li>
</ul>
Creator
An entity primarily responsible for making the resource
U.S. Department of Transportation<br />U.S. Environmental Protection Agency<br />U.S. Department of Labor<br />Centers for Disease Control and Prevention (CDC)<br />Assistant Secretary for Preparedness and Response (ASPR)
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-09-26
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
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Infection Prevention and Control
Category A
Guidance Document
R-IPC
Waste
Waste Management
-
https://repository.netecweb.org/files/original/a2ab8b2de877a48cb039d0c39bc36bfc.pdf
5c36f73d688aafb1d2435e37981f9dbf
PDF Text
Text
Managing Solid Waste
Contaminated with a Category A
Infectious Substance
June 2022
�Managing Solid Waste Contaminated with a Category A Infectious Substance
This document was approved for publication by the National Security Council (NSC)-led Homeland and
Critical Infrastructure Resilience (HCIR) and Countering Biological Threats (CBT) Interagency Policy
Committees on June 3, 2022.
This documents supersedes earlier versions from January 2017 and August 2019.
This document does not create new requirements, nor does it remove the obligation to comply with all
applicable federal, state, local, tribal, and territorial laws and regulations.
i
�Managing Solid Waste Contaminated with a Category A Infectious Substance
CONTENTS
Preface ......................................................................................................................................................... iii
Acronyms & Glossary of Terms ................................................................................................................... v
Acronyms .................................................................................................................................................. v
Glossary of Terms .................................................................................................................................. viii
Planning Guidance for Handling Solid Waste Contaminated with a Category A Infectious Substance ...... 1
Key Points ................................................................................................................................................. 1
1. Introduction ........................................................................................................................................... 3
2. Category A Waste: What It Is and What It Is Not ................................................................................ 4
3. Overarching Planning Considerations .................................................................................................. 5
4. Federal Government Roles & Responsibilities ..................................................................................... 9
5. Waste Generator Information & Responsibilities ............................................................................... 11
6. Waste Transporter Information & Responsibilities ............................................................................ 16
7. Waste Treatment Information & Responsibilities............................................................................... 18
8. Final Disposal Information & Responsibilities ................................................................................... 23
9. Protecting Worker Health and Safety ................................................................................................. 26
Appendix A – Additional Resources .......................................................................................................... 33
Appendix B – Infectious Agent Categorization .......................................................................................... 37
Appendix C – Decision Matrix for Waste Treatment ................................................................................. 43
Appendix D – Questions and Answers ....................................................................................................... 47
Background Questions & Answers ......................................................................................................... 49
Waste Generation Questions & Answers ................................................................................................ 61
Waste Transportation Questions & Answers .......................................................................................... 63
Waste Treatment Questions & Answers ................................................................................................. 70
Waste Disposal Questions & Answers.................................................................................................... 74
Worker Protection Questions & Answers ............................................................................................... 79
Appendix E – Directory of State and Territorial Waste Management Programs........................................ 87
Appendix F – Pathogen-Specific Information ............................................................................................ 91
F-1. Ebola................................................................................................................................................ 91
F-2. Monkeypox...................................................................................................................................... 94
ii
�Managing Solid Waste Contaminated with a Category A Infectious Substance
PREFACE
Solid waste contaminated with infectious substances can be managed safely.1
In the United States, much of this waste comes from hospitals, other healthcare facilities, medical
transportation operations, and laboratories, though people with certain infectious diseases may also
generate such waste at home. Infectious waste is routinely treated, transported, and disposed of in ways
that protect the health of the American public, the environment, and workers.
However, the 2014–2015 experiences with individuals with Ebola virus disease (EVD) in the United
States tested the nation’s capacity for managing solid waste contaminated with Ebola virus or other
potentially highly infectious waste—classified as Category A infectious substances under the U.S.
Department of Transportation’s Hazardous Materials Regulations (HMR). The HMR classify an
infectious substance (and solid waste containing it) as “Category A” if it is in a form (e.g., untreated)
capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or
animals upon exposure to the substance.2 The HMR require certain safety measures, including special
permits and packaging, for commercial transportation of materials contaminated with Category A
infectious substances (referred to as “Category A waste” throughout this document). Challenges
associated with managing Category A waste generated by U.S. patients with EVD—both before and
during hospitalization—highlighted a lack of universal understanding about how to handle such waste, as
well as poor acceptance of the fact that these activities can be done safely.
A product of extensive federal interagency coordination and stakeholder input, this guidance aims to
prepare the nation to effectively manage Category A waste associated with infectious disease incidents.
The guidance also aims to improve understanding of the safety of infectious waste management
processes. It is intended to help government and non-governmental leaders, local emergency medical
services, emergency managers, hospitals, healthcare providers, laboratories, environmental services
workers, waste management companies and workers, and related stakeholders safely handle, inactivate,
transport, and dispose of Category A waste.3 The guidance provides key information about procedures
and regulations regarding Category A waste. In addition to the HMR, the document discusses additional
U.S. Department of Labor (DOL)/Occupational Safety and Health Administration (OSHA), U.S.
Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC),
and U.S. Department of Agriculture (USDA) requirements, including federal select agent regulations of
HHS/CDC at 42 CFR part 73 and USDA at 7 CFR part 331 and 9 CFR part 121, that may be relevant for
waste management planning. The guidance is supplemented by several appendices that provide additional
resources, assist with decision making, and address questions and answers about Category A waste.
1
The definition of solid waste is not limited to wastes that are physically solid. Many solid wastes are liquid, semisolid, or contained gaseous material. For more information, see definition of “solid waste” in Glossary of Terms.
2
Hazardous Materials Regulations, 49 CFR § 173.134(a)(1)(i) (2013).
3
Parts of this guidance may not apply to every hospital, healthcare facility, or laboratory in every state. Contact
state, local, tribal, and/or territorial officials to discuss your organization’s waste management plans in order to
prepare for an incident before one occurs. See the directory of state and territorial waste management programs in
Appendix E – Directory of State and Territorial Waste Management Programs.
iii
�Managing Solid Waste Contaminated with a Category A Infectious Substance
This guidance focuses on managing waste contaminated with the Category A infectious substances that
affect humans.4 These substances are identified by the United Nations (UN) identification number 2814
under an international system for identifying hazardous materials. Appendix B – Infectious Agent
Categorization provides a non-exhaustive list identifying, among other categorizations, common agents
classified as UN 2814 Category A infectious substances affecting humans. Medical care of a person
suspected of or confirmed as having a disease caused by a Category A pathogen (i.e., germ) typically
generates used healthcare products or linens that are classified as Category A waste. While this document
chiefly addresses Category A waste associated with hospital care of infectious patients, it also recognizes
that infected people may contaminate their homes, vehicles in which they travel, and other environments
before they are hospitalized. Category A waste may also come from laboratories that work with UN 2814
Category A pathogens, including when they intentionally cultivate certain pathogens (a process known as
“culturing”) that are not considered Category A (i.e., UN 2814 infectious substances) in other forms (e.g.,
in body fluids or tissues of an infected person).5 Where appropriate, this document addresses these
additional, non-healthcare scenarios and settings from which Category A waste may arise.
Information in this guidance serves several purposes. As a whole, the document offers readers an
overview of Category A waste management in the United States. The main component of this guidance
addresses planning for Category A waste management activities, including considerations for developing,
evaluating, and revising organizational (e.g., hospital) or jurisdictional (e.g., state, territorial, or local)
plans. It is presented in sections that break down waste management activities according to
responsibilities as waste is moved from its point of generation to its place of disposal. Several
accompanying appendices provide users with information about pathogens classified as Category A
infectious substances, decision making for waste treatment and disposal activities, communicating
effectively about safe waste management and associated issues, and additional related resources. The
included listing of acronyms and glossary of terms applies to the entire document. Unless otherwise
noted, references to a particular appendix or section refer to parts of this document (and, in the electronic
version, can be clicked to navigate to that information directly).
Note that this document intentionally repeats some information, particularly when waste management
requires actions from multiple parties (e.g., overlapping responsibilities between waste generators and
waste transporters). Information presented in the planning guidance is also intentionally repeated in the
appendices to make it as accessible as possible for a wide variety of readers.
4
This document is not intended to cover Category B infectious substances (UN 3373) nor Category A Infectious
substances that affect animals only (UN 2900). Category A infectious substances that affect humans and animals are
categorized as Category A Infectious substances, affecting humans (UN 2814).
Appendix B – Infectious Agent Categorization distinguishes these “cultures only” pathogens from other Category
A pathogens.
5
iv
�Managing Solid Waste Contaminated with a Category A Infectious Substance
ACRONYMS & GLOSSARY OF TERMS
ACRONYMS
APHIS
Animal and Plant Health Inspection Service
ASPR
Assistant Secretary for Preparedness and Response
BSAT
Biological Select Agents and Toxins
CAA
Clean Air Act
CBT
Countering Biological Threats
CDC
Centers for Disease Control and Prevention
c/o
Cultures only
CFR
Code of Federal Regulations
DHS
U.S. Department of Homeland Security
DoD
U.S. Department of Defense
DOE
U.S. Department of Energy
DOL
U.S. Department of Labor
DOT
U.S. Department of Transportation
DTR
Defense Transportation Regulation
EMS
Emergency Medical Services
EMTALA
Emergency Medical Treatment and Labor Act
EPA
U.S. Environmental Protection Agency
EPCRA
Emergency Planning and Community Right-to-Know Act
EVD
Ebola virus disease
FBI
Federal Bureau of Investigation
FDA
Food and Drug Administration
FIFRA
Federal Insecticide, Fungicide, and Rodenticide Act
HAZMAT
Hazardous material
v
�Managing Solid Waste Contaminated with a Category A Infectious Substance
HAZWOPER Hazardous Waste Operations and Emergency Response
HBV
Hepatitis B virus
HCIR
Homeland and Critical Infrastructure Resilience
HFV
Hemorrhagic fever virus
HHS
U.S. Department of Health and Human Services
HICPAC
Healthcare Infection Control Practices Advisory Committee
HIV
Human immunodeficiency virus
HMIWI
Hospital/medical/infectious waste incinerator
HMR
Hazardous Materials Regulations
HW
Hazardous waste
HWI
Hazardous waste incinerator
ICAO
International Civil Aviation Organization
IMDG
International Maritime Organization Dangerous Goods Code
IV
Intravenous
LDR
Land Disposal Restriction
LEPC
Local emergency planning committee
MMR
Measles, mumps, and rubella
N/A
Not applicable
NETEC
National Emerging Special Pathogens Training and Education Center
NESHAP
National Emission Standards for Hazardous Air Pollutants
NIEHS
National Institute of Environmental Health Sciences
NIOSH
National Institute for Occupational Safety and Health
NSC
National Security Council
NSPS
New Source Performance Standards
OPIM
Other potentially infectious materials
OSH
Occupational Safety and Health
vi
�Managing Solid Waste Contaminated with a Category A Infectious Substance
OSHA
Occupational Safety and Health Administration
PHMSA
Pipeline and Hazardous Materials Safety Administration
PPE
Personal protective equipment
PUI
Patient (or person) under investigation (i.e., for a disease)
RCRA
Resource Conservation and Recovery Act
RESPTC
Regional Ebola and Other Special Pathogens Treatment Center
RMW
Regulated medical waste
SARS-CoV
Severe Acute Respiratory Syndrome-associated coronavirus
SLTT
State, local, tribal, and/or territorial
SP
Special permit
TB
Mycobacterium tuberculosis
Tdap
Tetanus, diphtheria, and pertussis
TRACIE
Technical Resources, Assistance Center, and Information Exchange
UN
United Nations
USC
United States Code
USDA
U.S. Department of Agriculture
WHO
World Health Organization
vii
�Managing Solid Waste Contaminated with a Category A Infectious Substance
GLOSSARY OF TERMS
Airborne transmission: One of the three main conventional routes of infectious disease transmission,
which involves either airborne droplet nuclei (i.e., the infectious material left behind when liquid droplets
containing infectious materials evaporate) or small particles in the respirable size range containing
infectious agents. Once released from an infectious source, these small particles can stay suspended in the
air for various amounts of time, depending on their size and various environmental factors, and travel a
range of distances to a susceptible host (i.e., a person who does not have immunity to that specific
pathogen. Larger particles settle (i.e., deposit) on environmental surfaces and other fomites. Some
pathogens (i.e., germs) can remain viable in the air or on environmental surfaces and fomites for long
periods of time. Infection can occur when the infectious particles enter the host, such as when they are
breathed in from the air.
Autoclave: A sterilization machine that utilizes a standardized process involving saturated steam under
pressure for a specified exposure time and at a specific temperature.
Bioaerosol: A suspension of airborne particles, generally comprised of microorganisms (e.g., bacteria,
viruses) or materials of biological origin released from humans, animals, plants, soil, water, or other
sources. Particles may range in size from very small to very large, and may include liquid droplets and
materials left behind after such droplets evaporate (known as “droplet nuclei”).
Biological Select Agents and Toxins (BSAT): See “Select agent.”
Bloodborne pathogens (BBP): Pathogenic microorganisms that are present in human blood (including
human blood components and products made from human blood) that can cause disease in humans.
Bloodborne Pathogens (BBP) standard: The Occupational Safety and Health Administration (OSHA)
standard that requires employers to protect workers from occupational exposure to bloodborne pathogens
(as defined above and including some Category A infectious substances). The standard applies to
exposure to blood and other potentially infectious materials, including semen, vaginal secretions,
cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in
dental procedures, any body fluid that is visibly contaminated with blood, all body fluids in situations
where it is difficult or impossible to differentiate between body fluids, any unfixed tissue or organ (other
than intact skin) from a human (living or dead), and HIV-containing cell or tissue cultures, organ cultures,
and HIV- or Hepatitis B virus (HBV)-containing culture medium or other solutions; and blood, organs, or
other tissues from experimental animals infected with HIV or HBV. See 29 CFR § 1019.1030.
Category A infectious substance: An infectious substance in a form capable of causing permanent
disability or life-threatening or fatal disease in otherwise healthy humans or animals when exposure to the
substance occurs. See 49 CFR § 173.134(a)(1)(i). Note that Category A infectious substances described in
this document and covered by the Hazardous Materials Regulations (HMR) at 49 CFR parts 171-180
should not be confused with the select agents regulated by the Federal Select Agent Program under 7 CFR
part 331, 9 CFR part 121, and 42 CFR part 73 (although an infectious substance or agent may be both
covered by the HMR and listed as a select agent); shipments of select agents must be transported in
accordance with federal select agent regulations. Infectious substances labeled “cultures only” in
Appendix B – Infectious Agent Categorization are only considered Category A when a pathogen(s) is
intentionally propagated, such as when a laboratory grows more of the pathogen for clinical diagnostic or
biomedical research purposes. The other substances, such as Ebola virus (and other hemorrhagic fever
viruses, HFVs) and variola virus (which causes smallpox), are considered Category A without being
cultured.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Category A waste: Waste contaminated with a Category A infectious substance. This waste must be
packaged and transported in accordance with the Hazardous Materials Regulations (HMR) or an
applicable DOT special permit.
Category B infectious substance: An infectious substance that is not in a form generally capable of
causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals
when exposure to it occurs. Transport as Biological substance, Category B (United Nations (UN) 3373).
See 49 CFR § 173.134(a)(1)(ii).
Chemoprophylaxis: Administration of medication before, during, or after possible or known exposure to
a pathogen to prevent either infection or disease.
Clean Air Act (CAA): The comprehensive federal law under the authority of which the U.S.
Environmental Protection Agency (EPA) regulates air emissions from stationary and mobile sources.
Among other things, this law authorizes EPA to establish National Ambient Air Quality Standards to
protect public health and public welfare and to regulate emissions of hazardous air pollutants.
Commerce: Trade or transportation in the jurisdiction of the United States within a single state, between
a place in a state and a place outside of the state, that affects trade or transportation between a place in a
state and place outside of the state, or on a United States-registered aircraft. See 49 CFR § 171.8.
Contact transmission: One of the three main conventional routes of infectious disease transmission,
which involves transfer of microorganisms from a source, such as an infected person, to a susceptible
host, such as another person. Indirect contact transmission is when such transfer occurs through a
contaminated intermediate object or person (i.e., a fomite). Direct contact transmission occurs when
microorganisms are transferred without a contaminated intermediate object or person.
Contaminated waste: See “Category A waste,” as these terms are used synonymously in the document.
Disinfectant: An antimicrobial product, typically in the form of a liquid or liquid-containing wipe that
will make certain biological agents, such as bacteria or viruses, inactive. Such products should be an U.S
Environmental Protection Agency (EPA)-registered disinfectant or one with microbial pathogen claims
appropriate for the pathogen.6 Although not covered in this document, this term can also apply to Food
and Drug Administration (FDA)-regulated liquid products used specifically on critical devices.
Droplet transmission: The transfer of infectious agents by droplets traveling directly from a source, such
as an infected person’s respiratory tract, to susceptible mucous membranes of a recipient.
Endemic: The condition in which a particular disease is naturally present in a particular community,
population, or geographic area.
Such products are included in EPA’s List L: EPA's Registered Antimicrobial Products that Meet the CDC Criteria
for Use Against the Ebola Virus (see U.S. Environmental Protection Agency, “List L: EPA's Registered
Antimicrobial Products that Meet the CDC Criteria for Use Against the Ebola Virus,” last modified January 10,
2018, https://www.epa.gov/sites/default/files/2018-01/documents/2018.10.01.listl_.pdf); U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, “Interim Guidance for U.S. Residence
Decontamination for Ebola and Removal of Contaminated Waste,” last modified August 5, 2015,
www.cdc.gov/vhf/ebola/prevention/cleaning-us-homes.html.
6
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Fomite: An object, item, or material (e.g., equipment, furniture, bedding, clothing) that can carry and
spread pathogens.
Frontline healthcare facility: A healthcare facility that is prepared to rapidly identify and isolate patients
who may have Ebola or other highly infectious diseases. Such a facility must be able to promptly inform:
the hospital/facility infection control program; state and local public health agency; and an assessment
hospital (which can receive and isolate patients under investigation for highly infectious diseases and care
for such patients until a diagnosis can be made and until discharge or transfer is completed), or Regional
Ebola and Other Special Pathogens Treatment Center (RESPETC) or state/jurisdiction treatment center
(which can safely care for patients with highly infectious diseases in the event that a cluster of such
patients overwhelms the RESPTC), as necessary, to arrange patient transfer. Frontline healthcare facilities
are also responsible to provide stabilizing treatment, per the Emergency Medical Treatment and Labor
Act (EMTALA) requirements. Frontline healthcare facilities are part of a tiered approached for managing
suspected and confirmed cases of highly infectious diseases in the United States.
Generator: The person or persons whose act or process produces (i.e., generates) waste. This term
generally provides a way to describe waste generators irrespective of what type of waste they produce
(e.g., solid, liquid, semi-liquid, infectious, hazardous, etc.). However, this term has a specific meaning
under the hazardous waste regulations of the Resource Conservation and Recovery Act (RCRA) subtitle
C, and hazardous waste generators must adhere to specific requirements for both managing their
hazardous waste on-site and ensuring proper management off-site. See www.epa.gov/hwgenerators.
Despite sick patients’ physiological processes generating waste (e.g., vomitus, feces), the term
“generator” typically does not apply to such patients; instead, it applies to healthcare or medical transport
organizations caring for and moving them, laboratories testing clinical samples obtained from them,
environmental remediation companies cleaning their homes, or others whose activities result in creating
the waste. See also “Offeror.”
Hazardous material: A substance or material that the Secretary of Transportation has determined is
capable of posing an unreasonable risk to health, safety, and property when transported in commerce, and
has designated as hazardous under section 5103 of federal hazardous materials transportation law (49
USC section 5103). The term includes hazardous substances, hazardous wastes, marine pollutants,
elevated temperature materials (as defined at 49 CFR § 171.8), materials designated as hazardous in the
Hazardous Materials Table (see 49 CFR § 172.101), and materials that meet the defining criteria for
hazard classes and divisions in part 173 of the Hazardous Materials Regulations (HMR). See 49 CFR §
171.8.
Hazardous Materials Regulations (HMR): The U.S. Department of Transportation (DOT) regulations
at 49 CFR parts 171-180.
Hazardous waste: A specific term defined in the Resource Conservation and Recovery Act (RCRA) and
implementing regulations. “Hazardous waste” is a subset of “solid waste” (where solid waste can be a
liquid, semi-solid, solid, or contained gaseous material) that when improperly managed poses a serious
threat to human health and the environment. There are specific regulatory definitions of “hazardous
waste” with which waste generators should be familiar. For purposes of transportation, “hazardous waste”
refers to any material that that is subject to the Hazardous Waste Manifest Requirements of the U.S.
Environmental Protection Agency (EPA), specified in 40 CFR part 262.
Hazardous Waste and Emergency Response Operations (HAZWOPER) standard: The Occupational
Safety and Health Administration (OSHA) standard that requires employers to protect workers engaged in
certain types of emergency response and recovery operations, including emergency response operations
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for releases of, or substantial threats of releases of, hazardous substances regardless of the location of the
hazard. See 29 CFR § 1910.120.
HAZMAT employee: A person who, in the course of their employment directly affects hazardous
materials transportation safety. This term includes a person, who during the course of employment: (1)
loads, unloads, or handles hazardous materials; (2) designs, manufactures, fabricates, inspects, marks,
maintains, reconditions, repairs, or tests a package, container, or packaging component that is represented,
marked, certified, or sold as qualified for use in transporting hazardous material in commerce; (3)
prepares hazardous materials for transportation; (4) is responsible for safety of transporting hazardous
materials; or (5) operates a vehicle used to transport hazardous materials. See 49 CFR § 171.8.
In commerce: Trade or transportation in the jurisdiction of the United States within a single state,
between a place in a state and a place outside of the state, that affects trade or transportation between a
place in a state and place outside of the state, or on a United States-registered aircraft. See 49 CFR §
171.8. Transportation of a hazardous material in a motor vehicle, aircraft, or vessel operated by a federal
or state, local, tribal, or territorial government employee solely for noncommercial federal or state, local,
tribal, and/or territorial (SLTT) government purposes is not considered to be “in commerce” and so is
exempt from the Hazardous Materials Regulations (HMR) under 49 CFR § 171.1(d)(5).
Inactivated: Having reached the point, through incineration, autoclaving, or other validated treatment,
where the waste material is no longer infectious, does not pose an infection risk, and is not considered to
be a regulated medical waste or a hazardous material when transported in commerce.
Incineration: The combustion of waste primarily for destruction. This process can reduce large volumes
of waste materials to ash and lessen toxic gaseous emissions. Residues or residuals (e.g., ash) from the
combustion of hazardous waste are also potentially subject to Resource Conservation and Recovery Act
(RCRA) regulations for disposal.
Incinerator, hazardous waste (HWI): A type of combustor that is designed, operated, and permitted to
burn hazardous waste. HWIs are subject to applicable federal and/or state, local, tribal, and/or territorial
(SLTT) regulatory requirements pursuant to both the Resource Conservation and Recovery Act
requirements (40 CFR parts 264, 265, and 266) and Clean Air Act standards (40 CFR part 63). Waste feed
capacity (i.e., waste size and volume/weight throughput limits over a specified period of time, such as an
hour) for HWIs is an important criterion to know before a biological incident occurs, as each HWI may be
set up to accept different waste amounts and sizes.
Incinerator, medical waste: A type of incinerator that is designed, operated, and permitted to burn
wastes produced by hospitals, veterinary facilities, and medical research facilities for the purpose of
inactivating pathogens. These wastes include both infectious (i.e., red/biohazard bag) medical waste and
non-infectious, general housekeeping waste. Hospital/medical/infectious waste incinerators are subject to
applicable Clean Air Act requirements (40 CFR part 60). Waste feed capacity (i.e., waste size and
volume/weight throughput limits over a specified period of time, such as an hour) for medical waste
incinerators is an important criterion to know before a biological incident occurs, as each medical waste
incinerator may be set up to accept different waste amounts and sizes.
Infectious substance: A material known or reasonably expected to contain a pathogen. See also
“Pathogen.”
Landfill: Disposal facilities in which wastes are placed in or on land. Regulatory requirements vary
depending on the type of waste the landfill is permitted to receive. For example, hazardous waste
landfills, often referred to as Resource Conservation and Recovery Act (RCRA) subtitle C landfills, are
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subject to different federal standards (40 CFR parts 264 and 265, subpart N) than non-hazardous waste
landfills, which are often referred to as RCRA subtitle D landfills (40 CFR parts 257 and 258). In
addition, state, local, tribal, and/or territorial (SLTT) requirements may apply in lieu of or in addition to
the federal standards.
Occupational Safety and Health (OSH) Act: The primary federal law enacted to assure safe and
healthful working conditions for workers in the United States. U.S. Department of Labor
(DOL)/Occupational Safety and Health Administration (OSHA) regulations promulgated under the OSH
Act set standards for protecting workers from occupational safety and health hazards, require employers
to maintain certain types of records, and assist states in their efforts to assure safe and healthful working
conditions through their own OSHA-approved State Plans. See also “State Plan.”
Offeror: A person who does either or both of the following: (1) performs or is responsible for
performing, any pre-transportation function required under the Hazardous Materials Regulations (HMR)
(49 CFR parts 171-180) for transportation of a hazardous material in commerce; (2) tenders or makes the
hazardous material available to a carrier for transportation in commerce. See 49 CFR § 171.8. See also
“Generator.”
Overpack: An enclosure that is used by a single offeror to provide protection or convenience in handling
of a package or to consolidate two or more packages. Overpack does not include a transport vehicle,
freight container, or aircraft unit load device. Examples of overpacks are one or more packages: (1)
placed or stacked onto a load board such as a pallet and secured by strapping, shrink wrapping, stretch
wrapping, or other suitable means; or (2) placed in a protective outer packaging such as a box or crate.
See 49 CFR § 171.8
Packaging(s): A receptacle (i.e., a containment vessel for receiving and holding materials) and any other
components or materials necessary for the receptacle to perform its containment function in conformance
with the minimum packing requirements of the Hazardous Materials Regulations (HMR). See 49 CFR §
171.8.
Pathogen: A microorganism (including a bacterium, virus, parasite, or fungus) or other agent, such as a
proteinaceous infectious particle (prion) that can cause disease in humans or animals. See 49 CFR §
173.134(a)(1).
Personal protective equipment (PPE): Equipment worn to prevent or reduce exposure, including of the
skin, eyes, face, head, extremities, respiratory tract, and mucous membranes, to hazardous substances
(e.g., pathogens, chemicals, other materials) or other hazards (e.g., heat, electricity, sharps). See 29 CFR
part 1910 subpart I.
Prion: a pathogenic agent that is able to cause abnormal folding of specific normal cellular proteins called
“prion proteins,” which are found most abundantly in the brain. This abnormal folding is associated with
neurological disease in humans and animals. Prions are believed to made of protein (i.e., they are
proteinaceous) and are highly resistant to all but the most destructive methods of inactivation. They
require specific inactivation, disposal, and containment procedures.
Regional Ebola and Other Special Pathogens Treatment Center (RESPTC): A specially-designated
hospital, identified in partnership between the U.S. Department of Health and Human Services
(HHS)/Assistant Secretary for Preparedness and Response (ASPR), state and local public health officials,
and the hospital or healthcare system, that can be ready within eight hours to receive a patient with
confirmed Ebola from its federal region, across the United States, or medically-evacuated from outside of
the United States, as necessary. These hospitals have enhanced capacity to care for other highly infectious
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diseases and are part of a tiered approached for managing suspected and confirmed cases of such diseases
in the United States.
Regulated medical waste (RMW): A waste or reusable material derived from medical treatment of
humans or animals including diagnosis and immunization; or from biomedical research, including
production and testing of biological products. Regulated medical waste containing a Category A
infectious substance must be classified as an infectious substance (either United Nations (UN) 2814 or
UN 2900) and managed appropriately. See 49 CFR § 173.134(a)(5).
Exceptions to regulated medical waste include: A material that is unlikely to cause disease in
humans or animals; non-infectious biological materials from humans, animals or plants; a
material containing neutralized or inactivated pathogens and no longer poses a health risk; blood
collected for transfusion or preparation of blood products sent for testing (unless believed to
contain an infectious substance); laundry, medical equipment conforming to the Occupational
Safety and Health Administration (OSHA) Bloodborne Pathogens standard (29 CFR §
1910.1030); any waste or recyclable material other than regulated medical waste; or corpses,
remains, and anatomical parts transported for interment, cremation, or medical research at a
college, hospital, or laboratory. See 49 CFR § 173.134(b).
Residual: A byproduct of waste treatment, such as ash left behind when waste materials are incinerated.
Resource Conservation and Recovery Act (RCRA): The primary federal law governing the disposal of
solid waste and hazardous waste. U.S. Environmental Protection Agency (EPA) regulations promulgated
under the Resource Conservation and Recovery Act (RCRA) set standards for treating, storing, and
disposing of hazardous waste.
Select agent: Also referred to as “biological select agents and toxins (BSAT),” a subset of biological
agents and toxins that the U.S. Department of Health and Human Services (HHS) and U.S. Department of
Agriculture (USDA) have determined have the potential to pose a severe threat to public health and
safety, to animal or plant health, or to animal or plant products. The current list of select agents and toxins
can be found at 42 CFR §§ 73.3 and 73.4, 9 CFR §§ 121.3 and 121.4, and 7 CFR § 331.3, as well as at
www.selectagents.gov. See also 42 USC § 262a and 7 USC § 8401. Appendix B – Infectious Agent
Categorization provides examples of HHS and USDA select agents and toxins. Note that while Category
A infectious substances described in this document do not specifically include infectious nucleic acids,
certain types of nucleic acid materials are regulated by the Federal Select Agents Program.
Tier 1 select agent or toxin: a subset of select agents and toxins that present the greatest risk of
deliberate misuse with significant potential for mass casualties or devastating effect to the
economy, critical infrastructure, or public confidence, and pose a severe threat to public health
and safety.
Sharps: any objects, including needles, scalpels, lancets, and broken glass, that could cause needle sticks,
puncture wounds, cuts or lacerations, or other such injuries to individuals who handle them or come into
contact with them inadvertently (e.g., when they have not been properly disposed of in approved sharps
containers).
Solid waste: Any garbage, refuse, sludge from a waste treatment plant, water supply treatment plant, or
air pollution control facility and other discarded material, resulting from industrial, commercial, mining,
and agricultural operations, and from community activities, but does not include solid or dissolved
material in domestic sewage, or solid or dissolved materials in irrigation return flows or industrial
discharges which are point sources subject to permits under the National Pollutant Discharge Elimination
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System at 33 USC § 1342, or source, special nuclear, or byproduct material as defined by the Atomic
Energy Act of 1954, as amended (68 Stat. 923) [42 USC §§ 2011 et seq.]. Any garbage, refuse, sludge
from a wastewater treatment plant, water supply treatment plant, or air pollution control facility and other
discarded material, resulting from industrial, commercial, mining, and agricultural operations, and from
community activities. Note that the definition of solid waste is not limited to wastes that are physically
solid. Many solid wastes are liquid, semi-solid, or contained gaseous material. Certain materials are
excluded from being defined as solid wastes, such as industrial point source discharges or domestic
sewage. See Resource Conservation and Recovery Act (RCRA) 1004(27).
Special permit: A document issued by the U.S. Department of Transportation (DOT)/Pipeline and
Hazardous Materials Safety Administration (PHMSA), or as otherwise prescribed in the Hazardous
Materials Regulations (HMR), under the authority of 49 USC § 5117 permitting a person to perform a
function that is not otherwise permitted under the HMR.
State Plan: An Occupational Safety and Health Administration (OSHA)-approved job safety and health
program operated by an individual state or territory instead of federal OSHA. State Plans are monitored
by OSHA and must be at least as effective as federal OSHA in protecting workers and in preventing
work-related injuries, illnesses, and deaths. When this document was published, 28 states, Puerto Rico,
and the Virgin Islands had OSHA-approved State Plans. Twenty-two State Plans (21 states and one U.S.
territory) cover both private and state and local government workers. The remaining six State Plans (five
states and one U.S. territory) cover state and local government workers only. For a complete list of
OSHA-approved State Plans and information about worker safety and health requirements in each state,
see: www.osha.gov/dcsp/osp/index.html.
Validated: A term used to describe a protocol or treatment cycle used for inactivating infectious materials
(including waste) that has been shown to ensure the waste is no longer infectious. Validation often
involves the use of biological indicators (e.g., spores, approved surrogate organisms or a culture-based
method using the actual target organism) to demonstrate that potentially infectious substances have been
exposed to sufficient heat, steam, pressure, or chemicals for a long enough period of time to ensure it is
completely non-infectious. See also “Inactivated waste.”
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PLANNING GUIDANCE FOR HANDLING SOLID WASTE
CONTAMINATED WITH A CATEGORY A INFECTIOUS
SUBSTANCE
KEY POINTS
This section briefly summarizes key points in this planning guidance. It is meant to provide an overview
of the document’s recommendations for developing plans for managing solid waste contaminated with a
Category A infectious substance (i.e., Category A waste). The remaining sections of the planning
guidance provide important details about considerations for safe and effective waste management for
which this summary is not a substitute.
•
A Category A infectious substance is a material known or reasonably expected to contain a
pathogen that is in a form capable of causing permanent disability or life-threatening or fatal
disease in otherwise healthy humans or animals who are exposed to it.
•
Infectious waste, including materials contaminated with Category A infectious substances, can be
managed safely.
•
Leadership within healthcare facilities; laboratories; state, local, tribal, and/or territorial (SLTT7)
governments; waste management companies; and other entities that may or will need to manage
Category A waste should ensure their organizations have plans to address the entire waste
lifecycle, from initial generation of the infectious waste to final disposition of any treated
byproducts (residuals).
•
Hospital care of a person infected with some pathogens classified as a Category A infectious
substance, particularly Ebola or another hemorrhagic fever virus (HFV), can result in large
volumes of potentially infectious waste, especially for diseases associated with severe illness and
lengthy hospital stays.
•
Outside of hospitals, people infected with some pathogens classified as Category A infectious
substances, such as Ebola and other HFVs, may contaminate their homes, vehicles in which they
travel, and other environments before they are hospitalized. Category A waste may also originate
from laboratories (e.g., research, clinical) that work with Category A pathogens, particularly
when they intentionally cultivate certain pathogens. Housing, care, and post-mortem management
of animals infected with certain Category A pathogens also results in Category A waste.
•
Every effort should be made to minimize the amount of Category A waste generated. Category A
waste should be physically separated, if practical, from other solid waste at the point of origin.
7
Treatment, disposal and certain other waste management activities are typically regulated at the state or territorial
level. However local and tribal governments may also have requirements that affect waste management activities
within their jurisdictions. This guidance uses the “SLTT” acronym to describe state, local, tribal, and/or territorial
requirements.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Similar considerations should be made for separating Category A waste from other, noninfectious hazardous materials.
•
The U.S. Department of Transportation (DOT)/Pipeline and Hazardous Materials Safety
Administration (PHMSA) regulates movement and certain other aspects related to management
of Category A infectious substances, including waste that is known or suspected to be
contaminated with them, through its Hazardous Materials Regulations (HMR). Additional federal
and SLTT laws and regulations may apply to various aspects of waste management.
•
Typically, the safest and best options for treating Category A waste so that it is no longer
infectious—a process known as “inactivation”—are implemented on-site, where the waste is
generated. Hospitals and laboratories often have on-site equipment that effectively inactivates
waste when operated under validated (i.e., demonstrated to be effective) and permitted
parameters. For example, autoclaves use saturated steam under pressure to heat materials to a
high enough temperature for a long enough period of time to inactivate the pathogen(s) of
concern in the waste. Medical incinerators with dual chambers burn materials at extremely high
temperatures, leaving behind ash that is no longer infectious. Facilities without such equipment,
SLTT governments responding to waste issues in the community, and others involved in waste
management can also use portable autoclaves for waste inactivation. In specific circumstances,
alternative treatment methods, including chemical disinfectants and alkaline hydrolysis digesters,
may also be appropriate.
•
When waste cannot be treated on-site, it must be sent off-site to special facilities typically
operated by commercial waste management companies. These facilities, regulated and permitted
by SLTT authorities, primarily use autoclaves and incinerators to treat waste on a larger scale
than what most hospitals, laboratories, and other entities are capable of doing on-site.
•
Before offering it for transportation, individuals and entities responsible for generating infectious
waste must classify it appropriately, including as Category A waste when required under HMR
requirements.
•
Individuals and entities must classify waste as hazardous waste when required under Resource
Conservation and Recovery Act (RCRA) requirements. These are set and enforced by the U.S.
Environmental Protection Agency (EPA) or by states/territories authorized to implement the
RCRA hazardous waste program in lieu of EPA.
•
Category A waste may be safely transported off-site for inactivation in packaging meeting HMR
requirements or the alternative packaging requirements of a DOT special permit. The HMR also
require that waste transporters comply with certain labeling and paperwork (i.e., shipping papers)
requirements. However, properly classifying (i.e., as Category A) and packaging waste begins at
its point of origin.
•
Management of waste that contains both a Category A infectious substance and certain other
materials, such as those that are radioactive, must comply with regulations applicable to all
substances in the waste. Such instances would need to be addressed on a case-by-case basis, and
may require issuance of a special permit to address the unique combination of potentially
hazardous materials.
•
Waste that has been inactivated through an effective treatment method, along with any materials
left over after treatment (i.e., residuals), is no longer infectious, poses no risk of infection, and is
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
not considered to be regulated medical waste (RMW) or a hazardous material8 (unless other types
of regulated hazardous materials, such as certain chemicals, are present) under federal or SLTT
laws and regulations. Therefore, such waste is no longer considered a Category A infectious
substance and is not subject to the requirements of the HMR for Category A infectious
substances.
•
Residuals, such as incinerator ash, must be evaluated to determine if the residual is still
hazardous. Even though materials that have been properly incinerated are no longer infectious,
ash may be categorized as hazardous waste due to its ability to concentrate certain toxic
substances (e.g., metals) that may have been present in the original waste or in other waste
incinerated at the same time.
•
Residuals must be transported and disposed of in accordance with SLTT requirements and
standard protocols for their disposal. Disposal options may vary depending on whether residuals
contain hazardous materials. Disposal options also may need to consider requirements for
managing inactivated waste that contains red bags, as the Occupational Safety and Health
Administration (OSHA) Bloodborne Pathogens standard (29 CFR § 1910.1030) permits using
red bags in lieu of biohazard labels to denote potentially infectious materials. As such, waste
containing red bags typically cannot be disposed of with other municipal waste streams. Ultimate
disposal facilities must meet federal requirements for environmental protection, which are
generally incorporated into waste and air permits.
•
Throughout the waste lifecycle, employers must protect workers from occupational exposure to
pathogens, chemicals, other hazardous materials, and other hazards that could cause injury and
illness. Even when handling waste materials that have been properly inactivated, workers can still
be injured by sharps (e.g., needles, scalpels), broken glass, or other items that, even if noninfectious, can cause cuts or puncture wounds. A comprehensive worker protection program aims
to eliminate hazards and implement engineering controls, safe work practices, administrative
controls, and personal protective equipment (PPE) to prevent worker injuries and illnesses.
•
At all stages of waste management, all involved parties should ensure effective communication
with one another. For example, individuals and entities generating waste (referred to as “offerors”
and “generators” in various contexts) must communicate with downstream waste transporters,
treatment companies, and disposal facilities about the nature and content of the waste to help
ensure safe, effective management of waste all the way to ultimate disposal.
1. INTRODUCTION
Infectious waste can be managed safely. This includes waste contaminated with a Category A infectious
substance (herein, “Category A waste”), as defined in the Federal Government’s Hazardous Materials
Regulations (HMR) at 49 CFR parts 171-180. Section 2 – Category A Waste: What It Is And What It Is
Not of this planning guidance and the Glossary of Terms further explain what is considered Category A
waste.
In the United States, Category A waste typically comes from hospitals, other healthcare facilities, and
laboratories. However, people with certain infectious diseases may also generate such waste at home or at
8
For more information, see definition of “hazardous material” in Glossary of Terms.
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any place where they have been physically present. Particularly when incidents such as outbreaks of
infectious diseases result in the generation of Category A waste, preparedness for managing that waste is
critical to ensuring a safe and effective response. Planning efforts should involve healthcare systems
(including hospitals and medical transport providers); waste management companies; state, local, tribal,
and/or territorial (SLTT) governments; federal agencies; and other stakeholders who may participate or
otherwise have interests in waste management activities during infectious diseases events—including
isolated cases or clusters of cases, outbreaks, and epidemics.
This guidance addresses planning for Category A waste management activities, including considerations
for developing, evaluating, and revising organizational (e.g., hospital or healthcare system) or
jurisdictional (e.g., SLTT) plans (i.e., overarching strategies) and protocols (i.e., specific steps or actions).
Following discussions of overarching planning considerations and governmental roles and responsibilities
as they relate to Category A waste, the remaining sections of this guidance are structured around the
waste lifecycle. They provide information for and describe responsibilities of those who generate, treat or
inactivate, transport, and dispose of Category A waste. Lastly, a section on worker health and safety
discusses protecting employees involved in waste management activities from initial generation to final
disposition. The guidance is supplemented by several appendices that provide additional resources, assist
with decision making, and address questions and answers about Category A waste.
2. CATEGORY A WASTE: WHAT IT IS AND WHAT IT IS NOT
Under the U.S. Department of Transportation (DOT) HMR, an infectious substance is classified as
“Category A” if it is in a form (i.e., untreated) capable of causing permanent disability or life-threatening
or fatal disease in otherwise healthy humans or animals upon exposure to the substance.9 This document
refers to materials contaminated with Category A infectious substances as “Category A waste.” Category
A waste may be generated in the course of caring for a person with an infection caused by a pathogen that
is considered to be a Category A infectious substance, from the home environment of such a person, and
from laboratories working with Category A infectious substances. Appendix B – Infectious Agent
Categorization provides examples of Category A infectious substances. Note that infectious substances
labeled “cultures only” in the appendix are only considered Category A when a pathogen(s) is
intentionally propagated, such as when a laboratory grows more of the pathogen for clinical diagnostic or
biomedical research purposes. The other substances, such as Ebola virus (and other hemorrhagic fever
viruses) and variola virus (which causes smallpox), are considered Category A without being cultured.
After proper treatment (as described in Section 6 – Waste Treatment Information and Responsibilities),
waste is inactivated and therefore no longer contains pathogens capable of causing disease (i.e., is not
infectious). After the treatment process, the waste no longer poses a health risk from biological agents and
is not considered to be regulated medical waste (RMW)10 or a hazardous material11 (unless other types of
regulated hazardous materials such as chemicals are present) under federal or SLTT laws and regulations.
The same is true of byproducts associated with waste treatment (i.e., residuals), such as the ash left behind
when Category A waste is incinerated. Therefore, such waste is no longer considered a Category A
infectious substance and is not subject to the requirements of the HMR for Category A infectious
9
Hazardous Materials Regulations, 49 CFR § 173.134(a)(1)(i) (2013).
10
For more information, see definition of “regulated medical waste” in Glossary of Terms.
11
For more information, see definition of “hazardous material” in Glossary of Terms.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
substances. However, SLTT requirements may dictate disposal of certain residuals, including materials in
red (i.e., biohazard) bags that have been autoclaved.
Waste or reusable materials from healthcare and laboratory operations, as well as from certain other
activities, that are not considered Category A waste may be classified as RMW. Requirements for RMW
vary among SLTT governments. However, whenever waste contains infectious substances other than
those classified as Category A, this type of waste must be managed as Category B waste whenever the
HMR also apply (e.g., during certain transportation activities). This document is not intended to cover
routine transportation, treatment, or disposal of Category B waste (including RMW containing Category
B infectious substances) or other non-infectious waste, except to the extent it addresses disposal of treated
waste that once was Category A waste but is no longer infectious.
3. OVERARCHING PLANNING CONSIDERATIONS
Leadership within healthcare facilities, laboratories, SLTT governments, and other entities that may or
will need to manage Category A waste should ensure their organizations have plans to address the entire
waste lifecycle, from initial generation of the infectious waste to final disposition of any treated
byproducts. Some organizations that will manage Category A waste at various points in its lifecycle may
already have plans, such as security plans for hazardous materials transportation required by DOT under
the HMR or waste management plans for hospital/medical/infectious waste incinerators required by the
U.S. Environmental Protection Agency (EPA) under the Resource Conservation and Recovery Act
(RCRA). Such existing plans may be modified to address management of Category A waste.
Waste management plans should detail how waste management tasks (classification, minimization,
segregation, storage, treatment, disposal, terminal cleaning, etc.) will be accomplished, and they should
provide jurisdiction- or facility-specific procedures. Each plan should incorporate input from appropriate
SLTT health and environmental departments. Plans should focus on the safety of the people who will
handle waste materials, including during on-site treatment, packaging, and transportation of waste for offsite treatment; the off-site treatment itself; and/or disposal of the waste. Potential exposures to pathogens,
chemicals, other hazardous materials, and sharps in the waste must also be considered in this planning.
Importantly, waste management plans also should consider ways to accurately and effectively
communicate about exposure risks and vulnerabilities and measures for reducing or eliminating them.
Facility Plans
Hospitals, healthcare systems, clinical and research laboratories, and other facility-level plans should
include protocols that reflect their capabilities for managing Category A waste. Facilities that intend to
treat (i.e., inactivate) such waste on-site will plan differently than facilities that need to package, store,
and transport waste off-site for treatment. For most facilities, protocols may address:
•
•
Minimizing the amount of Category A waste generated. Category A waste should be
physically separated, if practical, from other solid waste when it is generated. When mixed
together with other solid waste, manage waste (e.g., other RMW) as Category A waste. Mixed
waste streams that must be managed as Category A waste require significantly more resources
(e.g., storage areas, packaging materials, transportation capacity under waste hauling contracts,
disposal cost) than Category A waste streams that only contain Category A waste.
Planning for the amount of Category A waste likely to be generated. Hospitals that will
stabilize and transfer infectious patients to other facilities during infectious disease incidents
(including isolated cases or outbreaks) may generate relatively little Category A waste. Facilities
that are part of the U.S. Department of Health and Human Services (HHS) national network of
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
•
•
•
•
•
•
•
Regional Ebola and Other Special Pathogens Treatment Centers, including jurisdictional hospitals
and frontline facilities that augment regional centers, should have sufficient on-site treatment
capacity to inactivate the amount of Category A waste generated by their units.
Moving Category A waste within a facility. Use a pre-identified route from patient treatment
areas (or, in laboratories and other facilities, areas where Category A waste is generated) to a
secure storage location within the facility that serves as a waste holding area, either prior to
inactivation on-site or for storage prior to transport for off-site inactivation. Transport Category A
waste from the point of origin within the generating facility to a secure holding area with the use
of covered push carts, bins, or other leak-proof containers to ensure that there is no release or
spillage of the waste. Decontaminate the outside surfaces of all waste containers before moving
them. Avoid high-traffic areas or divert other traffic while Category A waste is being moved
through a particular area. Use designated elevators, such as freight elevators, if possible.
Cleaning up spills. Develop spill clean-up protocols, assemble spill clean-up kits, and train staff
on how to respond to and clean up spills consisting of blood, body fluids, and other potentially
infectious or contaminated materials within the facility. Spill clean-up kits typically contain
absorbent materials (such as clay cat litter or other absorbent granules), an appropriate
disinfectant, and tools for clean-up (including of bulk materials). Spill clean-up kits may also
include personal protective equipment (PPE) or other supplies workers may need to safely
manage spills.
Packaging waste for off-site treatment (if applicable). Section 6 – Waste Transporter
Information & Responsibilities discusses packaging requirements for Category A waste.
Treating waste on-site (if applicable). Section 7 – Waste Treatment Information and
Responsibilities discusses Category A waste treatment.
Storing packaged Category A waste containers prior to waste vendor transport. Facilities
should comply with any additional SLTT requirements for storage time, temperature controls, and
capacity. Emergency permits may be required for extended storage periods or to manage
increased volumes of waste. Consider measures for separating the areas for Category A waste
storage from other waste, locating the Category A wastes on impermeable/non-porous surfaces
(i.e., floors without carpet, cracks, or gaps) and providing protection and security against spillage,
weather, putrescence (i.e., rotting), pest infestation, trespassers, and theft. The waste holding area
should adequately accommodate the volume of packaged waste that may develop between waste
transport vendor pickups (e.g., 24-hour, 48-hour, or 72-hour intervals) and should be secure at all
times with access limited to authorized employees only. Employers must also follow applicable
U.S. Department of Labor (DOL)/OSHA requirements for signage and labeling (e.g., biohazard
signs). See 29 CFR § 1910.1030(g).
Transporting waste for off-site treatment. For any movement off-site, a detailed agreement or
contract should be in place with an entity that holds (i.e., has party status to) a DOT/Pipeline and
Hazardous Materials Safety Administration (PHMSA) special permit (SP). Facilities should have
contingency plans, such as for extended waste storage, in the event that transportation
infrastructure is compromised or a particular vendor is unable to immediately provide
transportation services.
Accepting waste from healthcare system partners. Smaller organizations, including ambulance
services and other medical transport providers, may not have fixed facilities and equipment for
properly managing Category A waste on their own. Category A waste generated in an ambulance
transporting a patient to a hospital may need to be left at the hospital to be packaged or treated.
(Medical transport providers and other entities outside of fixed facilities that may need to manage
Category A waste should work with healthcare system partners, as appropriate, to plan for and
safely conduct such activities.)
Collaborating with SLTT public health and environmental agencies. Entities planning for
Category A waste management activities should consider the extent to which pre-negotiated
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
•
•
working relationships or partnerships may facilitate safe waste management activities. Facility
leadership should work closely with SLTT health departments, environmental agencies, waste
management regulators, and other appropriate entities and officials to ensure that their plans for
managing waste do not conflict with any SLTT prohibitions related to the inactivation and
disposal of Category A waste. Additionally, facilities and their waste management contractors
should understand what requirements SLTT authorities may place on the transport of waste
within their jurisdictions.
Protecting worker health and safety, including by training staff. Section 9 discusses worker
health and safety considerations.
Exercising waste management plans. Exercises, and broader infectious disease incident
preparedness efforts, prepare teams (e.g., hospital and laboratory staffs) to respond effectively to
the situations for which plans are developed, and help identify weaknesses in planning efforts
before protocols must be implemented in response to real-world incidents.
Reviewing and updating plans. As facility needs, regulatory requirements, and other factors
change, facilities should regularly review and update their plans. Plans should also be updated to
reflect lessons learned from exercises or real-world response activities.
Jurisdictional Plans
SLTT government plans should include protocols that reflect the types of waste management needs and
challenges their jurisdictions may face. Plans may vary significantly depending on legal requirements,
capabilities, and infrastructure within a particular SLTT jurisdiction, as well as the scenario(s) on which
they are based. The presence of hospitals, laboratories, or other public facilities (e.g., airports, bus depots,
and train and rail stations) that may generate Category A waste; accessibility of facilities to treat and
dispose of waste; and other factors are likely to influence plans.
In developing waste management plans at the local level, governments may choose to utilize their existing
local emergency planning committees (LEPCs). Established under the Emergency Planning and
Community Right-to-Know Act (EPCRA), LEPCs develop emergency response plans, review those plans
at least annually, and provide citizens with information about potential hazards specific to the community.
To incorporate stakeholder input, LEPCs are comprised of
•
•
•
•
•
Elected state and local officials.
Police, fire, civil defense, and public health professionals.
Environment, transportation, and hospital officials.
Facility representatives.
Representatives from community groups and the media.
The local public health authority, in conjunction with SLTT health and environmental officials, needs to
direct the handling of Category A waste. The level of direction and support that waste generators require
may vary significantly, depending on the generators’ capabilities. For example, jurisdictions with a
Regional Ebola and Other Special Pathogens Treatment Center (RESPTC) or other specially-trained and
equipped facility12, as identified by the HHS/Assistant Secretary for Preparedness and Response (ASPR),
may need to provide less intensive support to such well-prepared entities compared to jurisdictions
12
U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response, Regional
Treatment Network for Ebola and Other Special Pathogens (Washington, DC, 2017),
www.phe.gov/Preparedness/planning/hpp/reports/Documents/RETN-Ebola-Report-508.pdf.
7
�Managing Solid Waste Contaminated with a Category A Infectious Substance
planning for Category A waste management at other frontline healthcare facilities. At a minimum, all
jurisdictions should be prepared to manage Category A waste generated in residential settings.
In a locality where a person is known or suspected to have a disease caused by a pathogen that is
classified as a Category A infectious substance, the SLTT public health authority is in the best position to
assess environmental contamination in residential environments and provide guidance about how to
manage waste associated with remediation activities. For example, when diseases caused by Category A
infectious substances are transmitted through contact with infectious body fluids, hard, non-porous items
such as furniture in a person’s residence can often be safely cleaned on-site using acceptable practices.13
When safe, on-site decontamination is not possible, such as for porous items, contaminated items should
be handled as Category A waste and packaged, transported, and treated off-site. The determination
whether the items are Category A waste or not is usually based on a variety of factors, including clinical
assessment of the patient (e.g., whether the patient has a suspected or confirmed diagnosis of a disease
caused by a Category A infectious agent), the types of materials contaminated and what they were used
for, and whether the items pose a public health risk. Section 5 – Waste Generator Information and
Responsibilities provides more information about classifying waste.
For most jurisdictions, plans may address:
•
•
•
•
Managing waste from residential environments. In some instances, the local health authorities
may recommend the use of a biohazard/environmental remediation company already under
contract to decontaminate the environment or transport safely packaged Category A waste from a
patient’s home to the hospital for safe processing. In other instances, they may initiate a separate
Category A waste transport contract. Contractors must transport Category A waste in full
compliance with the HMR or in compliance with a special permit, if applicable.
Containing and packaging Category A waste as close as possible to the point of generation.
If this cannot be accomplished due to space limitations, site-specific protocols should be
followed. Once primary waste containment has taken place, staff should refrain from opening
containers to manipulate waste unless handling is essential.
Storing packaged Category A waste containers prior to waste vendor transport, if
applicable. Localities should comply with any additional SLTT requirements for storage time,
temperature control, and volume. Emergency permits may be required for extended storage
periods or to manage increased volumes of waste. Consider measures for separating the areas for
Category A waste storage from other waste, locating the Category A wastes on impermeable
surfaces (i.e., non-concrete floors without carpet, cracks, or gaps) and providing protection and
security against spillage, weather, putrescence, pest infestation, and trespassers. The waste
holding area should adequately accommodate the volume of packaged waste that may develop
between waste transport vendor pickups (e.g., 24-hour, 48-hour, or 72-hour intervals) and should
be secure at all times with access limited to authorized employees only.
Identifying routes for transporting Category A waste for off-site treatment. Previous
incidents revealed that elected officials and their constituents were sometimes concerned about
the transport of Category A waste through their communities—in a few instances, to the point of
such officials prohibiting Category A waste from being transported along SLTT roadways.
Identifying acceptable routes and transportation support protocols, such as law enforcement
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, “Interim Guidance
for U.S. Residence Decontamination for Ebola and Removal of Contaminated Waste,” last modified March 2, 2015,
www.cdc.gov/vhf/ebola/prevention/cleaning-us-homes.html.
13
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
•
•
•
•
escorts, in advance of the need to move Category A waste will ensure that waste can be
appropriately transported for off-site inactivation and disposal as needed.
Coordinating with surrounding jurisdictions. Some SLTT governments may wish to align
their plans and protocols for managing Category A waste to ensure consistency between
neighboring jurisdictions. Coordinating with surrounding jurisdictions may also allow for prenegotiation of mutual aid agreements that may be useful in the event that an infectious disease
incident in a particular jurisdiction exceeds its capacity to respond without additional support.
Collaborating with potential waste-generating organizations within the jurisdiction.
Jurisdictions planning for Category A waste management activities should consider the extent to
which pre-negotiated working relationships or partnerships may facilitate safe waste management
actions. SLTT health and environmental officials may be involved in overseeing and coordinating
collection, storage, inactivation, transportation, and disposal of waste generated within their
jurisdictions. SLTT government agencies should communicate to facilities, medical transport
providers, and waste management contractors about any requirements they may place on the
transport of waste within their jurisdictions.
Protecting worker health and safety, including by training staff. Section 9 discusses worker
health and safety considerations.
Exercising waste management plans and protocols. Exercises, including as part of broader
infectious disease preparedness efforts, prepare teams (e.g., SLTT emergency responders, health
and environmental officials) to respond effectively to the incidents for which plans and protocols
are developed, and to help identify errors, threats, risks, weaknesses, and vulnerabilities in
planning efforts before protocols must be implemented in response to real-world incidents.
Reviewing and updating plans and protocols. As jurisdictional needs, regulatory requirements,
and other factors change, SLTT governments should regularly review and update their plans and
protocols. These should also be updated to reflect lessons learned from exercises or real-world
response activities as well as risk, threat, and vulnerability assessments.
4. FEDERAL GOVERNMENT ROLES & RESPONSIBILITIES
Various aspects of managing Category A waste are regulated by several different agencies, including
DOT/PHMSA and the DOL/OSHA. (Note: Category A waste is also subject to SLTT environmental and
health regulations. There may also be overlap between requirements for managing Category A waste from
laboratories and the federal select agent regulations of HHS/Centers for Disease Control and Prevention
(CDC) at 42 CFR parts 72 and 73 and U.S. Department of Agriculture (USDA) at 7 CFR part 331 and 9
CFR part 121.) In addition, facilities that inactivate Category A waste on-site (i.e., at the point of
generation) are subject to the DOT HMR requirements for packaging, handling, and transporting these
wastes before inactivation occurs, as well as for training and certifying staff responsible for those
activities.
Regulatory Requirements
U.S. Department of Transportation
The DOT HMR (49 CFR parts 171-180) apply to waste contaminated (or suspected by the offeror14 to be
contaminated) with any Category A infectious substance. Appendix B – Infectious Agent Categorization
provides examples of Category A infectious substances. As noted in Section 2, infectious substances
14
For more information, see definition of “offeror” in Glossary of Terms.
9
�Managing Solid Waste Contaminated with a Category A Infectious Substance
labeled “cultures only” in the appendix are only considered Category A when a pathogen(s) is
intentionally propagated. In these cases, the Category A infectious substance HMR apply to some
laboratory-generated materials (i.e., cultures) but not to patient specimens that are not cultured nor to
waste from patients. PHMSA is responsible for regulating and advancing the safe and secure
transportation in commerce15 of hazardous materials across all modes of transportation.
For Category A infectious substances in the United States, HMR classification criteria and packaging
requirements are consistent with international standards, which follow criteria developed by the United
Nations (UN) Subcommittee of Experts, working with the World Health Organization (WHO), CDC,
medical professionals, microbiologists, transportation professionals, and packaging technical experts. The
criteria are also consistent with the requirements contained in the 20th edition of the United Nations
Recommendations for the Transport of Dangerous Goods, the 2017–2018 edition of the International
Civil Aviation Organization (ICAO) Technical Instructions for the Safe Transport of Dangerous Goods
by Air, and the International Maritime Organization Dangerous Goods Code.16
Whenever transporting Category A waste involves steps that are not covered by the HMR, such as the use
of alternative packaging materials, a special permit is required. DOT/PHMSA has the primary
responsibility for the issuance of DOT special permits and approvals to the HMR.
The solid waste generated in a local area (e.g., in a residential environment prior to an infected person’s
hospital admission) or in the care of persons with suspected or known exposure to a Category A
infectious substance and wastes from laboratories that are contaminated with Category A infectious
substances from intentionally propagated pathogen cultures are also subject to procedures set forth by
federal and SLTT requirements.17 Wastes from non-Category A infectious substances must also be
managed in ways that meet applicable federal and SLTT requirements.
U.S. Department of Labor/Occupational Safety and Health Administration
Throughout the waste lifecycle, DOL/OSHA requires employers to protect workers from workplace
safety and health hazards. A variety of such hazards are associated with managing Category A waste,
including pathogens and sharps in the waste itself and chemicals used to treat the waste and clean
environments and equipment. OSHA standards for bloodborne pathogens (BBP, 29 CFR § 1910.1030),
PPE (29 CFR 1910 subpart I), and hazard communication (29 CFR § 1910.1200), as well as other OSHA
15
For more information, including governmental exemptions, see definition of “in commerce” in Glossary of Terms.
16
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration, Transporting
Infectious Substances Safely (Washington, DC, 2020), https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/202004/Transporting-Infectious-Substances-Safely.pdf.
17
In the case of an incident resulting from suspected or actual terrorism or other criminal activity, certain solid
waste, including Category A waste, may be considered as evidence. (The Attorney General, generally acting through
the Federal Bureau of Investigation (FBI) Director, will determine whether a particular situation will be treated as an
actual terrorist incident.) The FBI has primary responsibility to conduct, direct, or oversee crime scenes, their
security, and evidence management, through all phases of the response.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
requirements may apply during various waste management activities.18 For additional information, see
Section 9 – Protecting Worker Health and Safety of this guidance.
U.S. Environmental Protection Agency
The EPA sets and enforces federal hazardous waste regulations under the RCRA. As a general matter,
under RCRA and the majority of state and territorial programs, waste is categorized as either “hazardous
waste” or “nonhazardous (or solid) waste.” Importantly, the federal hazardous waste regulations under the
RCRA do not classify a waste as “hazardous” based on a waste’s infectious nature (though SLTT
hazardous waste regulations may be more stringent or broader in scope than federal regulations).
However, the waste could still be hazardous as defined under RCRA regulations due to the nature of the
contaminated material (e.g., presence of certain toxic metals or chemicals, such as solvents). This
determination (i.e., hazardous versus non-hazardous) under the RCRA is independent of the presence or
absence of infectious agents. Under EPA requirements, waste generators are responsible for determining
if waste is hazardous waste.
Federal Select Agent Program
Some agents are regulated by the HHS/CDC and USDA Federal Select Agent Program (7 CFR part 331,
9 CFR part 121, and 42 CFR part 73). These biological agents and toxins must be inactivated or destroyed
before final disposal or, in most cases, prior to being transferred as outlined in Section 16 of the federal
select agent regulations. Wastes generated during the treatment of patients infected with a select agent
identified as a Category A infectious substance by the HMR (e.g., Ebola viruses, Marburg viruses, Lassa
fever virus) are not subject to the federal select agent regulations as long as the material has been
subjected to decontamination or a destruction procedure (See the exclusion provision 42 CFR §§
73.3(d)(3) and 73.4(d)(3))).
Non-Regulatory Activities
U.S. Environmental Protection Agency
The EPA generally does not regulate medical waste itself. However, federal regulations establish
minimum criteria for facilities that accept waste for ultimate disposal. See Appendix A – Additional
Resources for further information.
U.S. Department of Health and Human Services
HHS/CDC and HHS/ASPR provide technical guidance for managing Category A waste. See Appendix A
– Additional Resources for more information.
5. WASTE GENERATOR INFORMATION & RESPONSIBILITIES
Managing Category A waste at the point of generation requires a multi-pronged approach that includes
waste minimization, proper classification, and appropriate storage (i.e., a secure location and segregation
from other wastes). These considerations apply regardless of whether a person with an infection caused
18
Bloodborne Pathogens, 29 CFR § 1910.1030 (2012); Personal Protective Equipment, 29 CFR part 1910 subpart I
(2016); Hazard Communication, 29 CFR § 1910.1200 (2013).
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
by a Category A agent creates waste in the residential environment before hospital admission, medical
treatment or transport generates the Category A waste, or Category A waste results from laboratory work
or other activities. The following information is critical for generators of waste. Additional information
about managing waste at its point of generation can also be found in the appendices of this document,
including Appendix D – Questions and Answers.
Waste Minimization and Segregation
As described previously, take steps to minimize the amount of Category A waste generated. Category A
waste may be physically separated, if practical, from other solid waste when it is generated, before the
two waste streams have been mixed. When mixed together, manage Category A waste and other solid
waste (e.g., other RMW) as Category A waste. Mixed waste streams that must be managed as Category A
waste may require significantly more resources (e.g., packaging materials, storage areas, transportation
capacity under waste hauling contracts) than Category A waste streams that only contain materials that
actually need to be managed as Category A waste.
Managing Large Amounts of Waste Associated With Patient Care Activities
Care of patients known or suspected to have diseases caused by a Category A infectious substance can result in
substantial amounts of waste. During the 2014 Ebola outbreak, patient care activities sometimes resulted in
more than ten 30-55-gallon packages a day due to the amounts of PPE required for hospital staff. Hospital
protocols should consider and address limiting the amount of waste generated by keeping infectious and noninfectious wastes separate and bringing only essential items directly needed for care into a patient room. Doing
so limits the volume of items in the contaminated area, thereby limiting the volume of items that will
ultimately require inactivation and disposal. As an example, where possible, hospital staff can remove all outer
wraps on pre-packaged kits or remove any internal packaging. Special attention should also be directed at
protecting large items (e.g., mattresses) from gross contamination through the use of protective coverings.
When care of the patient is complete, the protective covering is disposed of using the Category A waste
protocol. The mattress can then be cleaned using the facility’s existing procedures for terminal cleaning (i.e.,
for materials that do not need to be managed as Category A).
Regardless of whether Category A waste is generated in hospitals, laboratories, residences, ambulances,
or other settings, it is critical that facility staff, emergency responders, remediation contractors, and others
handling the waste be made aware of the ultimate treatment method for the waste and its implications for
what types of materials can be processed safely. No matter whether waste will be inactivated on-site or
transported for off-site inactivation, staff should be cognizant of the materials going into waste streams
since the operators of downstream treatment equipment (e.g., autoclaves, incinerators) will be unable to
segregate or separate materials within Category A waste. Materials that might cause problems with
inactivation processes (e.g., batteries or electronics) should be separated from the remaining waste at the
point of generation, and staff can select alternate treatment/disposal pathways for such components.
Waste that presents explosive hazards (e.g., batteries, sealed containers or oxygen cylinders) may require
special handling. During an incident resulting in Category A waste, there should be routine
communication among staff and the operators of downstream treatment equipment to ensure they are
following the optimal procedures for managing waste. Information and training on these considerations
should be part of the overall waste management plan, both for facility- and jurisdiction-level plans.
Determining Classification and Handling of Waste
For transportation under the HMR, it is the offeror’s responsibility to classify hazardous materials,
including infectious substances. This classification determines how the material must be packaged for
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
transport. The offeror must ensure and arrange for training and testing in accordance with the
requirements of the HMR for any employee classifying a hazardous material or performing any function
subject to the requirements of the HMR.19
Difference between the Terms “Offeror” and “Generator”
This document discusses individuals and entities who produce waste as “offerors” and “generators” in various
contexts.
As defined in the Glossary of Terms, an offeror is a person who performs or is responsible for performing any
pre-transportation function required under the HMR for transportation of a hazardous material in commerce
and/or who tenders or makes the hazardous material available to a carrier for transportation in commerce.
A generator is a person whose act or process produces (i.e., generates) a waste, and this term generally
provides a way to describe waste generators irrespective of what type of waste they produce (e.g., solid,
infectious, hazardous, etc.). Under RCRA subtitle C, hazardous waste generators have specific requirements
they must adhere to both for managing their hazardous waste on-site, as well as for ensuring proper
management off-site.
In some instances, these terms may be interchangeable, as the same person or persons may generate and offer
waste. However, this document also describes responsibilities specific to the offeror under the HMR and to the
generator under RCRA regulations.
Hazardous material classification should involve consultation with the generator or the group with the
best knowledge of the situation in which the waste was created. For healthcare facilities, this group would
include infectious disease personnel working in collaboration with relevant SLTT public health,
environmental, and/or waste management authorities. In turn, local governments should engage SLTT
public health and waste management authorities to make these decisions in the most informed manner
possible. Classification of an infectious substance is typically based on the source’s (e.g., human, animal)
medical history or symptoms (if applicable), laboratory processes that generated the material, endemic
local conditions, and/or professional judgment concerning the individual circumstances of the source.
When managing potentially infectious waste from patients, classification usually involves consideration
of clinical assessment of the patient (e.g., whether the patient has a suspected or confirmed diagnosis of a
disease caused by a Category A infectious agent) and whether the items pose a public health risk.
Typically, anything that comes into contact with or that is contaminated with body fluids from patients
with a disease caused by a Category A infectious substance (other than those designated as “cultures
only” in Appendix B – Infectious Agent Categorization) is classified as Category A waste. However, this
precautionary approach may increase the volume of waste that must be managed as Category A. In any
case, once an offeror classifies a material as Category A waste, it must be classified as UN 2814,
infectious substances, affecting humans.
Separately from classification under the HMR, it is the generator’s responsibility to make an accurate
waste determination under RCRA.20 Determinations as to whether waste is hazardous inform how and
19
Hazardous Materials Regulations, 49 CFR § 172.702 (1996).
As mentioned elsewhere in the text, the RCRA hazardous waste regulations do not classify a waste as “hazardous”
based on its infectious nature (though SLTT regulations may be more stringent or broader in scope). However, the
waste could still be defined as RCRA hazardous due to the presence of certain toxic metals or other chemicals.
20
13
�Managing Solid Waste Contaminated with a Category A Infectious Substance
where the waste will be disposed and whether treatment under the RCRA Land Disposal Restrictions
(LDRs) is necessary or otherwise required prior to disposal.
Consultation between waste offerors and generators, if separate and distinct from each other, helps to
facilitate the waste’s classification as a Category A substance under the HMR and/or as hazardous under
the RCRA, as appropriate. Collaboration between offerors and generators also helps to ensure that waste
can be effectively and efficiently managed.
There may be multiple steps in the waste lifecycle involving waste generators. For example, some off-site
treatment facilities generate incinerator ash as part of waste treatment. As generators, they must make
accurate determinations for any residuals and determine how and where that waste will be disposed.
Waste offerors and generators must also comply with applicable SLTT public health, environmental,
waste management, and other regulations.
Considerations for Waste Generators Planning to Ship Waste Off-Site for Inactivation
Waste generators who anticipate the possibility of sending waste off-site should plan in advance for its
transportation. Under most circumstances, such planning should include a pre-arranged contract(s) with a
qualified waste hauler(s) and protocols for properly packaging any waste to be transported off-site.
Arranging Waste Transportation
Most hospitals, laboratories, and other entities that generate Category A waste, including those that
manage such waste as part of environmental remediation efforts in residential or other environments,
should have detailed agreements or contracts in place with a waste hauler that holds (i.e., has party status
to) a DOT/PHMSA special permit for the specific type of waste that will be moved. When making
transportation arrangements, entities generating waste must ensure that any company considered for a
contract has proper training, equipment, and supplies for safely handling Category A waste. Such
companies must be able to comply with the HMR, including as discussed in Section 6 – Waste
Transporter Information and Responsibilities.
Note that transportation of a hazardous material in a motor vehicle, aircraft, or vessel operated by a SLTT
government employee solely for noncommercial federal or SLTT government purposes is not considered
to be “in commerce” and so is exempt from the HMR under 49 CFR § 171.1(d)(5).15 Note, however, that
when more stringent, agency-specific policies exist for a federal or SLTT department, agency, or
organization, that department, agency, or organization must follow the more stringent requirement and
comply with the HMR, as appropriate. For example, U.S. Department of Defense (DoD) personnel
transporting Category A waste must follow Defense Transportation Regulation (DTR) 4500.9-R, Part II,
Chapter 204. Similarly, SLTT personnel transporting waste must follow their own SLTT medical waste
regulations.
Facilities inactivating waste on-site should also plan for managing the residuals, including materials that
have been inactivated through autoclaving or ash from on-site incinerators. After proper treatment (as
described in Section 7 – Waste Treatment Information and Responsibilities), waste no longer contains
pathogens capable of causing disease (i.e., is not infectious), does not pose a health risk from biological
agents, and is not considered to be RMW10 or a hazardous material21 (unless other types of regulated
21
For more information, see definition of “hazardous material” in Glossary of Terms.
14
�Managing Solid Waste Contaminated with a Category A Infectious Substance
hazardous materials, such as chemicals, are present) under federal and SLTT laws and regulations.
However, additional SLTT requirements may govern transportation and disposal of these types of
materials.
All facilities relying on waste management companies to transport waste away from their on-site storage
areas should maintain contingency plans, such as for extended waste storage, in the event that
transportation infrastructure is compromised or a particular vendor is unable to provide transportation
services on schedule.
Packaging Category A Waste
The HMR require that all hazardous materials are properly packaged and labeled by a properly trained
person, according to the regulations’ packaging requirements. Under special circumstances, the DOT may
issue a special permit that allows for alternative packaging compared to what the HMR otherwise require.
This packaging must be equal to or greater in safety to what the HMR require. When alternative
packaging is needed (e.g., when required packaging is not feasible for large volumes of waste or when
required packaging materials are not available for purchase on the market), DOT can issue a special
permit.22 Issued under the authority of 49 USC § 5117, special permits allow a person to perform a
function that is not otherwise permitted under the HMR.
Although complying with the stowage and handling requirements of special permits is the responsibility
of waste transporters (sometimes called “haulers” or “carriers”), proper waste packaging starts at the point
of generation and in conjunction with hazardous materials classification (as required by the HMR),
hazardous waste determinations (as required under the RCRA), and waste segregation, as described
above. Facilities and jurisdictions planning for off-site transportation of waste should work with the waste
management contractors they select to identify proper, HMR- or special permit-compliant packaging for
the types of waste they anticipate generating or managing.
DOT provides guidance on how to use the HMR, which explains how to identify packaging requirements
for infectious substances in the regulations, at
hazmatonline.phmsa.dot.gov/services/publication_documents/howtouse0507.pdf. A searchable database
of special permits, which include specific packaging requirements, is also available at:
www.phmsa.dot.gov/approvals-and-permits/hazmat/special-permits-search. Question 6 in the
22
In some cases, packaging manufacturers may be able to produce larger, non-bulk packages that meet the HMR
requirements at 49 CFR § 178.609 or larger packaging that meets the requirements of 49 CFR subparts P and Q. The
availability of such packaging pay eliminate the need for a special permit.
15
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Waste Transportation Questions & Answers section of Appendix D – Questions and Answers provides
additional information about this topic.
It is critical for facilities and jurisdictions to train their workers on the requirements of proper packaging
prior to the waste being generated. Specialized protocols for packaging Category A waste, including any
packaging specifically approved through a special permit, may differ from the packaging requirements for
RMW that healthcare workers use routinely. Employers must ensure that workers packaging waste at its
point of generation can do so safely and in compliance with the HMR and OSHA’s Bloodborne
Pathogens (29 CFR § 1910.1030) and other standards. Particularly with respect to the HMR, working
with a qualified waste transporter can help waste generators understand exactly what needs to be done to
ensure compliance with applicable laws and regulations and to ensure the safety of their workers, the
public, and the environment.
6. WASTE TRANSPORTER INFORMATION & RESPONSIBILITIES
Whenever Category A waste, as determined by an offeror, cannot be inactivated on-site, waste
generators—including hospitals; laboratories; other types of facilities; environmental/biohazard
remediation companies; and federal and SLTT government agencies not transporting the waste
themselves in a non-commercial capacity—will need to work with a qualified transporter (sometimes
called “haulers” or “carriers”) to ship the waste off-site for treatment (i.e., inactivation) and ultimate
disposal. Transporters must ensure that they comply with all DOT regulations, particularly the HMR,
during the transportation of Category A wastes to protect the health and safety of their employees, the
public, and the environment. This section discusses the general HMR requirements for transporters.
Additional information is also available in the appendices of this document, including Appendix D –
Questions and Answers.
As this guidance has explained, the HMR regulate infectious substances as hazardous materials. The
HMR apply to transportation of any material that DOT determines is capable of posing an unreasonable
risk to health, safety, and property when transported in commerce. DOT/PHMSA regulates movement of
hazardous materials across all modes of transportation; and an infectious substance (e.g., Category A
waste) must conform to all applicable HMR requirements when offered for, or actually transported by,
air, highway, rail, or water.23
The HMR provide clear regulations for classification, packaging, and communication procedures for
Category A infectious substances.24 Category A waste may only be transported in two scenarios: in full
compliance with classification and packaging requirements of the HMR, or under the terms of a DOT
special permit. The latter scenario allows for transportation of the waste in a manner that deviates from
conventional, established HMR methods (e.g., using alternative packaging). A searchable database of
special permits is available at: www.phmsa.dot.gov/approvals-and-permits/hazmat/special-permitssearch.
23
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration, Transporting
Infectious Substances Safely (Washington, DC, 2020), https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/202004/Transporting-Infectious-Substances-Safely.pdf.
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration, “Department of
Transportation Guidance for Transporting Ebola Contaminated Items, a Category A Infectious Substance,” modified
July 18, 2017, www.phmsa.dot.gov/transporting-infectious-substances/packaging-ebola-contaminated-waste.
24
16
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Although the overall management of Category A waste and best practices for complying with the HMR or
a DOT special permit begin prior to the generation of the waste, the HMR primarily regulate waste
transportation and storage. The HMR continue to apply throughout transportation and storage, until waste
is no longer infectious (i.e., it has been inactivated).
Interstate and Intrastate Movement
The HMR apply to the transportation of hazardous materials in interstate (i.e., between states) or intrastate
(i.e., within the same state) commerce, which includes the movement of the hazardous material, as well as
its loading, unloading, or storage. This is a preemptive regulation that applies regardless of the state in
which the waste originated or to which it travels.
SLTT governments may have additional requirements for infectious waste transportation. Transporters
and others involved in managing Category A waste must comply with any applicable requirements in the
jurisdictions in which they operate. Individual SLTT governments may have additional licensing or
approval requirements for infectious waste transporters.
Exemptions from Hazardous Materials Regulations
For waste generated by patients in transportation, several exceptions may apply. The HMR do not apply
to the patients themselves, but may apply to waste created during transport. Transportation of Category A
waste as part of air ambulance operations is exempt from the HMR.25 A similar exception applies to waste
transported during motor vehicle ambulance operations under 49 CFR § 177.823(a)(3). After the patient
exits the aircraft or motor vehicle, the waste is subject to the HMR. The HMR also provides exceptions
for hazardous materials transported under the direct supervision of the DoD or the U.S. Department of
Energy (DOE) for the purpose of national security, and for air transport by an aircraft under the exclusive
direction and control of the government under 49 CFR § 173.7.26
If government employees transport the waste for destruction, the transportation would be excepted
because the HMR do not apply to the transportation of hazardous materials in a motor vehicle, aircraft, or
vessel operated by a government employee solely for noncommercial, government purposes.27 If
contractors transport the waste, the transportation would be subject to the HMR unless they qualify for
one of the exceptions above. In most cases a contractor would need to apply for a special permit.
Packaging, Labeling and Shipping Papers
The HMR require that all hazardous materials, including Category A waste, are properly packaged and
labeled according to the packaging requirements outlined in the regulations. All transporters must comply
with the HMR. As stated above, wastes that are suspected or known to be contaminated by Category A
infectious substances are a hazardous material. As such they may only be transported in two scenarios: in
25
Hazardous Materials Regulations, 49 CFR § 175.1(d) (2016).
26
An aircraft is under the exclusive direction and control of a government when the government exercises
responsibility for: (1) Approving crew members and determining they are qualified to operate the aircraft; (2)
Determining the airworthiness and directing maintenance of the aircraft; and (3) Dispatching the aircraft, including
the times of departure, airports to be used, and type and amount of cargo to be carried. See Hazardous Materials
Regulations, 49 CFR § 173.7(f) (2018).
27
Hazardous Materials Regulations, 49 CFR § 171.1(d)(5) (2018).
17
�Managing Solid Waste Contaminated with a Category A Infectious Substance
full compliance with classification and packaging requirements of the HMR, or under the terms of a
special permit as outlined in this section.
Under special circumstances, DOT may issue a special permit that allows for alternative packaging
compared to what the HMR require. Issued under the authority of 49 USC § 5117, special permits allow a
person to perform a function that is not otherwise permitted under the HMR. With respect to packaging
for Category A waste, packaging authorized under a special permit must be equal to or greater in safety to
what the HMR would ordinarily require. Although complying with the stowage and handling
requirements of special permits is the responsibility of waste transporters, proper waste packaging starts
at the point of generation and in conjunction with hazardous waste classification (as required by the
HMR) and hazardous materials determinations (as required under the RCRA) and waste segregation, as
described in Section 5. Waste transporters should work with their clients (i.e., offerors of Category A
waste) to ensure use of proper, HMR- or special permit-compliant packaging for the types of waste they
have been contracted to transport. Transporters also should contact and work closely with DOT to ensure
that all of the most current procedures are being followed.
DOT may make modifications to the special permit and may or may not approve transporters to use the
special permit. If a transporter wishes to be party to the special permit, it must apply for party status with
DOT before transporting any waste to which the special permit applies. DOT issues special permit party
status letters to approved transporters. That status is usually granted for two years, but may vary under
special circumstances. If a transporter chooses to have alternative packaging to what is in the current
special permit, it may apply for its own special permit.
The HMR also require that all hazardous materials are accompanied by a shipping document that provides
information on the type of hazardous material in the vehicle transporting it. A shipping document must
accompany all Category A infectious substances being transported in commerce.
Transporters should work closely with SLTT health departments, environmental agencies, waste
management regulators, and other appropriate entities and officials to ensure that their plans for managing
waste do not conflict with any SLTT prohibitions related to the inactivation and disposal of Category A
waste. Additionally, waste transporters and their clients (i.e., offerors of Category A waste) should
understand what requirements SLTT authorities may place on the transport of waste within their
jurisdictions.
Transporting Select Agents
Select agents are a subset of biological agents and toxins that HHS and USDA have determined have the
potential to pose a severe threat to public health and safety, to animal or plant health, or to animal or plant
products. The table in Appendix B – Infectious Agent Categorization includes select agents.
Importation and interstate shipment involving select agents is regulated by HHS and USDA through their
select agent regulations (7 CFR part 331, 9 CFR part 121, and 42 CFR part 73). The Animal and Plant
Health Inspection Service (APHIS)-CDC Form 2, Request to Transfer Select Agents and Toxins, is used
to request prior authorization of a transfer of select agent from the Federal Select Agent Program.
7. WASTE TREATMENT INFORMATION & RESPONSIBILITIES
All facilities and jurisdictions planning for managing Category A waste should consider how any waste
they generate and/or offer for transport will be treated (i.e., inactivated). A variety of options exist for
waste inactivation, including autoclaving, incineration, and, in certain circumstances, chemical
18
�Managing Solid Waste Contaminated with a Category A Infectious Substance
alternatives. Depending on facility or jurisdiction capabilities, the volume of waste needing treatment, and
other factors, these options may be deployed on-site (i.e., where the waste is generated) or off-site (e.g., at
specialized waste management contractors’ facilities). This section discusses considerations for several
possible scenarios involving these treatment modalities in the context of both on- and off-site treatment.
The tool in Appendix C – Decision Matrix for Waste Treatment also traces key decisions in the treatment
and the ultimate disposal of waste, including for waste treated on-site and for waste that cannot be treated
on-site.
Whenever possible, on-site treatment is highly recommended since off-site treatment may increase risk to
staff, waste handlers, and the public due to the additional steps that need to be taken to package, transport,
and inactivate the waste off-site. If a hospital, laboratory, or other facility has on-site treatment
capabilities for inactivation, those processes should be validated and periodically tested to ensure they
function properly—and will continue to do so during an infectious disease event that will result in
Category A waste. Validation is the responsibility of the equipment operator and may be an SLTT
requirement.
When on-site treatment is not an option, facilities and jurisdictions need to identify waste management
contractors capable of transporting and treating waste off-site, ideally in advance of the need for such
services. Section 5 discusses selecting a waste management contractor(s).
A waste management plan that considers on-site incineration should include a method for disposing of
residuals (e.g., ash, autoclaved materials). Ultimately, management of residuals from an effective
treatment operation should include testing the materials and making a determination about how and where
such waste should be disposed. See the discussion of waste determinations in Section 5. Residuals from
Category A wastes that have been fully inactivated either through autoclaving, incineration, or alternative
methods described in this section are no longer infectious and should be disposed of in accordance with
the applicable SLTT regulations. Section 8 – Final Disposal Information & Responsibilities discusses
disposal in more detail.
Waste inactivation methods
Autoclaving
Category A waste can be inactivated using an autoclave operating within permitted parameters as outlined
by the manufacturer and validated by the operator. An autoclave uses saturated steam under pressure to
heat materials to a high enough temperature for a long enough period of time to inactivate the pathogen(s)
of concern in the waste. Such time and steam pressure conditions will ensure that the waste material is no
longer infectious, does not pose a health risk, and is not considered RMW or a hazardous material under
federal law or SLTT requirements (unless other types of regulated hazardous materials, such as
chemicals, are present). Some infectious agents (e.g., prions, spores, and pathogens within biofilms) are
particularly stable in the environment and difficult to inactivate.
Autoclave operators should validate that their waste inactivation procedures meet required performance
standards as outlined by the manufacturer or any applicable SLTT requirements and effectively inactivate
pathogens of concern, including achieving certain exposure time and temperature requirements,
acceptable results on biological indicators (e.g., spores) or other test assays, and allowable concentration
of certain pollutants or contaminants in any effluent or other by-product of the process. For example, staff
should check the autoclave cycles frequently with validated biological indicators (such as commerciallyavailable spore-ampoule systems) placed in simulated locations to ensure adequate steam penetration
19
�Managing Solid Waste Contaminated with a Category A Infectious Substance
within the waste as a quality assurance measure to show that the waste treatment cycles are achieving
desired results.28
Autoclave cycle parameters may also vary significantly depending on the types, conditions, and amounts
of materials being autoclaved. For instance, frozen laboratory specimens or large volumes of liquid may
require longer cycle times or changes to other autoclave settings.
Many organizations require autoclaves to be inspected annually by professionals to ensure proper
operation and maintenance. Autoclave operators should keep records that include details of all autoclave
runs, biological indicator test results, maintenance, and repairs.
Incineration
Incineration is a thermal method of treatment using combustion to reduce waste to ash and flue gases.
Medical incinerators with dual chambers run at extremely high temperatures, well above the relatively
low temperatures needed to kill (i.e., inactivate) most Category A organisms. Incineration, if available onsite and properly permitted, would be the best method for large or bulky items, such as mattresses (though
consideration should be given to whether there are size limits for on-site incinerators) that may be
associated with terminal (i.e., final) cleaning after hospital patient discharge or residential environmental
remediation activities. Incineration that reduces waste to ash at any temperature inactivates almost all
infectious substances (except prions, as noted previously), including those classified as Category A.
Combustion at or above 1,000°C/1,832°F is necessary to destroy prion infectivity.
EPA regulates HMIWI under the Clean Air Act (CAA). These facilities require permitting and specialized
equipment for the combustion of the waste and the proper management of the remaining air or flue gases
to ensure safe emissions. Considering the CAA’s HMIWI regulations, it will be unlikely that hospitals
would install incinerators in anticipation of managing Category A waste on-site. However, such facilities
should work closely with the SLTT air permitting departments if they determine this is an option they
would like to pursue. Commercial waste management companies in the United States continue to operate
some incineration facilities capable of (i.e., with the capacity to and proper permits for) inactivating
Category A waste.
Alternative Methods
Other validated methods of waste treatment (e.g., chemical disinfection) may be necessary when
operational constraints, such as those associated with patient care activities outside of fixed hospital
facilities, preclude the use of autoclaves or incinerators. Chemical disinfection is commonly used for
surface decontamination. When waste includes body parts, tissues, organs, or other such materials (i.e.,
anatomical waste) from humans or animals, alkaline hydrolysis digesters (i.e., tissue digesters) may be an
appropriate alternative method.29 However, such alternative methods should be supported by objective
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, “Information on the
Survivability of the Ebola Virus in Medical Waste,” modified February 12, 2015,
www.cdc.gov/vhf/ebola/healthcare-us/cleaning/ebola-virus-survivability.html.
28
Ingrid H. Franke-Whittle, and Heribert Insam, “Treatment Alternatives of Slaughterhouse Wastes, and Their
Effect on the Inactivation of Different Pathogens: A Review,” Critical Reviews in Microbiology 39, no. 2 (2013):
139-151, www.ncbi.nlm.nih.gov/pmc/articles/PMC3622235/; World Health Organization, Global Healthcare Waste
Project, “Non-Incineration Treatment and Disposal of Healthcare Waste,” modified October 2016,
www.who.int/water_sanitation_health/facilities/waste/module15.pdf.
29
20
�Managing Solid Waste Contaminated with a Category A Infectious Substance
data that demonstrate their effectiveness at inactivating waste and that are acceptable to appropriate
regulatory authorities, including at the SLTT levels. Users of these alternative methods may need to
consider worker health and safety issues; the potential for triggering other federal environmental (e.g.,
under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA)), safety, and health regulations;
and the need to manage residuals from such methods.
Additional considerations
Activities and processes associated with inactivating Category A waste may be subject to other federal
(e.g., OSHA) and SLTT requirements. For instance, employers may be required to provide training and
implement controls, including PPE, to protect workers operating autoclaves. Employers may also need to
take steps to protect workers who manage residuals from waste treatment processes, as these workers can
still be injured by sharps, broken glass, or other items that, while sterile (i.e., not infectious) after
autoclaving, can cause cuts or puncture wounds. Worker health and safety is specifically addressed in
Section 9 – Protecting Worker Health and Safety.
It is critical that staff handling Category A waste be made aware of the ultimate treatment method for the
waste. No matter whether waste will be inactivated on-site or transported for off-site inactivation, staff
should be cognizant of the materials going into waste streams, as the operators of downstream treatment
equipment (e.g., autoclaves, incinerators) will be unable to segregate or separate materials within
Category A waste. Materials that might cause problems with inactivation processes (e.g., batteries or
electronics) should be separated from the remaining waste at the point of generation, and staff can select
alternate treatment/disposal pathways for such components. Waste that presents explosive hazards (e.g.,
batteries, sealed containers, or oxygen cylinders) may require special handling. During an event, there
should be routine communication among staff and the operators of downstream treatment equipment to
ensure they are following the best procedures for managing waste. Information and training on these
considerations should be part of the overall waste management plan, both for facility- and jurisdictionlevel plans.
Considerations for On-Site Inactivation
Facilities, including hospitals and laboratories, without organic autoclave capability of sufficient capacity
could consider portable, industrial autoclaves, which are available through waste management
contractors. These portable autoclaves can be delivered to a critical location and can handle larger
quantities of waste than most hospital autoclaves usually can. Challenges to these operations include
resources for hooking up gas, water, and electrical supplies, as well as managing effluent (e.g., liquid
discharge) from portable equipment. For example, in-line filters on the liquid exhaust may be suggested
for some types of Category A waste. Care should be taken in the selection of an autoclave to ensure that
the type of autoclave is appropriate for the waste and that all safety guidelines are followed. Treatment
parameters for portable autoclaves should also be validated prior to use on particular wastes.
Facilities that have autoclave units intended for typical medical, laboratory, or other wastes should test
surrogate waste in advance of an event to ensure that the parameters being used are sufficient for the
potential change in waste streams (e.g., more PPE, different materials, etc.). These facilities should check
to see if there are any prohibitions against their autoclave operation and discuss this with SLTT
environmental or health department in the jurisdiction in which they operate. They should also ensure
they have sufficient capacity to handle any increase in waste volume associated with an infectious disease
event that results in Category A waste.
Whenever Category A waste is moved for inactivation within a facility, waste management plans should
address how such movement will be accomplished. For example, identify a route from patient treatment
21
�Managing Solid Waste Contaminated with a Category A Infectious Substance
areas (or, in laboratories and other facilities, areas where Category A waste is generated) to a secure
storage location within the facility that serves as a waste holding area prior to inactivation on-site. If
reusable carts are used to move the waste, plans should provide for setting up a decontamination area
where the waste is transferred to the treatment system.
Hospitals that have in-unit (i.e., in special pathogen patient care areas) autoclaves should run and test
equipment periodically if it is not in continuous use.
Considerations for Off-site Inactivation
It is highly recommended that Category A wastes be treated on-site whenever possible. If Category A
wastes cannot be inactivated on-site, then the wastes will need to be transported off-site. Off-site
transportation requires additional steps and compliance with specific regulations as described in the next
section.
Whenever Category A waste is moved for packaging and storage within a facility prior to being
transported off-site for inactivation, waste management plans should address how such movement will be
accomplished. For example, identify a route from patient treatment areas (or, in laboratories and other
facilities, areas where Category A waste is generated) to a secure storage location within the facility that
serves as a waste holding area prior to off-site transportation. If reusable carts are used to move the waste,
plans should provide for setting up a decontamination area where the waste is transferred to the storage
area.
Packaging Requirements for Category A Wastes, Including DOT Special Permits
Packagings for Category A waste are almost exclusively designed to transport small samples between
laboratories, and are not adequate to move large volumes of waste. In 2014, in order to facilitate movement of
large volumes of Ebola contaminated waste, a Category A infectious substance, DOT issued a special permit to
authorize alternative packagings, subject to additional operational controls. Packaging manufacturers may be
able to produce larger non-bulk packages that meet the requirements of 49 CFR § 178.609 or make large
packaging in accordance with 49 CFR subparts P and Q.
Autoclaving
Commercial autoclave processing facilities are typically permitted by the SLTT environmental or health
department in the jurisdiction in which they operate. These facilities are required to have operating plans
or permits that outline how the facility will operate and the types of wastes they are permitted to treat.
These plans should include controls to show that the waste is inactivated effectively. For example, staff
should check the autoclave cycles frequently with biological indicators (spores) as a quality assurance
measure to show that the waste treatment cycles are achieving desired results.30
Considering that some of the packaging and waste streams being treated may be different than normal
medical wastes, commercial processing facilities should test surrogate waste in advance of an event to
ensure that the parameters being used are sufficient for the potential change in waste streams (i.e. more
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, “Information on the
Survivability of the Ebola Virus in Medical Waste,” modified February 12, 2015,
www.cdc.gov/vhf/ebola/healthcare-us/cleaning/ebola-virus-survivability.html.
30
22
�Managing Solid Waste Contaminated with a Category A Infectious Substance
PPE, different materials etc.) and more robust packaging. Commercial facilities should not open
containers to remove waste before processing the waste through the autoclave. However, containers must
be loosely capped or vented and solid waste bags must be loosely packed and loosely closed during
autoclaving for effective inactivation of infectious agents. Again, this may be different than the way the
facility typically operates and the ability to safely and effectively process unopened containers should be
tested in advance of accepting this type of waste. Commercial facilities should check to see if there are
any prohibitions against their autoclave operations in their permit or operating plans and discuss this with
SLTT environmental or health department in the jurisdiction in which they operate. Commercial facilities
should also ensure they have sufficient capacity to handle the increase in volume associated with an
infectious disease event that results in Category A waste. Facilities accepting this waste should also have
a backup plan for the management of the waste in the event of an operational issue.
Incineration
In most circumstances, off-site transportation will likely be needed for incineration. Incineration of
Category A waste is subject to applicable federal and/or SLTT laws and regulations.
Commercial incineration facilities are typically permitted by the SLTT environmental or health
department. These facilities are required to have operating plans or permits that outline how the facility
will operate and the types of wastes they are permitted to treat. These plans should include controls to
show that the waste is inactivated effectively. For example, staff should check the incineration times,
temperatures, and all appropriate air pollution control systems. Ash generated by these facilities is also
subject to regulations to determine how any remaining residuals must be properly disposed of.
Residuals (e.g., ash from incineration) should be evaluated to determine whether they may be hazardous
waste (e.g., ash can concentrate certain constituents such as toxic metals, if present in the original waste,
or in other wastes incinerated at the same time) and should be transported and disposed of in accordance
with SLTT regulations and standard protocols for waste disposal. The ultimate disposal facility must meet
federal minimum criteria, which are generally incorporated into waste and air permits.
Additional considerations
Commercial facilities accepting Category A waste for off-site treatment should have a backup plan for the
management of such waste in the event of an operational issue, such as equipment failure at the treatment
plant or delays in transporting residuals to disposal sites.
8. FINAL DISPOSAL INFORMATION & RESPONSIBILITIES
The ultimate disposition of waste, including any residuals from inactivation of Category A waste,
depends on a number of factors, including the characterization of the waste and residuals, SLTT laws and
regulations, and permit conditions for particular treatment/disposal facilities. As Section 4 explained, as a
general matter, under the RCRA and the majority of state/territorial programs, waste is categorized as
either “hazardous waste” or “nonhazardous (or solid) waste.” Importantly, the federal hazardous waste
regulations under the RCRA do not classify a waste as “hazardous” based on a waste’s infectious nature
(though SLTT hazardous waste regulations may be more stringent or broader in scope than federal
regulations). However, waste could still be hazardous as defined under RCRA regulations due to the
nature of contaminating materials (e.g., presence of certain toxic metals or chemicals, such as solvents).
Determination of waste as being hazardous versus non-hazardous under the RCRA is made independently
of the presence or absence of infectious agents. Under EPA requirements, waste generators are
responsible for determining if a particular waste is hazardous waste.
23
�Managing Solid Waste Contaminated with a Category A Infectious Substance
The requirements for hazardous waste management are based on subtitle C of the RCRA and its
implementing regulations beginning at 40 CFR part 260. Once a waste is determined to meet the
definition of a hazardous waste, it is subject to strict requirements “from cradle to grave” (i.e., from its
point of generation to its ultimate disposal).
Requirements for nonhazardous (or solid) waste are based on subtitle D of the RCRA. Disposal of solid
waste is primarily regulated at the state/territorial level, but there are minimum federal criteria that solid
waste facilities must meet in 40 CFR part 257 and federal criteria for municipal solid waste landfills in 40
CFR part 258. In addition, many states/territories have specific statutory or regulatory requirements for
identification, treatment, and disposal of medical waste.
Items that were previously Category A waste, once inactivated through autoclaving, incineration, or other
validated methods, are no longer considered to be Category A infectious substances under the HMR.
Inactivated materials will not generally be subject to specific federal RCRA hazardous waste regulations.
However, waste determinations for residuals should consider situations involving mixed materials (e.g.,
non-infectious solid waste with hazardous waste). As solid wastes, the inactivated material may be subject
to SLTT regulations. As some states/territories have additional requirements for treated medical waste,
including additional documentation or specific management requirements, facilities need to check with
the SLTT governments for the jurisdictions in which they operate and comply with those regulations.
Since situations vary, this section outlines considerations for final disposition and planning by facilities
and jurisdictions in which waste may be generated and facilities that will receive the waste and/or
residuals for ultimate disposal.
In determining how to dispose of waste/residuals, consider whether the Category A waste been properly
treated to inactivate pathogens it may have or was known to contain. Consult with the intended disposal
facility’s operator to determine waste analysis and acceptance procedures.
Inactivated Category A Waste Alone
If other types of hazardous waste are not present and the Category A waste has been inactivated, then:
•
The remaining waste is considered a solid waste. As described above, a hazardous waste
determination should be made independently of the fact that the waste has been inactivated. The
waste may be subject to additional SLTT solid waste regulations or SLTT regulations for treated
medical waste, including additional requirements for documentation, rendering the waste
unrecognizable, or other management steps. Facilities must understand and comply with these
requirements.
•
The facility where the properly inactivated waste (or residuals) is located should:
o
Verify with its SLTT regulatory official that the waste may be treated as a solid waste.
o
Confirm any SLTT-specific solid waste or treated medical waste requirements with
which the facility must comply. Verify that its usual solid waste treatment/disposal
facility is properly permitted and able to handle the material, especially if there is a large
volume.
o
Verify that the disposal facility’s management/owner is willing to accept the waste.
24
�Managing Solid Waste Contaminated with a Category A Infectious Substance
o
Ensure that the generating facility understands and complies with any special conditions
that may be imposed either by a permit or by the receiving facility.
o
Verify that the disposal facility properly received and processed the waste.
Category A Waste that Has Not Been Inactivated
If the Category A waste has not been inactivated (i.e., it remains Category A waste), then:
•
The Category A waste requires special handling in accordance with the HMR, as outlined in this
guidance; disposal options are likely more limited.
•
The entity generating the waste should:
o
Verify the classification of the waste (e.g., Category A, hazardous) with the appropriate
SLTT regulatory official.
o
Choose a facility permitted for such materials (e.g., medical waste incinerator; hazardous
waste incinerator, or HWI; HMIWI; other incinerator; or autoclave). Whether a particular
facility may receive such material depends on its permit(s).
o
Understand and comply with any special conditions that may be imposed either by a
permit or by the receiving facility.
o
Follow all conditions and packaging instructions under the HMR or applicable
DOT/PHMSA special permit, including using appropriate packaging for Category A
requirements and follow all packaging instructions prior to transport.
o
Verify that the disposal facility’s management/owner is willing to accept the waste.
o
Have a contingency plan in case the disposal facility is unavailable.
o
Verify that the disposal facility also has a contingency plan to handle disruptions.
o
After shipping the waste, verify that the disposal facility properly received and processed
the waste.
Disposing of Treated Waste Residuals
Facilities must also appropriately manage residuals from treatment, meaning they must determine (either
by testing or by knowledge) whether the residuals are a hazardous waste under the federal regulations
implementing the RCRA or the appropriate SLTT regulations. If the residuals (including incinerator ash)
are hazardous waste, then they must comply with all of the hazardous waste requirements, including
disposal in a hazardous waste-permitted unit.31 If the treatment residuals do not meet the definition of
“hazardous,” then they may be disposed of in accordance with applicable requirements for solid waste
disposal.
31
Under the RCRA, hazardous wastes are disposed of in carefully constructed units designed to protect the
environment, including groundwater and surface water resources.
25
�Managing Solid Waste Contaminated with a Category A Infectious Substance
The tool in Appendix C – Decision Matrix for Waste Treatment also traces key decisions in the treatment
and the ultimate disposal of waste. The tool describes the paths both for waste that may be inactivated onsite and for waste that cannot be treated on-site. In the first scenario, waste is treated on-site if it is
appropriate, available, and allowable under SLTT regulations. If the waste is no longer infectious and
does not contain some other hazardous material, it is then transported to an off-site disposal facility
permitted under SLTT regulations (typically at the state/territory level) to accept the waste (e.g., a RCRA
subtitle D landfill, a municipal waste combustor). Any treatment residuals are also tested and disposed of
appropriately (that is, assuming the residuals are not hazardous, they are disposed of in a subtitle D
landfill or solid waste facility). As mentioned previously, SLTT requirements may dictate disposal of
certain residuals, including materials in red (i.e., biohazard) bags that have been autoclaved. If on-site
treatment is performed but the treatment does not result in inactivation of the Category A waste, then the
waste must be either retreated on-site or sent off-site for treatment and disposal. Other types of hazards
present (e.g., mixed hazard wastes) may be either treated on-site or off-site.
In the second scenario, no on-site treatment is available (or the on-site treatment has not been effective).
The waste is thus managed in accordance with SLTT medical waste requirements and DOT requirements
for transportation (as well as any other appropriate requirements). The waste is sent to an off-site
treatment facility permitted to accept this material, most likely a medical waste incinerator, HMIWI, or
HWI. The waste is treated (incinerated) and the residuals are tested. If the residuals do not meet the
definition of a RCRA hazardous waste, they may be disposed of in a solid waste facility (e.g., RCRA
subtitle D landfill). If the residuals test as hazardous, then they would need to be categorized and
managed as a hazardous waste, which includes applicable RCRA treatment (distinct from inactivation,
such as stabilization for toxic metals) followed by disposal at a permitted, RCRA subtitle C facility.
Again, SLTT requirements may dictate disposal of certain residuals, including materials in red (i.e.,
biohazard) bags that have been autoclaved.
Ultimately, the key factor is that Category A waste, once inactivated through autoclaving, incineration, or
other validated methods, is no longer considered to be a Category A infectious substance or a regulated
medical waste that poses a health risk from the originating infectious substance. However, as discussed
above, other factors need to be considered prior to ultimate disposal.
9. PROTECTING WORKER HEALTH AND SAFETY
Protecting workers during handling, transport, treatment, and disposal of Category A waste begins before
the waste is generated, through anticipation, assessment, identification and planning for occupational
exposure risk and appropriate control measures. Remember that infectious agents in Category A waste are
not the only hazards that may be present. Hazard assessments and control measures must also account for
chemicals, radioactive materials, sharps, and other health and safety hazards to which workers may be
exposed.
The first and best strategy for protecting workers is to control hazards at their sources: if possible,
minimize the amount of waste generated, and ensure plans are in place to manage and contain waste
before generating it. Once waste is generated (i.e., the point of origin), implement protective measures
that continue through final disposition of the waste. Control measures should be set that protect against all
hazards present, including cases of mixed hazards. Under OSHA standards for bloodborne pathogens (29
CFR § 1910.1030), PPE (29 CFR part 1910 subpart I) including respiratory protection (29 CFR §
1910.134) (i.e., respirators to prevent inhalation of infectious materials), and hazard communication (29
26
�Managing Solid Waste Contaminated with a Category A Infectious Substance
CFR § 1910.1200), as well as other OSHA requirements, employers must protect workers who handle
Category A waste.32
A comprehensive protection program for waste workers relies on a hierarchy of engineering controls,
administrative controls, and safe work practices; PPE; and training, medical exams, and other elements
that OSHA standards require. This guidance provides general strategies for protecting workers, though
employers must assess their work sites and the job duties of their workers to implement appropriate
controls.
In all stages of the waste lifecycle, employers and workers should:
•
Limit the number of workers who handle Category A waste at various steps throughout the waste
lifecycle. For example, instruct and train healthcare workers generating Category A waste during
care of an infectious patient to package the waste properly (i.e., according to the HMR) instead of
requiring environmental services workers to also handle the waste. In waste hauling and treatment
operations, limit the number of staff who handle Category A waste.
•
Whenever gloves are removed or changed, wash hands with soap and water for at least 20
seconds, or use alcohol-based hand rubs followed by hand-washing as soon as possible. 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.
•
Wear dedicated work clothing while on the job. Change clothing and shower as soon as possible
if work clothing becomes soiled.
•
Discard soiled work clothing and PPE with other Category A waste.
•
Wear dedicated, washable footwear while on the job.
•
Train workers to notify a supervisor immediately if exposed to potentially infectious material or
waste on the job including on work clothing or exposed skin or through mucous membranes (e.g.,
eyes, nose or mouth).
•
Consider vaccination to protect workers from diseases for which a vaccine exists. Although
OSHA’s Bloodborne Pathogens standard (29 CFR § 1910.1030) only requires the Hepatitis B
vaccine series be made available to workers with occupational exposure, as defined in the
standard, employers may consider offering additional vaccines to their workers, such those for
Hepatitis A; influenza; measles, mumps, and rubella (MMR); and tetanus, diphtheria, and
pertussis (Tdap). Vaccine offerings should consider anticipated exposures based on hazard and
risk assessment.
32
Bloodborne Pathogens, 29 CFR § 1910.1030 (2012); Personal Protective Equipment, 29 CFR part 1910 subpart I
(2016); Hazard Communication, 29 CFR § 1910.1200 (2013). With some exceptions, OSHA’s Occupational
Exposure to Hazardous Chemicals in Laboratories standard (29 CFR § 1910.1450, 2012) supersedes, for
laboratories, the requirements of all other OSHA health standards in 29 CFR 1910 subpart Z.
27
�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
Plan, train workers for, and be ready to implement emergency response procedures for incidents
such as spills and potential exposures.
•
Consider making chemoprophylaxis available to workers as part of post-exposure follow-up and
care, as needed.
Engineering Controls
The work environment should be designed to eliminate or otherwise reduce worker exposure to hazards.
Engineering controls in waste operations serve as physical barriers between workers and pathogens,
reducing the likelihood and amount of worker exposure to sources of infectious substances. Equipment
that functions without worker actions (e.g., continuous operation of a negative-pressure ventilation system
in areas where waste is handled) provides the best protection. Other engineering controls include using:
•
•
•
For healthcare (and, to some extent, laboratories):
o
Barriers with windows or closed-circuit television monitors that minimize the need for
workers to use PPE to enter patient care areas, thus minimizing total volume of waste.
o
Needleless IV systems, retractable syringes, and other devices designed to prevent needle
stick injuries. These systems protect workers at the point of waste generation and
downstream waste workers.
For waste storage and transportation:
o
Rigid containers to transport waste off-site or within a facility, including puncture-proof
containers for sharps. If reusable carts are used to move waste within a facility, such as a
hospital or waste treatment plant, a decontamination area should also be set-up in the area
where the waste is transferred to the treatment system.
o
Puncture-proof, leak-proof, and tip-resistant containers for inactivated waste or on-site
storage/disposal.
o
Packaging that meets the requirements of OSHA’s Bloodborne Pathogens standard (29
CFR § 1910.1030) and DOT’s HMR () (or exceptions outlined in a special permit, if
applicable).
o
Suitable shelves, straps, or other equipment—especially in transport vehicles, where
containers may move or shift—to secure stacked Category A waste containers.
For waste treatment:
o
Equipment that ventilates outside the work area when treating Category A waste.
o
Barriers (with windows or closed-circuit television monitors) between areas where waste
processing equipment operates and where workers may control or observe the equipment.
Safe Work Practices and Administrative Controls
Develop protocols for handling, transporting, treating, and disposing of waste that, when properly
followed, reduce the likelihood of worker injury and illness. Waste management facilities must train
28
�Managing Solid Waste Contaminated with a Category A Infectious Substance
workers how to perform their jobs safely, including follow appropriate work practices and administrative
controls:
•
When utilizing onsite inactivation, develop a transportation and packaging plan that minimizes
repacking and staff handling. If reusable carts are used, a decontamination area should be setup in
the area where the waste is transferred to the treatment system.
•
Package waste in accordance with OSHA’s Bloodborne Pathogens standard (29 CFR §
1910.1030), CDC guidelines, and the HMR. Proper packaging from the outset minimizes
repackaging or additional handling. If DOT has issued a special permit for the waste, follow its
provisions.
•
To prevent toppling and spillage, place containers of waste as low as possible on dollies, hand
trucks, or carts and when stacking (including in transport vehicles).
•
Secure waste containers to prevent them from tipping.
•
Select waste processing techniques that minimize worker exposure to pathogens including by
minimizing the need for workers to handle waste (including in packaging).
•
Incinerate or autoclave entire, unopened waste containers to eliminate exposure associated with
handling and opening containers. For Category A waste, avoid reusable containers that must be
emptied into an incinerator or autoclave and/or processed for reuse.
•
Do not use open burning techniques, which could expose workers and other individuals to
harmful air contaminants.
•
Do not use waste management processes that involve shredding suspected or known Category A
waste, as these techniques may result in generation of bio-aerosols (aerosolized droplets
containing infectious particles that can be inhaled). Shredders also may become clogged or
jammed by atypical, porous waste materials (e.g., linens, carpet, curtains, or other textiles) that
must be discarded when decontamination is not possible.33
•
If workers use shredding equipment despite this guidance recommending otherwise, and if the
shredding equipment becomes clogged, avoid entering clogged shredding machines to resolve
mechanical problems. If a worker must do so, always ensure that the machine is off, the worker
correctly uses appropriate PPE, and the worker follows proper lockout/tag-out procedures for
controlling hazardous energy. To prevent worker exposure to infectious material in equipment
that becomes clogged prior to completing treatment, use chemical decontamination methods prior
to servicing equipment in addition to appropriate PPE.
•
Handle inactivated, non-infectious waste as though it may continue to pose a hazard from sharps
or other puncture injuries. In particular, autoclaved waste may contain needles, broken glass, and
other hazards (e.g., chemicals). Note that some hazardous chemicals should not be autoclaved.
33
U.S. Department of Labor/Occupational Safety and Health Administration, U.S. Department of Health and
Human Services/Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health,
and U.S. Environmental Protection Agency, Safe Handling, Treatment, Transport and Disposal of EbolaContaminated Waste, FS-3766 (Washington, DC, 2016), www.osha.gov/Publications/OSHA_FS-3766.pdf.
29
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Even though these items are sterile after treatment (assuming use of an effective inactivation
protocol), they can still cause cuts, puncture wounds, or other injuries.
Personal Protective Equipment
The OSHA PPE standard (29 CFR § 1910.132) requires that employers assess the workplace, determine
the presence of hazards, and then choose appropriate PPE to protect workers. Employers must select PPE
that protects workers against infectious substances and other hazards to which they may be exposed. PPE
selections should address hazards for specific workplaces and tasks, and may vary significantly for
workers performing differing operations throughout the waste lifecycle.
Depending on the route(s) of transmission of the pathogen of concern and the types of potential exposures
associated with a worker’s job tasks, workers must wear PPE to help minimize exposure to pathogens via
mucous membranes, broken skin, or through inhalation of bio-aerosols or airborne particles. For
additional information about PPE, see the OSHA PPE standards (29 CFR part 1910 subpart I). Employer
and workers may also consult OSHA’s PPE Selection Matrix for Occupational Exposure to Ebola Virus
for additional guidance on PPE for healthcare, laboratory, janitorial, and waste management workers who
may be involved in waste management tasks.34 Note that PPE may vary for Category A infectious
substances associated with exposures and transmission mechanisms different than those anticipated with
Ebola virus.
Employers should also follow manufacturer instructions on product labels and Safety Data Sheets for
EPA-registered disinfectants and other chemicals involved in waste management operations when
selecting PPE for their workers (i.e., to ensure that PPE protects workers from chemical hazards posed by
such disinfectants). Employers must also comply with applicable provisions of OSHA’s Hazard
Communication standard (29 CFR § 1910.1200).
When workers may be exposed to aerosolized infectious particles, employers must implement a
respiratory protection program that complies with the OSHA Respiratory Protection standard (29 CFR §
1910.134). A comprehensive respiratory protection program includes properly selected respirators
approved by the National Institute for Occupational Safety and Health (NIOSH), fit testing, and medical
exams for workers who will use such equipment. Note that not all respirators or respirator cartridges used
to protect workers against inhalation of infectious particles effectively protect them from exposure to
certain chemicals used in waste packaging procedures or for cleaning and decontaminating equipment and
surfaces.35
Workers must don (i.e., put on) and use PPE properly in order to achieve the intended protection and
minimize the risk of infection. Workers should doff (i.e., remove) PPE in a way that avoids selfcontamination. For example, avoid skin and mucous membrane contact with potentially infectious
materials (i.e., those contaminated with infectious agents); only remove respirators after leaving work
34
U.S. Department of Labor, Occupational Safety and Health Administration, PPE Selection Matrix for
Occupational Exposure to Ebola Virus, FS-3761 (Washington, DC, 2015),
www.osha.gov/Publications/OSHA3761.pdf.
Consult OSHA’s Respiratory Protection standard (29 CFR § 1910.134), as well as the manufacturer’s Safety
Data Sheet for the specific chemical(s) that workers are using, to learn more about selecting an appropriate
respirator to protect against chemical exposure. See: U.S. Department of Labor, Occupational Safety and Health
Administration, “Respiratory Protection,” last modified May 16, 2019, www.osha.gov/SLTC/respiratoryprotection.
Consider all respiratory hazards (biological, chemical, etc.) when selecting respirators to protect workers.
35
30
�Managing Solid Waste Contaminated with a Category A Infectious Substance
areas where air contaminants (e.g., airborne-transmissible or other potentially aerosolized agents) may be
present. The order of donning and doffing of PPE items may vary depending on the infectious agent(s) of
concern in the waste, 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. Employers and workers should refer to
updated guidance from OSHA and CDC for the most current information about recommended donning
and doffing procedures for particular Category A infectious agents. Disposal procedures for single-use
PPE items should help reduce the risk of self-contamination and, if possible, minimize the amount of
Category A waste generated. Reusable PPE should be decontaminated or packaged for decontamination
following task- or facility-specific procedures.
Worker Training
General Occupational Safety and Health Training
Employers must train workers about sources of exposure to infectious substances and appropriate
precautions. All training provided to workers must be in a manner and language they can understand.
Some types of work may necessitate that employers provide interactive training. For specific information
about training requirements, see, among other OSHA regulations, the Bloodborne Pathogens standard
(29 CFR § 1910.1030). In general:
•
Workers who may be exposed to items contaminated with Category A infectious substances prior
to packaging must be trained to handle and appropriately package such materials.
•
All facility personnel who may come in contact with packaged Category A waste must be trained
to handle the waste and/or containers of waste materials safely.
•
Facility leadership should have a post-exposure plan in place for any personnel who are
inadvertently exposed to Category A waste.
In addition, employers must train workers required to use PPE on what equipment is necessary, how to
don and doff it safely and effectively, when and how they must use it, and how to dispose of the
equipment (including frequency with which PPE must be disposed of and replaced). Practice and
observation of workers in correct donning and doffing of PPE are critical infection control measures. This
type of visual and interactive training helps to ensure that PPE is used in ways that achieve the intended
protection and that workers do not come into contact with contaminated surfaces of PPE during or after
removal. When respirators are needed to protect workers from inhalation exposures, employers also must
train employees on how: a particular respirator should be positioned on the face; to set strap tension; to
determine an acceptable fit; to achieve a proper seal between mask and the face; and perform regulated
functions; as well as the respirator itself. Employees must receive hazmat general awareness, function
specific, safety, and security awareness training and a respirator fit check.
Hazardous Materials Training
DOT also requires HAZMAT employers to provide training for HAZMAT employees, in accordance with
49 CFR § 172.702 and 49 CFR § 172.704.36 All HAZMAT employees who perform functions subject to
the HMR must be provided with general awareness, function-specific, safety, and security awareness
36
See 49 CFR § 171.8 for definitions of HAZMAT employer and HAZMAT employee.
31
�Managing Solid Waste Contaminated with a Category A Infectious Substance
training within 90 days of new employment or a change in job function; recurrent training must be
provided at least every three years.
Hazardous Waste Operations and Emergency Response
Routine Category A waste handling, transport, treatment, and disposal operations typically do not fall
under OSHA’s Hazardous Waste Operations and Emergency Response (HAZWOPER) standard (29 CFR
§ 1910.120). However, HAZWOPER requirements may apply to incidents that release, or substantially
threaten to release, a hazardous substance, including biological agents, into the environment, which may
occur during a transportation accident involving Category A waste.
Employers, such as those with contracts to transport Category A waste under a DOT special permit,
should be familiar with the provisions of the HAZWOPER standard (29 CFR § 1910.120), including
paragraph (q) for emergency response, and be prepared to comply with the standard, as needed. For
emergency response operations that fall under the HAZWOPER standard (29 CFR § 1910.120),
employers must have a written emergency response plan with certain basic and critical elements. They
must appropriately train workers who will respond to an emergency before participation in an actual
incident, implement medical surveillance for workers potentially exposed to hazardous substances during
work, maintain exposure records, and provide appropriate PPE to workers. Employers providing waste
transportation services under a DOT special permit generally must have a spill response plan and provide
hazardous materials training to workers, as required by 49 CFR § 172.704. Employers can plan and train
for emergency response operations involving spills in a way that complies with OSHA and DOT
requirements at the same time.
Although not every employer’s operations fall under the scope of the HAZWOPER standard (29 CFR §
1910.120), developing emergency plans can ensure a safe, effective response when emergencies,
including releases, substantial threats of releases of, or potential exposures to, hazardous substances do
occur. Employers should evaluate their risk and develop plans for emergency incidents. Such plans should
address worker safety and health considerations, SLTT requirements, DOT/PHMSA training and security
plan requirements, and the requirements of any DOT-issued special permits.
32
�Managing Solid Waste Contaminated with a Category A Infectious Substance
APPENDIX A – ADDITIONAL RESOURCES
These documents are provided as supplemental resources to this guidance for managing Category A
waste.
Waste Management
•
Managing Materials and Wastes for Homeland Security Incidents. U.S. Environmental Protection
Agency, 2019.
•
Procedures for Safe Handling and Management of Ebola-Associated Waste. U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2014.
•
U.S. Department of Labor, Occupational Safety and Health Administration; U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and
Health; and U.S. Environmental Protection Agency. Safe Handling, Treatment, Transport and Disposal
of Ebola-Contaminated Waste. FS-3766. Washington, DC, 2016.
•
Program Will Train First Responders and Hazardous Waste Workers on Infectious Disease Safety,
U.S. Department of Health and Human Services, National Institutes of Health, 2016.
•
U.S. Department of Defense, Department of the Army, U.S. Army Public Health Command.
Technical Guide 197: Guide for Developing Integrated Solid Waste Management Plans at Army
Installations. Aberdeen Proving Ground, Maryland, 2013. This document was developed for use by
U.S. Department of the Army facilities and personnel. Different regulatory requirements may apply
in other settings.
•
U.S. Department of Defense, Department of the Air Force. Air Force Instruction 41-201, Clinical
Engineering. Arlington, Virginia, 2017. This document was developed for use by U.S. Department
of the Air Force facilities and personnel. Different regulatory requirements may apply in other
settings.
•
U.S. Department of Defense, Department of the Air Force. Air Force Instruction 44-108, Infection
Control. Arlington, Virginia, 2019. This document was developed for use by U.S. Department of the
Air Force facilities and personnel. Different regulatory requirements may apply in other settings.
Emergency Planning
•
U.S. Department of Homeland Security, Federal Emergency Management Agency. Biological
Incident Annex to the National Response Framework. Washington, DC, 2017.
•
U.S. Department of Homeland Security, Federal Emergency Management Agency. National
Response Framework (NRF). Washington, DC, 2016.
Worker Health and Safety
•
Recommendations for the Selection and Use of Respirators and Protective Clothing for Protection
Against Biological Agents, U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, National Institute for Occupational Safety and Health, 2015.
33
�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
Safety and Health Topics: Respiratory Protection, U.S. Department of Labor, Occupational Safety
and Health Administration, 2015.
•
Safety and Health Topics: Infectious Diseases, U.S. Department of Labor, Occupational Safety and
Health Administration, 2017.
•
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and
National Institutes of Health. Biosafety in Microbiological and Biomedical Laboratories (BMBL),
5th edition, edited by L. Casey Chosewood and Deborah E. Wilson. HHS Publication No. (CDC)
21-1112. Atlanta, Georgia, and Bethesda, Maryland, 2009.
•
Selecting, Evaluating, and Using Sharps Disposal Containers, U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational
Safety and Health, 2015.
Environmental Management & Infection Control
•
Selected EPA-Registered Disinfectants, U.S. Environmental Protection Agency, 2016.
•
Army Regulation 200-1: Environmental Protection and Enhancement, U.S. Department of Defense,
Department of the Army, 2007. Note: This document was developed for use by U.S. Department of
the Army facilities and personnel. Different regulatory requirements may apply in other settings.
•
Information on Cleaning and Decontamination, U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, 2014.
•
Guideline for Disinfection and Sterilization in Healthcare Facilities, U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, Healthcare Infection Control
Practices Advisory Committee (HICPAC), 2008.
•
Guidelines for Environmental Infection Control in Healthcare Facilities, U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, Healthcare Infection Control
Practices Advisory Committee (HICPAC), 2003.
•
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings, U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Healthcare Infection Control Practices Advisory Committee (HICPAC), 2007.
•
Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with
Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach and updated guidance
on the appropriate use of Personal Protective Equipment (PPE), U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, 2018.
•
Guideline for Hand Hygiene in Health-Care Settings, U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, Healthcare Infection Control Practices
Advisory Committee (HICPAC), 2002.
34
�Managing Solid Waste Contaminated with a Category A Infectious Substance
For Further Information
•
From the U.S. Department of Transportation, including about the Hazardous Materials Regulations
(HMR) requirements and guidance, contact the Pipeline and Hazardous Materials Safety
Administration (PHMSA) Hazardous Materials Information Center at 1-800-467-4922.
•
From U.S. Environmental Protection Agency (EPA) information on solid and hazardous waste or
emergency response, visit www.epa.gov.
•
From the Occupational Safety and Health Administration (OSHA), visit www.osha.gov or contact
1-800-321-OSHA (6742).
•
From the Centers for Disease Control and Prevention (CDC), visit www.cdc.gov or contact 1-800CDC-INFO (1-800-232-4636).
•
About the National Emerging Special Pathogens Training and Education Center (NETEC), visit
www.netec.org or contact hpp@hhs.gov. In July 2015, U.S. Department of Health and Human
Services (HHS) announced the funding of the NETEC. The NETEC has helped ensure that U.S.
healthcare providers and facilities and healthcare waste management workers are prepared to safely
identify, isolate, transport, and treat patients with Ebola and other emerging threats. The NETEC
has been a collaboration between HHS’ Office of the Assistant Secretary for Preparedness and
Response (ASPR) and CDC to support Emory University (Atlanta, Georgia), University of
Nebraska Medical Center/Nebraska Medicine (Omaha, Nebraska), and Bellevue Hospital Center
(New York City, New York) in training healthcare providers, personnel affiliated with facilities,
patient evacuation providers, and other applicable personnel on strategies, including for waste
management, to respond to Ebola and other emerging infectious diseases. NETEC offers support
services to healthcare facilities and emergency medical services (EMS) providers to enhance their
operational readiness. These services include readiness consultations, and on-site or web-based
technical assistance to support them to prepare for, and respond to, Ebola and other special
pathogen events.
•
About the ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE),
visit asprtracie.hhs.gov. In 2015, HHS/ASPR created the TRACIE to meet the needs of regional
ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers,
public health practitioners, and others working in disaster medicine, healthcare system
preparedness, and public health emergency preparedness. ASPR TRACIE supports timely access to
information and promising practices, identifies and remedies knowledge gaps, and includes Topic
Collections (asprtracie.hhs.gov/technical-resources) with resources and information regarding
decontamination and waste management. The ASPR TRACIE provides personalized support and
responses to requests for information and technical assistance. ASPR TRACIE responses to
selected technical assistance requests are available on the ASPR TRACIE site, and can be located
in the infectious disease subcategory.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
APPENDIX B – INFECTIOUS AGENT CATEGORIZATION
Several federal departments and agencies identify various biological agents and toxins in their
regulations. This document is primarily concerned with Category A infectious substances (specifically,
United Nations (UN) 2814 infectious substances, affecting humans), as identified in the U.S. Department
of Transportation (DOT)/Pipeline and Hazardous Materials Safety Administration (PHMSA) Hazardous
Materials Regulations (HMR) at 49 CFR parts 171-180. However, the same Category A agents are also
designated as select agents by the U.S. Department of Health and Human Services (HHS)/Centers for
Disease Control and Prevention (CDC) and U.S. Department of Agriculture (USDA), which jointly
regulate biological select agents and toxins (BSAT) at 42 CFR part 73 (for CDC) and 7 CFR part 331 and
9 CFR part 121 (for USDA).
This appendix cross-references common Category A agents under the HMR and select agents under the
select agent regulations. This list is for guidance only; it is not all-inclusive.37 Find the most current list of
BSAT at www.selectagents.gov.
Designation of “cultures only” means that a Category A infectious substance is only considered
“Category A” when a pathogen(s) is intentionally propagated. The term “cultures” does not include
patient specimens collected directly from humans or animals, including, but not limited to, excreta,
secreta, blood and its components, tissue and tissue fluid swabs, and body parts being transported for
purposes such as research, diagnosis, investigational activities, disease treatment and prevention.
See additional explanatory information in the notes following the table.
Abrin
African horse sickness virus
African swine fever virus
Avian influenza virus, highly
pathogenicc
Bacillus anthracis
USDA Select Agent
(Plant Protection and
Quarantine, PPQ)
USDA Select Agent
(animal pathogens)
Select Agents
HHS Select Agent
UN 2900
(Infectious substances
affecting animals
only)
Agent
UN 2814
(Infectious substances
affecting humans)
Category A
Substances
✓
✓
✓
✓
✓
c/o
✓
c/o
✓
Bacillus anthracis Pasteur strain
Bacillus cereus Biovar anthracis*
37
✓
✓
✓
✓
✓
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration, Transporting
Infectious Substances Safely (Washington, DC, 2020), https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/202004/Transporting-Infectious-Substances-Safely.pdf.
37
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Botulinum neurotoxin producing
species of Clostridium*
Botulinum neurotoxins*
Brucella abortus
Brucella melitensis
Brucella suis
Burkholderia mallei*
Burkholderia mallei—
Pseudomonas mallei—Glanders
Burkholderia pseudomallei*
Coccidioides immitis
USDA Select Agent
(Plant Protection and
Quarantine, PPQ)
✓
✓
c/o
✓
c/o
✓
c/o
✓
c/o
✓
c/o
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
c/o
✓
c/o
Classical swine fever virus
Clostridium botulinum
USDA Select Agent
(animal pathogens)
✓
Chapare virus (South American
hemorrhagic fever virus)
Chlamydia psittaci—avian strains
Select Agents
HHS Select Agent
UN 2900
(Infectious substances
affecting animals
only)
Agent
UN 2814
(Infectious substances
affecting humans)
Category A
Substances
✓
✓
c/o
✓
c/o
Coniothyrium glycines (formerly
Phoma glycinicola and
Pyrenochaeta glycines)
Conotoxins (Short, paralytic alpha
conotoxins containing the following
amino acid sequence
X1CCX2PACGX3X4X5X6CX7)a
✓
✓
Coxiella burnetii
✓
c/o
✓
Crimean-Congo hemorrhagic fever
virus
✓
✓
Dengue virus
✓
c/o
✓
Diacetoxyscirpenol
38
✓
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Eastern Equine Encephalitis virusc
Ebola virus*
Escherichia coli, verotoxigenic
Flexal virus
✓
c/o
✓
✓
c/o
✓
✓
✓
c/o
✓
c/o
✓
✓
✓
c/o
Goat pox virus
✓
Guanarito virus (South American
hemorrhagic fever virus)
Hantaan virus
✓
Hantaviruses causing hemorrhagic
fever with renal syndrome
✓
Hendra virus
✓
✓
c/o
✓
c/o
✓
c/o
✓
✓
✓
✓
✓
✓
✓
✓
Herpes B virus
Human immunodeficiency virus
Japanese Encephalitis virus
Junin virus (South American
hemorrhagic fever virus)
Kyasanur Forest disease virus
Lassa fever virus
Lujo virus
✓
✓
✓
c/o
Lumpy skin disease virus
Machupo virus (South American
hemorrhagic fever virus)
Marburg virus*
Monkeypox virus
c
Mycobacterium tuberculosis
✓
✓
✓
✓
✓
✓
c/o
✓
✓
39
✓
USDA Select Agent
(Plant Protection and
Quarantine, PPQ)
USDA Select Agent
(animal pathogens)
✓
Foot-and-mouth disease virus*
Francisella tularensis*
Select Agents
HHS Select Agent
Agent
UN 2900
(Infectious substances
affecting animals
only)
UN 2814
(Infectious substances
affecting humans)
Category A
Substances
�Managing Solid Waste Contaminated with a Category A Infectious Substance
✓
c/o
✓
c/o
Mycoplasma mycoidesc
✓
✓
✓
✓
✓
✓
✓
Peronosclerospora philippinensis
(Peronosclerospora sacchari)
✓
✓
c/o
Peste des petits ruminants virus
Poliovirus
Rabies and other lyssaviruses
Rickettsia rickettsiia
Rift Valley fever virus
✓
✓
✓
✓
✓
c/o
✓
c/o
✓
c/o
✓
✓
✓
c/o
Rinderpest virus*
Russian spring-summer encephalitis
virus
Sabia virus (South American
hemorrhagic fever virus)
✓
✓
c/o
✓
c/o
Ralstonia solanacearum
Rathayibacter toxicus
Reconstructed replication
competent forms of the 1918
pandemic influenza virus
containing any portion of the
coding regions of all eight gene
segments (Reconstructed 1918
Influenza virus)
Ricin
Rickettsia prowazekii
USDA Select Agent
(Plant Protection and
Quarantine, PPQ)
✓
Mycoplasma capricolumc
Newcastle disease virusb, c (avian
paramyxovirus serotype 1)
Nipah virus
Omsk hemorrhagic fever virus
USDA Select Agent
(animal pathogens)
Select Agents
HHS Select Agent
UN 2900
(Infectious substances
affecting animals
only)
Agent
UN 2814
(Infectious substances
affecting humans)
Category A
Substances
✓
✓
c/o
✓
✓
40
✓
�Managing Solid Waste Contaminated with a Category A Infectious Substance
SARS-associated coronavirus
(SARS-CoV)
SARS-CoV/SARS-CoV-2 chimeric
viruses resulting from any
deliberate manipulation of SARSCoV-2 to incorporate nucleic acids
coding for SARS-CoV virulence
factors
Saxitoxin
Sclerophthora rayssiae
✓
✓
✓
c/o
✓
✓
c/o
West Nile virus
✓
✓
Synchytrium endobioticum
T-2 toxin
Tetrodotoxin
Vesicular stomatitis virus
✓
✓
c/o
Swine vesicular disease virus
Tick-borne encephalitis complex Far Eastern subtype
Tick-borne encephalitis complex Siberian subtype
Variola major virus (Smallpox
virus)*
Variola minor virus (Alastrim)*
Venezuelan equine encephalitis
virusc
USDA Select Agent
(Plant Protection and
Quarantine, PPQ)
✓
Staphylococcal enterotoxins
A,B,C,D,E subtypes
Tick-borne encephalitis viruses
USDA Select Agent
(animal pathogens)
✓
Sheep pox virus
Shigella dysenteriae type I
Select Agents
HHS Select Agent
UN 2900
(Infectious substances
affecting animals
only)
Agent
UN 2814
(Infectious substances
affecting humans)
Category A
Substances
✓
✓
✓
c/o
✓
c/o
✓
✓
c/o
✓
✓
✓
✓
✓
c/o
✓
c/o
✓
c/o
✓
✓
✓
c/o
✓
Xanthomonas oryzae
41
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Yellow fever virus
Yersinia pestis*
✓
c/o
✓
c/o
USDA Select Agent
(Plant Protection and
Quarantine, PPQ)
USDA Select Agent
(animal pathogens)
Select Agents
HHS Select Agent
UN 2900
(Infectious substances
affecting animals
only)
Agent
UN 2814
(Infectious substances
affecting humans)
Category A
Substances
✓
Note: “c/o” = agents that are considered Category A as cultures only (i.e., only when they are intentionally
propagated); UN = United Nations.
* denotes a Tier 1 Select Agent, one of a subset of biological agents and toxins that present the greatest risk of
deliberate misuse with significant potential for mass casualties or devastating effect to the economy, critical
infrastructure, or public confidence, and pose a severe threat to public health and safety.
a
C = Cysteine residues are all present as disulfides, with the 1st and 3rd Cysteine, and the 2nd and 4th Cysteine
forming specific disulfide bridges; The consensus sequence includes known toxins α-MI and α-GI (shown above) as
well as α-GIA, Ac1.1a, α-CnIA, α-CnIB; X1 = any amino acid(s) or Des-X; X2 = Asparagine or Histidine; P =
Proline; A = Alanine; G = Glycine; X3 = Arginine or Lysine; X4 = Asparagine, Histidine, Lysine, Arginine,
Tyrosine, Phenylalanine or Tryptophan; X5 = Tyrosine, Phenylalanine, or Tryptophan; X6 = Serine, Threonine,
Glutamate, Aspartate, Glutamine, or Asparagine; X7 = Any amino acid(s) or Des X and; “Des X” = “an amino acid
does not have to be present at this position.” For example, if a peptide sequence were XCCHPA then the related
peptide CCHPA would be designated as Des-X.
b
A virulent Newcastle disease virus (avian paramyxovirus serotype 1) has an intracerebral pathogenicity index in
day-old chicks (Gallus gallus) of 0.7 or greater or has an amino acid sequence at the fusion (F) protein cleavage site
that is consistent with virulent strains of Newcastle disease virus. A failure to detect a cleavage site that is consistent
with virulent strains does not confirm the absence of a virulent virus.
c
Select agents that meet any of the following criteria are excluded from the requirements of the Select Agent
Regulations at 7 CFR part 331, 9 CFR part 121, and 42 CFR part 73: Any low-pathogenic strains of avian influenza
virus, South American genotype of eastern equine encephalitis virus, West African clade of Monkeypox viruses (see
additional monkeypox information in Appendix F-2), any strain of Newcastle disease virus which does not meet the
criteria for virulent Newcastle disease virus, all subspecies Mycoplasma capricolum except subspecies
capripneumoniae (contagious caprine pleuropneumonia), all subspecies Mycoplasma mycoides except subspecies
mycoides small colony (Mmm SC) (contagious bovine pleuropneumonia), and any subtypes of Venezuelan equine
encephalitis virus except for Subtypes IAB or IC, provided that the individual or entity can verify that the agent is
within the exclusion category.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
APPENDIX C – DECISION MATRIX FOR WASTE TREATMENT
To transport materials that are suspected or known to be contaminated with a Category A infectious
substance, a U.S. Department of Transportation (DOT) special permit (SP) may be necessary. A special
permit allows for a variance of the Hazardous Materials Regulations (HMR) packaging requirements to
handle the larger volume of Category A waste generated during the treatment or transport of patients
infected with pathogens (i.e., germs) classified as Category A infectious substances or during remediation
of such individuals’ contaminated residential environments.
In 2014, DOT/Pipeline and Hazardous Materials Safety Administration (PHMSA) issued a special permit,
SP 16279, in response to the treatment of patients with Ebola virus disease (EVD) in the United States
and the subsequent accumulation of Ebola-contaminated waste. The special permit provided packaging,
operational, and safety controls to provide options for safely transporting Category A waste associated
with EVD events.
The decision matrix below outlines key considerations for managing Category A waste. As there was only
a DOT special permit for Ebola at the time this guidance was published, the matrix references SP 16279.
New DOT special permits would be needed for infectious substances other than Ebola.
#
Decision Point
Recommended Action
1. Does the incident resulting in waste involve
suspected or actual terrorism or another criminal
activity?
Yes = immediately contact the Federal
Bureau of Investigation (FBI), as certain
solid waste, including Category A waste,
may be considered as evidence. (The
Attorney General, generally acting through
the FBI Director, will determine whether a
particular situation will be treated as an
actual terrorist incident.) The FBI has
primary responsibility to conduct, direct,
or oversee crime scenes, their security, and
evidence management, through all phases
of the response.
No = move to 2; there is no need to
contact the FBI.
2. Is the waste properly classified as United Nations
(UN) 2814, Infectious substances, affecting humans,
6.2?
For transportation under the HMR, it is the offeror’s
responsibility to classify hazardous materials,
including infectious substances.
43
Yes = move to 3.
No = dispose of according to the
material’s classification and state, local,
tribal, and/or territorial (SLTT)
requirements (e.g., as regulated medical
waste (RMW), hazardous waste, nonhazardous waste).
�Managing Solid Waste Contaminated with a Category A Infectious Substance
#
Decision Point
Recommended Action
3. Does your facility have the capability to treat the
waste on-site to the point of rendering the agent
completely inactive (through autoclaving, or
incineration, or other validated methods)? Is the onsite treatment capability allowable under SLTT
requirements?
Yes = inactivate on-site, then move to 4.
4. Are residuals from treatment determined to be no
longer infectious?
Yes = dispose of treated materials and/or
residuals according to SLTT requirements.
Waste that is not infectious but remains
hazardous must be disposed of in a manner
appropriate for the hazardous nature of the
waste (e.g., in compliance with Resource
Conservation and Recovery Act (RCRA)
and SLTT requirements).
No = move to 5.
No = move to 5.
5. Do you have packaging available to contain Category
A waste that complies with the HMR (i.e., packaging
for Category A infectious substances that meet the
requirements of 49 CFR § 173.196)?
Yes = package the waste using the
compliant Category A packaging.
6. Is the waste contaminated with Ebola?
Yes = move to 7.
No = move to 6. In the meantime, ensure
that Category A wastes are stored
appropriately.
No = contact DOT/PHMSA to discuss a
special permit for waste transportation for
Category A infectious substances other
than Ebola.
7. DOT SP 16279 provides alternative requirements for
packaging and transporting Ebola waste.
DOT/PHMSA’s special permits database contains
records of the companies currently holding party
status to SP 16279.
Yes = the company with party status to SP
16279 has authority to transport the waste
under alternative requirements, and it has
trained its staff in loading, transporting,
and unloading the material at a disposal
facility.
Special permits search:
www.phmsa.dot.gov/hazmat/regs/sp-a/specialpermits/search
Enter “16279” in the “Special Permit” box and search
to display all entities that have held party status.
Have you contracted with one of the companies listed
as a party to SP 16279?
44
Contact the company to discuss scheduling
waste removal. Move to 8.
No = contact a company with party status
to SP 16279 to determine whether it is
available to assist with handling your
waste.
�Managing Solid Waste Contaminated with a Category A Infectious Substance
#
Decision Point
Recommended Action
If no companies respond affirmatively,
contact DOT/PHMSA to discuss next
steps.38
8. Does your waste transportation contractor have
access to a disposal or treatment facility where it can
unload your waste?
Off-site disposal facilities must be permitted to accept
medical waste (i.e., RCRA subtitle D landfills).
38
Yes = schedule transportation with your
contractor, making sure to inform DOT of
the planned movement of the waste and its
arrival at the disposal site.
No = work with your contractor to identify
why it does not have access to a disposal
facility.
Reach DOT/PHMSA’s Hazardous Materials Information Center by phone at 1-800-467-4922.
45
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
APPENDIX D – QUESTIONS AND ANSWERS
This section provides answers and guidance to potential questions that may be posed by the public
(including workers), the media, and stakeholders concerning the management of medical and infectious
waste from the point-of-origin (e.g., healthcare facilities or during patient transfer) to final disposal of the
inactivated waste (e.g., in a landfill accepting incinerator ash or materials inactivated with an effective
autoclave or other validated process). This guidance is also intended for use by state, local, tribal, and/or
territorial (SLTT) and federal partners, including, but not limited to, public health, worker safety and
health, environmental protection, waste management, and elected officials.
Each question has several parts to its answer:
•
•
•
A key message that summarizes the most important information.
A detailed answer that provides more in-depth information.
Selected background/references that supplement each answer.
Users of the document should note that the key messages are intended to highlight significant information
related to each question, but the full answers may provide additional details not included or introduced in
the key message.
The table below outlines questions and answers/guidance included in this section.
Category
1.
2.
3.
4.
5.
6.
7.
Background
Questions & Answers
8.
9.
10.
11.
12.
13.
Question
What is Category A waste?
What is regulated medical waste?
What is the composition of medical waste?
What is a Category A infectious substance?
Who determines if an infectious substance is “Category
A”?
What is waste treatment and disposal?
Prior to treatment, why must Category A waste be
handled differently than other waste, such as regular
trash from a healthcare facility or other regulated
medical waste?
How do the government and the medical waste industry
know that Category A waste can be handled safely?
What is a pathogen?
Which government agency(ies) is/are responsible for
regulating medical waste?
How are pathogens transmitted to people (or animals, if
applicable)?
What is the federal government doing to ensure that
healthcare facilities; ambulances services; and waste
transport, treatment, and disposal companies handle the
waste safely and comply with applicable requirements?
Who can I contact if I have questions about infectious
waste, regulated medical waste, and Category A waste?
47
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Category
Waste Generation
Questions & Answers
Waste Transportation
Questions & Answers
Waste Treatment
Questions & Answers
Waste Disposal
Worker Protection
Question
1. Where does Category A waste come from?
2. What can be done to reduce the amount of infectious
waste generated in the first place?
1. Who is responsible for properly identifying infectious
waste that is transported between facilities?
2. Is my family at risk of being exposed to infectious
waste if it is transported through my/our community?
3. If waste is inactivated, is there a risk to me or my
family if it is transported through or disposed of in
my/our community?
4. Will I be notified if Category A waste is transported
through my community or processed or disposed of at a
facility near my home or business?
5. Is there a plan in place to handle emergencies that
happen when transporting infectious waste, such as an
accident involving the truck carrying the waste?
6. Are there specific requirements for transporting
Category A waste?
1. Should infectious waste be pre-treated with a
disinfectant before it is sent from a facility for further
treatment and disposal?
2. What methods are used to inactivate infectious waste so
that it is no longer infectious?
3. How do waste treatment and disposal companies ensure
that the processes they use to inactivate infectious
waste are effective?
4. Are there any steps normally involved in treating
medical waste that should be avoided during treatment
and disposal of Category A waste?
5. What is my/my family’s risk of being exposed to
infectious waste if it is processed or inactivated at
facilities in my/our community?
1. Where does infectious waste end up after treatment?
2. Can burying inactivated waste in landfills affect crops
or ground water supplies nearby?
3. What requirements are in place to ensure air quality
near incinerator facilities that process infectious waste?
4. Is there potential harm to other natural resources when
infectious waste is transported or inactivated or when
inactivated waste is disposed of properly?
5. Is the ash from incinerated Category A infectious
substances hazardous, infectious, or dangerous?
6. Is waste that has been autoclaved (which means to
sterilize by means of high-pressure saturated steam)
hazardous, infectious, or dangerous?
1. What are the risks to workers handling infectious waste
before it is properly inactivated?
2. What specific tasks may lead to worker exposure to
untreated infectious waste?
48
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65
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67
70
71
72
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73
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Category
Question
3. What should employers do to protect workers involved
in handling, transport, and treatment of infectious waste
and disposal of inactivated waste?
4. What can workers involved in handling, transport, and
treatment of infectious waste and disposal of
inactivated waste do to protect themselves?
5. Is there training available on handling, transport, and
treatment of infectious waste and disposal of
inactivated waste that I can get in advance to be sure I
am prepared to do my job?
Page
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83
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BACKGROUND QUESTIONS & ANSWERS
1. What is Category A waste?
Key Message: “Category A waste” is a specific designation for waste contaminated with a Category A
infectious substance.
Answer: “Category A waste” is a specific designation under the U.S. Department of Transportation
(DOT) Hazardous Materials Regulations (HMR) for waste contaminated with a Category A infectious
substance, meaning an infectious substance in a form capable of causing permanent disability or lifethreatening or fatal disease in otherwise healthy humans or animals when exposure to the substance
occurs. See 49 CFR § 173.134(a)(1)(i) and the definitions of “Category A infectious substance” and
“Category A waste” in the Glossary of Terms.
Such waste results from a variety of tasks, the most common of which is likely to be patient care activities
in healthcare facilities and patient transportation operations. During these activities, needles/syringes,
intravenous (IV) access devices, tubing, dressings, personal protective equipment (PPE), and other
materials are used and become contaminated. Larger items, like bulk bedding materials and mattresses,
may also constitute contaminated waste from patient care and residential settings.
Hospitals, laboratories, and other facilities and worksites also generate waste that may be contaminated
with infectious substances that are not classified as Category A. Such waste is often managed as regulated
medical waste (RMW). When generating waste in a healthcare, patient transport, or laboratory setting
where infectious substances may be present follow the facility and SLTT requirements for proper waste
disposal.
RMW management is regulated at the SLTT levels. Once treated, these materials are no longer infectious
and are considered a solid waste subject to solid waste regulations if no other type of hazardous material
(e.g., chemical) is present that falls under another hazardous waste regulation.
Background/References:
▪
RCRA Orientation Manual 2014, EPA530-F-11-003. U.S. Environmental Protection Agency,
2014.
49
�Managing Solid Waste Contaminated with a Category A Infectious Substance
▪
Anderson, Henry A. “Evolution of Environmental Epidemiologic Risk Assessment,”
Environmental Health Perspectives 62 (1985): 389-392.
▪
Guidelines for Environmental Infection Control in Healthcare Facilities. U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2003.
▪
Lauer, James L., Donald R. Battles, and Donald Vesley. “Decontaminating Infectious Laboratory
Waste by Autoclaving.” Applied Environmental Microbiology 44, no. 3 (1982): 690-694.
2. What is regulated medical waste?
Key Message: The DOT HMR define “regulated medical waste” (RMW) as a waste or reusable material
derived from the medical treatment of an animal or human or from biomedical research. Category A
RMW is fully regulated and must be transported in compliance with all requirements of the HMR, or a
special permit (SP), if applicable.
Answer: RMW, also called “clinical waste” or “biomedical waste,” means a waste derived from the
medical treatment of an animal or human, including diagnosis and immunization, or from biomedical
research, including the production and testing of biological products. They consist of materials that are
typically seen in a doctor’s office, healthcare setting, or research facility, like gloves, gowns, and other
personal protective equipment that could be covered in blood or body fluids.
RMW is a subcategory of infectious substances under DOT’s HMR, and is subject to requirements for
proper packaging, emergency response and documentation. This helps ensure proper and safe transport of
these regulated wastes every day.
RMW containing a Category A infectious substance must be classified as a Category A infectious
substance for transportation purposes. It must be assigned the United Nations (UN) Identification Number
for UN 2814 - Infectious substances, affecting humans, or UN 2900 - Infectious substances, affecting
animals only, as appropriate.39 An infectious substance meets Category A criteria if it is in a form capable
of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals
upon exposure to the substance.
SLTT governments determine which generators of waste are subject to medical waste regulations in their
jurisdictions.
Background/References:
▪
39
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2008.
Hazardous Materials Regulations, Purpose and Use of Hazardous Materials Table, 49 CFR § 172.101 (1990).
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▪
Guidelines for Environmental Infection Control in Healthcare Facilities. U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2003.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
o
RMW Definition. 49 CFR § 173.134(a)(5).
o
Hazardous Materials Table entries for UN 2814 and UN 2900. 49 CFR § 172.101.
o
Classification Criteria. 49 CFR § 173.134.
o
Packaging Information. 49 CFR § 173.196.
o
Packaging Testing Information. 49 CFR § 178.609.
UN Hazard Numbers Guidance on Regulations for the Transport of Infectious Substances. World
Health Organization, 2007.
3. What is the composition of regulated medical waste?
Key Message: RMW can consist of sharps (e.g., needles, scalpels, lancets, and broken glass), bulk blood
and body fluids, microbiological wastes (e.g., cultures), anatomical and pathological wastes, and animals
exposed to or infected with human pathogens and the waste from these animals. The proportion of each of
these in the overall volume of RMW will vary.
Answer: RMW can consist of many types of materials. Some examples are sharps (e.g., needles, scalpels,
lancets, and broken glass); bulk blood, body fluids, and other potentially infectious materials (i.e., as
defined in the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens (BBP)
standard (29 CFR § 1910.1030) or items contaminated with these materials; anatomical and pathological
wastes; microbiological wastes (e.g., cultures); and animals exposed to or infected with human pathogens
and the waste from these animals.
While most RMW comes from healthcare facilities, including hospitals and doctors’ offices, materials
contaminated with blood or body fluids outside of traditional healthcare settings could also be considered
RMW under some circumstances. For example, RMW may come from cleanup of public spaces that have
been contaminated with blood or other body fluids.
Background/References:
▪
Bloodborne Pathogens. 29 CFR § 1910.1030. U.S. Department of Labor, Occupational Safety and
Health Administration.
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4. What is a Category A infectious substance?
Key Message: The DOT HMR define a Category A infectious substance as material known or expected
to carry pathogens (i.e., germs) in a form capable of causing life-threatening or deadly disease in humans
or animals when exposure to it occurs.
Answer: A Category A infectious substance is a material, which is in a form that, when exposure to it
occurs, is capable of causing permanent disability, life-threatening or fatal disease in otherwise healthy
humans or animals. For the purpose of the HMR, an infectious substance is a material known or
reasonably expected to contain a pathogen (i.e., germ). A pathogen is a microorganism (including a
bacterium, virus, parasite, or fungus) or another agent, such as a prion (i.e., a proteinaceous infectious
particle) that can cause disease in humans or animals.
An infectious substance is regulated as a hazardous material under the HMR. The HMR apply to any
material DOT determines is capable of posing an unreasonable risk to health, safety, and property when
transported in commerce. Classification of an infectious substance is based on the patient’s or animal’s
known medical history or symptoms, endemic local conditions, or professional judgment concerning the
individual circumstances of the source human or animal.
An infectious substance must conform to all applicable HMR requirements when offered for
transportation or transported by air, highway, rail, or water, in commerce.
The Ebola virus is one example of a Category A infectious substance. Appendix B – Infectious Agent
Categorization lists other Category A infectious substances.
Background/References: The definition of a Category A infectious substance within 49 CFR § 173.134
is based on criteria developed by the UN Subcommittee of Experts working with the World Health
Organization (WHO), Centers for Disease Control and Prevention (CDC), medical professionals,
microbiologists, transportation professionals, and packaging technical experts. The definition is consistent
with the requirements of the UN Recommendations for the Transport of Dangerous Goods (UN
Recommendations), the International Civil Aviation Organization (ICAO) Technical Instructions for the
Safe Transport of Dangerous Goods by Air (ICAO Technical Instructions), and the International Maritime
Dangerous Goods (IMDG) code.
▪
Transporting Infectious Substances Safely. U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration, 2020.
▪
Transporting Infectious Substances. Pipeline and Hazardous Materials Safety Administration,
U.S. Department of Transportation, 2017.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
Dangerous Goods Regulations, Division 6.2—Infectious Substances, 58th ed. International Air
Transport Association, 2017.
▪
Safe Management of Wastes from Health-Care Activities. World Health Organization, 2014.
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5. Who determines if an infectious substance is “Category A”?
Key Message: Under the DOT HMR, it is the responsibility of the offeror (the person who prepares,
tenders, or makes the hazardous material available to a carrier for transportation in commerce) to classify
a hazardous material for transportation.
Answer: Under the DOT HMR, it is the responsibility of the offeror (i.e., the person or entity generating
the material) to classify a hazardous material for transportation. The classification of the waste should be
based on the known medical risk factors or symptoms of the source patient, the endemic local conditions,
and/or professional judgment. The offeror should consult with the generator or the group with the best
knowledge of the situation in making the hazardous material classification and waste determination. In
healthcare facilities, the decision should be made by infectious disease personnel working in collaboration
with relevant SLTT public health and waste management authorities. See the definitions of “offeror” and
“generator” in the Glossary of Terms.
Background/References:
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
o
Class 6, Division 6.2—Definitions and exceptions. 49 CFR 173.134.
6. What is waste treatment and disposal?
Key Message: Waste treatment and disposal covers all of the steps in handling RMW, including Category
A waste, from the point it is generated to the final disposal of the waste itself and any residuals (e.g.,
incinerator ash) from the treatment. Waste treatment and disposal is governed by a combination of federal
and SLTT laws and regulations. Whenever possible, all Category A waste should be inactivated on-site
with an autoclave, incinerator, or similarly effective, validated technologies that comply with SLTT
requirements.
Answer: Waste treatment and disposal covers all of the steps in regulated medical waste including
handling waste from the point it is generated to the final disposal of the waste itself and any residuals
(e.g., incinerator ash) from the treatment of the waste.
Waste treatment and disposal is governed by a combination of federal and SLTT laws and regulations.
The type and characteristics of the waste determine the treatment and disposal requirements. Facilities
that generate contaminated waste should have a plan for how the waste will be managed. Each plan
should reflect input from appropriate SLTT health departments, and it should primarily focus on the
safety of those who will handle or package (or otherwise risk contact with) the contaminated waste
material at the source as well as further down the waste handling process. Whenever possible, Category A
infectious waste should be inactivated on-site with an autoclave, incinerator, or similarly effective,
validated technologies that comply with SLTT requirements.
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Background/References: SLTT regulatory agencies provide guidance to facilities in their jurisdictions
about waste characterization and management.
7. Prior to treatment, why must Category A waste be handled differently than other waste, such
as regular trash from a healthcare facility or other regulated medical waste?
Key Message: Compared to regular trash or RMW from a healthcare facility that is generally managed
under SLTT environmental regulations, Category A waste must be handled more carefully so that persons
are not exposed to the infectious substances in the waste. To accomplish this, entities that may need to
manage contaminated waste should have a plan to address all steps in the waste management cycle.
Answer: Category A waste must be handled more carefully so that persons are not exposed to the
infectious substances in the waste. Category A waste can be handled safely. The leadership for local
governments, facilities, and other organizations that may or will need to manage contaminated waste
should ensure that they have a plan to address the entire waste cycle. Each plan should have input from
SLTT public health and environmental authorities, as appropriate, and comply with applicable
regulations.
Regular trash or RMW from healthcare facilities is generally managed under SLTT environmental
regulations. This waste does not typically pose the same level of risk as a Category A infectious
substance; thus, the requirements for handling these wastes are different.
Because of the hazards posed by some Category A infectious substances (see Appendix B – Infectious
Agent Categorization for examples), these materials have more stringent packaging requirements than
other infectious substances and RMW. The transport of medical equipment, sharps, and used healthcare
products (such as soiled absorbent pads or dressings, emesis pans, portable toilets; used PPE, including
gowns, masks, gloves, goggles, face shields, respirators, booties, etc.; and byproducts of cleaning)
contaminated or suspected of being contaminated with a Category A infectious substance must comply
with the packaging requirements for infectious substances in the DOT HMR and, if applicable, the OSHA
Bloodborne Pathogens standard (29 CFR § 1910.1030).
Background/References:
▪
Department of Transportation Guidance for Transporting Ebola Contaminated Items, a Category
A Infectious Substance. U.S. Department of Transportation, Pipeline and Hazardous Materials
Safety Administration, 2017.
▪
Transporting Infectious Substances Safely. U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration, 2020.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
8. How do the government and the medical waste industry know that Category A waste can be
handled safely?
Key Message: Workers handle RMW on a regular basis without incident. Requirements and procedures
in place for routine waste handling are augmented by federal and SLTT requirements for handling
Category A waste. Complying with these requirements protects workers, public health, and the
environment.
Answer: Workers handle RMW on a regular basis without incident. Employers of workers who handle
contaminated waste are required to protect those workers from the hazards associated with their jobs,
including Category A infectious substances in the waste. Complying with the requirements of federal and
SLTT agencies ensures waste can be handled safely. These requirements cover how the waste must be
packaged, transported, inactivated, and disposed (e.g., U.S. Environmental Protection Agency, EPA;
DOT; and SLTT requirements), as well as protections for workers handling the waste (e.g., OSHA and
other SLTT requirements).
DOT regulates the design, manufacture, and certification of packaging used to contain and transport
hazardous materials safely. Because of the hazards posed by Category A infectious substances, these
materials have more stringent packaging requirements than other hazardous materials, including RMW.
The transport of medical equipment, sharps, and used healthcare products (such as soiled absorbent pads
or dressings, emesis pans, portable toilets; used PPE, including gowns, masks, gloves, goggles, face
shields, respirators, booties, etc.; and byproducts of cleaning) contaminated or suspected of being
contaminated with a Category A infectious substance must comply with the packaging requirements for
infectious substances in the DOT HMR and, if applicable, the OSHA Bloodborne Pathogens standard (29
CFR § 1910.1030). Using DOT-compliant packaging helps ensure that Category A waste can be handled
safely throughout the transportation process.
The DOT HMR classify hazardous materials according to the nature and severity of the hazards they
present. Higher risk hazardous materials must be transported to a waste treatment facility in packaging
that satisfy a higher design standard and are tested to prove they can withstand the stresses of
transportation. Packaging made to hold infectious substances are tested to a higher standard than others—
they are designed to withstand a drop from a height of 30 feet, exposure to heavy rain, freezing
temperatures, a 15-pound rod dropped on it from a height of three feet, and a three-foot drop onto an
eight-inch rod.
With specific respect to waste treatment, federal and SLTT governments have been working closely with
manufacturers and users of waste treatment equipment, such as autoclaves, to ensure that treatment
procedures are effective in inactivating (i.e., killing) pathogens, including Category A infectious
substances, in waste. Many states require manufacturers of medical waste autoclaves to provide data
demonstrating its effectiveness for their equipment to guide its use.
Achieving sufficient time/temperature conditions for the specific pathogen will ensure that the waste
material is no longer infectious.
Peer-reviewed literature also provides accounts of waste generators safely and effectively managing
Category A waste on-site, without having to transport theses wastes off-site for treatment. Once treated,
these wastes can be disposed of as either a solid waste or RMW at an appropriately permitted facility,
depending on SLTT requirements. These wastes can be safe to dispose of at a sanitary landfill or solid
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
waste incineration facility (or a waste-to-energy facility), as well. The facility/owner/operator will need to
follow any SLTT rules or regulations.
Background/References:
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970). U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
Lowe, John J., Shawn G. Gibbs, Shelly Schwedhelm, John Nguyen, and Philip W. Smith,
“Nebraska Biocontainment Unit Perspective on Disposal of Ebola Medical Waste,” American
Journal of Infection Control 42, no. 12 (2014): 1256-1257.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
Information on the Survivability of the Ebola Virus in Medical Waste. U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2015.
9. What is a pathogen?
Key Message: A pathogen in the broadest sense is anything that can produce an infectious disease.
Answer: A pathogen in the broadest sense is anything that can produce an infectious disease. Typically,
pathogens include bacteria, viruses, fungi, prions, and parasites (e.g., protozoa, helminths, and
nematodes). These agents may cause disease in susceptible plant, animal, or human hosts.
Also see the definition of “pathogen” in the Glossary of Terms.
Background/References:
▪
Casadevall, Arturo, and Liise-Anne Pirofski. “What is a Pathogen?” Annals of Medicine 34, no. 1
(2002): 2-4.
▪
Casadevall, Arturo, and Liise-Anne Pirofski. “Microbiology: Ditch the Term Pathogen,” Nature
516, no. 7530 (2014): 165-166.
▪
Casadevall, Arturo, and Liise-Anne Pirofski. “Q&A: What is a Pathogen? A Question That Begs
a Point,” BMC Microbiology 10 no. 6 (2012): 6-8.
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10. Which government agency(ies) is/are responsible for regulating medical waste?
Key Message: Individual states and territories have the primary regulatory authority for the management
and treatment of RMWs in the United States. SLTT regulations may differ from one another—some
jurisdictions may be more stringent than others. Specific SLTT regulations are generally found in the
SLTT solid waste or health department regulations. However, the DOT/Pipeline and Hazardous Materials
Safety Administration (PHMSA), EPA, U.S. Department of Agriculture (USDA), and OSHA each have
requirements that may affect RMW.
Answer: Since the late 1980s, individual states and territories have had the primary regulatory authority
for the management and treatment of RMW in the United States. This includes, but may not be limited to,
waste identification processes/procedures and requirements for treatment or inactivation prior to ultimate
disposal, as well as ultimate disposal requirements.
SLTT regulations may differ from one another—some jurisdictions may be more stringent than others.
Specific SLTT regulations are generally found in the SLTT solid waste or health department regulations.
DOT/PHMSA, EPA, USDA, and OSHA each have requirements that also may affect RMW.
DOT: For the purpose of transportation, DOT defines RMW as “a waste or reusable material derived
from the medical treatment of an animal or human, which includes diagnosis and immunization, or from
biomedical research, which includes the production and testing of biological products.”40 The DOT HMR
apply to the transportation of hazardous materials in interstate or intrastate commerce, which includes the
movement of the hazardous material, as well as its loading, unloading, or storage. The HMR regulate
materials that are suspected or known to be contaminated with a Category A infectious substance, as well
as other forms of RMW.
EPA: There are no specific EPA regulations under the federal Resource Conservation and Recovery Act
(RCRA) for the treatment/inactivation and disposal of RMW. As noted above, medical waste is primarily
regulated at the SLTT level. However, hospital infectious medical waste incinerators must meet specific
standards set by EPA’s Clean Air Act (CAA) regulations. In addition, solid waste landfills must meet
minimum federal criteria set out in the RCRA subtitle D regulations and state/territorial permits and any
hazardous waste treatment, storage or disposal facility must comply with the hazardous waste regulations
and requirements in their permits.
CDC and USDA: The U.S. Department of Health and Human Services (HHS) regulates select agents and
toxins under 42 CFR part 73; USDA regulates them under 7 CFR part 331 and 9 CFR part 121. The
federal select agent regulations include controls for who (i.e., which labs) can possess, use, or transfer
such agents and toxins. Waste generated during the treatment of patients infected with a select agent
identified as a Category A infectious substance in the HMR and which must be managed as such (i.e., the
agent is not designated as “cultures only”) are not subject to the select agent regulations as long as the
material has been subjected to decontamination or a destruction procedure (See the exclusion provision 42
CFR §§ 73.3(d)(3) and 73.4(d)(3)). The select agent regulations require that laboratory samples of select
40
Hazardous Materials Regulations, 49 CFR § 173.134(a)(5) (2013).
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agents obtained as part of patient care (i.e., for clinical diagnostic purposes) must be inactivated or
transferred for destruction within seven calendar days of the conclusion of patient care.
OSHA: OSHA sets standards and other requirements to protect workers from exposure to infectious
materials. These include the Bloodborne Pathogens (29 CFR § 1910.1030), PPE (29 CFR 1910 subpart
I), and Respiratory Protection (29 CFR § 1910.134) standards and the General Duty Clause of the
Occupational Safety and Health (OSH) Act of 1970. The Bloodborne Pathogens standard (29 CFR §
1910.1030) includes requirements for packaging, labeling, and handling blood, certain body fluids, and
other potentially infectious materials, and items contaminated with these materials.
As evidenced by these references, RMW is heavily regulated. Because of these tight regulations,
thousands of pounds of these materials are safely transported throughout communities each day without
incident.
Background/References:
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970). U.S. Department of Labor
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
Personal Protective Equipment. 29 CFR § 1910.132 (2011). U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Respiratory Protection. 29 CFR § 1910.134 (2011). U.S. Department of Labor, Occupational
Safety and Health Administration.
11. How are pathogens transmitted to people (or animals, if applicable)?
Key Message: Pathogens can be spread in a variety of ways, including through direct contact; indirect
contact with a contaminated environmental surface, equipment, or other item; droplets; ingestion; or
exposure to aerosolized or airborne infectious material. Susceptible (i.e., persons without immunity or
who are otherwise capable of getting a disease) individuals can be infected when they are exposed
through one or more of these routes.
Answer: Transmission of pathogens can occur by a variety of ways, generally referred to as means,
modes or routes of transmission. These include contact (direct and indirect), droplet, and airborne
transmission. Pathogens that can be transmitted from animals to humans are termed “zoonotic agents.”
Transmission of an agent to an individual is driven by what is known as the “chain of infection,” and is a
complex process with many steps. If any one step or component of this chain is missing or broken,
infection cannot occur. In short, all of the following must be present: presence of an infectious agent of
sufficient virulence and concentration (i.e., enough agent capable of causing infection), presence of a
reservoir (i.e., sources that normally harbor disease-causing organisms and thus serve as potential sources
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of disease), source or portal of exit from infected host, route of transmission, a susceptible host, and a
portal of entry into the host.
Background/References:
▪
Ostrowsky, Belinda. “Epidemiology of Healthcare-Associated Infections” in Bennett and
Brachman’s Hospital Infections, 6th edition, ed. William R. Jarvis, 1-20. Philadelphia,
Pennsylvania: Lippincott Williams & Wilkins, 2014.
12. What is the federal government doing to ensure that healthcare facilities; ambulance services;
and waste transport, treatment, and disposal companies handle the waste safely and comply
with applicable requirements?
Key Message: The federal government has strict requirements for handling, transporting, treating, and
disposing of Category A waste; and is working closely with healthcare facilities, waste transport and
treatment companies, landfill operators, and SLTT agencies to ensure all parties involved in the waste
cycle are prepared to handle infectious waste in a safe and effective manner.
Answer: The federal government has strict requirements for handling, transporting, treating, and
disposing of Category A waste. Whenever possible, the safest and best options for inactivating Category
A waste (e.g., using an autoclave, incinerator, or similarly effective validated technologies that comply
with SLTT requirements) are implemented on-site. When on-site treatment is not possible, materials that
are suspected or known to be contaminated with Category A infectious substances may only be
transported (e.g., for off-site treatment) in two scenarios: in full compliance with classification and
packaging requirements of the DOT HMR and the OSHA Bloodborne Pathogens standard (29 CFR §
1910.1030); or, under the terms of a special permit issued by DOT. As noted previously, “medical waste”
is generally regulated by SLTT governments, as are most other non-hazardous solid wastes, such as
municipal solid waste. For hazardous waste streams, EPA has authorized some territories and all but two
states to implement some or all of the RCRA hazardous waste program, such that authorized State
requirements apply in lieu of federal EPA requirements. In some cases, SLTT governments may impose
requirements that are more stringent or go beyond the federal regulations so it is important to check for
any SLTT requirements.
Because of the relatively large quantity of contaminated waste generated when treating patients who are
known or suspected of having certain infectious diseases, including Ebola virus disease (EVD) and other
hemorrhagic fever viruses (HFVs), the available packaging authorized under the regulations governing
the transport of Category A infectious substances (intended for laboratory materials) may not be large
enough to meet the need. DOT issued a special permit, SP 16279, authorizing transportation of Ebola
infectious materials in alternative packaging designs that meet safety requirements and that can help
accommodate the large volume of waste. Special permits for other Category A agents may have different
requirements that reflect specific characteristics of the waste, waste generation scenarios, packaging
needs, or other considerations.
Federal agencies, including CDC, OSHA, HHS/Assistant Secretary for Preparedness and Response
(ASPR), EPA, and DOT, have been working closely with healthcare facilities, waste transport and
treatment companies, landfill operators, and state/territorial/local agencies to ensure all parties involved in
the waste cycle are prepared to handle Category A infectious waste in a safe and effective manner. These
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activities include visits to hospitals and other facilities by experts in infection control, patient care, waste
handling, occupational health, and other subject matter areas; designation of certain facilities with higherlevel patient care and waste handling capabilities; and outreach efforts to ensure that impacted parties are
knowledgeable about requirements and procedures for safe waste handling.
Background/References:
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970), U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
13. Who can I contact if I have questions about infectious waste, regulated medical waste, and
Category A waste?
Key Message: Depending on the specific issue, a variety of federal and SLTT agencies have authority
over and provide information about managing waste, including Category A waste. Members of the public
can contact CDC, DOT, EPA, and OSHA, as well as the SLTT agencies in their area with questions.
Answer: Depending on the specific issue, a variety of federal and SLTT agencies have authority over and
provide information about the handling, transport, treatment, and disposal of infectious waste and RMW,
including Category A waste. Members of the public can contact CDC, DOT, EPA, and OSHA, as well as
the SLTT agencies in their area with questions.
▪
Regarding CDC guidance, contact: by phone, 1-800-CDC-INFO (1-800-232-4636); by email,
CDCINFO@cdc.gov; by web form, wwwn.cdc.gov/dcs/ContactUs/Form.
▪
Regarding DOT guidance or HMR requirements, contact: by phone, DOT/PHMSA’s Hazardous
Materials Information Center, 1-800-467-4922.
▪
Regarding EPA guidance on solid and hazardous waste issues, contact: by phone, 1-703-3088895; by web form, www.epa.gov/rcra/forms/contact-us-about-resource-conservation-andrecovery-act-rcra-laws-and-regulations.
▪
Regarding OSHA guidance and worker safety and health requirements, contact: by phone, 1-800321-OSHA (1-800-321-6742); by web, www.osha.gov/html/Feed_Back.html.
Background/References:
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
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▪
Links to Hazardous Waste Programs and U.S. State Environmental Agencies. U.S. Environmental
Protection Agency.
▪
CDC website. U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention.
▪
OSHA website. U.S. Department of Labor, Occupational Safety and Health Administration.
WASTE GENERATION QUESTIONS & ANSWERS
1. Where does Category A waste come from?
Key Message: Category A waste is typically generated during patient care in a healthcare facility, during
patient transport, in homes of individuals with certain infectious diseases, in laboratories analyzing or
studying pathogens (i.e., germs), and from other activities involving pathogens (i.e., germs) classified as
Category A infectious substances (see Appendix B – Infectious Agent Categorization). Category A waste
may include materials such as needles, specimen tubes, blood-soaked gauze pads, gloves, other PPE,
bedding, and other items may have blood or other pathogen-containing bodily fluids in/on them.
Answer: Category A waste results from a variety of tasks, the most common of which is likely to be
patient care activities in healthcare facilities and patient transportation operations. During these activities,
needles/syringes, IV access devices, tubing, dressings, PPE, and other materials are used and can become
contaminated with Category A infectious substances. Larger items, like bulk bedding materials and
mattresses, may also constitute Category A waste from patient care and residential settings.
Generally, contamination with Category A infectious substances comes from bodily fluids from a
symptomatic person. However, workers in clinical and research laboratories and in other settings may
generate Category A waste when they handle Category A infectious substances. Appendix B – Infectious
Agent Categorization provides more information about how the ways in which certain substances are
handled (e.g., intentional propagation or “culturing”) affects their categorization.
Background/References:
▪
Guidelines for Environmental Infection Control in Healthcare Facilities. U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2003.
▪
Guideline for Disinfection and Sterilization in Healthcare Facilities. U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2008.
▪
WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies, Report of a
WHO Consultation, Geneva, Switzerland, 23-26 March 1999. World Health Organization, 2000.
▪
Interim Guidance for U.S. Residence Decontamination for Ebola and Removal of Contaminated
Waste, U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, 2015.
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▪
Medical Waste. U.S. Environmental Protection Agency, 2017.
2. What can be done to reduce the amount of infectious Category A waste generated in the first
place?
Key Message: Healthcare facilities and other generators of infectious waste can reduce the amount of
such waste they produce by ensuring that non-infectious waste is kept separate from infectious waste.
Answer: The local public health authority is often in the best position to assess whether items in the
patient’s immediate environment are contaminated and pose a health risk. Generally, environmental
contamination occurs when items come in contact with bodily fluids. In the case of some diseases caused
by Category A infectious substances, including EVD, only persons who are symptomatic (have a fever),
generate bodily fluids that pose a risk. Other Category A agents may be transmissible even if a person is
not symptomatic. Correctly assessing the presence of symptoms, agent transmissibility, and actual
contamination is paramount to preventing mischaracterization, especially for large, bulky household
items.
In healthcare facilities, reducing the amount of infectious waste items may not be easily accomplished,
depending on the patient care procedures. Frequently, healthcare facilities can take steps to ensure that
routine solid waste items are not co-mingled with RMW. Failure to prevent the co-mingling of these
waste streams will result in increased expenses for treatment of larger volumes of RMWs.
One strategy for reducing the volume of RMW is to control the amount of material that becomes
contaminated. Removing packaging and other unneeded materials from medical equipment before
introducing it into a patient care area can help reduce the volume of waste that must be inactivated,
transported, and disposed.
Background/References:
▪
Interim Guidance for U.S. Residence Decontamination for Ebola and Removal of Contaminated
Waste, U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, 2015.
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WASTE TRANSPORTATION QUESTIONS & ANSWERS
1. Who is responsible for properly identifying infectious waste that is transported between
facilities?
Key Message: The DOT’s HMR require the offeror of infectious waste to classify the waste before it is
transported between facilities. The classification that an offeror (e.g., a healthcare facility or a patient
transporter) assigns to the waste (e.g., a RMW containing a Category A infectious substance) will
determine how it must be packaged and prepared for transportation.
Answer: The DOT’s HMR require the offeror of infectious waste to classify the waste before it is
transported between facilities. The classification that an offeror (e.g., a healthcare facility or a patient
transporter) assigns to the waste (e.g., Category A waste) will determine how it must be packaged and
prepared for transportation.
Background/References:
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
o
Class 6, Division 6.2—Definitions and exceptions. 49 CFR § 173.134.
▪
Transporting Infectious Substances Safely. U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration, 2020.
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
2. Is my family at risk of being exposed to infectious waste if it is transported through my/our
community?
Key Message: When infectious substances are transported in compliance with DOT requirements, the
risk to the public is minimized.
Answer: When infectious substances are transported in compliance with DOT requirements, the risk to
the public is minimized. Waste is required to be packaged appropriately to protect people. Packaging
requirements and other operational and safety controls are very robust and mitigate the risk in transport of
infectious waste that may be transported through your community. As described above, DOT has
stringent regulations regarding the packaging and transportation of infectious substances.
With over 25 years of management of RMW in the United States, during which medical wastes have been
transported to off-site waste treatment operations, there have been no reports of infections in communities
linked to this transport. There has only been one reported instance of infections resulting from waste
management activities, in which three medical waste treatment workers at a single facility in Washington
contracted Mycobacterium tuberculosis (TB) on the job.
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In the 10 years of Category A infectious waste identification, there are no reports of infections in
communities linked to Category A infectious waste transport.
Background/References: Packaging materials made to hold infectious substances are tested to a higher
standard than others—they are designed to withstand a drop from a height of 30 feet, exposure to heavy
rain, freezing temperatures, a 15-pound rod dropped on it from a height of three feet, and a three-foot
drop onto an eight-inch rod. DOT/PHMSA has also issued a special permit, SP 16279, which authorized
special permit holders to use a process for transporting Ebola-contaminated waste that involves a
combination of effective package designs and extensive operational controls related to packing,
disinfectant, driver qualifications, notification to DOT, vehicle inspection, loading, attendance, and
security plans. As the special permit is specific to Ebola, additional, but likely similar, special permits
would be needed for waste contaminated with other Category A infectious agents.
▪
Infectious Substance Special Permits. Pipeline and Hazardous Materials Safety Administration,
U.S. Department of Transportation, 2017,
▪
Transporting Infectious Substances Safely. U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration, 2020.
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Johnson, Kammy R., Christopher R. Braden, K. Lisa Cairns, Kimberly W. Field, A. Craig
Colombel, Zhenhua Yang, Charles L. Woodley, Glenn P. Morlock, Angela M. Weber, A. Yvonne
Boudreau, Thomas A. Bell, Ida M. Onorato, Sarah E. Valway, and Paul A. Stehr-Green.
“Transmission of Mycobacterium Tuberculosis from Medical Waste.” Journal of the American
Medical Association 284, no. 13 (2000): 1683-1688.
3. If waste is inactivated, is there a risk to me or my family if it is transported through or disposed
of in my/our community?
Key Message: Once the waste has been inactivated it is no longer infectious. There should be no risk to a
community during the transport or ultimate disposal of the waste unless other types of hazards are present
(e.g., chemical).
Answer: Once waste has been properly inactivated, it is no longer infectious and does not pose a health
risk if it is transported through or disposed of in your community unless other types of hazards are present
(e.g., chemical). Waste that has been inactivated in an effective autoclave cycle, or by incineration or
another validated method contains no live infectious agents. The validated exposure conditions (e.g., to
heat, steam, pressure, or certain chemicals) for inactivation will ensure that the waste material is no longer
infectious and, as such, is not considered RMW or a hazardous material under federal law.
Waste inactivated by autoclaving or, in circumstances where it is necessary, chemical methods, should
include a process control to show that the protocol is performed effectively. For example, staff should
check the autoclave cycles frequently for biological indicators (spores) as a quality assurance measure to
show that the waste cycles are achieving desired results.
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Background/References:
▪
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and
National Institutes of Health. Biosafety in Microbiological and Biomedical Laboratories (BMBL),
5th edition, edited by L. Casey Chosewood and Deborah E. Wilson. HHS Publication No. (CDC)
21-1112. Atlanta, Georgia, and Bethesda, Maryland, 2009.
▪
Safe Management of Wastes from Health-Care Activities. World Health Organization, 2014.
4. Will I be notified if Category A waste is transported through my community or processed or
disposed of at a facility near my home or business?
Key Message: Due to security concerns related to the transportation of some Category A infectious
substances, the public may not be notified regarding the route or disposal of Category A waste. The DOT
HMR and SP 16279 include requirements for providing information to transporters and emergency
responders.
Answer: Due to security concerns related to the transportation of some Category A infectious substances,
the public may not be notified regarding the route or disposal of Category A waste. The DOT HMR and
SP 16279 include requirements for providing information to transporters and emergency responders. SP
16279 requires shipping paperwork that describes the materials being transported. The SP also requires
marking and labeling of packages to inform transporters and emergency responders about any potential
hazards associated with the materials being transported. For more information regarding the required form
and content of the hazard communications, please refer to DOT’s guidance on transporting infectious
substances safely via the link below.
Background/References:
▪
Special Permit 16279. U.S. Department of Transportation, Pipeline and Hazardous Materials
Safety Administration, 2014. Materials transported under SP 16279 must meet provisions within
the special permit.
▪
Transporting Infectious Substances Safely. U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration, 2020.
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
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5. Is there a plan in place to handle emergencies that happen when transporting infectious waste,
such as an accident involving the truck carrying the waste?
Key Message: Yes, RMW and other hazardous materials transportation companies are required to
develop and implement emergency response plans when transporting any hazardous material. For
example, for Ebola, the special permit required specific emergency response plans be in place prior to
transporting the waste materials. DOT’s packaging requirements and other operational and safety controls
are very robust.
Answer: Yes, RMW and other hazardous materials transportation companies are required to develop and
implement emergency response plans when transporting any hazardous material. For example, for Ebola,
the special permit required specific emergency response plans be in place prior to transporting the waste
materials. DOT’s packaging requirements and other operational and safety controls are very robust. All
carriers authorized to transport infectious waste under SP 16279 are required to have a written spill
response plan that includes provisions for the decontamination of spilled materials and for PPE to be
carried on the vehicle and used to protect its employees from contact with infectious materials in any
form. These carriers must respond to any release or suspected release from a package that occurs during
transportation. These carriers are also required to develop and adhere to security plans that address
personnel security, preventing unauthorized access, and security during movement of the infectious
waste, as described in the regulations (49 CFR §§ 172.800-822). Security plans must be made available to
an authorized official of the DOT or U.S. Department of Homeland Security (DHS).
Individuals or companies that offer infectious waste for transportation must develop and implement
written security plans to address emergencies such as an accident. Security plans include an assessment of
possible transportation security risks including personnel security, unauthorized access and en route
security as well as a plan to address any identified risks. These plans are reviewed by DOT/PHMSA and
updated or revised as needed.
Background/References:
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970), U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
OSHA Hazardous Waste Operations and Emergency Response standard. 29 CFR § 1910.120
(2013), U.S. Department of Labor, Occupational Safety and Health Administration.
▪
Security Plans. 49 CFR Subpart I (2003). U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration.
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6. Are there specific requirements for transporting Category A waste?
Key Message: Yes, The DOT HMR dictate requirements for transporting Category A infectious
substances. Additionally, DOT/PHMSA issued a special permit (SP 16279) to enable the safe transport of
Ebola-contaminated waste. Materials that are suspected or known to be contaminated by Category A
infectious substances may only be transported in two scenarios: in full compliance with classification and
packaging requirements of the HMR, or under the terms of a special permit. SLTT governments may have
additional requirements for infectious waste transportation so facilities need to check with the
jurisdictions in which they operate.
Answer: Yes, DOT has developed specific requirements for packaging of Category A infectious
substances listed under 49 CFR § 173.196. Additionally, if these specific standards cannot be met entities
can request a special permit that shows equivalent safety in transporting these materials. Issued in 2014,
SP 16279 authorizes the safe transportation of certain Ebola-contaminated medical waste for disposal. It
specifically spells out how the waste must be packaged, marked, and transported. It also requires specific
documentation, called a shipping paper, to identify the key hazards in the event of an emergency to first
responders. Additional information on the transportation of all general Category A substances can be
found at: phmsa.dot.gov/hazmat/transporting-infectious-substances.
The DOT HMR regulate an infectious substance as a hazardous material. The HMR apply to any material
that DOT determines is capable of posing an unreasonable risk to health, safety, and property when
transported in commerce. An infectious substance must conform to all applicable HMR requirements
when offered for or actually transported by air, highway, rail, or water,41 but the overall handling of
contaminated waste begins with the creation of the waste, includes waste transportation, and ends at final
disposition.
DOT/PHMSA regulates movement of hazardous materials across all modes of transportation through the
HMR, which are designed to minimize the risks to life, property, and the environment during the
transportation of hazardous materials. For Category A infectious substances (see Appendix B – Infectious
Agent Categorization), the HMR provide clear regulations for classification, packaging, and
communication procedures that must be followed.42 DOT/PHMSA also has the authority to issue a special
permit for transporting contaminated waste in a manner that deviates from conventional, established
HMR methods (e.g., using alternate packaging).
Materials that are suspected or known to be contaminated by Category A infectious substances may only
be transported in two scenarios: in full compliance with classification and packaging requirements of the
HMR, or under the terms of a special permit. Because of the relatively large quantity of contaminated
waste generated when treating patients with known or suspected EVD, the available packaging authorized
under the regulations governing the transport of Category A infectious substances were not large enough
41
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration, Transporting
Infectious Substances Safely (Washington, DC, 2020), https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/202004/Transporting-Infectious-Substances-Safely.pdf.
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration, “Department of
Transportation Guidance for Transporting Ebola Contaminated Items, a Category A Infectious Substance,” modified
July 18, 2017, www.phmsa.dot.gov/transporting-infectious-substances/packaging-ebola-contaminated-waste.
42
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to meet the need. Alternative packaging designs, authorized under SP 16279, were needed to meet safety
requirements and to accommodate the large volume of waste.
The DOT HMR require the offeror of infectious waste to classify the waste before it is transported
between facilities. The classification that an offeror (e.g., a health care facility or a patient transporter)
assigns to the waste (e.g. a RMW containing a Category A infectious substance) will determine how it
must be packaged and prepared for transportation.
An offeror is a person who (i) performs, or is responsible for performing, any pre-transportation function
required under the HMR for transportation of the hazardous material in commerce, or (ii) tenders or
makes the hazardous material available to a carrier for transportation in commerce.43
When dealing with a known or suspected Category A infectious substance, the offeror should first talk to
all the necessary people within their organization or in their plan, such as infection control specialists or
relevant SLTT public health officials, when making a decision if the waste is a Category A infectious
substance. If they need to transport the waste off-site for inactivation/treatment, then they would work
with the RMW transporter or waste management facility to properly prepare the waste for transport.
What is the correct packaging for a Category A infectious substance?
The specific requirements for authorized packaging and materials for transporting a Category A infectious
substance are listed in 49 CFR § 173.196. In addition, each packaging must meet specific test standards in
accordance with 49 CFR § 178.609.
In general, a Category A infectious substance must be triple packed in a:
•
•
•
primary watertight receptacle;
watertight secondary packaging; and
rigid outer packaging.
Are there any additional HMR packaging requirements for a Category A infectious substance?
Yes, depending on the physical state and other characteristics of the material:
•
•
•
Category A infectious substances shipped at ambient temperatures or higher must be packaged in
accordance with 49 CFR § 173.196(b)(1);
Category A infectious substances shipped refrigerated or frozen must be packaged in accordance
with 49 CFR § 173.196(b)(2); and
Category A infectious substances shipped in liquid nitrogen must be packaged in accordance with
49 CFR § 173.196(b)(3).
Must the shipment of a Category A infectious substance be accompanied by a shipping paper?
Yes, the shipping paper requirements identify key hazard communication information. The shipping paper
must include the following:
43
Hazardous Materials Regulations, 49 CFR § 171.8 (1976).
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
•
•
•
•
UN identification number and proper shipping name for the applicable Category A infectious
substance. Include the UN identification number and proper shipping name in the format: “UN
2814, Infectious substances, affecting humans (Name of substance)”;
Hazard class: Division 6.2 (infectious substance);
Packing group: N/A;
Type and quantity of packaging; and
Emergency response information (e.g., telephone number).
What information is required on the outside of the outer packaging?
The outer packaging must be marked with the UN identification number and proper shipping name (see
above) and labeled with the black and white “INFECTIOUS SUBSTANCE” label that conforms to 49
CFR § 172.432.
The manufacturer who represents that the packaging is manufactured to meet a UN standard must mark it
with the appropriate packaging standard markings. The markings must be durable, legible, and placed in a
location as to be readily visible, in accordance with 49 CFR § 178.503(a).
Directional arrows to indicate the correct (upright) orientation of the closures of inner packagings that
contain liquids must be used in accordance with 49 CFR § 172.312.
Are there additional requirements for specific modes of transportation?
Yes, all hazardous materials packagings intended for transportation by aircraft must comply with the
general requirements for transporting hazardous materials by aircraft in 49 CFR § 173.27.
When unloaded from an aircraft, each package, overpack, pallet, or unit load device containing a
Category A infectious substance must be inspected for signs of leakage. If evidence of leakage is found,
the cargo compartment hold where the substance was stowed must be disinfected and the incident must be
reported by telephone within 12 hours to the National Response Center at 1-800-424-8802. (See 49 CFR
§§ 175.630(c) and 171.15(b)(3)).
Shippers and carriers also have the option of using international standards and regulations, instead of the
HMR, in accordance with the provisions in 49 CFR §§ 171.22-171.24.
For air transportation, the carrier may use the ICAO Technical Instructions for the Safe Transport of
Dangerous Goods by Air.
For maritime transportation, the carrier may use the IMDG.
Background/References:
▪
Special Permit 16279. U.S. Department of Transportation, Pipeline and Hazardous Materials
Safety Administration, 2014. Materials transported under SP 16279 must meet provisions within
the special permit. The requirements for packaging and labeling of Category A infectious
substances in transport can be found in 49 CFR § 173.196.
▪
Transporting Infectious Substances Safely. U.S. Department of Transportation, Pipeline and
Hazardous Materials Safety Administration, 2020.
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▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
WASTE TREATMENT QUESTIONS & ANSWERS
1. Should infectious waste be pre-treated with a disinfectant before it is sent from a facility for
further treatment and disposal?
Key Message: Whenever feasible, Category A waste should be inactivated on-site (i.e., wherever the
waste was generated) by autoclaving or incineration. However, other validated methods of waste
treatment that involve chemical disinfection may be necessary when operational constraints, such as those
associated with patient care activities outside of fixed hospital facilities, preclude the use of autoclaves or
incinerators.
Answer: In general, pre-treatment of large volumes of Category A waste or other RMW with a
disinfectant prior to transporting it for inactivation at an off-site facility will not achieve the outcome
desired (e.g., rendering the waste non-infectious) because only the outer surfaces of the waste will have
contact with the disinfectant. Additionally, spraying disinfectant on waste requires unnecessary
manipulation of the waste above and beyond the containment of the waste. Adding disinfectant also poses
an additional hazard to healthcare worker because of exposure to chemicals, increased weight of bagged
waste, and increased volume of liquid in bagged waste.
When operated within permitted parameters and according to validated protocols, autoclaving and
incineration methods that are typically used at off-site treatment facilities can effectively inactivate waste
without requiring pre-treatment. Unless otherwise specified, the packaging and transportation
requirements in the HMR or, if applicable, a DOT Special Permit are intended to allow for safe
transportation of waste for such treatment without the need for pre-treatment.
Background/References:
▪
Information on the Survivability of the Ebola Virus in Medical Waste. U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2015.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
▪
List L: EPA's Registered Antimicrobial Products that Meet the CDC Criteria for Use Against the
Ebola Virus. U.S. Environmental Protection Agency.
▪
List J: Registered Antimicrobial Products for Medical Waste Treatment. U.S. Environmental
Protection Agency.
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▪
Franke-Whittle, Ingrid H., and Heribert Insam. “Treatment Alternatives of Slaughterhouse
Wastes, and Their Effect on the Inactivation of Different Pathogens: A Review.” Critical Reviews
in Microbiology 39, no. 2 (2013): 139-151.
▪
Non-Incineration Treatment and Disposal of Healthcare Waste. Global Healthcare Waste Project,
World Health Organization, 2017.
2. What methods are used to treat infectious waste so that it is no longer infectious?
Key Message: Autoclaves or incinerators are most commonly used to inactivate contaminated waste.
Once waste has been properly inactivated, it is no longer infectious or a Category A waste.
Answer: Facilities may inactivate contaminated waste using an autoclave operating within permitted
parameters.44 Use an autoclave cycle that heats materials to a high enough temperature for a long enough
period of time to inactivate the organism(s) of concern in the waste. Such time/temperature conditions
will ensure that the waste material is no longer infectious, does not pose a health risk, and is not
considered RMW or a hazardous material under federal law.
A facility may also use incineration. Medical incinerators with dual chambers run at temperatures well
above the temperature needed to inactivate most Category A pathogens. Prions may be an exception to
this general statement. Parameters should be tailored to the specific materials to be incinerated.
Incineration would be the best method for large or bulky items. If a facility uses incineration, then its
waste management plan should include a method for disposal of the residuals.
Inactivation (e.g., through autoclaving or other validated methods) or incineration of contaminated waste
at a facility may be subject to federal or SLTT regulations, including environmental and worker safety
and health requirements.
Other methods of inactivation (e.g., chemical treatment, alkaline hydrolysis digesters) would need to
consider worker health and safety issues as well as the potential for triggering other federal or SLTT
regulations, including environmental regulations under the Federal Insecticide, Fungicide, and
Rodenticide Act (FIFRA).
Background/References:
▪
Information on the Survivability of the Ebola Virus in Medical Waste, U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2015.
44
Operators should validate that their waste inactivation procedures meet required performance standards, including
achieving certain exposure time and temperature requirements, acceptable results on biological indicators or other
test assays, and allowable concentration of certain pollutants or contaminants in any effluent or other by-product of
the process.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
3. How do waste treatment and disposal companies ensure that the processes they use to treat
infectious waste are effective?
Key Message: While methods for ensuring the effectiveness of waste treatment vary by process, large
commercial autoclaves, tested to inactivate materials using specific time, temperature, and pressure for
treatment have been shown to properly kill pathogens or viruses and incineration which reaches extremely
high temperatures (well above those needed to inactivate any Category A infectious substance) have
proven to be very effective.
Answer: Large commercial autoclaves, tested to inactivate materials using specific time, temperature,
and pressure for treatment have been shown to properly kill pathogens or viruses. Medical incinerators
with dual chambers reach extremely high temperatures (well above those needed to inactivate any
Category A infectious substance). These treatment methods have proven to be very effective. Treatment
facilities that use autoclaving should have protocols and operating requirements that include a process
control step to ensure the effectiveness of their equipment. For example, autoclave cycles should be
frequently checked using biological indicators (spores) as a quality assurance measure to ensure that the
cycles are achieving the desired results.
Incineration is effective due to the very high temperatures used and the relatively low temperatures
needed to inactivate most Category A infectious substances. One exception may be prions which are
extremely difficult to disinfect, requiring specialized treatments (e.g., combustion temperatures at or
above 1,000°C/1,832°F) for complete inactivation.
Other methods have not been standardized; thus, if a facility seeks to use, for example a chemical
treatment, it is likely to be required to perform substantial testing and quality control to ensure
inactivation. Facilities should verify requirements with SLTT health and/or environmental departments.
States/territories may require medical waste treatment companies to present data demonstrating
effectiveness of waste treatment processes prior to receiving a permit to operate in a particular
state/territory. States/territories may have oversight programs involving inspections of these operations on
a periodic basis.
Background/References:
▪
Information on the Survivability of the Ebola Virus in Medical Waste, U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2015.
4. Are there any steps normally involved in treating medical waste that should be avoided during
treatment and disposal of Category A waste?
Key Message: Employers of workers whose tasks involve treating and disposing of Category A waste
should ensure that their work practices minimize worker contact with the contaminated waste, prevent
generation of potentially infectious aerosolized particles, and comply with all applicable public health and
environmental requirements.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Answer: Employers of workers whose tasks involve treating and disposing of Category A waste should
ensure that their work practices minimize worker contact with the contaminated waste. For example,
protocols should involve autoclaving or incinerating entire packages of waste rather than unpacking for
loading into treatment equipment. Use of machines to move or load waste containers into processing
equipment may also reduce direct worker contact with infectious waste.
Prevent generation of potentially infectious aerosolized particles by avoiding the use of procedures that
result in sprays of droplets or air. For example, do not shred waste prior to treatment; and do not use highpressure sprays of air, water, or chemicals to clean waste processing facilities and equipment.
There is only one report of a waste treatment worker’s occupationally-acquired infection due to poor
aerosol control during laboratory waste shredding prior to treatment (See Johnson et al. below). However,
while this poorly controlled process released contaminated aerosols, the building’s ventilation design
helped to prevent these aerosols from a larger release to the community.
Employers must comply with all applicable public health and environmental requirements, including
those designed to ensure containment of treated waste disposed of in landfills.
Background/References:
▪
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health. Stericycle, Inc. Health Hazard Evaluation
Report, by Angela M. Weber, Yvonne Boudreau, and Vincent D. Mortimer. HETA 98-00272709. Cincinnati, Ohio, 1998.
▪
Weber, Angela M., Yvonne Boudreau, and Vincent D. Mortimer. “A Tuberculosis Outbreak
among Medical Waste Workers.” Journal of the American Biological Safety Association 5, no. 2
(2000): 70-88.
▪
Johnson, Kammy R., Christopher R. Braden, K. Lisa Cairns, Kimberly W. Field, A. Craig
Colombel, Zhenhua Yang, Charles L. Woodley, Glenn P. Morlock, Angela M. Weber, A. Yvonne
Boudreau, Thomas A. Bell, Ida M. Onorato, Sarah E. Valway, and Paul A. Stehr-Green.
“Transmission of Mycobacterium Tuberculosis from Medical Waste.” Journal of the American
Medical Association (JAMA) 284, no. 13 (2000): 1683-1688.
5. What is my/my family’s risk of being exposed to infectious waste if it is processed or inactivated
at facilities in my/our community?
Key Message: With federal and SLTT regulations in place to safeguard public health and the
environment, your and/or your family’s risk of being exposed to infectious waste, if processed or
inactivated at facilities in your community, is extremely low.
Answer: Your and/or your family’s risk of being exposed to infectious waste if processed or inactivated
at facilities in your community is extremely low. Federal and SLTT regulations work together to ensure
that waste is managed in a manner that protects public health and the environment from the time the waste
is generated through ultimate disposal. These regulations include DOT HMR requirements for
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classification, packaging, and communications. Materials to be transported must be in full compliance
with the HMR, or transported in compliance with a special permit.
Background/References:
▪
Johnson, Kammy R., Christopher R. Braden, K. Lisa Cairns, Kimberly W. Field, A. Craig
Colombel, Zhenhua Yang, Charles L. Woodley, Glenn P. Morlock, Angela M. Weber, A. Yvonne
Boudreau, Thomas A. Bell, Ida M. Onorato, Sarah E. Valway, and Paul A. Stehr-Green.
“Transmission of Mycobacterium Tuberculosis from Medical Waste.” Journal of the American
Medical Association (JAMA) 284, no. 13 (2000): 1683-1688.
▪
Keene, John H. “Medical Waste: A Minimal Hazard.” Infection Control & Hospital
Epidemiology 12, no. 11 (1991): 682-685.
▪
Phillips, G., “Microbiological Aspects of Clinical Wastes,” Journal of Hospital Infection, 41, no.
1 (1999): 1-6.
▪
Rutala, William A., and David J. Weber. “Infectious Waste—Mismatch Between Science and
Policy.” New England Journal of Medicine 325, no. 8 (1991): 578-582.
▪
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health. Stericycle, Inc. Health Hazard Evaluation
Report, by Angela M. Weber, Yvonne Boudreau, and Vincent D. Mortimer. HETA 98-00272709. Cincinnati, Ohio, 1998.
▪
Weber, Angela M., Yvonne Boudreau, and Vincent D. Mortimer. “A Tuberculosis Outbreak
among Medical Waste Workers.” Journal of the American Biological Safety Association 5, no. 2
(2000): 70-88.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
WASTE DISPOSAL QUESTIONS & ANSWERS
1. Where does infectious waste end up after treatment?
Key Message: Once an infectious waste has been properly inactivated (i.e., it is no longer infectious), it is
considered a solid waste and is handled, transported, and disposed according to the regular protocols for
solid waste management in the state/territory. This generally means that the waste is sent to a municipal
solid waste landfill or to a municipal waste combustor/incinerator.
Answer: Once an infectious waste has been properly inactivated (i.e., it is no longer infectious), it is
considered a solid waste and is handled, transported, and disposed according to the regular protocols for
solid waste management in the state/territory. This generally means that the waste is sent to a municipal
solid waste landfill or to a municipal waste combustor (otherwise known as a municipal waste
incinerator). However, SLTT requirements may dictate disposal of certain residuals, including materials
74
�Managing Solid Waste Contaminated with a Category A Infectious Substance
in red (i.e., biohazard) bags that have been autoclaved. If waste is determined to be hazardous under
RCRA, however, it will need to be managed according to applicable hazardous waste requirements. This
may include further treatment to address constituents in the waste (e.g., toxic metals, chemical
contaminants), followed by disposal at a hazardous waste-permitted facility.
A facility that has generated and then inactivated waste on-site through its normal processes, should
verify with its State/local regulatory official that the treated waste may be managed as a solid waste, and
also verify that the selected solid waste disposal facility can handle the waste, especially if there is a large
volume. The generating facility also should understand and comply with any special conditions that may
be imposed by a permit; by the receiving facility; or by a SLTT authority; and should verify that the
disposal facility received and properly processed the waste.
Background/References:
▪
Environmental Health Management Systems, Inc., Spectrum, and New York State Department of
Health. Technical Assistance Manual: State Regulatory Oversight of Medical Waste Treatment
Technologies, by N.S. Slavik, E. Krisiunas, and I. Salkin. TR 112222. Palo Alto, California,
1998.
▪
Criteria for Municipal Solid Waste Landfills. 40 CFR part 258, subtitle D of Resource
Conservation and Recovery Act (RCRA), Design Criteria, 128. U.S. Environmental Protection
Agency, 1988.
2. Can burying inactivated waste in landfills affect crops or ground water supplies nearby?
Key Message: Burying inactivated waste in appropriately designed and operated landfills should ensure
that the waste remains contained and does not affect crops or ground water supplies nearby. Landfills are
subject to minimum federal criteria under subtitle D of RCRA and to state/territorial regulations and
permits, which can vary depending on the types of waste the landfill is permitted to receive. Design and
operational requirements for landfills can include liners and ground water monitoring systems. The
critical protections provided by these requirements help ensure that putting waste in landfills does not
affect crops or ground water supplies nearby.
Answer: Burying inactivated waste in appropriately designed and operated landfills should ensure that
the waste does not affect crops or ground water supplies nearby. In particular, municipal solid waste
landfills in the United States are designed to meet technical requirements to prevent ground water
contamination, such as using liners to keep contaminants out of the soil and ground water. Municipal
solid waste landfills are also subject to extensive ground water monitoring requirements to ensure early
detection and prompt remediation (i.e., clean-up) of any potential contamination before it can spread.
Even after a municipal solid waste landfill ceases operating, strict closure and post-closure requirements
help ensure it does not pose a health or environmental hazard.
Background/References:
▪
Criteria for Municipal Solid Waste Landfills. 40 CFR part 258, subtitle D of Resource
Conservation and Recovery Act (RCRA), Design Criteria, 128. U.S. Environmental Protection
Agency, 1988.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
3. What requirements are in place to ensure air quality near incinerator facilities that process
infectious waste?
Key Message: Under EPA’s CAA requirements, incinerator operators must monitor for and comply with
limits for specific air pollutants.
Answer: Incinerator operators are subject to extensive requirements specified in permits issued under the
CAA. Generally, they must monitor for and meet specific limits for specific air pollutants. The precise
permit terms generally depend on the type of incinerator (e.g., medical waste incinerator, hazardous waste
incinerator, municipal waste incinerator, etc.). However, it is important to remember that wastes are
burned at extremely high temperatures in the incinerator and that these temperatures destroy infectious
substances.
Background/References:
▪
Hospital/Medical/Infectious Waste Incinerators: Promulgated Amendments to the Federal Plan to
Implement Standards of Performance for Existing Facilities and Promulgated Amendments to the
New Source Performance Standards. U.S. Environmental Protection Agency, 2015.
▪
Environmental Health Management Systems, Inc., Spectrum, and New York State Department of
Health. Technical Assistance Manual: State Regulatory Oversight of Medical Waste Treatment
Technologies, by N.S. Slavik, E. Krisiunas, and I. Salkin. TR 112222. Palo Alto, California,
1998.
▪
Clean Air Act Guidelines and Standards for Waste Management. U.S. Environmental Protection
Agency, 2016. Includes information on National Emission Standards for Hazardous Air
Pollutants (NESHAP); New Source Performance Standards (NSPS); and Waste Incineration
Rules – Clean Air Act (CAA) Section 129.
4. Is there potential harm to other natural resources when infectious waste is transported or
inactivated or when inactivated waste is disposed of properly?
Key Message: When infectious waste is transported, inactivated, and disposed following applicable
federal, state/territorial regulations (e.g., transported in compliance with the strict DOT HMR
requirements), any risk to the environment and public health is generally mitigated (i.e., removed or
minimized). Waste that has been properly inactivated is no longer infectious, and ultimate disposal
facilities would manage this material as they do any other inactivated infectious waste.
Answer: Regulatory requirements for transportation, treatment, and disposal address potential risks to
human health and the environment. When waste is transported, inactivated, and disposed following
applicable federal, state/territorial regulations (e.g., transported in compliance with the strict DOT HMR
requirements) any risk to the environment or public health is generally mitigated through the
classification and packaging requirements and, if necessary, the issuance of special permits with
76
�Managing Solid Waste Contaminated with a Category A Infectious Substance
appropriate conditions. Autoclaves and incinerators used to inactivate infectious waste generally operate
under strict controls using protocols demonstrated to be effective to address potential risks. The ultimate
disposal facility also operates under strict permit or regulatory conditions to ensure that waste placed
there does not pose a risk to the surrounding environment. Waste that has been properly inactivated no
longer has infectious substances and ultimately disposal facilities would manage this material as it does
any other treated waste.
Background/References:
▪
Criteria for Municipal Solid Waste Landfills. 40 CFR part 258, subtitle D of Resource
Conservation and Recovery Act (RCRA), Design Criteria, 128. U.S. Environmental Protection
Agency, 1988.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
5. Is the ash from incinerated Category A infectious substances hazardous, infectious, or
dangerous?
Key Message: The ash remaining after waste is incinerated is typically no longer infectious. Incinerators
operate at temperatures much higher than required to inactivate most Category A infectious agents.
Answer: For most Category A waste, the ash remaining after it is incinerated is not infectious and no
longer poses the risks associated with the Category A infectious substance. In rare cases, waste known to
or suspected of containing prions may require additional treatment to ensure complete destruction of the
prion.
Incinerator ash, as with other industrial wastes, nevertheless should be evaluated to ensure that
appropriate storage and disposal requirements are identified and complied with. For example, although
this ash may no longer be infectious, it could contain other toxic constituents (e.g., heavy metals)
depending upon what materials were combusted, and the owner/operator should evaluate the ash as is the
standard procedure prior to storage and ultimate disposal. Incinerators typically operate at very high
temperatures, much higher than required to inactivate most Category A infectious agents. Incinerator
operators are trained to operate the equipment to ensure full combustion of the wastes going into the
incinerator.
Non-hazardous waste is managed under the State solid waste regulations. Such waste, including
incinerator ash, can be disposed of safely in a sanitary landfill. Any hazardous waste generally must be
managed under the federal or SLTT hazardous waste regulations.
Background/References:
▪
Hazardous Waste Generators. U.S. Environmental Protection Agency, 2019.
▪
Clean Air Act Guidelines and Standards for Waste Management. U.S. Environmental Protection
Agency, 2016. Includes information on National Emission Standards for Hazardous Air
77
�Managing Solid Waste Contaminated with a Category A Infectious Substance
Pollutants (NESHAP); New Source Performance Standards (NSPS); and Waste Incineration
Rules – Clean Air Act (CAA) Section 129.
6. Is waste that has been autoclaved (which means to sterilize by means of high-pressure saturated
steam) hazardous, infectious, or dangerous?
Key Message: Waste that has been autoclaved using an effective autoclave cycle (or cycles) is not
infectious and is generally not dangerous. Note that special combination inactivation treatments (usually
alkaline chemicals along with stringent autoclave conditions) are needed for prions. However, sharps can
still injure workers handling the waste.
Answer: Waste that has been autoclaved using an effective autoclave cycle (or cycles) is not infectious
and is generally not dangerous. Note that special combination inactivation treatments (usually alkaline
chemicals along with stringent autoclave conditions) are needed for prions. However, sharps can still
injure workers handling the waste.
A facility may inactivate contaminated waste using an autoclave and an effective waste cycle (i.e., heated
to a temperature and for a length of time that has been demonstrated to permit full steam penetration of
the waste). This process generally uses sufficient heat and time to kill the Category A infectious
substances, although some porous waste materials may require modifications to the operating procedures
of the autoclave to achieve the necessary material temperatures prior to being held at the required
temperature. Some infectious agents (e.g., prions, spores, and pathogens within biofilms) are particularly
stable in the environment and difficult to inactivate. In particular, specialized inactivation procedures
(such as high alkaline conditions plus lengthy times/high temperature autoclave cycles) are required for
effective prion inactivation. Many States require manufacturers of medical waste autoclaves to provide
validation data for their equipment to guide its use.
Achieving validated time/temperature conditions will ensure that the waste material is no longer
infectious and is not considered RMW or a hazardous material under federal law.
Inactivation of contaminated waste at a facility may be subject to federal, State, local, environmental, and
OSHA regulation.
Background/References:
▪
Information on the Survivability of the Ebola Virus in Medical Waste. U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2015.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
WORKER PROTECTION QUESTIONS & ANSWERS
1. What are the risks to workers handling infectious waste before it is properly inactivated?
Key Message: Waste can be handled in a way that protects workers from exposure to infectious agents
and other hazardous substances in the waste, as well as from injuries from sharps, broken glass, and other
materials.
Answer: There are many possible hazards to workers involved in the handling, transport, treatment, and
disposal of infectious waste. Depending on the specific infectious agent(s) in the waste, workers may be
exposed to pathogens through direct contact with the waste, contact of mucous membranes or broken skin
with splashes or sprays of infectious material, or inhalation of bioaerosols containing infectious particles.
However, waste can be handled in a way that protects workers from exposure to infectious agents and
other hazardous substances in the waste, as well as from injuries from sharps, broken glass, and other
materials. Employers of workers who handle waste should use a combination of engineering and
administrative controls, safe work practices, and PPE to prevent or minimize worker exposure to
infectious agents and other hazardous substances in the waste they handle. These controls can also help
prevent or reduce injuries from sharps.
Use of this hierarchy of controls for worker protection should be done in the context of a comprehensive
infection prevention and control program. Using such controls is also generally part of compliance with
OSHA requirements, the DOT HMR, and CDC and EPA guidance.
Background/References:
▪
U.S. Department of Labor, Occupational Safety and Health Administration; U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health; and U.S. Environmental Protection Agency. Safe Handling,
Treatment, Transport and Disposal of Ebola-Contaminated Waste. FS-3766. Washington, DC,
2016.
▪
Hazardous Materials Regulations. 49 CFR parts 171-180. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration.
2. What specific tasks may lead to worker exposure to untreated infectious waste?
Key Message: Until waste is completely treated to inactivate or destroy any infectious material it may
include, unprotected workers may be exposed to disease-causing agents (i.e., pathogens) during waste
handling, transport, and treatment tasks. Using engineering controls, administrative controls and safe
work practices, and PPE can help prevent worker exposure during these operations.
Answer: From the point of waste generation until the waste is completely treated in a way that fully
inactivates or destroys any infectious material (e.g., pathogens including Category A infectious
substances agents) in the waste, unprotected workers may be at risk for occupational exposure to disease79
�Managing Solid Waste Contaminated with a Category A Infectious Substance
causing agents (i.e., pathogens) during waste handling (e.g., bare-handed contact with waste in the
container), transport, and treatment tasks. Depending on how a pathogen is transmitted, exposure may
occur through direct contact of mucous membranes (e.g., mouth, eyes, nose) or broken skin with
contaminated materials, splashes or sprays of infectious liquids or droplets to mucous membranes or
broken skin, or inhalation of infectious aerosolized (i.e., bio-aerosols) or airborne (i.e., droplet nuclei)
particles.
Workers may have direct contact with contaminated materials when generating, collecting, or packaging
waste at the point of origin, handling waste during transport (particularly if it is not properly and securely
packaged), manipulating waste during treatment (e.g., loading it into an autoclave or incinerator), and
during other tasks that require handling of untreated waste materials. Needle sticks and other injuries
(e.g., cuts or puncture wounds) from contaminated sharps in waste can cause worker infections.
Waste workers are at increased risk for exposure to splashes or sprays of infectious liquids or droplets and
air that contains infectious aerosolized particles (i.e., bio-aerosols) when handling waste before packaging
and during tasks that require additional manipulation of packaged waste. Correctly using appropriate
controls can prevent or reduce these exposures. Avoid dumping packaged waste into an autoclave or
incinerator that cannot accommodate or process an entire unopened container, as this may present
significant worker exposure hazards. Using high-pressure streams of air, water, or chemicals for cleaning
and disinfection may also produce infectious splashes, sprays, or droplets, including aerosolized particles.
Waste worker exposure to airborne (i.e., droplet nuclei) particles may occur during any task that involves
disturbing or moving waste or other potentially contaminated materials, as airborne-transmissible
pathogens are spread when droplets containing infectious materials dry and leave behind infectious
droplet nuclei that travel through the air.
Even after waste is inactivated, employers and workers should be cautious of waste that may contain
sharps (e.g., needles), broken glass, or other objects that pose cut or puncture hazards. See “Disposal
Issues - Question 6” above for additional information.
Background/References: Under the OSHA Bloodborne Pathogens, PPE, and Respiratory Protection
standards and other OSHA requirements, employers must protect workers who handle infectious waste
from exposure to infectious agents, including Category A infectious substances, in the waste they handle.
Waste worker protection guidance from OSHA, the National Institute for Occupational Safety and Health
(NIOSH), and EPA provides more detailed information about waste worker job tasks that may lead to
occupational exposure, and methods for controlling potential exposures:
www.osha.gov/Publications/OSHA_FS-3766.pdf.
▪
U.S. Department of Labor, Occupational Safety and Health Administration; U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health; and U.S. Environmental Protection Agency. Safe Handling,
Treatment, Transport and Disposal of Ebola-Contaminated Waste. FS-3766. Washington, DC,
2016.
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970), U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
▪
Personal Protective Equipment. 29 CFR § 1910.132 (2011). U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Respiratory Protection. 29 CFR § 1910.134 (2011). U.S. Department of Labor, Occupational
Safety and Health Administration.
3. What should employers do to protect workers involved in handling, transport, and treatment of
infectious waste and disposal of inactivated waste?
Key Message: Employers should follow the requirements and guidance of CDC, DOT, EPA, OSHA,
HHS/ASPR and any State/local agencies with authority over waste management, including worker safety
and health. Implementing appropriate worker protections as part of a comprehensive infection prevention
and control program will help ensure workers stay safe and healthy.
Answer: Employers should follow the requirements and guidance of CDC, DOT, EPA, OSHA, and any
SLTT agencies with authority over waste management, including worker safety and health. Implementing
appropriate worker protections as part of a comprehensive infection prevention and control program will
help ensure workers stay safe and healthy.
OSHA always requires employers to protect their workers from recognized safety and health hazards,
which can vary among different worksites and operations. Depending on the specific infectious
substances to which workers may be exposed, the work tasks they perform, and other potential hazards,
employers may be required to comply with provisions of OSHA’s Bloodborne Pathogens (29 CFR §
1910.1030), PPE (29 CFR 1910 subpart I), Respiratory Protection (29 CFR § 1910.134), and
HAZWOPER (29 CFR § 1910.120) standards and other requirements, including the General Duty Clause
of the OSH Act. These standards may require employers to provide training, PPE, and medical
surveillance to workers; develop and implement hazard assessments, safety and health plans, and controls
for worksite hazards; and maintain records of medical exams, worker exposures, and other data.
Employers should ensure that the controls they implement in their work practices—including engineering
controls and administrative or work practice controls that govern how workers do certain tasks—are
sufficient to prevent worker exposures to infectious agents and other hazards, as needed.
Employers must also comply with public health and environmental protection requirements of CDC (e.g.,
when possessing select agents), DOT (e.g., when packaging and transporting infectious waste), and EPA
(e.g., when treating or incinerating waste, and when disposing of treated waste products in landfills).
SLTT requirements may also apply.
Other things employers can do to protect their workers who must handle infectious waste include:
•
Minimizing the generation of waste, including by separating regular trash from medical waste or
other types of potentially infectious waste.
•
Ensuring that all sharps, including needles and broken glass, are disposed of and stored in
appropriate rigid, puncture-proof containers.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
•
Providing workers with facilities and supplies to wash their hands regularly and shower and
change clothes, if necessary, before leaving the workplace.
•
Minimizing the number of staff members required to handle infectious waste.
Background/References:
▪
U.S. Department of Labor, Occupational Safety and Health Administration; U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health; and U.S. Environmental Protection Agency. Safe Handling,
Treatment, Transport and Disposal of Ebola-Contaminated Waste. FS-3766. Washington, DC,
2016.
▪
U.S. Department of Labor, Occupational Safety and Health Administration. PPE Selection Matrix
for Occupational Exposure to Ebola Virus. FS-3761. Washington, DC, 2015.
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970), U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
Personal Protective Equipment. 29 CFR § 1910.132 (2011). U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Respiratory Protection. 29 CFR § 1910.134 (2011). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
Hazardous Waste Operations and Emergency Response. 29 CFR § 1910.120 (2013), U.S.
Department of Labor, Occupational Safety and Health Administration.
▪
Transporting Infectious Substances. U.S. Department of Transportation, Pipeline and Hazardous
Materials Safety Administration, 2017.
▪
Environmental Health Management Systems, Inc., Spectrum, and New York State Department of
Health. Technical Assistance Manual: State Regulatory Oversight of Medical Waste Treatment
Technologies, by N.S. Slavik, E. Krisiunas, and I. Salkin. TR 112222. Palo Alto, California,
1998.
▪
Hazardous Waste Generators. U.S. Environmental Protection Agency, 2019.
▪
Medical Waste. U.S. Environmental Protection Agency, 2017.
▪
Select Agent Regulations. U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention; and U.S. Department of Agriculture; 2017.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
4. What can workers involved in handling, transport, and treatment of infectious waste and
disposal of treated waste do to protect themselves?
Key Message: Workers should make sure they are knowledgeable about their job tasks before attempting
to perform them, and always follow the training and procedures provided to them by their employer.
Answer: Workers should make sure they are knowledgeable about their job tasks before attempting to
perform them, and always follow the training and procedures provided to them by their employer.
While certain OSHA standards require employers to provide training to workers on how to do their jobs
safely and healthfully, workers should seek information from their employers before starting a job or
changing work tasks. Always correctly implement or use the engineering, administrative, and work
practice controls required by the employer. Always correctly put on, use, and take off PPE required by the
employer. Always follow the training provided by the employer.
Even if your employer does not require you to wear dedicated work clothing and footwear, it may be a
good idea to shower and change your clothes and shoes after handling Category A waste. This helps
ensure that you do not spread infectious material outside of your workplace, including to your home and
family members.
Workers should also follow good hand-hygiene practices, including thoroughly washing their hands with
soap and water or using an alcohol-based hand rub if running water is not immediately available. An
alcohol-based hand rub does not replace washing with soap and water, but rather is used as an adjunct to
routine hand washing.
Background/References:
▪
U.S. Department of Labor, Occupational Safety and Health Administration; U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health; and U.S. Environmental Protection Agency. Safe Handling,
Treatment, Transport and Disposal of Ebola-Contaminated Waste. FS-3766. Washington, DC,
2016.
▪
U.S. Department of Labor, Occupational Safety and Health Administration. PPE Selection Matrix
for Occupational Exposure to Ebola Virus. FS-3761. Washington, DC, 2015.
▪
U.S. Department of Health and Human Services, Food and Drug Administration. “Safety and
Effectiveness of Consumer Antiseptics; Topical Antimicrobial Drug Products for Over-theCounter Human Use.” Federal Register 81 (September 6, 2016): 61106-61130.
▪
U.S. Department of Health and Human Services, Food and Drug Administration. “Safety and
Effectiveness of Health Care Antiseptics; Topical Antimicrobial Drug Products for Over-theCounter Human Use.” Federal Register 82 (December 20, 2017): 60474-60503.
▪
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
Healthcare Infection Control Practices Advisory Committee (HICPAC). “Guideline for Hand
Hygiene in Health-Care Settings,” Morbidity and Mortality Weekly Report, MMWR 51, RR-16
(2002): 1-48.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
▪
World Health Organization. Guidelines on Hand Hygiene in Healthcare. Geneva, Switzerland:
World Health Organization, 2009.
▪
Aurora B. Le, Selin Hoboy, Anne Germain, Hal Miller, Richard Thompson, Jocelyn J. Herstein,
Katelyn C. Jelden, Elizabeth L. Beam, Shawn G. Gibbs, and John J. Lowe, “A pilot survey of the
US medical waste industry to determine training needs for safely handling highly infectious
waste,” American Journal of Infection Control 46, no. 2 (2018): 133–138.
5. Is there training available on handling, transport, and treatment of infectious waste and
disposal of treated waste that I can get in advance to be sure I am prepared to do my job?
Key Message: Your employer may be required to provide you training on how to do your job safely and
healthfully. Training may also be available to you through other sources not mentioned specifically in this
document.
Answer: In many cases where workers are required to handle potentially infectious material, including
Category A waste, OSHA requires employers to provide training to workers on how to do your job safely
and healthfully. For example, workers who may be exposed to Category A infectious substances that are
also bloodborne pathogens (e.g., Ebola, HIV, Hepatitis B and C viruses) must receive initial training
when they start their jobs and regular (e.g., annual) refresher training, including anytime new work tasks
or exposures are introduced or tasks or exposures change. Though not all Category A infectious agents
fall under OSHA’s Bloodborne Pathogens standard (29 CFR § 1910.1030), employers may still be
required to provide worker training as part of the agency’s requirements for PPE selection and use,
hazardous waste operations and emergency response, or other mandates.
State/local agencies, including States that operate their own worker safety and health programs (OSHA
State Plans), may have additional or more stringent requirements regarding worker training.
The National Institute of Environmental Health Sciences (NIEHS) Worker Training Program has been
working closely with government agencies, private-sector employers, and academic institutions to
coordinate the development of worker training materials, particularly related to Ebola. Additional
information about NIEHS programs and resources related to hazardous materials management is available
at www.niehs.nih.gov/careers/hazmat/index.cfm.
The NETEC also provides information about preparedness and response to Ebola specifically and
provides employers with resources for training and preparing their workers www.netec.org.
Background/References:
▪
Occupational Safety and Health Act. 29 CFR §§ 651 et seq. (1970), U.S. Department of Labor,
Occupational Safety and Health Administration.
▪
Bloodborne Pathogens. 29 CFR § 1910.1030 (2012). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
Personal Protective Equipment. 29 CFR § 1910.132 (2011). U.S. Department of Labor,
Occupational Safety and Health Administration.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
▪
Respiratory Protection. 29 CFR § 1910.134 (2011). U.S. Department of Labor, Occupational
Safety and Health Administration.
▪
Hazardous Waste Operations and Emergency Response. 29 CFR § 1910.120 (2013), U.S.
Department of Labor, Occupational Safety and Health Administration.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
APPENDIX E – DIRECTORY OF STATE AND TERRITORIAL WASTE
MANAGEMENT PROGRAMS
State
Alabama
Alaska
American
Samoa
Arizona
Arkansas
California
Colorado
Commonwealth
of the Northern
Mariana Islands
Connecticut
Delaware
District of
Columbia
Florida
Georgia
Guam
Agency with waste
program management
responsibility
Alabama Department of
Environmental
Management Land
Division
Alaska Department of
Environmental
Conservation
American Samoa
Environmental Protection
Agency
Arizona Department of
Environmental Quality
Arkansas Department of
Health
Agency phone
number
Agency website
(334) 271-7730
adem.alabama.gov/programs/land/default.
cnt
(907) 269-7802
dec.alaska.gov/eh/sw/index.htm
(684) 633-2304
www.epa.as.gov/hazardous-materials
(602) 771-4136
legacy.azdeq.gov/environ/waste/index.ht
ml
www.healthy.arkansas.gov/programsServi
ces/epidemiology/Environmental/Pages/
MedicalWasteProgram.aspx
www.cdph.ca.gov/certlic/medicalwaste/P
ages/default.aspx
(501) 661-2936
California Department of
Public Health,
Environmental
Management Branch
Colorado Department of
Public Health and
Environment
Bureau of Environmental
and Coastal Quality,
Division of Environmental
Quality
Department of Energy &
Environmental Protection
Waste Management
Division
Delaware Department of
Natural Resources and
Environmental Control
Department of Health
(916) 558-1784
Department of Public
Works
Florida Department of
Environmental Protection
Florida Department of
Health
Georgia Department of
Natural Resources
Guam Environmental
Protection Agency
(303) 692-3320
www.colorado.gov/pacific/cdphe/medical
waste
(670) 664-8500
deq.gov.mp/sec.asp?secID=11
(888) 424-4193
www.ct.gov/deep/cwp/view.asp?a=2718
&q=325340&deepNav_GID=1646
(302) 739-9403
regulations.delaware.gov/AdminCode/titl
e7/1000/1300/1301.shtml#TopOfPage
(202) 442-5955
doh.dc.gov/
(202) 673-6833
dpw.dc.gov/
(850) 245-8705
www.dep.state.fl.us/waste/
(850) 245-4277
(404) 362-2692
www.floridahealth.gov/EnvironmentalHealth/biomedical-waste/index.html
epd.georgia.gov/solid-waste
(671) 300-4751
epa.guam.gov/programs/solid-waste/
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
State
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Agency with waste
program management
responsibility
Hawaii Department of
Health, Division of
Environmental Health
Idaho Department of
Environmental Quality
Waste Management
Division
Illinois Environmental
Protection Agency
Agency phone
number
Agency website
(808) 586-4226
health.hawaii.gov/shwb/solid-waste/
(208) 373-0121
www.deq.idaho.gov/waste-mgmtremediation/solid-waste/medical-waste/
(217) 524-3289
www.epa.illinois.gov/topics/wastemanagement/waste-disposal/specialwaste/pimw/index
www.in.gov/isdh/25513.htm
Indiana State Department
of Health
(317) 233-1325
Iowa Department of
Natural Resources, Solid
Waste Division
Kansas Department of
Health and Environment
Kentucky Energy and
Environment Cabinet,
Department for
Environmental Protection
Louisiana Department of
Environmental Quality
Louisiana Department of
Health
Maine Department of
Environmental Protection
Maryland Department of
the Environment,
Hazardous Waste Program
Executive Office of Health
and Human Services,
Department of Public
Health
Massachusetts Executive
Office of Energy and
Environmental Affairs,
Department of
Environmental Protection
Michigan Department of
Environmental Quality
Minnesota Pollution
Control Agency
Mississippi Department of
Environmental Quality
(515) 281-5918
Mississippi State
Department of Health
Missouri Department of
Natural Resources
(601) 576-7400
(785) 296-1500
(502) 564-6716
www.in.gov/legislative/ic/code/title16/ar4
1/ch16.html
www.iowadnr.gov/InsideDNR/Regulatory
Land/SolidWaste.aspx
www.kdheks.gov/waste/techguide/sw0001.pdf
waste.ky.gov/RLA/Pages/medical_waste.
aspx
(225) 219-5337
www.doa.la.gov/pages/default.aspx
(225) 342-8959
new.dhh.louisiana.gov/index.cfm/page/61
0
www.maine.gov/dep/waste/biomedical/in
dex.html
www.dsd.state.md.us/comar/subtitle_chap
ters/26_Chapters.aspx
(207) 287-7718
(410) 537-3314
(617) 573-1600
www.mass.gov/eohhs/gov/departments/dp
h/programs/environmental-health/commsanitation/medical-waste.html
(617) 626-1000
www.mass.gov/eea/agencies/massdep/rec
ycle/hazardous/infectious-waste-disposaland-transport.html
(517) 284-6588
www.michigan.gov/deq/0,4561,7-1353312_4123_4119---,00.html
www.pca.state.mn.us/waste/health-careindustry
www.deq.state.ms.us/mdeq.nsf/pdf/SW_
MDEQMedicalWasteFactSheet/$File/Me
dWasteFactSheet.pdf
www.msdh.state.ms.us/msdhsite/index.cf
m/30,116,83,pdf/licensureinfecreg.pdf
www.sos.mo.gov/cmsimages/adrules/csr/
current/10csr/10c80-7.pdf
(651) 296-6300
(601) 961-5171
(573) 751-5401
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
State
Montana
Nebraska
Agency with waste
program management
responsibility
Missouri Department of
Health and Senior Services
Montana Department of
Environmental Quality
Nebraska Department of
Environmental Quality
Nevada
Nevada Division of
Environmental Protection
New Hampshire
New Hampshire
Department of
Environmental Services,
Waste Management
Division
New Jersey Department of
Environmental Protection
New Mexico Environment
Department, Solid Waste
Bureau
New York Department of
Environmental
Conservation
North Carolina Department
of Environment and
Natural Resources,
Division of Waste
Management
North Dakota Department
of Health, Waste
Management Division
Ohio Environmental
Protection Agency
Oklahoma Department of
Environmental Quality
Oregon Department of
Environmental Quality
Pennsylvania Department
of Environmental
Protection
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
Junta de Calidad
Ambiental (Environmental
Quality Board)
Rhode Island Department
of Environmental
Management, Office of
Waste Management
Agency phone
number
(573) 751-6400
(406) 444-2544
(402) 471-2186
Carson City:
(775) 687-4670
Las Vegas:
(702) 486-2850
(603) 271-3503
Agency website
s1.sos.mo.gov/cmsimages/adrules/csr/curr
ent/19csr/19c30-20.pdf
deq.mt.gov/Land/solidwaste
www.deq.state.ne.us/NDEQProg.nsf/Pubs
Form.xsp?databaseName=CN=DEQSER6
/O=NDEQ!!Publica.nsf&documentId=5B
AF8C9D1B655D1786257754005E7D0C
&action=editDocument
ndep.nv.gov/bwm/Docs/Med_Waste.html
des.nh.gov/organization/commissioner/p2
au/pps/hs/pphfp/infectious.htm
(609) 633-1418
www.nj.gov/dep/dshw/rrtp/rmw.htm
(505) 827-0197
www.env.nm.gov/swb/SpecialWasteMgt.
htm
(518) 402-8792
www.dec.ny.gov/chemical/8789.html
(919) 707-8200
deq.nc.gov/about/divisions/wastemanagement/waste-management-permitguidance/solid-waste-section/medicalwaste
(701) 328-5166
www.ndhealth.gov/wm/InfectiousWaste/
(614) 644-3020
www.epa.ohio.gov/dmwm/Home/Infectio
usWaste.aspx
www.deq.state.ok.us/lpdnew/swindex.htm
l
www.deq.state.or.us/lq/sw/infectiouswast
e/
www.dep.pa.gov/Business/Land/Waste/S
olidWaste/MunicipalWaste/RegulatedMedical-ChemotherapeuticWaste/Pages/default.aspx
www2.pr.gov/agencias/jca/Pages/default.
aspx
(405) 702-0100
(503) 229-5696
(717) 783-2388
(787) 767-8181
(401) 222-2797
89
www.dem.ri.gov/programs/wastemanage
ment/facilities/medical-waste.php
�Managing Solid Waste Contaminated with a Category A Infectious Substance
State
South Carolina
South Dakota
Tennessee
Texas
U.S. Virgin
Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Agency with waste
program management
responsibility
South Carolina Department
of Health and
Environmental Control,
Division of Waste
Management
South Dakota Department
of Environment and
Natural Resources
Tennessee Department of
Environment &
Conservation, Division of
Solid and Hazardous
Waste Management
Texas Commission on
Environmental Quality
Department of Planning
and Natural Resources
Utah Department of
Environmental Quality
Division of Solid and
Hazardous Waste
Vermont Agency of
Natural Resources Waste
Management Division
Virginia Department of
Environmental Quality
Washington Department of
Ecology
Office of Environmental
Health Services Public
Health Sanitation Division
Wisconsin Department of
Natural Resources
Wyoming Department of
Environmental Quality
Agency phone
number
Agency website
(803) 898-3432
www.scdhec.gov/Environment/LW/Infect
iousWaste/
(605) 773-3153
denr.sd.gov/des/wm/sw/swmedicalwaste.a
spx
(615) 532-0780
www.tn.gov/environment/article/permitwaste-special-waste-approval
(512) 239-6413
www.tceq.texas.gov/permitting/registratio
n/medical_waste/mw.html
dpnr.vi.gov/environmentalprotection/solid-waste-managementprogram-summary/
www.deq.utah.gov/ProgramsServices/pro
grams/waste/solidwaste/
(340) 774-3320
ext. 5215
(801) 536-0200
(802) 828-1138
anr.vermont.gov/index.php
(804) 698-4000
www.deq.virginia.gov/Programs/LandPro
tectionRevitalization/SolidHazardousWas
teRegulatoryPrograms/MedicalWaste.asp
x
(360) 407-6700
www.deq.virginia.gov/ConnectWithDEQ/
EnvironmentalInformation/EbolaContami
natedWasteinVirginia.aspxw
www.ecy.wa.gov/index.html
(304) 368-4420
ext. 79404
www.wvdhhr.org/wvimw/index.asp
(888) 936-7463
dnr.wi.gov/topic/healthwaste/infectious.ht
ml
deq.wyoming.gov/shwd/
(307) 777-7937
Note: Additional state, local, tribal, and/or territorial (SLTT) worker health and safety requirements may
apply to the management of solid Category A waste, including requirements of various OSHA State
Plans.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
APPENDIX F – PATHOGEN-SPECIFIC INFORMATION
This appendix describes information specific to individual pathogens that are classified as Category A
infectious substances (see Appendix B – Infectious Agent Categorization for additional information). This
appendix may be expanded or revised to provide additional pathogen-specific guidance for new and
emerging infectious diseases.
For each pathogen, the appendix provides information about classification and requirements under the
U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR) (including any
DOT/PHMSA special permits issued under its authority), inactivation, and environmental surface
disinfection.
F-1. EBOLA
Summary
Ebola virus
Classification
DOT Special Permit (SP) issued?
Packaging
Category A, always (until inactivated)
Yes, SP 16279
Consult SP 16279 from the DOT/PHMSA
database
United Nations (UN) 2814, Infectious substances,
affecting humans (Ebola waste)
Autoclaving, incineration, chemical
Validated cycle that reaches ≥121°C/250°F for
≥30 minutes; time and temperature depend on
type, state, and volume of material
Cycle must reduce materials to ash
When required by operational considerations
outside of fixed facilities; support effectiveness
with objective data
Must have label claims against non-enveloped
viruses; consult U.S. Environmental Protection
Agency (EPA) List L
Shipping Name
Inactivation methods (must be validated)
Autoclaving
Incineration
Chemical
Disinfectant(s)
Classification
Ebola virus is always considered a Category A infectious substance, regardless of whether or not it is
cultured. It must be managed accordingly under the HMR.
Special Permit
SP 16279 provides alternative requirements for packaging and transporting Ebola waste. The
DOT/Pipeline and Hazardous Materials Safety Administration (PHMSA) special permits database
contains records of the companies currently holding party status to SP 16279. To view the SP and entities
that have held party status to it, enter “16279” in the “Special Permit Number” box and click “Search” on
the page at: www.phmsa.dot.gov/approvals-and-permits/hazmat/special-permits-search.
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Inactivation
Ebola virus should typically be inactivated through autoclaving or incineration. Other validated methods
of waste treatment (e.g., chemical disinfection) may be necessary when operational constraints, such as
those associated with patient care activities outside of fixed hospital facilities, preclude the use of
autoclaves or incinerators. Alternative methods should be supported by objective data that demonstrate
their effectiveness at inactivating Ebola-contaminated waste.
When autoclaving Ebola-contaminated waste, achieving sufficient time/temperature conditions will
ensure that waste materials are no longer infectious. For Ebola virus, the waste should reach 121°C/250°F
for at least 30 minutes. As described in other sections of this document, using biological indicators (e.g.,
spores) can ensure adequate time, temperature, and heat/steam penetration to inactivate Ebola virus
particles in the waste.
Incinerators operate at extremely high temperatures, well above the relatively low temperatures actually
required to inactivate Ebola virus. Incineration that reduces waste to ash at any temperature inactivates
Ebola virus. Incineration, if available on-site and properly permitted, would be the best method for large
or bulky items, such as mattresses (though consideration should be given to whether there are size limits
for on-site incinerators) that may be associated with terminal (i.e., final) cleaning after hospital patient
discharge or residential environmental remediation activities.
Environmental Surface Disinfection
For disinfecting environmental surfaces, use an EPA-registered disinfectant or one with the equivalent
microbial pathogen label claims against non-enveloped viruses. Consult EPA.
Shipping Paper Requirements
The HMR’s shipping paper requirements identify key hazard communication information. Under the
HMR, shipping papers must include:
•
•
•
•
•
UN identification number and proper shipping name for the applicable Category A infectious
substance. For Ebola, include the UN identification number and proper shipping name: “UN
2814, Infectious substances, affecting humans (Ebola waste);”
Hazard class: Division 6.2 (infectious substance);
Packing group: N/A;
Type and quantity of packaging; and
Emergency response information (e.g., telephone number).
Additional Resources
•
Ebola Concept of Operations (ConOps) Planning Template. U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, 2015.
•
Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety
Answering Points (PSAPs) for Management of Patients Under Investigation (PUIs) for Ebola Virus
Disease (EVD) in the United States. U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, 2015.
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Waste Management
•
Department of Transportation Guidance for Transporting Ebola Contaminated Items, a Category A
Infectious Substance. U.S. Department of Transportation, Pipeline and Hazardous Materials Safety
Administration, 2017.
•
Guidance for the Proper Packaging of Ebola Suspected Waste. U.S. Department of Transportation,
Pipeline and Hazardous Materials Safety Administration, 2014.
•
Ebola-Associated Waste Management. U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, 2015.
•
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration
“Packaging and Handling Ebola Virus Contaminated Infectious Waste for Transportation to
Disposal Sites.” Federal Register 79, no. 210 (October 30, 2014): 64646.
•
Guidance for Collection, Transport, and Submission of Specimens for Ebola Virus Testing. U.S.
Department of Health and Human Services, Centers for Disease Control and Prevention, 2015.
•
Transporting Infectious Substances: Safety Advisory, Information on Infectious Substances Special
Permits, and Information on Packaging of Ebola-Contaminated Waste. U.S. Department of
Transportation, Pipeline and Hazardous Materials Safety Administration, 2017.
•
U.S. Department of Defense, Department of the Army, U.S. Army Public Health Command. Ebola
Virus Disease Waste Management in the Medical Treatment Facility. Standard Operating
Procedure EHE37-001. Aberdeen Proving Ground, Maryland, 2016. Note: This document was
developed for use by U.S. Department of the Army facilities and personnel. Different regulatory
requirements may apply in other settings.
Worker Safety and Health
•
Guidance on Personal Protective Equipment (PPE) to Be Used by Healthcare Workers during
Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola
Who Are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including
Procedures for Donning and Doffing PPE. U.S. Department of Health and Human Services, Centers
for Disease Control and Prevention, 2015.
•
U.S. Department of Labor, Occupational Safety and Health Administration. PPE Selection Matrix
for Occupational Exposure to Ebola Virus. FS-3761. Washington, DC, 2015.
•
Safety and Health Topics: Ebola. U.S. Department of Labor, Occupational Safety and Health
Administration, 2014.
•
U.S. Department of Labor, Occupational Safety and Health Administration; U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health; and U.S. Environmental Protection Agency. Safe Handling,
Treatment, Transport and Disposal of Ebola-Contaminated Waste. FS-3766. Washington, DC,
2016.
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Environmental Management & Infection Control
•
Information on the Survivability of the Ebola Virus in Medical Waste. U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, 2015.
Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus Interim Guidance for
U.S. Residence Decontamination for Ebola and Removal of Contaminated Waste. U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2015.
F-2. MONKEYPOX
Summary
Previous studies have defined two distinct Monkeypox clades, West African and Congo Basin, with
unique disease manifestations (i.e., how disease presents in people, the severity of its effects, and how
readily it spreads). Human disease associated with West African clade monkeypox virus infection is less
severe and associated with less human-to-human transmission compared to infections with Congo Basin
clade monkeypox virus.45 Because of this, recommendations for managing waste contaminated with
monkeypox virus differ based on the clade of the virus.
Monkeypox virus
Clade
Classification
DOT Special Permit
(SP) issued?
Packaging
Shipping Name
Inactivation methods
(must be validated)
Autoclaving
Incineration
Any clade(s) except West African45
Category A, always (until inactivated)
None issued as of publication of this
document. See PHMSA’s Infectious
Substance Special Permit website for
status:
https://www.phmsa.dot.gov/transportinginfectious-substances/infectioussubstance-special-permits
Package in accordance with
requirements for Category A infectious
substances found in 49 CFR § 173.196.
United Nations (UN) 2814, Infectious
substances, affecting humans
(Monkeypox waste)
Autoclaving, incineration, chemical
Validated cycle that reaches
≥121°C/250°F for ≥30 minutes; time and
temperature depend on type, state, and
volume of material
Cycle must reduce materials to ash
45
West African clade45
Regulated Medical Waste (RMW)
No, not required unless using a
packaging not currently
authorized by the HMR.
Package in accordance with
applicable regulations for RMW
found in 49 CFR § 173.197.
United Nations (UN) 3291,
Regulated medical waste
(Monkeypox waste)
Treat and/or dispose of such
waste in accordance with
applicable SLTT laws and
regulations for RMW.
Christina L. Hutson, Victoria A. Olson, Darin S. Carroll, Jason A. Abel, Christine M. Hughes, Zachary H. Braden,
Sonja Weiss et al., “A prairie dog animal model of systemic orthopoxvirus disease using West African and Congo
Basin strains of monkeypox virus,” Journal of General Virology 90, no. 2 (2009): 323–333.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Chemical
Disinfectant(s)
When required by operational
considerations outside of fixed facilities;
support effectiveness with objective data
U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant
with an emerging viral pathogen label claim or any product on List Q with an
emerging pathogen label claim, whenever EPA’s Emerging Viral Pathogens
Policy is active for monkeypox virus
Classification
Monkeypox virus is considered a Category A infectious substance in most circumstances, regardless of
whether it is cultured. It typically must be managed accordingly under the HMR.
However, the U.S. Government does not consider the West African clade of monkeypox virus as meeting
the definition of a Category A infectious substance under the HMR. It is excluded from the federal select
agent regulations of the U.S. Department of Health and Human Services (HHS)/Centers for Disease
Control and Prevention (CDC) at 42 CFR parts 72 and 73 and is not regulated by the U.S. Department of
Agriculture (USDA) at 7 CFR part 331 and 9 CFR part 121, as it is not an agricultural select agent. Waste
contaminated with West African clade monkeypox virus should be managed as RMW.
Offerors classifying waste materials for transportation under the HMR, and individuals or entities
assessing their responsibilities under the federal select agent regulations, should rely on the results of
molecular assays or genetic sequencing of samples (i.e., from known or suspected monkeypox patients
whose care results in the generation of waste) to determine the clade of virus.
Special Permit
At the time this document was published, there was no SP available for packaging and transporting waste
contaminated with monkeypox virus. If a SP is issued in the future, the Infectious Substance Special
Permit website (https://www.phmsa.dot.gov/transporting-infectious-substances/infectious-substancespecial-permits) will be updated with the permit information. Without a SP, waste contaminated with a
clade(s) of monkeypox virus other than the West African clade must be labeled, packaged, and
transported as a Category A infectious substance. As noted above and consistent with the U.S.
Government’s position, waste contaminated with West African monkeypox virus should be labeled,
packaged and transported as RMW.
To learn more about the DOT/PHMSA special permits process, including the application process, visit
the “Special Permits Overview” page at: https://www.phmsa.dot.gov/hazmat/special-permits/specialpermits-overview. Applications for special permits may be submitted at:
https://www.phmsa.dot.gov/hazmat/special-permits/special-permits-applications. The DOT/PHMSA
special permits database provides more information on specific permits and holders of party status. View
and search for special permits on the page at: www.phmsa.dot.gov/approvals-and-permits/hazmat/specialpermits-search.
Inactivation
Waste contaminated with monkeypox virus of a clade(s) other than West African should typically be
inactivated through autoclaving or incineration. Other validated methods of waste treatment (e.g.,
chemical disinfection) may be necessary when operational constraints, such as those associated with
patient care activities outside of fixed hospital facilities, preclude the use of autoclaves or incinerators.
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Alternative methods should be supported by objective data that demonstrate their effectiveness at
inactivating monkeypox-contaminated waste.
When autoclaving waste contaminated with monkeypox virus of a clade(s) other than West African,
achieving sufficient time/temperature conditions will ensure that waste materials are no longer infectious.
The waste should reach 121°C/250°F for at least 30 minutes. As described in other sections of this
document, using biological indicators (e.g., spores) can ensure adequate time, temperature, and heat/steam
penetration to inactivate monkeypox virus particles in the waste. The type of materials contaminated with
monkeypox virus affects conditions necessary in the inactivation process to ensure waste materials are no
longer infectious. Non-combustible, porous, and refractory materials (e.g., ceiling tiles) may take longer
than non-porous materials to achieve necessary temperatures to inactivate the virus, particularly if waste
materials are wet.
Incinerators operate at extremely high temperatures, well above the relatively low temperatures actually
required to inactivate monkeypox virus. Incineration that reduces waste to ash at any temperature
inactivates monkeypox virus. Incineration, if available on-site and properly permitted, would be the best
method for large or bulky items, such as mattresses (though consideration should be given to whether
there are size limits for on-site incinerators) that may be associated with terminal (i.e., final) cleaning
after hospital patient discharge or residential environmental remediation activities.
This guidance does not apply to inactivation of waste contaminated with West African clade monkeypox
virus. Such waste should be treated and disposed of in accordance with applicable SLTT laws and
regulations for RMW.
Environmental Surface Disinfection
For disinfecting environmental surfaces contaminated with monkeypox virus, regardless of clade, use an
EPA-registered hospital disinfectant with an emerging viral pathogen claim or any product on List Q with
an emerging pathogen claim. Follow the manufacturer’s directions for concentration, contact time, and
care and handling.
Shipping Paper Requirements
The HMR’s shipping paper requirements identify key hazard communication information.
Under the HMR, shipping papers for waste contaminated with monkeypox virus of all clades must
include:
•
•
•
•
•
UN identification number and proper shipping name for the applicable waste stream:
o For Category A infectious substances (i.e., waste contaminated with monkeypox virus of
any clade except West African), include “UN 2814, Infectious substances, affecting
humans (Monkeypox waste).”
o For RMW (i.e., waste contaminated with West African clade monkeypox virus), include
“UN3291, Regulated medical waste (Monkeypox waste).”
Hazard class: Division 6.2 (infectious substance);
Packing group:
o For Category A infectious substances (i.e., waste contaminated with monkeypox virus of
any clade except West African): does not apply;
o For RMW (i.e., waste contaminated with West African clade monkeypox virus): II;
Type and quantity of packaging; and
Emergency response information (e.g., telephone number).
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�Managing Solid Waste Contaminated with a Category A Infectious Substance
Pack and mark waste contaminated with West African clade monkeypox virus (and not another clade of
monkeypox virus) as RMW. See “Packing and Marking of Category B Infectious Substances” in the
DOT/PHMSA “Transporting Infectious Substances Safely” publication:
https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/2020-04/Transporting-Infectious-SubstancesSafely.pdf.
Additional Resources
•
Monkeypox. U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, 2022.
•
Emerging Viral Pathogens Policy. U.S. Environmental Protection Agency, 2022.
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Domestic Resilience Group. (2022). Managing Solid Waste Contaminated with a Category A Infectious Substance.
URL
https://www.phmsa.dot.gov/transporting-infectious-substances/planning-guidance-handling-category-solid-waste
Objectives
<p>This guidance focuses on managing waste contaminated with the Category A infectious substances that affect humans.4 These substances are identified by the United Nations (UN) identification number 2814 under an international system for identifying hazardous materials. Appendix B – Infectious Agent Categorization provides a non-exhaustive list identifying, among other categorizations, common agents classified as UN 2814 Category A infectious substances affecting humans. Medical care of a person suspected of or confirmed as having a disease caused by a Category A pathogen (i.e., germ) typically generates used healthcare products or linens that are classified as Category A waste. While this document chiefly addresses Category A waste associated with hospital care of infectious patients, it also recognizes that infected people may contaminate their homes, vehicles in which they travel, and other environments before they are hospitalized. Category A waste may also come from laboratories that work with UN 2814 Category A pathogens, including when they intentionally cultivate certain pathogens (a process known as “culturing”) that are not considered Category A (i.e., UN 2814 infectious substances) in other forms (e.g., in body fluids or tissues of an infected person).5 Where appropriate, this document addresses these additional, non-healthcare scenarios and settings from which Category A waste may arise.</p>
<p>Information in this guidance serves several purposes. As a whole, the document offers readers an overview of Category A waste management in the United States. The main component of this guidance addresses planning for Category A waste management activities, including considerations for developing, evaluating, and revising organizational (e.g., hospital) or jurisdictional (e.g., state, territorial, or local) plans. It is presented in sections that break down waste management activities according to responsibilities as waste is moved from its point of generation to its place of disposal. Several accompanying appendices provide users with information about pathogens classified as Category A infectious substances, decision making for waste treatment and disposal activities, communicating effectively about safe waste management and associated issues, and additional related resources. The included listing of acronyms and glossary of terms applies to the entire document. Unless otherwise noted, references to a particular appendix or section refer to parts of this document (and, in the electronic version, can be clicked to navigate to that information directly).</p>
<p>Note that this document intentionally repeats some information, particularly when waste management requires actions from multiple parties (e.g., overlapping responsibilities between waste generators and waste transporters). Information presented in the planning guidance is also intentionally repeated in the appendices to make it as accessible as possible for a wide variety of readers. (Page 4.)<br /><br /></p>
<p>4. This document is not intended to cover Category B infectious substances (UN 3373) nor Category A Infectious substances that affect animals only (UN 2900). Category A infectious substances that affect humans and animals are categorized as Category A Infectious substances, affecting humans (UN 2814).</p>
<p>5. Appendix B – Infectious Agent Categorization distinguishes these “cultures only” pathogens from other Category A pathogens. (See page 37.)</p>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Managing Solid Waste Contaminated with a Category A Infectious Substance
Subject
The topic of the resource
Waste Management
Description
An account of the resource
<strong>Key Points:</strong><br />
<ul>
<li>This documents supersedes earlier versions from January 2017 and August 2019.</li>
<li>This document does not create new requirements, nor does it remove the obligation to comply with all applicable federal, state, local, tribal, and territorial laws and regulations.</li>
<li>See the <a href="/items/show/552" title="Key Points" target="_blank" rel="noreferrer noopener">Summary of Key Points and Significant Changes</a></li>
</ul>
<br /><strong>This replaces: </strong>Domestic Resilience Group. (2017). Interim – Planning Guidance for the Handling of Solid Waste Contaminated with a Category A Infectious Substance. from 2017-01-19.<strong></strong><strong><br /></strong>And a previous version from 2019-08.<strong><br /><br />What this is for</strong>: This Guidance is for safe handling of solid waste contaminated with a Category A infectious substance (henceforth, "contaminated waste") and the proper management of inactivated Category A waste materials in the United States.* An infectious substance meets Category A criteria if it is in a form capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals upon exposure to the substance.<br /><br /><strong>Who this is for</strong>: Local emergency medical services (EMS); hospital or healthcare facility personnel; public health officials; environmental officials; individuals and organizations involved in healthcare waste management and solid waste management operations; and Federal, State (or, in some jurisdictions, tribal or territorial), or local officials who have to handle, transport, or dispose of waste from a person with a suspected or known exposure to a Category A infectious substance. NOTE: Parts of this guidance may not apply to every State or hospital, depending on individual State or hospital plans in place.<br /><br /><strong>How to use</strong>: Use these recommendations to: 1)identify handling considerations for contaminated waste for your locality; 2) develop a contaminated waste protocol or evaluate an existing protocol; 3) guide protection of worker health and safety; and 4) support the development of Category A waste management and response plans for contaminated and inactivated waste materials. This guidance does not address wastewater streams or provide instruction on decontamination measures, nor does it remove the obligation to comply with all applicable Federal, State,and local laws and regulations.<br /><br />*NOTE: Wastewater treatment is regulated by the Environmental Protection Agency and State agencies and is outside the scope of this document. This document is also not intended to describe environmental cleaning and decontamination
Creator
An entity primarily responsible for making the resource
U.S. Department of Transportation<br />U.S. Environmental Protection Agency<br />U.S. Department of Labor<br />Centers for Disease Control and Prevention (CDC)<br />Assistant Secretary for Preparedness and Response (ASPR)
Publisher
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This document was approved for publication by the National Security Council (NSC)-led Homeland and Critical Infrastructure Resilience (HCIR) and Countering Biological Threats (CBT) Interagency Policy Committees on June 3, 2022.
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-06-10
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam (Item 452)
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Autoclave
Category A
Ebola
Federal
Guidance Document
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-WM
Regulations
Sterilizer
Training
Viral Hemorrhagic Fever
Waste
Waste Management
-
https://repository.netecweb.org/files/original/8487cfbb259e200542a50db950c8e305.png
29c0b1db1f358a707366a7e6467e7615
https://repository.netecweb.org/files/original/90cd1ef105d9f95d38fa68dde74ea5a6.pptx
4482096dbf282e0f5f64f12e4df9828f
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
In Person Course
Document relating to an in person course.
Objectives
Waste Management education
Dublin Core
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Title
A name given to the resource
“Let’s talk Trash”
Subject
The topic of the resource
Waste Management
Description
An account of the resource
Slides on waste from a NETEC Year 4- Year 5 course.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-08-07
Contributor
An entity responsible for making contributions to the resource
2022-11-14 by IPC general asset review, marked for archive with note: "powerpoint"
2023-01-04 Lisa noted broken link in blog post - do not Archive.
2023-12-04 - Joanna added to 2024-01-01 review for updating
2024-03-08 - Joanna added thumbnail
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01 No review "not updated" - needs updating for SPORSA
Relation
A related resource
Y - D0.1WM/D0.2WM Qualtrics # 1101, original #
Y - D0.1WM/D0.2WM Qualtrics # 1105, original #
Y - D0.1WM/D0.2WM Qualtrics # 1109, original # 2
Y - D0.1WM/D0.2WM Qualtrics # 1111, original # 3
Y - D0.1WM/D0.2WM Qualtrics # 1112, original # 4
Y - D0.1WM/D0.2WM Qualtrics # 1115, original #
Y - D0.1WM/D0.2WM Qualtrics # 1116, original # 5
Y - D0.1WM/D0.2WM Qualtrics # 1121, original # 9
Y - D0.1WM/D0.2WM Qualtrics # 1122, original # 9a
Y - D0.1WM/D0.2WM Qualtrics # 1133, original #
Autoclave
Category A
Ebola
MERS-CoV
Not updated
R-WM
Waste
Waste Management
-
https://repository.netecweb.org/files/original/392d87f792e5d921c1a6fa77ce6e53b7.png
fc24682d7da998341c42059d6dc9affc
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:27:08
Objectives
This instructional series was created by the University of Maryland Baltimore County (UMBC), Department of Emergency Health Services, with assistance from the Maryland Department of Health, and funding from the U.S. Centers for Disease Control and Prevention.
This program is designed to meet the needs of first responders who are expected to deal with the health needs of people who find themselves in health emergencies they cannot manage on their own. These first responders are typically emergency medical services personnel, such as EMTs and paramedics, but can also be first-aid trained fire fighters, law enforcement personnel, and volunteers such as Red Cross disaster workers. Health officers in summer camps, youth clubs, and other organizations that work with groups of people who may have some vulnerability may also benefit from this program.
Event Type
Instructional series
URL
https://eid4emt.umbc.edu/courses/index.php?courseNum=8
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Module 7: Infectious Waste Disposal and Equipment Decontamination" src="https://www.youtube.com/embed/etjdqfwoO24" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Module 7: Infectious Waste Disposal and Equipment Decontamination
Subject
The topic of the resource
Infection Control
Description
An account of the resource
EID 4 EMT Free Video Training Series -
Emerging Infectious Diseases Videos for Prehospital Providers -
Infectious Waste Disposal and Equipment Decontamination
Creator
An entity primarily responsible for making the resource
University of Maryland, Baltimore County (UMBC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-15
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 217, original # 8a
Y - D0.1IC/D0.2IC Qualtrics # 218, original # 9
Y - D0.1IC/D0.2IC Qualtrics # 222, original # 10
Y - D0.1IC/D0.2IC Qualtrics # 223, original # 11
Y - D0.1IC/D0.2IC Qualtrics # 225, original # 12
Y - D0.1IC/D0.2IC Qualtrics # 229, original # 16
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Decontamination
Equipment and Supplies
Pre-Hospital
R-IPC
Waste
Waste Management
-
https://repository.netecweb.org/files/original/180695c4e547c60466cb50f5fc4efcb6.pdf
b7697a4e4a4ffb091332dc1c814b8dbd
PDF Text
Text
Procedural Guidance on the Proper Packaging of Ebola Suspected Waste
DOT Guidance for Preparing Packages of Ebola Contaminated
Waste for Transportation and Disposal
This guidance is intended for persons who prepare packages containing waste contaminated or
suspected of being contaminated with Ebola, for transportation to off-site treatment and disposal. It
provides guidance on DOT regulations regarding the transportation of a Category A infectious substance
only and highlights some of the requirements of the HMR, which can affect transportation safety. This
document should not be used as a substitute for the HMR to determine compliance.
An infectious substance is 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). The HMR
apply to any material DOT determines is capable of posing an unreasonable risk to health, safety, and
property when transported in commerce. 1 An infectious substance must conform to all applicable HMR
requirements when offered for transportation or transported by air, highway, rail, or water. Refer to
the Center for Disease Control and Prevention (CDC) for guidance on handling these agents before
transporting them (see http://www.cdc.gov/vhf/ebola/hcp/index.html).
Strict compliance with the HMR is required. For more information on the HMR requirements see
http://phmsa.dot.gov/hazmat/transporting-infectious-substances. The HMR contains federal
requirements for transporting hazardous materials in commerce. 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.
In addition, the motor carrier, including its driver, must comply with the Federal Motor Carrier Safety
Regulations (FMCSR), 49 C.F.R., Parts 300-399, as applicable.
Packaging Preparation: Bag the waste in plastic film bags and place in a rigid
outer packaging.
Note: Individual plastic film bags may weigh no more than 10 kg (22 lbs.) when filled. An outer
packaging may contain more than one set of triple bagged waste.
Step 1
•
•
•
1
Follow all appropriate occupational safety and health requirements in place by regulating
agencies and your facility;
Place the potentially contaminated waste into the first plastic bag;
Prior to closure, treat potentially contaminated waste with an U.S. Environmental Protection
Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g.,
The HMR applies to interstate, intrastate, and foreign commerce.
1
�Procedural Guidance on the Proper Packaging of Ebola Suspected Waste
•
•
•
•
norovirus, rotavirus, adenovirus, poliovirus) that is recommended by the CDC for use as a
disinfectant for the Ebola virus. Please review product label to ensure it meets these
requirements;
Place sharps waste in an authorized sharps container, and close and seal it in accordance with
the packaging instructions for that container;
Wrap objects with sharp edges to prevent the tearing or puncture of the plastic bag;
Close the plastic film bag by tying the bag with a knot or other equally effective positive means
of closure that will not tear or puncture the outer bag or liner such as heat sealing, tape, or
adhesive, and will ensure any liquid contents will not leak from the packaging; and,
Disinfect the exterior surface of the plastic bag with an EPA-registered hospital disinfectant with
a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) that is
recommended by the CDC for use as a disinfectant for the Ebola virus.
Step 2
•
•
•
Place the first plastic film bag, with the knot facing upward, into a second plastic film bag;
Close the second plastic film bag by tying the bag with a knot or other equally effective positive
means of closure that will not tear or puncture the outer bag or liner such as heat sealing, tape,
or adhesive, and will ensure any liquid contents will not leak from the packaging. Make sure the
primary bag does not interfere with closing the second bag;
Disinfect the exterior surface of the second bag with an EPA-registered hospital disinfectant
with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus
that is recommended by the CDC for use as a disinfectant for the Ebola virus.
Step 3 – Preparation of outer packaging
•
•
•
•
•
•
The outer package must be either a rigid UN Standard or DOT Approved non-bulk packaging. If
the outer packaging is fabricated from fiberboard, it must be a minimum of triple wall and
contain a 6 mil polyethylene plastic liner.
Place absorbent material sufficient to absorb all free liquid (if any) in the bottom of the rigid
outer packaging or the liner of the fiberboard outer packaging;
Place the double bagged waste into the rigid outer packaging or into the outer fiberboard
packaging with an installed liner;
Close the liner (if used) either by zip tie or other equally effective means of closure or as
specified by the manufacturer of the packaging;
Securely close the outer packaging as specified by the manufacturer of the packaging;
Disinfect the exterior surface of the package with an EPA-registered hospital disinfectant with a
label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus that is
recommended by the CDC for use as a disinfectant for the Ebola virus.
2
�Procedural Guidance on the Proper Packaging of Ebola Suspected Waste
Authorized Packaging Materials
Plastic film bag
Plastic film bags must:
•
•
•
Be 175 liters or smaller (46 gallons);
Be marked and certified by its manufacturer as having an impact resistance of 165 grams and a
tearing resistance of 480 grams in both the parallel and perpendicular planes with respect to the
length of the bag when tested in accordance with ASTM D 1709 and ASTM D 1922;
Be compatible with the EPA-registered hospital disinfectant with a label claim for a nonenveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) used to disinfect the waste
and packagings.
Outer packaging
The outer packaging must:
•
•
•
•
Be a UN Standard or DOT Approved non-bulk packaging:
o Drums made of plastic, or triple wall corrugated fiberboard (authorized under approval);
or
o Boxes made of plastic or triple wall corrugated fiberboard;
Be certified and tested to the PG II level; 2
Have a minimum of a 6 mil polyethylene plastic liner if the outer packaging is fiberboard;
Must be marked and labeled in accordance with 49 CFR §172.301.
Operational Controls – Medical Facility
•
•
The outer packaging must be closed except when being filled with inner packagings containing
waste materials;
Before loading the package into a transport vehicle, the medical facility must ensure that the
package is not leaking and the package is closed and sealed according to the recommended
closure instructions.
Operational Controls – Transporter
Note: If the waste contaminated or suspected of being contaminated with Ebola cannot be
packaged and transported in accordance with the HMR, the waste transporter may apply for a
special permit. The following list of operational controls is provided as guidance for those
seeking special permits and should be addressed in the special permit application.
2
Will be either an X or Y certified package.
3
�Procedural Guidance on the Proper Packaging of Ebola Suspected Waste
•
•
•
•
•
•
•
•
•
•
•
•
Materials may be transported by highway only.
The motor carrier, including its driver, must comply with the Federal Motor Carrier Safety
Regulations (FMCSR), 49 CFR Parts 300-399, as applicable.
Loading and unloading the vehicle must be performed using manual means. Fork trucks or
other powered mechanical handling equipment may not be used for loading or unloading the
vehicle.
After loading and prior to transportation, the transporter must perform an external visual
inspection of the transport vehicle to determine that it is closed and free of leakage.
All shipments must be accompanied by a Hazardous Materials Shipping Paper in accordance
with 49 C.F.R. §172 Subpart C.
While in transportation, the doors on the motor vehicle or shipping container being used to
transport the material must be closed and locked except when an outer packaging is being
loaded or unloaded into the vehicle.
The transporter may only transport the vehicle loaded with the material to a final destination
that is authorized by applicable laws for treatment or disposal of such materials, without
unnecessary delay from the time the carrier's motor vehicle leaves the shipper’s premises.
Waste must be transported to the nearest appropriate disposal facility available at the time the
material is offered for transportation without additional loading or unloading of the vehicle.
The transporter must have a written spill response plan that includes provisions for the
decontamination of spilled materials and for personal protective equipment to be carried on the
vehicle and used to protect its employees from contact with infectious materials in any form.
The transporter must respond to any release from a package that occurs during transportation.
The response must include complete removal of any spilled material and decontamination of
the release site, vehicle surfaces and external surfaces of the package involved. Any release
must be reported to PHMSA as soon as practicable.
Each motor vehicle used must be decontaminated in accordance with applicable federal, state
and local laws.
Each motor vehicle and driver involved in the transport of the contaminated waste must be
made available for a Commercial Vehicle Safety Alliance (CVSA) Level I hazardous materials
inspection prior to transport. If violations of the CVSA North American Standard Out-of-Service
Criteria (2014 edition) are found, the violation(s) must be corrected prior to transporting
hazardous materials.
4
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Procedural Guidance on the Proper Packaging of Ebola Suspected Waste
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration. (2014). Procedural Guidance on the Proper Packaging of Ebola Suspected Waste.
URL
https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/docs/suspected_ebola_patient_packaging_guidance_final.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Procedural Guidance on the Proper Packaging of Ebola Suspected Waste: DOT Guidance for Preparing Packages of Ebola Contaminated Waste for Transportation and Disposal
Subject
The topic of the resource
Waste Management
Description
An account of the resource
This guidance is intended for persons who prepare packages containing waste contaminated or suspected of being contaminated with Ebola, for transportation to off-site treatment and disposal. It provides guidance on DOT regulations regarding the transportation of a Category A infectious substance only and highlights some of the requirements of the HMR, which can affect transportation safety. This document should not be used as a substitute for the HMR to determine compliance.
Creator
An entity primarily responsible for making the resource
U.S. Department of Transportation (DOT)
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Ebola
Guidance Document
R-IPC
Viral Hemorrhagic Fever
Waste
Waste Management
-
https://repository.netecweb.org/files/original/bb85272eb8f4d2088fb9de3f85c33810.pdf
2bdcf8dd877cefd151a00d66fc5ab9e5
PDF Text
Text
FactSheet
Safe Handling, Treatment, Transport and
Disposal of Ebola-Contaminated Waste
Workers involved in handling, treatment, transport and disposal of medical,
laboratory and other waste must be protected from exposure to Ebola virus—which
causes Ebola virus disease—and from physical and chemical hazards that may be
associated with waste management tasks.
Safe handling, treatment, transport and disposal
of waste that is suspected or known to be
contaminated with Ebola virus begins at the
point the waste is generated (i.e., 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, and other vehicles; airport and other
transportation facilities; residences; or other
areas with suspected or confirmed Ebola-virus
contamination; and
• Removing and discarding disposable personal
protective equipment (PPE) after working in
an environment with suspected or confirmed
Ebola-virus contamination.
Waste management steps
at point of origin
• Take steps to minimize 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.
U.S. Dept. of Health and Human Services (HHS)
Ebola is spread primarily through direct contact
with blood or other body fluids of a person who
is ill with Ebola and from contact with objects
contaminated with 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.
Sharps containers must be closable, puncture-resistant,
leakproof, and labeled or color-coded.
• 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, leakproof bags,
and store in a rigid, leakproof container to
reduce the risk of worker exposure: www.cdc.
gov/vhf/ebola/hcp/environmental-infectioncontrol-in-hospitals.html. If waste ultimately
will be transported, follow U.S. Department of
Transportation (DOT) guidance for packaging
from the outset to minimize repackaging or
additional handling: phmsa.dot.gov/hazmat/
packaging-of-ebola-contaminated-waste.
• Employers should follow manufacturer
instructions on product labels and Safety Data
Sheets for Environmental Protection Agency
(EPA)-registered disinfectants when selecting
PPE for their workers.
�• Use a puncture-proof container for sharps.
See www.cdc.gov/niosh/docs/97-111.
• 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 non-bulk
packagings (49 CFR 172.301).
• Ensure that the outsides of waste containers
are not contaminated. Use a combination of
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
if they come into contact with potentially
infectious waste.
• If porous containers (e.g., corrugated
cardboard boxes) become contaminated, they
should be placed into another container.
• Disinfect the outsides of waste bags with
an EPA-registered disinfectant with label
claims for use against non-enveloped viruses
(e.g., norovirus, rotavirus, adenovirus,
poliovirus) (see page 3: “Disinfectants
for Ebola virus”). Follow manufacturer
recommendations for 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.
• Follow CDC guidelines and DOT Hazardous
Materials Regulations (HMR), at www.cdc.gov/vhf/
ebola/hcp/medical-waste-management.html and
phmsa.dot.gov/hazmat/transporting-infectioussubstances.
Use appropriate protective equipment
The Occupational Safety and Health Administration (OSHA) Personal Protective Equipment
(PPE) standard (29 CFR 1910.132) 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 Ebola virus and other hazards to which they may be
exposed. Workers with different job tasks—for instance, those who load waste containers onto
trucks compared to those who empty containers onto processing lines—may have very different
exposures and require different PPE. 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:
•
•
•
•
•
•
Nitrile gloves (consider using double-gloves and/or puncture-resistant gloves for extra protection);
Goggles or face shields;
Fluid-resistant or impermeable gowns or coveralls, and aprons;
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.
OSHA’s PPE Selection Matrix is intended to help employers select appropriate PPE for
protecting workers who may be exposed to Ebola virus on-the-job: www.osha.gov/Publications/
OSHA3761.pdf. The National Institute for Occupational Safety and Health (NIOSH) also provides
recommendations for the selection and use of protective clothing and respirators for protection
against biological agents: www.cdc.gov/niosh/docs/2009-132.
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: www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html. 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.
2
�Collecting and transporting waste
Disinfectants for Ebola virus
• Under the Bloodborne Pathogens standard,
29 CFR 1910.1030, and other OSHA
requirements, employers already must
protect workers who collect and transport
waste from exposure to infectious agents,
such as the hepatitis B virus and human
immunodeficiency virus (HIV), in the waste
they handle on a daily basis. Although
exposure to these other agents may be more
likely, employers are also required to protect
workers from exposure to the Ebola virus.
• Following stringent packaging protocols,
including decontaminating waste containers,
at the point of origin (i.e., where the waste was
generated) may reduce the risk of exposure
to Ebola virus and other infectious agents for
workers involved in collecting packaged 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.
• Employers must take steps to protect workers
from exposure to contaminated waste
containers and to protect workers when they
must handle waste containers that are visibly
soiled or otherwise known or suspected of
having Ebola-virus contamination.
• 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 more
serious hazard(s) exists.
• Follow DOT HMR, at phmsa.dot.gov/hazmat/
transporting-infectious-substances.
• Use an EPA-registered disinfectant
with label claims for use against nonenveloped viruses (e.g., norovirus,
rotavirus, adenovirus, poliovirus)
to treat contamination/spills and to
disinfect non-porous surfaces after bulk
spill material has been removed.
• Non-enveloped viruses are typically
more difficult to destroy than enveloped
viruses, such as Ebola. Stronger
disinfectants used to destroy nonenveloped viruses are also capable of
inactivating enveloped viruses.
• See EPA List L of selected registered
antimicrobial products for use against
the Ebola virus: www.epa.gov/
oppad001/list-l-ebola-virus.html.
• Always follow the manufacturer’s
instructions (e.g., concentration,
application method and contact time)
for the specific disinfectant.
• Never mix chemicals (e.g.,
disinfectants/cleaners) together.
Certain combinations of chemicals
can be deadly or can reduce the
effectiveness of the disinfectant.
other agents may be more likely, employers
are also required to protect workers from
exposure to the Ebola virus.
• 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 Ebola virus and other infectious
agents than workers with job tasks such as
handling waste products that have already
been treated (e.g., incinerator ash or waste that
already was appropriately autoclaved at its point
of origin). Waste that has been properly treated
and decontaminated is no longer infectious.
• 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.
Processing waste in a treatment/
disposal facility
• Under the Bloodborne Pathogens standard,
29 CFR 1910.1030, and other OSHA
requirements, employers already must
protect workers who process waste in
a treatment/disposal facility from exposure
to infectious agents, such as the hepatitis B
virus and HIV, in the waste they handle on
a daily basis. Although exposure to these
3
�• Employers must consider increasing levels
of PPE for waste processing and treatment/
disposal workers if they determine that a more
serious hazard exists.
• Follow applicable EPA, state, and local
regulations for hospital/medical/infectious
waste incinerators: www.epa.gov/
ttnatw01/129/hmiwi/rihmiwi.html.
• Workers tasked with processing reusable
collection and storage containers, conducting
housekeeping within processing facilities,
or cleaning transport vehicles may refer to
OSHA’s “Cleaning and Decontamination of
Ebola on Surfaces” Fact Sheet for additional
guidance: www.osha.gov/Publications/OSHA_
FS-3756.pdf.
Safer waste processing techniques
• Select waste processing techniques that
minimize potential worker exposure to
Ebola virus or other pathogens.
• Incinerating entire, unopened waste
containers in incinerators eliminates
exposures associated with handling and
opening containers. Incinerator facilities
should be operated in compliance with
applicable federal, state, and local
regulations.
• If using autoclave or rotoclave
equipment, develop, validate and
regularly test protocols using biological
and non-biological indicators to ensure
that the autoclave temperature and
pressure are maintained for long
enough time periods to kill all organisms
throughout the waste content and that
heat/steam can penetrate packaging and
any porous materials.
• Weekly (or more frequent) testing with
biological or non-biological indicators
ensures 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 (see
related section at left).
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.
• Shredding, particularly with equipment that
is not closed and ventilated out of the work
area, may result in generation of bio-aerosols
(aerosolized droplets containing infectious
particles that can be inhaled).
• Shredders may become clogged or jammed
by atypical, porous waste materials (e.g.,
linens, carpet, curtains, or other textiles) that
must be discarded when decontamination is
not possible.
• If at all possible, do not enter a clogged
shredding 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:
www.osha.gov/SLTC/controlhazardousenergy.
• 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.
• 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
(e.g., if non-infectious materials, such as toxic
metals, are present in regulated amounts).
Use appropriate respiratory protection
• In instances where workers may be exposed
to bio-aerosols (e.g., as a result of using highpressure air or water for cleaning) 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. See www.cdc.gov/niosh/npptl/
topics/respirators/disp_part/n95list1.html.
Final disposal of treated waste
• Waste that has been properly treated and
disinfected using thermal/heat treatment
(e.g., microwaves), autoclaving, incineration,
or a combination of these or other generally
accepted methods is not considered to be
infectious.
4
�Follow applicable OSHA standards
• Wearing a respirator for extended periods
of time can be uncomfortable. Workers who
need respirators for long time periods may
find powered air-purifying respirators more
tolerable.
• Respirators used for protecting workers
against Ebola virus may not be effective
for also protecting them from exposure
to certain chemicals used for treating and
decontaminating waste, or for cleaning
and decontaminating equipment. To learn
more about the requirements for selecting
an appropriate respirator to protect against
chemical exposure (elastomeric respirator
with appropriate chemical or combination
cartridges or a supplied-air respirator), consult
OSHA’s Respiratory Protection standard,
29 CFR 1910.134, and the manufacturer’s
Safety Data Sheet (SDS) for the specific
chemical(s) that workers are using. See
OSHA’s Respiratory Protection web page:
www.osha.gov/SLTC/respiratoryprotection.
• Employers must ensure that they comply
with OSHA’s Bloodborne Pathogens standard,
29 CFR 1910.1030, to protect workers who
may be exposed to blood or other potentially
infectious materials.
• OSHA’s Personal Protective Equipment
(PPE) standard, 29 CFR 1910.132, provides
additional information about how to select
and use appropriate PPE, training and other
requirements.
Worker training is essential
Employers must train workers about
sources of exposure to Ebola and
appropriate precautions.
Where workers may be exposed to blood
or other potentially infectious materials,
such as in the waste handling, treatment,
transport and disposal industry, employers
must provide the training required by
OSHA’s Bloodborne Pathogens standard,
29 CFR 1910.1030. This includes information
about how to recognize tasks that may
involve exposure and the methods to
reduce exposure, including engineering
controls, work practices and PPE.
Infection control for all waste workers
• Limit the number of workers who handle
waste to essential staff. For example, instruct
and train healthcare 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.
• 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 Ebolacontaminated 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 or exposed
skin or through mucous membranes (e.g.,
eyes, nose, mouth).
Employers must train workers required to
use PPE on what equipment is necessary,
how to put it on and take it off safely and
effectively, when and how they must use
it, and how to dispose of the equipment.
• Employers must comply with OSHA’s Hazard
Communication standard, 29 CFR 1910.1200,
when their workers use certain chemicals for
cleaning and decontamination.
• OSHA’s Lockout/Tagout standard, 29 CFR
1910.147, contains requirements on controlling
hazardous energy when working with
machinery.
• In some cases where a specific OSHA
standard doesn’t apply, the General Duty
Clause (Sec. 5(a)(1)) of the Occupational Safety
and Health Act requires employers to furnish
to each employee a place of employment
5
�that is free from recognized hazards that are
causing or are likely to cause death or serious
physical harm to employees.
• Employers may also be required to follow
state regulations that cover potentially
infectious medical waste, sometimes referred
to as regulated medical waste: www.epa.gov/
osw/nonhaz/industrial/medical/programs.htm.
Assistance for Employers
OSHA’s On-site Consultation Program offers free
and confidential advice to small and mediumsized businesses in all states across the country,
with priority given to high-hazard worksites.
On-site Consultation services are separate from
enforcement and do not result in penalties or
citations. Consultants from state agencies or
universities work with employers to identify
workplace hazards, provide advice on compliance
with OSHA standards, and assist in establishing
safety and health management systems. To
locate the OSHA On-site Consultation Program
nearest you, call 1-800-321-6742 (OSHA) or visit
www.osha.gov/consultation.
Additional resources
• About Ebola
{{ www.osha.gov/SLTC/ebola
{{ www.cdc.gov/niosh/topics/ebola
• About bloodborne pathogens
and needlesticks
{{ www.osha.gov/SLTC/bloodbornepathogens
{{ www.cdc.gov/niosh/topics/bbp
• About management of Ebola-associated waste
{{ www.cdc.gov/vhf/ebola/healthcare-us/
cleaning/waste-management.html
{{ www.cdc.gov/vhf/ebola/healthcare-us/
cleaning/handling-waste.html
• For selection and use of PPE,
including respirators
{{ www.osha.gov/SLTC/
personalprotectiveequipment
{{ www.cdc.gov/niosh/ppe
{{ www.osha.gov/SLTC/respiratoryprotection
{{ www.cdc.gov/niosh/topics/respirators
• About toxic and hazardous substances,
including chemical hazards
{{ www.osha.gov/SLTC/
hazardoustoxicsubstances
{{ www.cdc.gov/niosh/npg
• About Hazard Communication
{{ www.osha.gov/dsg/hazcom
• About controlling hazardous energy
(Lockout/Tagout)
{{ www.osha.gov/SLTC/
controlhazardousenergy
Disclaimer: This document is not a standard or regulation, and it creates no new legal obligations. It contains
recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory
in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace.
The Occupational Safety and Health Act requires employers to comply with safety and health standards and regulations
promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, the Act’s General Duty Clause,
Section 5(a)(1), requires employers to provide their employees with a workplace free from recognized hazards likely to
cause death or serious physical harm. State Plans adopt and enforce their own occupational safety and health standards
at www.osha.gov/dcsp/osp.
This information will be made available to sensory-impaired individuals upon request. The voice phone is (202) 693-1999;
teletypewriter (TTY) number: (877) 889-5627. For other requests or questions, contact OSHA at 1-800-321-OSHA (6742). To
receive NIOSH documents or more information about occupational safety and health topics, contact NIOSH at 1-800-CDCINFO (1-800-232-4636), TTY: 1-888-232-6348, web: www.cdc.gov/info, or visit the NIOSH website at www.cdc.gov/niosh.
U.S. Department of Labor
OSHA - DTSEM FS-3766 03/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste
Dublin Core
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Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
U.S. Department of Labor, Occupational Safety and Health Administration, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Environmental Protection Agency. (2016). Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online
URL
https://www.osha.gov/Publications/OSHA_FS-3766.pdf
Dublin Core
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Title
A name given to the resource
Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste
Subject
The topic of the resource
Waste Management
Description
An account of the resource
Ebola-Contaminated Waste safe handling Fact Sheet
Creator
An entity primarily responsible for making the resource
U.S. Department of Labor, Occupational Safety and Health Administration<br />Centers for Disease Control and Prevention (CDC)<br />National Institute for Occupational Safety and Health (NIOSH)<br />Environmental Protection Agency (EPA)
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-03
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Relation
A related resource
Y - D0.1WM/D0.2WM Qualtrics # 1110, original # 14
Category A
Ebola
Guidance Document
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-WM
Sterilizer
Waste
Waste Management
-
https://repository.netecweb.org/files/original/ca42e4ae60b148b047c670fce6db3795.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/vhf/ebola/clinicians/cleaning/waste-management.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola-Associated Waste Management
Subject
The topic of the resource
Waste Management
Description
An account of the resource
<div>
<p><strong>Who this is for</strong>: Hospitals and healthcare providers that care for patients under investigation (PUIs) for Ebola virus disease (EVD) or with confirmed cases of EVD.</p>
<p><strong>What this is for</strong>: To help hospitals and healthcare providers safely handle, transport, and dispose of waste generated by the care of patients under investigation (PUIs) for or with confirmed Ebola virus disease (EVD).</p>
<p><strong>How to use</strong>: This guidance is intended to provide key information about procedures and regulations regarding waste associated with the care of patients under investigation (PUIs) for or with confirmed Ebola virus disease (EVD).</p>
</div>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-04-03
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Category A
Ebola
Federal
Guidance Document
Infection Prevention and Control
R-IPC
Regulations
Sterilizer
Viral Hemorrhagic Fever
Waste
Waste Management
-
https://repository.netecweb.org/files/original/b196bf3165239a1886f84a82b46061d7.pdf
78e13bd60e22cfed3bef09cc797212b5
PDF Text
Text
ASPR TRACIE Technical Assistance Request
Request Receipt Date (by ASPR TRACIE): 25 January 2019
Response Date: 31 January 2019
Type of TA Request: Standard
Request:
The requestor asked ASPR TRACIE for assistance in identifying best practices related to Ebola
medical waste management, especially for hospitals that do not have an autoclave or incinerator.
She is particularly interested in how other facilities move waste from the red zone to the green
zone and what vendors others are using for Category A waste removal.
Response:
The ASPR TRACIE Team directed the requestor to the VHF/Ebola Topic Collection for initial
information. Other Topic Collections, including Emergency Operations Plans/Emergency
Management Program, were also reviewed for relevant resources. A list of comprehensively
developed Topic Collections can be found here: https://asprtracie.hhs.gov/technicalresources/topic-collection.
Section I below includes ASPR TRACIE-developed resources that include related information.
Section II identifies specific documents referenced in ASPR TRACIE-developed resources that
are most relevant to the request.
I.
ASPR TRACIE-Developed Resources
EMS Infectious Disease Playbook: This playbook synthesizes multiple sources of information in
a single planning document addressing the full spectrum of infectious agents to create a concise
reference resource for emergency medical services (EMS) agencies developing their service
policies. Waste management is one of the considerations discussed throughout the document.
While focused on the pre-hospital setting, the playbook may help inform coordination and
planning for the arrival of potentially infectious patients via EMS and procedures for handling
waste generated during transport.
VHF/Ebola Topic Collection: In response to the 2014-2016 West Africa Ebola outbreak, ASPR
TRACIE developed this Topic Collection to assist healthcare and public health systems in
planning and response. One of the categories included in the Topic Collection is
Decontamination and Waste Management.
Frontline Hospital Playbook: Special Pathogens: Attached is ASPR TRACIE’s draft Frontline
Hospital Playbook: Special Pathogens, scheduled for release in 2019. Information on Category A
waste and spill management begins on page 3-25.
1
TRACIE
�II.
Specific Waste Management Resources
Centers for Disease Control and Prevention. (2015). Ebola-Associated Waste Management.
The information provided in this webpage is intended to help healthcare providers and
facility staff safely handle, transport, and dispose of waste associated with the care of
patients with suspected or confirmed Ebola virus disease.
Domestic Resilience Group. (2017). Interim – Planning Guidance for the Handling of Solid
Waste Contaminated with a Category A Infectious Substance.
This federal inter-agency guidance approved by the Domestic Resilience Group of the
National Security Council is for the safe handling of Category A contaminated solid
waste. Information on off-site inactivation of waste begins on page 13.
Lowe, J., Gibbs, S., Schwedhelm, S. et al. (2014). Nebraska Biocontainment Unit Perspective on
Disposal of Ebola Medical Waste. (Abstract only.) American Journal of Infection
Control. 42(12):1256-1257.
The authors describe Ebola medical waste processing requirements and their impact on
U.S. hospitals.
University of Toledo Medical Center. (2015). University of Toledo Medical Center Emergency
Operations Plan.
This is an emergency operations plan for an academic medical center that may be
referenced and adapted for use by other facilities. Annex L includes Category A
infectious waste disposal guidance beginning on page 44.
U.S. Department of Labor, Occupational Safety and Health Administration, Centers for Disease
Control and Prevention, National Institute for Occupational Safety and Health, and
Environmental Protection Agency. (2016). Safe Handling, Treatment, Transport and
Disposal of Ebola-Contaminated Waste.
This fact sheet provides a step-by-step summary of actions workers should take from the
point Ebola-contaminated waste is generated through final disposal.
U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration.
(2014). Procedural Guidance on the Proper Packaging of Ebola Suspected Waste.
This document includes general information on transporting Ebola-contaminated waste
and links to related Department of Transportation guidance.
2
TRACIE
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Waste Management
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
The requestor asked ASPR TRACIE for assistance in identifying best practices related to Ebola medical waste management, especially for hospitals that do not have an autoclave or incinerator. She is particularly interested in how other facilities move waste from the red zone to the green zone and what vendors others are using for Category A waste removal.
Citation
Citation information for the publication itself.
ASPR TRACIE. (2019). Ebola Waste Management.
URL
https://files.asprtracie.hhs.gov/documents/aspr-tracie-ta-ebola-waste-management-redacted-1-31-19.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Waste Management
Subject
The topic of the resource
Waste Management
Description
An account of the resource
This ASPR TRACIE TA response includes links to best practices related to the Ebola and other Category A agent medical waste management. The information can also be used by facilities without autoclaves or incinerators. <br /><br />Related resources: <br />
<ol>
<li><a href="https://asprtracie.hhs.gov/technical-resources/45/vhf-ebola/43#decontamination-and-waste-management" target="_blank" rel="noreferrer noopener">ASPR TRACIE VHF/Ebola Topic Collection, section on Waste Management</a>.</li>
<li><a href="https://repository.netecweb.org/items/show/16" target="_blank" rel="noreferrer noopener">ASPR TRACIE EMS Infectious Disease Playbook</a>.</li>
<li><a href="https://repository.netecweb.org/items/show/451" class="permalink">Ebola-Associated Waste Management</a></li>
<li><a href="https://repository.netecweb.org/items/show/540" class="permalink">Interim – Planning Guidance for the Handling of Solid Waste Contaminated with a Category A Infectious Substance</a></li>
<li><a href="https://repository.netecweb.org/items/show/153">Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste</a></li>
<li><a href="https://repository.netecweb.org/items/show/454" class="permalink">Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste</a></li>
<li><a href="https://repository.netecweb.org/items/show/456" class="permalink">Procedural Guidance on the Proper Packaging of Ebola Suspected Waste: DOT Guidance for Preparing Packages of Ebola Contaminated Waste for Transportation and Disposal</a></li>
</ol>
Creator
An entity primarily responsible for making the resource
ASPR TRACIE
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-01-31
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Ebola
R-IPC
Viral Hemorrhagic Fever
Waste
Waste Management
-
https://repository.netecweb.org/files/original/8e1c5658576d9a00af2162ce47809675.png
b263ad9fbe0f18136487eb0e126e6ace
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Self-paced
Objectives
<div><b>Continuing Education Units Available<br /></b></div>
CNE .72<br />CME .75
URL
https://courses.netec.org/courses/infection-control-for-special-pathogen-isolation
Access
Description of access information (e.g. itunes).
Free with free account
Dublin Core
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Title
A name given to the resource
NETEC - Online Course - Infection Control for Special Pathogen Isolation
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This course will provide information on the importance of having robust infection control procedures in place to care for a patient with Ebola or other special pathogen. Some topics that will be discussed include patient placement, patient care, donning and doffing personal protective equipment and how to transfer and dispose of waste from care of the patient.<br /><br />This course is intended primarily for healthcare workers and teams in a biocontainment unit or special pathogen isolation area. Additional medical staff and public health professionals may also find the course to be of benefit. Those individuals may include but are not limited to, medical and nursing staff, administration, education/training leadership, and infection control leadership. Staff specializing in emergency management, communications, specialized clinical areas, laboratory, facilities management and environmental services are also welcome.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-02-22
Relation
A related resource
Y - PPE pos 83 qualtrics 304
Y - D0.1PPE/D0.2PPE Qualtrics # 304
Contributor
An entity responsible for making contributions to the resource
2022-12-07 Note from Benjamin - ON Air Force online courses list - DO NOT ARCHIVE
2023-10-17 by Darrell Ruby, T&E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-10-17
Type
The nature or genre of the resource
Online Course
Donning and Doffing
Infection Prevention and Control
Intake
Internal Transport
Patient Care
Patient Placement
Personal Protective Equipment (PPE)
R-T&E
Special Pathogens
Training
Waste
Waste Management
-
Online Course
Access portal to an online course.
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Self-paced
URL
https://openwho.org/courses/ressources-connaissances-ebola
Access
Description of access information (e.g. itunes).
Free Online
Objectives
<strong>Aperçu</strong> : Ce cours offre les décideurs et les intervenants en première ligne un aperçu à la maladie à virus Ebola (MVE) et l’accès à la formation de « e-PROTECT » qui vous aidera à vous protéger vous-même et les membres de votre équipe et à prévenir la propagation de cette maladie. Ces ressources peuvent être utilisées en tant que rappels ou compléments de connaissances pour les travailleurs expérimentés ou en tant qu’introduction aux sujets pour les autres. La plupart des ressources sont disponibles en anglais et en français et peuvent être téléchargées pour un usage sans connexion. Une version en Lingala est également disponible (WHO).
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola: Ressources de connaissances pour les intervenants
Subject
The topic of the resource
Contenu Français
Description
An account of the resource
Online course created by the WHO. This course is also available in <a href="https://repository.netecweb.org/items/show/299">English</a>.
Creator
An entity primarily responsible for making the resource
WHO
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
2023-03-31 by J Mundy change to just R-T&E for next review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Communications
CONOPS
Decontamination
Donning and Doffing
Ebola
Emergency Department
Emergency Management
EMS
Français
French
Identify
Infection Prevention and Control
Inform
International Response
Isolate
Isolation/Biocontainment
Occupational Health
Patient Care
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Physical Infrastructure
Pre-hospital Transport
Public Health
R-T&E
Special Pathogens
Staffing
Staffing Model
Training
Waste
-
https://repository.netecweb.org/files/original/5654c5068ddae71071028fbe5c8a2359.pdf
dda5ee2cf37e4ba9e2a703fea3157ccb
PDF Text
Text
Are you preparing suspected Ebola
contaminated waste for transportation?
Ebola contaminated waste is considered a Category A infectious substance and must be
doubled bagged and placed in a rigid outer package (drum) prior to transportation.
Packaging Requirements:
Use plastic film bags, 175 liters or smaller (46 Gallons), and weigh no more than 22 lbs.
when filled.
Plastic film bags must be compatible with the EPA-registered disinfectant that is
recommended by the CDC for use against the Ebola virus. For the EPA list of registered
disinfectants see http://www.epa.gov/oppad001/list-l-ebola-virus.html.
Packaging Preparation:
PROPERLY CLOSED
SHARPS CONTAINER
Bag the waste
1
• Put contaminated waste into plastic bag
• Use authorized container for sharps
• Wrap sharp edges to prevent puncturing
of the plastic bag
• Add EPA-registered disinfectant
• Tie a knot to close the bag
• Spray exterior surface with disinfectant
2 Double bag
• Put first bag into a second plastic bag
with the knot facing upward
• Tie a knot to close the bag
• Spray exterior surface with disinfectant
* LINER
3 Put contaminated waste in outer drum
• Place absorbent material in bottom of
drum or liner if using fiber drum
• Put bags in outer drum (can be metal,
poly, or fiber drum with plastic liner*)
• If using fiber drum, zip tie liner
• Secure the drum
ABSORBENT
MATERIAL
For more information on transporting infectious-substances, please visit the
PHMSA website at:
http://phmsa.dot.gov/hazmat/transporting-infectious-substances
or contact the Hazmat Info Center: 1-800-467-4922
�
Dublin Core
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Title
A name given to the resource
Are You Preparing Suspected Ebola - Contaminated Waste For Transportation?
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.phmsa.dot.gov/training/hazmat/are-you-preparing-suspected-ebola-contaminated-waste-transportation
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Are You Preparing Suspected Ebola - Contaminated Waste For Transportation?
Subject
The topic of the resource
Waste Management
Description
An account of the resource
Poster with guidance for suspected Ebola-contaminated waste
Creator
An entity primarily responsible for making the resource
U.S. Department of Transportation, Office of Hazardous Materials Safety (PHMSA)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-08-08
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Ebola
Infection Prevention and Control
R-IPC
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Online Course
Access portal to an online course.
URL
https://openwho.org/courses/knowledge-resources-ebola
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Approximately 3 hours.
Access
Description of access information (e.g. itunes).
Free with free OpenWHO account.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola: Knowledge resources for responders
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Decision-makers and frontline responders will find a set of resources on Ebola virus disease here. These resources can be used as refreshers for experienced personnel or as an introduction to the topic for everyone else. Most of the materials are available in English and French, and can be downloaded for offline use. A version in Lingala is also available. (WHO)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-07-05
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
2023-03-31 by J Mundy change to T&E for next review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Communications
CONOPS
Decontamination
Donning and Doffing
Ebola
Emergency Department
Emergency Management
EMS
Identify
Infection Prevention and Control
Inform
International Response
Isolate
Isolation/Biocontainment
Occupational Health
Patient Care
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Physical Infrastructure
Pre-hospital Transport
Public Health
R-T&E
Special Pathogens
Staffing
Staffing Model
Training
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
In Person Course
Document relating to an in person course.
URL
https://cdn.who.int/media/docs/default-source/ebola/introduction-to-ebola-disease.pdf?sfvrsn=26c6c127_1
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Introduction to Ebola Disease: Managing Infectious Hazards
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
General
Description
An account of the resource
WHO Ebola disease course slides, description of the virus and infection prevention and control
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-09
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Communications
Decontamination
Donning and Doffing
Ebola
Emergency Department
Emergency Management
Identify
Infection Prevention and Control
Inform
International Response
Isolate
Isolation/Biocontainment
Lab
Laboratory
Patient Care
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Pre-hospital Transport
Public Health
R-PPE
Special Pathogens
Training
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Jennings, B. M., K. A. Yeager, N. R. Feistritzer, M. M. Gullatte and K. K. Martyn (2018). "Enacting high reliability principles while caring for people with Ebola Virus Disease." Am J Infect Control.
Abstract
<div>
<h4>BACKGROUND:</h4>
<p>Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD.</p>
<h4>PURPOSE:</h4>
<p>The analysis reported here illustrates how the members of EUH's SCDU tacitly enacted high reliability (HR) principles while caring for patients with EVD.</p>
<h4>METHODS:</h4>
<p>A qualitative study was conducted to describe the experience of members of the EUH SCDU who worked with EVD patients in 2014. We completed 17 semi-structured interviews involving registered nurses, physicians, and support personnel (eg, laboratory technicians). Interview recordings were transcribed and analyzed using conventional content analysis. Exploring HR principles was not among the questions guiding this exploration, but the participants repeatedly described concepts related to HR.</p>
<h4>RESULTS:</h4>
<p>The goal of the SCDU team was to save patients' lives while protecting their own lives. Rigorous training and meeting high standards were required to make the team. The fear surrounding EVD set in motion the enactment of HR principles. HR principles served to alleviate failures or breakdowns in infection prevention and control, thus keeping patients and staff safe.</p>
<h4>CONCLUSIONS:</h4>
<p>These findings illustrate that it is possible to move HR principles from theory to practice in high-risk situations. HR principles were essential to safety and to infection prevention and control.</p>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
pay online - or through clinicalkey, or elsevier subscription
URL
https://www.ncbi.nlm.nih.gov/pubmed/29784444
Read Online
Online location of the resource.
https://www.ajicjournal.org/article/S0196-6553(18)30461-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Enacting high reliability principles while caring for people with Ebola Virus Disease
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD.
Creator
An entity primarily responsible for making the resource
Jennings B. M., Yeager K. A., Feistritzer N. R., Gullatte M. M., Martyn K. K.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-18
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 822, original #
Y - D0.1PM/D0.2PM Qualtrics # 910, original # 7
Fitness for Duty
Infection Prevention and Control
Nursing
Occupational Health
Personal Protective Equipment (PPE)
Personnel Management
R-PM
R-PPE
R-Res&Pub
Site Managers
Staff Retention
Staff Rotation Schedules
Staff Support
Staffing
Staffing Model
Trained Observer
Treatment and Care
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
In Person Course
Document relating to an in person course.
URL
https://repository.netecweb.org/pdfs/EMSandPrehospital.zip
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
EMS & Prehospital
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Past in Person Course Presentation.<br />Course Learning Objectives:<br />
<ul>
<li>Increase healthcare worker knowledge and understanding of serious communicable diseases (smallpox, SARS, MERS, Ebola, novel influenza).</li>
<li>Increase understanding of standard and transmission-based infection control procedures.</li>
<li>Describe administrative and environmental controls that will decrease the likelihood of inadvertent exposure to infectious bodily fluids to include donning and doffing of PPE, configuration of the ambulance to protect environmental surfaces and facilitate decontamination and disinfection of the vehicle.</li>
<li>Describe waste management and post-mission health monitoring. Allow learners to practice the donning and doffing of PPE under the direct supervision of faculty that have experience with transport and management of patients with serious communicable disease.</li>
</ul>
<br />Download the file at the URL below.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Contributor
An entity responsible for making contributions to the resource
2023-10-30 by Darrell Ruby/Amy Mead - Get Updated Version. Good content, needs reviewed and updated by EMS SME's. Alex Isakov pending new version to send.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-10-30
Donning and Doffing
Emergency Department
Emergency Management
EMS
Infection Prevention and Control
Personal Protective Equipment (PPE)
Pre-hospital Transport
R-EMS
R-PreH
R-T&E
Waste
-
https://repository.netecweb.org/files/original/9dfc2680d3b27b64c7d5c8c2bab3083b.docx
7b200d9b0d70810abb6fa0fe8f596410
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Facilitator Guide: Spills and Waste
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Facilitator Guide: Spills and Waste
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, More Tools: Scenario - Spills and Waste
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-25
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 438, original # 329
Y - D0.1TE/D0.2TE Qualtrics # 403, original # 003 (additional resources)
Y - D0.1TE/D0.2TE Qualtrics # 418, original # 305 (additional resources)
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T & E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-10-17
Example
Leadership Toolbox
Other Tools
R-T&E
Training
Waste
-
https://repository.netecweb.org/files/original/9b358e234f47bd42e387a0f4d5ff5826.docx
19850692d023e4f6168fd353b2d67b65
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Skills Drill: Objectives
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Skills Drill: Objectives
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, More Tools: Skills Drill Objectives
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-25
Contributor
An entity responsible for making contributions to the resource
2022-07 by Gary, Special Populations Treatment & Care group
2022-03-08 by PPE group UNMC (JC) - sp. date (both said 1 year)
2024-03-28 by J. Mundy – Skipped 2023 (Q2) - bumping to 2024 (Q4)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-08-22 ** Specific review date
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 413, original # new item 7
Y - D0.1TE/D0.2TE Qualtrics # 418, original # 305 (additional resources)
Y - D0.1TE/D0.2TE Qualtrics # 438, original # 329 (additional resources)
Decedent Management
Donning and Doffing
Example
Exercises and Drills
Leadership Toolbox
Other Tools
Pediatrics
Personal Protective Equipment (PPE)
R-PPE
R-T&E
Skills
Specimen Collection
Spills
Waste
-
https://repository.netecweb.org/files/original/370c0d6c63a78d277bb9e6e4047076b9.docx
a845b7bf005723b142db125172a69a37
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Skills Drill: Equipment List
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Skills Drill: Equipment List
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, More Tools: Items needed for Skills Drills
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-25
Contributor
An entity responsible for making contributions to the resource
2022-07 by Andi, Special Populations Treatment & Care group
2023-10-17 by Darrell, Training and Exercises group - marked archive, cannot archive - in Sporsa.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-10-18
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 413, original # new item 7
Y - D0.1TE/D0.2TE Qualtrics # 418, original # 305 (additional resources)
Y - D0.1TE/D0.2TE Qualtrics # 438, original # 329 (additional resources)
Ebola
Example
Isolate
Leadership Toolbox
Other Tools
Pediatrics
R-T&E
Waste
-
https://repository.netecweb.org/files/original/902d63dc64839424794cbe3cf08e8f2d.docx
3fa6b794d3d2c46b96b9706e649f9f0d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Refresher Training Agenda
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Refresher Training Agenda
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, Response: Emory SCDU Refresher Training
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-25
Contributor
An entity responsible for making contributions to the resource
2022-03-17 by Anna Yaffee (Adult Care Group) keep in RL SCDU relevant
2023-02-19 by Anna Yaffee T&C group Q1 review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-02-19
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 417, original # 304
Y - D0.1TE/D0.2TE Qualtrics # 426, original # 316
Y - D0.1TE/D0.2TE Qualtrics # 428, original # 321
Contact Transmission
Droplet Transmission
Ebola
Lassa
Leadership Toolbox
Marburg
R-T&E
Response Tools
Training
Waste
-
https://repository.netecweb.org/files/original/43ff301165c4b039e2dd255dd3157194.docx
1115ef0fd1de87466366e49281b6cf04
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Unit Training Agenda Detailed
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Unit Training Agenda Detailed
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, Preparedness: SCDU Training Agenda November 2016
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-11-09
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 407
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T & E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-10-17
Example
Leadership Toolbox
Preparedness Tools
R-T&E
Special Pathogens
Waste
-
https://repository.netecweb.org/files/original/3f99daa00ebdcae0480e6a302f08d899.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/25465251
Citation
Citation information for the publication itself.
Lowe, J. J., S. G. Gibbs, S. S. Schwedhelm, J. Nguyen and P. W. Smith (2014). "Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste." Am J Infect Control 42(12): 1256-1257.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
pay online - or through clinicalkey, or elsevier subscription
Read Online
Online location of the resource.
https://www.ajicjournal.org/article/S0196-6553(14)01219-X/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste
Creator
An entity primarily responsible for making the resource
Lowe, J. J., S. G. Gibbs, S. S. Schwedhelm, J. Nguyen and P. W. Smith
Subject
The topic of the resource
Waste Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-12-01
Type
The nature or genre of the resource
Publication
Description
An account of the resource
Clinical practices surrounding the current Ebola epidemic have been center stage in discourse concerning research and practice of care.
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Relation
A related resource
Y - D0.1WM/D0.2WM Qualtrics # 1117, original # 5a1
Y - D0.1WM/D0.2WM Qualtrics # 1119, original # 6
Y - D0.1WM/D0.2WM Qualtrics # 1120, original # 7
Autoclave
Ebola
Infection Prevention and Control
Personal Protective Equipment (PPE)
Public Health
R-WM
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/28609169
Citation
Citation information for the publication itself.
Le, A. B., L. Witter, J. J. Herstein, K. C. Jelden, E. L. Beam, S. G. Gibbs and J. J. Lowe (2017). "A gap analysis of the United States death care sector to determine training and education needs pertaining to highly infectious disease mitigation and management." J Occup Environ Hyg 14(9): 674-680.
Abstract
PURPOSE: A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and training and education needs in relation to highly infectious disease mitigation and management were explored in an effort to identify where occupational health and safety can be enhanced in this worker population. METHODS: Collaborating national death care organizations distributed the 47-question electronic survey. N = 424 surveys were initiated and results recorded. The survey collected death care sector-specific information pertaining to the comfortability and willingness to handle highly infectious remains; perceptions of readiness, current policies and procedures in place to address highly infectious diseases; current highly infectious disease training levels, available resources, and personal protective equipment. RESULTS: One-third of respondents have been trained on how to manage highly infectious remains. There was a discrepancy between Supervisor/Management and Employee/Worker perceptions on employees' willingness and comfortability to manage potentially highly infectious remains. More than 40% of respondents did not know the correct routes of transmission for viral hemorrhagic fevers. CONCLUSIONS: Results suggest death care workers could benefit from increasing up-to-date industry-specific training and education on highly infectious disease risk mitigation and management. Professional death care sector organizations are positioned to disseminate information, training, and best practices.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
pay online - or through Taylor and Francis subscription
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A gap analysis of the United States death care sector to determine training and education needs pertaining to highly infectious disease mitigation and management
Creator
An entity primarily responsible for making the resource
Le, A. B., L. Witter, J. J. Herstein, K. C. Jelden, E. L. Beam, S. G. Gibbs and J. J. Lowe
Subject
The topic of the resource
Decedent Management
Description
An account of the resource
A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and training and education needs in relation to highly infectious disease mitigation and management were explored in an effort to identify where occupational health and safety can be enhanced in this worker population.
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-09-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10
Decedent Management
Ebola
Infection Prevention and Control
Personal Protective Equipment (PPE)
Public Health
R-DM
Special Pathogens
Training
Waste
-
https://repository.netecweb.org/files/original/8c7f028995127765b991d83b313ba36a.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
http://www.sciencedirect.com/science/article/pii/S0196655317309975
Citation
Citation information for the publication itself.
Le, A. B., S. Hoboy, A. Germain, H. Miller, R. Thompson, J. J. Herstein, K. C. Jelden, E. L. Beam, S. G. Gibbs and J. J. Lowe (2017). "A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste." American Journal of Infection Control.
Abstract
The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste—contaminated with EVD and other highly infectious pathogens—is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
pay online - or through clinicalkey, or elsevier subscription
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste
Creator
An entity primarily responsible for making the resource
Le, A. B., S. Hoboy, A. Germain, H. Miller, R. Thompson, J. J. Herstein, K. C. Jelden, E. L. Beam, S. G. Gibbs and J. J. Lowe
Subject
The topic of the resource
Waste Management
Description
An account of the resource
The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-17
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-10
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control
Autoclave
Category A
Ebola
Infection Prevention and Control
R-WM
Special Pathogens
Training
Waste
-
https://repository.netecweb.org/files/original/4c7e9663a3a47f47552231dfd46a89a7.png
225a70b426ff74c1fdcb3bd7e3b60813
https://repository.netecweb.org/files/original/e2fe9a9a33aacb9c1e46c4808e700ea5.png
1d0fd78fe48d5b3fd94b0b1644f4997d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
http://www.cdc.gov/vhf/ebola/index.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Centers for Disease Control and Prevention (CDC): CDC's Response to the West African Ebola Epidemic
Creator
An entity primarily responsible for making the resource
CDC
Subject
The topic of the resource
General
Description
An account of the resource
U.S. Healthcare Workers and Settings | Ebola Hemorrhagic Fever | CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Autoclave
Communications
CONOPS
Decontamination
Donning and Doffing
Ebola
Emergency Department
Emergency Management
EMS
Federal
Identify
Infection Prevention and Control
Inform
Isolate
Isolation/Biocontainment
Occupational Health
Patient Care
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Physical Infrastructure
Pre-hospital Transport
Public Health
R-PPE
Special Pathogens
Staffing
Staffing Model
Training
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
URL
https://www.nebraskamed.com/biocontainment/ebola
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Nebraska Biocontainment Unit Webinars
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
General
Description
An account of the resource
Resources - National Ebola Training and Education Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Format
The file format, physical medium, or dimensions of the resource
Under Construction
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (BH)
2023-03-30 by PPE group - Jill Morgan - General Asset Review - Kate B. confirmed
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-03-30
Communications
Diagnosis
Donning and Doffing
Ebola
Emergency Department
Emergency Management
Epidemic
Epidemiology
Ethics
Example
Immunology
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Nursing
Outbreaks
Outcomes
Patient Care
Patient Transport
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
Public Relations
Quarantine
R-PPE
Specimen Handling
Specimen Transport
Therapeutics
Virology
Waste
-
https://repository.netecweb.org/files/original/9cbdb4075ded38785ecff3d35eb0178b.png
392f73830addae8f1948151f22d116d0
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/rGk8s8tySew" frameborder="0" title="Cleaning Spills Video"></iframe>
URL
https://www.youtube.com/watch?v=rGk8s8tySew&list=PLrAuA0-_XmsP0AGyLUknA9pW9b7PBQ1t7&index=7
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Cleaning Up Spills
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Emory University Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-12-03
Contributor
An entity responsible for making contributions to the resource
2022-02-07 by Joanna Mundy (video now private)
2022-12-07 general asset review - IPC (needs updating)
2024-03-28 by J. Mundy – Skipped 2023 (Q2) - bumping to 2024 (Q4)
Source
A related resource from which the described resource is derived
Emory Healthcare YouTube: https://www.youtube.com/channel/UCdznuDWlX476PqxNJdoubjg
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-10 - needs updating
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 213, original # 7 (additional resources)
Decontamination
Infection Prevention and Control
Not updated
R-IPC
Spills
Waste
-
https://repository.netecweb.org/files/original/900d8badf43b6443015d034d49e56e01.pdf
aa18e407143ac03813c9bd0e0b7ea6f7
PDF Text
Text
VIROLOGY
crossm
Validation of Autoclave Protocols for
Successful Decontamination of Category
A Medical Waste Generated from Care of
Patients with Serious Communicable
Diseases
Brian T. Garibaldi,a Mallory Reimers,b Neysa Ernst,b Gregory Bova,b
Elaine Nowakowski,b James Bukowski,b Brandon C. Ellis,c Chris Smith,b
Lauren Sauer,d Kim Dionne,c Karen C. Carroll,c Lisa L. Maragakis,e
Nicole M. Parrishc
Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland,
USAa; Johns Hopkins Hospital, Baltimore, Maryland, USAb; Department of Pathology, Johns Hopkins University
School of Medicine, Baltimore, Maryland, USAc; Johns Hopkins Office of Critical Event Preparedness and
Response, Baltimore, Maryland, USAd; Division of Infectious Diseases, Johns Hopkins University School of
Medicine, Baltimore, Maryland, USAe
ABSTRACT In response to the Ebola outbreak in 2014, many hospitals designated
specific areas to care for patients with Ebola and other highly infectious diseases.
The safe handling of category A infectious substances is a unique challenge in this
environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its
biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3
(BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of
the validation process revealed that autoclave factory default settings are potentially
ineffective for certain types of medical waste and highlighted the critical role of
waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste.
Received 25 October 2016 Returned for
modification 17 November 2016 Accepted
28 November 2016
KEYWORDS Ebola, sterilization, medical waste, serious communicable diseases,
Copyright © 2017 American Society for
Microbiology. All Rights Reserved.
autoclave
Accepted manuscript posted online 7
December 2016
Citation Garibaldi BT, Reimers M, Ernst N, Bova
G, Nowakowski E, Bukowski J, Ellis BC, Smith C,
Sauer L, Dionne K, Carroll KC, Maragakis LL,
Parrish NM. 2017. Validation of autoclave
protocols for successful decontamination of
category A medical waste generated from care
of patients with serious communicable
diseases. J Clin Microbiol 55:545–551. https://
doi.org/10.1128/JCM.02161-16.
Editor Alexander J. McAdam, Boston Children's
Hospital
Address correspondence to Brian T. Garibaldi,
bgariba1@jhmi.edu.
T
he Ebola outbreak in West Africa in 2014 revealed potential gaps in the abilities of
U.S. hospitals to safely provide care for patients with highly infectious diseases. Prior
to the outbreak, the capacity to care for patients in the United States infected with
high-consequence pathogens was limited to a few specialized facilities, or biocontainment units (BCUs) (1–3). In response to the crisis, the Centers for Disease Control and
Prevention (CDC) recommended a tiered approach wherein U.S. hospitals serve as
frontline health care facilities, Ebola assessment hospitals, or Ebola treatment centers
(ETCs) (4). The Office of the Assistant Secretary for Preparedness and Response (ASPR),
a federal office in the Department of Health and Human Services (HHS), created a
regional response plan, which called for the creation of Regional Ebola and Other
Special Pathogen Treatment Centers (RETCs) (5). These RETCs were modeled in part on
the U.S. facilities that provided care for Ebola patients, namely the University of
Nebraska Medical Center, the National Institutes of Health, Emory University, and
Bellevue Hospital Center, and also include design elements based on local capabilities
and lessons learned from the outbreak (6).
February 2017 Volume 55 Issue 2
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Journal of Clinical Microbiology
One of the unique challenges of caring for patients with highly infectious diseases
is the handling of patient medical waste containing category A infectious substances
(7–11). A category A infectious substance is “capable of causing permanent disability or
life-threatening or fatal disease in otherwise healthy humans or animals when exposure
to it occurs” (12). Only a small number of civilian facilities process category A substances, and the cost and logistical barriers to transporting waste to those facilities are
substantial. The amount of waste generated during the care of an Ebola patient is also
significantly greater than that for routine medical care. This is partly due to the high
volume of gastrointestinal losses, but also reflects the higher staff-to-patient ratio and
the large amount of disposable personal protective equipment (PPE) required (9–11).
Medical waste that is treated onsite through the use of steam sterilizers, or autoclaves,
can be handled as regulated medical waste (9). The CDC and ASPR recommend that
facilities preparing to care for patients infected with Ebola consider installing on-site
autoclaves to handle category A infectious substances (7).
The Johns Hopkins Hospital (JHH) BCU is the ASPR region 3 RETC serving Maryland,
Delaware, Pennsylvania, Virginia, West Virginia, and Washington, DC (5). The JHH BCU
includes two pass-through autoclaves for treating infectious waste prior to transporting
it off the unit (6). A preliminary risk assessment (PRA) was conducted to identify
potential high-consequence events during autoclave use and to offer opportunities for
risk reduction. The PRA identified the following two main risks associated with waste
disposal and autoclave use: (i) the exposure of a health care worker to infectious
material, and (ii) the failure to effectively sterilize waste. To address the risk of sterilization failure, the JHH BCU conducted a series of validation experiments using mock
patient care trash loads. These experiments demonstrated that autoclave factory
default settings are potentially inadequate for sterilizing highly infectious waste and
that careful attention to waste packaging prior to autoclave processing is a critical
factor for successful sterilization. The lessons learned from this validation process can
inform waste management protocols to ensure effective treatment of highly infectious
medical waste at facilities that utilize on-site autoclaves.
RESULTS
We found that 16 of 19 (84%) autoclave cycles performed using factory default
settings failed to sterilize the biological indicators in the center of the load. This
included all runs performed using a liquid or gravity cycle for 30 min or a vacuum cycle
for 15 min at 123°C or 134°C, respectively. These failed runs contained simulated loads
composed of liquids (0.5 to 1 liter) in suction canisters or sharps containers, as well as
PPE and other paper products. Water-saturated and unsaturated bed linens (blankets,
sheets, and pillow cases) treated with a vacuum cycle for 15 min or with either of the
other two default cycles (liquid or gravity) for 30 min also failed to be sterilized. Failure
to sterilize the biological indicators occurred regardless of the type of bag closure used,
including those that were goose-necked and secured lightly with autoclave tape or
were just lightly folded and placed in the autoclave tray. The autoclave service
contractor (Modular Component Systems, LLC, Stevensville, MD) was notified of these
failures and confirmed that each autoclave was operating within manufacturer specifications.
These runs on simulated loads were repeated multiple times with various sterilization cycle parameters. Initially, attempts were made to identify a single cycle type
(liquid, gravity, or vacuum) that would work well for all waste packaged together, as the
sorting of trash by type may be too great a safety risk. Repeated runs using a liquid
cycle for 60 or 120 min with goose-necked, double, or triple autoclave bags failed,
regardless of cycle type. In fact, all runs conducted in which any of the bags were
goose-necked or tightly sealed failed. All runs in which a solidifier was used failed.
Dissolvable autoclave bags began to break apart within 1 min after coming into contact
with moist or wet materials, such as bed linens, so they were not tested in the
autoclave.
For liquid cycles, purge times were adjusted and maximized at 14 min with a
February 2017 Volume 55 Issue 2
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�Autoclave Validation for Highly Infectious Waste
Journal of Clinical Microbiology
TABLE 1 Optimized cycles and parameters used in this study for adequate sterilization of
simulated waste
Parameter
Cycle type
Sterilization time (min)
Sterilization temperature (°C)
Dry/cool time (min)
Purge time (min)
Precharge (psig)
No. of prevacsa
Prevac vacuum point (in. Hg)
Autoclave bag type and configuration
Bag closure
aPrevac,
PPE and dry trash
Saturated linen
Liquid
Vacuum
Vacuum
Liquid
30
60
120
134
134
123
1
10
35
4
5
14
20
20
20
3
3
3
10
10
10
Standard clear bags, double bagged
Clamped outer bag, loosely twisted inner bagb
prevacuum pulse.
clamp and place in tray prior to autoclaving.
bRemove
sterilizing temperature of 123°C for 60 to 120 min. Large volumes of liquids (Ͼ3 liters)
required the longest time for sterilization (120 min). Dry waste, such as PPE and other
paper and plastic items, required the least amount of time (30 min) when using a
vacuum cycle at 134°C with a precharge set to 20 psig (pounds per square inch gauge),
a purge time of 4 min, a prevacuum set point of 10 in. Hg (inches of mercury), and 3
prevacuum pulses. The most difficult loads to sterilize were those containing saturated
linens (soaked with Ͼ1 liter of water) comprising a cotton blanket, sheets, and pillow
cases, which required a vacuum cycle of a minimum of 60 min to achieve adequate
sterilization using the settings as described for other dry waste. Nine of nine runs
(100%) containing multiple saturated linens and using a shorter sterilizing time (3 runs
each of 15, 30, and 45 min) failed.
We found that the double bagging of waste was optimal with the inner bag lightly
secured by a 7 in. by 1/8 in. rubber band (Pale crepe gold, item no. 909713; Alliance
Rubber Company, Hot Spring, AR), which allowed for a small opening at the point
where the bag was gathered. For safety, the optimal closure for the outer bag was a
2-in. binder clamp (item no. 308957; Office Depot, Boca Raton, FL), which was removed
and placed in the autoclave tray with the bag prior to sterilization. The optimized
parameters are summarized in Table 1.
Since initiating the use of the optimized parameters, we have completed two
consecutive quarterly validations of the autoclave system. We found that 18 of 18
(100%) mock patient loads (6 PPE, 6 linen, and 6 liquid loads) passed with the optimized
parameters compared to only 3 of 19 (16%) mock loads that passed with use of the
factory default settings.
DISCUSSION
Current protocols for sterilizing waste from patients with serious communicable
diseases, such as Ebola, are based on guidelines for biosafety levels (BSLs) 3 and 4
laboratories (13). While these protocols have been developed to enhance laboratory
safety in the handling of infectious materials, they may not be adequate for the type
and volume of waste generated from patient care activities. The validation process of
the JHH waste-handling system identified several critical issues that need to be
considered in the design of protocols for sterilizing waste generated from the care of
patients with highly infectious diseases, such as Ebola.
First and foremost, the JHH experience highlighted the need to validate waste
management protocols using simulated patient care loads. The simulated loads need to
reflect the expected volume and type of waste that will be generated from a patient
with a particular disease, and they need to feature the materials that will be used in
patient care, including the same autoclave bags, personal protective equipment (PPE),
linens, and liquid waste containers. The validation cycles with simulated waste must be
processed with biological indicators buried within the trash load, since indicators
outside the autoclave bag may not accurately reflect the conditions inside the bag
February 2017 Volume 55 Issue 2
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Journal of Clinical Microbiology
during the autoclave cycle. Based on the validation results, individual facilities may
need to reassess the use of particular patient care items. For example, the JHH BCU no
longer uses heavy cotton blankets in patient care rooms, since heavy linens saturated
with water were the most likely to fail the validation protocol, even at the highest
settings of pressure and temperature.
This validation process led to several important changes in the JHH BCU protocols for the packaging of in-room waste. Since we found that each type of load
requires different autoclave cycle parameters to ensure proper sterilization, waste
is now separated according to the overall composition (paper and PPE, linens, and
liquids of Ͼ0.1 liters) in separate bags within the patient’s room before transporting
it to the waste management area. Providers will never reach into trash containers
to re-sort waste once it has been discarded. If waste types are inadvertently
packaged together, the entire load will be run on the liquid cycle to ensure
adequate sterilization. The reason that all loads are not run on the liquid cycle is
that this cycle takes 2 to 4 times as long as the other available cycles. It would be
challenging to sterilize the anticipated large amounts of waste from an Ebola
patient if each cycle took 2 h to complete. The tradeoff for this is the extra step of
separating waste in the patient’s room.
One of the most important findings of this study is that autoclave bags should
not be sealed prior to treatment, so as to allow steam to penetrate into the center
of the bag. Despite testing many different types of closures, we found that
biological indicators in the center of a load are not sterilized unless there is an
opening in both the inner and the outer autoclave bags. This point is critical, since
within-bag biological indicators were not adequately sterilized even in loosely
taped autoclave bags, especially those with tightly packed loads or those containing saturated linens. Individual facilities will need to develop their own protocols to
safely transport waste from the site of patient care to the autoclave, being careful
to not load sealed bags into the autoclave. For example, at JHH, a metal clamp is
used to close the outer autoclave bag for transport, and the clamp is then removed
and placed in the autoclave tray just prior to placing the load into the autoclave.
After autoclaving, the sterilized clamp can be reused.
Indicators placed in solidified liquids did not pass the validation process regardless
of the autoclave parameters used or the type of cycle selected. This raises potential
safety concerns, since currently, there is a paucity of data regarding the use of
solidifying agents in the care of patients with highly infectious diseases. Further
investigation is warranted, as large volumes of highly infectious liquid waste are likely
to be encountered with Ebola patients as well as those with other diseases. Current JHH
BCU patient care protocols do not utilize solidifying agents.
Finally, autoclaves need to be operated and tested on a regular basis to ensure
that they achieve the proper temperature and pressure parameters before being
used for patient care. At JHH, each autoclave is operated four times per week in
accordance with manufacturer’s recommendations. Quarterly validation of each
autoclave cycle is conducted using the three types of simulated trash loads and
biological indicators. If changes are made to waste-handling protocols or new
equipment is used in patient care, the validation process is repeated to ensure
adequate treatment of patient care waste. Detailed logs of all weekly and quarterly
validation runs are maintained, and preventive maintenance is conducted on an
annual basis. It is also important that autoclave settings for all load types be
reviewed following preventive maintenance or other repairs, as settings may
inadvertently be reset to factory defaults, which would result in run failure. For this
reason, all optimized autoclave settings should be recorded should the need to
reinstall them arise.
Conclusions. The sterilization of waste containing category A infectious substances
using steam sterilizers, or autoclaves, has been adopted by a number of hospitals
preparing to care for patients with Ebola and other serious communicable diseases.
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TABLE 2 Initial factory default cycles and parameters tested
Cycle type
Vacuum
Gravity
Liquid
aPrevac,
Sterilize temp (°C)
134
123
123
Sterilize time (min)
15
30
30
Dry/cool time (min)
30
30
15
No. of prevacsa
3
0
0
prevacuum pulse.
While autoclave sterilization may be an effective and safe way to process infectious
waste for transport and disposal, this study shows that factory default settings and
laboratory waste guidelines are likely insufficient to adequately sterilize pathogens in
the center of medical waste autoclave loads. Autoclave parameters may need to be
adjusted, with particular attention paid to the way that waste loads are packaged prior
to treatment. Each facility utilizing autoclaves for the treatment of infectious medical
waste should validate their waste management protocols with simulated patient trash
loads and within-bag biological indicators to ensure that waste is properly decontaminated.
MATERIALS AND METHODS
Design of the JHH waste-handling system. To facilitate the unidirectional flow of waste through
the unit, the JHH BCU installed two pass-through steam sterilizers (PSS-500, software version 7923;
Primus Sterilizer Co., Omaha, NE). Waste is transported in sealed containers from patient care areas to a
special waste-handling room at the far end of the unit. Contaminated waste is loaded on the unit side,
and once treated, is unloaded on the clean side and packaged for transport and disposal. The autoclaves
have a special “Bioseal” function, which allows biological separation of the clean and dirty sides. When
the autoclave cycle is completed, the door gasket on the clean side retracts, while the gasket on the dirty
side remains sealed. The doors cannot be opened simultaneously, which prevents cross-contamination
of the autoclave’s clean and dirty sides. Each autoclave is a stand-alone unit, which allows for continued
operation of one autoclave if the other unit requires maintenance. Steam intake and electrical and
mechanical infrastructures are located on the clean side of the waste-handling area to facilitate autoclave
maintenance even while the BCU is caring for a patient. The entire system is connected to the hospital’s
backup power system, which has two substations and enough backup fuel to maintain power for up to
90 h in the event of a citywide loss of electricity (6).
Autoclave validation process. The BCU team partnered with experts in The Johns Hopkins Hospital
biosafety level 3 (BSL-3) laboratory in the division of medical microbiology to design and test autoclave
sterilization protocols. The BSL-3 lab uses an autoclave to sterilize laboratory waste in accordance with
current federal guidelines from the CDC, NIH, and HHS (13). The BCU autoclaves were validated using
simulated loads consistent in quantity and composition with items expected from patient rooms in the
BCU. These items included unsaturated (dry) and saturated (soaked with at least 1 liter of water) linens
(cotton blankets, sheets, and pillow cases), personal protective equipment (PPE), such as gowns, gloves,
booties, and hoods, dry trash (paper and plastic products, etc.), and liquids (0.1 to 1 liter), including
suction canisters and laboratory sharps containers. A solidifying agent (MediChoice fluid solidifier; Owens
and Minor, Mechanicsville, VA) was tested to determine if liquids were effectively treated after the
conversion to a solid state.
Three types of bags were tested, namely, standard red biohazard bags (MediChoice can liners, 30 in.
by 43 in.; Owens and Minor, Mechanicsville, VA), clear autoclave bags (autoclavable biohazard waste
bags, 25 in. by 30 in. and 31 in. by 28 in.; Medline Industries, Inc., Mundelein, IL), and dissolvable bags
(water-soluble bags, 36 in. by 39 in.; Elkay Plastics, Commerce, CA). The test loads for the validation were
packaged based on published protocols utilized in existing biocontainment units (8–10). The loads were
double or triple bagged, and each bag was filled to 50% to 75% of capacity. The bags were secured using
the following variety of closures: a goose-necked closure, with and without autoclave tape; a lightly
folded closure, with and without autoclave tape; a rubber-banded closure; and a clamped closure.
Different combinations of closures for inner and outer bags were tested. For example, a lightly folded
inner bag was tested with a rubber-banded outer bag.
Three separate biological indicators were used to test each load. A rapid biological indicator (3M
Attest 1292; 3M, St. Paul, MN) and a standard biological indicator (3M Attest 1262) were placed into the
center of each load (or directly into liquids) and affixed by a string to the outside of the bags for easy
retrieval after autoclaving. In addition, an individual test pack containing a rapid biological indicator (3M
Attest 1296/1296F rapid readout biological indicator steam pack) was placed in the autoclave tray next
to the autoclave bags. This test pack served as a control to ensure that the autoclave cycle was sufficient
to sterilize a biological indicator that was not buried inside a waste load. When the cycle was completed,
the rapid biological indicators were incubated for 3 h according to the manufacturer’s instructions using
a 3M Attest auto reader 390 before being read; standard biological indicators were incubated at 56 Ϯ
2°C (3M Attest steam incubator) for 48 h before being read. Nonautoclaved rapid and standard biological
indicators were used as positive controls for all of the runs. The lot numbers for all biological indicators
were recorded to ensure that test indicators and controls were obtained from the same lot.
February 2017 Volume 55 Issue 2
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TABLE 3 Autoclave cycles and parameters modified from factory default settings and
tested in this study
Parameter
Type of cycle
Settings/range tested
Vacuum, gravity, liquid
Sterilization time (min)
15–180
Sterilization temp (°C)
123–134
Exhaust
Dry time/liquid cool time (min)
Slow
Rapid
1–45
Purge time (min)
2–14
Precharge (psig)
1–20
No. of prevacs
1–6
Prevac vacuum point (in. Hg)
5–10
aPrevac,
Purpose or comment
Various types were selected
based on load type
Various times were tried based
on load type
Various temps were tried based
on load type and duration of
sterilization phase
For liquid cycles
For vacuum and gravity cycles
Time for removing moisture/
cooling the chamber
Time for removing air from the
chamber
Pressure to be achieved during
the charge portion of all
prevacsa
No. of pulses autoclave pulls
before starting a cycle
Sets vacuum endpoint for pulses
prevacuum pulse.
Autoclave cycle types and sterilizations parameters. Table 2 shows the initial factory default
settings tested for all of the load types. Liquid, gravity, and vacuum cycles were used depending on the
type of load to be sterilized. A liquid cycle was used for all loads containing Ͼ0.1 liters of liquid, and
gravity or vacuum cycles were used for loads containing dry waste or linens. The individual cycle
parameters modified from factory default settings that were tested are shown in Table 3. The modifications included presterilization steps, such as the time spent removing air from the chamber (purge
time), the pressure achieved during the charge portion of all prevacuum phases relative to atmospheric
pressure (precharge), the vacuum endpoint in in. Hg for all pulses (prevacuum endpoint), and the
number of prevacuum pulses. The sterilization parameters included temperature, cycle length, type of
exhaust, and dry time. Forty-two different load-run configurations were tested, including unique cycle
programs developed as a result of this study.
ACKNOWLEDGMENTS
We would like to thank the National Ebola Treatment and Education Center (NETEC),
as well as our colleagues at Emory University, the University of Nebraska Medical
Center, Bellevue Hospital, and the NIH for their assistance in developing and validating
our sterilization protocols. We would also like to thank our colleagues at Modular
Component Systems, LLC (Stevensville, MD) for assisting us with setting up and
maintaining our autoclaves.
This work was supported by the Office of the Assistant Secretary for Preparedness
and Response, Hospital Preparedness Program (HPP) Ebola Preparedness and Response
Activities (no. U3R2015002863).
The authors have no conflict of interest to report.
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Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases.
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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https://www.ncbi.nlm.nih.gov/pubmed/27927920
Citation
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Garibaldi, Brian T., Mallory Reimers, Neysa Ernst, Gregory Bova, Elaine Nowakowski, James Bukowski, Brandon C. Ellis, Chris Smith, Lauren Sauer, Kim Dionne, Karen C. Carroll, Lisa L. Maragakis, and Nicole M. Parrish. 2016. "Validation of autoclave protocols for the successful decontamination of Category A medical waste generated from the care of patients with serious communicable diseases." Journal of Clinical Microbiology. doi: 10.1128/jcm.02161-16.
Abstract
In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of Category A infectious substances is a unique challenge in this environment. One solution is onsite waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its Biocontainment Unit (BCU). The JHH BCU and The Johns Hopkins Biosafety Level 3 Clinical Microbiology Laboratory designed and validated waste handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste, and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste.
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https://journals.asm.org/doi/10.1128/JCM.02161-16
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases.
Creator
An entity primarily responsible for making the resource
Johns Hopkins
Subject
The topic of the resource
Waste Management
Description
An account of the resource
General Resources | Ebola Hemorrhagic Fever Resources: In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment.
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-02-01
Type
The nature or genre of the resource
Publication
Source
A related resource from which the described resource is derived
Garibaldi BT, Reimers M, Ernst N, Bova G, Nowakowski E, Bukowski J, Ellis BC, Smith C, Sauer L, Dionne K, Carroll KC, Maragakis LL, Parrish NM.
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC
Relation
A related resource
Y
Y - D0.1IC/D0.2IC Qualtrics # 209, original # 4a (additional resources)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-10
Autoclave
Category A
Decontamination
Ebola
Infection Prevention and Control
R-IPC
R-Res&Pub
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
URL
http://www.emoryhealthcare.org/ebola-protocol/ehc-message.html
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Must provide contact info and sign user agreement. Lots of clicking to get to end protocols.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emory University Protocols
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
General
Description
An account of the resource
Resources - National Ebola Training and Education Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Autoclave
Donning and Doffing
Ebola
Emergency Department
Emergency Management
EMS
Example
Identify
Infection Prevention and Control
Inform
Isolate
Isolation/Biocontainment
Occupational Health
Patient Care
Personal Protective Equipment (PPE)
Physical Infrastructure
R-PPE
Regional Treatment Center
Special Pathogens
Staffing
Staffing Model
Waste