Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach.
OBJECTIVE
To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks.


METHODS
A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point.


RESULTS
The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste.


CONCLUSIONS
The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.
Centre for Ecology, Evolution and Conservation, University of East Anglia, Norwich, England .
Kelly L
KL
Edmunds
Department of Family and Community Medicine, University of Gezira, Gezira, Sudan .
Samira Abd
SA
Elrahman
Centre for Ecology, Evolution and Conservation, University of East Anglia, Norwich, England .
Diana J
DJ
Bell
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England .
Julii
J
Brainard
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England .
Samir
S
Dervisevic
Reproductive Health Department, Egerton University, Egerton, Kenya .
Tsimbiri P
TP
Fedha
School of International Development, University of East Anglia, Norwich, England .
Roger
R
Few
Department for International Development, East Kilbride, Scotland .
Guy
G
Howard
School of Environmental Sciences, University of East Anglia, Norwich, England .
Iain
I
Lake
Médecins Sans Frontières, Bruxelles, Belgium .
Peter
P
Maes
Department of Dairy, Food Science and Technology, Egerton University, Egerton, Kenya .
Joseph
J
Matofari
Centro de Educación, Conservación, e Interpretación Ambiental, Inter American University of Puerto Rico, San Germán, Puerto Rico .
Harvey
H
Minnigh
Department of Pathology, University of Gezira, Gezira, Sudan .
Ahmed A
AA
Mohamedani
Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland .
Maggie
M
Montgomery
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England .
Sarah
S
Morter
Faculty of Engineering and Technology, Egerton University, Egerton, Kenya .
Edward
E
Muchiri
Tshwane University of Technology, Pretoria, South Africa .
Lutendo S
LS
Mudau
Faculty of Engineering and Technology, Egerton University, Egerton, Kenya .
Benedict M
BM
Mutua
Faculty of Engineering and Technology, Egerton University, Egerton, Kenya .
Julius M
JM
Ndambuki
Department of Civil and Environmental Engineering, University of Surrey, Guildford, England .
Katherine
K
Pond
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America .
Mark D
MD
Sobsey
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England .
Mike
M
van der Es
Water Security Research Centre, University of East Anglia, Norwich, England .
Mark
M
Zeitoun
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England .
Paul R
PR
Hunter
D029043:Ebolavirus; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control; D006801:Humans; D017744:Medical Waste Disposal / Q000379:methods*
D017744:Medical Waste Disposal