"US hospitals 'unprepared' to safely handle infectious Ebola waste"

[suffragette]

http://www.theguardian.com/world/2014/sep/24/us-hospital-ebola-waste-handle
US hospitals may be unprepared to safely dispose of the infectious waste generated by any Ebola virus disease patient to arrive unannounced in the country, potentially putting the wider community at risk, biosafety experts said.

Waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training, infectious disease and biosafety experts told Reuters.


~~~

“At its peak, we were up to 40 bags a day of medical waste, which took a huge tax on our waste management system,” Emory’s Dr Aneesh Mehta told colleagues at a medical meeting earlier this month.

Emory sent staff to Home Depot to buy as many 32-gallon rubber waste containers with lids that they could get their hands on. Emory kept the waste in a special containment area for six days until its Atlanta neighbor, the US Centers for Disease Control and Prevention, helped broker an agreement with Stericycle.



Note: this report is from a week ago, so very recent but before the person in Dallas was diagnosed.

Home Depot run for hazardous waste containment gear?

I hope this issue gets addressed quickly as a known nationwide policy because it will be an important component of control here.

[Warpy]

1. Now is when the policy of understaffing our health care

because people who know what they're doing cost so much money is going to show just how completely unprepared this country is for any epidemic, even a large scale flu epidemic.

[suffragette]

2. Very good point Warpy

Understaffing and part time staffing seems to have become the norm in so many important areas, such as health care and education and that does not bode well for dealing with any serious situations.

[Mojorabbit]

9. I mentioned this in a thread recently and was admonished for it

We both have worked as nurses. If there is an influx of these patients needing this type of isolation most hospitals will be overwhelmed in no time at all. Most hospitals are poorly staffed.

It will take one staff member coming down with the disease because of fatigue and not maintaining perfect ppe technique(and that will happen) and you will see housekeeping and other staff not showing up for work. I worked when HIV AIDs was first being diagnosed and I remember what happened then with some of the staff refusing to care for patients.

I hope they locate everyone who has been in contact with this patient and get in front of this. I hope hospitals only receive small numbers of patients so they can handle the cases.

[Warpy]

10. Admonished for it? By a hospital suit, maybe

I was in the trenches during the worst of the HIV horror show, too, and remember staff members trying to get out of caring for dying AIDS patients (and they all were in the mid 80s) because they were preggers of some other excuse. It didn't work.

Ebola is going to be that much worse because full precautions will be needed just to enter the room and give the poor patient a Tylenol or swap the IV out. Suiting up and down is time consuming and other patients will be getting short shrift.

There are too few nurses on staff to deal with it, but where it will really show the stupidity of staff cutting is in housekeeping. When housekeepers are terminally cleaning rooms after Ebola patients have either survived or succumbed, they will be cutting corners because there are too few of them to do the kind of job that needs to be done.

Hospital staff cutting only worked while the population was relatively healthy. They are not prepared for even a bad flu epidemic, let alone a deadly enteric virus.

[freshwest]

3. No incincerators? Hospitals, schools, labs, veterinary clinics and even some apartment

buildings had them at one time. Of course that was in the stone age when I was growing up.

Ebola stricken areas bury or burn the infected stuff. I understand cities are laid out in different ways today, but Emory should have had an incincerator. When it's burned, that's the end of it.

This is basic. If nothing else, install incincerators at treatment facilities. Do we have to reinvent the wheel every generation?

[suffragette]

4. It does seem as if we have to reinvent the wheel all too often, doesn't it?

From the article, it seems that DOT, CDC and EPA had not agreed on how this should be handled. Hopefully, they have come to an agreement.

It also says Emory ended up bringing in an autoclave to sterilize the waste, which was then hauled away to be incinerated.
It sounds like waste is being handled by contracting with private companies who dispose of it.

They cite a number of experts who express concern with the situation.
Full article is worth a read.

[freshwest]

5. I would not trust private companies to dispose of the waste, looking at EPA superfund sites.

That is the private sector doing what it always does, hiring the cheapest labor, ill-equipped and too often irreponsible overall. Out of sight and out of mind, then drive off. This is a long standing problem.

I'm sure they have great concern and want to do the right thing. Still do not see the logic in sending the waste off site where things go wrong. They autoclave but still want it to be incincerated - do they feel it is not enough, maybe?

Control it at its source. Don't get me wrong, I'm not always for the simplest solution, either. Installing incinerators won't be cheap, but it's logical to contain the virus in a well controlled environment with trained people. The people at Emory and other hospitals know what they are doing.

The waste should not be transported by anyone, but destroyed at the source, and Emory should have been ready. They should maintain control over it.

Now, going to the home and other places patients have been to destroy any infected materials, well, that is a different matter. Hazmat suits, evacuations if necessary in shared housing as it's cleansed, whatever.

This will keep happening as most people fly around the world. Disappointed that Emory, which is so highly regarded, hadn't set up something of this type years ago. I thought this was their area of expertise. I posted an OP on plans to reduce this in Africa:

http://www.reuters.com/article/2014/09/16/us-health-ebola-obama-idUSKBN0HB08S20140916

Comments on that when cited on another website ranged from 'Good job, Obama' to conservatives saying to let them all die, Obama will bring the infected troops home to kill us like the Spanish flu; and there were factual rebuttals on every bit of conservative hysteria:

I have to say that most of the posters here should be ashamed of their comments. They show your lack of understanding of the world as well as a couple with some thinly veiled racism. None of you could be involved with a church that sends medical people throughout the world to help in countries where people are dying. You also don’t have any friends or relatives working in the oils business who work in places like this. You all should work on your compassion a wee bit.

Y’all, of course, realize that the US military doesn’t just consist of guys with guns, right? There are engineers, doctors, nurses, scientists. Heck, there already is one health center in Liberia being run by US military personnel. And, of course, if the US sends engineers, doctors and nurses in there will need to be some guys with guns to protect them. Why should we do that? Because ebola will spread. The CDC is already working with hospitals in the US on how to deal with it. It is in our interest to contain that and minimize the impact. also, troops have been training for germ warfare, exposure to this type of situation.

Why do people think ISIS needs to be contained but not Ebola? Why do people think that people who wish harm to the US are not trying to leverage the outbreak of Ebola against the US? This is why we cannot allow this to fester in anarchy. That, and we are human beings who are supposed to care about other defenseless humans beings who are suffering from this outbreak.

This will be a great opportunity for our CBN (chemical biological nuclear)Trained troops to get the real hands on Bio-warfare training. Good to have this knowledge for the future. With Synthetic Biology and the ease of modifying the genetics of organisms, we will see terrorists and even Military uses of Hemorrhagic and other diseases in our lifetimes. If ISIS or some other group got one of their members sick then he could be transported to USA or Europe and blow himself up in a crowed place. You Obama haters better use logic and not emotion with this issue.

The 1918 Flu originated in Haskell County, Kansas, spread to US Army bases, went to surrounding cities, went to US ports, and went to foreign ports and Europe. It was called the Spanish Flu because most countries, including the US, Allies, and Central Powers, had censorship to conceal bad news, so Spanish newspapers were the only source of information about the 1918 Influenza Epidemic that came from the US. It should have been called the Kansas Flu.

Folks, there are daily flights from the Unites States to these West African countries and back. Some of those arriving on the flights are your neighbors, co-workers, children’s classmates, neighborhood small business employees, etc. The United States is the largest melting pot in the world as far as people diversity goes. Even if direct flights to these countries are stopped, you cannot stop people from seeing their family members – they’ll always find a way. It is in your best interest that the United States helps to contain the disease there in West Africa than wait for it to get here. Its only a matter of time before it gets here.

Looks like it is already here, although I've also read pieces saying that some forms of it have been found in the USA years ago. Thanks for the thread.

[suffragette]

6. Have to say I didn't think about what the logistics of disposing of the waste

Would be here in the U.S.
I assumed a system would already be in place that would also work for Ebola. And I share your views on potential problems with private companies doing this.
It sounds like Emory was better able to handle this than most hospitals would be and they still had problems. The problem came to light because they were the first U.S. hospital to have to deal with this issue.
That is what is so concerning here. This is an area of expertise for them, but our system is not ready for the logistics of dealing with it.

[JustAnotherGen]

8. Ita fresh

No way can we trust a privately owned business to do the right thing here. It's a national interest and it needs a national solution.

[freshwest]

11. Indeed. The GOP just slashed funding set to protect us from Ebola:

GOP House guts White House’s request for funds to fight and contain Ebola

By David Ferguson - September 9, 2014

House Republicans have gutted a White House-sponsored bill that would direct funding to the fight to contain the hemorrhagic fever Ebola, which is raging out of control in multiple African countries.

The Hill blog reported that a source familiar with the budget negotiations confirmed that House Appropriations Committee Chairman Hal Rogers (R-KY) will agree to provide only $40 million of the $88 million the Obama administration asked for in its 2015 budget.

Twenty-five million dollars of the $40 million would go to the Centers for Disease Control and Prevention (CDC) and $15 to the Biological Advanced Research and Development Authority (BARDA) in order to speed up production of an experimental anti-Ebola drug.

The Obama administration originally asked for $58 million for BARDA, a division of the Department of Health and Human Services. The agency is tasked with coordinating the nation’s response to public health crises, including medical testing, vaccines, drug development and other products and services associated with “public health and medical consequences of chemical, biological, radiological, and nuclear (CBRN) accidents, incidents and attacks, pandemic influenza, and emerging infectious diseases.”

http://www.rawstory.com/rs/2014/09/09/gop-house-guts-white-houses-request-for-funds-to-fight-and-contain-ebola/

to unhappycamper:

http://www.democraticunderground.com/1104866

Apparently, the kill ratio from refusing Medicaid expansion, cutting off food to mothers, children, the poor, elderly and disabled and polluting us to death is isn't meeting their quota for ridding them of the 47% fast enough. Not to mention all those, uh, not-quite-white people here and there. The Party of Death rolls on. Call it what it is. I'm tired of the debating over policy with people who refuse national solutions that don't enrich the Koch brothers. They want people dead so they can be wealthier.

[JustAnotherGen]

13. You are on to something

Something big . . . I think there is a strong element on that side of the aisle of "since they won't go away" - we'll rid ourselves of them.

[suffragette]

14. Ironic that. The 'fight it over there' proponents are happy to allocate the $$ when it funds war

and death, but not about health there and here.
Even when there's such direct linkage to protecting health here.

I think you're making an important point here.

[Dreamer Tatum]

7. Urban Hospitals Burning Infectious Medical Waste

OMFG, if that was an actual headline, the DU shitstorm would be EPIC.

[pnwmom]

12. Air pollution concerns reduced the number of them from when we were growing up.

Everyone used to burn piles of leaves in the fall, too.

[magical thyme]

15. at least leaves can be composted, which is a very good use for them nt

[KittyWampus]

16. This ends up being pertinent.

[suffragette]

18. Yes, All too pertinent

Experts had clearly been raising serious and legitimate concerns that went unheeded.
Very similar to the way the warnings from Doctors without Borders were ignored in the early stages in Africa.

[Barack_America]

17. Yep. Waste management has been my primary concern all along.

You would be amazed at the amount of waste a person in isolation generates.

Honestly, this guy should just have one nurse and one infectious disease fellow gowned up with him at a time and everyone else is welcome to treat him remotely.