Hospitals worldwide are be unprepared to safely dispose of the infectious waste generated by any Ebola virus disease patient to arrive unannounced in the country, potentially putting the wider community at risk, biosafety experts said.

In the US, waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training, infectious disease and biosafety experts told Reuters.

Many US hospitals are unaware of the regulatory snafu, which experts say could threaten their ability to treat any person who develops Ebola in the US after coming from an infected region. It can take as long as 21 days to develop Ebola symptoms after exposure.

The issue created problems for Emory University Hospital in Atlanta, the first institution to care for Ebola patients here. As Emory was treating two US missionaries who were evacuated from West Africa in August, their waste hauler, Stericycle , initially refused to handle it. Stericycle declined comment.

Ebola symptoms can include copious amounts of vomiting and diarrhoea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up.

Ebola has become a global problem. Clinical waste from Ebola cases, of which there will be many more, and from those secondary and suspect cases arising worldwide, will generate massive amounts of high risk waste.

That waste must be treated. But by whom, and where?

Individual hospitals will have no capacity for suitable on-site treatment, apart perhaps from taking the waste to the local hospital laboratory and autoclaving it there. However, those autoclaves would not necessarily be suitable for waste processing, not performance tested to the same degree as required by the Environment Agency, and not licensed for waste processing.

A red bag for these wastes will not offer any additional protection!

Local treatment undertaken as close as possible to the patient facility will reduce risk of any incident.

Bags are convenient since they do not provide a complete seal. This cannot reliably be addressed by double bagging which merely offers two incomplete seals. The outside surfaces must be treated with disinfectant making handling more difficult. Run-off should be contained as this may be contaminated, irrespective of concerns regarding chemical residues.

Rigid waste containers might offer leakproof seals but not all such ‘leakproof’ waste bins can actually deliver this, though at least they are easier to handle and would generally remain upright, reducing the risk of spillage.

Undeniably, local treatment will reduce the risk of exposure. Those handling wastes must be properly protected by suitable PPE which in this case necessitates far more than a pair of gloves and a high viz tabard.

Few local waste treatment units exist. The Pyropure pyrolysis device looks promising, and small freestanding autoclaves might be installed but if patient numbers increase and waste outputs grow, capacity may be limited. An approved treatment option is required and overall the Pyropure device looks like a winner, if approval for this purpose is confirmed and the company can ramp up manufacture, installation and testing to met expected demand.

Treatment residues must be separated from untreated waste to avoid unintended release of untreated wastes, and for this the Pyropure device would win hands down. But whichever process is applied there will be some residues. These should be completely safe, but I might anticipate some hesitation to accept these residues for onward disposal – similar concerns arose during the foot and mouth outbreaks though with the sight of all those carcasses burned in open pits put this into context and soon resolved the matter.

CDC and others are close to issuing guidelines for safe disposal of Ebola waste and it would not be surprising if these were adopted worldwide. That’s fine, but there will be significant compromise and therefore lesser standards of safety if the necessary resources are not available locally.