PROCEDURES FOR HANDLING AND PACKAGING BIOMEDICAL FROM SUSPECTED OR CONFIRMED CASES OF EBOLA

The following represents Stericycle’s guidelines regarding waste from suspected or confirmed cases of Ebola (“contaminated waste”). The guidelines are put in place to ensure safe and compliant handling, to protect all employees involved in the collection, transportation and disposal of the waste. Stericycle is requesting a signed confirmation, by an authorized representative from the healthcare facility, acknowledging that they have read and understood the guidelines, have communicated them to all concerned personnel and will abide by the process as described in this document. Stericycle will not collect any “contaminated waste” from a healthcare facility until it has received the signed confirmation.

SUSPECTED Ebola cases: • All “contaminated waste” from a suspected Ebola patient must be segregated from other and dealt with separately. It is very important that waste from suspected cases are not comingled or in contact with other waste. • If there is accidental comingling or contact, then all waste must be treated as “contaminated waste” • Biomedical waste from the suspected patient generated from other departments within the healthcare facility must also be treated as “contaminated waste” • “Contaminated waste” must be packaged, at the point of generation, under the following conditions: i. A securely closed Stericycle-provided plastic bag meeting the requirements of the Transport Equivalency Certificate SU 11521.1; ii. The securely closed plastic bag in (i) is contained in a second securely closed Stericycle-provided plastic bag meeting the requirements of the Transport Canada Equivalency Certificate SU 11521.1; iii. The securely closed plastic bags referred to in (ii) are contained in a securely closed Stericycle-provided UN standardized plastic drum meeting the requirements of the Transport Canada Equivalency Certificate SU 11521.1 and contains sufficient absorbent material to absorb any free liquid visible in the plastic bags; iv. The UN standardized plastic drum is securely closed with the drum seal; v. The UN standardized plastic drum described in (iii) is disinfected prior to segregated storage • Any (broken glass, needles) must be contained in a single-use, leak and puncture proof container meeting the requirements of a Type 1C sharps container (Stericycle recommends product code SY45), and must be placed directly into the plastic bag referred to in (i) above. • The container(s) must then be identified “QUARANTINE” and two biohazard symbols on at least 2 sides and stored in a secured location pending availability of final laboratory results. • IF the results are EBOLA NEGATIVE, then the QUARANTINE identification MUST BE REMOVED and the containers can be released to Stericycle as regular biomedical waste. Stericycle will not pick up any waste with the QUARANTINE markings.

• IF the results are EBOLA POSITIVE, then: i. The Stericycle-provided class 6.2 UN2814 labels and the Incinerate only labels must be affixed on at least 2 sides ii. The healthcare establishment must immediately contact their Stericycle District Manager:

a. British Columbia, Alberta, Saskatchewan, Manitoba Mike MacDougall 604.835.6287 [email protected] b. Ontario Dave Leger 647.381.8795 [email protected] c. Alternate BC to Ontario Sam Matsumura 416.577.0456 [email protected]

iii. Special pickup procedures will then be established and communicated iv. Stericycle will NOT collect any UN2814 waste unless it has been notified and that all the required paperwork and handling procedures have been confirmed. The Generator Certificate below will be required before the pick-up is completed.

PACKAGING Stericycle has prepared and made available container kits, contents as follows: • One (1) UN standardized plastic drum (Type 1C) • Six (6) red type 1C bags (37X50) • Two (2) bilingual labels – Infectious Substance Affecting Humans UN2814 Class 6 • Two (2) universal biohazard symbols • Two (2) quarantine Labels • One (1) Bilingual label referencing our Equivalency permit – 1A equivalent packaging as per Equivalency Certificate SU11521 (Ren.1)/ Emballage conforme tel que requis par le Certificat d’equivalence SU115121 (Ren.1) • Two (2) INCINERATE ONLY labels • One (1) Drum Seal • Two (2) Absorbent pads to absorb any visible free liquids

The price for each kit is $250 (includes contents as listed above, and product drop-off charges) and may be ordered through our customer service team at 1.866.836.6660 prompt 1, and referencing service code PD00. There is a minimum order requirement of 4 kits. Pick up of “contaminated waste” will be through a dedicated route, and therefore additional transportation charges may apply. Please note, reusable containers, plastic pails, drums or any containers other than those provided or approved by Stericycle cannot be used for “contaminated waste”.

Please find attached, the Equivalency Certificate issued by Transport Canada authorizing Stericycle to transport “contaminated waste” as described.

HEALTHCARE FACILITY CONFIRMATION

I, ______as the authorized representative of ______, acknowledge that I have read and understood these guidelines, have communicated them to all concerned personnel and will abide by the process as described in this document.

______Printed Name /Title /Generator

______Signature Date

Generator Certification of Proper Waste Packaging Ebola Virus Disease (EVD)

Generator Certification: This document certifies that offered for shipment have been properly packaged by the generator on site and that all proper waste packaging protocols as outlined in the Stericycle PROCEDURES FOR HANDLING AND PACKAGING BIOMEDICAL WASTE FROM SUSPECTED OR CONFIRMED CASES OF EBOLA (attached) as well as the requirements in the Transport Canada Equivalency Certificate SU 11521.1 (attached) were followed. The Generator acknowledges receipt of the Equivalency Certificate and all packaging instructions and commits that training has been provided to any and all personnel (including clinicians and all healthcare providers) who have been conducting any part of the packaging required for transport.

The generator certifies that the waste container(s) prepared for this shipment have been properly identified and segregated from other wastes, packaged in accordance to policy and Equivalency Certificate, and labeled, in accordance with applicable Ministry of the Environment and Transport of Dangerous Goods Regulations..

PLEASE PROVIDE THIS DOCUMENTATION PRIOR TO SHIPMENT to the Stericycle Driver – This document shall accompany each shipping document prepared and shipped as infectious substance affecting humans.

Total number of containers prepared for shipment: ______Date of Shipment: ______

______Printed Name /Title Hospital/Generator

______Signature Date