Tuesday, July 8, 2014

Ebola Pandemic in West Africa. Comprehensive Plan, Holistic Approach. Medical Waste Considerations

EM planners:

As part of any comprehensive plan during disease outbreak (endemic, epidemic, pandemic) disease containment practices must be strictly adhered to.

Patient identification, isolation, treatment, proper disposal of medical waste, and human remains of deceased handled with some form of religious practice and customs which may not be safe or practical.

Current focus has been on the Ebola pandemic affecting West Africa nations, World Health Organization (WHO), Doctors without Borders, and other organizations assistance in response to these outbreak in each regional nation involved.

The following information is not a comprehensive plan of action, but only one portion of an entire plan for addressing medical disease containment that must be considered by emergency planners.  A constant review, table-top exercises, and other procedures to ensure plans are effective and up to date.  

Medical equipment and suppliers shall always have to be included in every aspect of your planning process.  

Your local public health office\agency should provide additional guidance, and policy.


Charles D. Sharp
Chief Executive Officer
Black Emergency Managers Association  
1231  Good Hope Road  S.E.
Washington, D.C.  20020
Office:   202-618-9097 
bEMA 
“Our lives are not our own. We are bound to others, past and present, and by each crime and every kindness, we birth our future.” ¯ David Mitchell, Cloud Atlas


Medical Waste Considerations for Waste Handlers
MEDICAL WASTE CONSIDERATIONS

Overview
§ AIDS
Why Should You Be Concerned About Medical Waste?
Hospitals, clinics, nursing homes, laboratories, doctors' and veterinarians' offices, private households-and many other places-have to dispose of materials that have been used in medical care or treatment. Some of this material is infectious-that is, it has the potential to cause some kind of infection and/or disease. Examples of medical wastes are used "sharps"-hypodermic needles and syringes, IV needles, scalpel blades, and glass items; items containing or soaked with blood or certain other body fluids; human or animal organs or body parts; lab cultures that may contain disease-causing agents; and things like gloves, bedding, dressings, sponges, and other items that have been used in surgery, autopsy, or treatment of patients with certain contagious diseases.
It is possible for medical waste to cause infection and/or disease if it enters the body through broken skin or puncture wounds; if it splashes into the eyes, nose, or mouth; if it is inhaled; or if it is swallowed.
Medical waste may be dangerous for other reasons besides the risk of disease-for example, sharps can cause cuts. Some of the material disposed of by hospitals and other health care facilities may be hazardous for other reasons. It may contain hazardous chemicals, or low-level radioactive wastes. If the medical waste contains hazardous waste or radioactive waste, it cannot go to solid waste landfills.
On the other hand, not all waste created at such facilities is dangerous. Hospitals contain offices and cafeterias that create waste that is not dangerous, and much of the waste generated by patient care poses no threat at all to landfill workers. Even materials that have been classified as medical waste will not always cause disease-they merely pose a risk that must always be considered in handling, storage, transportation and disposal.
This information will outline current practices for disposing medical waste, partially summarize the regulations covering medical waste disposal, explain the specific and general risks that medical waste may pose to you in your job, and suggest ways you can protect yourself from those risks.
How Is Medical Waste Disposed?
The required disposal methods for medical waste depend on the type of waste and on the nature of the facility that created it.
Medical waste disposal by health care facilities and households is subject to regulation at the state level by the Louisiana Department of Health and Hospitals (DHH) and the Louisiana Department of Environmental Quality (DEQ). In addition, all employers except state and local governments are required to dispose medical wastes according to regulations of the federal government's Occupational Safety and Health Administration (OSHA). These agencies' rules (which are summarized in more detail later) are similar. They require that "sharps" (needles and syringes, scalpel blades, etc.) should be placed in closed, leak proof containers (though these do not have to be puncture-resistant). This type of container must be labeled or color-coded as containing medical waste.
Red or orange are the colors used on containers to indicate that they contain medical waste. Typically, hospitals use hard red plastic containers for "sharps," and red trash bags for other medical waste, however, other colors could be used and it is important to look at the labeling or identification on the container. Another indicator of the presence of medical waste, which may be used instead of or in addition to the red or orange color code, is the "BIOHAZARD" symbol.
Medical waste from health care facilities must be treated in a way that destroys its potential for causing disease, prior to disposing it in a landfill. Acceptable treatment methods may include incineration, steam sterilization (or autoclaving), and chemical disinfection. Waste that has been treated, but that is still recognizable as medical waste (for example, waste that has been autoclaved which is still in a red bag or sharps container), must be labeled with the name of the facility that generated it, the type of treatment method used, and the name or initials of the person in charge of treatment.
Many landfills in Louisiana do not accept medical waste from health care facilities unless it has been incinerated. Incinerated waste would not be recognized as medical waste. Therefore, as a general rule, if you encounter any red bags, red sharps containers, or packaging marked with the biohazard symbol, in waste that is sent to your landfill, you should notify your supervisor before handling them in any way.
Not all medical wastes are covered by regulations that require this kind of labeling and treatment. The most obvious example is waste generated by private households. Many diabetics, allergy suffers, dialysis patients, and other people who receive medical care at home (not to mention users of illegal intravenous drugs) have to dispose needles and syringes and other medical wastes. Rules promulgated by the Louisiana Department of Health and Hospitals require households to package their medical wastes in tightly closed, wrapped containers before discarding them in household garbage. However, these regulations frequently violated. Therefore, medical wastes will be mixed with ordinary trash, and you may encounter it in connection with your work.
What Regulations Govern the Disposal of Medical Waste?
In Louisiana, there are three (3) sources of regulations for medical wastes: OSHA, the Louisiana Department of Health and Hospitals, and the Louisiana Department of Environmental Quality.
Summary of OSHA Regulations
The following is a partial summary of OSHA regulations regarding occupational exposure to blood borne pathogens, 29 C.F.R. Part 1910.1030. If your employer is covered by OSHA, it must make a copy of the complete regulations and an explanation of their contents accessible to you. In Louisiana, these regulation apply to all private employers and to federal civilian employers. If the employer has any employees who can be reasonably anticipated to be exposed to infectious material, it must follow these OSHA regulations. According to OSHA's written enforcement procedures (OSHA Instruction CPL 2-2.44C, March 6, 1992), employees who handle medical waste are considered to have occupational exposure. In general, the rules require employers to develop exposure control plans, to adopt engineering controls and work practices that minimize exposures, to provide handwashing facilities and personal protective equipment, to provide training to workers, to provide hepatitis B vaccines free of charge, to provide medical evaluation and follow-up to exposed workers, and to keep medical and training records.
Under the OSHA rule, exposure means skin, eye, mucous membrane (mouth and nasal) contact with blood or other potentially infectious materials. Blood means human blood, blood products, or blood components. Other potentially infectious materials include all body fluids in situations where it is difficult or impossible to differentiate between body fluids.
Exposure Control Plan Covered employers must prepare an "Exposure Control Plan." This plan must contain separate lists of job classifications where some or all of the employees may be exposed and a list of job tasks and procedures in which exposure may occur (whether or not personal protective equipment is used). The Exposure Control Plan must also contain a timetable for implementing various provisions of the regulations and a description of the procedure that will be followed if an exposure occurs. The plan must be made accessible to all employees.
Methods of Compliance Section (d) of 1910.1030 specifies the procedures that must be followed by all employers to comply with the regulation. "Universal precautions," an approach to infection control that assumes that all blood and certain body fluids are infectious for HIV (Human Immunodeficiency Virus which leads to AIDS), HBV (Hepatitis B Virus), and other blood borne pathogens, must be followed. If the circumstances are such that different body fluids cannot be distinguished from each other, all should be treated as potentially infectious.
Employers are required to employ "engineering and workplace controls" wherever possible to minimize or eliminate employee exposure. Engineering controls either remove the hazard or isolate the worker from exposure. An example of an engineering control is the use of a ventilated cab on earth-moving equipment to protect workers from dust and aerosols. Workplace controls alter the manner in which tasks are performed to reduce exposure-for example, always cleaning equipment with implements or with high-pressure hoses, rather than by hand. Employers are required to examine, maintain, and replace engineering controls on a regular basis to insure their effectiveness.
Personal Protective Equipment Appropriate personal protective equipment must be used to reduce risk of worker exposure. Employers must make readily available at no cost to employees appropriate specialized clothing or equipment to protect against exposure to blood and other potentially infectious materials. Personal protective equipment must prevent such materials from passing through to an employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time that the equipment is in use.
Personal protective equipment consists of, but is not limited to, gloves, face shields, masks, and eye protection, gowns, aprons, and similar items. Employers must ensure that appropriate personal protective equipment is used and used correctly. Employers must also see to it that personal protective equipment is properly cleaned, laundered, repaired, replaced, or disposed as needed, at no cost to the employee.
The employer must ensure that employees observe precautions for handling and using personal protective equipment, including:
§  removal of garments penetrated by blood and other infectious material as soon as possible;
§  placing contaminated protective equipment in designated areas or containers for storing, washing, decontaminating, or discarding each day or shift;
§  replacing gloves if torn, punctured, contaminated, or if their ability to function as a barrier is compromised;
§  utility gloves may be decontaminate for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, etc.;
§  wearing appropriate face and eye protection such as goggles, glasses with solid side shields or chin-length face shields when splashes, sprays, spatters, or droplets of infectious materials pose a hazard to the eyes, nose, or mouth.
Handwashing and Hygiene Employers must provide handwashing facilities that are readily accessible to all employees. When this is not feasible, they must provide antiseptic towelettes. Employers must ensure that employees wash their hands as soon as possible after removing gloves and other personal protective equipment, or after contact with potentially infectious material.
Disposal Methods for Medical Waste at Health Care Facilities The rules provide requirements for handling contaminated sharps, including a requirement that they be placed in a closed, puncture-resistant, leakproof, color-coded (or biohazard-labeled) containers prior to disposal. If the container can leak, it must be placed in a second closed, leakproof container.
Blood and other potentially infectious material (other than sharps) must be placed in leakproof, color-coded (or biohazard-labeled) container before it leaves the facility. If outside contamination occurs, or if the container is punctured, it must be placed in another leakproof, labeled or color-coded container.
Disposal of medical wastes must be in accordance with all applicable federal, state, and local regulations.
Training All persons with a potential for exposure must be provided with adequate training and information including general explanation of the modes of transmission, symptoms, epidemiology, warning signals relating to possible exposure, and procedures to follow if exposure occurs.
Hepatitis B Vaccine Covered employers must make available, free of charge, and at a reasonable time and place, the hepatitis B vaccine and vaccination series to all employees who are at risk of occupational exposure. Employees may decline either antibody pre-screening or vaccination; if they decline vaccination, they must sign a declination form.
If an Exposure Incident Occurs Employees should immediately report exposure incidents. The employer is responsible for establishing the procedure for evaluating exposure incidents.
Recordkeeping The employer must keep medical records and records of training sessions. Medical records must be kept confidential (though an employee and his or her representative may see and copy his own record on request) and must be maintained for thirty (30) years after employment has ended.
Training records, including the dates, content, names and qualifications of trainers, and names and job titles of trainees, must be kept for three (3) years.
Summary of Louisiana Department of Health and Hospitals Regulations
This agency has regulations governing the packaging, labeling, storage, transportation, and treatment of medical waste, contained in the Louisiana Sanitary Code, Part XXVII.
Definitions and Exclusions - The regulations define several categories-medical waste, infectious biomedical waste, and potentially infectious biomedical waste. The latter is used most extensively throughout the regulations, and is defined, in pertinent part, as follows:
"...waste considered likely to be infectious by virtue of what it is or how it may have been generated in the context of health care or health care like activities."
"Potentially Infectious Biomedical Waste" includes, but is not limited to the following:
1) Cultures and stocks of infectious agents and associated biologicals, including cultures from medical and pathological laboratories, from research and industrial laboratories.
2) Human pathological wastes including tissue, organs, body parts and fluids that are removed during surgery or autopsy.
3) Human blood, human blood products, blood collection bags, tubes and vials.
4) Sharps used or generated in health care or laboratory settings.
5) Bandages, diapers, "blue pads," and other disposable materials if they have covered infected wounds or have been contaminated by patients isolated to protect others from the spread of infectious diseases.
6) Any other refuse which has been mingled with potentially infectious biomedical waste.
Eating utensils, animal carcasses and bedding, and "very small quantities" (less than 250 grams or 1/2 pound) of human or animal tissue, clean dressings, and clean surgical wastes from persons or animals not known to be infected, are excluded from the definition of potentially infectious biomedical waste. The last two categories of material must be disposed in tightly closed plastic bags or other impervious containers.
Animal carcasses and tissues and wastes from large animals must be disposed either as potentially infectious biomedical waste, or according to regulations of the Livestock Sanitary Board. Carcasses, tissue, and wastes of pets may be buried, rendered [cooked at a minimum temperature of 250 degrees Fahrenheit for at least thirty (30) minutes], incinerated, or disposed either in accordance with these regulations or on the order of a licensed veterinarian.
Packaging and Labeling - Potentially infectious biomedical waste (i.e., medical waste) must be packaged in a manner that prevents exposure to the material. Liquids must be in a sturdy, leak-resistant container. Sharps must be in a closed, rigid, break-resistant, puncture-resistant container. Plastic bags and other containers must be clearly labeled, impervious to moisture, strong enough to prevent tearing or bursting under normal conditions, and closed prior to transport. A second level of containment is necessary if the material is to be stored prior to transport.
All containers of potentially infectious biomedical waste must be labeled "Potentially Infectious Biomedical Waste," "Medical Waste," or "Infectious Waste." Untreated waste must bear the name and address of the generator or transporter when it leaves the generator's premises. Treated waste that is still recognizable must carry a supplemental label to specify the treatment method used, the date of treatment, and the name or initials of the person responsible for treatment. All labels must be clearly visible and legible, and must be water resistant. Note: There are no requirements in the DHH Regulations that state that the bags, boxes, containers, etc., be a certain color.
Storage and Transport -  Potentially infectious medical wastes must be stored in a secure manner. Compactors shall not be used for storage. Except for small quantities (defined as a single package containing less than 11 pounds of waste other than sharps or less than 2.2 pounds of sharps), wastes can be transported off the site where they were generated only by transporters permitted by the State Health Officer.
Small quantity generators, including doctors', dentists', and veterinarians' offices and private households, may transport small quantities of properly packaged and labeled wastes to approved large quantity generators, permitted storage facilities, or permitted treatment facilities without meeting the requirements for transport and treatment that large quantity generators must meet.
Transportation of potentially infectious waste (except by small quantity generators, as described above) is governed by Part XXVII.Chapter 7 of the regulations. This section contains provisions for transporter permits; written contracts between generators and transporters; vehicles used in transportation; transporter operation plans (including worker safety and decontamination provisions), and delivery of potentially infectious biomedical waste only to properly permitted facilities.
Special Rules Applicable to Households and Other Small-quantity, Non-healthcare Facilities - Households and other small-quantity, non-healthcare facilities may dispose their waste in the ordinary trash. The waste must be packaged to assure that there will be no leakage, even if the original package is violated (generally, this means double bagging, or placing sharps containers in a second rigid disposal container). Sharps must either be encased in plaster or in another substance as approved by the State Health Officer, or placed in a sharps container of standard manufacture or other similar container of a type approved by the State Health Officer. This sharps container should then be placed in another bag or other rigid container containing a greater volume of non-infectious waste. Note: No labels or symbols are required on these containers.
Treatment and Disposal - Acceptable treatment methods for potentially infectious biomedical waste are set forth in Part XXVII.Chapter 11 of the regulations. These include incineration; steam sterilization [generally, autoclaving at least 248 degrees Fahrenheit (120 degrees C.) and a minimum pressure of 15 psi for a minimum of 30 minutes, or longer if necessary]; disposal of liquids into a sanitary sewer system that meets the requirements of Part XIII of the Sanitary Code; thermal inactivation [dry heat of at least 320 degrees F. (160 C.) at atmospheric pressure for at least 2 hours, excluding lag time]; chemical disinfection (use of chemical agents that have been approved by the State Health Officer); and irradiation (only with the written approval of the State Health Officer).
Sharps must be incinerated, encased in plaster or other approved substances in a tightly closed container, or treated in some other manner that renders them unrecognizable as medical sharps and practically precludes the release of recognizable needles and syringes if compacted.
Once treated, potentially infectious biomedical waste may be disposed in a permitted sanitary landfill in accordance with the Solid Waste Regulations of the Department of Environmental Quality. As noted above, treated and still recognizable medical waste must carry a supplemental label specifying the treatment method and date, and the name or initials of the person responsible for treatment.
On-site Storage and Treatment - Generators may store and treat their own potentially infectious biomedical wastes, if they obtain a proper permit and comply with substantive provisions of the regulations as to packaging, labeling, storage, transportation, and treatment.
Enforcement - These regulations are enforced by the Office of Public Health.
Summary of Louisiana Department of Environmental Quality Regulations
Currently, the Solid Waste Regulations, Louisiana Administrative Code Title 33, Part VII, Chapter 7, paragraph 711.D.1.e, deals with medical wastes. The regulation states that infectious waste from hospitals or clinics may be deposited in Type I or II landfills if it has been properly packaged and identified and is treated by a method approved by the Department of Health and Hospitals. Infectious waste is defined as follows:
"waste that contains pathogens of sufficient virulence and quantity that exposure to it could result in an infectious disease in a susceptible host."
The La. R.S. 30:2180 D., authorizes the Department of Environmental Quality to promulgate rules and regulations for the transportation, incineration, and disposal of medical waste.
What Are the General Risks Posed by Medical Waste?
The concern created by medical waste is that it can cause infection and/or disease. In order for this to happen, several things must occur. First, infectious agents (for example, viruses) must be present in the waste. It is important to keep in mind that certain types of materials are classified as medical waste because they might cause disease. Blood, for example, is considered infectious because it might contain viruses. Any given sample of blood or blood-soaked material may, in fact, be harmless.
Not only must infectious agents be present in the waste for it to cause disease-they must also survive in the waste in large enough quantities to be able to cause infection if an exposure occurs. The hepatitis B virus (or "HBV"), for example, is usually present in the blood of persons infected with hepatitis B in higher quantities than the AIDS virus (or "HIV") is in persons infected with HIV. For this reason, it is much easier to contract hepatitis than AIDS from exposure to infected blood. Further, HIV normally does not survive for very long outside a living organism. Therefore, the chance of contracting AIDS from contact with medical waste outside a health care setting is considered to be remote by the Agency for Toxic Substance and Disease Registry of the Public Health Service.
Second, an exposure has to occur in a manner that will be effective in transmitting the disease. There are four basic ways that a person can be exposed to infections: through the skin; through mucous membranes in the eyes, nose, and mouth; by inhaling infectious agents; and by swallowing them. Not all of these "routes" of infection will actually transmit a given disease. For example, AIDS can only be transmitted by sexual contact; by contact with the blood of an infected person on mucous membranes, broken skin, or through needle sticks; or from a pregnant woman to her fetus. It cannot be transmitted by inhalation or by touching an infected person.
Finally, in order for the exposure to cause disease, enough of the infectious agent must be transmitted to the person who is exposed so that his immune system cannot effectively protect him or her from the disease. Even if the waste does contain a large enough concentration of a disease-causing agent, and exposure does occur in a way that could transmit the disease, disease may or may not develop. For example, AIDS can be transmitted through being stuck by a needle that contains the blood of an HIV-infected person. However, the chance of contracting AIDS from a single needle stick, even if the needle does contain HIV-infected blood, has been estimated by the Centers for Disease Control to be only approximately 0.4%, or 1 in 250. The chances of becoming infected with hepatitis B from a single needle-stick, even if the needle contains blood of an infected person, is between 6 and 30 percent. A person's chances of not contracting the disease from an exposure are usually better if he or she receives prompt medical attention.
What Are the Specific Risks to Landfill Workers from Medical Wastes?
The risk to landfill workers from medical waste that has caused the most public health concern is that of contracting hepatitis B or AIDS from needle-sticks or from infected blood or blood-containing fluids being splashed or rubbed into open wounds, non-intact skin, or mucous membranes.
Some of the other diseases that could be transmitted through both medical waste and ordinary household waste include the common cold, "pink-eye" (bacterial conjunctivitis), chicken pox, and flu-all of which can be transmitted by mucous membrane exposure, inhalation of airborne particles from soiled articles, or inadvertent swallowing of particles after handling soiled articles. Bacterial infections are less common communicable diseases that can potentially be transmitted through cuts or abraded skin, following handling of contaminated articles.
Drawing together information from a variety of sources, the Agency for Toxic Substances and Disease Registry (a division of the United States Public Health Service, or ATSDR), has attempted to quantify the risk of disease caused by medical waste to workers. One of the categories of workers for which these risks were examined was "refuse workers"-workers involved in waste collection and disposal. This category includes landfill operators. The only diseases for which enough data were available were hepatitis B and AIDS.
AIDS
AIDS can be transmitted in three ways-through exposure to infected blood or blood products (for example, through a needle stick injury), through sexual contact, or from a pregnant woman to her fetus. At writing, there have been no documented cases of transmission of AIDS through contact with contaminated surfaces or dried blood. The virus that causes AIDS dies rapidly in normal environmental conditions outside a living host, making transmission outside the health care setting unlikely. As of the date of the ATSDR study, there had been no cases of HIV infection from medical waste reported in the scientific literature.
Contaminated sharps, like used hypodermic needles, create the greatest concern for AIDS transmission. However, the ATSDR study estimated that, out of approximately 200,000 refuse workers in the U. S., less than 1 case of HIV infection per year is expected to result from injury from discarded sharps.
Hepatitis B
Hepatitis B is a viral infection that causes acute and chronic hepatitis, cirrhosis, and liver cancer. Symptoms include combinations of anorexia, nausea, vomiting, abdominal pain, and jaundice.
Hepatitis B virus (HBV) is transmissible in the same ways as the AIDS virus. As with AIDS, the greatest risk is from being cut or stuck by a contaminated sharp. However, since HBV is much more concentrated in infected blood than the AIDS virus (HIV) is, and since it is able to survive in the environment for a longer period of time (up to 7 days at 77 degrees Fahrenheit and 42% relative humidity)-HBV is more likely than the AIDS virus to be transmitted by medical waste. The ATSDR still concludes, however, that transmission of HBV outside a health care setting is a remote possibility.
In another study, dealing with a health care setting, the federal Centers for Disease Control has estimated that 12,000 health care workers whose jobs entail exposure to blood become infected with hepatitis B each year, that 500-600 of them are hospitalized as a result of that infection, and that 700-1,200 of those infected become carriers. Of the health care workers infected with hepatitis, about 250 can be expected to die of hepatitis, cirrhosis of the liver, or liver cancer.
However, landfill workers as a group face much lower risks of becoming infected than health care workers do. The ATSDR study estimated that in the 200,000 refuse workers nationwide, medical waste injuries from discarded sharps can be expected to cause only between 1 and 15 cases of hepatitis B infection per year.
What Can Be Done to Reduce the Risk of Infection?
Your risk of being infected by medical waste can be reduced to a very low level if you obtain proper preventative medical care, follow safe work practices, report any exposures promptly, and obtain medical care and counseling if exposure does occur.
Preventative Medical Care
A safe and effective vaccine is available for hepatitis B. According to the federal Centers for Disease Control, the vaccine provides 80-95% protection against hepatitis B. (It can also help prevent infection if it is administered immediately after exposure to the HBV virus.) It consists of a series of three (3) injections, usually in the arm, the second given one (1) month from the first, and the third given six (6) months after the initial dose. All employers covered by OSHA regulations must make this vaccine available free of charge to workers who have occupational exposure to blood or other potentially infectious material. In Louisiana, state and local government employees are not covered by OSHA; however, your employer may provide this as a service to employees. Other immunizations that may be appropriate are the tetanus vaccine and immune globulin ("gamma globulin"). You should consult a physician about whether or not to have these immunizations.
Safe Work Practices
§  Each landfill should have standard operating procedures (SOPs) for accepting, rejecting, and handling medical waste. Find out as much as you can about the wastes you may encounter and what you should do if you find them. For example, ask your supervisor what, if any, medical wastes are disposed at your facility; what you should do if you encounter a red bag or other biohazard; what personal protective equipment you should use, both routinely and if you encounter a special hazard; and what you should do if you are stuck with a hypodermic needle or are otherwise exposed to potentially infectious wastes.
§  Follow your employer's SOPs and your supervisor's instructions about reporting and handling medical wastes.
§  Be alert to potential hazards.
§  If you encounter a red bag, red sharps container, or something marked with the biohazard symbol; or sharps, blood or blood-containing material, human or animal parts; or other material that appears to be medical waste, TREAT IT AS IF IT IS HAZARDOUS. Inform your supervisor before covering it or handling it in any way. Your supervisor may want to reject the waste, and, if so, will contact the hauler, or the person who disposed the waste, to come pick it up.
§  Wear person protective equipment under circumstances in which you might be exposed. Boots should have steel toes and puncture-resistant soles. 6" lace-up boots provide added protection for the ankles. Gloves should be worn whenever the hands may come in contact with hazards; leather provides better protection than rubber against punctures. Arms and other skin surfaces should be covered whenever the skin might be exposed to infectious agents. Safety glasses and hard hats may also provide protection to the head and face from splashes. Special equipment, such as respirators, face shields, dust masks, boot covers, or impervious clothing may be necessary if a spill occurs, if splashing or splattering is expected, or if another unusual hazard arises.
§  Cover all cuts, abrasions, and other areas of non-intact skin while on duty.
§  Avoid physical contact with medical wastes, whether they are in red bags or sharps containers or not. If you are required to move these items-for example, to separate them for pickup-use a shovel or other implement. Never handle any wastes with your bare hands.
§  Be aware of the possible presence of medical wastes when handling all wastes and when cleaning all machinery and equipment, and try to avoid contact. In particular, be aware that sharps can become stuck in the wheels and tracks of landfill vehicles, and can pose hazards to operators and maintenance workers. Where possible, use some implement or cleaning method other than your hands. If you do have to use your hands to clean or maintain equipment, make sure that you are wearing gloves that minimize the chance of being cut, and NEVER REACH WHERE YOU CAN'T SEE.
§  Avoid handling personal items, like pens, combs, etc., while wearing gloves. Always wash your hands after removing your gloves, even if the gloves have not been cut or punctured.
§  Always wash before eating, drinking, smoking, or putting anything in your mouth, and before leaving work.
§  Change your clothes and boots immediately after work so that you do not contaminate family members.
§  If you come in contact with infectious waste (for example, if you are splashed with blood or blood-containing bodily fluids), wash your hands and any exposed skin thoroughly in warm water and soap, or in waterless antiseptic cleaner, if soap and water are unavailable.
§  Remove clothing, boots, and gloves that have been in contact with infectious waste as soon as possible, taking care to avoid contact with exposed skin surfaces. Use gloves to remove other items of clothing.
§  The risk of disease from clothing soiled with medical waste is very low, but it should still be handled as little as possible. While wearing gloves, place it in a leakproof bag prior to cleaning. Soiled clothing should be handled with gloves and laundered according to manufacturer's instructions. Boots and leather goods may be brush-scrubbed with soap and hot water to remove contamination.
Report All Exposures Immediately
If you are exposed to infectious waste-including any time that you are stabbed by a hypodermic needle or other sharp, or any time that blood or other body fluid in waste comes into contact with a place where you have an open wound; non-intact skin, or mucous membrane (eyes, nose, or mouth)-report the exposure to your supervisor immediately, and try to make sure that the incident is recorded. Wash the exposed area thoroughly with soap and water, and apply a disinfectant such as alcohol or hydrogen peroxide. Your employer may be able to trace the waste, which may make it possible to determine how likely it is that the waste came from an infected individual (if your employer is covered by OSHA, he must attempt to locate the source individual, and attempt to obtain his or her consent to an HBV and HIV test). Further, receiving prompt medical attention following exposure can be very important for your own health.
Medical Care and Counseling after Exposure
You should receive prompt, confidential medical attention following an exposure. If your employer is covered by OSHA, this follow-up care and all necessary tests must be provided to you free of charge.
§  Particularly in the case of a needle stick or exposure by another kind of sharp, vaccination for hepatitis B and/or a gamma globulin shot may be recommended, if you have not already been immunized. These have been shown to be effective at preventing infection if administered soon after exposure.
§  A tetanus shot may be administered after any waste-related cut incident.
§  Other tests, counseling, and treatment may be recommended, depending on the circumstances of exposure and your medical history.
§  If your employer is covered by OSHA, the results of any HBV or HIV test on the source individual must be made available to you, and you must be given a written opinion by the healthcare professional who evaluated you.
§  Accurate records should be kept of the exposure and of your medical evaluation. Your medical records, including your HIV or HBV status, are confidential. You have the right to see and copy these records on request.
Conclusion
With proper preventative care, safe work practices, prompt reporting of exposures, and post-exposure medical attention and follow-up, there is little likelihood that medical waste will harm you on the job.

Louisiana Department of Environmental Quality 602 N. Fifth Street Baton Rouge, LA 70802
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Monday, July 7, 2014

July 2014. Ebola Pandemic. International issue to be addressed. Health Ministers agree on priority actions to end Ebola outbreak in West Africa

http://www.afro.who.int/en/media-centre/pressreleases/item/6695-health-ministers-agree-on-priority-actions-to-end-ebola-outbreak-in-west-africa.html

Containment procedures required.

Keep it simple: 
if something is endemic it means it is found regularly, eg measles etc... 

if something is epidemic it means that it is not normally occur that often, and the infection levels have risen ALOT, this is within a particular country 


if something is pandemic then it means the a particular disease has risen sharply in a short space of time over a whole continent or many countries..



 


Health Ministers agree on priority actions to end Ebola outbreak in West Africa

Accra, 03 July 2014 – The Emergency Ministerial meeting on Ebola Virus Disease (EVD) has ended today with Health Ministers agreeing on a range of priority actions to end the Ebola outbreak in West Africa. The scale of the ongoing outbreak is unprecedented with reports of over 750 cases and 445 deaths in Guinea, Sierra Leone and Liberia since March 2014.
In a Communiqué issued at the end of the two-day meeting, the Ministers agreed that the current situation poses a serious threat to all countries in the region and beyond and called for immediate action. They expressed concern on the adverse social and economic impact of the outbreak and stressed the need for coordinated actions by all stakeholders, national leadership, enhanced cross-border collaboration and community participation in the response.
Speaking at the closing session, the World Health Organization’s (WHO) Regional Director for Africa, Dr Luis Sambo commended the Ministers and said: “We have adopted an inter-country strategy to tackle this outbreak. It’s time for concrete action to put an end to the suffering and deaths caused by Ebola virus disease and prevent its further spread”.
In spite of the ongoing efforts to tackle the outbreak, there was consensus that a number of gaps and challenges remain. These relate to coordination of the outbreak, financing, communication, cross border collaboration, logistics, case management, infection control, surveillance, contact tracing, community participation and research.

The World Health Organization will establish a Sub-Regional Control Center in Guinea to act as a coordinating platform to consolidate and harmonize the technical support to West African countries by all major partners; and assist in resource mobilization. The delegates also underscored the importance of WHO leading an international effort to promote research on Ebola virus disease and other hemorrhagic fevers.

The Ministers adopted a common inter-country strategy which highlights the following key priority actions for the affected countries:
·        Convene national inter-sectoral meetings involving key government ministries, national technical committees and other stakeholders to map out a plan for immediate implementation of the strategy.
·        Mobilise community, religious, political leaders to improve awareness, and the understanding of the disease
·        Strengthen surveillance, case finding reporting and contact tracing
·        Deploy additional national human resources with the relevant qualifications to key hot spots.
·        Identify and commit additional domestic financial resources
·        Organise cross-border consultations to facilitate exchange of information
·        Work and share experiences with countries that have previously managed Ebola outbreaks in the spirit of south-south cooperation
The delegates also urged partners to continue providing technical and financial support and work with WHO to effectively coordinate the response. In an effort to promote regional leadership, and highlight the seriousness of the outbreak, the delegates strongly recommended that the forthcoming Economic Community of West African States (ECOWAS) Heads of States summit addresses the issue of EVD outbreak.
In March 2014 Guinea notified WHO about cases of Ebola virus Disease. The cases were initially confined to rural Guinea with the epicenter being Gueckedou. What started as a rural outbreak has now spread to Conakry the capital of Guinea as well as cross border spread into Sierra Leone and Liberia. The current Ebola outbreak has surpassed all other outbreaks in terms of cases, deaths and geographic spread across Guinea, Liberia and Sierra Leone.

In an effort to interrupt further spread of this virus in the shortest possible time, the World Health Organization convened an Emergency Ministerial meeting in Accra, Ghana from 2-3 July 2014 involving eleven (11) countries mostly from West Africa and a number of key international partners involved in the Ebola outbreak response. The aim of the meeting was to discuss how to contain the disease, share experiences and agree on a strategy for an accelerated operational response to bring an end to the outbreak.
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Sunday, July 6, 2014

Bahamas: July 3, 2014. NEMA participated in CDEMA Council Meeting

http://www.bahamas.gov.bs

Featured Story
NEMA participated in CDEMA Council Meeting
Authored by:National Emergency Management Agency
Source:National Emergency Management Agency
Date:July 3, 2014

Delegates to the Fifth Caribbean Disaster Emergency Management Agency Council Meeting, held June 27, 2014 in Bridgetown, Barbados. Standing Left to right: Ambassador Elizabeth Harper, Guyana; Mr. Carl Herbert, National Disaster Coordinator, St. Kitts & Nevis; Permanent Secretary Carl A. Francis, Ministry of National Security; Trinidad and Tobago, Hon. George Lightbourne, Turks and Caicos; Colonel Shelton Defour, National Disaster Coordinator, Belize; Mr. Howe Prince, National Disaster Coordinator, St. Vincent and the Grenadines; Captain Stephen Russell, Director, National Emergency Management Agency, Bahamas; Permanent Secretary Nicholas Bruno, Ministry of National Security, Dominica; Hon. Noel Arscott, Jamaica; Permanent Secretary Lana  McPhail , Grenada. Seated left to right: Mr. Ronald Jackson, Executive Director CDEMA; the Hon. Adriel Braithwaite, Attorney General, Barbados, Chair of Council meeting; and the Hon Deputy Governor Stanley Reid, Anguilla, Deputy Chair Council meeting. (PHOTO/CDEMA)

BRIDGETOWN, Barbados –  Captain Stephen Russell, Director of the National Emergency Management Agency attended the Fifth Meeting of the Caribbean Disaster Emergency Management Agency Council of Ministers meeting, which focused on enhancing the coordinating responses to disasters affecting the region.

The meeting was held Friday, June 27, 2014 at the Hilton Hotel in Barbados. The meeting was attended by Ministers and Permanent Secretaries with responsibility for disaster management within the CDEMA Participating States.

The Council is the highest level decision making body in the CDEMA governance structure.  Discussed were several key matters requiring their approval and endorsement for implementation by the CDEMA Coordinating Unit and Participating States.

Considering the prevailing economic situation across the region, financing the operations of the CDEMA Coordinating Unit (CU) was among the main items on the Agenda.

The Council reviewed the agency’s financial status and looked in particular, at options for sustainable finances including the results of a feasibility study on the establishment of an endowment fund and the recommendations from a market research on fee based services that the Coordinating Unit could offer. Also discussed was the organisational restructuring of the CDEMA CU.

Policies presented for endorsement were the regional Comprehensive Disaster Management (CDM) Strategy 2014-2024, Implementation Plan and Performance Management Framework, Regional Response Doctrine Proposal for Strengthening Response Coordination Capacity of CDEMA and the Model Organisation Structure for National Disaster Offices.

These policies, developed through a lengthy and rigorous participatory process involving a wide range of stakeholders are critical to furthering national and regional processes for building disaster resilience.

One of the standing agenda items was “Operational Matters and Readiness”. This focused on the agency’s primary responsibility, which is, coordinating regional response to disasters affecting its Participating States.

The meeting discussed the status of readiness for the 2014 Hurricane Season and the 2013-2014 emergency events including the December 2013 rains which affected St. Vincent and the Grenadines, Dominica and Saint Lucia.

Preceding the Meeting, was a symposium on Thursday, June 26 on the Integration of Climate Change Adaptation and Disaster Risk Reduction.

CDEMA is governed through the Council, a Technical Advisory Committee (TAC) and the Coordinating Unit. As a specialised regional Agency of CARICOM, the Heads of Government of the Participating States determine the policies. The Council is the highest level of governance of CDEMA and major decisions on its operations are also made as required by this body.

There is a sub-committee, the Management Committee of Council, which makes recommendations to the Council to enhance the management and functioning of the CDEMA policy identification and organisation performance review.

The Council meets annually during the month of June. The Heads of Government or their designated representatives attend the annual Meetings.

Small Business Disaster Preparedness

http://emergencysafety.blogspot.ca/2014/05/small-business-disaster-preparedness.html?m=1

Friday, 30 May 2014
Small Business Disaster Preparedness

RCAF CC-150 delivering relief supplies during Hurricane Katrina in 2005.
Photo credit: US Navy


Disasters do not discriminate. When they hit, they do not identify what buildings or communities to hit.
It whacks everybody or sometimes just locations without prejudiced. But we continue to see the lack of preparedness by small and medium size businesses being undertaken and investing their time to understand what's involved. Gone are the days when this was only for the big multinational companies to worry about.
Company's with as few as 5 part-time employees need to be ready for risk any contingencies that disasters bring.
Everything from ensuring their employees are safe to how to recover.
Management after the event occurs needs to be understood - before it strikes. Being prepared to ride out a disaster can solve all these issues and improve their ability to recover quickly.
This is not a hypothetical scenario. It is a proven fact. Nor does not require a lot of capital investment if approached with common sense. Education and practice critical to successful outcomes and recovery. The cavalry is not always available or coming over the hill to support your recovery needs in your businesses time frames.
Improvising, Adapting and Overcoming at the last minute is not wise nor safe and leads to increased risk of a businesses ability to recover.  
Businesses no longer have excuses or reasons why they cannot be prepared for a crisis or disaster. Small business owners feel the consequences and exposure to a disaster far more than large enterprise and multinationals, with a lot more to lose in not being prepared. Thankfully, there are solutions to help reduce exposure to the risk of catastrophic business failure.  
There are effective ways to implement a disaster management plan with resources and education programs available in most countries with small incremental associated costs.

Accountability

It starts by building a preparedness plan.
It does not have to be overly complex and nor does it need to follow the rigors or standards of a big corporation or government agency.  The plan needs to be written down, duplicated and understood by everyone associated with it.
It has to have  a detailed and laid out operational components that identify direction, control, development (over time), along with maintenance and status of your firms operations.
From there, it requires an overview of your facilities and infrastructure and what types of vulnerabilities they could be exposed too.
Know your employees and their background.
They are often part of your team that can help solve problems.
This is accomplished by creating a preparedness plan based on emergency response requirements before and during a disaster in the development process that begins with discussions and questions that need to be asked internally.
Doing so builds the outline for a plan and thus, steps to recovery. Flood disasters are very different than Tornado's or large fires.
Plan for those that are most likely to hit your business, big and small.
Plan for the worst and practice during advisories warnings that are considered to have a minor or low impact. Restaurant owners often have no idea of how simple disaster strategies can incorporated in preparing a training and disaster response plans.
Such business owners can start by testing how evacuation procedures work by offering a special evening with patrons asked to participate with discount coupons on their meals to see what does and does not work. Small industrial workshops can have local fire department support during evacuation tests to help identify gaps by simply asking them to show up and observe often at no charge if planned in advance during their routine patrols.

Mitigation

Insurance does not solve all a businesses requirements in how you gets back into service after a disaster. It is one of hundreds of steps that will be required. It is a proven fact that if prepared and developed properly, a company's ability to get back on its feet is 50 to 80% more likely to make a successful recovery by having a thorough preparedness plan in place.  In fact, the more prepared a business is with a plan, the more likely it qualifies to receive a discount on insurance premiums.
Read the fine print of your insurance policy and have a discussion with your carrier about mitigation and preparedness options and how it could save money that could be invested in any upgrades required. In some Provinces and States such discounts will not be available in all areas such as identified flood plains.
But this should not deter you from implementing a resilience and mitigation plan if you want to get back into business quickly. Business owners can make significant changes to their management plan without impacting their daily operations.
Disaster preparedness can become as easy as breathing if implemented with the right knowledge and tools.

River Murray flood Mannum, Australia 1956
Photo credit: State Library: Southern Australia

Risk

Risk and exposure to crisis and disaster events will vary, from isolated violence, industrial accidents to catastrophic storms. Each one has a level of risk that needs to be assessed and prepared for. If you have a large part-time staff, a thorough and detailed understanding is required of their abilities. This can be identified through analysis of your plan to determine needs and outcomes desired. If you have employees out in the field, risk surveys are required to take into account physical and management elements are low and high risk and ensuring each employee understands expectations and responsibilities.

It will identify what employees are capable of and weaknesses that are in need of further evaluation. In past surveys of employees who work out in the field they often do not even know who to call in case of emergency if their head office is no longer able to be reached. Nor do they understand what they should do next and understand their vulnerabilities. We tend to literately freeze and become incapable of deciding what to do next.

It should be no surprise the majority think they are on their own and each person decides for themselves what they are going to do next - if anything.

These results has been found in small and large organizations all over the world and yes, in places that have been repeatedly hit by natural disasters such as hurricanes, typhoons and tornadoes.

The failure generally starts with the lack of knowledge in creating a plan and preparing for its use by practicing it so that gaps can be identified and corrected. No longer is there the excuse for not knowing or working with government agencies in preparing a disaster management plan as many local, regional and national emergency response agencies have made information freely available.

Emergency preparedness plans can vary from as little as 10 pages up to 80 based on the complexity and size of the business. But none of the elements are exceeding difficult to write or practice and ensuring all employees are aware and capable of carrying out disaster assignments.


DDRS HA/DR Smart Phone App

Communications

Telling your employees to just go home is not enough. In some cases, that can prove fatal and nor does it necessarily absolve the company's responsibility of ensuring their safety stops as soon as they exit the firm's doors. Gone are the days where a small businesses simply kept on file the employee's basic information and a contact number in case of emergency if an event occurs.
Today, employers preparedness planning needs to be elevated to a whole new level. With availability of social media, SMS and other communications options, the level dialogue and options available expands a company's options. You can use Twitter and lock the account to be private and accessible to employees only for private communications on updates and status reports - for free.
The same goes for Facebook, by setting up a company group page with the same restrictions. These are just some of the ways company's can develop emergency action planning and procedures.
Photo Credit: FEMA

Planning

Some small business owners tend to be hands on and micromanage every detail of their company. During a disaster this can often compound problems and increase risks that do not have to occur. Wherever possible, delegation is a critical step to review. A business owner does need need to undertake every responsibility or be accountable all on their own, especially if they have managers of their operations that are trained in various duties required.
By creating an emergency management team, the owner can resolve most issues as they unfold and enhance the safety of not only all employees but the ability to recover after an incident occurs. Far too often, a business owner who tries to do it all on their own will suffer more by doing so. In some cases, small businesses that only have 2 or 3 employees can reach out with other nearby businesses to create the framework and response plan that helps everyone far more effectively than if operating independently.
This is particularly true of small town business centers that often have only 5 to 10 tenants that comprise in total, 20 to 40 employees on site during each shift. By banding together, resources could be shared and pooled for most emergency contingencies along with expertise and responsibilities. If a plan is put into place and practiced.
Photo Credit: FEMA

Preparedness

Preparedness planning only works if all risks are identified. In doing so, all situation variables and contingencies can be prepared for. Small business owners often assume, failing identify levels of risk using historical patterns and lessons learned of the past.
By doing, a proper mitigation plan can be developed with known costs that shore up identified weaknesses. This step supports the next phase of requirements, response options.
Too frequently, businesses tend to rely upon information from media sources that are - literately - 30 second long sound bytes. 10 inches of rain at X and potential flooding at Z.
Not nearly enough information to know what response plan should be enabled. If past historical events are reviewed, then a sense of what could occur can be understood.
Attribution: Peter Baeklund

Situation awareness is vital to coordinating and implementing a disaster plan. Doing an analysis exposes what challenges were experienced helps identify evacuation routes and potential flash points of delay and infrastructure vulnerabilities should be taken into account. It won't cost the company other than its research time to understand what the risks (and outcomes) were and develop response plans accordingly.
Does the company know what roads are identified as city recommended evacuation routes or where these routes are relative to where employees live? Most, if not all business owners do not have it documented anywhere and the potential impact it may have on operations. This is one of several areas of concern that small businesses need to recognize and rectify.
Knowing where hospitals are may sound reasonably easy to remember. But what about shelters, food stores, alternative fuel supply locations. In the past, small business owners had a tendency to wing it on the fly on a case by case basis.
Given how hard it is to build, maintain and restore a business, many are now recognizing the need for change in mindset and follow through.

Photo Credit: Australia Emergency Management

Advanced warning - makes a difference

In some cases, the crisis is known in advance with sufficient time to take action to save lives and property. How well this is understood varies around the world.
Attitudes will vary based on culture, demographics, social policy and the surrounding communities infrastructure. By reviewing your community's composition, businesses can take into account possible delays, infrastructure weaknesses and change how what one plan works in city XYZ will have to be modified to work in their own.
Ultimately, how an emergency response plan is carried out will only be as effective relative to the investments and its management is carried out. Those that have maintained important paper documents in duplicate, back up critical company data on systems at different locations, and understand risk management will increase their odds of recovery.
Preparing and planning often collide when the moment of truth arrives, to act or not.
No longer is it just a matter of putting plywood over windows, but planning and activating services such as transportation, spare fuel, water, medications and knowing the company's employees vulnerabilities and supporting their needs. During hurricane and typhoon seasons the level of advance warning is increasing not just by hours, but days with high levels of accuracy as to the storms intensity and path.
The same is becoming true of annual spring thaws that are the cause of severe flooding in many parts of the world. Satellites with specialized sensors track ground saturation levels enabling advanced warning, sometimes days in advance.
Some events are not as easy to give 24+ hour warning as in the case of the recent Balkan Floods that hit Serbia, Bosnia and Croatia in eastern Europe. Even the winter floods that started in December of last year and hit southern England surprised meteorologist as to the length and power of the storms that hammered the country for three straight months. Warnings varied week to week on predicted flood levels.
The  flash flood which hit Toronto in the summer of 2013 hit so fast that there was barely 8 hours notice.
Calgary Alberta's floods warnings were issued 3 days in advance of their impact on the city, yet many businesses were caught unprepared, caught flat footed and wound up losing everything as a result. The city is still making repairs. Many small businesses permanently closed. In such scenarios, the costs of inaction were significant. It can and does happen in your company's backyard.



Last line of defense, not your first. Photo Credit: FEMA

Recovery

Creating a sound preparedness plan that is practiced and understood, recovery will be easier to manage and get the company back on its feet.
It becomes a less stressful environment, allowing for sound judgement and decision making to proceed with recovery efforts. Not only will many hours not be wasted but weeks in delays can be avoided.
This cannot be assured all the time. As we have pointed out in other editorials, some events bring utter devastation making recovery a very long term process regardless of how well prepared the company planned and carried out proper steps. Nonetheless, the time will be shorter than others that did nothing at all.
Some argue that the economics do not make it practical to prepare for such events. In many parts of the world that probably holds more than a grain of truth, but it does not mean it should be ignored.
Small businesses that understand the risks and results and want to be in business afterwards will review choices that should be made. Setting aside funds for a rainy day works just prudently for a business as it does for individuals and families.


Downtown of Lacombe, Alberta Red River Flood 2013
Photo Credit: City Gov't of Lacombe

Cost of not preparing

The costs do not have to be astronomical and nor do businesses have be burdened all by themselves as mentioned earlier. Purchasing used equipment such as generators, shelters, storage tanks, and secondary storage facilities can be reduced through effective planning and shared cost with other small businesses.
As is often the case, many  employees may have established networks of resources that can be used to support the company's needs - so long as they are aware of their availability and open the dialogue to examine their potential use in advance of an incoming disaster event. In doing so, action steps can be taken immediately before and afterwards in their usage, reducing the level of chaos and unknown management challenges.


Share the cost of contracting tractor - trailer units to store your inventory with other business owners. By planning ahead there can be significant dividends for those that cannot afford inventory insurance. Photo Credit: Wikipedia


Small businesses can survive a disaster. It takes time and energy to implement an effective strategy and plan. It does not take millions of dollars and can be carried out by most business owners and managers if the right tools and education programs are acquired. 
Technology, knowledge and training can deliver remarkable results allowing an organization to fully recover.

Available online resources:
·                        Ready.gov
·                        Public Safety Canada
·                        City of London (U.K.) Business Continuity Guide
·                        Australia Emergency Management Institute
·                        New Zealand Civil Defence Business Continuity Guide (pdf file)
·                        Red Cross International



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