May 14, 2024

Packaging Prion Waste For Transport and Disposal

Healthcare organizations and laboratory facilities that are disposing of waste, which contains or potentially contains prions, including Creutzfeldt-Jakob Disease (CJD), must package it appropriately for disposal and transport. Proper packaging ensures the safety of all staff and treatment facility workers and maintains compliance with federal, state, and local regulations.

What are Prion Diseases?   

Prion diseases are rapidly progressive, uniformly fatal brain diseases that can infect humans and animals, including mammals, cattle, sheep, goats, deer, elk, cats, and zoo ungulates, which are mammals with hooves. In humans, prion diseases may manifest spontaneously (sporadic) or be passed down genetically (inherited). They can also occur through iatrogenic transmission, meaning they are spread through a medical procedure or treatment.

Which Prion Diseases Affect Humans?

There are five human prion diseases known to date:

  • Creutzfeldt-Jakob Disease (CJD)
  • Variant Creutzfeldt-Jakob Disease (vCJD)
  • Gerstmann-Straussler-Scheinker Syndrome
  • Fatal Familial Insomnia
  • Kuru

What is Creutzfeldt-Jakob Disease (CJD)?

Creutzfeldt-Jakob disease (CJD) is a form of brain damage believed to be caused by a prion protein which folds abnormally. It seems to encourage other proteins to have abnormal shapes, affecting their ability to function. As a result, CJD causes a rapid decrease in mental function and movement.

While the majority of cases occur sporadically, there have been instances of iatrogenic transmission. However, thanks to modern medical sterilization processes, such as incineration, the last reported case of CJD from Iatrogenic transmission was in 1976.

Does Stericycle Accept Prion Waste?

Yes, Stericycle will collect, transport, and treat prion waste. Prion waste is regulated medical waste (RMW) that, following Stericycle’s waste acceptance policy (and some state regulations), must be packaged and handled for treatment via incineration. Prions are resistant to autoclaving and other sterilization techniques. Incineration, on the other hand, is considered the most effective method of prion waste disposal. RMW incineration helps render the waste noninfectious and unrecognizable before it is disposed.

How to Package Prion Waste

Our prion handling and treatment policy requires that prion waste is packaged according to specific guidelines, using materials provided by Stericycle.  The generator or customer must:

  1. Package the prion waste using two liners, as required by state and federal regulations.
  2. Place the waste inside a liner and secure the top.
  3. Place the closed liner inside a second liner and secure the top of the second liner.
  4. Hand-tie the top of each liner by gathering and twisting the neck of the liner and using either a hand knot or zip tie (or equivalent per the manufacturer’s specifications) to secure the liner. This will prevent the inner contents from leaking when inverted.
  5. Place the liners into a fiberboard box with the required state and federal markings.
  6. Close and tape the top and bottom of the fiberboard box with a two-inch wide pressure-sensitive tape or equivalent.
  7. Label the box as “Incinerate-Only” using a pre-printed label or written by hand using a pen or marker, since medical waste that contains or may contain prion waste must be incinerated.
  8. Label the box with an incinerate only barcode. 

It’s important to also note that the box must not be labeled with any markings noting that the contents may include CJD or prion waste. Containers must also not be overweight, bulging, or leaking. Additionally, containers must not have medical waste on the outside of the packaging or have sharps protruding from the packaging. 

How Should Packages Be Prepared For Transport?

To prepare RMW packages that contain or may contain prion waste for transport, generators need to follow these steps:

  • The RMW packages are included on regulated medical waste shipping papers as incinerate-only medical waste.
  • In accordance with Federal Department of Transportation (DOT) Regulations [49 CRF 172.204], each shipper or generator must certify by printing (manually or mechanically) on the shipping papers that the materials being offered for shipment are properly classified, described, packaged, marked and labeled, and are in proper condition for transportation according to the applicable DOT regulations.
  • Additional state regulations may be applicable. If location management is unsure of additional state regulations, contact your local Environmental Health and Safety (EHS) manager or appropriate internal resource.

To ensure your organization correctly packages its prion waste, consult an RMW management expert like Stericycle.