Healthcare Environmental Solutions Fall 2020 by Downing and Associates

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

VOL. XVI NO.4 3 XII NO.

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Current Trends for Managing Infectious Waste History

hile in the midst of the COVID-19 pandemic, it is an ideal time to assess the options for managing infectious waste. As we consider modern solutions, it is important to be aware of how hospitals have historically managed this waste stream. Just as recent as 25-30 years ago, most hospitals actually managed their infectious waste on-site. The technology of the time was incineration. Based on the 1990 Clean Air Act Amendments, most incinerators were ultimately shut down because they were unable to pass stack testing. Many hospitals transitioned to cleaner technologies such as autoclaves to properly treat this infectious material. However, an unintended consequence of this regulation shifted a majority of hospitals to outsource the treatment of their infectious material. Hospitals opted for this temporary solution because it required no capital investment. Many of these hospitals invested millions of dollars to upgrade their incinerators, yet they were still unable to pass air quality testing. According to Carl Solomon Sr., Director of Environmental Services at UC San Diego Health “Some states, such as California, have completely banned the incineration of medical waste due to air emission and safety concerns, requiring expensive transport and treatment of the waste off the medical center’s campus.”

by Arthur McCoy

As many hospitals are reconsidering their strategy for managing infectious waste, we will examine the justification used by many hospitals and healthcare systems that are transitioning back to an on-site model. The two business models of managing infectious waste, on-site and off-site, are dramatically different. While some off-site service vendors try to build financial and operational dependance on their respective services, the on-site model delivers the exact opposite by providing the hospital operational and financial independence from any waste service provider. Following are points that many hospitals consider while making a decision on either business model:

Disease Prevention

hy did so many hospitals treat on-site 2530 years ago? The underlying justification was related to basic infection control practices: treat at the point of generation. Whether it is infectious patients or infectious waste, hospitals strive to minimize these infectious outputs into their respective communities. This sentiment is very much alive today as we plan and respond to deadly emerging pathogens. Bio Safety Labs that have a rating of 4 (BSL4) are used for studying and containing such exotic pathogens as Ebola Virus, smallpox, and Lassa Virus. Such labs are required to autoclave their infectious waste prior to leaving the facility.1

Emergency Readiness/PPE

he reality for hospitals is that we could continue to see an uptick in these emerging diseases. As a result, many hospitals are now looking to include on-site treatment infrastructure as a proactive health and safety measure to prevent the further spread of disease. In order to protect our healthcare heroes, PPE supplies must be fortified. Some infectious waste treatment technologies are going through the approval procedure with the FDA to reprocess certain types of PPE. The reprocessing of PPE would expand domestic inventories.

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Current Trends for Managing Infectious Waste Continued from page 1

In addition to disease outbreak, hospitals need to be prepared against any natural or man-made disasters. Hospitals that lack on-site treatment infrastructure are vulnerable when the transportation infrastructure is compromised from severe storms and hurricanes. Such events could force hospitals to pile up infectious waste until waste services are able to resume. According to Solomon,“On-site processing and treatment of biohazardous medical waste also gives a hospital surge capacity, and the ability to continue processing waste if an outside service provider is unable to access and support a hospital due to some external disaster, e.g. fire, earthquake or flood, as long as the hospital’s facilities are not damaged and their infrastructure is intact.”

Environmentally Friendly

n comparing the environmental impact of managing infectious waste on-site or off-site, the EPA developed a carbon footprint calculator to quantify the CO2 emissions produced by shipping the waste off-site.2 This metric is important to quantify the environmental consequence from either methodology. Bhushan Shelat - Director of Environmental Services at Stanford Health Care says, “The implementation of our on‑site biohazardous waste treatment system has proven to be a sustainable option,” suggesting this is due to the reduction of untreated waste needing to be shipped off-site for treatment.

Compliance/Safety

very infectious waste generator has a cradle-to-grave liability associated with Regulated Medical Waste. Many hospitals have elected to safely inactivate this waste on-site, before it is transported. Truck accidents are a daily occurrence, and no hospital wants the potential publicity of a waste spill that is untreated. In addition, some states are getting very aggressive in keeping untreated infectious waste out of landfills. This has resulted in severe fines and bad publicity for some hospitals. As a result, hospitals are turning to on-site technology to treat all waste from high-risk areas within the hospital. According to Fiona Nemetz - Director, EVS, Parking, Safety and Security at Northside Hospital in Atlanta, “The improved worker safety is recognized as EVS team members no longer have to package RMW for shipment. During the packaging process, EVS team members can experience cuts or lacerations from contaminated medical devices when they are attempting to get them into the secondary packaging.”

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Environmental solutionsnews

Covering Infection prevention, medical waste management & sustainable practices

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Aggressive Cost Savings

ccording to Shelat,“Since implementing our on-site program, we have significantly reduced our operating costs, additionally enabling our team to closely monitor safety and compliance as we continue to identify opportunities for improvement.” Every hospital and health system should evaluate the financial impact of waste. It’s important to consider lifecycle costs. Regarding any capital investment, it is critical to calculate the projected payback. Since the 1980’s, the University of Washington Medical Center has been treating on-site at several of its locations. “Last year we invested in another system that delivered a 9-month payback compared to hauling,” stated Toby Purvis – Director of Environmental Services. According to Solomon,“Some landfills have waste acceptance policies allowing hospitals and labs to treat, through sterilization, red biohazardous waste bags and red sharps collection containers, on-site and dispose of this treated waste in their trash compactor. This adds savings if a hospital or lab is using disposable sharps collection containers.” Nemetz goes on to say, “The cost savings are recognized when on-site solutions are utilized as the cost of the equipment can be amortized over 10 years and when that it used for calculations, there are significant cost savings compared to hauling for treatment. Typically, the vendor selling the on-site solution is able to assist with the ROI calculations. Finally, when on-site technology is utilized, the systems allow the EVS worker to transport from the soiled utility room directly to the on-site technology. This eliminates the need to package for shipment and therefore provides labor reductions. The majority of on-site technologies do not require a dedicated operator today.”

Current Trend

he U.S. Government’s largest healthcare system, The Department of Veterans Affairs, has seen great value with on-site processing. The VA has done extensive research to support their decision to expand onsite processing, which has resulted in other VA hospitals being approved for on-site technology. “We see on-site waste processing as a solution to reduce costs and reduce the amount of infectious waste that leaves our hospitals. On-site treatment also prepares us to respond to a pandemic without putting the community at risk,” stated Aubrey Weekes - Director, Environmental Programs Service at Department of Veterans Affairs. In the case of Solomon, he recommends having medical waste treatment systems with redundancy, so you can continue to process biohazardous waste should equipment be out of service for any reason, e.g. scheduled maintenance, down-time for required spore ampule testing, or other reasons. According to Rudy Vingris - Healthcare Business Development Manager for Waste Management, Inc., “Autoclave treatment of biohazardous/infectious waste continues to be the most prevalent and proven technology available.” He added that, “new technologies continue to evolve and come to market.” Shelat goes on to mention that their on-site system provides process efficiencies that enable them to better manage their biohazardous waste program, including the flexibility of simultaneously compacting landfill waste. Regardless of which methodology your hospital selects, it is advisable to fully vet the companies and technologies you consider. No one technology or service company will be a panacea without a partnership approach to doing business. As Vice President of San-I-Pak, Inc., Arthur has been involved in the planning and implementation of hundreds on-site programs at hospitals across the country. He also served on the Underwriter Laboratory (UL) Committee 2334 for establishing standards on all medical waste treatment technologies. 1. https://www.cdc.gov/labs/pdf/CDC-BiosafetyMicrobiologicalBiomedical Laboratories-2009-P.PDF 2. https://www.epa.gov/climateleadership/center-corporate-climate-leadershipsimplified-ghg-emissions-calculator fall 2020

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CDC Report: COVID-19 Contamination Despite Mask Wearing at Bars, Restaurants

study that compared 154 “case-patients,” who tested positive for COVID-19, to a control group of 160 participants from health care facilities who were symptomatic but tested negative, showed that 70% of the case-patients were contaminated with the virus and fell ill despite “always” wearing a mask, according to the September 11 Centers for Disease Control (CDC) Morbidity and Weekly Mortality Report. The study, conducted at 11 outpatient health care facilities* in California, Colorado, 2020 Maryland, Massachusetts, Minnesota, HES 1/2 Page Island Monster North Carolina, Ohio, Tennessee, Utah, 5-7/16” x 7-1/8” and Washington last July. CDC personnel administered structured interviews in English

or five other languages by telephone and entered data into REDCap software. According to the report, “Participants with and without COVID-19 reported generally similar community exposures, with the exception of going to locations with on-site eating and drinking options. Adults with confirmed COVID-19 (case-patients) were approximately twice as likely as were control-participants to have reported dining at a restaurant in the 14 days before becoming ill. In addition to dining at a restaurant, case-patients were more likely to report going to a bar/coffee shop, but only when the analysis was restricted to participants without close contact with persons with known COVID-19 before illness onset.

Since the pandemic began, reports of exposures in restaurants have been linked to air circulation. Direction, ventilation, and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance. Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use. Among adults with COVID-19, 42% reported close contact with a person with COVID-19, similar to what has been reported previously (4). Most close contact exposures were to family members, consistent with household transmission of SARS-CoV-2 (8). Fewer (14%) persons who received a negative SARS-CoV-2 test result reported close contact with a person with known COVID-19. To help slow the spread of SARS-CoV-2, precautions should be implemented to stay home once exposed to someone with COVID-19, in often, wear masks, and social distance. If a family member or other close contact is ill, additional prevention measures can be taken to reduce transmission, such as cleaning and disinfecting the home, reducing shared meals and items, wearing gloves, and wearing masks, for those with and without known COVID-19, the study authors urged.

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he findings in the report are subject to at least five limitations, the authors noted. “First, the sample included 314 symptomatic patients who actively sought testing during July 1–29, 2020 at 11 health care facilities. Symptomatic adults with negative SARS-CoV-2 test results might have been infected with other respiratory viruses and had similar exposures to persons with cases of such illnesses. Second, the survey question assessing dining at a restaurant did not distinguish between indoor and outdoor options. In addition, the question about going to a bar or coffee shop did not distinguish between the venues or service delivery methods, which might represent different exposures. The subjects may have concurrently participated in activities where possible exposures could have taken place, that were not included in the analysis or measured in the survey. Third, adults in the study were from one of 11 participating health care facilities and might not be representative of the United States population. Fourth, participants were aware of their SARS-CoV-2 test results, which could have influenced their responses to questions about community exposures and close contacts. Finally, case or control status might be subject to misclassification because of imperfect sensitivity or specificity of PCR-based testing.”

News Briefs

Great Barrington Declaration: COVID Lockdowns are Unnecessary rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals. Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.” Dr. Martin Kulldorff, professor of medicine at Harvard University, a biostatistician, and epidemiologist with expertise in detecting and monitoring infectious disease outbreaks and vaccine safety evaluations. Dr. Sunetra Gupta, professor at Oxford University, an epidemiologist with expertise in immunology, vaccine development, and mathematical modeling of infectious diseases. Dr. Jay Bhattacharya, professor at Stanford University Medical School, a physician, epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations.

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he social lockdowns and the near shutdown of the world’s economy in the face of coronavirus disease 2019 (COVID-19) represents a huge mistake, argue leading scientists in the world of epidemiology. The Great Barrington Declaration was issued on October 4 by scientists who argue that most of us should return to our pre-COVID ways of life. The Declaration brought a swift rebuttal. Rupert Beale, PhD, of the Francis Crick Institute, said that herd immunity depends on the wide distribution of a COVID-19 vaccine, which has yet to be developed. Further, he argued that “the Declaration prioritizes just one aspect of a sensible strategy—protecting the vulnerable—and suggests we can safely build up ‘herd immunity’ in the rest of the population. This is wishful thinking. It is not possible to fully identify vulnerable individuals, and it is not possible to fully isolate them. Furthermore, we know that immunity to coronaviruses wanes over time, and re-infection is possible—so lasting protection of vulnerable individuals by establishing ‘herd immunity’ is very unlikely to be achieved in the absence of a vaccine.” According to an Epoch Times article, the Declaration, was signed by more than 34,000 medical doctors and health scientists from around the world. was launched by three epidemiologists from Harvard, Oxford, and Stanford. In the article, citizen journalist, Omid Ghoreishi, writes that more than 440,000 members of the general public have also signed the petition. “The Epoch Times could not verify the status of the signatories.” Ghoreishi wrote. An FAQ on the Great Barrington Declaration website reads, “Pranksters have added fake signatures such as Dr. Johnny Bananas, Dr. Neal Ferguson and Dr. Person Fakename. One lockdown supporter adding fake names even bragged about it on Twitter. The fake signatures are less than 1% of the total, and most have been removed from the count tracker.” The original text of the document follows: The Great Barrington Declaration “As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies and recommend an approach we call Focused Protection. Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed. Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza. As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity. The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection. Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside

fall 2020

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COVID-19, Plastic, and the Future of the Oil Industry

Oxford Scientists Develop 5-minute COVID-19 Antigen Test

uch of the plastic waste generated during the COVID-19 pandemic is not being recycled because it is cheaper to produce new plastic now, reports a Reuters.com article. Recyclers worldwide are experiencing a major drop in source material as low oil prices are keeping the manufacture of new plastic more economical. Recycled plastic containers cost 83% to 93% more to produce than new bottle-grade plastic, according to market analysts at the Independent Commodity Intelligence Services (ICIS). Since the COVID-19 pandemic hit, recyclers worldwide told Reuters their businesses have shrunk by more than 20% in Europe, by 50% in parts of Asia and as much as 60% for some firms in the United States. The pandemic spurred increased production of face masks, partly from plastic. In March, China used 116 million of them – 12 times more than in February, official data show. In China, total production of masks is projected to be 100 billion in 2020, according to a report by Chinese consultancy iiMedia Research. The demand for hospital gowns and gloves, which are made from sanitary plastic, has been spiking. The drop in oil prices has cut sales of recycled plastic across South and Southeast Asia by an average of 50%, according to Circulate Capital, a Singapore-based investor in Asian recycling operations. The demand for recycled plastic on average has had an even more dramatic impact throughout the Philippines, Vietnam and India, where as much as 80% of the recycling industry was not operating during the height of the pandemic. The recycling industry is likely to experience even more competition from new plastic manufacturers as car makers build more energy efficient fossil fuel and electric vehicles. Oil companies will not lose out, however, unless viable plastic alternatives can be manufactured on a large scale. Great quantities of oil will be needed to meet the rising demand for new plastic-based consumer goods purchased by millions of new middle-class consumers in Asia and elsewhere.

xford, England – Scientists from Britain’s University of Oxford have demonstrated a rapid testing technology capable of accurately identifying the SARS-CoV-2 (COVID-19) virus in less than five minutes, announced in mid-October. Previous viral RNA tests took 1.5 to 2 hours to give a result. The Oxford-developed technology is highly sensitive in detecting fragments of the coronavirus in genetic material that distinguish it from other viruses, the researchers said in a pre-print study. Because it only requires a simple heat-block to maintain a constant temperature for RNA reverse transcription and DNA amplification, the testing device is portable and easy to use. What’s more, the results can be read by the naked eye. The technology, which was validated using clinical samples at Shenzhen Luohou People’s Hospital in China, has built-in checks to prevent false positives or negatives. Results have been highly accurate, the researchers said. The investigators at the Oxford’s Engineering Science Department and the Oxford Suzhou Centre for Advanced Research (OSCAR) who developed the testing device say it which will undergo product development in early 2021. Once approved, kits could be available next summer for use in mass testing at airports, businesses, and rural areas. Siemens Healthineers announced the launch of a rapid antigen test kit in Europe to detect coronavirus infections but warned that the industry may struggle to meet a surge in demand.

Resident Opposition Puts Stericycle Incinerator Permit in Peril

OCKWOOD, NV – Citizens have taken legal action to block construction of a medical waste incinerator outside Las Vegas, KOLO television reports. Last August, Storey County Commissioners passed an application for a special use permit for the incinerator to be built by waste disposal company, Stericycle. The company received the nod after similar plans were turned down by North Las Vegas. Stericycle purchased the land parcel from County Commissioner and land developer, Lance Gilman, who is part-owner of the Tahoe-Reno Industrial Center. Gilman had recused himself from the final vote on the Stericycle permit. The other two other commissioners had voted to approve. Nevada law requires written notification to property owners within 300 feet of a proposed hazardous waste facility. One Lockwood resident, who wants the commissioners to rescind their approval of the permit, told the news channel that she was unaware of plans for the incinerator until after the commissioners’ vote. According to county records, the commissioners received opposition letters from wild horse advocacy group, American Wild Horse Campaign, Blockchains, a company located adjacent to the industrial park, and from the fire chief and chief deputy district attorney regarding concerns about potential height Stericycle’s proposed building and potential costs to the county. The proposed plant site would consist of a single 50,000+ square foot building housing two rotary Kiln Thermal Reduction/Destruction units (main and back up incinerators) for incinerator/processing activities, warehousing, and office space, parking for approximately 30 employees, along with truck parking. Stericycle’s plans also mention location of a Stericycle document destruction subsidiary at the site. The company also has been evaluating building an electric or gas power generating capacity on the site to power internal operations, as well as future potential for commercial sale to neighboring properties. Such plans would be subject to a special use permit.

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California Medical Waste Law to Take Effect January 2021

Hospital Study Highlights ED Waste Reduction Solutions

uthors of a Lexology.com article say that compliance mandates added to the California Integrated Waste Management Act will be profitable for medical waste disposal companies, but costly for pharmaceutical companies and medical device manufacturers. The Spencer Fane LLP attorneys write that once the 2018 “California Sharps and Drug Takeback Bill” becomes effective next January, CalRecycle has the legal ability to impose stiff penalties against those companies who violate the law, which include penalties of up to $50,000 per day if a violation is intentional, knowing or reckless (or otherwise up to $10,000 per day). Under the law, “covered entities” include pharmaceutical and medical device manufacturers and distributors who sell or offer for sale their products in the State of California. “Covered Products” include prescription and nonprescription drugs and home generated sharps waste, such as needles, lancets and other devices used to pierce the patient’s skin for the delivery of medication. The law, which encompasses all pharmaceutical and home-generated sharps waste that are sold or offered for sale in California, requires a manufacturer of covered drugs or home-generated sharps waste to offer safe disposal methods (such as mail back programs) for their customers’ used and unused products. The law requires each covered entity to register covered products and submit a stewardship plan to CalRecycle. The state then will review the plan and approve, disapprove, or conditionally approve it. Stewardship plans must be submitted to CalRecycle by July 2021. Mail back or take back programs are anticipated to be in place in late 2022 or early 2023. Covered entities must also pay an annual fee to CalRecycle.

asic changes to emergency department (ED) disposal policies and practices lead to significantly lower operating costs and improved operations, researchers from Massachusetts General Hospital (MGH) have found, according to a MedicalExpress.com article. Switching from disposable to reusable items in the ED, debulking packaging before items are shipped to hospitals, better sorting of infectious waste, and more effective recycling of items like glass and aluminum could have positive impacts both environmentally and financially, according to the study published in the Western Journal of Emergency Medicine. The MGH investigation is the first to quantify and characterize the volume of waste emanating from emergency departments. MGH Department of Emergency Medicine researchers note that healthcare facilities in the U.S. generate more than 7200 tons of waste each day, making them the second largest contributor to landfill waste and responsible for 10% of greenhouse gas emissions, as well as other pollutants known to adversely affect human health. A 24-hour waste audit in July 2019 at MGH’s Level 1 trauma center in Boston revealed opportunities for cost savings and improvements in operational efficiency. Led by investigators from the Warren Alpert Medical School at Brown University, the team collected and manually sorted waste into separate categories, then weighed each waste stream component. In addition, they calculated direct pollutant emissions from ED waste disposal activities. Among the findings was that 85 percent of all items disposed of as regulated medical waste (RMW) did not meet the criteria for regulated medical waste. Training staff to recognize the difference between RMW and what can be disposed as regular solid waste, the study authors said, would save hospitals a lot of money.

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Covid-19 Infections Among Health Workers Declining: WHO

ealth workers’ COVID-19 infection levels, which were spiking throughout the pandemic, are subsiding said a WHO panel interviewed in a virtual media conference in mid-October, Medical Express reports. Health workers represent less than three percent of the population in most countries, but have accounted for around 14 percent of all Covid-19 cases reported to the WHO, and in some countries they have accounted for over a third of cases. The UN health agency said analysis of reported data from 83 countries, mainly in Europe and the Americas, showed that “there has been a substantial decline in (health worker) infection since the beginning of the epidemic.” A number of factors have contributed to the high numbers of health workers infected by the virus, including a dire shortage in the beginning of personal protective equipment (PPE), and insufficient training in how to use it. WHO experts said the declining infection rate was likely linked in part to increased availability of personal protective gear and better understanding and adherence to infection prevention measures. This includes continuously wearing a medical mask or a respirator depending on the situation, frequently performing hand hygiene, keeping physical distance as much as possible. As the pandemic entered a second wave at the beginning of fall in countries above the Equator. While large variations were seen in different countries, the downward trend was evident even in countries where overall cases were rising, the WHO panel said in a virtual media conference.

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COVID-19 Outbreak Associated With Air Conditioning in China

uangzhou, China – Findings of a study published in the July 2020 CDC Research Letter Emerging Infectious Diseases, describe the role of air conditioning in the transmission of COVID-19. Between January 26–February 10, 2020, in an air-conditioned restaurant in Guangzhou, China, three family clusters (A, B, and C) were seated at adjacent tables. The distance between each table was about 1 m. Families A and B were each seated for an overlapping period of 53 minutes and families A and C for an overlapping period of 73 minutes. The air outlet and the return air inlet for the central air conditioner were located above table C. The airflow direction was consistent with droplet transmission, the paper stated. The Chinese scientists, from the Department of Control and Prevention for Infectious Disease at the Guangzhou Center for Disease Control and Prevention, traced contacts between members of the family clusters and examined the potential routes of transmission. They concluded that the most likely cause of the restaurant outbreak was droplet transmission but added that the virus transmission in the outbreak cannot be explained by droplet transmission alone. Larger respiratory droplets (>5 μm) remain in the air for only a short time and travel only short distances, generally <1 m (2,3). The distances between patient A1 and persons at other tables, especially those at table C, were all >1 m. However, strong airflow from the air conditioner could have propagated droplets from table C to table A, then to table B, and then back to table C, the scientists said. The paper further explained that larger respiratory droplets (>5 μm) remain in the air for only a short time and travel only short distances, generally <1 m, noting that the key factor for infection was the direction of the airflow. Study limitations included not simulating the airborne transmission route. The teams also did not perform serologic studies of swab sample–negative asymptomatic family members and other diners to estimate risk for infection. “To prevent spread of COVID-19 in restaurants, we recommend strengthening temperature-monitoring surveillance, increasing the distance between tables, and improving ventilation,” the authors said.

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News Briefs

French Firm Innovates Single‑use Mask Recycling

ienne, France – French entrepreneurs have devised a method for recycling polyester and other plastic fibers, including the polypropylene used in single-use surgical masks, according to a Connexion France article. The company, Plaxtil, would convert the fiber to plastic blocks which then can be used to make new objects, using a process they developed in 2017. Although the material is not as strong as newly manufactured plastic-based oil processing, it is versatile for most uses. A Plaxtil spokesperson explained that the processing system can be financed best in a “circular economy” where recycled plastic is returned to manufacturers to make new products. The company worked with local government to conduct a trial which involved installing collection bins for surgical masks in town. Collected masks were “quarantined” for four days before being put through the shredder in the same way as other textiles at the factory. After shredding, the mask fiber was disinfected using ultra-violet light before being turned into Plaxtil blocks. Another company, Cosmolys, which specializes in handling hazardous medical waste – received approval last year for a three-year project to see if throwaway surgical instruments made out of polypropylene can be recycled into a useful plastic. Early results are promising, the firm says.

Scientists Detect COVID-19 Virus Mutations That Could Lead to Prevention, Earlier Treatment

Studies Show ICU Infection Control Basics are Effective in COVID-19 Cases

ORONTO, CANADA – Canadian and U.S. studies show a significant decrease in mortality for COVID-19 patients in intensive care units (ICU) since the pandemic, reports CTVNews.ca. Physicians from Toronto’s University Health Network (UHN) found that using tried and true ICU treatments have been successful in saving COVID-19 patients. The therapies shown to boost the survival rate of COVID-19 patients include: steroids, which have shown to decrease mortality by some 20 percent; more use of blood thinners, which are used to help prevent deadly clots; breathing therapies that help patients maintain a more optimal level of oxygen; and, delaying or preventing the use of ventilators, the use of which carries greater risks. Even the positioning of patients has been helpful, as well as the use of extracorporeal membrane oxygenation (ECMO) in the most severe cases. Since the start of the COVID-19 pandemic, the death rate for intensive care unit (ICU) patients dropped from an average of 60% in early March to 42% by the end of May, UHN reports. Adhering to ICU infection control standards and evidence-based practices led to survival benefits (15 per cent), noted the lead investigator of a U.S. study published in the September 14 issue of the journal, Chest. The multi-center, retrospective, observational cohort study of ICUs was conducted in four hospitals in New Orleans by University Medical Center. The New Orleans findings showed that patients in ICU had a better chance of surviving and needed less time on a ventilator when doctors followed an established checklist of ICU practices. The investigators collected data on adults admitted to an intensive care unit (ICU) and tested for SARS-CoV-2 between March 9, 2020 and April 14, 2020.

cientists have new knowledge about SARS-CoV-2, the coronavirus that causes COVID-19, that could lead to prevention and faster detection, reports Duke Today. According to the findings published Oct. 16 in the journal PeerJ, researchers at Duke University’s Wray Lab have identified a number of “silent” mutations in the roughly 30,000 letters of the virus’s genetic code that helped it thrive once it made the leap from wildlife to humans. The way in which the virus folds its RNA molecules within human cells provide insight into how and why the global pandemic got started and has been difficult to halt. Duke researchers first developed statistical methods allowing them to identify adaptive changes arising in the SARS-CoV-2 genome in humans, but not in closely related coronaviruses found in bats and pangolins. Previous research detected fingerprints of positive selection within a gene that encodes the “spike” proteins studding the coronavirus’s surface. These proteins play a key role in the virus’ ability to infect new cells. The Duke study likewise flagged mutations that altered the spike proteins, suggesting that viral strains carrying these mutations were more likely to thrive. The researchers think that the mutations occurring in two other regions of the SARS-CoV-2 genome, dubbed Nsp4 and Nsp16, may have given the virus a biological edge over previous strains without altering the proteins they encode. Nsp4 and Nsp16 are among the first RNA molecules that are produced when the virus infects a new person, the researchers said. Asymptomatic carriers pose a huge challenge in stopping the COVID-19 spread. The Duke scientists don’t yet know how the changes in RNA structure might set the SARS-CoV-2 virus in humans apart from other coronaviruses. They suspect a link between these changes and the virus’s ability to spread before people even know they have it. The Duke research may lead to new molecular targets for treating or preventing COVID-19, thus enabling scientists with the ability to predict future zoonotic disease outbreaks before they happen.

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American Entrepreneur Launches a Line of Reusable PPE Garments for Women

HILADELPHIA, PA – A woman-owned company manufactures and sells stylish chemical-resistant and antimicrobial workwear for women in STEM that are reusable, reports Inquirer.com. AmorSui makes reusable lab coats, pants and dresses in eco-friendly fabrics that protect wearers and offer five sizes (XS-XL), instead of the typical one-size-fits-all. A software app tracks each garment’s uses and alerts the wearer when it should be cleaned. Starting in the fall of 2018, the firm has grown to employ 20 full- and part-time employees and is projected to reach $1 million in sales this year. The garments are made in factories in Allentown and Brooklyn, and all products are sourced and made within the U.S. by women- or minority-led vendors and companies. Whether hospitals wash the PPE in-house or work with a laundering partner, they will save financially, she said. A disposable gown costs as much as $9 for a onetime use compared with AmorSui’s reusable gowns at $80, or 80 cents a use. Add $1 or $2 for cleaning and at less than $3 a use, the financial savings are considerable. The amount of waste saved is even greater.

COVID-19 Impacts Healthcare System Building Plans

s the COVID-19 pandemic continues, health systems have focused on patient care and investing in facilities upgrades and expansions to meet the requirements of that care, according to a Bizjournals article. Construction of “surge” facilities to treat patients with the virus, outpatient centers to help fund hospital costs, and redesign of existing spaces to accommodate new protocols have become high priority. General contractors are serving not just as building coordinators, but as key advisers as health systems weigh their options. Administrators are considering design solutions for handling ICU bed surges, patient intake and overflow, allocating special spaces for telemedicine and routine procedures, such as mammograms, skin cancer treatments, eye surgeries and colonoscopies. Remodeling of existing facility spaces and offsite modular construction are leading alternatives. Also, expansion into retail, business or airport settings are being considered as health care systems prepare for future crises. Solutions such as modular construction allow a lot of work to be done away from the hospital and faster by smaller teams of workers. This approach avoids disruption and improves infection control, as do specially designed heating, ventilation and air conditioning systems. 10

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Fewer Medical and Dental Appointments Reduces Medical Waste During Pandemic

T. LOUIS, MO – The increase in COVID-related PPE has been balanced by the reduction in PPE from other procedures and places like dentist offices that have been seeing fewer patients, according to a report by KMOX radio. Despite the extensive use of personal protective equipment to protect medical personnel and the general public from COVID-19, the amount of medical waste being produced in the U.S. has actually decreased, says the president of France-based multinational, Veolia Environmental Services, one of the country’s largest waste management companies. Meanwhile, recycling centers report significant increases in PPE being mixed in with recyclables. A spokesperson for not-for-profit cleaning and greening initiative, Brightside St. Louis, emphasized the health risk to workers at the recycling plant. In England, the governmental Department for Environment, Food & Rural Affairs website outlines proper disposal of masks, gloves or other PPE for residents and businesses, instructing them to use their regular trash bin, not the recycling bin. When self-isolating, they should double bag and store contaminated PPE for 72 hours before putting them in their regular trash bin, the guidance says.

Monitoring COVID-19 in Sewage

cientists at the University of South Carolina (U of SC) who have been detecting community levels of COVID-19 in sewage samples since last April say their methodology can be used to monitor virus trends and implement efficient controls, according to an Infection Control Today® article. U of SC Norman Molecular Microbial Ecology Laboratory researchers say their sewage surveillance methods help locate asymptomatic as well as symptomatic carriers, an approach which augments, but does not replace individual testing. By taking composite samples from a wastewater treatment plant, the scientists establish a “catchment population,” the entire population of people that are connected to a municipal sewage system. The method, which provides 24-hour composite samples, allows correlation with reported case levels in a community. Sewage surveillance also can capture asymptomatic as well as symptomatic carries, helping public health officials adjust alerts and advisories. Laboratory results have shown a sharp decline in the abundance of virus across sewer sheds in the state when mandatory mask policies were imposed. In the past, sewage surveillance has been used to detect the polio virus and norovirus, as well as opioid use in communities. The U of SC research is being conducted in partnership with the CDC and the South Carolina Department of Health and Environmental Control. Eight different wastewater treatment plants are being surveilled in South Carolina, two treatment plants in Texas, and one in California.

Copper Works as a Microbial, But it is Costly

ach year, 2 million hospital patients in the U.S. acquire infections that result in 90,000 deaths. According to a StatNews.com report, hospital leaders are aware of the antimicrobial properties of copper, yet they remain reticent to implement retrofits on a large scale. In 2007, scientists at the Medical University of South Carolina conducted a study inside eight intensive care unit rooms at three U.S. hospitals where copper was installed on different objects: bedrails, overbed tray tables, intravenous poles, and armrests of visitors’ chairs, as well as on surfaces like nurses’ call buttons. Over six years, they found that infections in these rooms dropped 58% compared to eight unmodified ICU rooms. He also found significantly lower rates of VRE and MRSA bacteria, notorious for causing inpatient infections, in the copper rooms. Recent research, such as a 2016 at Sentara Leigh Hospital in Virginia, which found that copper oxide surfaces reduced drug-resistant microbes by more than 75, and other clinical trials in Iowa and Indiana showed the copper as a highly effective antimicrobial. Researchers studying SARS-CoV-2, the disease that causes Covid-19, observed that the virus dies within hours of landing on a copper surface. Could the costly metal effectively prevent or reduce infections throughout an entire facility? Answers are inconclusive. For now, improved cleaning regimens, staff training, and increased surveillance are achieving infection reduction at lower cost than switching out miles of stainless steel and plastic surfaces with copper. fall 2020

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