Measures for the management of Ebola virus disease-associated waste and linen in home settings

February 25, 2015

This document provides guidance for the safe management (handling, containment, transport and disposal) of waste (including linen and sharps) generated in home settings from persons under investigation or confirmed with the Ebola virus disease (EVD).Footnote i  Its use is intended for public health officials and companies providing waste management and environmental cleaning/decontamination services. 

The guidance is based on currently available scientific evidence, standards and regulations, and adopts a precautionary approach where the evidence is lacking or inconclusive.  It is subject to review and change as new information becomes available.

The guidance should be read in conjunction with relevant federal, provincial, territorial and local legislation, regulations, and policies, and adapted to local requirements as necessary.

Table of Contents

EVD-associated Waste and Environmental Contamination

The Ebola virus is categorized as a Risk Group 4 agent, under the Public Health Agency of Canada's Human Pathogens and Toxins Act,Footnote ii as it is likely to cause serious disease and effective treatment is not available.  Waste contaminated with the Ebola virus requires special handling and disposal to prevent exposure to the virus.Footnote 1

All EVD-associated waste is considered regulated biohazardous and includes items (including linen and sharps) contaminated with human blood and body fluids (i.e., respiratory secretions, saliva, emesis, feces, and urine) that warrants special handling and disposal as it may in certain situations present a risk of disease transmission.Footnote 2 EVD-associated waste that has been appropriately incinerated or autoclaved is not infectious and does not pose a health risk.Footnote 3Footnote 4

In addition to the Ebola virus being viable in blood and other body fluids, the Ebola virus has been found to remain viable on solid surfaces (glass, steel, rubber) in the dark for up to six days.Footnote 5 Infectivity has been shown to drop by 90 percent in the first 36 hours,Footnote 6 however, given the low infectious dose required for infection and the severity of the disease, the potential for environmental transmission should be considered.Footnote 5

Recommended Measures for Waste Management/Environmental Cleaning Companies

It is the responsibility of the company providing waste management and/or environmental cleaning services to minimize the risk of exposure to and transmission of infectious diseases.  The following measures are recommended for companies for the safe management of EVD-associated waste and environmental cleaning.

  • Implement a biohazardous waste management and environmental cleaning program with the development of policies and procedures to include the following:
    • protocols for adequate supplies of biohazard waste bags and containers, cleaning supplies, disinfectants, hand hygiene products and personal protective equipment (PPE),Footnote 7
    • protocols for segregating, packaging, labelling, moving, storing and transporting EVD-associated waste (both on- and off-site),
    • methods for keeping records of the quantities of EVD-associated waste generated and disposed of,
    • a list of all regulations and legislation concerning EVD-associated waste that are applicable in the jurisdiction,
    • access to individuals/team trained in hazardous materials, in the event of an off-site accident or spill,Footnote iii
    • all personnel handling EVD-associated waste and/or providing cleaning services should wear appropriate PPE,Footnote 7
    • protocols for regular, ongoing training and education of personnel on proper handling and potential hazards of EVD-associated waste, type and quality of waste containers, and PPE selection  and use, including protocols for safe removal of PPEFootnote 7 (i.e., gloves, fluid-resistant or impermeable gown, fluid-resistant mask with eye goggles or fluid-resistant mask with face shield). Enhanced PPEFootnote 7 (i.e., apron, hazardous material suits, double gloving, head and neck coverings, foot and leg coverings) should be used based on risk assessment, according to company policy.  For information on PPE selection and use, refer to Infection Prevention and Control Expert Working Group:  Advice on Infection Prevention and Control for Ebola Virus
    • provision for regular and ongoing education on Hand HygieneFootnote 8 performed according to company PPE protocol, with alcohol-based hand rub (minimum 60% alcohol) or washing with soap and water, if hands are visibly soiled.
  • Assign only personnel trained and educated in occupational health and safety, IPC practices and appropriate selection and use of PPEFootnote 7 for the management of EVD-associated waste.
  • Develop and implement a monitoring system, using a trained observer, for ensuring consistency in safely putting on and removing PPEFootnote 7 when handling EVD-associated waste and environmental cleaning.
  • Develop and implement protocols for the containment and storage of EVD-associated waste according to company's biohazardous material policies, and for off-site transport in accordance with Transport Canada's Transportation of Dangerous Goods Regulations (TDGR).Footnote iiiFootnote 9
  • Determine capability for/availability of transporting EVD-associated waste within their municipality/region and ensure that waste is disposed of in accordance with local, municipal or regional requirements and regulations and/or bylaws for regulated biohazardous waste.
  • Provide education to personnel on steps to take if a breach in safe handling and containment occurs, resulting in potential exposure to EVD, during the management of EVD-associated waste. This includes:
    • personnel to immediately stop work, safely remove PPEFootnote 7 according to company protocol and leave the area,
    • rinse the affected skin surface with soap and water OR for mucous membrane splashes (e.g., conjunctiva), irrigate with copious amounts of water or eyewash solution according to company's first aid protocol,
    • report immediately according to company's exposure/injury protocol, including notification to Public Health authorities, and
    • adhere to follow-up procedures.Footnote 7Footnote 10

Recommended Management of EVD-associated Waste in the Home Setting

Persons under investigation and persons confirmed with EVD will require hospitalization and involvement of public health officials for follow-up with waste management and environmental cleaning in the home setting. An assessment of the home setting should be done to determine the specific areas/room(s) visibly or potentially contaminated and arrangements made for a company to provide management of EVD-associated waste and for environmental cleaning.

The handling of EVD-associated waste and environmental cleaning in the home setting should not be done by family/other household members or friends.

Examples of waste

Human
blood and other body fluids (urine, feces, emesis, semen, respiratory secretions, saliva).
Linen
sheets, pillow slips, towels, wash cloths.
Other non-sharps
used tissues and PPE, and any items possibly contaminated or contaminated with blood or body fluids (toiletries, clothing, incontinent products/pads), non-fluid impermeable mattresses, pillows, and furniture, and other household items that cannot be cleaned and disinfected.
Sharps
needles, syringes, razors/blades, nail clippers.

Human WasteFootnote 5Footnote 11Footnote 12Footnote 13Footnote 14Footnote 15Footnote 16

LinenFootnote 2Footnote 5Footnote 9Footnote 13Footnote 14Footnote 15

  • Handling, containing and removing linen from the home setting should only be done by trained personnel wearing appropriate PPEFootnote 7 Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings
  • Consider all linen in the specific area/room(s) contaminated linen, whether used or not, and the handling of linen should occur within the area/room(s) deemed requiring decontamination.
  • The following measures are recommended for EVD-associated linen:
    • contain linen at point of use,
    • fold linen inward and handle with a minimum of agitation and shaking to avoid contamination of the air, surfaces and persons,
    • place linen immediately into a sturdy, leak resistant container lined with a leak and tear resistant plastic biohazard bag,
    • do not manually compact linen into the bags,
    • when the bag is two-thirds full, seal securely preventing tearing/puncturing the bag and ensuring no leaks,
    • remove the bag from the container (Note:  this container should stay in the room/area until decontamination completed and relined with a new biohazard bag for next fill),
    • decontaminate the entire outside of the bag by wiping using a disinfectant with a broad spectrum virucide claim with a Drug Identification Number (DIN) and used according to the manufacturer's instructions,Footnote vi
    • place the decontaminated bag into a second biohazard bag and seal securely, preventing tearing/puncturing the second bag and ensuring no leaks,
    • wipe the entire outside of the second bag using a disinfectant with a broad spectrum virucide claim with a DIN, and used according to the manufacturer's instructions,Footnote vi immediately before removing it from the room/area.
  • To move the double-bagged linen from the room/area, personnel should place the double bagged linen in a leak-proof/impervious, puncture-resistant plastic or metal single-use container.  The linen container should be:
    • located at the periphery/outside of the area for taking off PPE to avoid risk of recontamination of the container during PPE removal,
    • securely sealed, clearly labelled and identified as EVD-associated biohazardous material, by a second person wearing appropriate clean PPE, and
    • decontaminated by wiping the entire outside of the container using a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions,Footnote vi immediately before removing the container from the room/area.
    • Containers should not be re-opened once sealed.
  • For moving large or heavy containers, carts with guard rails or raised edges should be used and loaded in a manner that will prevent items from tipping.
  • Carts should be disinfected after each use with a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions.Footnote vi
  • The container should be moved immediately and directly to a designated locked holding area with restricted access and stored as per the company's biohazardous material policy until ready for transport to disposal site.
  • EVD-associated waste storage areas should be clearly marked with a biohazard symbol and kept separate from other storage areas.
  • Containers should be packaged and transported separately in accordance with Transport Canada's TDGR Footnote iii and disposed of in accordance with local, municipal or regional requirements and regulations and/or bylaws for regulated biohazardous waste.

Other Non-Sharps WasteFootnote 2Footnote 5Footnote 9Footnote 13Footnote 14Footnote 15

  • Handling, containing and removal of waste should only be done by trained personnel wearing appropriate PPEFootnote 7 Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings
  • The following measures are recommended for non-sharps waste:
    • contain waste at point of generation,
    • place waste immediately into a sturdy and leak resistant container lined with a leak and tear resistance plastic biohazard bag,
    • do not manually compact waste in the bags,
    • when the bag is two-thirds full, seal securely preventing tearing/puncturing the bag and ensuring no leaks,
    • remove the bag from the container (Note:  this container should stay in the room/area and relined with a new biohazard bag for next fill),
    • decontaminate the entire outside of the bag by wiping using a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions,Footnote vi
    • place the decontaminated bag into a second biohazard bag and seal securely, preventing tearing/puncturing the second bag and ensuring no leaks,
    • wipe the entire outside of the second bag using a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions,Footnote vi immediately before removing it from the room/area,
  • To move the double-bagged waste from the room/area, personnel should place the double bagged waste into a leak-proof/impervious, puncture-resistant plastic or metal single-use container. The container should be:
    • located at the periphery/outside of the area for taking off PPE to avoid risk of recontamination of the container during PPE removal,
    • securely sealed, clearly labelled and identified as EVD-associated biohazardous material, by a second person wearing appropriate clean PPE, and
    • decontaminated by wiping the entire outside of the container using a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions,Footnote vi immediately before removing the container from the room/area.
  • Containers should not be re-opened once sealed.
  • For moving large or heavy containers, carts with guard rails or raised edges should be used and loaded in a manner that will prevent items from tipping.
  • Carts should be disinfected after each use with a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions.Footnote vi
  • The container should be moved immediately and directly to a designated, locked holding area with restricted access and stored as per the company's biohazardous material policy until ready for transport to disposal site.
  • EVD-associated waste storage area should be clearly marked with a biohazard symbol and kept separate from other storage areas.
  • Containers should be packaged and transported separately in accordance with Transport Canada, TDGR,Footnote iii and disposed of in accordance with local, municipal or regional requirements and regulations and/or bylaws for regulated biohazardous waste.

Sharps WasteFootnote 13Footnote 17

  • Sharps should be segregated from other waste and discarded:
    • at point of use,
    • directly into single-use containers, that are leak-proof/impervious, puncture resistant, fitted with securely closed lids and specifically designed for sharps waste.
  • Sharps containers should not be filled beyond two-thirds full, to allow for safe closure.
  • The following measures for sharps containers are recommended:
    • when the container is two-thirds full, securely close the lid,
    • wipe the outside of the container using a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions.Footnote vi
    • place the sharps container into a second leak-proof/impervious, puncture resistant biohazard container,
    • securely seal, clearly label and identify the second container as EVD-biohazardous sharps material,
    • wipe the outside of the second container using a disinfectant with a broad spectrum virucide claim with a DIN and used according to the manufacturer's instructions.Footnote vi
  • The container should be moved immediately and directly to a designated, locked holding area with restricted access and stored as per the company's biohazardous material policies until ready for transport to disposal site.
  • EVD-associated sharps waste storage areas should be clearly marked with a biohazard symbol and kept separate from other storage areas.
  • Containers of EVD-associated sharps waste should be transported separately in accordance with Transport Canada's TDGR,Footnote iii and disposed of in accordance with local, municipal or regional requirements and regulations and/or bylaws for regulated biohazardous waste.

Recommended Management of On-site Spills Related to EVD-associated Blood and Other Body FluidsFootnote vii

  • On-site spills containing EVD-associated human waste (i.e., blood, emesis, urine, and feces) should be managed by trained personnel wearing appropriate PPE.Footnote 7 Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings
  • Spill kits should be made available, according to company policy, for use in designated areas.
  • The spill area should be isolated from access to other individuals until cleaning and disinfection is completed.
  • All spill incidents should be documented, according to company policy.
  • The following cleaning and disinfection measures are recommended:
    • allow fluid and droplets to settle,
    • gently cover the spill with disposable absorbent paper towels, wipes or pads (a solidifier agent may be used); remove organic/bulk material and place waste immediately into sturdy, leak and tear resistant biohazard plastic bag and securely seal, (Refer to Other Non-Sharps Waste section above)
    • with disposable cleaning cloths or wipes, apply a disinfectant with a broad spectrum virucide claim with a DIN to the surface and allow sufficient contact time according to manufacturer's instructions,Footnote vi
    • do not spray disinfectant or use a wet vacuum to avoid any splashes and splatter, and
    • start at one end of the affected area and move in one direction until all surfaces have been disinfected; do not use a circular motion.Footnote 18
  • Use cleaning cloths, wipes, etc., only once and after use, discard all cleaning items immediately into a biohazard bag located within reach. (Refer to Other Non-Sharps Waste section above)

Recommended Environmental Cleaning Measures Related to EVD for Home SettingsFootnote 5

All personnel providing cleaning services should wear appropriate PPE.Footnote 7 Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings.

  • Special cleaning of upholstery and carpets is not indicated unless they are grossly/obviously soiled with blood or other body fluids.
  • Grossly contaminated items (e.g., upholstery/cloth chairs/seats, seat covers or carpets covered in blood or other body fluids) that are difficult to clean should be removed and treated as waste.
  • All surfaces, areas and items/objects visibly contaminated or potentially contaminated with blood or other body fluids should be cleaned and disinfected (i.e., bathrooms, bedrooms, kitchen and all other area – toilets/toilet seats, sinks, faucets, locks, walls, counters, door knobs, light switches, tables/work surfaces, telephones, other high contact surfaces and items/objects).
    • visible blood and other body fluids should be removed first with disposable damp cleaning cloths or wipes and regular detergent,
    • apply a disinfectant with a broad spectrum virucide claim with a DIN to the surfaces/objects and allow sufficient contact time, according to manufacturer's instructions,Footnote vi and
    • allow to air dry.
  • Floors should be cleaned with regular detergent and water, using a mop, and rinsed, then:
    • apply a disinfectant with a broad spectrum virucide claim with a DIN and allow sufficient contact time, according to manufacturer's instructions,Footnote vi and
    • allow to air dry.
  • Do not spray disinfectant or use wet vacuum to avoid any splashes and splatter.
  • Do not use compressed air, pressurized water or similar procedures which might create droplets.
  • Dry sweeping and dusting with a broom or cloth should not be done.
  • Use cleaning cloths, wipes, buckets, mop handles/mop heads, etc., only once and after use, discard all cleaning items immediately into a biohazard bag located within reach (Refer to Other Non-Sharps Waste section above.

References

Reference 1

Public Health Agency of Canada.  Ebolavirus.  Pathogen Safety Data Sheet – Infectious Substances.  August 2014.  Accessed on October 8, 2014

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Reference 2

Government of Canada.  Canadian Biosafety Standards and Guidelines, 1st Edition, 2013.  Accessed on October 8, 2014

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Reference 3

Centers for Disease Control and Prevention.  Ebola-associated waste management. Accessed on October 30, 2014

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Reference 4

World Health Organization. Ebola virus disease (EVD) – Key questions and answers concerning health care waste, December 2014.  Accessed on February 20, 2015

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Reference 5

Centers for Disease Control and Prevention. Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus. Access on October 30, 2014

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Reference 6

Sagripanti JL. Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces.  Arch Virol 2010; 155:2035-2039.

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Reference 7

Public Health Agency of Canada.  Infection Prevention and Control Expert Working Group:  Advice on Infection Prevention and Control for Ebola Virus, December 2014.

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Reference 8

Public Health Agency of Canada.  Hand Hygiene Practices in Healthcare Settings, 2012.

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Reference 9

Transport Canada.  Transportation of Dangerous Goods Regulations (TDGR).

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Reference 10

World Health Organization. Infection prevention and control guidance summary. Ebola guidance package, August 2014. Access on December 22, 2014

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Reference 11

Centers for Disease Control and Prevention. Interim guidance for managers and workers handling untreated sewage from Individuals with Ebola in the United States.

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Reference 12

Centers for Disease Control and Prevention. FAQs on Interim Guidance for Managers and Workers Handling Untreated Sewage from Suspected or Confirmed Individuals with Ebola in the U.S. (2014). Accessed on December 22, 2014

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Reference 13

Centers for Disease Control and Prevention. Procedures for Safe Handling and Management of Ebola-associated Waste. Accessed on Dec 15, 2014

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Reference 14

World Health Organization. Safe management of wastes from health-care activities, 2014. Accessed on December 22, 2014

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Reference 15

Canadian Standards Association.  Standard Z317.10.09.  Handling of waste materials in healthcare facilities and veterinary healthcare facilities.  March 2009.

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Reference 16

World Health Organization (WHO)/ United Nations Children's Fund (UNICEF) 2014. Ebola Virus Disease (EVD). Key questions and answers concerning water, sanitation and hygiene. Accessed on December 24, 2014

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Reference 17

Canadian Standards Association. Standard Z316.6, Evaluation of Single-Use and Reusable Medical Sharps Containers for Biohazardous and Cytotoxic Waste (R4.8.3).

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Reference 18

Public Health Agency of Canada. Environmental Sanitation Practices to control the Spread of Communicable Diseases in Passenger Conveyances and Terminals – June 23, 2014.

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