While the Ebola epidemic continues to grow in Guinea, Liberia, and Sierra Leone, a major challenge facing many parts of the World, including the U.S., is how to effectively and efficiently dispose of the waste created from this and other deadly viruses.
The following infographic, created by Eastern Kentucky University’s Online Masters in Safety, Security, and Emergency Management program, outlines the costs and methods associated with Ebola waste disposal, and considers the challenges that arise from successfully disposing of and containing waste from Ebola and other deadly diseases.
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Medical Waste Disposal
In 2014, between $2 and $2.5 billion were spent disposing of medical waste in general, including costs related to Ebola. By 2017, projected expenditure is $3.2 billion. Figures are broken down into two categories: non-hazardous (85% of waste) and regulated or hazardous waste (15%). While there is less hazardous waste to deal with, expenses are far greater in this category.
Regulated waste includes items contaminated with body fluids, which could be infectious: bandages, disposable surgical tools, and swabs, for instance. Pathological waste includes organs, tissues, and body parts. Chemicals like mercury, certain drugs, and disinfectants are regulated as are sharp items (lancets, needles, and glass) and radioactive substances (toxic waste).
Unregulated waste includes items most households dispose of: food, paper, cardboard, and plastics.
How to Dispose of Hazardous Medical Waste
The primary method of disposal, accounting for 90% to 95%, is via autoclave. Using steam, items are sterilized and their mass is reduced under pressure. Incineration is another method: there were 34 incinerators in the United States in 2013. Three other methods are deep landfill burial for sharp objects, chemical disinfectant, and thermal/microwave systems, which kill pathogens under high temperatures.
A primary benefit of autoclaving is that it reduces the volume of waste. The cost of this method is a major detractor. Where incineration is concerned, the major issue is release of dangerous substances into the air. These include pathogens and pollutants.
Statistics on Ebola
According to the World Health Organization, there have been 20,656 cases of Ebola confirmed or suspected. The number of cases confirmed in a laboratory is 13,151. The death toll is 8,153. Ebola is not spread by water, food, or air. One only contracts Ebola via bodily fluids (coughing, sneezing) and used needles.
Specific Ebola Challenges
Treatment per patient with Ebola has been broken down by volume and expenses: 1,000 pounds of hazardous waste and $1,000 per barrel. Compared with other viruses and illnesses hospitals treat, Ebola costs between thirty and forty times more. There are numerous extra steps professionals must take to reduce the risk of spreading this disease while treating an individual and sterilization of showers and toilets takes longer.
To get a picture of what hazardous waste disposal looks like, the Nebraska Bio-containment Unit handles 465 cubic feet of solid waste per Ebola patient. This amounts to over 1,100 pounds of protective clothing and other items. Patients produce, on average, 9 liters of liquid waste such as blood from the eyes and ears, hemorrhaging, diarrhea, and vomit.
To prevent potential litigation, hospitals must work extra-hard to reduce the risk of spreading infection during the transportation of waste from their site to an off-site autoclave or incinerator. If someone was to become infected and the source of infection was traced back to a particular hospital, a patient might initiate a lawsuit. To mitigate the risks, hospitals must obtain special transportation permits, use temperature-controlled vehicles, and have plans in place for emergencies and spills. Hi-jacking protection has to be in place and chemicals must be secured in three layers of watertight bags held within watertight hard containers.
Logistically, Ebola poses another problem: it is difficult to detect early on because symptoms mimic those of other infections. They include vomiting, severe headaches, and diarrhea. Not until one starts bleeding from the eyes or ears is it obvious that food poisoning or another gastric infection is not the culprit. Post-symptom detection requires about 72 hours of lab cultures and blood tests are required to detect Ebola: feces and urine are not enough. The virus lasts for 6 days.
While destroying waste, ash from incinerators puts local water sources at risk. One toxin (dioxin) in this ash is a proven cause of cancer, birth defects, and immune system disorders. While this is true when disposing of all medical waste, Ebola produces much more waste and, consequently, more ash.
The Future of Ebola Waste Disposal
More germ-killing agents will be used to destroy Ebola such as UV and gamma rays. More autoclaves will be set up including on-site incinerators for large hospitals. The San-I-Pack portable waste disposal system will also reduce costs related to disposal. Off-site costs are 30 cents per pound of waste, reduced to 8 cents for on-site disposal. This will result in significant savings for the United States medical system.