Keeping Ebola Treatment Units Clean and Safe: Waste Management

Cleaning Hospital

Wearing full protection, a worker cleans up waste in a hospital treating Ebola patients in Sierra Leone, September 2014. Workers used a strong, 0.5% chlorine solution followed by soap and water on floors to carefully clean up body fluids. Photograph by Michael Duff

The bodily fluids of Ebola victims, including vomit, urine, feces, blood, and sweat, were highly infectious. Therefore, safe and careful management of waste disposal was critical.  The problem was particularly challenging in hospitals filled to capacity with severe staff shortages and limited supplies. Safe handling of human waste was also an issue in the homes of Ebola victims. CDC published guidelines with specific recommendations for the safe handling of infectious waste, but in Guinea, Liberia, and Sierra Leone, the problem was compounded by severe shortages of water and sanitation services both in health care facilities and the affected communities. 

ETU Waste Disposal

Health care workers wearing PPE safely disposing trash in an ETU in Guinea, September 2014. Photograph by Ricci Shryock, World Food Programme

ETU Washing Clothes

Washing items thoroughly in chlorine water and soap at the Ebola Treatment Unit at Island Clinic in Monrovia that opened in September 2014. Photograph by Morgana Wingard, USAID

Chlorine Disinfectant—The Smell Was Everywhere

Chlorine became a trusted ally in the fight against Ebola because it damaged the Ebola virus and helped prevent infection. CDC recommended a mild (0.05%) solution of HTH (High Test Hypochlorite) chlorine for use in health care facilities when washing bare hands and disinfecting items that came into direct contact with the patient’s skin or body. A stronger (0.5%) solution with a higher concentration of HTH chlorine was used to disinfect floors, surfaces, medical equipment, bedding, and gloved hands. 

In an effort to be vigilant, chlorine use extended into the community where handwashing stations with containers of the mild chlorine solution could be found outside office buildings, police stations, hotels, and stores. The smell of chlorine was everywhere, but became the smell of safety and survival.

Dry chlorine granules were diluted to make the required chlorine disinfectant solution in buckets such as this one.

Kallon, Isata

Isata Kallon

Isata Kallon, a nurse at Kenema Government Hospital in Sierra Leone, discusses the lack of chlorine protocols early in the outbreak. (Transcript)