Tag: infectious disease
Another Ebola Challenge: Disposing Of Medical Waste

Another Ebola Challenge: Disposing Of Medical Waste

By Monte Morin, Los Angeles Times

A single Ebola patient treated in a U.S. hospital will generate eight 55-gallon barrels of medical waste each day.
Protective gloves, gowns, masks and booties are donned and doffed by all who approach the patient’s bedside and then discarded. Disposable medical instruments, packaging, bed linens, cups, plates, tissues, towels, pillowcases, and anything that is used to clean up after the patient must be thrown away.
Even curtains, privacy screens, and mattresses eventually must be treated as contaminated medical waste and disposed of.
Dealing with this collection of pathogen-filled debris without triggering new infections is a legal and logistical challenge for every U.S. hospital now preparing for a potential visit by the virus.
In California and other states, it is an even worse waste-management nightmare.
While the U.S. Centers for Disease Control and Prevention recommend autoclaving (a form of sterilizing) or incinerating the waste as a surefire means of destroying the microbes, burning infected waste is effectively prohibited in California, and banned in several other states.
“Storage, transportation, and disposal of this waste will be a major problem,” California Hospital Association President C. Duane Dauner warned U.S. Sen. Barbara Boxer, D-Calif., in a letter last week.
Even some states that normally permit incineration are throwing up barriers to Ebola waste.
In Missouri, the state attorney general has sought to bar Ebola-contaminated debris from a St. Louis incinerator operated by Stericycle Inc., the nation’s largest medical waste disposal company.
Due to restrictions on burning, California hospital representatives say their only option appears to be trucking the waste over public highways and incinerating it in another state — a prospect that makes some environmental advocates uneasy.
Under federal transportation guidelines, the material would be designated a Class A infectious substance, or one that is capable of causing death or permanent disability, and would require special approval from the Department of Transportation, hospital representatives say.
“These are some pretty big issues and they need some quick attention,” said Jennifer Bayer, spokeswoman for the Hospital Association of Southern California.
“We fully expect that it’s coming our way,” Bayer said of the virus. “Not to create any sort of scare, but just given the makeup of our population and the hub that we are. It’s very likely.”
The Ebola virus is essentially a string of genetic material wrapped in a protein jacket. It cannot survive a 1,500-degree scorching within an incinerator, or the prolonged, pressurized steam of an autoclave.
“The Ebola virus itself is not particularly hardy,” CDC Director Dr. Thomas Frieden said under questioning on Capitol Hill recently. “It’s killed by bleach, by autoclaving, by a variety of chemicals.”
However, CDC guidelines note that “chemical inactivation” has yet to be standardized and could trigger worker safety regulations.
California health officials recently tried to reassure residents that the state’s private and public hospitals were up to the task and were actively training for the possible arrival of Ebola.
“Ebola does not pose a significant public health risk to California communities at the present time,” said Dr. Gil Chavez, an epidemiologist and deputy director at the California Department of Public Health. “Let me tell you why: Current scientific evidence specifies that people cannot get Ebola through the air, foo,d or water. … The Ebola virus does not survive more than a few hours on impervious surfaces.”
It was unclear whether California officials viewed the waste issue as a potential problem.
Although a third of the state’s private hospitals and “a few” of its public hospitals reported to Boxer’s office that there would be problems complying with the CDC’s incineration recommendation, and others, a state public health official told reporters he was not aware of any conflicts.
Dr. David Perrott, chief medical officer for the California Hospital Association, said there was also confusion about whether infected human waste could be flushed down the toilet.
“Here’s what we’ve heard from the CDC: It’s OK,” Perrott said. “But then we’ve heard from some sources, that maybe we need to sterilize it somehow and then flush it down the toilet or you have to check with local authorities. It sounds maybe a little gross, but there is a real question about what to do with that waste.”
Dr. Thomas Ksiazek, a professor of microbiology and immunology of the University of Texas Medical Branch, has said he believes there’s been a lot of overreaction on the topic of Ebola medical waste.
“There are other ways to deal with the waste; autoclaving would be chief among them,” Ksiazek said. “The problem is, most hospitals don’t use it for most disposable items. They’re quite happy to bag them up and send them to a regular medical disposal company.”
But Allen Hershkowitz, a senior scientist at the Natural Resources Defense Council, said incineration is simple and effective, and should be available to hospitals to help dispose of the mountain of waste.
Hershkowitz said states began to crack down on medical waste incineration years ago because many materials that did not need to be burned were being sent to combustors and were emitting dangerous pollutants.
In this case of Ebola medical waste, he said California should reconsider its restrictions.
“There’s no pollutant that’s going to come out of a waste incinerator that’s more dangerous than the Ebola virus,” Hershkowitz said. “When you’re dealing with pathogenic and biological hazards, sometimes the safest thing to do is combustion.”

AFP Photo/Seyllou

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U.N. Goal On Child Deaths Set To Be Missed: Study

U.N. Goal On Child Deaths Set To Be Missed: Study

Paris (AFP) — A U.N. target for slashing infant deaths will be missed, mainly through failures to roll back infectious disease and complications during pregnancy, experts said on Wednesday.

Under the fourth so-called Millennium Development Goal (MDG), all U.N. members were meant to reduce deaths among children under five by two-thirds by the end of 2015 from 1990 levels.

There were 6.3 million deaths in 2013 worldwide, a near halving of the 1990 toll of 12.7 million.

The decrease shows “countries have made great progress in improving child survival since the turn of the millennium,” specialists reported in The Lancet.

“Nevertheless, Millennium Development Goal 4… will probably only be achieved by a few countries.”

The study, led by Robert Black of Johns Hopkins Bloomberg School of Public Health in Baltimore, delved into causes of under-five deaths in 2013.

Pre-term complications were to blame for 965,000 deaths world-wide, while pneumonia accounted for another 935,000 deaths and complications during childbirth for 662,000. Diarrhea and malaria were also major killers.

China, the Democratic Republic of Congo, India, Nigeria, and Pakistan together accounted for about half of all deaths globally in 2013, the paper found.

The research should help frame debate for the Sustainable Development Goals, which are due to be decided by U.N. leaders in September 2015 as a successor to the MDGs, the authors hope.

On current trends, in 2030 4.4 million children under five will still die, and 60 percent of these deaths will occur in sub-Saharan Africa.

AFP Photo/Dibyangshu Sarkar

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Doctor Exposed To Ebola Treated In U.S.

Doctor Exposed To Ebola Treated In U.S.

Washington (AFP) — An American doctor who was exposed to the Ebola virus in Sierra Leone was admitted to a clinic of the National Institutes of Health outside Washington.

The patient, whose identity was not revealed, was volunteering as a physician in a unit treating those suffering from the tropical fever that has already killed more than 3,000 people in west Africa since the end of last year.

“Out of an abundance of caution, the patient has been admitted to the NIH Clinical Center’s special clinical studies unit that is specifically designed to provide high-level isolation capabilities and is staffed by infectious diseases and critical care specialists,” the medical research center said in a statement, released Sunday.

“The unit staff is trained in strict infection control practices optimized to prevent spread of potentially transmissible agents such as Ebola.”

It stressed that treating the patient in the United States “presents minimal risk” to other patients, NIH staff, and the public.

Two American doctors and a Christian missionary infected by the Ebola virus in Liberia were flown back to the United States to receive treatment and have since recovered.

Global health experts have agreed that blood therapies and convalescent serums can be used to fight Ebola immediately, while safety trials begin for potential vaccines.

There is no drug or vaccine on the market to treat Ebola.

Ebola is transmitted by close contact with the bodily fluids of an infected person. The virus causes fever, vomiting, diarrhea and sometimes fatal bleeding.

The Ebola epidemic has now infected more than 6,500 people in West Africa and killed nearly half of them, according to the World Health Organization.

AFP Photo/Zoom Dosso

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Smallpox Discovered In Old Storage Room Near D.C.

Smallpox Discovered In Old Storage Room Near D.C.

By Lauren Raab, Los Angeles Times

National Institutes of Health workers preparing to move a lab in Bethesda, Md., found an unwelcome surprise in a storage room this month: vials of smallpox.

There is no evidence that any of the vials was breached, and no lab workers or members of the public were exposed to the infectious and potentially deadly virus, the federal Centers for Disease Control and Prevention said in its announcement Tuesday.

The vials labeled variola — a name for the smallpox virus — were found July 1 “in an unused portion of a storage room” and seem to date to the 1950s, the CDC said. They were immediately put into a containment lab, then moved Monday to the CDC’s containment facility in Atlanta, it said.

The samples are being tested to see whether any of them are viable — that is, can grow — and will then be destroyed, the CDC said.

The most common type of smallpox is serious, contagious, and frequently fatal, with about 30 percent of cases resulting in death, according to the CDC. Luckily, the disease was declared eradicated in 1980 after a worldwide vaccination program.

The last U.S. case of smallpox was in 1949, and the last naturally occurring case anywhere in the world was in Somalia in 1977, according to the CDC. Since then, according to the World Health Organization, the only known cases stemmed from a 1978 lab accident in England.

By international agreement, live smallpox samples are supposed to be held in only two places worldwide: one at the CDC in Atlanta and the other near Novosibirsk, Russia. A debate has been taking place in recent years over whether (or when) to destroy the last living strains of the virus. Some argue that the disease could re-emerge, so virus samples are needed to conduct research that would protect the public. Others argue that keeping live samples is the very thing ensuring smallpox is not fully wiped out.

The World Health Organization decided in May to postpone a decision on whether to destroy remaining stocks.

Photo via WikiCommons

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