Managing Solid Waste Contaminated with a Category A Infectious Substance

Key Points:

• 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.
• See the Summary of Key Points and Significant Changes

This replaces: Domestic Resilience Group. (2017). Interim – Planning Guidance for the Handling of Solid Waste Contaminated with a Category A Infectious Substance. from 2017-01-19.
And a previous version from 2019-08.

What this is for: 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.

Who this is for: 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.

How to use: 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.

*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

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.

2022-06-10

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. (Page 4.)

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).

5. Appendix B – Infectious Agent Categorization distinguishes these “cultures only” pathogens from other Category A pathogens. (See page 37.)

Domestic Resilience Group. (2022). Managing Solid Waste Contaminated with a Category A Infectious Substance.