Issuu

ye 20 rs 14 Iss ’ G ue uid e

OCT-DeC 2014

VOL. X NO. 4

Attention Readers !

Are you looking for Products, Equipment or Services for your business or healthcare facility? If so, please check out these leading companies advertised in this issue:

Infectious & Non-Infectious Waste Containers & Linen Carts Bomac Carts – pg 6 Rehrig Healthcare Systems – pg 2 Snyder Industries Inc – pg 19 TQ Industries – pg 8 Infectious Waste Sterilizing Systems Clean Waste Systems – pg 24 The Mark-Costello Co – pg 6 Ozonator Industries – pg 23 STI Biosafe – pg 18 Liquid Disposal Systems Bemis Health Care – pg 7 Room Disinfection Systems Xenex – pg 5 Shredders Shred-Tech – pg 19 Vecoplan LLC – pg 20 WEIMA America – pg 8

By Alice P. Jacobsohn

significant amount of criticism has been published on the management of Ebola-contaminated waste, yet most of it fails to properly assess the jurisdiction of government agencies, misinterprets regulatory requirements, or sets impractical precedents, and, ultimately, fails to provide a solution.

Transportation

number of news articles have sited a conflict between the U.S. Department of Transportation (DOT) and the Centers for Disease Control and Prevention (CDC). For example, on October 14, a Fox News article titled, “Toxic mess: Agencies at odds over Ebola-waste disposal,” quoted Dr. Jeffrey Duchin, chairman of the public health committee for the Infectious Disease Society of America, saying that the CDC considers Ebola-waste safe to be handled by medical waste companies. That article also states that the DOT wants the waste to be “treated” before transport, which the article says is in conflict with the CDC. This article and many others state that medical waste companies cannot accept the waste. A few reference restrictive DOT regulations as the cause. This and similar articles and comments by so-called experts are incorrect. There is not a conflict in requirements between the DOT and CDC. The DOT’s regulations have always allowed for the transport of infectious substances such as Ebola-contaminated materials. The CDC’s assessment that this

type of waste is safe for transport does not in any way define how it should be transported, who is capable of transporting the waste, and where the waste should ultimately be managed for disposal. None of these issues have been addressed by the CDC because they are not within the CDC’s jurisdiction -- the CDC is not a regulatory agency, other agencies have responsibility for these issues, and the CDC’s resources are focused on patient care and disease prevention. The CDC has stepped in to assist hospitals with the management of Ebola-contaminated waste by working with the DOT and healthcare waste companies whose business plans do not include Ebola waste management. When the U.S. Congress enacted the Hazardous Materials Transportation Act in 1975, the DOT was given jurisdiction to create regulations for the management of hazardous materials, which includes infectious substances, in transport. Originally, the DOT based the classification system for managing infectious waste using the CDC’s bio-hazardous waste categories in which infectious materials were placed into four management categories based on the level of risk of the spread of disease. The problem was that the CDC’s definition of risk was based on materials found in laboratories not in hospitals or in transport; thus, the classification system used by the DOT was awkward in practice. Ultimately, as more focus on the Continued on page 3

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Managing Ebola-Contaminated Waste: A Jurisdictional Mess PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers Alice P. Jacobsohn Sandy Woodthorpe Production & Layout Barb Fontanelle Christine Pavelka Advertising Sales Rick Downing Subscription / Circulation Donna Downing Editorial, Circulation & Advertising Office 6075 Hopkins Road Mentor, OH 44060 Ph: 440-257-6453 Fax: 440-257-6459 Email: downassoc2@oh.rr.com For subscription information, please call 440-257-6453. M e d i c a l Wa s t e M a n a ge m e n t (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission of Medical Waste Management, in whole or in part, without written permission of the publisher is prohibited. Annual subscription rate U.S. is $19.95. Outside of the U.S. add $10.00 ($29.95). Contact our main office, or mail-in the subscription form with payment. ©

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Continued from page 1 management of infectious substances came before the international community, in December 2002, the Committee of Experts on the Transport of Dangerous Goods and on the Globally Harmonized System of Classification and Labelling of Chemicals, in which the U.S. participates, created a classification system for transportation that the DOT subsequently adopted into final regulations. The new system uses two categories: “Category A materials are infectious substances that can cause permanent disability, life-threatening or fatal disease in otherwise healthy humans and animals when exposed. This is based on known medical history or professional judgment about the circumstances. Category B materials are infectious substances that are not capable of causing permanent disability, life-threatening or fatal disease in otherwise healthy humans and animals when exposed.” Ebola waste is considered a Category A material. During the rulemaking process, the DOT’s revised regulations incorporated the comments of healthcare waste shippers (healthcare facilities or generators) and transporters. The rulemaking process was open to the public and the CDC also was included. The classification system is based on worse-case scenario of daily transport. Unusual circumstances and emergencies were not considered, but instead are managed through a process of requesting an exception to the rules. Because of the level of risk that the international community identifies as Category A materials, the DOT’s Hazardous Materials Regulations require handling requirements that Category B materials do not. Unlike what has been reported in the news, the DOT does not ban the transport of Category A materials. The requirements for Category A substances may be found in Title 49 of the Code of Federal Regulations section 173.196 and include triple packaging with each layer leak-proof, an outer rigid packaging of adequate strength to manage the contents, and absorbent material if transporting liquid waste. The regulations also include requirements based on waste conditions such as waste that has been refrigerated or frozen prior to transport. Ideally, the DOT favors the position of infection control experts that Category A materials be disposed of on-site and not transported in order to eliminate risk. The World Health Organization through its waste guidance, Ebola Virus Disease (EVD) Key questions and answers concerning water, sanitation and hygiene, says, “All health-care waste produced during the care of Ebola cases, should be collected safely in designated containers and bags, treated and then safely disposed of and/or destroyed, preferably onsite. If waste is moved off-site, it is critical to understand where and how it will be treated and destroyed.”

On-site treatment is not necessarily disposal and may not change the DOT classification of infectious substances. If infectious substances are killed or deactivated on-site, the waste will no longer be considered regulated as an infectious substance under the DOT’s regulations. The DOT, however, does not have jurisdiction over treatment and disposal technologies. What this says is that ash from a state-permitted onsite incinerator and the fluff (plastic, paper) remaining after use of a permitted autoclave or some other disposal technology is no longer a DOT-categorized waste, thus the regulations for infectious substances transportation would no longer apply. The DOT has issued guidance on the management of Ebola-contaminated waste that essentially follows the existing regulations for Category A materials. When establishing the regulations for Category A materials, however, the DOT envisioned small quantities of generated waste not the huge amounts generated by Ebola patients. Therefore, in managing the waste generated at Texas Health Presbyterian Hospital in Dallas, the agency issued an emergency special permit to Stericycle, Inc. that maintains the level of safety required in the regulations, but deviates in some of the specific packaging requirements. Since the issuance of the Texas special permit, the DOT has issued a Safety Advisory on Ebola-contaminated waste and another, longer-term, special permit. This non-site specific special permit (Special Permit DOTSP 16279) was issued to Veolia ES Technical Solutions, LLC and according to the DOT, “Authorizes the transportation in commerce of waste contaminated with or suspected of being contaminated with the Ebola virus for disposal. Other waste haulers not yet authorized under Special Permit DOT-SP 16279 may apply for party status in accordance with 49 CFR 107.107.” The special permit includes nine pages of requirements on the types of packaging that may be used, transportation operating parameters, shipping papers, spill plans, and hazardous materials training requirements.

Treatment and Disposal Technology

ome news articles have focused on disposal technology and which ones are capable of managing Ebola-contaminated waste. In comments published on a LinkedIn site called the Medical Waste Advisory Group, Bob Spurgin, Environmental Consultant and Waste Management Professional located in California, stated that he believes that “operating parameters should not be standardized, but rather reflect the size, volume, contents, density, weight, and overall constituency of the waste load. . . . So with Ebola waste I would suggest that any technology and any site that proposes to accept Ebola waste perform efficacy tests Continued on page 18

oct-dec 2014

Medical Waste Management

news briefs

CDC Releases New Reports on Ebola Cases in Liberia and the United States

he effort to contain the Ebola epidemic in Liberia is showing preliminary signs of progress in some counties, but maintaining and extending these trends will require sustained efforts, according to three early-release articles in CDC’s Morbidity and Mortality Weekly Report (MMWR) on November 14. The three reports are among six MMWR articles on Ebola recently released by the CDC. One of the six reports provides an overview of the complex and rapidly changing situation in Liberia. There is widespread distribution of disease in urban and rural settings. Containing the epidemic will require more intensive efforts to identify new cases and perform contact tracing in the densely populated capital city of Monrovia while rapidly containing outbreaks in hard-to-reach and newly affected areas. Two other reports document a significant decrease in new Ebola cases in two of Liberia’s 15 counties. Nevertheless, new cases continue to occur in these areas. United States, Liberian and international partners are now responding to new outbreaks in remote parts of the country as opposed to the larger outbreaks primarily occurring in more accessible areas. In recent weeks, there has been approximately one new outbreak or cluster per day. For comparison, during the past four decades, CDC has responded to approximately one Ebola outbreak every one to two years. The Ebola epidemic in Liberia poses new challenges for response containment efforts. Because small outbreaks will expand if they are not contained quickly, response efforts are being adapted to manage smaller outbreaks in widely scattered, remote areas. Declines in cases in two counties may also be a sign that medical and humanitarian support provided by the U.S. government and its partners – augmented by efforts from local communities and the Liberian government – is helping to slow the epidemic. “The recent decrease in cases suggested by these reports shows how important it is to continue to intensify our Ebola response,” said CDC Director Tom Frieden, M.D., M.P.H. “We have to keep our guard up. In Guinea, cases have increased and decreased in waves; we can’t stop until we stop the last chain of transmission.” Half of Liberia’s Ebola cases have been in Montserrado County, which is home to the capital city of Monrovia with its population of about 1.5 million. Since mid-September there has been a 73 percent decline in admissions to Ebola Treatment Units (ETUs), a 58 percent decline in blood samples testing positive for Ebola, and a 53 percent decline in body collections. Expansion of ETUs, safe burials, and public education and community action appear to be important factors in this improvement. The report warns that Ebola has not been eliminated from Montserrado County. New cases continue to occur, and a reversal of this recent positive trend remains possible. Another report documenting a decrease in Ebola cases in Liberia comes from Lofa County, where Liberia’s Ebola epidemic began. The weekly number of newly reported cases in Lofa decreased from a peak of 153 new cases in the week ending on August 16 to four new cases in the week ending November 1. Weekly admissions to the county’s ETU dropped from a peak of 133 in the week ending August 16 to one new admission in the week ending November 1. Results for testing of deceased persons for Ebola were 95% positive from June 8 to August 16 but declined to 25 percent positive during August 24 to November 1. The Ebola containment strategy in Lofa County had several key elements: • Encouraging community behavior change, including safe burial practices. • Establishing an ETU • Setting up a local Ebola hotline and outreach teams that quickly transported people with Ebola symptoms to the ETU

Initiating active case finding, which means rigorously identifying and following up with contacts of patients with Ebola • Training community volunteers to monitor patient contacts for Ebola symptoms The strategy recently implemented in Lofa County might serve as a model for reducing transmission of Ebola, but the report warns that new Ebola cases continue to be reported in Lofa County, and continued vigilance is needed there and in other affected areas, including Guinea and Sierra Leone. A separate MMWR article released recently explores how healthcare workers in West Africa were at increased risk of Ebola infection if they were not working in ETUs. This report, which covers events before mid-August, highlights the importance of recent key efforts of the international Ebola response in West Africa, such as establishing more ETUs and strengthening infection control in all healthcare facilities. Isolating infected patients is essential for preventing transmission. Historically, this has been accomplished by caring for infected persons in specialized ETUs with strict isolation and infection control protocols, including guidelines for patient movement, physical layout, disinfection, and use of personal protective equipment (PPE) designed to protect health care workers and patients. CDC disease detectives and Liberia’s Ministry of Health investigated 62 Ebola cases before mid-August 2014 among healthcare workers not working in ETUs. The cases fell into 10 clusters, seven of which were primarily associated with hospitals. “Healthcare workers in West Africa are on the front lines of the fight against Ebola. Protecting these workers will help stop the Ebola epidemic in West Africa at it source,” says CDC Director Tom Frieden, M.D., M.P.H. “Recent investments in infection control training and equipment in West Africa can reduce risk, protect workers and patients, help stop Ebola at the source, and reduce risks of spread of Ebola globally.” The investigation found that in four of the 10 clusters, healthcare workers contracted Ebola from patients who had been admitted to a hospital and were suspected to have Ebola but did not yet have a confirmed diagnosis. In another four clusters, healthcare workers contracted Ebola from patients who were initially thought to have another diagnosis but eventually tested positive for Ebola. In one cluster, healthcare workers contracted Ebola from a patient who initially tested negative for Ebola but was tested later and came back positive. During past Ebola outbreaks, up to 25 percent of cases have been among healthcare workers. Factors in healthcare worker infections in Liberia included: • inconsistent recognition/triage of Ebola patients; • overcrowding of hospitals/clinics; • limitations in physical layout of hospitals; • lack of training in PPE and inadequate supply of PPE; and, • limited supervision of and adherence to infection control. The report notes that the immediate consequences of Ebola among healthcare workers in West Africa are closure of health facilities, loss of routine services, grief and fear among healthcare workers, and public mistrust of healthcare workers and health facilities. All undermine the overall Ebola response effort. Since August 2014, the U.S. government and a consortium of partners have worked with the Liberian Ministry of Health to strengthen the infection control infrastructure and training in non-ETU health facilities. Infection control specialists will be embedded in non-ETU facilities. In addition, U.S. Public Health Service medical staff have opened the Monrovia Medical Unit which is a 25-bed facility dedicated to treating medical care workers in Liberia who contract the Ebola virus.

•

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Medical Waste Management

news briefs

North Dakota Facility Designated Ebola-Related Waste

ismarck, N.D. – According to an Associated Press article on SFGate. com, Ebola waste could be sent to a medical waste incineration facility in North Dakota. Officials at Healthcare Environmental Services Inc., located in Fargo, say the plant would accept Ebola-contaminated waste from other states on a case-by-case basis. As of October, the company announced it did not currently have any plans to do so. Chad Wold, the company’s director, said, “We are not actively engaged in looking for Ebola-contaminated waste,” Wold said. “If someone outside the tri-state area desperately needs our help, we would consider it.” Healthcare Environmental Services is a subsidiary of Sanford Health, which has been designated by North Dakota’s Health Department to handle any Ebola cases. The Fargo incinerator handles about 6 million pounds of medical waste each year originating from North Dakota, South Dakota, Minnesota, Wisconsin and California. Wold acknowledged contingency plans for Ebola-related waste are underway by companies in some of the states that send medical waste to the Fargo facility. “Any Ebola waste shipped to incinerators would have to follow “rigorous” federal packing, shipping and tracking guidelines, said Steve Tillotson, assistant director for North Dakota’s Health Department’s waste management division. If the Fargo facility handled any Ebola waste, a state Health Department official would be on site to monitor, Tillotson said. “We’d want to make sure they’re following their permit to the letter, and probably encourage the incinerator owner to take a few additional precautions, as well,” he added. Two North Dakota landfills and the state Health Department have approved disposal of ash from Ebola waste. The federal Centers for Disease Control and Prevention says incinerated Ebola waste poses no danger.

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Medical Waste Management

oct-dec 2014

news briefs

Decontamination Using Electron-Beam Technology

ollege Station, TX – A Texas A&M AgriLife scientist thinks he has come up with an effective alternative for sanitizing equipment and wastewater contaminated by Ebola virus, reports Newswise.com. Dr. Suresh D. Pillai, director of the National Center for Electron Beam Research, believes that eBeam, or electron-beam sanitation, could be safer and less costly than the methods currently being used. What is an electron beam? eBeam is essentially an intense heat ray that results when free electrons in a vacuum are manipulated by electric and magnetic fields to form a fine beam. The kinetic energy of the electrons can be controlled electronically and with great precision. Disinfection occurs at the point where the beam collides with particles of solid-state matter. Pillai has been running tests using a 10-million electron volt, 18-kilowatt, electron beam, device located in the university’s AgriLife Center. The device has an automated conveyor on which test materials to be disinfected are moved beneath the eBeam. The device is being used for research in food safety, food quality, environmental protection and aerospace applications, Pillai says. Lower voltage eBeam technology has been used effectively for sterilizing medical devices and equipment – and even food, such as in the decontamination of spices. Two benefits of electron-beam technology for healthcare applications are that it runs on regular, commercial electricity and it avoids use of radioactive isotopes or chemicals. Electron-beam technology is also scalable, according to Pillai. “This is a technology that is already available off–the-shelf,” he says. “It is adaptable to municipalities and cities and even hospitals for wastewater treatment and other applications.” The initial high cost of eBeam has spurred studies and entrepreneurial activity to develop mobile units that could be transported to the site to sterilize disposal equipment and treating wastewater streams. “They wouldn’t be really small but relatively miniaturized, in the sense they could be transportable on one, maybe two trailer trucks,” Pillai says. “Unfortunately, there are lots of naysayers who talk about negative aspects of this technology without actually understanding it,” he said. “One of the goals of the [AgriLife] Center is to educate decision-makers and the general public about the benefits of this technology. It is extremely important for an advanced country like the United States to adopt this technology to solve some of the contemporary challenges we face, such as infectious waste.”

Gundersen Health System Achieves Energy Independence

a Crosse, WI – Wisconsin’s Gundersen Health System is now producing more energy than it consumes, according to a ThinkProgress.com article. Gundersen Health System is a network of hospitals, medical clinics, nursing homes and other health facilities. The system has invested $30 million of its own money and leveraged $11 million in state and federal grants to reach the goal that it set in 2008. Gundersen’s energy efficiency has improved by more than 40 percent, resulting in annual financial savings of nearly $2 million from conservation alone. Regional partnerships in energy creation include dairy digesters, wind turbines, and a landfill gas-to-energy initiative. Local projects also include geothermal energy and a biomass boiler. Rounding out the green energy mix is solar power from the solar panels installed on the hospital’s parking decks. “We are keeping nearly 477,000 pounds of particulates out of the atmosphere each year,” said Gundersen CEO Jeff Thompson. Another big area of improvement is waste reduction. Gundersen has cut hazardous and pharmaceutical waste by 40 percent since 2010. Recyclable cups have replaced Styrofoam ones and the company has reduced its food waste 70 percent. Training staff to use nearly all parts of vegetables and donating leftover food to the Salvation Army account for most of the food waste reduction. About 200 hospitals across the U.S. use cogeneration, a cost-effective and efficient power strategy that captures heat from the energy generation process and turns it into more energy.

www.bemishealthcare.com

oct-dec 2014

Medical Waste Management

news briefs

CDC Increasing Supply of Ebolaspecific Personal Protective Equipment for U.S. Hospitals

www.weimaamerica.com

info@weimaamerica.com

he Centers for Disease Control and Prevention (CDC) has ordered $2.7 million in personal protective equipment (PPE) to increase Strategic National Stockpile (SNS) supplies to assist U.S. hospitals caring for Ebola patients. Products are being configured into 50 kits that can be rapidly delivered to hospitals. Each kit can provide the PPE needed by clinical teams to manage the care of one Ebola patient for up to five days. Purchases are based on PPE guidance for caring for Ebola patients that was issued by CDC on October 20. As product is delivered to SNS facilities, it is assembled into kits by SNS personnel. The kits can be rapidly delivered from the SNS as requested to those hospitals that receive suspected or confirmed Ebola cases but may need additional PPE supplies that otherwise are not immediately available. Although the number of kits is limited, they will help address shortterm PPE needs. Purchases include impermeable gowns, coveralls, and aprons; boot covers; gloves; face shields and hoods; N95 respirators; powered-air purifying respirator systems and ancillaries; and disinfecting wipes. Since the issuance of the CDC guidance, there has been a sudden increase in demand for PPE. Across the United States, availability for these products varies by product type and model, requested quantity, manufacturer, distributor, and geographic region. “We are making certain to not disrupt the orders submitted by states and hospitals, but we are building our stocks so that we can assist when needed. Some of these products are not normally used by hospitals for regular patient care,” said Greg Burel, director of CDC’s Division of Strategic National Stockpile. There are alternatives that can be used in the event certain products are unavailable, and those alternatives are included in CDC’s guidance. Hospitals should coordinate with their state public health departments if there is a need to request PPE supplies from CDC to care for an Ebola patient. The state health department will follow the established protocol for submitting this request to CDC. The latest CDC PPE guidance is available at http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html.

Pittsburgh-Area Hospitals Recognized for Infection Control

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Medical Waste Management

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ittsburgh, PA – Four Western Pennsylvania hospitals have been recognized for making significant improvements in hospitalacquired infection (HAI) control, reports post-gazette.com. Teams from Allegheny Valley Hospital, along with VA Pittsburgh Healthcare System, took first place honors and prizes in the Fine Award for Teamwork Excellence in Health Care competition. Each hospital’s Platinum Award came with a $25,000 cash prize. The competition, conducted along with the Jewish Healthcare Foundation, challenges Pittsburgh-area hospitals to overcome various obstacles in healthcare. The judging panel is made up of 15 experts in their fields. Allegheny Valley Hospital received the prestigious Platinum award for consistently reducing hospital-acquired infections for three consecutive years. The hospital made huge strides in driving down its clostridium difficile (C. diff) infection rate, which had been running higher than the national average. “Infection control prevents unnecessary pain, expense, and death. Pain management relieves suffering, and it gives patients hope and a greater measure of control of their lives. Both processes relieve the anguish of patients’ families and caregivers,” said Foundation chairman, Milton Fine. Other hospitals recognized for HAI control were St. Clair Hospital in Mt. Lebanon, which won the $15,000 Gold Award for reducing surgical site infections, and Children’s Hospital of Pittsburgh of UPMC, which won the $10,000 Silver Award for a central line infection reduction project.

2014

Medical Waste Management NEWS

buyers guide Directory ’

category listings

Air & Surface Cleaning/ Disinfection Systems 1 Priority Env. Svcs., Inc Abatement Technologies Advanced Vapor Technologies, LLC AmeriVap Systems, Inc Biomist, Inc Bioquell Inc Cleanint Daylight Medical Hygiena Infection Prevention Technologies, LLC sBioMed LLC Steriliz TRU-D LLC TSK Products UltraViolet Devices Inc UVAIRx Inc Vaportek Inc Xenex Healthcare Services

Alternative Energy Systems NewWay Global Energy PEAT International Inc SunWize Technologies Inc ZeroWaste Energy Systems

Automated Equipment & Container Cleaning Systems Aaqua Tools ARE Industries Hubscrub Company McClure Industries, Inc

Balers & Compactors Allegheny Shredders American Baler Co Compaction Technologies Harris IPS Balers Mfg J.V. Manufacturing, Inc Marathon Equipment Company San-I-Pak Inc

Containers (Pharmaceutical, Medical Waste & Sharps) BD Medical Covidien Daniels Sharpsmart Jake, Connor & Crew Inc McClure Industries, Inc PCM Medical Waste Recycling Post Medical Inc Rehrig Pacific Company San-I-Pak Inc Scott Distribution LLC / Scott Containers Snyder Industries Inc Solutions Inc

Containers / Carts (Linens) Bomac Carts McClure Industries, Inc PCM Medical Waste Recycling Tecni-Quip Carts

ICP Medical JT Environmental Consulting Kessler Consulting Inc Medasend Biomedical Inc MedAssure One Sustainabile Method Recycling LLC Pharma-Cycle Inc Prime Compliance Quest Recycling Services, LLC San-I-Pak Inc Sharps MD Sioux Services LLC Solid Waste Solutions Corp SRI Surgical Stericycle Visionary Solutions LLC

Containers / Carts (Recycling & Document Storage) Big Dog Shred Bins Bomac Carts Jake, Connor & Crew Inc Jedstock Inc McClure Industries, Inc Rehrig Pacific Company Schaefer Systems International, Inc Scott Distribution LLC / Scott Containers Solutions Inc Tecni-Quip Carts Toter Inc

Food Waste Containers & Compostable Bags BioBag Ecosafe Zero Waste Jake, Connor & Crew Inc Natur-Tec®

Sodexo

Janitorial Supplies & Services

Hazardous Gas Collection Systems

Century Products LLC Geerpres Inc Jani-King International, Inc Unifirst Corporation Rubbermaid Commercial Products LLC TL Services, Inc

Class 1 Inc

Hazardous Waste Disposal & Infection Compliance Services Aristea Sustainability Assured Waste Solutions Badrick Consulting Clean Harbors Curtis Bay Medical Waste Svcs. Golder Associates Inc

oct-dec 2014

Healthcare Facility Management Services HHA Services

Laboratory Solvent Recycling Systems B/R Instrument Corp

Medical Waste Management

2014 Liquid Waste Disposal Systems (Biohazardous) Ansell Sandel Med. Solutions Bemis Health Care Dornoch Medical Systems, Inc Liquitech, Inc Stryker

Medical Waste Device Recycling Implant Recycling Stryker

Medical Waste Treatment Systems (Autoclaves, etc) The Bell Process BioMedical Technology Solutions Bondtech Corporation Clean Waste Systems ECODAS Honua Technologies The Mark Costello Co OnSite Sterilization, LLC OZONATOR Industries Red Bag Solutions ReGen LLC San-I-Pak Inc SteriMed Medical Waste STI Biosafe

buyers’ guide

category listings

Palmero Health Care Parker Laboratories Proctor & Gamble Professional Disposables Intl Resurgent Health & Medical Safety-Med Products Spartan Chemical Co, Inc Sporicidin by Contec, Inc Surfacide UltraClenz Vital Vio Wexford Labs Xpedx

Motorized Carts, Tugs & Lifting Systems Bayne Premium Lift Systems PHS West Inc Red Devil Equipment Co

Odor Control West Sanitation Services Inc Zorbx

Recycling Services Battery Solutions BCS Call2Recycle Heritage Environmental Services Metal Conversion Technologies, LLC Sustainable Solutions

Shredding Equipment (Plant-Based & Office Shredders)

Sanitizing Products, Hand Cleaners & Dispensing Systems Betco BioMed Protect, LLC Clorox Professional Products CS Medical, LLC Deardorff Fitzsimmons Corp Dial Corp, A Henkel Company Ecolab Inc Elyptol, Inc Evolon/Freudenberg Co. Georgia-Pacific Professional Germ Pro Products GOJO Industries Inc Kimberly-Clark Professional Micro-Scientific®

Allegheny Shredders Cumberland Engrg. Corp MBM Corporation Harris Republic Machine Security Engineered Machinery Co Shred-Tech UNTHA America Vecoplan, LLC WEIMA America, Inc Whitaker Brothers

Tracking Devices & Software (Healthcare) Walsh Integrated

Spill Control Materials

Trade Associations American Society for Healthcare Engineering (ASHE) Assoc. for the Healthcare Environment (AHE) Copper Development Association Inc Practice Greenhealth

Uniforms & Work Clothing Unifirst Corporation

Waste Tracking & Routing Software (Medical Waste Collection & Transport) Clear Computing eRouteIt, LLC EZshred Software Imec Technologies Inc PC Scale Inc™ RouteOptix Mgmt Systs Inc

X-Ray Film Recovery/ Silver Reclamation AG Medical Systems Inc Arch Enterprises, Inc Commodity Resource & Environmental Inc Pyromet Silver Refiners Rochester Silver Works LLC United DMS of Tennessee LLC

SorbTech Mfg, Inc UltraTech International

Who Reads Medical Waste Management News? ➤

2391 Hospital Facility Executives

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689 Hospital Facility Engineers

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1658 Hospital Environmental Services Directors, Sustainability Coordinators and Infection Control Managers

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687 Infectious and Non-Infectious Waste Transporters and Disposal Companies

If you would like to advertise your products or services to this market, please contact Rick Downing at 440-257-6453 or rickdowning@oh.rr.com. 10 Medical Waste Management

oct-dec 2014

2014 A

1 Priority Environmental Services, Inc Fort Worth, TX (817) 595-0790 www.go1priority.com

Aaqua Tools

Rancho Cordova, CA (800) 777-2922 www.AaquaTools.com

Abatement Technologies Suwanee, GA (800) 634-9091 www.abatement.com

Advanced Vapor Technologies, LLC Everett, WA (800) 997-6584 www.advap.com

AG Medical Systems Inc Lake in the Hills, IL (800) 262-2344 www.amsstoreandshred.com

buyers’ guide

company index American Baler Co

Bellevue, OH (800) 843-7512 www.americanbaler.com

Chicago, IL (312) 422-3800 www.ashe.org

AmeriVap Systems, Inc Dawsonville, GA (800) 763-7687 www.amerivap.com

Ansell Sandel Medical Solutions Chatsworth, CA (866) 764-3327 www.sandelmedical.com

Arch Enterprises, Inc Mexico, MO (800) 835-0478 www.archenterprises.com

Wichita, KS (316) 943-5000 www.areindustries.com

Association for the Healthcare Environment (AHE) Chicago, IL (312) 422.3860 www.ahe.org

PO Box 80 Delmont, PA 15626 (800) 245-2497 Evelyn Jefferson ejefferson@alleghenyshredders.com www.alleghenyshredders.com Allegheny Security Grinders are your solution when the highest level of destruction is required. Utilizing our proprietary single-shaft rotary design coupled with screen sizes ranging from 3/8” to 4”, these powerful grinders provide secure dump and run destruction of confidential documents, digital media, plastics, and various types of medical waste.

The Bell Process

www.thebellprocess.com

American Society for Healthcare Engineering (ASHE)

ARE Industries

Allegheny Shredders

Assured Waste Solutions Gastonia, NC www.assuredwaste.com

Aristea Sustainability & Waste Management Solutions (917) 362-5751 Linda Zengen linda.zengen@gmail.com

B/R Instrument Corp

9119 Centreville Rd Easton, MD 21601 (410) 820-8800 Kathy Ebling kathy@brinstrument.com www.brinstrument.com Recycle, Recover and Reuse waste Xylene, Xylene substitutes, Alcohol and Formalin from the Clinical Laboratory to reclaim lost dollars from solvent purchasing and disposal costs. All B/R Instrument Recycling Systems are based on Distillation by Vapor Temperature for quality, reusable solvents. Recycle solvents indefinitely to meet and exceed sustainability goals.

Badrick Consulting

Portland, OR (503) 539-8704 Tom Badrick tbadrick@aol.com www.badricksustainability.com

Battery Solutions

Howell, MI (800) 852-8127 www.batteryrecycling.com

Bayne Premium Lift Systems Greenville, SC (800) 535-2671 www.baynethinline.com

BCS

Canoga Park, CA (888) 286-7188 www.scrapdr.com

BD Medical

Franklin Lakes, NJ (201) 847-6800 www.bd.com

oct-dec 2014

Bemis Health Care

300 Mill St Sheboygan Falls, WI 53085 (920) 467-4621 Nancy Steinpreis hcg@bemismfg.com www.bemishealthcare.com “Control Today, Protect Tomorrow” with products that collect and dispose of infectious waste. These include our Quick-Drain Liquid Infectious Waste Management Systems; Quick-Fit Suction Liners and Hi-Flow™ and Hydrophobic Rigid Suction Canisters; and Sentinel by Bemis™ Sharps Disposal Containers. See ad on pg 7

Betco

Toledo, OH (888)GO-BETCO www.betco.com

BioBag

Palm Harbor, FL (727) 789-1646 www.biobagusa.com

Big Dog Shred Bins

Poway, CA (855) 792-4050 www.bigdogshredbins.com

BioMedical Technology Solutions, Inc Englewood, CO (866) 525-2687 www.bmtscorp.com

Biomist, Inc

Wheeling, IL (847) 850-5530 www.biomistinc.com Medical Waste Management 11

2014

buyers’ guide

company index

B Continued

Copper Development Association Inc

Bioquell Inc

New York, NY (212) 251-7200 www.copper.org

Horsham, PA (215) 682-0225 www.bioquell.com

Covidien

Mansfield, MA (508) 261-8000 www.covidien.com

Clean Waste Systems

Bomac Carts

201 Badger Parkway Darien, WI 53114 (262) 882-5000 Cindy Lapidakis sales@bomaccarts.com www.bomaccarts.com H e a v y - D u t y u t i l i t y ca r t s a re our specialty. From Recycling, Manufacturing, Shipping/Receiving, Commercial Laundry and Mailrooms, our offering meets a broad range of uses in many industries. See ad on pg 6

Bondtech Corporation Somerset, KY (800) 414-4231 www.bondtech.net

Call2Recycle

Atlanta, GA (877) 723-1297 www.call2recycle.org

Century Products LLC

Greensboro, NC (800) 927-0981 www.centuryproductsllc.com

Class 1 Inc

Cambridge, ON Canada (800) 242-9723 www.class1inc.com

Clean Harbors

Norwell, MA (800) 282-0058 www.cleanharbors.com

3535 Plymouth Blvd Ste 112 Minneapolis, MN 55447 (877) 478-5195 Peter Jude peter@cleanwastesystems.com www.cleanwastesystems.com Clean Waste Systems is the designer, manufacturer, parts and service company for its patented, OMW1000 Ozone Medical Waste Processing System in the United States and foreign markets. Clean Waste Systems specializes in the design and development of ozone-based technologies using Humidizone™ for its sterilization and sanitation processes. See ad on pg 24

Clear Computing

Tinton Falls, NJ (888) 332-5327 www.clearcomputing.com

Cleanint

Georgetown, TX (888)715-0464 www.cleanint.com

Clorox Professional Products

Oakland, CA (800) 537-1415 www.cloroxprofessional.com

Commodity Resource & Environmental Inc Burbank, CA (818) 843-2811 www.creweb.com

Compaction Technologies Mendota Hts, MN (877) 860-6900 www.compactiontechnologies.com

12 Medical Waste Management

oct-dec 2014

CS Medical, LLC

Creedmoor, NC (877) 255-9472 www.csmedicalllc.com

Cumberland Engineering Corp New Berlin, WI (262) 641-8600 www.cumberland-plastics.com

Curtis Bay Medical Waste Services Baltimore, MD (855) 228-1715 www.curtisbayenergy.com

E ECODAS

59100 Roubaix France +33 3 20 70 98 65 www.ecodas.com

Ecolab Inc

St Paul, MN (877) 927-9726 www.ecolab.com

Ecosafe Zero Waste

Surrey, BC Canada (604) 560-5133 www.ecosafezerowaste.com Elyptol, Inc Santa Monica, CA (424) 500-8099 www.elyptol.com

eRouteIt, LLC

Lincoln, NE (402) 202-2518 www.erouteit.com

D Daniels Sharpsmart

Chicago, IL (312) 546-8900 www.danielsinternational.com

Daylight Medical

Middleburgh Hts, OH (800) 459-8500 www.daylightmedical.com

Deardorff Fitzsimmons Corp Merlin, OR (888) 582-2700 www.dfcorp.us

Dial Corp, A Henkel Company

Scottsdale, AZ (800) 253-DIAL www.dialprofessional.com

Dornoch Medical Systems, Inc Riverside, MO (888) 466-6633 www.dornoch.com

Evolon/Freudenberg Company

3500 Industrial Dr Durham, NC 27704 (919) 479-7212 Eva Welsh eva.welsh@freudenberg-nw.com www.evolon.com Evolon Microfilament Technology is a new generation of high performance cleaning, proven to remove 99.9% of bacteria without use of disinfectants. Evolon’s outstanding properties result from a worldwide-patented technology from the Freudenberg Group. Freudenberg is one of the world’s largest producers of nonwovens, with 21 manufacturing or processing sites in 13 countries.

2014 E Continued

EZshred

PO Box 8 Chesterland, OH 44026 (877) 392-7123 Tiffanie Julian tjulian@ezshred.com Built for shredding companies, EZshred is a simple to use software system to run your shredding business. From scheduling and routing to invoicing and reporting, EZshred gives you time to manage and grow your business. Ask about our cutting-edge handheld barcode scanning, GPS, recycling or medical waste solutions as well!

Geerpres Inc

Muskegon, MI (231) 773-3211 www.geerpres.com

buyers’ guide

company index HHA Services

St Clair Shores, MI (800) HHA-1140 www.hhaservices.com

Honua Technologies

Jedstock Inc

Hubscrub Company

Manchester, NH (603) 624-4243 www.hubscrub.com

Hygiena

Camarillo, Ca (888) HYGIENA www.hygiena.com

Imec Technologies Inc

Atlanta, GA (866) 435-5647 www.gppro.com

Germ Pro Products

IPS Balers Mfg

Akron, OH (800) 321-9647 www.gojo.com

Harris

Cordele, GA (800) 468-5657 www.harrisequip.com

Heritage Environmental Services (877) 436-8778 www.heritage-enviro.com

McClure Industries, Inc.

9051 SE 55th Ave Portland, OR 97206 (503) 777-2821 Richard Michael richard@mcclureindustries.com www.mcclureindustries.com McClure Industries, Inc. manufactures over 80 models of Sanitrux laundry, linen and trash carts. Sanitrux are ASTM-E tested and certified Class II fire retardant and meet or exceed all NFPA fire codes. Sanitrux are specifically designed for the tough commercial environment.

Kimberly-Clark Professional

Roswell, GA (678) 352-6207 www.kcprofessional.com

Lombard, IL (630) 693-0500 www.liquitech.com

Auburn Hills, MI (800) 359-9855 www.infectionpreventiontechnologies.com

GOJO Industries Inc

Tampa, FL (813) 971-8333 www.kesconsult.com

Implant Recycling

Georgia-Pacific Professional

Tampa, FL (800) 966-5367 www.germproproducts.com

Kessler Consulting Inc

Infection Prevention Technologies, LLC

North Charleston, SC (800) 223-2508 www.mbmcorp.com

Middlesex, NJ (732) 356-7888 www.jedstock.com

Champaign, IL (217) 643-7488 www.imec.ie

solutions@golder.com www.golder.com

MBM Corporation

Addison, TX (800) JANIKING www.janiking.com

Honolulu, HI (808) 523-3140 www.honuatech.com

Detroit, MI (877) 446-4544 www.implantrecycling.com

Golder Associates Inc

Jani-King International, Inc

Liquitech, Inc Environmental Solutions

Marathon Equipment Company

Medasend Biomedical Inc Garden Grove, CA (800) 200-3581 www.medasend.com

Vernon, AL (800) 269-7237 www.nexgenbalers.com

MedAssure

Farmingdale, NJ (732) 363-7444 www.medassureservices.com

Baxley, GA (800) 280.2313 www.ipsbalers.com

Metal Conversion Technologies, LLC

J.V. Manufacturing, Inc Springdale, AR (800) 678-7320 www.jv.com

JT Environmental Consulting Orlando, FL (888) 583-6826 www.jtenv.com

Jake, Connor & Crew Inc Kitchener, ON Canada (877) 565-JAKE (5253) www.jakeconnorandcrew.com

Cartersville, GA (678) 721-0022 www.metalconversion.com

The Mark Costello Co

15351 Texaco Ave Paramount, CA 90723 (562) 630-7950 www.mark-costello.com Celebrating 57 years of specializing and providing solutions to the most complex situations that have made us the leader in the Waste Handling Equipment, On-Site Medical Waste Sterilization Equipment and Industrial Recycling Equipment in the marketplace. See ad on pg 6 oct-dec 2014

Micro-Scientific® Rolling Meadows, IL (847) 454-0835 micro-scientific.com

Natur-Tec®

Circle Pines, MN (763) 404-8700 www.natur-tec.com

Medical Waste Management 13

2014 N Continued NewWay Global Energy Johnson Creek, WI (920) 988-0686 www.newwayglobal.net

One Sustainabile Method Recycling LLC Louisville, KY (502) 561-3404 www.osmllc.net

OnSite Sterilization, LLC Pottstown, PA (610) 495-8214 www.askonsite.com

buyers’ guide

company index PC Scale Inc™ Oxford, PA (800) 962-9264 www.pcscaletower.com

PCM Medical Waste Recycling

Pinellas Park, FL (727) 547-6277 www.pcmmedicalwasterecycling.com

PEAT International Inc Northbrook, IL (847) 559-8567 www.peat.com

Pharma-Cycle Inc

Newport, RI (617) 755-0883 www.pharma-cycle.com

PHS West Inc

Hanover, MN (888) 639-5438 www.phswest.com

Quest Recycling Services, LLC Frisco, TX (877) 321-1811 www.questrecycling.com

Red Bag Solutions Baltimore, MD (877) 973-3224 www.redbag.com

Red Devil Equipment Co Plymouth, MN (800) 221-1083 www.reddevilequipment.com

ReGen LLC

Cullman, AL (256) 796-7898 www.regenllc.net

PO Box 26030 Regina, SK S4R 8R7 Canada (877) 662-7555 Peter Klaptchuk pklaptchuk@OzonatorIndustries.com www.ozonatorindustries.com OZONATOR is the most energyefficient, cost-effective, odorless, environmentally friendly technology available in the bio-hazardous waste industry. With zero emissions, ease of operation, quick cycle time and low operating costs the OZONATOR is the complete solution to your biohazardous waste needs. See ad on pg 23

Rochester Silver Works LLC

Rochester, NY (585) 743-1415 www.rochestersilverworks.com

RouteOptix Management Systems Inc Kitchener, ON Canada (866) 926-7849 www.routeoptix.com

Rubbermaid Commercial Products LLC Winchester, VA (540) 667-8700 www.rubbermaidcommercial.com

Safety-Med Products Burlington, WI (866) 421-3400 www.safety-med.com

Alpharetta, GA (866) 330-4845 www.postmedical.com

Practice Greenhealth Reston, VA (888) 688-3332 practicegreenhealth.org

Prime Compliance

Wyoming, MI (616) 893-8243 www.thehipaaman.com

Proctor & Gamble Cincinnati, OH (513) 983-1100 www.pg.com

Palmero Health Care

Professional Disposables Intl (PDI)

Stratford, CT (800) 344-6424 www.palmerohealth.com

Orangeburg, NY (845) 365-1700 www.pdipdi.com

Parker Laboratories

Pyromet Silver Refiners

Fairfield, NJ (973) 276-9500 www.parkerlabs.com

Golden, CO (800) 932-7707 www.resurgenthealth.com

Post Medical Inc OZONATOR Industries

Resurgent Health and Medical

Aston, PA (610) 497-1743 www.pyromet999.com

14 Medical Waste Management

oct-dec 2014

Rehrig Pacific Company

4010 East 26th St Los Angeles, CA 90058 (800) 421-6244 info@rehrigpacific.com www.rehrighealthcare.com Combined with a widely recognized commitment to customer service, Rehrig has become a leading supplier to many of the largest and most innovative companies in the world. Now, Rehrig is applying our expertise in secure reusable injection molded containers to help improve the collection of Regulated Medical Waste (RMW) and Sharps. Our new line of products offers sustainable solutions for both generators and disposal companies alike. See ad on pg 2

Republic Machine

Louisville, KY (502) 637-6778 www.republicmachine.com

San-I-Pak, Inc

PO Box 1183 Tracy, CA 95378 (209) 836-2310 Arthur McCoy arthurmccoy@sanipak.com www.sanipak.com Since 1978, San-I-Pak, Inc. has been providing technological solutions for managing infectious & solid waste. San-I-Pak has proven to be a critical component of the patient care infrastructure, especially during times of crisis. Contact us at sanipak@ sanipak.com or (209) 836-2310 to find out how we can help your hospital become more financially and operationally independent.

2014

buyers’ guide

company index

S Continued

Orem, UT (801) 922-1111 www.sbiomed.com

Schaefer Systems International, Inc

Scott Distribution LLC DBA Scott Containers Grapevine, TX (817) 756-6909 www.scottcontainers.com

Security Engineered Machinery Co, Inc Westboro, MA (800) 225-9293 www.semshred.com

Sharps MD

Tarpon Springs, FL (727) 940-5872 www.wastealliance.net

Snyder Industries Inc

PO Box 4583 Lincoln, NE 68504 (800) 351-1363 info@snyderplasticsolutions.com www.medwastecontainers.com Snyder Medical Waste is a special division of Snyder Industries, Inc. and was established in 1957. Snyder’s extensive line of returnable containers is considered the industry standard for the collection and transportation of medical waste. See ad on pg 19

SorbTech Mfg, Inc

Reading, PA (484) 638-1126 www.siouxservices.com

SteriMed Medical Waste Solutions Inc

Gainesville, GA (678) 414-0674 wwwconstantlygreen.net

Farmington Hills, MI (855) 783-7463 www.sterimedsystems.com

Steris Corporation Mentor, OH (440) 354-2600 www.steris.com

Tecni-Quip Carts

Solid Waste Solutions Corp

Louisville, KY (877) 228-2901 www.medicalwastecontainers.com

Sioux Services LLC

Sustainable Solutions

Rochester, NY (855) 882-2013 www.steriliz.us

Gaithersburg, MD (800) 763-3946 www.sodexousa.com

Solutions Inc

295 Pinebush Rd Cambridge, ON N1T 1B2 Canada (800) 465-3214 shred@shred-tech.com www.shred-tech.com Shred-Tech® is globally recognized for designing and manufacturing firstclass reduction systems and shredding machinery to cost-effectively meet your waste reduction and recycling needs. See ad on pg 19

Steriliz

Naperville, IL (630) 861-9000 www.surfacide.com

Sodexo

Evanston, IL (847) 328-5622 www.solidwastesolutionscorp.com

Shred-Tech

Surfacide

Lake Forest, IL (847) 367-5910 www.stericycle.com

sBioMed LLC

Charlotte, NC (704) 944-4500 www.ssi-schaefer.us

Stericycle

Plaistow, NH (570) 371-8464 www.sorb-tech.com

Spartan Chemical Company, Inc

Maumee, OH (800) 537-8990 www.spartanchemical.com

Sporicidin by Contec, Inc Spartanburg, SC (800) 762-3472 www.sporicidin.com

SRI Surgical

Tampa, FL (813) 891-9550 www.srisurgical.com

STI Biosafe

5750 West 80th St Indianapolis, IN 46278 (317) 313-8989 www.stibiosafe.com STI Biosafe has over 15 years of experience in the commercial treatment of medical waste without burning. STI product offerings include units from 300 pounds per hour up to 2 metric tons per hour. STI has engineered products for indoor and outdoor installations. See ad on pg 18

Stryker

Kalamazoo, MI (269) 385-2600 www.stryker.com

oct-dec 2014

TL Services, Inc

Van Buren, AR (877) 474-7227 www.tlservices.com

Toter Inc

Statesville, NC (800) 424-0422 www.toter.com

TRU-D LLC

SunWize Technologies Inc San Jose, CA (866) 476-9493 www.sunwize.com

960 Crossroads Blvd Seguin, TX 78155 (800) 826 1245 Jobeth Reilly tqcarts@tqind.com www.tqind.com TECNI-QUIP is a Cart Manufacturer, offering standard models and custom capabilities for the collection of: Waste, Biohazardous and Recycling. Models are available in Fiberglass, Stainless or Aluminum. Please visit our website www.tqind.com or call (800) 826-1245. See ad on pg 8

Memphis, TN (800) 774 5799 www.tru-d.com

Medical Waste Management 15

2014

buyers’ guide

company index W

T Continued

TSK Products

Walsh Integrated

Eatontown, NJ (732) 982-1090 www.tsk-products.com

Montreal, Que Canada (514) 595-8500 www.walshintegrated.com

UltraClenz

Jupiter, FL (800) 931-8911 www.ultraclenz.com

UltraTech International Jacksonville, FL (800) 764-9563 www.spillcontainment.com

Ultraviolet Devices, Inc Valencia, CA (661) 295-8140 www.uvdi.com

UniFirst Corporation Wilmington, MA (800) 455-7654 www.unifirst.com

United DMS of Tennessee LLC Knoxville, TN (865) 637-2560 www.uniteddms.com

Vecoplan LLC

PO Box 7224 High Point, NC 27264 (336) 861-6070 Bob Gilmore info@vecoplanllc.com www.vecoplanllc.com Vecoplan engineers, manufactures, and provides parts and service on a range of shredders and systems for processing medical waste, destroying confidential records, and recycling scrap. An integral component in turnkey waste sterilization systems, our machines are used to shred sharps, textiles, plastics, and for red bag processing. AAA NAID compliant for secure destruction of paper, film, disks, and hard drives. See ad on pg 20

Visionary Solutions LLC Knoxville, TX (865) 482-8670 www.vs-llc.com

Hampton, NH (603) 601-2304 www.untha-america.com

UVAIRx Inc

Vaportek Inc

Sussex, WI (800) 237-6367 www.vaportek.com

3678 Centre Circle Fort Mill, SC 29715 (888) 440-7170 info@weimaamerica.com www.weimaamerica.com For more than 25 years WEIMA has remained focused on the art of shredding and briquetting. We are passionate about improving these technologies. We invite you to profit from this growing wealth of knowledge and experience by specifying a WEIMA solution to your next challenge - the WEIMA team is ready. See ad on pg 8

West Industries

UNTHA America

Centennial, CO (303) 327-5355 www.uvairx.com

WEIMA America, Inc

291 River St, Ste 202 Troy, NY 12180 (518) 268-1101 Meredith Palmer info@vitalvio.com www.vitalvio.com Vital Vio provides overhead LED lighting solutions that not only illuminates a room with white light, but simultaneously kills up to 99.9% of bacteria. The result is a significant reduction in harmful bacteria like MRSA, C. diff, E.Coli, Listeria, and Salmonella with the simple flip of a light switch.

16 Medical Waste Management

oct-dec 2014

121 Interpark, Suite 104 San Antonio, TX 78216 (800) 553-0069 www.xenex.com Xenex is the only provider of Xenonbased UV, the most powerful, non-toxic and effective way to disinfect. Xenex Germ-Zapping Robots™ produce the only Full Spectrum UV Disinfection that can kill C.diff spores in 5 minutes. Proven effective against c.diff, MRSA and 22+ pathogens. Published in ICHE, AJIC and Journal of Infection Prevention. See ad on pg 5

Baton Rouge, LA (225) 302-5570 www.westindustries.com

Xpedx

Wexford Labs

Kirkwood, MO (800) 506-1146 www.wexfordlabs.com

Vital Vio

Xenex Healthcare Services LLC

Whitaker Brothers

Rockville, MD (800) 243-9226 www.whitakerbrothers.com

Loveland, OH (888) 973-3976 www.xpedx.com

ZeroWaste Energy Systems Kleinburg, ON Canada www.zwes.ca

Zorbx

Strongsville, OH (800) 201-5530 www.zorbx.com

Attention Advertisers !

Now is the time to schedule your 4-color logo/photo listing in next year’s Buyers’ Guide Issue. For more information, contact Rick Downing at 440-257-6453.

Product/Equipment Profiles

1 Minute “Kill and Walkaway” Wipe – Fight Against EV-D68

edline offers a large variety of surface disinfectant wipes, featuring products such as the Micro-Kill Bleach with a 3 minute C-Diff Spore kill time and Micro-Kill ONE with a one minute kill time against organisms such as tuberculosis, enveloped & non-enveloped viruses, bacteria including antibiotic-resistant, and fungi. With respiratory viruses such as the EV-D68 going around, it is more important than ever to properly disinfect surfaces in healthcare settings. When picking out a disinfectant against this particular virus, it is recommended to look for non-enveloped viruses on the labeling such as Poliovirus, Norovirus, and Rhinovirus. MicroKill ONE kills these organisms, and it kills them in just one minute! Additionally, unlike most competitive products, Micro-Kill ONE remains wet for the entire contact time, allowing cleaning staff to wipe the surface and walk away feeling confident that the surface will be properly disinfected. Contact your Medline representative today to learn more about Micro-Kill Disinfectants with some of the fastest contact times and extensive organism kills in the market! For more information contact Medline at 800-633-5463, service@medline.com or visit www.medline.com.

New Ebola Rapid Testing Technologies Will Detect Surface and Airborne Infectious Viruses Onsite, in Minutes

athSensors Inc., a leading biotechnology and e nv i r o n m e n t a l t e s t i n g company, is developing a suite of mobile bio-detection technologies that can quickly detect the Ebola virus and other potentially lethal pathogens used in bioterrorism. The mobile PathSensor systems are easy-to-use, require minimal training and can detect infectious pathogens (virus, bacteria or toxin) from safely obtained samples. Portable PathSensors systems can be deployed for pathogen detection at any port of entry (air, land and water) as well as healthcare facilities and entertainment venues. Onsite personnel can handle testing easily and receive a result in less than five minutes. PathSensors CANARY® technology licensed from the MIT-Lincoln Laboratory delivers extremely rapid detection of more than 25 pathogens at previously unattainable levels of speed and sensitivity. CANARY® incorporates pathogenspecific antibodies expressed on a biosensor surface that, in the presence of a pathogen (virus, bacteria or toxin), trigger an intracellular calcium release that in-turn activates bioluminescent proteins to generate the emission of light. For more information, visit http://www.PathSensors.com, call 443-557-6150 or email info@PathSensors.com.

R-D™ Rapid Disinfector™ Takes the Guesswork Out of UVC Disinfection with the

he Steriliz R-D Rapid Disinfector offers state-of-the-art UVC technology and superior operational performance, at an economical value. Proprietary UVC Challenge Device light sensors definitively measure actual UVC dose delivered to targeted treatment areas and determine if the published UV-C kill dose was delivered to targeted areas of the environment. The R-D is a dose based system that does not rely on time or distance. Key features of this system include: • A definitive way to measure, record and report that published doses of UVC (necessary to kill C.diff.) have been delivered • Eliminates guesswork – built-in program measures irradiation dosage, thereby preventing under- or over-estimating of time necessary to adequately disinfect patient rooms • Measures total UVC light exposure – proven to be more effective in eradicating pathogens versus measuring only indirect UVC exposure • Has demonstrated the ability to reduce room cleaning times by more than 30 minutes compared to competitive systems • Demonstrated savings of $1.25 million and a reduction of 25.8% in C.diff occurrences over 10,000 patient days in one hospital alone For more information contact Steriliz at 855-882-2013, sales@steriliz.us or visit www.rapiddisinfector.com.

Stopping the Spread of Infection With CleanintUV Technology

RSA is a major cause for concern, and cannot be treated with common antibiotics. This “superbug” has made itself at home in healthcare settings, but is also found on household surfaces such as television remote controls and bed linens. CleanintUV generates UV light that destroys the DNA or RNA structure of infectious cells. The CleanintUV technology automatically detects if an object is placed in the chamber, and delivers a lethal dose of UV light, eliminating lingering pathogens. Indicators lights will let you know that it is working. When the “clean” light is on, you know your device is safe to use. CleanintUV can be placed on a desk, cart, nurses station, counters, sign-in areas or mounted on a wall. The CleanintUV is completely portable through the rechargeable battery pack, or can be plugged into any outlet. CleanintUV accommodates common handheld devices such as television remotes, handheld phones, glucometers, pens, pencils, baby bottles, pacifiers and many other items. For more information, contact Cleanint at 888-715-0464, info@cleanint.com or visit www.cleanint.com.

oct-dec 2014

Medical Waste Management 17

medical waste management

Managing Ebola-Contaminated Waste: A Jurisdictional Mess Continued from page 3

with packaging that is as required for a Category A substance and determine if spore kill is achieved and if so at what operating parameters.” Spurgin is correct is assessing that no two treatment technologies are identical and that a technology should be properly tested; but, in practice, there are difficulties with this approach. State agencies have jurisdiction over the approval or permitting of treatment technologies. The term Category A is a DOT classification and is not found in state requirements. Instead, each state creates its own requirements based on its own criteria for approval. Generally, requirements for efficacy in the state permitting process are based on what the DOT would consider Category B waste; therefore, most existing technologies cannot accept Ebola waste without further discussions with jurisdictional state agencies. Some technologies operate with additional U.S. Environmental Protection Agency (EPA) requirements through the Resource Conservation and Recovery Act, registration under the Federal Insecticide Fungicide and Rodenticide Act, or have some management requirements passed on to states through the EPA, such as Clean Air Act requirements for incinerator emissions. None of these EPA requirements are based on the DOT’s category system. Therefore, healthcare waste generators and transporters may obtain a DOT authorization only to find that they do not have a facility to take the waste. Note that the use of chemicals for on-site treatment can reduce the level of risk for purposes of transportation, but may not change the state-determined classification of the waste. Hospital disinfectants have proven effective on hard surfaces such as those found in operating rooms and have been approved for that use at the state level and through the EPA, but none have been fully tested to determine whether they penetrate a typical load of infectious waste. CDC Director Dr. Tom Frieden appeared before Congress in midOctober and was asked about Ebola-contaminated waste. He stated

that the waste can be “readily decontaminated” and can be “killed with bleach.” However, a number of years ago, Underwriters Laboratories (UL) embarked on creating an industry standard for chemical disposal methods for infectious substances. The Healthcare Waste Institute, representing healthcare waste disposal companies, with concerns for worker safety, blocked the UL effort because there was not proof of efficacy for a typical load of infectious waste. Without this testing, states have not approved chemical treatment technologies for infectious waste. In fact, the CDC’s own Ebola-waste guidance states, “Other methods of inactivation (e.g., chemical inactivation) have not been standardized and would need to consider worker safety issues, as well as the potential for triggering other federal safety regulations.”

Preparedness

he National Waste and Recycling Association (NW&RA) that represents municipal solid and healthcare waste management companies issued a press release in early October where President and CEO Sharon Kneiss stated, “Both the healthcare waste industry and the municipal solid waste industry are well-situated to safely manage waste materials from Ebola patients.” Unfortunately, this blanket industry statement is not entirely true. The statement was made before the DOT issued Special Permit 16279 and without discussion at the state level. Some healthcare waste companies, but not all, have filed for party status, but not municipal solid waste companies. In addition, where states are reluctant to allow waste management facilities to accept the waste, companies cannot be “well-situated.” Generally, solid waste companies do not train their employees for infectious substances management. A few employees are trained for purposes of preventing improper loads from healthcare facilities entering Continued on next page

rmckee@stibiosafe.com

www.stibiosafe.com 18 Medical Waste Management

oct-dec 2014

medical waste management Continued from previous page their trucks or landfills or addressing sharps on recycling conveyor belts or stuck in landfill compactor tires. The cost of obtaining the necessary approvals, training employees, and the risk of liability have not been addressed by any agency at the federal or state levels. As Dr. Macgregor-Skinner, a public health preparedness expert at Pennsylvania State University, stated in a Washington Times news article on October 2, “Ebola patients create an enormous amount of waste that is deemed Category A -- highly infectious, able to kill people, with no vaccine – and now you want a private company to say, ‘Yeah we’ll take that waste, no problem!’ That’s not going to happen. We don’t have the logistics organized.” In addition, what we are seeing is disposal technology tested for Ebola-waste only because that is the problem at hand. Instead of following Spurgin’s advice to test operating parameters by using sample spores or test loads of high-risk materials, testing is being conducted for each different disease in a specific, already operating, technology. While different diseases can pose divergent levels of risk, based on the number of Category A diseases, testing by disease as opposed to category or disease-type may not be practical or cost-effective. This also creates a precedent to test at the point when a problem is at hand and not to prepare in advance or for the possibility of an epidemic. According to Hal Miller, General Manager, Larson-Miller, Inc., and chair of the Healthcare Waste Institute, who successfully tested his autoclave for Ebola-contaminated waste, “The biggest problem is not the management of Ebola waste, but ensuring penetration of the load. Some triple wall packaging is not autoclave friendly and we don’t want our employees opening containers. Existing containers were designed for small quantities not the amounts of waste seen coming from Ebola patients.” He added, “Another problem is that landfills may not be willing to accept the waste left after autoclaving. Healthcare waste companies that decide to test their equipment for Ebola waste and obtain a DOT special permit are spending the money to prepare, but may never see a return on their investment. This is a good thing for people, but a difficult business decision to make.” Rob Trabucco, President, with David Fink, General Manager, Medical Environmental Technologies, LLC, stated, “We got ahold of linen from a local linen company, packed it into three red bags and then polydrums placing spores in the middle and ran the drums through our autoclave until we found the right parameters to handle the waste.” When asked why he positioned his company to be Ebola-waste ready when there may never be financial reimbursement for the costs, Trabucco stated, “We gain credibility when the state says we can handle Ebola waste, when the state says we know what we are doing.”

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Refusal to Engage

further complication comes from states that decide they do not want to manage waste from Ebola patients. Despite DOT and CDC requirements and guidance, Louisiana Attorney General Buddy Caldwell obtained a temporary restraining order blocking ash from waste that was already incinerated in Texas from entering the state, i.e. the waste was no longer subject to DOT requirements. Caldwell was blocking Veolia Environmental Services from transporting the ash and Chemical Waste Management, Inc. from accepting the ash at its Louisiana landfill. Missouri Attorney General Chris Koster successfully negotiated with Stericycle, Inc. after filing for a temporary restraining order to get the company’s agreement that it would not bring Ebola waste to the company’s St. Louis facility. Koster used claims of past violations at the facility to force the agreement. Should these states find an Ebola patient at one of their hospitals, their perspective may change. Neither the CDC nor any other federal agency are engaged in these court challenges, leaving waste companies to fend for themselves. “I can’t blame companies for refusing to take the waste, not when the issue is too political and too silly,” said Miller. He added, “No one wants reporters stationed at their gate, but we have to be able to take the waste somewhere. I met with the Department of Environmental Quality in Idaho where my company operates and was told that they would not block my facility from accepting Ebola-contaminated waste, but we did Continued on page 20

www.shred-tech.com oct-dec 2014

Medical Waste Management 19

news briefs

Managing EbolaContaminated Waste: A Jurisdictional Mess

Continued from page 19

not discuss out-of-state waste and other states may not have the same viewpoint.” Fink made the same comment, “We have a verbal agreement from California to allow us to accept Ebola waste and filed to be a party to the DOT’s special permit, but we never discussed with California acceptance of out-of-state Ebola waste. If the issue arises, we hope California Medical Waste will allow it.” For now, some companies will continue to position themselves 1/2 pg 4c horizontal to manage Ebola-contaminated waste and a few states will preapprove this positioning. Mostly, waste will be managed on a caseby-case basis through extensive negotiations among federal and state agencies, healthcare facilities, and waste management companies leaving the waste to fester in administrative limbo until settlement. At least, waste generators now have detailed container specifications acceptable for use. We are still in dire need of a rational, nationally agreed-upon policy for dealing with large quantities of highlyinfectious waste. Alice P. Jacobsohn is a government relations leader and attorney with a focus on assisting industry in understanding regulatory requirements, participating in the legislative and regulatory process, and positioning themselves for growth. She is the former director of the Healthcare Waste Institute. She can be reached at alicej5251@gmail.com.

Mushroom is Source of New Antibiotic

urich, Germany – According to a study published in the Journal of Biological Chemistry, a cap mushroom that grows on horse manure might be the source of a promising new antibiotic. Microbiologists and molecular biologists at the Swiss Federal Institute of Technology in Zurich and the University of Bonn were investigating the interactions between fungi and bacteria when they made the discovery that something in the common cap mushroom, Coprinopsis cinerea (C. cinerea), killed certain bacteria. The “something,” known as copsin, kills many pathogens. The medical implications of copsin are enticing because it is a type of protein, similar in structure and behavior to the kinds of proteins produced by humans, such as those found on the skin and in the mucous membranes. Stunningly, bacteria do not become resistant to copsin, and because of the way copsin binds to fats in the cell walls of bacteria, it prevents bacteria from repairing itself. Markus Aebi, Professor of Mycology and the principal investigator, said, “Whether copsin will one day be used as an antibiotic in medicine remains to be seen. This is by no means certain, but it cannot be ruled out either.” According to Aebi, copsin has likely been used by Coprinopsis cinerea as a first line of defense against bacteria for countless generations - even millions of years. The question is, why has bacteria not adapted? “Fungi have internal instructions on how to use these substances without resulting in selection of resistant bacteria,” Aebi says. Copsin has the potential for unlocking a number of mysteries, including ones that could help solve the problem of antimicrobial resistant (AMR) bacteria. For the near term, copsin could be useful to the food industry. This is because copsin kills many pathogens including Listeria, a type of bacteria that can cause severe food poisoning from consumption of raw milk cheeses and dried meats.

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oct-dec 2014

news briefs

U.S. Air Force Hospital Langley Adds Xenex Ebola-Zapping Robot to Inventory

tanding at 5 feet 2 inches tall, U.S. Air Force Hospital Langley’s newest staff member doesn’t initially have a commanding presence. However, after five minutes, its impact has the potential to save countless lives around the world. The 633rd Medical Group recently received a germ-zapping robot, nicknamed “Saul,” which harnesses the power of technology to destroy viruses – including the Ebola virus. Shortly after the president issued an executive order addressing the critical issue of Ebola, the 633rd MDG responded with cutting-edge technology to protect the health of the service members, their families and the community. The hospital staff partnered up with Xenex Disinfection Services, the company that created Saul, as part of a response plan designated to ensure the 633rd MDG is equipped to handle viruses like Ebola. “We are very proud to be the first Air Force hospital to acquire this robot for disease containment and Ebola virus preparedness,” said U.S. Air Force Col. Marlene Kerchenski, 633rd Medical Group Director of nursing services. “Saul will provide an extra measure of safety for both our patients and our intensive care unit staff.” Xenex robots quickly destroy the microorganisms that cause healthcare associated infections (HAI), such as Clostridium difficile (C.diff), Methicillin-resistant Staphylococcus aureus (MRSA) and the Ebola virus. The Xenex germ-zapping robot works by pulsing xenon, an inert gas, at high intensity in a xenon ultraviolet flash lamp. This produces ultraviolet C (UVC), which penetrates the cell walls of microorganisms including bacteria, viruses, mold, fungus and spores. Their DNA is instantly fused so that they are unable to reproduce or mutate, effectively killing them on surfaces and in the air without contact or chemicals.

Ebola Infectious Waste Disposal Poses Major Challenges

est Africa – Each Ebola patient produces up to 40 times more waste than other patients, according to one expert quoted in a ScientificAmerican.com article. Dr. Daniel Bausch, a professor in the Department of Tropical Medicine at Tulane University and consultant to World Health Organization, notes that the level of waste generated is an issue peculiar to Ebola cases. As with any medical waste, Ebola waste comes from a number of sources – bedding, dressings, medical devices – in short, everything that comes into contact with the patient— as well as patient secretions. But there’s another huge source of waste that must be considered – the PPE, or personal protective equipment, that healthcare workers must to wear. As with any epidemic illness, all this waste must be disposed of carefully and according to guidelines set by the Centers for Disease Control and Prevention. Worn only one time, PPE first must be removed properly and decontaminated before it can be disposed. This process multiplies Ebolainfected waste exponentially. “Relatively small amount of waste comes from the patient himself or herself,” Bausch told Scientific American. “People are having eight to 10 liters a day of diarrheal stools during the acute phases of the illness and then there’s all the other routine waste like needles and gloves.” “In the United States, of course, we are somewhat beholden to higher tech solutions, which in some ways are a little bit more problematic in terms of treating all that waste, and we need autoclaves or incinerators that can handle that sort of thing. It’s not the actual inactivation that’s particularly difficult; it’s just the process of getting the waste from, of course, the frontline of care and interaction with the patients safely to the place where it can be incinerated or autoclaved,” Bausch explained.

WHO Updates PPE Guidelines for Ebola Response

Online Infection Control Training Course Developed for Ebola

eneva, Switzerland – In light of concerns raised by the current Ebola Virus Disease (EVD) virus outbreak, the World Health Organization has completed a rigorous review and is now updating its personal protective equipment (PPE) guidelines for healthcare workers, reports InfectionControlToday.com. To develop the guidelines and accommodate new evidence, the organization has been reviewing PPE use during care of suspected and confirmed EVD patients. These guidelines help to clarify and standardize safe and effective PPE use for protecting healthcare workers and patients. In addition, PPE procurement processes are specified. “These guidelines hold an important role in clarifying effective personal protective equipment options that protect the safety of healthcare workers and patients from Ebola virus disease transmission,” says Edward Kelley, WHO director for service delivery and safety. “Paramount to the guidelines’ effectiveness is the inclusion of mandatory training on the putting on, taking off and decontaminating of PPE, followed by mentoring for all users before engaging in any clinical care.” Gloves, face cover, protective foot wear, gowns or coveralls, and head cover are considered essential to prevent EVD transmission to healthcare workers. The review panel stressed the importance of proper use and other standard infection control precautions. “Although PPE is the most visible control used to prevent transmission, it is effective only if applied together with other controls including facilities for barrier nursing and work organization, water and sanitation, hand hygiene, and waste management,” says Marie-Paule Kieny, assistant director-general of health systems and innovation. In addition, the aim in developing the guidelines was to promote protection against infection while allowing health workers to provide the best possible care to patients with maximum ease, dexterity, comfort and minimal heat-associated stress.

ashington, D.C. – Several healthcare organizations have recognized the crucial need for Ebola infection control education and have come up with a solution – online training, according to AssociationsNow.com. Johns Hopkins Hospital, the Centers for Disease Control and Prevention, and the Association for Professionals in Infection Control and Epidemiology (APIC) came together to look at the problem of educating healthcare workers who treat Ebola patients. Their meetings resulted in the launch of an online program on how to use personal protective equipment (PPE). The training teaches methods previously offered to medical officials by the CDC. Pamela Falk, APIC representative, says the program was designed to support medical training professionals. The program is a collaboration between the Centers for Disease Control and Prevention, Johns Hopkins University, Salesforce Foundation, Miami University, Association for Professionals in Infection Control and Epidemiology, and the Society for Healthcare Epidemiology of America “Infection preventionists have been working around the clock to prepare clinicians for Ebola by training and disseminating information,” Falk said in a news release. “This innovative program will assist [infection preventionists] in training healthcare personnel on proper [personal protective equipment] use through visual demonstrations put in the context of CDC’s new [personal protective equipment] guidance.” The new personal protective equipment training materials are currently available on the CDC website and will soon be made available on iTunes U for downloads to smart devices. The videos will be updated and refined on an ongoing basis based on user feedback and best practices in managing patients with Ebola in U.S. hospitals. oct-dec 2014

Medical Waste Management 21

news briefs

Uncertainties Persist Over Ebola Waste Handling

inneapolis, MN – Rules and protocols for handling Ebola Virus (EVD) waste are in the process of being established across the United States in the aftermath of this Fall’s cases, according to an Associated Press report published on StarTribune.com. The logistics of transporting Ebola waste are being debated across the U.S. Meanwhile, the Centers for Disease Control and Prevention officials say that once incinerated, the virus is dead and the waste poses no danger. Yet, public concern remains an issue. For instance, even though the U.S. Department of Transportation has developed special permitting for shipment of Ebola waste, many commercial contractors are hesitant to handle it. When the apartment where Ebola patient, Thomas Eric Duncan, had been staying had to be cleared and decontaminated, one environmental services company was found that could do the job. And once it was completed, the contents of 140 55-gallon drummed filled with items from the apartment had to go someplace. It went to an incineration plant that could accept the waste and the resulting ashes were then shipped to Port Arthur, TX. Veolia North America, the company that owns the incinerator that burned the waste, was all set to send the ashes to a Louisiana landfill. Then Louisiana officials legally blocked the move, citing public safety concerns. The CDC and other organizations, including Doctors Without Borders, maintain that Ebola virus cannot survive heat above 60 degrees (Celsius) for several minutes. The virus also is sensitive to detergents such as chlorine (beach). Even if concerns can be overcome by scientific proof, disposal logistics loom. In the U.S., Ebola waste is categorized as a Class A infectious substance under federal transportation guidelines, meaning it can cause death or permanent disability. Yet the high volume of Ebola waste makes it different from infectious waste, such as AIDS. The waste also is difficult to manage. The ordinary packaging requirements for Class A waste, which typically consists of needles and blood vials, must be packaged inside two small water-tight containers and then placed inside a third container for transport. But CDC guidelines call for Ebola-related waste to be decontaminated and bagged, then bagged a second time and placed into 55-gallon drums. Associated Press reporters polled 123 hospitals, finding that only a handful had an onsite plan or facility for handling Ebola waste or were in the process of drafting plans. The majority said they relied on outside contractors – and few of those contractors meet state and federal guidelines for handling Ebola waste. Meanwhile, logistics for shipping Ebola waste may have been ironed out with a new permit developed by the U.S. Department of Transportation. Stericycle and South Carolina-based Advanced Environmental Options Inc. both have received federal approvals to transport Ebola waste. Linda Greene, who sits on the Association for Professionals in Infection Control and Epidemiology Regulatory Review Panel, said the new DOT permits provide a measure of security for hospitals wondering whether their existing contractors would handle Ebola waste. Protocols are still evolving, though, she adds. 22 Medical Waste Management

oct-dec 2014

San Francisco Drug Take-Back Law Upheld

an Francisco, CA – Drug makers that sell prescription and over-the-counter medicines in this city must comply with a pharmaceutical waste law, according to an EnvironmentalLeader.com article. The San Francisco Safe Drug Disposal Stewardship Ordinance was drafted originally in 2010. The law requires manufacturers to fund and manage the secure collection and disposal of unused medicine. The measure was put on hold, however, when PhRMA and Genentech agreed to help fund a county-wide pilot drug take-back program. The city and county of San Francisco has become the third municipality in the US to introduce extended producer responsibility (EPR) legislation for pharmaceuticals. EPR laws require drug makers to take part in stewardship programs; pay all administrative and operational costs and fees associated with the stewardship plan; and adequately promote their stewardship plan and outreach to stakeholders, including residents, pharmacists and retailers. King County (Washington State) passed EPR legislation in 2013 after several tries. A similar law had been enacted by Alameda County, but the pharmaceutical industry balked and brought a law suit in 2012. Just this year, however, the law was upheld on appeal in the Ninth Circuit Court.

Technology is the Solution to Ebola Medical Waste Threat at US Hospitals, Not Lowering DOT Safety Standards, Says Healthcare Coalition

he Healthcare Coalition for Emergency Preparedness (HCEP) recently announced that it remains concerned about conflicting Ebola medical waste regulations and confusion over regulations and proper procedures at hospitals across the U.S. HCEP is specifically concerned about untreated Ebola waste leaving the hospital and being transported through communities. According to HCEP, there are simple solutions and technologies available to help hospitals implement appropriate protocols, along with international guidelines regarding infection control procedures and preparedness in our hospitals. The Nebraska Medical Center that treated an American doctor infected with Ebola is a good example for the proper use of safe and effective protocols. HCEP urges local health officials and healthcare providers to work together to ensure: 1) That those already infected (as well as those suspected of or under quarantine) with Category A illnesses (i.e. Ebola) should be routed to hospitals that can properly treat such patients at international standards; 2) Hospitals have proper protocols for handling Ebola waste in the hospital, including on-site treatment; 3) Hospitals perform on-site sterilization of Ebola waste before it’s removed from the facility along with disinfecting liquid Ebola waste before it’s put into a municipal sewer system. “There is no reason for DOT to lower safety standards when there are affordable, existing technologies commonly used today that allow hospitals to properly and safely treat substances infected with Ebola and other dangerous Category A pathogens on-site,” said HCEP Executive Director Darrell Henry. “For example, the Dallas Ebola waste issue could have been remedied quickly by routing the patient to one of the several other local hospitals that can sterilize waste on-site instead of Texas Health Presbyterian Hospital, which didn’t have such capabilities.” Henry added: “Appropriately disinfecting waste on-site instead of trucking it across the city will help promote confidence in our health system and government agencies ability to protect the public.” The HCEP recently sent letters outlining these concerns and solutions to the U.S. Department of Health and Human Services, all state health commissions and the U.S. DOT. In the interest of public safety and of following best practices, the letters encouraged the state and federal agencies to follow the World Health Organization’s (WHO) standards for Ebola waste and asked they help ensure that hospitals have on-site capabilities to sterilize Ebola/ Category A infected waste before removal and transportation through our communities. Around 1,000 hospitals in America have on-site waste sterilization systems in daily use to treat Category A infectious substances. These existing and affordable technologies can kill ALL Category A pathogens such that infected items become sterile, safe for handling by healthcare workers (and even the public), and require no further treatment by hospitals to transport or dispose of with general waste—per various federal government and international guidelines.

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TOP STORIES Managing Ebola-Contaminated Waste: A Jurisdictional Mess PAGE 1 CDC Releases New Reports on Ebola Cases in Liberia and the United States PAGE 4 Decontamination Using Electron-Beam Technology PAGE 7 Mushroom is Source of New Antibiotic PAGE 20 Technology is the Solution to Ebola Medical Waste Threat at US Hospitals, Not Lowering DOT Safety Standards, Says Healthcare Coalition PAGE 22