Ebola-Associated Waste Management

Key Point

• • Waste generated in the care of PUIs or patients with confirmed EVD is subject to procedures set forth by local, state, and federal regulations. Basic principles for spills of blood and other potentially infectious materials are outlined in the U.S. Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030).
• Waste contaminated (or suspected to be contaminated) with Ebola virus is a Category A infectious substance regulated as a hazardous material under the U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR; 49 CFR, Parts 171-180). Requirements in the HMR apply to any material DOT determines is capable of posing an unreasonable risk to health, safety, and property when transported in commerce¹. For off-site commercial transport of Ebola-associated waste, strict compliance with the HMR is required.
  • If a person requires a variance to the HMR, that person must apply for a Special Permit under 49 CFR § 107.105. DOT may grant a special permit if the applicant can demonstrate an alternative packaging will achieve a safety level that is (1) at least equal to the safety level required under the HMR, or (2) consistent with the public interest if a required safety level does not exist. DOT has granted multiple special permits authorizing the transportation in commerce of certain Ebola-associated waste.
  • Ebola-associated waste that has been appropriately incinerated, autoclaved, or otherwise inactivated is not infectious, does not pose a health risk, and is not considered to be regulated medical waste or a hazardous material under federal law. Therefore, such waste no longer is considered a Category A infectious substance and is not subject to the requirements of the HMR.
• Inactivation or incineration of Ebola-associated waste within a hospital system may be subject to state, local, and OSHA regulations.
  • On-site inactivation
    • Ebola-associated waste may be inactivated through the use of appropriate autoclaves. Other methods of inactivation (e.g., chemical inactivation) have not been standardized and would need to consider worker safety issues, as well as the potential for triggering other federal safety regulations.
  • On-site incineration
    • Ebola-associated waste may be incinerated. The products of incineration (i.e., the ash) can be transported and disposed of in accordance with state and local regulations and standard protocols for hospital waste disposal.
• Ebola-associated waste disposal is subject to state and local regulations. Ebola-associated waste that has been appropriately inactivated or incinerated is not infectious and is not considered to be regulated medical waste or a hazardous material under federal law.

Relevant CDC guidance

Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus

Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in the United States

Guidance for Collection, Transport and Submission of Specimens for Ebola Virus Testing

For questions on CDC guidance, contact 1-800-CDC-INFO (1-800-232-4636).

Relevant DOT guidance

Federal Register Notice – Safety Advisory: Packaging and Handling Ebola Virus Contaminated Infectious Waste for Transportation to Disposal Sites (Department of Transportation, Pipeline and Hazardous Materials Safety Administration) [PDF – 2 pages]

Department of Transportation Guidance for Transporting Ebola Contaminated items, a Category A Infectious Substance

Department of Transportation Guidance for Preparing Packages of Ebola Contaminated Waste for Transportation and Disposal [PDF – 4 pages]

Transporting Infectious Substances: Q&A

Safety Advisory: Packaging and Handling Ebola Virus Contaminated Infectious Waste for Transportation to Disposal Sites [PDF – 2 pages]

For questions on DOT guidance or the HMR requirements, contact DOT’s Pipeline and Hazardous Materials Safety Administration’s (PHMSA’s) Hazardous Materials Information Center at 1-800-467-4922, 9:00 am to 5:00 pm Eastern Standard Time.

Relevant OSHA guidance

OSHA/NIOSH/EPA Fact Sheet: Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste {PDF – 6 pages]

OSHA PPE Selection Matrix for Occupational Exposure to Ebola Virus [PDF – 3 pages]

OSHA – Ebola Website

For questions on OSHA guidance, contact 1-800-321-OSHA (6742).

¹ The HMR applies to interstate, intrastate, and foreign commerce.