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Dear All,
The issue of using single clinical bag for handling infectious materials i.e. clinical waste is addressed in the CDC guidelines-Guidelines for Environmental Infection Control in Health-Care Facilities http://www.cdc.gov/~HCF_03.pdf, details are as follows:
point I, (3), page 119, which states: A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, provided the bag is sturdy and the waste can be discarded without contaminating the bags exterior.
Point G, (3), page 100, which states: Single bags of sufficient tensile strength are adequate for containing laundry, but leak-resistant containment is needed if the laundry is wet and capable of soaking through a cloth bag.1264
Furthermore, with reference to international guidelines related to clinical waste management(Table 1), practices of double bagging of waste is not recommended.
Lastly, practices of double-bagging of items from isolation rooms is not considered as an infection control measure, for details, please refer to:
Maki DG, Alvarado C, Hassemer C. Double-Bagging of Items from Isolation Rooms Is Unnecessary as an Infection Control Measure: A Comparative Study of Surface Contamination with Single-and Double-Bagging. Infection Control. 1986; 7(11): 535-7. Available from: http://www.jstor.org/stable/30146425
Regards,
Sony SO
Nursing Officer, Infection Control Branch (Team 2)
Centre for Health Protection
office phone: +852 2125-2922; fax: +852 3523-0752
HA email sony@ha.org.hk; DH email no_icb4@dh.gov.hk
Please consider the environment before printing this e-mail
Table 1: international guidelines for handling clinical waste
1. Biohazard Waste Industry Australia and New Zealand (BWI) (formerly ANZCWMIG). (2007). Industry Code of Practice for the Management of Clinical and Related Wastes. Retrieved 11 August 2010 from http://www.epa.sa.gov.au/xstd_files/Waste/Code%20of%20practice/Code%20of%20Practice%206th%20Edition.pdf
2. UK Department of Health. Environment and sustainability Health Technical Memorandum 07-01: Safe management of healthcare waste Retrieved August 2014 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf
3. Uk Health & Safety Executive. (2009). Carriage of Dangerous Goods Manual-Carriage of clinical waste Retrieved 11 August 2010 from http://www.hse.gov.uk/cdg/manual/clinical/index.htm
4. World Health Organization WHO. (2008). Safe Management of Wastes from Health-Care Activities. Retrieved August 2014 from http://apps.who.int/iris/bitstream/10665/85349/1/9789241548564_eng.pdf
5. (2003)201410http://www.moh.gov.cn/mohyzs/s3576/200804/18353.shtml
6. (1997)(97) 201410http://wm.epa.gov.tw/medicalwaste/Documents/HandBook39all3.pdf
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Friday, October 31, 2014 5:20 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Ebloa Waste
[This message is posted on behjalf of Belinda Henderson, ACIPC President. Note that this issue has been discussed through the ACIPC Executive Council at National and State/juristictional level. ICPs are urged to check with their state/juristiction authorities and local waste contractors regarding any local impact of this issue Moderator]
We want to update our members on the issue of Ebola Waste transport in Australia. One of our members, Terry Grimmond, has been working with authorities to develop a practical, safe and legal packaging solution so we asked him to summarise where Australia is at.
Thank you Belinda,
Many ACIPC members will have seen the Oct 3 CDNA/AHPPC recommendations for double-bagging Ebola waste and transporting it as clinical waste1 (i.e. shipping as UN 3291). These recommendations are sound and evidence-based.
However, what many may not know is that the Australian Dangerous Good Code (ADG)2 requires substances known or reasonably expected to contain a Category A Infectious Substancein any form (e.g. Ebola waste) to be packaged according to ADG P620 requirements, which require:
a 95k Pa pressure-tested, leakproof primary receptacle that is sealed and placed inside a:
leakproof secondary receptacle containing absorbent material, sealed and placed inside:
a rigid outer container certified to ADG 9m drop, Rod Impact, and Water-spray tests.
The issue is, P620 packaging is designed for specimens, cultures, etc and no P620 packaging exists for large Category A items such as waste bags, mattresses, etc.
If waste companies pick up Ebola waste in anything other than P620 packaging, they would be breaking the law. Alternative packaging systems must be approved as safe as ADG P620.
Submissions need be made to the competent authority (CA) in each state (no Federal CA) and an approval in one state is not applicable in another, so multiple submissions need be made.
With the CDNA recommendation (double-bag and handle as clinical waste (CW), the medical waste firm SteriHealth saw the compliancy issue early (same occurred in USA with CDC and DOT) and retained me to work with CA to develop a triple-packaging system of equivalent safety to ADG. The Biohazard Waste Industry is also working with CA to obtain packaging approvals.
I worked with WorkCover NSW for several weeks and, after developing a leakproof sealing system for CW bags, and consultation with Westmead Hospitals IPs (Kath Dempsey, Jo Tallon), we have developed a triple-packaging system we believe is of equal safety to ADG P620. Multi-sized systems will need be approved but in this instance I submitted a system with a high chance of approval so that at least one system was available.
WorkCover NSW hope to release their decision tomorrow [31 October Moderator]. Hopefully an approval in NSW will make submissions easier and faster in other states.
Yesterday [29 October Moderator] I spoke with Prof Lyn Gilbert, Head of Ebola Task Force and Prof Chris Baggoley, Chief Medical Officer, Australian Dept of Health and they have scheduled the item for discussion this week to examine means of expediting the submission process Australia-wide.
Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist, Grimmond and Associates
terry@terrygrimmond.com
1. Ebola Virus Disease (EVD). CDNA NATIONAL GUIDELINES FOR PUBLIC HEALTH UNITS 3 Oct 2014. Communicable Disease Network Authority, Australian Department of health. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm/$File/EVD-SoNG.pdf.
2. The Australian Dangerous goods Code Ed 7.3(2014). http://www.ntc.gov.au/heavy-vehicles/safety/australian-dangerous-goods-code/.
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