When the Centers for Disease Control and Prevention assured the public this month that most American hospitals could treat cases of Ebola, it was technically correct. Hospitals routinely treat highly contagious diseases, and top-tier ones are extensively equipped to isolate patients who pose special risks.
But the infection over the past week of two Texas hospital workers betrayed what even many of the best hospitals lack: the ability to handle the tide of infectious waste that Ebola generates.
Ebola's catastrophic course includes diarrhea, vomiting and hemorrhaging of blood, a combination difficult enough to contain in less-communicable illnesses. When they are highly contagious, disposing of the waste and cleaning up what is left behind require expertise and equipment that some specialists said are lacking even in highly regarded medical facilities.
Those shortcomings are compounded, they said, by surprising gaps in scientists' knowledge about the Ebola virus itself, down to the time it can survive in different environments outside the body.
'The time for educating on these things is not when we're in the midst of a crisis,' Paul D. Roepe, the co-director of Georgetown University's Center for Infectious Disease, said in a telephone interview. 'The time was years ago. Even with the billions we've spent preparing our health systems for this sort of scenario, we're still so open to error.'
A handful of medical centers nationwide, including ones at Emory University and the University of Nebraska that treated the first Ebola cases in this country, are specially equipped and their staff members trained to address the challenges. But they are the exceptions.
Most hospitals do not have incinerators or the steam sterilizers called autoclaves with the capacity to handle large amounts of infectious waste. Texas Health Presbyterian Hospital, the 866-bed facility in Dallas where two nurses became ill after treating an Ebola patient, has had to pack and ship 55-gallon drums of waste - from body fluids to linens to contaminated protective suits to an entire hospital bed - to a Port Arthur, Tex., incinerator for disposal.
The federal Department of Transportation, which regulates hazardous waste shipments, was forced to issue special permits to move waste from the hospital and an Ebola victim's apartment because the agency's packaging requirements were not designed for such large volumes of highly infectious material.
Perhaps more important, some specialists said, is the lack of training and practice that hospital workers need to treat Ebola victims and safely handle the waste they produce.
Debra Sharpe, a Birmingham, Ala., biosafety expert, has overseen safety at a nonprofit laboratory that researches emerging diseases and bioweapons, and has run a company that trained workers to handle biological agents. The infectious waste problems in those jobs parallel those in hospital settings, she said in an interview.
Graphic: Ebola Facts: When Did Ebola Arrive and Spread at a Dallas Hospital?
'It's totally shocking,' Ms. Sharpe said. 'It would take me anywhere from four to six weeks to train an employee to work in a high containment lab in a safe manner. It's ludicrous to expect doctors and nurses to figure that out with a day's worth of training.
'None of the science is new; none of the protection components are new. It's just new in a health care setting. Hospitals and the C.D.C. should have been reaching out to the biosafety community before now, to try to adjust to this.'
The C.D.C. does have general guidelines for handling Ebola waste and a question-and-answer web page with some occasionally unexpected recommendations - for instance, that infectious body wastes can be safely flushed into public sewer lines. (Ms. Sharpe concurred with this, but added that many treatment facilities, as a precaution, pour bleach into a toilet and wait several minutes before flushing.)
Beyond the advisories, gray areas complicate waste problems. Because Ebola is such a messy illness, patients' rooms must be scrupulously cleaned lest a stray drop of blood or vomit spread virus to an unknowing patient or worker. But the cleaning itself is so hazardous that it, too, requires special training and a knowledge of which hospital sterilizers and cleaners are likely to kill the virus.
In Dallas, hospital officials summoned a private hazardous waste cleanup firm to sterilize the room where Thomas Eric Duncan, the nation's first Ebola victim, died last week. Some 140 55-gallon drums of potentially contaminated material were also hauled from the Dallas apartment where he had stayed.
Scientists say Ebola is in a class of viruses that are generally more susceptible than many to chemical disinfectants. But out of caution, the C.D.C. recommends that rooms be cleaned with agents powerful enough to kill hardy viruses like the flu and polio.
That is not the only unresolved question. 'The recommendations from C.D.C. on what to do and not to do are based on relatively sparse science,' Dr. Roepe said. 'I can only find two that address the simple question of how long the virus persists outside the human body.
'The number you'll hear from most people is from a few days up to a week,' he said. 'But the context in which the virus is found outside the body matters a great deal. How long can it last on a doorknob? We don't have a lot of raw data, believe it or not.'
Posted by Unknown on Friday, October 17, 2014 - Rating: 4.5
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