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

Emerging infectious diseases present threats to global health.1 The 2014–2016 Ebola virus disease outbreak in western Africa – caused by the Democratic Republic of the Congo strain – caught local and global health-care communities unaware and unprepared. By 2 September 2015, the outbreak had been associated with at least 28 073 confirmed, probable or suspected cases – reported in 10 countries – and more than 11 290 deaths.2 There were extraordinary challenges for the health-care systems and local governments involved in the response to the outbreak – and many of those challenges will persist long after the outbreak has passed.3 One such challenge was the safe disposal of potentially infected faecal and health-care waste – especially in the overcrowded urban communities where many of the cases occurred. It has been estimated that a patient in a bed within an African centre for Ebola treatment produced up to 300 litres of liquid waste and excreta per day.4 Every one of those litres could have been contaminated with Ebola virus5 and needed to be disposed of in such a way as to minimize the risks of transmission.6 The safe disposal of waste that could harbour Ebola virus is particularly challenging when that waste has been produced beyond any formal health-care setting. In the three countries most affected by the recent outbreak – i.e. Guinea, Liberia and Sierra Leone – severe shortages of water and sanitation services in health-care facilities and the affected communities often complicated the safe disposal of waste. According to the most recent data, nearly one third of health-care facilities in Guinea, Liberia and Sierra Leone have no piped water, 22% have no improved sanitation and 40% have no system to manage health-care waste.7 The corresponding percentages for households within the same countries are probably higher.8