Achieving Success by Validation! Decontamination Protocols of Category A Medical Waste for Patients with Serious Communicable Diseases

Abstract

<h3>Purpose</h3> During the 2014 Ebola outbreak, treatment centers for Ebola and special pathogens had to determine safe handling protocols for the management of category A infectious substances. There have been challenges achieving validation of adequate sterilization with autoclaving. To achieve successful inactivation requires alteration of cycle parameters (temperature, pressure, and time), and packaging methods. Successful inactivation is verified through the use of biological indicators, data loggers, and the evaluation of drain and exhaust lines. We aim to describe a successful waste sterilization process utilizing an autoclave in Emory University Hospital's biocontainment unit where we maintained appropriate safe handling waste processes. <h3>Methods & Materials</h3> Waste was differentiated by type to include patient general waste, linens, liquids, and sharps (including continuous renal replacement therapy cartridges). This helped us to determine appropriate packing methods and cycle parameters to ensure adequate inactivation by autoclaves. A biological indicator (BI) was used to monitor the efficacy of the autoclave sterilization process. Waste was double bagged with autoclave bags using the "gooseneck" method and secured with autoclave tape. This allowed for waste packaging to maintain closure of biohazard bags and contain leaks and aerosols. Following failed loads, action plans were generated until achieving successful inactivation. In order to determine the effectiveness of autoclave sterilization parameters, repeat loads were performed to ensure reliability. Once cycle specifications were finalized, each cycle type was repeated to achieve three successful runs with all passing biological indicators. <h3>Results</h3> We achieved effective inactivation of waste by altering autoclave factory settings. Following separation of waste and determine appropriate packing methods, we ran 26 total cycles achieving passing biological loads in 17 cycles. Failed loads occurred primarily in liquids and sharps where parameters were readjusted until achieving three successful cycles. <h3>Conclusion</h3> Safe handling of category A infectious waste requires validation of inactivation of waste by autoclave. Validation of autoclave parameters need to be assessed with particular attention to waste loads and packaging prior to treatment. We achieved successful inactivation of infectious medical waste with simulated patient waste loads while maintaining the integrity of waste packaging to ensure no leakage of liquid or aerosol particles occurred.