Environmental infection control considerations for Ebola

The presentation revealed the following strategies in the disposal of waste from Ebola-infected patients:
Nebraska Medicine BCU:

• Solid waste in patient care rooms → Health care workers (HCWs) placed into clear autoclave bags and secured → put into another autoclave bag in the corridor with autoclave tape → bag taken by HCW in full personal protective equipment (PPE) and put in autoclave in isolation unit or waste-holding container → after successful sterilization is validated by the autoclave, the waste is put in a red biohazard bag, top twisted and goose-necked → placed in a medical waste shipping box for incineration → directly transported to incinerator in a dedicated truck.
• Linen
  • BCU linen is dyed blue to distinguish from rest of hospital linen.
  • Patient linen and HCWs’ PPE handled like other BCU solid waste
  • HCWs’ scrubs and undergarments are discarded in isolation unit before showers → these and used towels are put in green nylon fluid-repellant laundry bags → subject to autoclave sterilization → laundered in small-batch laundry facility → ready for reuse.
• Liquid waste generated by patient
  • Pretreated in commode with Ecolab Neutral Disinfectant Cleaner for 25 minutes → cover placed over toilet → flushed
  • Bedside commode waste put in toilet commode by HCWs in full PPE → treated → disposed.
  • Effluent dialysis liquid → put in stainless steel mixing container in patient room shower → treated with Ecolab Neutral Disinfectant → disposed
• Patient arriving by ambulance
  • Entrance corridor cleared before arrival of ambulance → BCU staff in full PPE wait inside and outside the entrance → patient put in isolation unit → emergency personnel exit unit following standard exit protocol → BCU HCWs wipe and disinfect floors, doors, and walls from entrance to isolation unit → PPE and other wastes from ambulance processed as BCU solid waste.

Emory SDCU

• Solid waste from patient room put in red biohazard bags with 200-300ml water → bag is secured and its outside wiped with bleach wipes → put in a second bag (secured and outside wiped with bleach wipes) → bag moved to anteroom → put in an autoclave specific bag; secured with autoclave rubber band and outside wiped with bleach wipes → placed in a covered waste container outside anteroom; lid secured and outside of container wiped with bleach wipes → bags removed from container and placed in autoclave → inside and outside of the empty container and lid wiped with bleach wipes → after sterilization is complete, bags put in two red bags twisted and goose-necked → placed in a medical waste shipping box for incineration → directly transported to incinerator in a dedicated truck; bleach wipes disposed as solid waste.
• Liquid waste
  • Pretreated prior to disposal: commode pretreated with MicroChem Plus → commode covered, flushed twice
  • Non-ambulatory patient: autoclave-capable bedside commode used → treated with MicroChem Plus before use → after use, solidifier added → disposed similarly to solid waste
  • Vomit: solidifier added to bag → disposed similarly to solid waste
• Patient arriving by ambulance
  • SDCU staff in full PPE wait inside and outside the entrance → patient put in isolation unit, emergency personnel leave → floors, doors, and walls  from entrance to isolation unit wiped and disinfected by Environmental Service personnel → PPE of emergency personnel and staff and other wastes from ambulance processed as solid waste