Planning, Preparation and Partnerships for Managing the Unexpected

Posted by Rich D'Addario on Fri, Oct 09, 2015 @ 10:30 AM

 A panel of environmental services (EVS) and waste stream experts convened to discuss emergency preparedness strategy, including EVS’ growing role and lessons learned from, Ebola –the worst health crisis in 35 years.. The panel walked through preparedness issues ranging from staff tracking to contact tracing to managing highly infectious waste. Panel guests also highlighted the importance of cross-functional teams and collaboration with hospitals, government officials, industry and community leaders.


Selin Hoboy, vice president of legislative and government affairs at Stericycle, has more than 15 years of experience in regulated healthcare hazardous waste.  She discussed solutions for reducing risk and protecting people and the environment during a crisis, all of which were centered on effective preparedness planning. Compliance improvements, various regulations, strategic vendor partnerships and other network needs were discussed in detail.

Brian Frislie, director of environmental services at Emory Healthcare, shared his story about how his role on the Ebola response team led to a call from the White House and a meeting with the President to discuss the outbreak and lessons learned. Regular calls with the Centers for Disease Control, the National Institutes of Health and the World Health Organization helped the Obama administration recognize the valuable role that EVS can play during world health crises.

Frislie is proud to have been a part of the EVS evolution. What started as a reactive department is now a strategic, executive function. His team is the front line of defense against hospital-acquired infections. As such, he must stay up-to-date on outbreak trends and cleaning, sanitizing and disinfecting technology and processes. With more than 30 years in healthcare EVS, he helped write the Standard Operating Procedures for processing Ebola waste, co-authored an article on Ebola waste handling in the American Journal of Infection Control (May 2015 ) and managed the processing of more than 4.5 tons of Ebola waste from Emory University Hospital’s Special Communicable Disease Unit.

Even when ‘N=1’, size matters with Ebola. Caring for one patient at Emory resulted in:

  • 50 waste contractor boxes
  • 3 cases of red biohazard bags
  • 1 case autoclave bags
  • 1 bag of autoclave bag rubber bands
  • 1 incubator
  • 1 case spore testing pack
  • 2 cart covers
  • 1 spill kit
  • 1 pair heat resistant gloves
  • 12 plastic barrels with lids and casters

 What have been the lessons learned?

  • Define your hospital preparedness: Brian’s counterpart at Texas Children’s Hospital, Elex Sanchez director of environmental services and sustainability advises EVS teams to check their own supplies and suppliers’ supplies to stay ahead. He also cautions to keep teams small. Highly infectious disease areas become one of most exposed areas for staff; small groups are easier to control.
  • Train and Retrain: Receiving a patient or having one show up in your emergency room is not the time for a trained team member to have cold feet. Run drills rather than lecture.. Gown up and walk through it to know where items are kept, how to donn and doff garb, and to understand the patient and waste stream flow.
  • Recognize vulnerability: Nationally all hospitals should be concerned for an outbreak and have some type of means to control the situation until other resources are available. Discuss your plan with hospitals in your region and visit to see how they plan to manage the patient along with what supplies and resources are needed.

Half of the nation’s 4,500-5,000 hospitals were not prepared to handle a single Ebola patient. One of the biggest challenges is sustaining the readiness, maintaining supplies and resources over time. Every hospital should be prepared with the right supplies, inventory and waste stream management strategy. Once faced with a health crisis, there is no time to plan.

Hoboy cautions that landfills will not accept Ebola waste. Because the hospital has to send the waste offsite for treatment, waste processes are vital to any preparedness plan. Unfortunately regulated medical waste containers and standard protocols will not suffice. Specific packaging requirements for Category A wastes are required as well as the right sized containers and DOT permits.

More insights from the experts include:

  • Do not underestimate the amount of waste generated by staff and patients during caregiving; make a contingency plan. The waste does not stop coming once the crisis starts.
  • Leaders should look ahead, particularly for compliance issues, for the safety of teams and the community.
  • Treat your vendors as your partners and review the science behind each challenge. Do not be led by hysteria and fear so that the right business decisions can be made.

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Topics: Ebola, CDC

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