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 recommends 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 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.

Rules for transport

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.

Getting ready

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, food 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 one-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.”

Overreaction?

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 about 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 materials that didn’t 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.”

by: http://www.sfgate.com/news/article/Another-challenge-disposing-of-waste-5909413.php

The first of many public meetings concerning the disposal of more than 15 million pounds of M6 propellant at Camp Minden drew close to 150 concerned citizens and officials to the Minden Civic Center Thursday night.

There, they learned the agreement reached between the Environmental Protection Agency (EPA) and the U.S. Army, which will fund the $28.5 million clean up of the illegally stored material left by Explo Systems, Inc., calls strictly for open air burning.

“Local contractors, the Maddens, designed a device,” Webster Parish Sheriff Gary Sexton, who set up the meeting, said. “For some reason, that device is not being considered in this clean up process.”

“We’re disappointed,” James Madden, owner of Madden Contracting, said. Madden’s son, David spent time and money researching and building a prototype that would’ve allowed closed incineration of the product. “We considered we built a better mousetrap.”

However, Madden may not be out of it yet. The Army must first design a bid package and go through a process required by law to find a company to take on the project.

“The Maddens can throw in a bid on the open tray process,” Sexton said. “They certainly have the right to come in and I think they will do that.”

State Sen. Robert Adley said while discussion concerning responsibility was taking place, the Maddens developed a plan to deal with it. Adley, along with others in the local delegation, attended a demonstration of the incinerator at Camp Minden last January.

“It looked good to us,” Adley said. “We’re not professionals, but under law, by their interpretation, the EPA cannot use that process. I regret that, but it’s where we are at this stage of the game.”

Adley said that under existing law, the Louisiana Military Department and Maj. Gen. Glenn H. Curtis are required to take bids from whoever provides one.

“At the end of the day, he (Curtis) can sit down and decide who’s qualified, who has the experience and if they have the financial backing to do it,” Adley said. “All of those things will be taken into consideration. It would be wonderful if it ended up being someone who, when they finish, will be sitting here breathing this air with us.”

David Madden seemed resigned to the EPA’s decision after attending an informal meeting with officials earlier in the day.

“I’ve studied this process and, yes, I did work for an incinerator,” he said. “I met with EPA officials and other experts not associated with the EPA, and they are going down the right path with the open trays.”

Madden said his change of heart hinged on the haste with which the disposal must take place to avoid more degradation of the product, which makes it more dangerous.

“It is important this get started the first quarter of next year,” he said. “I have looked at the air quality plumes (from open tray burning). Only 10 percent of this fallout will go to Doyline. There’s an equal amount going toward Bossier and going north. Our business is about a mile and a half due east. We’re all going to get some of this.”

District 10 State Rep. Gene Reynolds said, going forward, communication is key.

“On my website and in my office, we will keep all of the completely updated materials,” Reynolds said. “We’re going to keep (the public) informed with everything that comes out from this point forward.”

Sexton stressed the importance of the public’s help.

“Help us calm the fears of the people in the community about what we don’t know is going to happen with the destruction of the M6 propellant,” he said. “We may all speculate on things that may happen, but we don’t need to talk about what we have to worry about. The people who are going to be responsible – whoever the contractor is – the people that are going to be disposing of this product, keep them in your prayers because something could happen to the people who are responsible for going out there and opening those bunkers, picking this product up, moving it and destroying it where we can live in a safer community.”

The next public meeting is tentatively scheduled for Dec. 16. Time and location have not been decided.

by: http://press-herald.com/open-tray-burning-wins-out-over-closed-incinerator-for-m6-propellant-at-camp-minden/

Chairman of the South West Regional Health Authority (SWRHA) Dr Lackram Bodoe said a back-up of medical waste at the San Fernando General Hospital had to do with a delay in payment to a contractor and not the malfunctioning of the incinerator.

Responding to complaints about the dangers posed by the accumulated medical waste, which included amputated limbs, needles, and bloodstained items, Bodoe assured that the $9 million incinerator installed last year was functioning well.

He said it was allowed to accumulate because daily paid workers refused to work on Tuesday.

Speaking with members of the media at SWRHA’s symposium on leadership at the Southern Academy of Performing Arts on Wednesday, Bodoe said:

“I want to give the assurance that the incinerator itself is working well.

“It is a new incinerator that was installed last year and the issue had to do with a contractor who was supposed to remove the garbage and there was a delay of funding and that is what created a temporary situation yesterday.”

Asked how soon the situation will be rectified, he said: “I have just been given the assurance by the CEO that the matter is being dealt with as we speak, so I expect by the end of the day it will be sorted out.”

In addition, Bodoe said the SWRHA was also considering introducing a new type of technology, called the radio wave technology for incineration, which was much more atmosphere friendly.

However, a Public Service Association representative, who wished to remain anonymous, said the incinerator had been breaking down on a regular basis since it was installed last year and was not working at this time.

“They even had to revert to the old incinerator and that is unsafe and unhealthy to people operating that incinerator. Since last week Thursday the incinerator (new one) is down,” he added.

He said workers took the action on Tuesday because since last week they were assured that the garbage problem would have been sorted out.

from: http://www.guardian.co.tt/news/2015-06-19/swrha-chairman-delay-payment-causes-medical-waste-back

The combustion, or burning, of solid waste proceeds through a series of stages. Water is first driven from the unburned waste by heat produced from material burning nearby or from an auxiliary burner. As the waste heats up, carbon and other substances are released and converted into burnable gases. This is referred to as gasification. These gases are then able to mix with oxygen. If the temperature inside the burn chamber is high enough and maintained for a long enough period of time, the hot gases are completely converted into water vapour and carbon dioxide, which is then released into the air. If the temperature inside the burn chamber is not high enough and the burn time is too short, complete conversion of the burnable gases does not occur and visible smoke is released into the air.  Another result of burning at low temperatures is the creation of pollutants that were not originally present in the waste. This process is known as de novo synthesis. Dioxins, furans and other complex chemical pollutants can be formed through this process.

Ash produced from combustion takes the form of either fly ash or bottom ash.  Fly ash is the fine particles carried away in the form of smoke while bottom ash is the course non-combustible and unburned material that remains after the burn is complete. The type and amount of pollutants in the fly and bottom ash depend upon what waste is burned and completeness of the combustion process.

The completeness of combustion is determined by all of the following factors:

Temperature

The temperature generated is a function of the heating value of the waste and auxiliary fuel, incinerator or burn unit design, air supply and combustion control.  Complete combustion requires high temperatures. Generally, temperatures that exceed 650oC with a holding time of 1-2 seconds will cause complete combustion of most food and other common household waste.  Segregation of waste is required when using methods that don’t routinely achieve these temperatures. Dual chamber incinerators, which are designed to burn complex mixtures of waste, hazardous waste and biomedical waste, must provide a temperature higher than 1000oC and a holding time of at least one second to ensure complete combustion and minimize dioxin and furan emissions.  When these high temperatures and holding times are achieved, waste will be completely burned and ash, smoke and pollutant concentrations will be minimized.

Because exhaust gas temperatures vary from ambient to greater than 1000°C each time a batch waste incinerator is used, optional air pollution control systems with evaporative cooling towers and scrubbers are seldom recommended. However, it may be necessary to employ these systems with large continuous feed incinerators if additional cleaning of exhaust gas is required by regulatory authorities.

Holding Time

Complete combustion takes time.  Holding time, otherwise known as retention or residence time, is the length of time available to ensure the complete mixing of air and fuel, and thus the complete burning of waste. Low temperatures, low heating values of the waste and reduced turbulence require that the holding time be increased to complete the combustion process.

Turbulence

The turbulent mixing of burnable gases with sufficient oxygen is needed to promote good contact between the burning waste and incoming air. This will help in achieving the high temperatures at which waste can be completely burned. The amount of mixing is influenced by the shape and size of the burn chamber and how the air is injected. Passive under-fire ventilation achieved during open burning does not result in sufficient turbulence for the burning of a wide variety of waste.  Also, it is important not to overfill the burn chamber as airflow may be blocked and the amount of turbulence further reduced.  The more advanced incineration designs provide effective turbulence through the forced introduction of air directly into hot zones.

Composition of the Waste

The heating value, wetness and chemical properties of the waste affect the combustion process and the pollutants that are contained in the resulting smoke and ash. The higher the burn temperature, holding time and turbulence that are achieved, the less effect the composition of the waste has on completeness of the burn.

The permit that allows the Radford Army Ammunitions Plant to burn hazardous waste from firearms outdoors is up for renewal. Community activists see an opportunity to address environmental and health concerns about the open burning – and state regulators see a chance to explore new technology to solve an old problem.
Just a handful of people turned at the Blacksburg Public Library on a recent afternoon for a meeting of the Environmental Patriots of the New River Valley.

“Is there anything we could post to get more people involved? Yes, petitions, a letter campaign… When the EPA was pushed to the wall in Louisiana, they said ‘Uncle.’ So, we want you Senator Kaine and you Senator Warner to do just what Senator Vitter did in Louisiana and write to the EPA and ask them, ‘How is this not a violation of the clean air act?'”

Devawn Oberlender is looking to take a pager from the book of a far away town, where citizen protestors succeeded in stopping outdoor burning explosives of arms and weapons waste at the Louisiana Army Ammunition Plant.

“The opportunity that we have right now only comes up very ten years, because the permit is good for ten years, so what we need to replicate is what they did in north western Louisiana at Camp Minden.

There they formed a “Stop the Burn” movement that ultimately brought together elected officials, state and local regulators and the army for a plan to give up open burning and use a modern indoor incinerator to dispose of the toxic materials. Now, with the open burning permit at the Radford Arsenal up for renewal, the Virginia Department of Environmental Quality is exploring that idea for the first time. William Hayden is spokesman for DEQ in Virginia.

“We have not reached any conclusions yet but that is something that would be looked at as we move forward. We have asked the Arsenal to come up with alternatives to open burning and we do expect to have some options that go beyond the idea of just burning it the open.”

Brian Salvatore is a professor of Organic chemistry at Louisiana State University who argued for using contained incineration.

“This is what we fought for here at camp Minden. And yes it added another 15million dollars and almost doubled the cost of the contract but this was something that, the EPA was willing to go to bat for us for. So I’m glad that the people in the EPA and in the state worked together here and they worked with the Army as well to find the additional money. And we’re quite satisfied here that this alternative — which, in the beginning of this we didn’t know all the details of what these modern incinerators can do. We’re quite confident here that this is going to do the job and the amount of material that’s going to be released total will be on the order of tens of grams as opposed to tons of these emissions.”

A spokesman for the Environmental Protection Agency’s Region 3, which includes Virginia, said it could not comment on the possibility of incinerators like that being adopted at the Radford site, but a spokesperson for BAE Systems, the contractor in charge of the arsenal, confirmed it is “looking for viable alternatives to its current methods of waste disposal.”

The department of Environmental Quality has asked BAE to conduct an environmental impact study on its current open burning practice. William Hayden says it’s the first time DEQ has asked for one.

“Because we’re getting in to an issue that has generated a lot of public interest in the Radford area we knew that the more information we had, the better. People from the public have been asking for us information; they’ve been asking Radford (the arsenal) for information.”

And one of them is Oberlender who says, “We’ve been burning waste out there, open burning it since 1941. You know, it’s not going away.”

And neither are the environmental patriots of the new river valley. Taking another page from the story of Camp Minden Louisiana’s successful effort to get its outdoor burning moved indoors. They’re scheduling meetings with state and federal officials to keep the pressure on. The first is this Friday with U.S. Representative Morgan Griffith who sits on the Committee on Energy and Commerce, which has oversight of the EPA. The group is looking to make a national issue out of one that has for so long been so local and one of the few places where open burning of hazardous waste from explosives is still allowed.

Info from: http://wvtf.org/post/moving-forward-open-burning

PESHAWAR:
Even with clear rules which state hospital waste must be incinerated within 24 hours of its collection, incinerators at two major hospitals in Khyber-Pakhtunkhwa (K-P) are out of order and the waste is dumped outside the hospitals.

According to data collected by the Environmental Protection Agency (EPA), 15 to 20 tons of hospital waste is generated daily in the provincial capital alone. Almost half of the total waste is recycled while the rest is collected by the Peshawar Development Authority (PDA).

LRH

“To be honest, we have one incinerator which is not in proper working condition and hardly disposes a quarter of the total waste generated,” said an official at Lady Reading Hospital while requesting anonymity. “But we have a new incinerator which will soon be functional.”

The official, who did not know the exact figure of the waste generated, said LRH has been among the well-equipped hospitals across the country. It has over 5,000 people (at least 3,000 in outpatient and 2,000 in accident and emergency departments) from across the province on a daily basis.

“The incinerator under process has some issues as a few of its parts are yet to be obtained,” said the official. “It also needs sufficient gas—another major problem—but we are in contact with Sui Northern Gas Pipeline Limited (SNGPL).”

The LRH official added the supply of gas to the hospital is not enough for sterilisation. He said the hospital administration is in contact with SNGPL authorities and the issue will soon be resolved.

HMC

Hayatabad Medical Complex (HMC) Chief Executive Dr Mumtaz Marwat said the incinerator at HMC is out of order but it does burn some waste. “The leftover is collected by the PDA and the hospital administration has approved Rs0.4million for a new incinerator, which will soon be installed.”

Khyber Teaching Hospital (KTH) Chief Executive Dr Inayat Shah Roghani said the incinerator at KTH was working properly and recycles over 200 kilogrammes of waste per hour.

“Along with the solid waste generated by KTH, we also recycle waste that comes from a few private hospitals in University Town,” said Roghani.

The EPA has already sent a written notice to the health directorate, asking it to properly dispose of medical waste as mentioned under Hospital Waste Management Rules 2005. These say the responsibility of waste management lies solely with the institute that generated it.

What happens next

Even if the incinerators at these hospitals are repaired, the problem of unattended dump is likely to persist. This is mostly because of the small private health centres which lack the basic knowledge and dispose of their waste as ‘municipal waste’. The ever-increasing number of such centres is directly proportional to the waste generated, making it a threat for the environment as at times the waste is just left in a pile or buried to groundwater.

SAN DIEGO – A local company has joined the front lines of an effort that has sparked a lot of debate: how to dispose of Ebola waste.

A representative from Envitech just returned from Texas after the first batch of medical waste was disposed of this past weekend.

The spacesuit-like gear is just one reminder of how contagious Ebola can be. The virus attacks the organs and liquefies parts of the body, with blood and other liquids seeping out of all body openings.

The medical supplies used to treat the first U.S. Ebola patient, Thomas Duncan, arrived in a semi-truck at a Galveston facility on Saturday.

“It was kind of all hands on-deck,” said Andy Bartocci, national sales manager at Envitech. He says a company official flew into Texas this weekend.

Envitech’s scrubbing system was installed at the Galveston site earlier this year. Here is how it works: once the Ebola-tainted supplies are incinerated at more than 2,000 degrees, the scrubber removes all the pollutants from the exhaust gas.

“We were on hand as they were burning this waste and the system operated flawlessly throughout that time,” said Bartocci.

The air scrubbers are newly designed after more stringent EPA standards went into effect this month.

“Somebody is probably more exposed to harmful pollutants pumping gas into their automobile than they would be by working or living around one of the medical waste incinerators,” said Bartocci.

Still, some states do not want that waste. Missouri’s attorney general is seeking a court order barring the waste from being shipped to a St. Louis incinerator. Among the concerns is the handling before it gets into the incinerator.

As for California, the state has a ban on the burning of medical waste, so any Ebola waste would have to be shipped to another state on public highways.

Many states like California began cracking down on medical waste incineration because hospitals were sending materials that did not need to be burned, which led to more pollutants.

Some are calling for California to reconsider these restrictions when it comes to Ebola waste.

by: http://www.10news.com/news/local-company-helps-dispose-of-ebola-tainted-waste-10202014