The United States is days away from settling the critical question of how hospitals should handle and dispose of medical waste from Ebola patients, a government official said on Wednesday.
Experts have warned that conflicting U.S. regulations over how such waste should be transported could make it very difficult for U.S. hospitals to safely care for patients with Ebola, a messy disease that causes diarrhea, vomiting and in some cases, bleeding from the eyes and ears.
Safely handling such waste presents a dual challenge for regulators, who want to both prevent the accidental spread of the deadly disease and avert any deliberate attempts to use it as a bioweapon.
Most U.S. hospitals are not equipped with incinerators or large sterilizers called autoclaves that could accommodate the large amounts of soiled linens, contaminated syringes and virus-spattered protective gear generated from the care of an Ebola patient, said Dr. Jeffrey Duchin, chair of the Infectious Diseases Society of America's Public Health Committee.
Sterilizing Ebola waste before it is transported is important not only to protect waste haulers but to guard against someone using the waste "for nefarious purposes," said Sean Kaufman, president of Behavioral-Based Improvement Solutions, an Atlanta-based biosafety firm. "It's not just a safety issue," he said.
The matter, which was first reported by Reuters last month, may pose a significant challenge for Texas Health Presbyterian Hospital in Dallas, which is now treating the first Ebola patient to be diagnosed on U.S. soil.
Duchin said he is not aware of whether the hospital has its own incinerator or large autoclave, but if it does not, "they are going to have to find a temporary solution for managing infectious waste. That puts the hospital in a very difficult situation."
Cynthia Quarterman, administrator of the U.S. Department of Transportation's Pipeline and Hazardous Material Safety Administration, which oversees dangerous shipments, said her agency is "working on how we can clarify even further for hospitals, for the public, what the appropriate transportation should be."
Another official said that news could come within days.
The issue centers on guidance over handling Ebola-contaminated waste. The U.S. Centers for Disease Control and Prevention advises hospitals to treat items infected with the Ebola virus in leak-proof containers and discard them as they would other biohazards that fall into the category of "regulated medical waste."
But the DOT deems Ebola a Category A infectious agent, meaning it is capable of killing people and animals, and not "regulated medical waste," a category in which pathogens are not capable of causing harm.
Waste management contractors who normally handle hazardous hospital waste say they cannot legally haul the material, which leaves hospitals stuck without a way to dispose of the waste.
Already the issue has created problems. When Emory University Hospital in Atlanta was preparing to care for two U.S. missionaries infected with Ebola in West Africa in its high-security biocontainment unit, their waste hauler, Stericycle, initially refused to handle it.
Bags of Ebola waste quickly began piling up until the hospital worked out the issues with the help of the U.S. Centers for Disease Control and Prevention.
CDC spokesman Tom Skinner said the waste management problem has not been resolved yet, but he has said previously that the CDC is meeting with officials at the DOT to resolve the matter.
Duchin said he has heard that the discussion "has been elevated at the fed to decision makers who can solve the problem."
A DOT official said the CDC and DOT will likely issue joint guidance by next week.