Keeping ETU'S Clean and Safe: Waste Management

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. 


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

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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.

Equipping Families: Household Protection Kits

Tragically, at the height of the epidemic, people were turned away from ETUs because there were simply no beds for them. Although the wisdom of providing families with PPE was debated, responders, including MSF and UNICEF, began to distribute household protection kits in 2014 in order to reduce the risk of infections among families. Each kit included biohazard bags, soap, PPE and gloves.

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UNICEF, USAID and the Paul G. Allen Family Foundation provided 9,000 household protection kits that were distributed across Liberia in fall 2014. Photograph by Morgana Wingard, USAID

Kuhar, David

Dr. David Kuhar

In the following audio file, Dr. David Kuhar discusses infection prevention.

Kallon, Isata

Isata Kallon

In the following audio file, Isata Kallon discusses the use of chlorine to combat the spread of Ebola.