Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste.

Clinical practices surrounding the current Ebola epidemic have been center stage in discourse concerning research and practice of care. As the medical community becomes more sophisticated in understanding the many facets of treating and containing this virus, the Nebraska Biocontainment Unit Q6 has identified Ebola medical waste disposal as a key area of concern for U.S. hospitals. The requirements for processing Ebola medical waste stand to impact most U.S. hospitals currently preparing readiness plans to receive and treat patients with suspected or confirmed Ebola virus disease (EVD). The U.S. Centers for Disease Control and Prevention (CDC) has issued recommendations to guide health care facilities in preparing to isolate potential or confirmed EVD patients, and hospitals have established plans to isolate and care for these patients.1,2 The CDC’s guidance includes facility and provider EVD preparedness checklists to aid the U.S. health system in preparing to prevent the spread of the virus within the United States.3 Hospitals are undertaking multiple measures to minimize the risk of EVD, including establishing EVD staffing, appropriate levels of personal protective equipment (PPE), infection prevention and control measures, environmental cleaning, laboratory procedures, public health reporting, and clinical protocols to minimize the exposure risks of health care workers (HCWs). Health care facilities and providers routinely use PPE precautions and are able to refine and implement existing protocols to effectively protect HCWs treating a suspected or confirmed patient, but waste associated with caring for an EVD patient cannot be processed as standard medical waste. Two high-level isolation facilities located at the University of Nebraska Medical Center and Emory University have treated EVD patients in the U.S. These units are ideally equipped for treating patients in high-level isolation because each unit is staffed with HCWs rigorously trained in donning and doffing PPE, and the facilities have been specifically engineered for high-level isolation with in-unit waste processing capability.4 The Nebraska Biocontainment Unit’s strategy for waste management uses a pass-through autoclave to process all medical waste exiting the high-level isolation unit. Through discussions with health care entities planning for EVD patients, first-hand knowledge gained by treating EVD patients transported to the United States, and review of current guidance, we provide insight into key logistical and regulatory considerations for management of EVD medical waste in facilities without in-unit waste sterilization capabilities.