SPECTRE Blog Series: Considerations for Managing Category A Waste in a Healthcare Facility-Treatment Options to Inactivate Category A Pathogens & Packaging Category A Waste for Off-Site Treatment

In this post, we will discuss the following considerations for managing Category A waste in a healthcare facility:

  • Treatment options to inactivate Category A pathogens
  • Packaging Category A waste for off-site treatment

Treating waste on-site: Whenever possible, on-site treatment is highly recommended since off-site treatment may increase the risk to staff, waste handlers, and the public due to the additional steps that need to be taken for package and transport. If a facility has capabilities for on-site inactivation, those processes should be validated and periodically tested to ensure they function correctly and consistently. A variety of options exist for waste inactivation:

  • Autoclaving: Uses saturated steam under pressure to heat materials to a high enough temperature for a long enough period to inactivate pathogens of concern in the waste.
  • Incineration: A thermal method that uses combustion to reduce waste to ash and flue gases. Medical incinerators with dual chambers run at extremely high temperatures, well above the relatively low temperatures needed to inactivate most Category A organisms.
    • Considered the best method for large or bulky items (i.e., mattresses) or items associated with terminal cleaning after a patient has been discharged.
    • Facilities are regulated under the Clean Air Act (CAA) with permitting and specialized equipment for the combustion of the waste and the proper management of the remaining air or flue gases to ensure safe emissions.
  • Alternative methods: Some infectious agents (e.g., prions, spores, and pathogens within biofilms) are remarkably stable in the environment, difficult to inactivate, and require other validated methods of waste treatment. These methods are also commonly used for surface decontamination or when waste includes body parts, tissues, organs, or other materials. Such methods are subject to federal and SLTT regulations, including the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).
    • Chemical disinfection
    • Alkaline hydrolysis digesters (i.e., tissue digesters)

Packaging waste for off-site treatment: Packaging Category A waste is almost exclusively designed to transport small samples between facilities and is inadequate to move large volumes of waste. During the 2015 Ebola Outbreak, the U.S. Department of Transportation (DOT) issued special permits that authorized alternative packaging to facilitate the movement of large volumes of Ebola virus-contaminated waste. Requirements for packaging and shipments of Category A waste include:

  • Meets the test standards of the Hazardous Materials Regulations (HMR).
  • Triple packaging
    • Primary leakproof receptacle
    • Leakproof secondary packaging
    • Rigid outer packaging
  • Be marked with a United Nations (UN) package certification mark on the outer packaging.
  • Requirement of “INFECTIOUS SUBSTANCE” and “BIOHAZARD” labeling. 

Alexandra McKenna Lewis is a 4th-year medical student at the University of Texas Medical Branch John Sealy School of Medicine.





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