Healthcare Environmental Solutions Fall 2019 by Downing and Associates

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Environmental solutionsnews Covering infection prevention, medical waste management & sustainable practices

VOL. XII XV NO. NO. 43 VOL.

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Is the U.S. Ready for the Next Outbreak of Ebola?

ome say those in charge of our medical emergency systems, the Centers for Disease Control and Prevention (CDC), Occupational Health and Safety Administration (OSHA), Department of Transportation (DOT), were not prepared for the Ebola outbreak in 2014, (and still aren’t). Others disagree, saying that, of course, not everything went smoothly but could we really expect even near perfection under such circumstances. Thomas Eric Duncan, a Nigerian, was diagnosed with Ebola in September, shortly after arriving in Texas. Three people, two nurses who attended him and a health worker who handled his clinical specimens, contracted Ebola. One of the nurses became the first person diagnosed with Ebola on American soil. The Nigerian died, but the other three were eventually declared virus-free. Earlier, in July 2014, a number of people returned to the U.S. and came down with the disease or came back after being diagnosed. They were treated at several hospitals – in Worcester, Massachusetts, Dallas, Atlanta, Omaha, and New York City. In those cases, the hospitals knew they were handling Ebola virus and were more careful handling the patients and their waste. But most of America knew only about Duncan and the three ancillary people who were infected. The others were not unexpected, giving those healthcare providers foreknowledge that made dealing with the virus easier.

By Kathleen Marquardt

Because some hospitals were dealing well with these patients, CDC Director Thomas Frieden showed a confidence that hospitals across the country were well prepared to deal with Ebola. And most of them probably would have handled Ebola patients well if they knew what they were dealing with from the beginning. The symptoms of Ebola are the symptoms of many other diseases. There is also the prospective problem that, while 80% of people entering the U.S. from the affected West African countries live within 200 miles of one of the designated Ebola treatment centers, (according to the CDC), there are another 20% who don’t and

will be going to hospitals that are not on the alert for Ebola. On July 17, 2019, the World Health Organization (WHO) finally declared the Ebola outbreak in the Democratic Republic of the Congo (DRC) was now a public health emergency of global concern. The catalyst was that Ebola was diagnosed in Goa, a city of two million, where people are crowded together, elevating the chance of the disease spreading. When they declared this emergency, Robert Steffen, chair of the emergency committee of WHO, asked that all countries, companies, and individuals support the DRC by not placing “travel and trade restrictions as a result of the declaration. Any border closures will have a ‘terrible impact’ on the economy of the affected region”. Complying with this, naturally, will allow the spread of the disease globally, so the U.S. has to be even better prepared than in 2014. Ebola viruses are transmitted through direct contact with infected blood or body fluids/substances (urine, feces, vomit) or through exposure to objects (such as needles) that have been contaminated with infected blood or body fluids. The role of the environment in transmission has not been established. Limited laboratory studies under favorable conditions indicate that Ebola virus can remain viable on

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Is the U.S. Ready for the Next Outbreak of Ebola? Continued from page 1

solid surfaces, with concentrations falling slowly over several days. Because of these factors, handling the waste is of utmost importance to control and eradicate the disease. Many hospitals installed on-site incinerators starting in the 1980s, after OSHA and DOT began regulating medical waste. But when, in 2009, the Environmental Protection Agency (EPA) issued new standards to the Clean Air Act, of the 2,400 existing incinerators, only 22 commercial incinerators complied with the new regulations thus making 2,300+ incinerators obsolete without upgrades. Alice P. Jacobsohn, in the Jan-March 2015 edition of Healthcare Environmental Solutions, wrote, “Many hospitals tried to upgrade their incinerators to comply with the new requirements. Hospitals spent millions of dollars and their incinerators still failed to meet the standards, so they became gun shy about spending more money for on-site treatment. The incinerators were removed, and transporters were hired as an interim measure, but then transporting became permanent.”

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The Affordable Care Act also acted to tighten hospitals’ purse strings, and many hospitals don’t have extra space for large equipment. Today, only 20 percent of hospitals house onsite options, and many of these are not large enough to handle t h e vo l u m e s of waste from Ebola patients. The other 80 percent of hospitals contract with a medical waste hauling company to carry containerized waste to statepermitted disposal facilities. Hospitals are working hard to be ready for the next outbreak. Because the waste materials from Ebola may be more contagious than contact with the patient, how to dispose of the waste is a critical issue that needs to be dealt with early. Arthur McCoy, Sr. V.P. at San-I-Pak World Health Systems, noted, “hospitals that lack the infrastructure to autoclave their infectious waste on-site can become vulnerable quickly as was the case at both Emory and Bellevue Hospital. Other hospitals that have on-site autoclaves, i.e., Nebraska Medical Center, quickly realized their limiting factor for how many patients they can treat was based on their autoclave capacity to process the infectious waste. On-site waste sterilizers are a best practice for reducing the spread of such deadly diseases. Furthermore, without such infrastructure, hospitals can pay as much as $100K a day (i.e., Bellevue Hospital during the 2014 outbreak) to have this deadly infectious waste transported on public roadways to treatment facilities that are often hundreds of miles away.” In December 2014, the World Health Organization issued guidelines that state, “It is not recommended to transport untreated infectious waste and therefore all waste should be treated on-site.” That is a good recommendation, but it won’t/can’t happen overnight. Hospitals had that ability with their incinerators, but since those were shut down by EPA standards, hospitals are inclined to be cautious about investing in high cost equipment. Today, most hospitals contract with waste management companies to dispose of their infectious waste. Bob Spurgin, Medical Waste Consultant at Spurgin and Associates, noted that, “Medical waste is not and never will be federally regulated fall 2019

-- it’s left to the states. So rules vary, depending on where you are. Not to a great degree but still permits are very different in each location. What needs to happen is for these t ra nsport e rs a nd treatment sites to have consistent policies and procedures to handle the waste. DOT has taken care of that on the transport side, so those are uniform n ow. C o m m e r c i a l treatment sites have the ability to handle large quantities of material so it’s just the understanding of consistency for treatment and disposal. Guidance from the Centers for Disease Control and Prevention (CDC) in consultation with the service providers would help cement this.” Many people, including former Senator, Joe Lieberman and former Secretary of Homeland Security, Tom Ridge, in a Chicago Tribune article, “Ebola is raging again - and the U.S. is not ready,” were concerned that, “Despite assurances that our country would be able to handle such a serious disease, our public health agencies and health care institutions made some serious mistakes.” Not everything went perfectly, yet all situations were handled, and those entities concerned, the CDC, OSHA, and DOT, did what they were set up to do. These agencies do not overlap – they have their own jurisdictions. There is not one single control center. But, after 2014, corrections were made where necessary, and those agencies are much more ready to deal with an outbreak, according to Spurgin. So, the answer to the title question is: the U.S. is seemingly more prepared than in 2014, but only time – and an outbreak – will tell if we are truly prepared. A postscript on this: While only one person died and another had a relapse, there is now concern about life expectancy after recovering from Ebola. A study in Guinea revealed that 59 survivors died after discharge: “Five died within a month of hospital discharge, three within three months, four within 3-12 months after discharge, and four died a year after discharge. The exact date of death was not determined for the remaining 43 Ebola survivors who died,” wrote Jenny Lei Ravelo for Devex News. So, the goal must be to eradicate Ebola at its source, while countries are treating those infected.

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No Conclusive Links to Health Effects from Waste Incinerators in UK

FDA Black Box Warning Tied to Reduction in Fluroquinolone Prescriptions

ondon, England — Results of the largest and most comprehensive analysis to date in the UK show no link between exposure to emissions from municipal waste incinerators (MWIs) and infant deaths or reduced fetal growth, according to findings published in Science Daily. Conducted by Imperial College London researchers, the study findings showed that living closer to the incinerators themselves is associated with a very small increase in the risk of certain defects, compared to the general population. But whether this is directly related to the incinerator or not remains unclear, the researchers noted. The analysis, led by a team at Imperial College London and funded by Public Health England and the Scottish Government, used computer modeling and birth defect statistics to investigate any correlation between particulate matter (PM) concentrations around MWIs at 22 sites across the UK and health effects. The study used data from the years 2003 to 2010. An earlier study published in Environment International, in 2018, analyzed records covering more than one million births in England, Scotland and Wales and revealed no evidence of a link between small particles emitted by the incinerators and adverse birth outcomes such as effects on birthweight, premature birth, infant death, or stillbirth, for children born within 10 km of MWIs in Great Britain. The team’s latest findings, however, also published in the journal Environment International, looked at occurrence of birth defects within 10 km of a subset of 10 incinerators in England and Scotland between 2003 and 2010. The team used health data on more than 5000 cases of birth defects among over 200,000 births, still births and terminations in England and Scotland. They found no association between birth defects and the modelled concentrations of PM10 emitted by MWIs, but there was a small increase in the risk of two birth defects among those living closer to MWIs specifically congenital heart defects and hypospadias (a defect affecting the male genitalia.) The study showed that living closer to an incinerator in itself may slightly increase the risk of some specific defects, although the reasons for this are unclear, one of the scientists wrote. Another scientist added that while it’s not possible to rule out all impacts on public health, modern and well-regulated incinerators are likely to have a very small, or even undetectable, impact on people living nearby. The researchers emphasized that ongoing review of evidence is needed to explore links further, as well as ongoing surveillance of incinerators in the UK to monitor any potential long-term impacts on public health.

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tudy findings published in Infection Control and Hospital Epidemiology show that a significant decline in fluoroquinolones use was found at 29 southeastern U.S. hospitals after the US Food and Drug Administration (FDA) strengthened a “black box” warning on such drugs. The FDA made its initial safety announcement in May 2016, recommending avoidance of fluoroquinolones for uncomplicated infections such as acute exacerbation of chronic bronchitis, uncomplicated urinary tract infections, and acute bacterial sinusitis. Researchers at Duke Center for Antimicrobial Stewardship and Infection Prevention in Durham, North Carolina calculated monthly estimates of hospital wide inpatient antibiotic use between January 2013 and December 2017 before and after the FDA made it’s initial black box warning. The study collected data from 28 community hospitals and one academic hospital. Although “aggressive stewardship efforts,” had some effect, the rate of use dropped significantly following the FDA announcement. The study showed that fluoroquinolone use decreased by 0.7% each month before the FDA announcement, resulting in an approximate 25% decrease from January 2013 through July 2016. Further, a decrease in fluoroquinolone use of 10.4 days of therapy per 1,000 patient days was observed between July and August 2016. Researchers found that fluoroquinolone use continued to decrease at a similar rate of 0.09% each month after the the black box warning. Antibiotics frequently used as treatment for community-acquired infections, including cefotaxime, ceftriaxone, and ertapenem, collectively declined by 0.5% per month before the FDA announcement and increased by 0.6% per month after July 2016. The same trend, or a similar trend, most likely would be seen on a national level, the study’s principle investigator noted.

Ingestible Pills with Sensors Reveal Drug Resistant Infections

ork, England — In a study published in Science Daily, scientists showed that by combining a modified common antibiotic with a type of ingestible sensor they could tell quickly whether an infection is resistant to common antibiotics. The new method, developed by a team of researchers at University of York could help clinicians rapidly detect infections that are treatable with common antibiotics, reserving stronger alternatives for the patients that need them most. “Resistance to new antibiotics can emerge very quickly after they come into use and so we need to reserve them for when they are really needed. The discovery may also help to identify and isolate resistant bacteria, reducing the chances of large outbreaks,” the lead study author explained. Beta-lactam antibiotics (such as penicillin) can be attached to the surface of a sensor to track how the drug is metabolized in the body. The development of “smart” pills is considered to have great promise, especially in costly treatment areas such as chemotherapy. The York study, which is the result of a close collaboration between physical, chemical and biological scientists, lays an important foundation for managing drug resistant infections. The study team is working with clinicians at York Teaching Hospital National Health System Foundation Trust to integrate this modified antibiotic into a rapid diagnostic test for antimicrobial resistance in urinary tract infections.

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Russian Government Agency Confirms Ex-Bioweapons Lab Explosion in Siberia

oltosvo, Russia — Russia’s consumer-safety watchdog Rospotrebnadzor confirmed an explosion and fire at a Cold War era Soviet bioweapons lab that now researches (and houses) strains of Ebola, Smallpox and Anthrax and other viruses, according to a Radio Free Europe/Radio Liberty (RFE/RL) report. No biohazardous substances were present in the sanitary inspection room at the time of the fire, added Rospotrebnadzor. The September 16 blast occurred after a gas cylinder exploded during scheduled repair work in a laboratory on the fifth floor of the six-story Russian State Centre for Research on Virology and Biotechnology, commonly known as Vector, the facility said in a statement. Russia’s TASS news agency reported that one worker was being treated for severe burns. The fire, covering 30 square meters was later extinguished by fire fighters. All glass in the building was said to have been broken in the blast. The facility is one of the largest scientific virological and biotechnological centers in Russia, housed in a reinforced concrete laboratory building located near Novosibirsk, in Siberia. Vector is one of two institutions on the planet where the smallpox virus survives. The other is the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta.

Public Health England Warns of New Global Superbug Threat

Study Shows Global Influenza Surveillance Needs to Include Infant Cases

tlanta, GA — A study published recently in The Lancet showed that the frequency of severe influenza disease among infants may be significantly underestimated, suggesting a need to expand flu vaccination programs to mothers and infants. Led by U.S. Centers for Disease Control investigators, the Influenza and Respiratory Syncytial Virus in Infants (IRIS) study looked at the incidence of laboratory-confirmed influenza-associated admissions among infants at four hospitals in Albania, Jordan, Nicaragua, and the Philippines. The researchers assessed the frequency of influenza virus infections using real-time RT-PCR (rRT-PCR) and serology over the course of two influenza seasons (2015–16 and 2016–17) in Albania, Jordan, and Nicaragua, and over a continuous 34 week period (2015–16) in the Philippines. The infants enrolled in the study were younger than 1 year and were admitted to a hospital within 10 days or less of illness onset. Of the total 1,943 infants in the study, 94 (5%) were influenzapositive by both rRT-PCR and serology, 58 (3%) were positive by rRTPCR-only, and 102 (5%) were positive by serology only. Seroconversion to at least one of the influenza A or B viruses was observed among 196 (77%) of 254 influenza-positive infants. Of the 254 infants with influenza virus, 84 (33%) had non-respiratory clinical discharge diagnoses (e.g., sepsis, febrile seizures, dehydration, or other non-respiratory viral illness). The study findings suggest that global influenza numbers could be least twice that of previous estimates, pointing to a need to increase preventive efforts.

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ccording to coverage of the annual Public Health Conference by The Guardian, nineteen new forms of lethal superbugs have been discovered in the United Kingdom (UK) and antibiotic resistant strains of bacteria are cropping up in seafood around the world. A Public Health England (PHE) study showed an increase in antibiotic resistant bacteria in the UK, including new forms of the Multi Resistant Staphylococcus Aureus (MRSA), gonorrhea and enterococcus bugs can cause urinary tract infections, sexually transmitted diseases, kidney problems and bowel disease. Meanwhile, the emergence of previously rare pandemic-causing illnesses, such as pandemic ‘swine flu’, Middle East respiratory syndrome, Crimean-Congo hemorrhagic fever and monkeypox, is causing concern among various health directorates. Investigators at Florida Atlantic University who collected bacteria samples from Bottlenose dolphins in the Indian River Lagoon reported that the mammal’s resistance to common antibiotics in various strains of E. coli more than doubled in 15 years. The most common resistance – found in 91.6 per cent – was to erythromycin. The head researcher said this represented a significant health concern because of the dolphins’ proximity to dense human populations. Meanwhile, the resistance to drugs of a pathogen called Vibrio alginolyticus, known to cause serious seafood poisoning, was reported to be on the rise, as are cases of nosocomial infection rates from the pathogen Acinetobacter baumannii. The impact of antibiotic overuse is not limited to microbial resistance, researchers noted. Findings published in the Journal of the American College of Cardiology, reported that patients frequently using fluoroquinolones had a greater risk of developing aortic and mitral regurgitation, which can lead to heart failure. The UK has been one of Europe’s more successful nations at restricting and reducing antibiotic prescriptions, although Germany and the Netherlands showed better numbers (about one third lower.)

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Technology to Advance Infectious Disease Forecasting for Outbreak Management

ntegrating advanced data analytics, such as infectious disease modeling or machine learning, could help forecasting infectious disease outbreaks, greatly improve epidemic management, save lives and reduce the economic impact of outbreaks, according to study findings published in Nature. “Present capacity to develop, evaluate, manufacture, distribute and administer effective medical countermeasures (e.g., vaccines, diagnostics, therapeutics) is inadequate to meet the burden of both recurrent and emerging outbreaks of infectious diseases,” the researchers explain in a commentary article. That leaves contact tracing, outbreak investigations, social distancing and supportive clinical care as the only feasible tools to slow an emerging outbreak. New applications of data science and statistical analyses to disease outbreaks could help decision-makers during public health crises, as was seen during the 2014–2016 Ebola virus disease (EVD) outbreak in West Africa, where there was a strong push to use refined clinical trials to confirm that Ebola vaccines could be safe and efficacious. Predicting short-term (i.e., days to weeks) trends of disease activity or incidence (such as the number and location of new cases) in an ongoing outbreak leads to effective control. Overcoming data collection, analytics and communications obstacles is critical, however. Obtaining and making available software for digitizing handwritten text reliably, quickly and securely from clinical or epidemiological records will be a persistent need for the foreseeable future. Sharing that data in a timely fashion requires dependable infrastructure such as electrical power and telecommunications access. In addition, the study authors said that formalized training in “outbreak science” for public health practitioners will be a vital component in ensuring that the public and private sector workforce can respond quickly to any emerging epidemic threat.

Cephalosporin Use Linked to C. Difficile Infection Spikes

ew york, NY — A link between higher hospital-wide use of cephalosporins and hospital-associated C. difficile highlights the importance of tracking trends of antimicrobial use over time, according to study published recently in Infection Control & Hospital Epidemiology. Analyzing patient microbiological and pharmacy data from 171 hospitals, researchers from the Centers for Disease Control followed use of four classes of antibiotics thought to increase the risk of Clostridioides difficile. The study team focused on use of cephalosporins (used for a wide variety of bacterial infections), fluoroquinolones (used for respiratory and urinary tract infections), carbapenems (broad spectrum antibiotics often reserved for unresponsive infections), and lincosamides (used against staph and strep infections). Overall, they found a 12 percent increase in hospitalassociated infection for every 100 days of facility-wide antibiotic therapy. When the investigators analyzed each drug class separately, however, a different picture emerged. Where cephalosporins use was higher, infection rates corresponded. Yet, data analysis revealed another trend – reduced use of the three other antibiotic classes correlated with hospital antibiotic stewardship initiatives. Higher infection rates were also associated with a larger portion of patients over age 65, higher rates of community-onset, longer length of stay, and teaching hospitals.

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Federal Judge Decides AIG Won’t Have to Foot $12M Waste Management Lawsuit

he financial services giant, AIG, is off the hook for covering $12 million in legal expenses incurred by Waste Management Inc. in an environmental contamination case, reports a Law360.com article. Granting a summary judgment to AIG Specialty Insurance Co., U.S. District Judge Andrew S. Hanen wrote that Waste Management cannot recoup legal expenses from defending and investigating claims. Multiple felony counts for violating the federal Clean Water Act and lying to state and federal investigators were filed against two Waste Management of Hawaii, Inc. managers in 2014 by the U.S. Attorney General. At issue was the flow of garbage, including large amounts of medical waste, from the Waimanalo Gulch Sanitary Landfill onto beaches and coastal waters off Leeward Oahu during heavy rains. According to a 2014 BizJournals.com article, the federal indictment alleged the company’s environmental protection manager conspired with employees from an environmental consulting firm to submit false reports to the state Health Department’s Clean Water Branch about the company’s stormwater management system at the landfill. Waste Management insisted that the stormwater caused by the December 2010 rains had not come into contact with waste from the landfill. According to federal prosecutors, Waste Management was allowed to discharge stormwater from the landfill into the ocean, but only if it went through a stormwater management system to ensure that it didn’t come into contact with garbage in the landfill before it went out to sea.

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New Approach to MRSA and VRE Eliminates Isolation and Contact Precautions

ccording to a ContagionLive.com commentary article, results of a recent study show that discontinuing contact precautions for patients with endemic MRSA and/or VRE colonization led to reduced hospital stays and saved the hospital money in gown and glove expenditures. Researchers at the Beth Israel Deaconess Medical Center in Boston, Massachusetts conducted the study between May 2015 and April 2017. During the first year, they looked at pre-intervention infection rates and patient contact precautions. In the second year, a discontinuation of contact precautions (DcCP) protocol was instituted. Rates of MRSA and VRE were measured before and after the new protocol was put into place. Earlier rooming contributed to a 61% decrease in expenditure on gowns, while pairing infected patients in double-occupancy rooms was found to increase the number of available beds and help improve access and patient flow. A 16% reduction in gloves provided more cost savings. The Boston hospital has 673 beds, of which 64% are double-occupancy rooms. In addition to studying MRSA and VRE rates, the research team also looked at patient satisfaction scores, patient falls, and nosocomial pressure ulcers (frequently associated with contact precautions related to these infections), as well as gown and glove expenditures. The study findings revealed that by removing contact precautions for patients with endemic MRSA and/or VRE colonization, the hospital could save money and increase bed availability without a statistically significant increase in nosocomial MRSA/VRE-related infections. The study shed light on the need for more analysis on the necessity to isolate patients with these endemic infections and colonization. When the study team assessed the monthly incidence of MRSA and VRE, they saw an increase in the rate of nosocomial MRSA clinical isolates. That rate was not statistically significant, nor was the rate of nosocomial VRE isolates.

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Tennessee Fines Erlanger Health $39K for Hazardous Waste Violations

hattanooga, TN — The Tennessee Department of Environmental Conservation (TDEC) has imposed fines of more than $39,000 on Erlanger Health System for hazardous waste violations stemming from a 2018 inspection by the agency, according to a NewsChannel9.com report. Erlanger, which operates The Chattanooga-Hamilton County Hospital Authority, was cited for the violations after TDEC inspectors found uncovered containers, drums containing hazardous waste without labels and documentation irregularities, including employee training records, in September of 2018. A TDEC Compliance Evaluation Inspection noted missing Hazardous Waste Annual Reports for 2015, 2016, and 2017, as well as lack of notification for five active hazardous waste streams and missed inspections of the facility’s storage areas. The state held a meeting with Erlanger officials in February of 2019, in which the hospital’s team was “able to demonstrate ongoing actions to correct all violations.” But, in a follow-up inspection by state officials later that same month, inspectors found open containers of hazardous waste, more missed inspections and mislabeled containers. For all of the violations combined, TDEC fined Erlanger $4,162.50 for damages and $35,000 in a civil penalty. Erlanger Health System has taken corrective action and identified gaps in processes at the main facility. The company issued a statement indicating it has been working with TDEC and has resolved all issues and continues to work with the state to develop new policies and processes to benefit health centers across the state. The Chattanooga-Hamilton County Hospital Authority is a regional teaching hospital and Level 1 trauma facility.

CDC Launches Infection Control Training Program

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tlanta, GA — The CDC’s Health Research & Educational Trust has announced a convenient way for health care professionals to keep current on infection control training. National infection prevention experts have developed a new curriculum, called STRIVE, which stands for States Targeting Reduction in Infections Via Engagement. The program, which has courses that focus on audit and feedback, hand hygiene, environmental cleaning and engaging patients and families, is recommended for all staff, infection preventionists, infection prevention and control team or committee members, hospital leaders, clinical educators, nurse managers, physician managers, environmental services managers, and patient and family advisors. The courses consist of downloadable modules in PDF form that can be taken in any order. Participants can receive free continuing education credits on the CDC’s Training and Continuing Education Online site by completing all course modules, taking the evaluation and post-test, and scoring at least 75% on the post-test. Additional courses focusing on specific infections, such as Clostridioides difficile, are available starting in late September of this year. The CDC, in collaboration with various clinical partners, also presents a webinar series, Tune in to Safe Healthcare, which focuses on a variety of infection control and prevention topics. The webinars feature CDC and external experts and serve as a tool to educate healthcare providers on best practices to improve patient safety. Webinars are offered free of cost. Some offer continuing education credits. The webinar series can be viewed on CDC’s Safe Healthcare Webinar Playlist.

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Scientists Seek Alternative to Sulfur Hexafluoride (SF6), a Greenhouse Gas

an-made sulphur hexafluoride gas, or SF6, is the ideal high-voltage insulator and has myriad uses, but it also is a greenhouse gas when it escapes into the atmosphere, which is why researchers at University of Cardiff, China Electric Power Research Institute and private corporations, such as ABB, have been working to find an alternative. As the world’s power generation capacity expands and use of SF6 grows to meet industry demand, the amount of SF6 being released into the atmosphere is alarming scientists, such as the University of Cardiff investigators, who expect SF6 to be banned by environmental regulators. Inert, colorless, odorless and non-flammable, SF6 is has been used widely in electronics, laser, medical, meteorological, military, space aviation, and other fields since it was first produced commercially in 1953. In health care, sulfur hexafluoride is used as an injectable ultrasound contrast agent. It works by changing the way ultrasound waves travel within the heart, liver and urinary tract, resulting in sharper imagery. SF6 gas was recognized as a greenhouse gas at the 1997 Kyoto Protocol-COP3; since then its use and emissions in the atmosphere have been regulated by international treaties. It has a global warming potential (GWP) 23,900 times greater than that of CO2 and an atmospheric life of 3,200 years. Due to its perceived global warming potential, the California Air Resources Board (CARB) passed a regulation restricting Sulfur Hexafluoride gas emissions under the California Global Warning Solutions Act of 2006. The rule places a ban on the sale, use, and release of SF6 for processes not specifically exempted, including use in chemical vapor deposition (CVD) chamber cleaning, etching, use as a dielectric medium and use as an arc quenching medium. Other exemptions under the California law include injection or other entry of SF6 into a human or other animal body for the purpose of improving health; use of SF6 in a diagnostic tool in order to either identify a disease or condition by its outward signs and symptoms or analyze the underlying physiological/biological cause(s) of a disease or condition; use of SF6 in a medical treatment process for a disease other than a medical condition; use in equipment calibration and in testing to find alternatives to sulfur hexafluoride use, and use for research in a research facility. Research into candidate replacement gases has included dry air, nitrogen, carbon dioxide, and polyfluorinated gases especially Trifluoroiodomethane (CF3I), Perfluorinated Ke t o n e s, O c t a f l u o ro t e t ra - hyd ro f u ra n , Hydrofluoroolefin (HFOs) and Fluoronitriles.

State Regulators Say “No” to Infectious Waste Processing Facility in El Paso

l Paso, TX — The Texas Commission on Environmental Quality voted down an application by MedCare Environmental for a medical waste facility to operate in an El Paso neighborhood, reports KFOXTV.com. The types of medical waste that would have been processed at this facility and disposed at the Greater El Paso County Landfill include: discarded human organs and other body parts and tissue removed during surgery, human blood and blood products, contaminated syringes, used scalpels, as well as animal carcasses, body parts, and bedding of animals that have been infected with agents that may produce human infection. The bedding would have been brought from Arizona, New Mexico, and other parts of Texas. Local officials and concerned citizens had fought to keep the facility out of El Paso, opposing an earlier TCEQ decision to give a preliminary go-ahead to MedCare. Their efforts, which included 2019 providing evidence against claims the company made in its application, resulted in a re-evaluation HESuse 1/2compatibility Page Island of land with the surrounding neighborhood. The Executive Director of the TCEQ concurred with the concerns raised in the motions to 5-7/16” x 7-1/8” overturn, particularly with the discrepancy in the number of residences in the one-mile radius, and recommended Commissioners overturn the approval of the medical waste company’s application.

Vecoplan’s Universal Shredders Pull Double Duty! IT’S A MEDICAL WASTE SHREDDER...

...AND A SECURE DESTRUCTION SHREDDER...

• Vecoplan has years of med-waste experience developing systems used in hospitals world wide for red bag processing • Shreds sharps and other tough materials • Shreds to an unrecognizable consistency • Turnkey medical waste sterilization systems

• The same Vecoplan shredders are used for confidential data destruction. • Gain control of HIPAA compliance and costs by “in house” destruction of records, disks, drives and other media • Vecoplan shredders are AAA NAID compliant • Vecoplan shredders are currently being used in hundreds of secure destruction operations

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5708 Uwharrie Road • Archdale, NC 27263 fall 2019

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

News Briefs

ADVERTISER NEWS Evan Reilly Joins TECNI-QUIP Carts

QI LLC, TECNI-QUIP Carts announced the addition of Evan Reilly to the team in the role of outside sales and new product development. TECNI-QUIP Carts manufactures healthcare approved carts for EVS transport of waste and soiled linen as well as clean linen transport and custom carts. A recent graduated of Texas A & M Corpus Christi, Reilly majored in Business with an emphasis on marketing. Evan is no stranger to the company as his grandparents, Jane and Charles Clement, founded the company in 1961. Evan was introduced to the company at an early age and worked in fabrication during his high school and college summers.

Researchers Find Drug-Resistant Staph Bacteria Common Throughout London

team of English and Chinese researchers who studied the occurrence of drug-resistant staphylococcus in public places throughout London found the common skin bacteria prevalent on elevator buttons, ATMs and bathroomdoor handles, according to findings published in Nature. The researchers collected 600 samples from locations throughout East and West London such as hospitals, public washrooms and ticket machines, finding 11 species of staphylococci. Nearly half of the samples—including 57 percent in East London and about 41 percent in West London—contained bacteria known to be resistant to two or more frontline antibiotics. Just under half of the staph found in hospital public areas was drug resistant, compared with 41 percent in community settings. Highly troublesome to humans are the resistance genes and elements present in the staph bacteria which, according to the study authors, can spread to human pathogens and result in the emergence of new [antimicrobial-resistant] clones. Although these bacteria are nonpathogenic themselves, the increased levels of antibiotic resistance the investigators found in general public settings in the community and in hospitals pose a potential risk to public health, they noted. The simple act of hand washing is highly effective at preventing transmission of staph and other germs, the researchers emphasized.

Product/Equipment Profiles EarthSafe Introduces Multi-Purpose Cleaner and Disinfectant to Bridge the Gap in Infection Prevention With the launch of PUR:ONE, a universal cleaner/disinfectant, the EvaClean Infection Prevention System by EarthSafe fills the need for an end-to-end sanitation solution while eliminating the need for multiple chemicals.

arthSafe began by developing the EvaClean Infection Prevention System, which leverages advanced electrostatic sprayer technologies to cover three-times the area in 80% less time, a “drop and go” sanitizing/disinfection chemistry, and simplified, scalable processes for higher-level compliance and maximum output. Still, a critical gap remained in daily cleaning and floor disinfection strategies. Enter PUR:ONE—A one-step cleaning and disinfection solution for high touch surfaces and floors, and the new front-end component of the all-encompassing EvaClean System. But, PUR:ONE does much more than fill a necessary gap in environmental hygiene. It’s the first single step cleaner and disinfectant to receive EPA registration as effective against bacteria in biofilm and is on K-List of approved products for use in cases of Candida auris, plus other emerging pathogen threats, which are vital concerns in healthcare. While PUR:ONE is powerful enough to kill C. diff in 4 minutes, this broad-spectrum chemistry also works for daily cleaning and floor disinfection, the latter typically lacking in most cleaning protocols. With a top NFPA rating of triple zero, it’s also safer for personnel, patrons and patients, and the only sporicidal disinfectant that won’t damage equipment or floor finishes.

Like EvaClean’s PURTABS sanitizer and disinfectant, PUR:ONE is a NaDCC pre-measured tablet concentrate that is sustainable, stable and economical. Because EvaClean’s entire program is standardized around a single chemistry solution, it streamlines cleaning processes from beginning to end, reduces potential failure points due to human error, eradicates chemical hazards and exposure, increases worker safety, and ensures a higher level of compliance. The difference is in the application method. PURTABS are designed for use with EvaClean’s Protexus Electrostatic Sprayers, while PUR:ONE works with existing microfiber cleaning programs, as well as dry wipes and spray bottles. It can also be mixed on the go at a workstation cart, the ideal single dosing solution for floor disinfection using disposable or launderable microfiber mop heads. When combined with EvaClean’s best practice guidelines and training for optimal implementation efficiency, it creates a synergistic system that will enhance cleaning protocols from A to Z.

For more information please visit www.earthsafeca.com and www.evaclean.com.

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

fall 2019

sanipak@sanipak.com

www.sanipak.com

fall 2019

HEALTHCARE ENVIRONMENTAL SOLUTIONS news