Infection penetrates the media on a daily basis. The recent Staphylococcus aureus (MRSA) infections in schools, the meningitis infection at Prairie View A&M in Texas, Norwalk infection at retirement communities, the recent Vibrio cholerae (cholera) outbreak in Northern Iraq, and the Anthrax attacks of 2001 show that disease outbreak control is an integral part of our society and economy.
Different types of infection require various methods of containment. Attempts to contain infections due to cholera range from water treatment and vaccinations while MRSA outbreaks are fought with elevated sanitation methods such as comprehensive disinfection and hygiene measures.
Evacuation Shelter Disinfection and Restoration
Thousands have been displaced from their homes due to the hurricanes affecting the US gulf coast. While many have sought shelter with family and friends, others have had to rely on government shelters for basic needs.
These government shelters provide and roof, clothing, food, and medical needs in the hope of transitioning affected families back to their homes or to a long-term housing facility.
Once the affected have left the short-term government shelters, these facilities must be restored to their pre-storm status. Before the conventional use of these facilities is available, government mandated steps to restore the environment must be completed.
Common areas used by those in the shelter such as bathrooms, cots, phones, handrails, walls, floors, kitchens, vending machines, doors, HVAC system, protective floor mats, First Aid rooms, and processing areas must be disinfected.
Pandemic Influenza
One of the most potent types of infection, and potentially the widest ranging, is pandemic influenza. In the last century, three influenza pandemics have swept the
globe. In 1918, the first pandemic (the “Spanish Flu”) killed over 500,000 Americans and more than 20 million people worldwide.
One-third of the U.S. population was infected and the average life expectancy was reduced by 13 years. Pandemics in 1957 and 1968 killed tens of thousands of
Americans and millions across the world. There is evidence that viruses from birds played a role in each of those outbreaks.
Today’s threat is from a new influenza strain, influenza A (H5N1). H5N1 is spreading through bird populations across Asia, Africa, and Europe, infecting domesticated birds, including ducks and chickens, and long-range migratory birds. The first recorded appearance of H5N1 in humans occurred in Hong Kong in 1997. Since then, the virus has infected over 200 people in the Eastern Hemisphere, with a mortality rate of over 50 percent.
During late 2003 and early 2004, outbreaks of highly pathogenic avian influenza A (H5N1) occurred among poultry in 8 countries in Asia: Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam. At that time, more than 100 million birds either died from the disease or were destroyed in an attempt to prevent further spread of the disease (WHO).
Thailand reported new human cases of H5N1 in October, November, and December 2005, and Vietnam reported new human cases in November 2005. China reported the country’s first confirmed human cases in November 2005 and has continued to report human cases in December 2005 and January 2006. Turkey reported the country’s first confirmed human cases on January 5, 2006 and reported two additional confirmed human cases on Jan 7, 2006.
Global Response Begins at Home
Our Legal Environment
In the 1970’s, environmental legislation was poor or non-existent. The 1965 Solid Waste Disposal Act encouraged states to develop waste management programs.
The Clean Air Act and Clean Water Act had required installation of pollution control devises on smokestacks and pipes.
These acts did not directly dictate where the waste was supposed to go or the processing of the waste prior to disposal. Landfills at the time were simply holes in the ground that were compacted by bulldozers until full and then covered with topsoil in preparation for commercial development above.
Medical waste was discarded through the municipal waste stream, garbage collection, and sanitation workers were exposed to potential infection.
Prior to the Resource Conservation and Recovery Act of 1976 (RCRA), there wasn’t stringent record keeping requirements to identify the origination of the waste. The Resource Conservation and Recovery Act was enacted in 1976 to address the limitations of the existing legislation.
"A policy success is a government intervention, or the elimination of one, that improves the allocation of resources and reduces the degradation of the environment."
Theodore Panayotou, Green Markets
RCRA was the first environmental law to take a life-cycle approach when it established standards for waste from its generation to its disposal. One of the best aspects of RCRA was the flexibility it offered private industry in explaining waste classification. By clearly dictating the handling standards for medical waste, RCRA was a major step forward in disease outbreak control.
In addition to the list of regulated substances banned from conventional disposal, RCRA uses a characteristic system to explain its scope. Under this characteristic system, any substance that meets any of the components (ignitability, reactivity, corrosivity, or toxicity) is regulated waste. And this regulated waste has stringent disposal requirements.
The drawback of RCRA was not in its structure or scope but in its implementation. While RCRA clearly dictated the handling standards in regards to medical waste, state agencies lacked standardized enforcement. The Texas Commission on Environmental Quality (TCEQ) previously cited exemptions to the medical waste handling standards dictated by RCRA.
Previously, according to the TCEQ, the waste generated from a home or lodging was exempt from special handling requirements. RCRA did not grant these exemptions.
A cornerstone of the EPA’s 2006-2011 Strategic Plan is the Cross-Goal Strategies that focus on reconciling federal direction and state implementation. State environmental programs conduct a great portion of the day-to-day work involved in compliance and enforcement activities.
The EPA has placed higher priority in joint planning with States and Tribes. This joint planning is already starting to clarify enforcement on the local level.
Closing the Gap between Federal Direction and State Implementation
When communicating remediation and disposal requirements to the public, city personnel display a consistent approach between federal direction, state implementation, and the local city level enforcement of RCRA standards.
This consistent approach will not only add efficiencies on an organizational level at the EPA but it will also increase the effectiveness in our government agencies and private industry’s protection of the public. With the challenges that infection control brings, this increase in effectiveness is the best possible approach in the protection of society's health.
