Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach

Viruses in Wastewater-A Concern for Public Health and the Environment

Wastewater monitoring provides essential information about water quality and the degree of contamination. Monitoring these waters helps identify and manage risks to public health, prevent the spread of disease, and protect the environment. Standardizing the appropriate and most accurate methods for the isolation and identification of viruses in wastewater is necessary. This review aims to present the major classes of viruses in wastewater, as well as the methods of concentration, isolation, and identification of viruses in wastewater to assess public health risks and implement corrective measures to prevent and control viral infections. Last but not least, we propose to evaluate the current strategies in wastewater treatment as well as new alternative methods of water disinfection.

A framework for supporting health capability-based planning: Identifying and structuring health capabilities

The COVID-19 pandemic has highlighted that health security systems must be redesigned, in a way that they are better prepared and ready to cope with multiple and diverse health threats, from predictable and well-known epidemics to unexpected and challenging pandemics. A powerful way of accomplishing this goal is to focus the planning on health capabilities. This focus may enhance the ability to respond to and recover from health threats and emergencies, while helping to identify the level of resources required to maintain and build up those capabilities that are critical in ensuring the preparedness of health security systems. However, current attempts for defining and organizing health capabilities have some important limitations. First, such attempts were not designed to consider diverse scenarios and multiple health threats. Second, they provide a limited representation of capabilities and lack a systemic perspective. Third, they struggle to identify capability and resource gaps. In this article, we thus propose a new framework for identifying and structuring health capabilities and support health capability planning. The suggested framework has three main potential benefits. First, the framework may help policymakers in planning under high levels of uncertainty, by considering multiple realistic and stressful scenarios. Second, it can provide risk analysts with a more comprehensive representation of health capabilities and their complex relationships. Third, it can support planners in identifying resource and capability gaps. We illustrate the use of the framework in practice considering an outbreak scenario caused by three different health threats (COVID-19, Ebola, and Influenza viruses).

The COVID University Challenge: A Hazard Analysis of Critical Control Points Assessment of the Return of Students to Higher Education Establishments

The COVID-19 pandemic has disrupted economies and societies throughout the world since early 2020. Education is especially affected, with schools and universities widely closed for long periods. People under 25 years have the lowest risk of severe disease but their activities can be key to persistent ongoing community transmission. A challenge arose for how to provide education, including university level, without the activities of students increasing wider community SARS-CoV-2 infections. We used a Hazard Analysis of Critical Control Points (HACCP) framework to assess the risks associated with university student activity and recommend how to mitigate these risks. This tool appealed because it relies on multiagency collaboration and interdisciplinary expertise and yet is low cost, allowing rapid generation of evidence-based recommendations. We identified key critical control points associated with university student' activities, lifestyle, and interaction patterns both on-and-off campus. Unacceptable contact thresholds and the most up-to-date guidance were used to identify levels of risk for potential SARS-CoV-2 transmission, as well as recommendations based on existing research and emerging evidence for strategies that can reduce the risks of transmission. Employing the preventative measures we suggest can reduce the risks of SARS-CoV-2 transmission among and from university students. Reduction of infectious disease transmission in this demographic will reduce overall community transmission, lower demands on health services and reduce risk of harm to clinically vulnerable individuals while allowing vital education activity to continue. HACCP assessment proved a flexible tool for risk analysis in a specific setting in response to an emerging infectious disease threat. Systematic approaches to assessing hazards and risk critical control points (#HACCP) enable robust strategies for protecting students and staff in HE settings during #COVID19 pandemic.

What is the risk of acquiring SARS-CoV-2 from the use of public toilets?

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.

Review of Current Healthcare Waste Management Methods and Their Effect on Global Health

Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. This booming industry is also creating more waste than ever before and, as such, there is a growing need to treat and dispose of this waste. Healthcare waste (HCW) disposal includes a multitude of disposal methods, including incineration, landfilling and chemical treatments. These rudimentary methods and their growing use present their own problems that negatively impact both the environment and, in turn, damage public health, thus contributing to a global healthcare crisis. The aim of this review was to examine the current HCW disposal methods in place and the harmful effects they have on the environment and on public health. The findings accumulated in this review demonstrate a heavy reliance on basic, low tech HCW disposal techniques and uncovered the negative impacts of these methods. There is a notable lack of employment of "greener" HCW disposal methods on a largescale due to cost, access and feasibility. Despite innovations in HCW disposal, there is no scalable, global green solution at present. Further, the review highlights that global health consequences of HCW disposal methods often differ depending on how developed the country is.

Greenwashing of Local Government: The Human-Caused Risks in the Process of Environmental Information Disclosure in China

The increasing occurrences of greenwashing pose great risks to environmental protection. The current studies mainly focused on corporate greenwashing, and few paid attention to the greenwashing of the local government (GLG), thus lacking methods to identify the risks of forming the GLG and finding practicable countermeasures. This paper tries to fill the research gap in the study of the GLG by analyzing human factors. Given that the GLG is in close relationship with environmental governance pressures related to environmental information disclosure (EID), this paper attempts to analyze the human-caused risks of forming the GLG in the process of EID. This work focused on the process analysis, examined the human causes that form the GLG in the stages of collecting, medium, and disseminating of environmental information (EI), and offered countermeasures embedded with resilience accordingly.

Personal protective equipment for viral hemorrhagic fevers

PURPOSE OF REVIEW

Viral hemorrhagic fevers (VHF) encompass many organisms that have caused sporadic outbreaks with high case fatality rates. This article reviews VHF with reported human-to-human transmission and describes updates about personal protective equipment (PPE) for healthcare personnel (HCP) and others. We summarize existing information about appropriate PPE use, training, and compliance for care of VHF patients in endemic and nonendemic countries, as well as addresses the challenges HCP experience when using PPE.

RECENT FINDINGS

PPE is essential in protecting HCP from exposure to disease-causing pathogens. Recent evidence shows that anyone involved in care, management, and transport of certain VHF patients must use elements of PPE as part of appropriate infection prevention and control (IPC) practices. Strict adherence to standard precautions has effectively interrupted human-to-human transmission of a number of VHF. However, unclear protocols, inconsistent training, climate challenges, and cultural sensitivities impede proper PPE use. Appropriate PPE use can drastically reduce the risk of HCP exposure to VHF.

SUMMARY

Infections caused by certain VHFs can be highly pathogenic and associated with significant morbidity and mortality. Though it is well documented that use of PPE and good IPC practices are critical to reducing transmission, little conclusive evidence exists about the ideal PPE ensemble or components. Concerns with comfort, compliance, training, and usability may impede proper PPE use. Basic PPE elements, used appropriately as part of stringent IPC, must always form the foundation of care for HCP-treating patients with VHF. More research is required to identify the ideal PPE ensemble for caring for VHF patients in various settings.

Knowledge System Analysis on Emergency Management of Public Health Emergencies

The Coronavirus Disease 2019 (COVID-19) infectious pneumonia pandemic highlights the importance of emergency management of public health emergencies (EMPHE). This paper addresses the challenge of building a knowledge system for EMPHE research that may contribute to understand the spatial and temporal characteristics of knowledge distribution, research status, cutting-edge research and development trends, and helps to identify promising research topics and guide research and practice of EMPHE. Based on the Web of Science, this paper retrieves 1467 articles about EMPHE published from 2010 to date. Then, based on high-frequency keywords, we use CiteSpace to analyze their knowledge co-occurrence network, clustering network and knowledge evolution. Furthermore, we summarize the features and gaps in EMPHE research, providing references for future research directions. Based on the above analysis, this work constructs a knowledge system about EMPHE research, providing a comprehensive visual summary of the existing research in the field of EMPHE, with the aim to guide future research and practice.

Municipal Solid Waste Disposal Operational Performance in Wa Municipality, Ghana

BACKGROUND

The generation and management of solid waste pose potential adverse impacts on human health and the environment.

OBJECTIVE

The present study examines the operational performance of municipal solid waste (MSW) disposal in the Wa Municipality, Ghana.

METHODS

The study applied both qualitative and quantitative research methods and modelled the Wa Municipality's MSW disposal system using the municipal solid waste decision support tool (MSW DST). Acid gases (sulphur oxides and nitrogen oxides) and total particulate matter that have a direct impact on human health were set as the objective functions for modelling five MSW disposal scenarios. The modelled scenarios were: 1) landfill disposal only; 2) composting and landfill disposal; 3) composting, incineration, refuse derived fuels (RDF) and landfill disposal; 4) separation, composting, incineration, RDF and landfill disposal; and 5) separation, transfer, material recovery, composting, incineration, RDF and landfill disposal. The pollutants chosen as indicators for substance flow analysis included lead, cadmium, arsenic, mercury, copper, chromium, and zinc.

RESULTS

Scenarios 4 and 5 produced the least engineering cost of 1 150 000 US $/year for the entire MSW disposal system, whereas scenario 2 produced the highest cost of 1 340 000 US $/year. Scenario 5 produced the least average health impacts of -5.812E-04 lbs/year, while scenario 2 generated the highest engineering cost and produced the highest average health impact of 9.358E-05 lbs/year. Scenarios 5 and 4, which included waste-to-energy conversion in the systems, produced the lowest average health impacts (-5.812E-04 lbs/year and -5.611E-04 lbs/year, respectively).

CONCLUSIONS

The adoption of an integrated solid waste management concept, including waste-to-energy technologies, will not only help to lessen MSW disposal hazards, but also to produce alternative sources of energy for Ghana and other developing countries.

COMPETING INTERESTS

The authors declare no competing financial interests.

Evaluation of hospital-grade disinfectants on viral deposition on surfaces after toilet flushing

BACKGROUND

Past studies have shown that infectious aerosols created during toilet flushing result in surface contamination of the restroom. The goals of this study were to quantify viral contamination of surfaces in restrooms after flushing and the impact of disinfectants added to the toilet bowl prior to flushing on reducing surface contamination.

METHODS

The degree of contamination of surfaces in the restroom was assessed with and without the addition of coliphage MS2 to the toilet bowl before flushing. The bowl water and various surfaces in the restroom were subsequently tested for the presence of the virus.

RESULTS

The toilet bowl rim, toilet seat top, and toilet seat underside were contaminated in all trials without a disinfectant added to the bowl water before flushing. All disinfectants significantly reduced concentrations on surfaces when the contact time was ≥15 minutes. Hydrogen peroxide resulted in very little reduction of virus in the toilet bowl (<1 log₁₀). Peracetic acid and quaternary ammonium had the greatest log reductions on virus in the organic matter in the toilet.

CONCLUSIONS

Toilet flushing resulted in extensive contamination of surfaces within the restroom. Addition of disinfectant to the toilet bowl prior to flushing reduced the level of contamination in the bowl and fomites after flushing.

A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste

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Waste management is overlooked in the containment of highly infectious pathogens.

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Complexities of category A waste deter facilities' willingness to accept the waste.

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Enhanced training on properly handling and transporting category A waste is urged.

Background

The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste—contaminated with EVD and other highly infectious pathogens—is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste.

Methods

A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste.

Results

Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste.

Conclusions

Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety.

Surface Cleaning and Disinfection: Efficacy Assessment of Four Chlorine Types Using Escherichia coli and the Ebola Surrogate Phi6

In the 2014 West African Ebola outbreak, international organizations provided conflicting recommendations for disinfecting surfaces contaminated by uncontrolled patient spills. We compared the efficacy of four chlorine solutions (sodium hypochlorite, sodium dichloroisocyanurate, high-test hypochlorite, and generated hypochlorite) for disinfection of three surface types (stainless steel, heavy-duty tarp, and nitrile) with and without pre-cleaning practices (prewiping, covering, or both) and soil load. The test organisms were Escherichia coli and the Ebola surrogate Phi6. All tests achieved a minimum of 5.9 and 3.1 log removal in E. coli and Phi6, respectively. A 15 min exposure to 0.5% chlorine was sufficient to ensure <8 Phi6 plaque-forming unit (PFU)/cm² in all tests. While chlorine types were equally efficacious with and without soil load, variation was seen by surface type. Wiping did not increase disinfection efficacy and is not recommended because it generates infectious waste. Covering spills decreased disinfection efficacy against E. coli on heavy-duty tarp but does prevent splashing, which is critical in Ebola contexts. Our results support the recommendation of a 15 min exposure to 0.5% chlorine, independently of chlorine type, surface, pre-cleaning practices, and organic matter, as an efficacious measure to interrupt disease transmission from uncontrolled spills in Ebola outbreaks.

Aerosolization of Ebola Virus Surrogates in Wastewater Systems

Recent studies have shown that Ebola virus can persist in wastewater. We evaluated the potential for Ebola virus surrogates to be aerosolized from three types of wastewater systems: toilets, a lab-scale model of an aeration basin, and a lab-scale model of converging sewer pipes. We measured the aerosol size distribution generated by each system, spiked Ebola virus surrogates (MS2 and Phi6) into each system, and determined the emission rate of viruses into the air. The number of aerosols released ranged from 10⁵ to 10⁷ per flush from the toilets or per minute from the lab-scale models, and the total volume of aerosols generated by these systems was ∼10^-9 to 10^-7 mL per flush or per minute in all cases. MS2 and Phi6, spiked into toilets at an initial concentration of 10⁷ plaque-forming units per milliliter (PFU mL^-1), were not detected in air after flushing. Airborne concentrations of MS2 and Phi6 were ∼20 PFU L^-1 and ∼0.1 PFU L^-1, respectively, in the chambers enclosing the aeration basin and sewer models. The corresponding emission rates of MS2 and Phi6 were 547 PFU min^-1 and 3.8 PFU min^-1, respectively, for the aeration basin and 79 PFU min^-1 and 0.3 PFU min^-1 for the sewer pipes.

Censored Regression Modeling To Predict Virus Inactivation in Wastewaters

Among the many uncertainties presented by poorly studied pathogens is possible transmission via human fecal material or wastewaters. Such worries were a documented concern during the 2013 Ebola outbreak in West Africa. Using published experimental data on virus inactivation rates in wastewater and similar matrices, we extracted data to construct a model predicting the T90 (1 × log₁₀ inactivation measured in seconds) of a virus. Extracted data were as follows: RNA or DNA genome, enveloped or not, primary transmission pathway, temperature, pH, light levels, and matrix. From the primary details, we further determined matrix level of contamination, genus, and taxonomic family. Prior to model construction, three records were separated for verification. A censored normal regression model provided the best fit model, which predicted T90 from DNA or RNA structure, enveloped status, whether primary transmission pathway was fecal-oral, temperature, and whether contamination was low, medium, or high. Model residuals and predicted values were evaluated against observed values. Mean values of model predictions were compared to independent data and considering 95% confidence ranges (which could be quite large). A relatively simple model can predict virus inactivation rates from virus and matrix attributes, providing valuable input when formulating risk management strategies for little studied pathogens.

Disinfection of Ebola Virus in Sterilized Municipal Wastewater

Concerns have been raised regarding handling of Ebola virus contaminated wastewater, as well as the adequacy of proposed disinfection approaches. In the current study, we investigate the inactivation of Ebola virus in sterilized domestic wastewater utilizing sodium hypochlorite addition and pH adjustment. No viral inactivation was observed in the one-hour tests without sodium hypochlorite addition or pH adjustment. No virus was recovered after 20 seconds (i.e. 4.2 log10 unit inactivation to detection limit) following the addition of 5 and 10 mg L-1 sodium hypochlorite, which resulted in immediate free chlorine residuals of 0.52 and 1.11 mg L-1, respectively. The addition of 1 mg L-1 sodium hypochlorite resulted in an immediate free chlorine residual of 0.16 mg L-1, which inactivated 3.5 log10 units of Ebola virus in 20 seconds. Further inactivation was not evident due to the rapid consumption of the chlorine residual. Elevating the pH to 11.2 was found to significantly increase viral decay over ambient conditions. These results indicate the high susceptibility of the enveloped Ebola virus to disinfection in the presence of free chlorine in municipal wastewater; however, we caution that extension to more complex matrices (e.g. bodily fluids) will require additional verification.

The Disinfection Characteristics of Ebola Virus Outbreak Variants

The recent Ebola virus outbreak in West Africa has forced experts to re-evaluate their understanding of how to best disinfect areas contaminated with infectious bodily fluids. Recent research has found that Ebola virus remains viable in blood for 7–10 days making appropriate disinfection crucial to infection control. We sought to determine if the three most important outbreak variants of Zaire ebolavirus (Mayinga, Kikwit and Makona) exhibit separate phenotypes when challenged with a range of sodium hypochlorite (NaOCl) concentrations or 70% ethanol (EtOH) at average West African temperature. The time dependent killing of Ebola virus was evaluated by measuring infectious virus and viral RNA (vRNA), to determine if RNA detection is a viable method for decontamination measurement in areas without high containment laboratory access. Makona was less susceptible to weaker concentrations of NaOCl (0.05 and 0.1%) than Mayinga and Kikwit. At the recommended concentration of NaOCl (≥0.5%) all of the variants were inert after 5 minutes of contact time. Similarly, all variants were inactivated by 70% EtOH after 2.5 minutes, only Makona was detected at 1 minute. In multiple instances, high amounts of vRNA was detected in the absence of infectious virus, suggesting that it does not serve as an accurate measure of remaining infectivity after cleansing.