Ebloa Waste

[Michael Wishart]

[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. ICP’s 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 Substance…in 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 Hospital’s IP’s (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/.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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[Sony SO]

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/.

______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the svha.org.au domain (or any other domain of St Vincents Health Australia Limited or any of its related bodies corporate) (an SVHA Email Address) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

________________________________
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Verily Thomas]

Verily Thomas
Clinical Nurse Consultant | Infection Prevention and Control
SWSLHD-Bankstown/Lidcombe Hospital
Eldridge Road, Bansktown.NSW 2200
Tel 02 97228000 pager 28230
Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
http://www.health.nsw.gov.au

[Description: cid:image002.jpg@01CE8EA5.483A6E60]
LET’S KEEP OUR HOSPITAL ENVIRONMENT CLEAN
HAND HYGIENE SAVES LIVES

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Terry Grimmond
Sent: Friday, 31 October 2014 11:51 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Ebloa Waste

Hi Sony,
I agree with you. But for countries who have harmonized with UNTDG Model Recommendations, Ebola is Category A UN2814. It is not Clinical Waste UN3291. The national law steps in and CDC and DoH recommendations are over-ruled. As happened in USA last month where DOT over-ruled CDC on this issue.
Best regards, Terry
Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph (NZ): +64 7 855 3212
Mob (NZ): +64 274 365 140
E: terry@terrygrimmond.com
[Twitter_logo_blue]: @terrygrimmond
W: http://terrygrimmond.com
[cid:image003.gif@01CFF50D.6D9958E0]
“This email (including any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are reminded that any dissemination, distribution or copying of this email or attachments is prohibited. If you have received this email in error, please notify me immediately by return email or telephone and destroy the original message. Thank you.”

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sony SO
Sent: Friday, October 31, 2014 12:58 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Ebloa Waste

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/.

______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the svha.org.au domain (or any other domain of St Vincents Health Australia Limited or any of its related bodies corporate) (an SVHA Email Address) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

________________________________
***************************************************************************
Disclaimer

This Email may contain privileged and confidential information and is solely for the use of the intended recipient. If you are not the intended recipient, you must not print, copy, distribute or take any action in reliance on it. If you have received this Email by mistake, please notify the sender and then delete this Email from your computer. The Hospital Authority does not accept liability arising from Email transmitted by mistake.

Although this Email and any attachments are believed to be free of virus or other defects that might affect any computer system into which it is received and opened, it is the responsibility of the recipient to ensure that it is virus free, and no responsibility is accepted by the Hospital Authority for any loss or damage in any way arising from its use.

All views or opinions expressed in this Email and its attachments are those of the sender and do not necessarily reflect the views and opinions of the Hospital Authority.
***************************************************************************
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

_____________________________________________________________________
This email has been scanned for the Sydney & South Western Sydney Local Health Districts by the MessageLabs Email Security System.
Sydney & South Western Sydney Local Health Districts regularly monitor email and attachments to ensure compliance with the NSW Ministry of Health’s Electronic Messaging Policy.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

_____________________________________________________________________
This email has been scanned for the Sydney & South Western Sydney Local Health Districts by the MessageLabs Email Security System.
Sydney & South Western Sydney Local Health Districts regularly monitor email and attachments to ensure compliance with the NSW Ministry of Health’s Electronic Messaging Policy.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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[Verily Thomas]

Hi All
This has been a very worrying issue especially considering that what we are most concerned about is blood and body fluids with EBV.We have taken care of the entry side of it but the waste management bit I am not so sure may be wrong.
Is the waste not hazardous if it is not properly treated as in autoclaved, incinerated or treated in any other way to render it nonhazardous? Does our clinical waste guidelines cover this as it would be concerning if this waste is not properly disposed of and ends up being a problem with community spread, just saying. Still trying to figure out which waste it fits under really particularly where the quality of some of the clinical waste bags is not very ideal, as in paper thin, with incidents of body fluid exposure due to tears especially when the bags are very heavy.
Just a thought I have tried to look under the EPA guidelines nothing much coming up on infectious waste would be good to know what the majority are doing.- http://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.html
Kind Regards
Verily Thomas
Clinical Nurse Consultant | Infection Prevention and Control
SWSLHD-Bankstown/Lidcombe Hospital
Eldridge Road, Bansktown.NSW 2200
Tel 02 97228000 pager 28230
Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
http://www.health.nsw.gov.au

[Description: cid:image002.jpg@01CE8EA5.483A6E60]
LET’S KEEP OUR HOSPITAL ENVIRONMENT CLEAN
HAND HYGIENE SAVES LIVES

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Terry Grimmond
Sent: Friday, 31 October 2014 11:51 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Ebloa Waste

Hi Sony,
I agree with you. But for countries who have harmonized with UNTDG Model Recommendations, Ebola is Category A UN2814. It is not Clinical Waste UN3291. The national law steps in and CDC and DoH recommendations are over-ruled. As happened in USA last month where DOT over-ruled CDC on this issue.
Best regards, Terry
Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph (NZ): +64 7 855 3212
Mob (NZ): +64 274 365 140
E: terry@terrygrimmond.com
[Twitter_logo_blue]: @terrygrimmond
W: http://terrygrimmond.com
[cid:image003.gif@01CFF50D.6D9958E0]
“This email (including any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are reminded that any dissemination, distribution or copying of this email or attachments is prohibited. If you have received this email in error, please notify me immediately by return email or telephone and destroy the original message. Thank you.”

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sony SO
Sent: Friday, October 31, 2014 12:58 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Ebloa Waste

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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