COVERSHEET PROGRAMMATIC INITIAL ENVIRONMENTAL EXAMINATION ... · COVERSHEET PROGRAMMATIC INITIAL ENVIRONMENTAL EXAMINATION Global USAID Response to Avian Influenza Outbreak and Surveillance

COVERSHEET

PROGRAMMATIC INITIAL ENVIRONMENTAL EXAMINATION

Global USAID Response to Avian Influenza Outbreak and Surveillance for Ebola

Virus in Livestock in Africa

1. EXECUTIVE SUMMARY

1.1. PROGRAM/ACTIVITY DATA

Program/Activity Number Program/ Activity Title Global USAID Response to Avian Influenza Outbreak and

Surveillance for Ebola Virus in Livestock in Africa

Country/Region Global (GH, AFR, ANE, E&E, LAC, DCHA and EGAT)

USG Foreign Assistance Framework Functional Objective & Number: Investing in People, 3 Program Area: Health Program Element: PIOET, 3.1.4

Period Covered August 1, 2015 - September 30, 2019 Life of Project Amount $330,000,000

IEE Amendment Yes, this document is Amendment #2. Amendment #1 was completed on September 3, 2017. The original PIEE was approved on June 21, 2015.

IEE Prepared By Lindsay Parish

Management Unit Contact Point l1:[email protected]

1.2. ENVIRONMENTAL ACTION RECOMMENDED

Categorical Exclusion x Negative Determination x Positive Determination

Project does not cover the following activities

-Large scale construction activities are not authorized under this PIEE. - The use of incinerators with capacities to destroy> 100 kilograms of waste per hour are not authorized under this PIEE.

1.3. THRESHOLD ENVIRONMENTAL DETERMINATIONS

Note: Upon final approval of this PIEE, these recommendations are affirmed as threshold decisions and conditions become mandatory elements of project implementation.

Activity or Activity Category Recommended Determination

1. Monitoring and surveillance (M & S) for the presence Negative Determination with Conditions, of avian influenza, Ebola and other emerging pandemic per 22CFR216.3(a)(2)(iii) threats and zoonotic diseases in wild and domestic animals, which include sampling and laboratory analysis of infectious disease Field and laboratory testing for the presence of pandemic disease agents including, but not limited to avian influenza and Ebola. 2. Disinfection of poultry, and food manufacture and Negative Determination with Conditions, transportation workers, clothing, shoes/boots, poultry per 22CFR216.3(a)(2)(iii)

houses, vehicles, tools, medical equipment, culling

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Activity or Activity Category equipment, and all other equipment and materials which come into contact with the virus or products containing the virus. 3. Animal and human vaccination, veterinary examination and treatment, and human patient examination and treatment.

4. Laboratory research and testing.

5. Culling of diseased livestock and disposal of diseased livestock, wild birds, and their manure.

6. Small scale construction and renovation of laboratory and research facilities.

7. Procurement, installation, commissioning, operation, and maintenance of treatment equipment for medica l and pesticide wastes (i.e. incinerators with capacities to destroy approximately 12 to 100 ki lograms of waste per hour).

Recommended Determination

Negative Determination with Conditions, per 22CFR216.3(a}(2}(iii)

Note: This type of activity does not include extermination of uninfected wild bird populations or their natural habitats or similar extreme measures. If these activities are proposed, th is would require a Positive Determination, Scoping Exercise, and Environmental Assessment, unless U.S. migratory species are involved in wh ich case an Environmental Impact Statement under NEPA procedures wou ld be required. Negative Determination wit h Conditions, per 22CFR216.3(a}(2}(iii) Negative Determination with Conditions, per 22CFR216.3(a)(2)(ii i)

Note: This type of activity does not include extermination of uninfected wild bird populations or their natural habitats or similar extreme measures that would require a Positive Determination, Scoping Exercise, and Environmental Assessment, unless U.S. migratory species are invo lved in which case an Environmental Impact Statement under NEPA procedures would be required. Negative Determination with Conditions, per 22CFR216.3(a}(2}(iii)

Negative Determination with Conditions, per 22CFR216.3(a)(2}(iii)

For incinerators with capacities to destroy approximately 12 to 100 kilograms of waste per hour1

Note: The use of incinerators with capacities to dest roy> 100 ki lograms of waste per hour are not authorized under this PIEE. The PIEE will be amended if capacities exceed this amount, with a

1 USAID PATH Incinerator Guidebook (2010) https://www.path .org/publications/files/TS mmis incin guide.pdf

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Activity or Activity Category Recommended Determination resulting scoping study and, if necessary, an Environmental Assessment developed and approved by the COR and the GH BEO. Multiple installations serving a facility that in total exceed these thresho lds will also receive a positive determination.

8. Provision and training in the use of personal Negative Determination with Conditions, protective equipment (PPE) per 22CFR216.3(a)(2)(iii)

9. Communication, public awareness campaigns and Categorical exclusion, per training in pandemic threat response. 22CFR216.2(c)(2)(i)

[education, technica l assistance, tra ining].

1.4.SUMMARY OF IMPLEMENTATION, MONITORING, AND REPORTING MEASURES

1. Environmental Management Training. The GH AOR/COR and Activity Manager(s) assigned to t his

program are to enro ll in and successfully complete the Bureau for Global Hea lth Environmental

Management Process Train ing course. The course is offered through GHPOD.

2. Provision of the IEE. The AOR will provide a copy of this IEE to the implementing partner and brief them on their environmental compliance responsibilities.

3. Public International Organization (PIO) environmental safeguards. In cases where the implementing partner (IP) is a PIO, t he GHAOR will consult with the IP to determine if t he organization has adequate environmental safeguards for the activity. If the PIO chooses to use their environmental compliance process and templates, they will provide the GHAOR with examples of the proposed reporting format and monitoring process to demonstrate that they have the necessary environmental mitigations and compliance for the project. The GH AOR, in consultation with the GH BEO, w ill assess the PIO's environmental safeguards. The PIO may choose to use the USAID environmental compliance procedures and templates (Appendices A-C). The USAID EMMP, or the PIO's proposed environmental safeguards plan, will be provided t o the GHAOR concurrently with t he project work plan for review and approval and t he GH BEO for concurrence.

4. Pesticides or pesticide products. The procurement or use of pesticide requires the preparation of a separate section evaluating the risks and benefits of the planned pesticide use, which must address the factors outline in 22 CFR 216.3 (b)(l)(i). A Safer Use Action Plan (SUAP) may be required for review and approva l by the GHAOR and Global Health BED. Pest icide used on this project must be approved by US Envi ronmenta l Protection Agency or WHOPES and be registered in the country where to application is to occur.

Pesticide use, only to the extent that they are classified as disinfectants, will be used for Ebola activities. AOR: AC

5. Assurance of sub-awardee, -grantee, -contractor capacity and compliance. The implementing partner shall assure that sub-awardees, -grantees, -contractors have the capability to implement the relevant requirements ofthis IEE. The implementing partne r sha ll, if appropriate, provide training to sub-awardees, -grantees, and -contractors in their environmental compliance responsibilities

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6. AOR monitoring responsibilities. As required by the ADS 204, the AOR will actively monitor and evaluate whether the conditions of this IEE are being implemented effectively and whether new or unforeseen consequences arise during implementation not identified and reviewed in this IEE. If new or unforeseen consequences arise, the team will suspend the activity and initiate appropriate, further review in accordance with 22CFR216.

7. Annual compliance documentation and reporting. The IP shall complete the attached EMMP (or PIO equivalent) with the project work plan. The IP is responsible for annually preparing and submitting to the AOR for review and approval, the attached Environmenta l Mitigation Monitoring Report (EMMR) to document compliance with the conditions of this IEE.

8. Environmental Mitigation and Monitoring Report: Implementing partners under this award will complete an annual environmental mitigation and monitoring report (EMMR) that covers the documentation of the EMMP and its effectiveness.

• The environmenta l monitoring report is due to the AOR by December 31 of each year. • The EMMR w ill record the environmenta l mitigation and monitoring measures outlined in

the EMMP and will indicate the activities used to ensure that those measures were implemented.

• Based on the process outlined in the Project Work plan, the implementing partners' annual reports to USAID will include brief updates on mitigation and monitoring measures being implemented, results of environmenta l monitoring, and any other major modifications/revisions in the development activities, and mitigation and monitoring procedures. The EMMR will also identify issues and challenges associated with the implementation of the EMMP.

The EMMR must be stored in project files.

9. Integration of compliance responsibilities in prime and sub-contracts, agreements, and grants. The AOR shall assure that the cooperative agreements document references and require compliance with the conditions set out in this IEE, as required by ADS 204.3.4(a)(6) and ADS 303.3.6(3)(e). The implementing partner sha ll assure that sub-contracts, agreements, and grants reference and requ ire compliance with relevant elements of these conditions.

10. Compliance with human subject research requirements. The AOR in consultation with the Cognizant Human Subjects expert shall assure that the IP and sub-awardees demonstrate completion of all requirements for ethics review and adequate medical monitoring of human subjects who participate in research trials carried out through this agreement. The BEO for Global Health may request copies of documentation from the AOR to demonstrate compliance with applicable requirements of human subject trials. All documentation demonstrating completion of required review and approva l of human subject trials must be in place prior to initiating any trials and cover the period of performance of the trial as described in the research protocol. Specifically, the implementing partner must provide a brief description of the research and the steps taken to comply with USAID requ irements for the protection of human research subjects. This information must be provided to the AOR as part of the EMMP or as part of an amended EMMP.

11. New or modified activities. As part of the work plan, the implementing partner in collaboration with the AOR shall review all on-going and planned activities to determine if they are within the

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scope of this IEE. The implementing partner shall complete the screening questionnaire (Part 1 of EMMR) with the annual work plan (Appendix A).

• If activities outside the scope of this IEE are planned, the AOR sha ll assure that an amendment to this IEE addressing these activities is prepared and approved prior to implementation of any such activities.

• Any ongoing activities found to be outside the scope of this IEE shall be modified to comply or halted until an amendment to this IEE is submitted and approved.

12. Compliance with Host Country Requirements. Nothing in this IEE substitutes for or supersedes implementing partner, sub-awardees/-grantee/-contractor's responsibi lity for compliance with all applicable host country laws and regulations. The implementing partner and sub-awardee, -grantee, -contractor must comply with host country environmental regu lations unless otherwise directed in writing by USAID. However, in case of confl ict between host country and USAID regulations, the latter shall govern.

13. Small-Scale Construction Activities. Small scale construct ion and renovation activities to improve laboratory and research facilities wil l be limited to minor renovation activities. Examples include minor expansions or additions to laboratory and research facilities, repairing roofs and walls, installation of laboratory benches and she lving, installation of windows, repairing of plumbing and electrical systems.

14. Asbestos and lead-based paint. The IP will not use construction materials containing asbestos or lead-based paint. When conducting renovation on existing buildings, the IP will investigate for the presence of asbestos or lead paint prior to initiating work and will provide appropriate personal protective equipment (PPE) and a disposal process for handing the hazardous waste, if identified.

15. Air pollution control technology for incinerators. Small- or large-scale incinerators procured or operated by t he Implementing Partner must contain adequate air pollution control technology to ensure compliance with host country guidelines and applicable international air quality emission requirements, including:

• 74 FR 51367: US Environmental Protection Agency. Standards of Performance for New Stationary Sources and Emissions Guidelines for Existing Sources: Hospital/Medical/Infectious Waste Incinerators; Final Rule. October 6, 2009.

• Directive 2000/76/EC: Of the European Parliament and of the Council of 4 December 2000 on the incineration of waste.

• AP 42 and Emission Factors: US Environmenta l Protection Agency.

A small-sca le incinerator is one with a capacity to destroy approximately 12 to 100 kilograms of waste per hour, while a large-scale incinerator has a capacit y to destroy more than 100 kilograms of waste per hour. Refer to the USAID PATH Incinerator Guidebook for additional information on incinerators.

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1.5.APPROVAL OF ENVIRONMENTAL DETERMINATION AND MEASURES

1.5.1. Clearance:

l .. '2.-'D {

Paul Mahanna, Date Office Director, GH/ID

Id- /) I I I: tlndsay Parish Date AOR, Bureau, GH/ID

Rachel Dagovltz Date Global Health Bureau Environmental Officer

1.5~3. Distribution List:

Brian Hli'sh, Africa Bureau Environmental Officer

\ '

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SECTION 2: PIEE SUPPORTING INFORMATION

2.1.PROGRAM/ACTIVITY DATA

Program/Activity Number Program/ Activity Title Global USAID Response to Avian Influenza Outbreak and

Surveillance for Ebola Virus in Livestock in Africa Country/Region Global (GH, AFR, ANE, E&E, LAC, OCHA and EGAT)

USG Foreign Assistance Framework Functional Objective & Number: Investing in People, 3 Program Area: Health Program Element: PIOET, 3.1.4

Period Covered August 1, 2015 - March 30, 2019

Life of Project Amount $330,000,000 IEE Amendment Yes, this document is Amendment #2. Amendment #1 was

completed on September 3, 2017. The original PIEE was approved on June 21, 2015.

IEE Prepared By Lindsay Parish Management Unit Contact Point l12arish@usaid .gov

2.2. PURPOSE AND SCOPE

This Programmatic Initial Environmental Examination (PIEE) provides a screening-level environmental examination of the actions USAID anticipates taking in response to the outbreak of the HSN1 subtype of the Influenza A virus, commonly known as "avian influenza (Al)." It also coyers activities under an Ebola-specific project focused on investigating the livestock in which the Ebola virus and other filoviruses may be circu lating as well as the behaviors and conditions that facilitate evolution, amplification, and spread of these viruses.

The purpose of amendment #2 is to update the PIEE to allow for small scale construction, laboratory renovations under the outlined conditions, and procurement and use of incinerators with the capacity to destroy approximately 12 to 100 kg of waste per hour. Additionally, the updated FAO program to support the Global Health Security Agenda in place of some activities of the Surveillance for Ebola Virus in Livestock in Africa project. The purpose of amendment #1 was to include Ebola in the research of the screening-level environmental examination of actions USAID is undertaking globally in response to emerging pandemic threats. Previous activities had focused on the ongoing outbreak of the H5N1 subtype of the Influenza A virus, commonly known as "highly pathogenic avian influenza" (HPAI). Subsequently, the Ebola virus disease and other zoonotic diseases of high risk were included in the research. This PIEE is intended to help fulfill the environmenta l review requirements of the U.S. Agency for International Development's (USAID's) environmental regulations, found in 22CFR216.

The nature of USAID 's involvement in the global high risk zoonotic disease response can be expected to evo lve, and do so rapidly in the case of a potential pandemic. This PIEE attempts to anticipate all or most of the types of activities USAID might engage in as part of this response, to provide an environment al examination and threshold decision for these potential actions, and to identify appropriate mitigating measures and best practices to employ. FAO has successfully conducted influenza surveillance and response in Africa, Asia and Middle-East.

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As a partner of USAID 's Emerging Pandemic Threats 2 (EPT-2) program, FAO is currently expanding its surve illance activities to include other zoonotic viruses with pandemic potential with a geographic focus on locations and animal production/marketing systems where disease risk factors and drivers facilitate emergence, spill-over, spread and persistence of viruses in livestock populations. Under this Ebola- specific project, FAQ will investigate livestock populations in which Ebola virus and other filoviruses may be circulating as well as those behaviors and conditions that facilitate evolution, amplification, and spread of these viruses. Under support for the Global Health Security Agenda, FAO will support surveillance, laboratory training, and workforce training. Additionally, FAO will investigate livestock populations in which zoonotic disease (including Ebola and Al) may be circulating as well as those behaviors and conditions that facilitate evolution, amplification, and spread of these pathogens.

To achieve the goal of this surveillance project, a multi-disciplinary and multi-sectoral approach under country-led "One Health platforms" is needed to ensure that joint surveillance of Ebola in wildlife, livestock, and humans will be carried out at key animal- human interfaces. Specific capacities of key government authorities will be improved so they are able to deliver the surveillance project, including designing the system, field sample collection, laboratory proficiency testing, data analysis, early warning and dissemination of information for public use. The specific objectives for the Surveillance for Ebola Virus in Livestock in Africa project are as follows:

• Better understanding of dynamics of disease drivers that facilitate the emergence and further transmission of Ebola and other filoviruses among livestock in 12 countries in Africa;

• Improved risk maps identifying agro-ecological and socio-economic drivers of evolution, spillover, amplification, and spread of Ebola and other filoviruses;

• Prioritized critical points of the animal-animal and animal-human interfaces along the livestock value chains where risk-mitigation interventions for Ebola and other filoviruses can be targeted.

Field support activities, must be supplemented by activity-specific EMMPs which will be provided to the GHAOR with the work specification. Such country-level EM MPs will be based on the content of this PIEE, but will provide additional detail related to the activity and mitigation measures, and assign environmental mitigation responsibilities to those parties responsible for the management of country-level HPAI, Ebola, and other zoonotic disease activities.

2.3. PROGRAM OVERVIEW

2.3.1. Background

FAQ will use its expertise in surveillance, capacity strengthening, risk modeling and policy dialogue and to begin critical work to identify if livestock are associated with evolution, spillover, amplification, or spread of Influenzas and Ebola in Africa, to include other zoonotic viruses with pandemic potential with a geographic focus on locations and animal production/marketing systems where disease risk factors and drivers facilitate emergence, spill-over, spread and persistence of viruses in livestock populations.

Avian Influenza (Al) virus can be serially transmitted between and among wild and domestic bird populations and can decimate domestic production and harm trade. Migrating wild birds may transfer HPAI long distances and across international borders, and are one source of the current outbreaks. Another source is the movement of infected birds in the commercial trade, both caged wild birds and poultry. The HPAI virus may also be transmitted to humans by direct contact with infected birds, body parts and waste, leading to sickness and potential death. The worst-case scenario is that the virus may mutate to become able to be transmitted from human to human, leading to an epidemic or

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pandemic. USAID has classified countries into five levels of risk for avian influenza (http://www.usaid.gov/our work/global health/home/ News/news items/avian influenza.html):

1. Endemic, characterized by widespread and recurring HSNl infections in animals since Dec 2003 -South Asia, East Asia, and parts of South -East Asia

2. Epidemic, with isolated HSNl outbreaks in animals since July 2005 -China, India, Europe, Nigeria and proximal countries in West Africa

3. High Risk, countries proximal to endemic or epidemic countries, or at risk of animal outbreaks due to bird migration and/or transport of birds -Africa, except for southern Africa

4. At-Risk due to bird migration and/or transport of birds - southern Africa 5. Pandemic risk, at lower risk of animal outbreaks, but would be affected by a human pandemic -

North, Central and South America.

In the spring of 2006, European researchers investigating returning migratory birds from Africa found no avian influenza virus, indicating that this route of transmission is less important than originally believed. Globally, the most important route of spread remains unrestricted poultry movements. (http://www.birdlife.org/action/science/species/avian flu)

WHO reports on the cumulative number of laboratory-confirmed human cases and deaths from avian influenza. See http://www.who.int/csr/disease/avian influenza/country/en

USAID Health 's response to HPAI is found at the following web address: https://www.usaid.gov/our work/global health/home/News/news items/avian influenza.html. See http://www.irinnews.org/Avianflu.asp for a list of African and Asian countries and what each is doing to prepare itself against/for outbreak.

For more information on migration and the potential for spread of HPAI see: http://www.fao.org/AG/AGAINFO/subjects/en/health/diseases-cards/specialavian.html.

The primary goal at present is to exclude, contain, or eliminate the spread of the HPAI virus and other pandemic viruses wherever found and prevent the spread to humans, which may lead to mutation to human transmissibility. USAID's current plan to assist is listed briefly below under section 2.3.2.

Specific regional issues related to avian influenza are described below:

Africa There are two major migration routes for migratory birds coming to Africa to over winter. The Black Sea/Mediterranean Flyway passes from southern Spa in along the coast of West Africa through coastal Morocco, Mauritania, and Senegal and then inland across the major water basins in West Africa, including the Senegal River Basin, leading to the Niger River Basin, t he Volta Basin, and finally the Chad Lake Basin. The other flyway follows the Nile Rivers into Egypt, Sudan, Ethiopia, Uganda, Eastern Congo, Kenya and northern Tanzania, where it merges with the flyway that crosses the Sahel. The countries with the highest risk then are these countries that contact the Nile as well as Senegal, The Gambia, Mali, Burking Faso, Niger, northern Nigeria, northern Cameroon, and Chad.

These water basins form idea l nesting and rest areas for migratory birds and it is believed that t hese basins could represent the areas of first introduction of the virus into the African continent. West Africa is a major wintering area for many non-passerines, including considerable numbers of some Palearctic duck species, severa l species of shorebirds and some birds of prey, as well as passerines (song birds). Passerines favor the dry savannah zones, whereas the non-passerines favor the wetlands and large water basins. Large populations of waterfowl such as Northern Pintail ducks and

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Garganey ducks (a smal l European duck having a conspicuous white stripe over each eye and down the back of the head in the male) winter there. The populations of Garganeys and Northern Pintails are 2 million and 500 thousand birds respectively.

The inland lowlands with rich soils near wetlands represent approximately SO percent of the agriculturally available area in West Africa and contain dense human populations. Over wintering birds in Africa 's wetlands, rivers, and shorelines may transmit the disease to loca l wild birds, and from there to domestic poultry, or directly to poultry where the two mix. Farmers grow their crop at the receding water edge at reservoirs, rivers or lakes during the dry season, allowing domestic poultry to roam freely around field crops, houses and the surrounding vegetation. Most people in these areas are poor and are not likely to dispose of dead poultry even if they are diseased, as they represent not only a source of protein but also a source of income.

Regional trade in diseased poultry forms another source of inoculum and is apparently the source of the disease outbreak in West Africa.

The HPAI virus has been found in seven African countries, Egypt, Sudan, Nigeria, Niger, Burkina Faso, Cameroon, and Djibouti, and is expected to move to other countries across Africa.

Recent studies have shown that the Ebola virus and other filoviruses such as Marburg have been spilling over in human populations in West Africa for at least ten years . The animal host(s) of the Ebola virus and the mechanism(s) by which it spreads from animals to people are stil l not known which is a major obstacle to the development and targeting of interventions to prevent future Ebola epidemics inhuman populations.

Asia/Near East The first outbreaks of the highly pathogenic version of avian influenza were reported in Asia in 2003. 99 of the 115 human deaths from avian influenza up to May 2006 have been from five countries in Asia {Vietnam, Indonesia, Thailand, China, and Cambodia, http://www.who.int/csr/disease/avian influenza/country/cases table 2006 05 12/en/index.html). Like in Africa, many smallholders raise ch ickens or ducks as a source of income and as meat for feasts. Detection and contro l in these areas will be difficult.

Most outbreaks in south-east Asia can be linked to movements of poultry and poultry products (or accidental transfer of infected material from poultry farms, such as water, straw or soil on vehicles, clothes and shoes). Prior to April 2005, wild birds found dead or dying with HSNl in Asia were largely sedentary species that scavenge near poultry, live markets or captive bird populations. The lack of a trail of HSNl infections along migratory pathways from infected breeding habitats in Mongolia, China and Russia to southern wintering areas in Asia suggests that migratory wild birds are not spreading the disease long distances between continents. With few exceptions, there is limited correlation between the pattern and timing of spread among domestic bird sand wild bird migrations. http://www.birdlife.org/action/science/species/avian flu .

Europe and Eurasia In the spring of 2006, European researche rs investigating returning migratory birds from Africa found no avian influenza virus, indicating that this route of transmission is less important than originally believed.

Latin America/Caribbean While it is possible for the virus to show up in migratory birds in the Americas, according to Robert

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Webster, historica lly there is little crossover offlu viruses between American and European migratory birds. USAID places the LAC region in the pandemic risk category, where they would be affected by human-human transmitted disease, but not at risk from migratory flocks.

Specific regional issues related to avian Ebola are described below:

Africa Past outbreaks of Ebola in central Africa were contained due to their isolated nature. The 2014 outbreak occurred throughout West Africa, in an area that covers more than one country (hereafter referred to as an "epizone"} because of cross-border movement of people, animals and their products as well as shared disease epidemiological features such as same stra in(s} of pathogens, agroeco logical systems and socio- economic conditions. One of the most important factors to identify are the linkages among animal production and market systems which can form a common livestock value chain along which disease transmission can take place. The proposed countries or epizones to be targeted under this project include: Burkina Faso, Cameroon, Cote d'Ivoire, Ethiop ia, Guinea, Kenya, Liberia, Mali, Senegal, Sierra Leone, Tanzania, and Uganda.

2.3.2. Description of Activities

Laboratory Capacity Building:

Training lab technicians to identify bird influenza and filovi ruses (including Ebola};

Procurement of essential equipment and supplies (including reagents, mobile Polymerase Cha in Reaction (PCRs), ELISA readers, antigen kits, high biosecurity lab equipment, Vertica l Laminar Air Flow Hood, High security Freeze/thaw, and Virologica l Diagnostic Kits}; and

Establishing and implementing lab quality assurance procedures

Biohazard handling procedures

Strengthening Surveillance Systems

Working w ith the U.N. Food and Agriculture Organization (FAO} and Ministries of Agriculture/Rural Development/Livestock /Environment and Sanitation to strengthen wild/migratory bird, livestock, and wildlife survei llance, including:

o Procurement of equipment (laptops, Geographic Information Systems (GIS} equipment, etc.} and supplies for animal survei llance and proper handling of dead birds; and

o Training to properly identify sick animals and use established referral mechanisms for dead bird and sample transport.

Working with Ministries of Hea lth to build on existing human and animal surveillance systems, including existing Integrated Disease Surveillance and Response systems and hea lth facilities.

Enhance country-level ability to co llect and test animal and livestock samples by provid ing training and necessary suppl ies.

Conducting risk-based surveillance to detect filoviruses (including Ebola) in livestock systems particularly where these animals interface with wildlife and/or people.

Support National Avian Influenza and other Infectious Disease Task Forces to develop animal and human surveillance and rap id response teams at national and district levels, including training border officials to strengthen cross-border surveillance.

Building Capacity for Human Response

Working with the World Health Organization (WHO) and Min istries of Hea lth to bui ld capacity for human response, including:

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o Training health workers (including those working at community levels) to identify potentially infected patients and refer them to the appropriate level of care and contact lab facilities for initial testing; and

o Procuring essential equipment and supplies (including personal protective equipment).

Responding to Animal Infections

Working with Ministries of Agriculture to strengthen response to outbreaks in animals. Activities may include: Procurement of protective gear for field workers handling dead and infected wildlife and livestock;

o Procurement of materials and supplies for animal response, including disinfectants and infection prevention materials and materials and equipment;

o Humane euthanasia and environmentally appropriate carcass disposal o Training of appropriate use of personal protective equipment (PPE) and

waste/biohazard management, and o Training for local communities on animal quarantine and household management of

domestic poultry. Developing and beginning to introduce interventions to reduce exposure of livestock to filoviruses (including Ebola)

Communications and Public Awareness

Mass media campaigns (internet, press, radio, television, posters, flyers); Community-based awareness and mobilization campaigns; Development and use of communications, including informational, educational, and behavior-change materials; Messages are targeted to children and adolescents at the appropriate reading level and content; and Risk communications through information, education and communication materials, radio spots, print media advertisements, etc.

2.4. BASELINE INFORMATION AND APPLICABLE HOST COUNTRY REQUIREMENTS

2.4.1. Locations Affected

All USAID countries have various sizes of extensively and widely scattered populations of domestic poultry and livestock that are raised for income, meat and eggs by most rural and many urban peoples. All of these are susceptible to infection by HPAI and other diseases of potential pandemic threat. Many species of migratory birds corning to Africa from Europe, the Middle East and Asia are thought to be susceptible. Ebola surveillance activities will focus on livestock populations primarily found throughout Burkina Faso, Cameroon, Cote d'Ivoire, Ethiopia, Guinea, Kenya, Liberia, Mali, Senegal, Sierra Leone, Tanzania, and Uganda.

2.4.2. Applicable Laws, Regulations and Policies

A current succinct listing of policies from African, Asian and Middle Eastern countries preparing themselves to exclude, detect, contain and deal with HPAI can be found at this United Nations web address: http://www.irinnews.org/Avianflu.asp. Applicable country- level environmental requirements will need to be addressed through individual country- specific EM MPs. Regional Bureaus may require individual USAID country missions to write country-specific IEEs. Depending upon the activities proposed, this may include an overview of examination of land use, geology,

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climate, groundwater resources, surface water resources, terrestrial communities, aquatic communities, environmentally sensitive areas (e.g., wetlands or protected species), agricultural cropping patterns and practices, infrastructure and transport services, air quality as re levant to the activity(ies). This analysis should also draw on the Country Strategy and supportive ana lysis (such as the Environmenta l Threats and Opportunities Assessment, and Conflict Vulnerability Assessment).

The Integrated Pest Management (IPM) Collaborate Research Support Project (CRSP) or the Global Health Integrated Vector Management IQC are two resources for Bureaus to access expertise in pest management.

Resources for understanding and dealing with reducing waste (especially plastic) generation through "green procurement" or "Environmentally Preferable Purchasing, or EPP" can be found at: www.epa.gov/oppt/epp. Resources for understanding and deal ing with "rapid environmental impact assessment in disaster response" can be found at: http://www.benfieldhrc.org/disaster studies/rea/rea index.htm and http://www.reliefweb.int/rw/lib.nsf /db900SID/DPAL-5ZAHW2?0penDocument

2.5. EVALUATION OF POTENTIAL ENVIRONMENTAL IMPACTS

Activity 1: Monitoring and surveillance (M & S) for the presence of avian influenza, Ebola, and other related diseases in wild and domestic animals, as well as humans.

The main environmental concern regarding monitoring and surveillance activities is the potential to inadvertently transmit avian influenza, Ebola, and other related diseases between monitored locations. Monitoring and surveillance (M & S) personnel, medical personnel, and animal health officials visiting potentially affected premises should be extremely conscientious that they, through their work in surve illance and epidemiological investigations or vaccination initiatives, could actually be infection and disease spreaders.

It is essential to thoroughly disinfect items that have been in contact with potentially infectious disease, including shoes, clothes before working with poultry/entry to a place where poultry are kept, cages, bird processing or culling equipment. M & S personnel will need to reduce exposure to and transfer of bird manure from place to place.

Threshold Decision: A negative determination (with conditions) is recommended for support to HPAI, Ebola, and other related disease M & S activities per 22CFR216.3(a)(2)(iii).

Conditions: 1. Through communications and training, ensure that M & S personnel be extremely conscientious

that they, through their work in surveillance and epidemiological investigations or vaccination initiatives, could actual ly be infection and disease spreaders;

2. Provide personal protective equipment and clothes to those that visit livestock or homes being monitored for disease, including boots for walking through livestock and wildlife manure, gloves for handling birds or people, and masks;

3. Provide potable baths with disinfectant for boots and vehicle tires (use a pre- disinfectant bath to wash off the organic matter before entering disinfectant);

4. Ensure that M & S personnel clean and disinfect equipment, personal protection equipment, tools, and instrumentation;

5. M & S workers should not purchase or transport live or processed birds for food while at work. 6. Ensure that M & S workers properly dispose of used or disposable gloves and masks and other

pg. 13 10/24/17

protective clothing and equipment.

For more discussion on potential risks oftransmission by M & S personnel and others, see: http://www.fao.org/ag/AGAinfo/sub jects/en/ health/d iseases-cards/avian qa.html#7.

Activity 2: Disinfection of poultry, and food manufacture and transportation workers, clothing, shoes/boots, poultry houses, vehicles, tools, medical equipment, culling equipment, and all other equipment and materials which come into contact with the virus or products containing the virus.

The environmental issue of concern from disinfection activities is the potential for t oxic effects on humans and non-target organisms from exposure to pesticide components in most disinfection products. Many of these pesticides are acutely toxic to people in sufficiently high concentrations and can be toxic to the environment in sufficient quant ities.

Disinfectants are defined by the EPA as a class of pesticides that are used to destroy or inactivate infectious fungi and bacteria, but not necessarily their spores. The term pesticide or disinfectant in the context of this PIEE does not apply to cleaning agents such as ordinary soap and wate r, bleach, or isopropyl alcohol. The use of such non-pesticide products is governed by the need to not waste money through overuse of these products and by common sense.

There is a list of 31 exempted pesticide disinfectants that are not considered by the EPA to be public health or environmental risks (www.epa.gov/docs/fedrgstr/EPA-PEST/1996/Ma rch/Day-06/pr-577.html). When any non-exempt pesticide disinfectants are proposed, t he environmental review required for approval of their use must fulfill all analytical elements required by 22CFR216.3(b), USAID's Pesticide Procedures. (https:Uwww.epa.gov/pesticides#what pesticide)

Risks from human exposure to pesticide disinfectants include acute poison ing of children who inadvertently come into contact with or ingest the chemica ls, people t ransporting the chemicals in bulk from the port of entry to the storage facility, transport from the storage facility to the point of use, people who mix the chemicals, people who apply the chemicals, people coming into contact with the applied chemicals through meat, eggs, proximity, or ground water contamination, and export meat and egg market ce rtifiers who may be concerned about residues. The HPAI virus may also become resistant to some disinfectants to the extent they are overused, possibly leading to t he need for rotation of disinfectant products and active ingredients.

Pesticide disinfectants can cause harm to aquatic organisms if dumped into waterways and lakes and will disrupt microbial processes in waste treatment facilities. Bulk quantities that are inadvertently spilled may kill all exposed organisms.

Currently, there is a problem in that little or no management of such disinfectants typica lly occurs in small-sca le facilities in countries where USAID works. Training and supplies are min imal. The quality of the products being sold in developing countries may be in question and require testing fo r presence and amount of active ingred ient(s) and the absence of toxic contaminants from poor quality manufacturing processes in certain countries. Clearly there is a strong precedent for use of safety procedures, training and equipment to reduce human exposure to disinfectants and residues, and properly dispose of them. Individua l count ry IEEs w ill address these risk issues and missions will devote resources to their mitigation.

Threshold Decision: A negative determination (with conditions) is recommended for support to HPAI disinfection activities per 22CFR216.3(a)(2)(iii). The condition is that all IEEs and EM MPs for specific

pg.14 10/24/17

country-leve l HPAI projects include the pesticide analysis below, with additional country-specific information, where appl icable.

Pesticide Procedures Analysis for HPAI Disinfection Products (including conditions):

USAID programs shou ld use a three-stage process for determin ing the suitability of a pesticide with respect to its registration status:

1. If the product is among the 100 currently registered by US EPA for avian influenza, then the program may use the product, so long as they have approva l from the appropriate host government authorities, and complete a country-specific IEE. All HPAI programs should try to use this option.

2. If the product is identica l in formulation to one or more of the products on the list above, then the program may use that product, so long as the program can demonstrate that none of the 100 EPA-approved pesticides are available in the country, the product does not infringe on any patents, it can be shown to meet required quality control to be fu lly effective and not conta in harmful contaminants, and the program has approval from the appropriate host government authorities. Using a product that is not on the approved list, even if an identical formulation, does not automatically merit a "negative determination with conditions". Rather, when any non-exempt pesticide disinfectants are proposed, the environmental review required for approva l of their use must fulfill all analytical elements required by 22CFR216.3(b}, USAID's Pesticide Procedures to justify their use. If in doubt, the operating unit should contact the REA and BEO for technical advice. See Appendix F for the list of approved disinfectants.

3. If the product in question is not on the EPA-approved list, and is not identica l in formulation to any products on that list, then the operating unit shou ld directly contact the REA and BEO to seek approval pr ior to use of the product in question. The mission shou ld assemble all the information they can about the product in question, preferably including a product label. Among other requirements, the program must demonstrate that none of the 100 EPA-approved pesticides are ava ilable in the country, that the product meets required quality control to be fully effective and not contain harmful contaminants, and that the program has approva l from the appropriate host government authorities. As mentioned above, when any non-exempt pesticide disinfectants are proposed, the environmental review required for approval of their use must fulfill all analytical elements required by 22CFR216 .3(b}, USAID's Pesticide Procedures to justify their use.

Disinfectants are defined by the EPA as a class of pesticides that are used to destroy or inactivate infectious fungi and bacteria, but not necessarily their spores. There is a list of 31 exempted disinfectants that are not considered by the EPA to be public health or environmental risks (http://www.epa.gov/docs/fedrgstr/EPA-PEST/1996/March/ Day-06/pr- 577.html}. See Appendix F for the list of these exempted disinfectants. When any non-exempt pesticide disinfectants are needed, the environmental examination required for approva l of their use must fulfill all analytical elements required by 22CFR216.3(b), USAID's Pesticide Procedures.

To the extent poss ible, those analytical elements which are not specific to a country or to a disinfectant product are addressed in below of this document, and need not be repeated in country-level examinations. The identity of those elements which must be addressed in country-level examinations, and the manner of t he ana lysis needed in each case is also specified. Also identified in Appendix G is additional information and analysis which might be needed in support of supplemental IEEs for countrylevel programs.

pg.15 10/24/17

Additional Conditions:

1. Children are not to be permitted to have access or exposure to the undiluted disinfectant products. Disinfectants should be stored under lock and key.

2. Produce simple safe disinfectant use training materials, quick reference guides, posters and flye rs.

3. Procure protective clothing (gloves, masks or organic chemical respirators where t oxic gasses are produced, boots, etc.) for ministry staff and others that mix and apply disinfectants.

4. As additional disinfectant choices become available, regularly update the list of regist ered products and evaluate them following the 12 Pesticide Procedures (a. through I.) found in Regulation 216.3.

5. Have HPAI action-implementing partners put the conditions above into action plan matrices with timel ines, assignment of roles/responsibility, deadlines, and sign-off by Chief of Patty or responsible authority. The plan with completed actions and signed is sent to USAID to show compliance (this essentially becomes part of monitoring).

Discussion and Information Resources:

The risk of t he impact of disinfectants on health and the environment can be significantly reduced if the above conditions are met. Disinfectants are considered pesticides and as such must meet the requirements of Regulation 216.3 b. Pesticide Procedures.

The above conditions should be part of most if not all HPAI treatment programs using disinfectants. Additional conditions can be written into individual country-specific IEEs as appropriate.

See http://www.epa.gov/pesticides/factsheets/avian flu products.htm to find a list of 100 disinfectants currently registered by EPA for use in treating Avian Influenza A virus in the USA. Since this is a different strain of Al than t he HSNl strain, USAID missions would invoke the "or similar use" proviso. Disinfectants will not be used in livestock surveillance activities for Ebola.

To search for the registration and risk data for individual disinfectant products and chemicals in the disinfectants, see http://www.pesticideinfo.org/lndex.html.

See http://www.encapafrica.org/EGSSAA/cur rent EGSSAA sect ions/EGSSAA-Pt2Ch13-SaferPesticideUse .pdf to understand pesticide safety issues in Africa.

See http://www.encapafrica.org/EGSSAA/current EGSSAA sections/EGSSAA-Pt2Ch12-lntegPestMngmt.pdf for ideas in developing an integrated pest management program that reduces pesticide use in Africa.

Activity 3: Animal and human vaccination, veterinary and human surveillance, examination, and treatment,

The environmental concern with this set of activities is the potential for infection and disease spread through exposure to medical and vete rinary waste generated through these activities.

Transmission of disease through infectious waste is the greatest and most immediate threat from healthcare and veterinary wast e. Human healthcare and veterinary waste is dangerous and risks from exposure to HPAI and Ebola virus are highly hazardous. If handled, treated, or disposed of incorrectly it can spread disease and potentially contaminate people, livestock, wild animals, plants and ecosystems.

pg.16 10/24/17

People w ho come in direct contact with the waste are at greatest risk. Examples include healthcare and veterinary workers, clean ing staff, patients, visitors, waste collectors, disposal site staff, waste pickers, drug addicts and those who knowingly or unknowingly use "recycled" contaminated syringes and needles.

Medical and veterinary waste as defined by this PIEE includes (but is not limited to}: disposable gloves, disposable masks and safety clothing, ELISA test kits, antigen kits, other diagnostic kits and diagnostic reagents, infection prevention materials, vaccines, pharmaceuticals, needles, sca lpels and ot her metal laboratory equipment, plastics like bags, containers and syringe vials. Specia l precaut ions need to be taken if plastics are to be burned as they release very carcinogen ic chemica ls like furans. Needles, sca lpels and other sharp objects present additional risks beyond transmission of HPAI and Ebola and require special attention.

Diseased patients w ill come into contact with hea lth ca re providers, presenting opportun ities for the virus to reenter the field on the health care workers, on their clothes, and through the disposal of medical waste and for the virus to mutate and become transmissible among humans. Health care workers can reduce their risk of exposure to the vi rus by taking basic protect ive measures, such as use of safety equipment and proper hygiene measures.

Currently, little or no management of hea lthcare wastes t ypica lly occurs in small-scale facilities in Africa. Training and supplies are minimal. Common practice in urban areas is to dispose of hea lthcare waste along with the general solid wast e or, in peri-urban and rural areas, to bury waste, without treatment: in an unlined pit. In some cities small hospitals and veterinary clinics may incinerate waste in dedicated onsite incinerators, but often they fai l to operate them properly. Unwanted pharmaceuticals and chemicals may be dumped into the local sanitation outlet, be it a sewage system, septic tank or latrine.

M any Africans may not have access to optimal safety equipment, safety procedures, clean wate r, or specia l training on dealing with Al and Ebola-infected people and wastes. Further, at the point of a human pandemic, if it happens, safety equipment and disinfectants wil l need to be quickly procured in bulk and used by health ca re workers.

Large-sca le vaccination programs may also take place that produces quantities of medical waste including syringes, needles, and different types of plastics. The safe handling and disposa l of these wi ll take on additional significance during a pandemic.

Clearly, waste management plans will be needed for each country that embarks on HPAI management and Ebola surveillance in livestock, and USAID should assist in this regard.

Threshold Decision: A negative determination (with conditions} is recommended per 22CFR216.3{a}{2){iii } because of disease t ransmission risks from inappropriately conducting these activities. This type of activity does not include extermination of uninfected wild bi rd populations or their natural habitats or similar extreme measures. If these activities are proposed, this would require a Positive Determination, Scoping Exercise, and Environmental Assessment, unless U.S. migratory species are involved in which case an Environmental Impact Statement under NEPA procedures would be requ ired.

Conditions for Disposing of Medical and Veterinary Waste Including Sharps and Plastics and Patient Care Hygiene:

1. Work with partners to assure that the medical facilities and operations involved have adequate

pg.17 10/24/17

procedures and capacities in place to properly handle, label, treat, store, transport and properly dispose of blood, sharps and other medical waste. The Africa Bureau's Environmental Guidelines for Small Sca le Activities in Africa (EGSSAA) Chapter 8 http://www.encapafrica.org/EGSSAA/current EGSSAA sections/EGSSAA-Pt2Ch08- Healthcarewaste.pdf contains a final section on "Questions to help guide development of a healthcare waste management program". Use this questionnaire to assess adequate partner procedures and capacities for waste disposal.

2. Produce written patient hygiene, and waste management and disposal plans with clear responsibilities, written internal rules, and follow the plan.

3. Perform short-term safety training on patient ca re hygiene, handling and proper disposal options for medical and veterinary waste (can and likely should be included as a component in overa ll training on HPAI management).

4. Children are not to be permitted to have access or exposure to the medica l and veterinary waste. Before disposal, waste should be stored under lock and key.

5. Produce simple safe hygiene and waste disposal training materials, quick reference guides, posters and flyers.

6. Procure protective clothing (gloves, masks, clothing, boots, etc. ) for ministry staff and others that have contact with patients and handle and dispose of medical and vet erinary waste.

7. Highly hazardous hea lthcare wastes including sharps, highly infectious non-sharp waste, large quantities of expired or unwanted pharmaceuticals, feces from HPAI infected birds and patients, and Al-infected bird byproducts and bodily fluids of HPAI patients shou ld be destroyed and buried on-site away from water sources and bodies of water.

8. Practice good hygiene principles and vaccinate workers as feasible. 9. Minimize waste by reusing and recycle materia ls as appropriate, and sort and separate waste by

risk and how it should be treated and disposed of. The most important function of treatment is disinfection. It is the high concentration of infectious agents that makes infectious waste dangerous.

10. Have HPAI action-implementing partners put the conditions above into action plan matrices with timelines, ass ignment of roles/responsibi lity, deadlines, and sign-off by Ch ief of Party or responsible authority. The plan with completed actions and signed is sent to USAID to show compliance (this essentially becomes part of monitoring).


The risk of the impact of medical and veterinary waste on hea lth and the environment can be significantly reduced if the following conditions are met. The fo llowing conditions should be part of most if not all HPAI treatment programs producing medical and veterinary waste. Additional conditions can be written into individual country-specific IEEs as appropriate.

USAID should work with its partners to ensure that a medical waste management and disposal plan is in place and implemented w hich achieves destruction and burial of all waste products and includes the identification of roles, responsibilities, and a timeline for action completion (and Action Plan).

See Africa Bureau's EGSSAA Chapter 8 on Health Care Waste (cited above). This chapter contains guidance which should inform the Team's activities to promote proper handling and disposal of medica l waste, particularly in the section t itled, "Minimum elements of a complete waste management program." The program is also encouraged to make use of the attached "Minimal Program Checklist and Action Plan" for handling hea lt hca re waste, which was adapted from the above EGSSAA chapter and which should be further adapted for use in individual USAID country programs.

pg.18 10/24/17

See http://www.reusablebags.com/facts.php?id=8 for dealing with plastic waste, like plastic bags, conta iners, and the plastic syringe cylinder. If not contaminated by pathogenic waste, plastic bags for moving and containing products can be recycled or reused, as can plastic syringe cylinders.

See http://environmentalrisk.comell.edu/AgPlastics/ for information on dealing with and recycling agricultural plastics.

For a study on recycling plastics from medical and health care faci lities, see http://www.ncbi.nlm.nih.gov/entrez/guery.fcgi?cmd=Retrieve&db=PubMed&list uids=12092754&dopt =Abstract. Also, plasticware that is not contaminated with human or animal blood or other potentially infectious biological material may be disposed of in sturdy cardboard boxes.

See Annex C for Safe Management of Healthcare Wastes, or also http://www.jhpiego.org/scripts/pubs/category detail.asp?categorOly id=9 for specific infection prevention, quality assurance, waste management, including incineration related issues of plastics, infectious materia ls, and other wastes in healthcare facilities with limited resources.

Other important references to consult in establish ing a waste management program are "WHO's Safe Management of Wastes from Healthcare Activities" http://www. who. int/water _sa nitation_hea lth/publications/wastema nag/ en/

During a human pandemic, other than likely requiring the quarantine of infected people, the cond itions for dealing w ith infected patients will be the same as those above, except with much greater urgency and greater quantities of activities, waste products, and all forms of risk to human and environmental quality. Information on the USA response to a potential pandemic is found at the following two sites: http://www.cdc.gov/flu/avian and http://www.pandemicflu.gov/. The proper use of safety equipment, good hygiene, disinfectants and vaccines will likely reduce the spread of a pandemic outbreak of HPAI HSN1.

The above conditions should be part of most if not all HPAI treatment programs generating medical and veterinary waste. Additional conditions can be written into individual country-specific IEEs as appropriate.

Activity 4: Laboratory research and testing Many procured laboratory consumables inevitably end up as waste (e.g. laboratory chemicals, test kits), generate waste as a consequence of their use (e .g. laboratory chemicals, reagents, test kits); or have the potential to end up as waste due to spoilage or expiration (laboratory chemica ls). Improper disposal of potentially infectious and pharmaceutical wastes has potentially significant adverse impacts, as discussed above. Implementing partners must analyze and address potential environmental effects of the systems, policies, and practices that they support. To the greatest degree practicably permitted by this level of control, USAID and IPs must work to assure appropriate management of laboratory waste streams.

Threshold Decision: A negative determination (with conditions) is recommended per 22CFR216.3(a}(2)(i ii).

Conditions: 1. Work with partners to assure that the medical faci lities and operations involved have adequate

procedures and capacities in place to properly handle, label, treat, store, transport and properly dispose of laboratory waste .

pg.19 10/24/17

2. Produce written patient hygiene, and waste management and disposal plans with clear responsibilities, written internal rules, and follow the plan.

3. Perform short-term safety training on patient care hygiene, handling and proper disposal options for laboratory or medical waste (can and likely should be included as a component in overa ll training on HPAI management).

4. Children are not to be permitted to have access or exposure to the laboratory or medical waste. Before disposal, waste should be stored under lock and key.

5. Produce simple safe hygiene and waste disposal training materials, quick reference guides, posters and flyers.

6. Procure protective clothing (gloves, masks, clothing, boots, etc.) for laboratory staff and others that have contact with laboratory and medical waste.

7. Highly hazardous healthcare wastes including sharps, highly infectious non-sharp waste, large quantities of expired or unwanted pharmaceuticals, feces from HPAI infected birds and patients, and Al-infected bird byproducts and bodily fluids of HPAI patients should be destroyed and buried on-site away from water sources and bodies of water.

8. Practice good hygiene principles and vaccinate workers as feasible. 9. Minimize waste by reusing and recycle materials as appropriate, and sort and separate waste by

risk and how it should be treated and disposed of. The most important function of treatment is disinfection. It is the high concentration of infectious agents that makes infectious waste dangerous.

10. Have HPAI action-implementing partners put the conditions above into action plan matrices with timelines, assignment of roles/responsibility, deadlines, and sign-off by Chief of Party or responsible authority. The plan with completed actions and signed is sent to USAID to show compliance (this essentia lly becomes part of monitoring).

Activity 5: Culling of diseased livestock, and disposal of diseased livestock, wild birds, and their manure. The environmenta l concern with this type of activity is the potentia l for HPAI transmission through exposure to diseased livestock, wi ld birds and their manure and surroundings.

Poultry manure is a primary source of transmission of HPAI among birds. Avian Influenza virus from waterfowl can remain viable in feces and water for up to 32 days. HPAI can spread through feca lcontaminated materials such as bird cages, pa llets, eggs, manure and feedstuffs, and from people going from farm to farm without appropriate cleaning and disinfection procedures. Infected dead birds are another source and reservoir of HPAI transmission and infection potent ial, as are eggs and other bird byproducts. Biosecurity of commercial poultry flocks is essential in preventing outbreaks and spread of HPAI.

Wild endemic and migratory fowl will become infected, potentia lly decimating populations of non-target and, in some cases, endangered wild bird species. There is an environmental imperative to reducing transmission opportunities to wildlife through domestic pou ltry carcass, manure and byproduct management.

In disease outbreaks, large numbers of poultry may need to be killed for control, conta inment or eradication purposes. Infected poultry should preferably be slaughtered on the affected farm, as close as possib le to where they are housed to reduce exposure from handling and transport. Methods for killing large numbers of poultry in commercial operations include dangerous alternatives such as gassing with carbon dioxide (method of choice), ca rbon monoxide, hydrogen cyanide, nitrogen, argon, and anesthetics, as well as electrocution, and mechanica l means. Use of some of these methods presents risks to human hea lth including death. A local IEE should recognize, anticipate, and reduce these risks.

pg.20 10/24/ 17

These scenarios should be incorporated into the National HPAI Control Strategies.

Clearly, poultry manure, diseased birds, dead wild birds, eggs, and other infected bird byproducts must be disposed of and taken out of exposure to other birds and vectors or carriers of the virus like flies and scavengers. It cannot be left in the open or buried in open pits. It must be covered by soil away from water sources. All poultry manure, carcass and byproduct handling equipment must be disinfected.

Threshold Decision: A negative determination (with conditions) is recommended per 22CFR216.3(a}(2}(iii). This type of activity does not include extermination of uninfected wild bird populations or their natural habitats or similar extreme measures. If these activities are proposed, this would require a Positive Determination, Scoping Exercise, and Environmental Assessment, unless U.S. migratory species are involved in which case an Environmental Impact Statement under NEPA procedures would be required.

Conditions for Managing Poultry Manure, Diseased Poultry, and Wild Birds:

1. Work with partners to assure, to the extent possible, that poultry manure and dead birds are properly handled, treated, stored, transported and disposed.

2. Produce a written manure and diseased bird management and disposal plan with clear responsibilities, written internal rules, and follow the plan.

3. Perform short-term safety training on handling and proper disposal options for manure and diseased birds (can and likely should be included as a component in overall training on HPAI management).

4. Children and the elderly are not to be permitted to have access or exposure to diseased birds, manure and body parts. Before disposal, waste should be stored securely.

5. Produce simple safe manure and diseased bird disposal training materials, quick reference guides, posters and flyers.

6. Procure protective clothing (gloves, masks, clothing, boots, etc.) for ministry staff and others that regularly handle and dispose of manure and diseased birds

7. Practice good hygiene principles and vaccinate workers as feasible. 8. Regularly disinfect all manure and diseased bird handling and culling equipment. 9. Do not attempt to cull potentially infected wild bird populations as they will likely scatter and

further spread HPAI. Take measures to reduce the trade in wildlife and wild birds. 10. Have HPAI action-implementing partners put the conditions above into action plan matrices

with timelines, assignment of roles/responsibility, deadlines, and sign-off by Chief of Party or responsible authority. The plan with completed actions and signed is sent to USAID to show compliance (this essentially becomes part of monitoring).


Properly managed, livestock production can enhance land and water quality, biodiversity, and social and economic well-being. However, when improperly managed, livestock production may cause significant economic, social and environmental damage such as by transmission of disease-causing agents to other animals and potentially humans like that occurring with HPAI. Livestock product processing can also have negative impacts on the environment and human health. Further, many species of wild birds, migratory and local, terestrial and aquatic, can be infected by HPAI and can serve as reservoirs of and vehicles for transmission. Some species like ducks and likely other birds may carry and transmit the disease, show no serious signs of infection, and may not die.

For guidelines on dealing with manure, see EGSSAA Chapter 11 on Livestock Production:

pg.21 10/24/17

http://www.en_capafrica.org/EGSSAA/current EGSSAA sections/EGSSAA-Pt2Ch11-Livestock.pdf.

See http:Uwww.oie.int/eng/AVIAN INFLUENZA/home.htm (the web site of the World Organization for Animal Health} for best practices in dealing with HPAI issues, including: Methods of humane killing for disease control purposes and carcass disposal.

See http:ljwww.frameweb.org/ev.php?ID=13653 201&1D2=DO TOPIC to understand the conservation and biodiversity community's response to HPAI in Africa.

The SO team shall work with implementing partners to assure that the livestock production activities are designed and implemented in such a way as to avoid potential harmful impacts as much as possible. The above EGSSAA Livestock chapter's table titled, Mitigation and Monitoring Issues Environmental Mitigation and Monitoring Issues for Livestock Projects shall be used as guides in the design. Implementing partners should monitor for and report on adverse impacts, particularly land and habitat degradation.

The above conditions shou ld be part of most if not all HPAI treatment programs dealing with or advising on disposal of poultry manure and sick or dead birds. Additional conditions can be written into individual country-specific IEEs as appropriate.

Activity 6: Small-scale construction and renovation of laboratory and research facilities

Small-scale construction and renovation activities to improve laboratory and resea rch facilities will be limited to minor renovation activities. Examples include minor expansions or additions to laboratory and research facilities, repairing roofs and walls, insta llation of laboratory benches and shelving, installation of windows, repairing of plumbing and electrical systems.

Renovation activities have potential adverse impacts described below:

• Standing water. Activities may result in standing water on-site, which readily becomes breeding

habitat for mosquitoes and other disease vectors.

• Impacts of materials sourcing. Construction activities require a set of materials often procured

locally: timber, fill, sand and gravel, bricks. Unmanaged extraction of these materials can have

adverse effects on the environment.

• The use or removal of toxic materials such as asbestos, lead paint, formaldehyde (sometimes

used in products like particle board, plywood, and insulation) are unsafe for both workers and

future users of the facilities as residues can present health hazards, especially to children.

• Occupational and Community Health and Safety Risks. Renovation activities may present risks of

physical injuries such as falls, crushes, and cuts to construction workers, as well as toxic haza rds

resulting from exposures cement dust, paints and solvents. Where access to a site is not well

controlled, these risks may extend to the community as well.

Operational issues include: • General impacts of facilities in operation: In operation, general/institutional facilities and

compounds generate a set of waste streams (e.g., gray water, latrine discharge, so lid waste). In

general, if improperly managed, such wastes can contaminate ground and surface water, create

breeding habitat for disease vectors, etc. For example, failure to design or maintain appropriate

drainage structures can result in standing water within the compound or on adjacent land. Local

erosion, including damage to adjacent fields, and sed imentation of nearby surface waters ca n

pg.22 10/24/17

also result.

Threshold Decision: A negative determination (with conditions) is recommended per 22CFR216.3(a)(2)(iii).

Conditions:

The implementing partner should develop a design plan that includes the use of appropriate building materials and complies with international best management practices and host country laws and regulations. Storage areas should be designed so that that hazardous materials are aboveground and in leak-proof containments to avo id spills from occurring during normal operation or natural disaster events. Renovation planning should also include a site survey that adequately evaluates site conditions based on the size and complexity of the renovation activity.

Standard operating procedures (SOPs) should guide renovation activities in conformance with international best management practices and host country laws and regulations. Considerations include, but are not limited to: water source protection, site security, relevant occupationa l health and safety concerns, etc. SOP guidance should include a WMP w ith procedures for properly disposing of non-hazardous and hazardous materials in accordance with international best management practices and host country laws and regulations. Considerations include, but are not limited to: proper handling and storage of waste, safe disposal practices and acceptable disposal locations, and use of appropriate personal protective equipment. The WMP shou ld also provide instructions for recovering reusable materials and reduce the disposal of construction debris and wastes by recycling eligible materials such as scrap wood, scrap metal, and concrete that can safely be repurposed. Workers must be trained in all SOPs to minimize adverse health and environmenta l associated with small-sca le rehabilitation activities.

After rehabilitation work is completed, the IP shou ld provide guidance materials and training to host country organization on the proper use, operation, and maintenance of the renovated space.

Activity 7: Procurement, installation, commissioning, operation, and maintenance of treatment equipment for medical and pesticide waste (i.e. incinerators with capacities to destroy approximately 12 to 100 kilograms of waste per hour)

The Implementing Partner will conduct the procurement, installation, commissioning, operation, or maintenance of treatment equipment for medical and pesticide wastes (i.e. incinerators). Incinerators will not exceed the maximum capacity to burn 100 kilograms of waste per hour.

In their operations, all hazardous waste treatment equipment and insta llations themselves present hazards, particularly (but not on ly) when improperly operated or sited, or when the equipment is not specified. Examples of these risks and impacts, which generally scale with treatment capacity or size, include:

• Worker risks due to mishandling of medical and pesticide wastes • Toxic air emissions and toxic ash from incineration:

o Incineration of materials containing chlorine (e.g. PVC plastics) can generate dioxins and furans, w hich are human carcinogens and have been associated with a range of adverse hea lth effects. Only modern incinerators, operating at 850-1,100 °C, fitted with specia l gas-cleaning equipment, and operated and maintained to specificat ion, are able to comply with the international emission standards for dioxins and furans.

o Incineration of heavy metals or materials with high metal content (in particular lead, mercury and cadmium) can lead to the spread of toxic metals in the environment. On ly

pg. 23 10/24/17

modern incinerators operating at 850-1,100 °-C and fitted with special gas-cleaning equipment are able to comply with the international emission standards for dioxins and furans.

Threshold Decision: A negative determination {with conditions) is recommended per 22CFR216.3( a }(2)(iii).

Conditions:

Incinerators will not exceed the maximum capacity to burn 100 kilograms of waste per hour. The use of incinerators with capacities to destroy> 100 kilograms of waste per hour are not authorized under this PIEE. The PIEE will be amended if capacities exceed this amount, with a resulting scoping study and, if necessary, an Environmental Assessment developed and approved by the COR and the GH BEO. Multiple installations serving a facility that in total exceed these t hresholds will also receive a positive determinat ion.

Incinerators procured or operated by the Implementing Partner must contain adequate air pollution control technology to ensure compliance with host country guidelines and applicable international air quality emission requirements, including:

• 74 FR 51367: US Environmental Protection Agency. Standards of Performance for New Stat ionary Sources and Emissions Guidelines for Existing Sources: Hospital/Medical/Infectious Waste Incinerators; Final Rule. October 6, 2009.


• AP 42 and Emission Factors: US Environmental Protection Agency.

Activity 8: Provision and training in the use of personal protective equipment {PPE)

The environmental concerns regarding this type of activity is simply to assure that the equipment procured is appropriate to the application and that sufficient equipment is procured to support the anticipated activities.

Personal Safety Equipment

People who use safety equipment (masks, gloves, boots, et c.) when handling diseased or dead birds, manure, byproducts, infected patients, body fluids, and disinfectants greatly reduce their risks of transferring or contracting HPAI and being directly harmed by disinfectants.

Unfortunately, most Africans do not use safety equipment for reasons of knowledge, cost, inconvenience or comfort, thus increasing t heir risks. Provision of safety equipment and t raining on the necessity and use of such equipment w ill reduce the rate of non-compliance and risk. Missions will need to plan and implement programs to provide, train, monitor and properly dispose of safety equ ipment . AFR's Hea lth Program plans to donate safety equipment, and missions can augment t his process by planning and determining the areas of greatest need.

Threshold Decision: A negative determination {with conditions) is recommended per 22CFR216.3(a)(2)(iii).

Conditions:

1. Provide training on the proper use and disposal of safety equipment.

pg.24 10/24/17

2. Ensure a reasonably high level of quality for the equ ipment procured. 3. Use care to procure the type of equipment specially requi red for the type of disinfectants to be

used, the vira l load and transmission routes, and the risks to be encountered. 4. Ensure that donations of disinfectants are accompanied by safety equipment.

The proper use of safety equipment can greatly reduce risk of harm to human health from chemicals used to combat the disease, to exposure to the virus, and to domestic poultry health from disease transmission. The Bureau for Africa EGSSAA web reference http://www.en ca pafrica .org/EGSSAA/ current EGSSAA sections/EGSSAA-Pt2Ch13-Safe rPesticide Use. pdf provides a table that matches types of chemicals (basically liquid, solid or gas) and the specia l types of safety equipment needed for each.

The above conditions should be part of most, if not all, HPAI treatment programs using or advising on use of personal safety equipment. Additional conditions can be written into individual country-specific IEEs, as appropriate.

Training

Training courses provide an avenue for teaching skills to health, veterinary and agricultural technical staff involved in dealing with the HPAI outbreaks. For USAID, Regulation 216 requires that such training include not only human safety but environmental issues as well. The training can be short and use the train the trainer methodology, turning those trained into topic experts and reinforcing what they have learned.

Such training can include the following topics: • Description of the disease and symptom recognition; • Regulatory and quarantine issues;

Surveillance; zoning and compartmenta lization; Proper use of personal safety equipment, Proper handling, use and disposal of disinfectants;

• Proper handling, use and disposal of medical and veterinary wast e; • Environmental issues arid protection; • Proper disposal of poultry manure and bird parts; • Vaccines and diagnostic methods; • Methods of humane killing for disease control purposes and carcass disposa l;

Food safety;

• Planning and record keeping; and • Safety of animal products in international trade. • Incineration as a disposal method for waste, special treatment of plastics, and sharps • Dealing with wild birds and wild bird die-off

Activity 9: Communication, public awareness campaigns and training in avian influenza and Ebola response.

Communication and public awareness campaigns will be conducted using cost-effective outreach tools such as disseminating public messages through internet, radio and television outlets, and use of posters, billboards and informational flyers. Social media tools will be used for both the avian influenza and Ebola activities as needed to maintain the community and stakeholders informed and engaged, where needed.

pg.25 10/24/17

These are methods for informing or 'training' a large number of people in a very short timeframe and can increase public awareness of t he importance of animal quarantine issues and household egg and meat management, handling, and cooking requirements. These methods should be supported by and integrated into USAID's response in each affected country. AFR's Hea lth Program plans to invest in com munication technologies and methodologies to raise awareness and reduce risks. Missions can augment this process by planning and determining the areas of greatest need.

Threshold Decision: This category of activities is recommended for a categorical exclusion from environmental examination, per 22CFR216.2(c)(2)(i) [education, t echnica l assistance, t ra ining].

2.6. RECOMMENDED DETERMINATIONS AND CONDITIONS

Following from the analysis, the following determinations and conditions are recommended.

2.6.1. Recommended Determinations

Activity or Activity Category 1. Monitoring and surveillance (M & S) for the presence of avian influenza, Ebo la and other emerging pandemic threats and zoonotic diseases in wild and domestic animals, which include sampling and laboratory analysis of infectious disease Field and laboratory testing for the presence of pandemic disease agents including, but not limited to avian influenza and Ebola. 2. Disinfection of poultry, and food manufacture and transportation workers, clothing, shoes/boots, poultry houses, vehicles, tools, medical equ ipment, culling equipment, and all other equipment and materials which come into contact with the virus or products containing the virus. 3. Anima l and human vaccination, veterinary examination and treatment, and human patient examination and treatment.

4. Laboratory research and testing.

5. Culling of diseased livestock and disposal of diseased livestock, wild birds, and their manure.

pg. 26

Recommended Determination Negative Determination with Conditions, per 22CFR216.3(a)(2)(ii i)

Negative Determination with Conditions, per 22CFR216.3(a)(2)(iii)

Negative Determination with Conditions, per 22CFR216.3(a)(2)(iii )

Note: This type of activity does not include extermination of uninfected wild bird populations or their natural habitats or similar extreme measures. If t hese activities are proposed, this would require a Positive Determination, Scoping Exercise, and Environmental Assessment, unless U.S. migratory species are involved in which case an Environmental Impact Statement under NEPA procedures would be required. Negative Determination w ith Condit ions, per 22CFR216.3(a)(2)( iii) Negative Determination w ith Conditions, per 22CFR216.3(a)(2)(iii)

Note: This type of activity does not include exterminat ion of uninfected wild bird

10/24/17

popu lations or their natural habitats or similar extreme measures that would require a Positive Determination, Scoping Exercise, and Environmental Assessment, unless U.S. migratory species are involved in which case an Environmental Impact Statement under NEPA procedures wou ld be required.

6. Small sca le construction and renovation of Negative Determination with Conditions, laboratory and research facilities. per 22CFR216.3(a){2){iii)

7. Procurement, installation, commissioning, operation, Negative Determination with Conditions, and maintenance of treatment equipment for medical per 22CFR216.3{a)(2){iii) and pesticide wastes (i.e. incinerators with capacities to For incinerators with capacities to destroy destroy approximately 12 to 100 kilograms of waste per approximately 12 to 100 kilograms of waste hour). per hour2

;

Note: The use of incinerators with capacities to destroy> 100 kilograms of waste per hour are not authorized under this IEE. The IEE wil l be amended if capacities exceed th is amount, with a resulting scoping study and, if necessary, an Environmental Assessment developed and approved by the COR and the GH BEO. Multiple installations serving a facility that in total exceed these thresholds will also receive a positive determination.

8. Provision and training in the use of personal Negative Determination with Conditions, protective equipment (PPE) per 22CFR216.3(a)(2){ iii)

9. Communication, public awareness campaigns and Categorical exclusion, per training in pandemic threat response . 22CFR216.2(c)(2)(i)

[education, technical assistance, training].

2.6.2. Recommended Conditions

1. Environmental Management Training. The GH AOR/COR and Activity Manager{s) assigned to this

program are to enroll in and successfully complete the Bureau for Global Health Environmental

Management Process Training course. The course is offered through GHPOD.

2. Provision of the IEE. The AOR will provide a copy of this IEE to the implementing partner and brief them on their environmental compliance responsibilities.

3. Public International Organization (PIO) environmental safeguards. In cases where the implementing partner (IP) is a PIO, the GHAOR will consult with the IP to determine if the organization has adequate environmental safeguards for the activity. If the PIO chooses to use

2 USAID PATH Incinerator Guidebook (2010) https://www.path.org/publications/files/TS mmis incin guide.pdf

pg. 27 10/24/17

their environmental compliance process and templates, they will provide t he GHAOR with examples of the proposed reporting format and monitoring process to demonstrate that they have the necessary environmental mitigations and compliance for the project. The GHAOR, in consultation with the GH BEO, will assess the PIO's environmental safeguards. The PIO may choose to use the USAID environmental compliance procedures and templates (Appendices A-C). The USAID EMMP, or the PIO's proposed environmental safeguards plan, will be provided to the GHAOR concurrently with the project work plan for review and approval and the GH BEO for concurrence.

4. Pesticides or pesticide products. The procurement or use of pesticide requires the preparation of a separate section evaluating the risks and benefits of the planned pesticide use, which must address the factors outline in 22 CFR 216.3 (b)(l)(i). A Safer Use Action Plan (SUAP} may be required for review and approval by the GHAOR and Global Health BEO. Pesticide used on this project must be approved by US Environmental Protection Agency or WHOPES and be registered in the country where to application is to occur.

Pesticide use, only to the extent that they are classified as disinfectants, will be used for Ebola activities. AOR: AC

5. Assurance of sub-awardee, -grantee, -contractor capacity and compliance. The implementing partner shall assure that sub-awardees, -grantees, -contractors have the capability to implement the relevant requirements of this IEE. The implementing partner shall, if appropriate, provide training to sub-awardees, -grantees, and -contractors in their environmental comp liance responsibilities

6. AOR monitoring responsibilities. As required by the ADS 204, the AOR will actively monitor and evaluate whether the conditions of this IEE are being implemented effectively and whether new or unforeseen consequences arise during implementation not identified and reviewed in this IEE. If new or unforeseen consequences arise, the team will suspend the activity and initiate appropriate, further review in accordance with 22CFR216.

7. Annual compliance documentation and reporting. The IP shall complete the attached EMMP (or PIO equivalent) with the project work plan. The IP is responsible for annually preparing and submitting to the AOR for review and approva l, the attached Environmenta l Mitigation Monitoring Report (EMMR) to document compliance with the cond itions of this IEE.

8. Environmental Mitigation and Monitoring Report: Implementing partners under this award will complete an annual environmental mitigation and monitoring report (EMMR} t hat covers the documentation of the EMMP and its effect iveness.

• The environmental monitoring report is due to the AOR by December 31 of each year. • The EMMR will record the environmental mitigation and monitoring measures outlined in

the EMMP and will indicate the activities used to ensure that those measures were implemented.

• Based on the process outlined in the Project Work plan, the implementing partners' annual reports to USAID will include brief updates on mitigation and monitoring measures being implemented, results of environmental monitoring, and any other major modifications/revisions in the development activities, and mitigation and monitoring procedures. The EMMR will also identify issues and challenges associated with the implementation of the EMMP.

pg.28 10/24/17

The EMMR must be stored in project files.

9. Integration of compliance responsibilities in prime and sub-contracts, agreements, and grants. The AOR shall assure that the cooperative agreements document references and require comp liance with the conditions set out in this IEE, as required by ADS 204.3.4(a)(6) and ADS 303.3.6{3)(e). The implementing partner shall assure that sub-contracts, agreements, and grants reference and requ ire compliance with relevant elements of these conditions.

10. Compliance with human subject research requirements. The AOR in consultation with the Cognizant Human Subjects expert shall assure that the IP and sub-awardees demonstrate completion of all requirements for ethics review and adequate medica l monitoring of human subjects who participate in research trials carried out through th is agreement. The BEO for Global Hea lth may request copies of documentation from the AOR to demonstrate compliance w ith applicable requirements of human subject trials. All documentation demonstrating completion of required review and approval of human subject trials must be in place prior to initiating any tria ls and cover the period of performance of the trial as described in the research protocol. Specifically, the implementing partner must provide a brief descript ion of the research and the steps taken to comply with USAID requirements for the protection of human research subjects. This information must be provided to the AOR as part of the EMMP or as part of an amended EMMP.

11. New or modified activities. As part of the work plan, the implementing partner in collaboration with the AOR shall review all on-going and planned activities to determine if they are within the scope of this IEE. The implementing partner shall complete the screening questionnaire (Part 1 of EM MR) with the annual work plan (Appendix A).

• If activities outside the scope of t his IEE are planned, the AOR sha ll assure that an amendment to this IEE addressing these activities is prepared and approved prior to implementation of any such activities.

• Any ongoing activities found to be outside the scope of this IEE shall be modified to comply or halted until an amendment to this IEE is submitted and approved.

12. Compliance with Host Country Requirements. Nothing in this IEE substitutes for or supersedes implementing partner, sub-awardees/-grantee/-contractor's responsibility for compliance with all applicable host country laws and regulations. The implementing part ner and sub-awardee, -grantee, -contractor must comply with host country environmental regulations unless otherwise directed in w riting by USAID. However, in case of conflict between host country and USAID regulations, the latter shall govern.

13. Small-Scale Construction Activities. Small sca le construction and renovation activities to improve laboratory and research facilities will be limited to minor renovation activities. Examples include minor expansions or additions to laboratory and research faciliti es, repairing roofs and wa lls, installation of laboratory benches and shelving, installation of windows, repairing of plumbing and electrica l systems.

14. Asbestos and lead-based paint. The IP will not use construction materials contain ing asbestos or lead-based paint. When conducting renovation on existing buildings, the IP will investigate for t he presence of asbestos or lead paint prior to initiating work and will provide appropriate personal protective equipment (PPE) and a disposal process for handing the hazardous waste, if identified.

pg. 29 10/24/17

15. Air pollution control technology for incinerators. Small- or large-sca le incinerators procured or operated by the Implementing Partner must contain adequate air pollution control techno logy to ensure compliance with host country guidelines and applicable international air quality emission requirements, including:

• 74 FR 51367: US Environmental Protection Agency. Standards of Performance for New Stationary Sources and Emissions Guidelines for Existing Sources: Hospital/Medical/Infectious Waste Incinerators; Final Rule. October 6, 2009.


• AP 42 and Emission Factors: US Environmental Protection Agency.

A small-scale incinerator is one with a capacity to destroy approximately 12 to 100 kilograms of waste per hour, while a large-sca le incinerator has a capacity to destroy more than 100 kilograms of waste per hour. Refer to the USAID PATH Incinerator Guidebook for additional information on incinerators.

2.7.MONITORING AND REPORTING

The Implementing Partner and the AOR/COR, in consultation with the BEO, will actively monitor and evaluate whether environmental consequences unforeseen under activities covered by this IEE arise during implementation and modify or end activities as appropriate. Monitoring and reporting will be documented via the Environmental Mitigation and Monitoring Template (EMMT). If additional activities that are not described in this document are added to this program, an amended environmental examination must be prepared. If the PIO chooses to use their environmental compliance process and templates, they will provide the GHAOR with examples of the proposed reporting format and monitoring process to demonstrate that they have t he necessary environmental mitigations and compliance for the project.

The EM MT consists of three parts:

• The Environmental Screening Form

The AOR/COR conducts annual screenings of their projects using the Environmenta l Screening Form to determine whether project activities and annual workplans remain within the scope of the activities reviewed during the IEE process. For sub- projects, sub-grants, and subactivities, Implementing Partners must annually screen their activities and submit the completed form to the AOR/COR. If an activity does not fall within the scope of this IEE, a supplemental or amended environmental document must be prepared.

• The Environmental Mitigation and Monitoring Plan {EMMP}

The Implementing Partner is responsible for submitting the Environmental Mitigation and Monitoring Plan (EMMP) to the AOR/COR for review and approval. The GH BEO concurs on the EMMP. The EMMP is submitted with the workplan, after clearance of this IEE and prior to initiating project work. Implementing Partners will use the EMMP to describe the specific actions they will undertake under each category of activity when screening reveals potential environmental impacts as outlined in Section 2.5 of this IEE. The EMMP also ident ifies the person responsible for monitoring compliance with mitigation measures and the indicator, method, and frequency of monitoring. Refer to the attached GH EMMP Template.

pg.30 10/24/17

• The Environmental Mitigation and Monitoring Reporting {EMMR)

Annually, the Implementing Partner is responsible for completing the Environmental Mitigation and Monitoring Report {EMMR) and submitting it to the AOR/COR. The EMMRs are reviewed by the AOR/COR and the BEO (and/or MEO, as appropriate). The EMMRs ensure compliance with 22 CFR 216 and ADS 204.5 by documenting that the condit ions specified in this IEE have been met for all activities carried out under "Globa l USAID Response to Avian Influenza Outbreak and Surve illance for Ebola Virus in Livestock in Africa" by reporting on the results of applying the mitigation measures described in the EMMP and identifying outstanding issues with respect to required conditions. Verification may require digital photos and/or site visits.

The Implementing Partner for "Globa l USAID Response to Avian Influenza Outbreak and Surveillance for Ebola Virus in Livestock in Africa" will submit the EMMR on all activities by December 31 of each year for the life of the project, using the guidance and forms contained in the GH IEE BOP. Any sub- awards, sub-grants, and sub-activities must incorporate provisions stipulating a) the completion of an annual environmental monitoring report and b) that activities to be undertaken w ill be within the scope of the environmental determinations and recommendations of this IEE. This includes assurances that any mitigating measures required for those activities will be followed. Refer to the attached GH EMMR Template (Appendix C).

pg. 31 10/24/ 17

Project Name:

A. Environmental Screening Form

YOUR PROJECT NAME

Original IEE File #/DCN:

Naine of Prime Implementing Organization: Date of Screening:

Name of Sub-awardee Organization (if this EMMT is Funding Period for this award: for a sub):

-FY _ _ FY __

Geographic location of USAID-funded activities Current FY Resource Levels: (Province, District):

FY

This report prepared by: Date of Previous EMMT for this

Name: organization (if any):

Date:

Indicate which activities your organization is implementing.

Key Elem ents of Pro grain/ Activities Implemented Yes

1 Education, Technical Assistance, or Training

Includes: strategic planning, data analysis, technical consultation, surveys, knowledge and information transfer, meetings, technical material development, outreach programs, and training services.

2 Research and Development

Includes: health-related research and development activities aimed at advancing knowledge and technology, including research and evaluation, monitoring and surveillance, programs, pilot studies, case studies, and assessments.

3 Public Health Commodities

Includes: procurement, storage, transpmtation, distribution, and disposal of public health commodities, including pharmaceuticals, nutritional supplements, chemicals (e.g., disinfectants, solvents, laboratory reagents, etc.), medical supplies, and family planning commodities (e.g., contraceptives, condoms, etc.).

pg.32 10/24/17

No

4 Small-Scale Construction or Rehabilitation

Includes: hospitals, clinics, laboratories, voluntary and counseling testing centers, or training centers. Total smface area of the disturbed environment is nuder 10,000

square feet and less than $200,000 total cost.

5 Small-Scale Water and Sanitation

Includes: pond and spring improvements and installation of hand-dug wells, individual or community latrines, hand-washing stations, and small-scale septic and leach field systems.

6 Nutrition

Includes: small-scale food production, procurement and distribution of supplements, preventing undernutrition, providing nutritional care and suppo1t, and improving nutritional outcomes in programs.

7 Vector Control

Includes: procurement, distribution, or use of pesticide products such as insecticide-treated bednets, larviciding agents, and fumigants.

NOTE: USAID uses USEPA's definit ion of pesticides, which includes "any substance intended for: preventing, destroying, repelling, or mitigating any pest. This includes herbicides, fungicides, plant regulators, and desiccants."

Emergency Response

8 Includes: coordination with outside organizations and technical experts, deployment of resources and response teams, and development of technical materials.

DESCRIPTION OF ACTIVITIES:

Provide a description of activities with sufficient details to understand the scope and scale of the interventions. The EMMP should reference the governing IEE (GH- or country-level) .

pg.33 10/24/17

B. Environmental Mitigation and Monitoring Plan I ~ ....,-,-. ~-

l!rogr!!!rl

C_ategory of Activity Describe specific from Section 2.6 of environmental impacts of Description of Mitigation Who is Monitoring Monitoring Frequency of

--IEE your organization's activities Measures for these activities as responsible for Indicator Method Monitoring (based on analysis in Section required in Section 2.6 of __ monitoring?

2.5 of the IEE) IEE 1. Education, Technical Assistance, Training

2. Research and Development

3. Public Health Commodities

4. Small-Scale Construction

5. Small-Scale Water and Sanitation

6. Nutrition

7. Vector Control

8. Emergency Response

pg. 34 10/24/17

Prepared by:

ignat1J(e Date:. _______ _

!Name and Titl~

Reviewed and Approved by:

Signaturd Date: -------~

Agreement Officer's Representative/ Contracting Officer's Representative

Concur:

511m_.u_!.lrd Date: --------GH Bureau Environmental Officer

pg. 35 10/24/17

C. Environmental Mitigation and Monitoring Report

Progra

List each Mitigation Measure from column 3 in the EMMP Status of Mitigation Measures

List any outstanding issues relating to required (EMMT Part 2 of 3) conditions

i. Education, Technical Assistance, Training

2. Research and Development

3. Public Health Commodities

4. Small-Scale Construction

5. Small-Scale Water and Sanitation

6. Nutrition

7. Vector Control

8. Emergency Response

Prepared by:

Signatur~ Date: _______ _

I Name and Title : I

pg.36 10/24/17

Remarks

AFR

Al BEO CFR

cs EGSSAA ELISA EPA

EPP

FAO GC GIS HSN1 HPAI IEE NGO M&S OIE

Epizooties)

PCR PEA

PIEE

Bureau for Africa, USAID

Avian Influenza

D. Glossary

Bureau Environmental Officer, USAID Code of Federal Regulations

Country Strategy

USA! D/ Africa's Environmenta l Guidelines for Sma II Sca le Activities in Africa Enzyme-Linked lmmunosorbent Assay U.S Environmental Protection Agency

Environmentally Preferable Purchasing U.N. Food and Agriculture Organization General Counsel, USAID

Geographic Information Systems Hemagglutinin 5, Neuraminidase 1 (highly pathogenic strain of Al virus) Highly Pathogenic Avian Influenza. HSN1 strain of avian influenza Initial Environmental Examination Non-Governmental Organization Monitoring and Surveillance World Organization for Animal Health (Office Internationa l des

Patient Care Report

Programmatic Environmental Assessment

Programmatic Initial Environmental Examination

Private Voluntary Organization

Rapid Environmental Impact Assessment

PVO

REA REDSO

RCSA

SD

so USAID

WARP

WHO

Regional Economic Development Support Office, USAID

Regional Center for Southern Africa, USAID

Office of Sustainable Development, AFR

Strategic Objective

U.S. Agency for International Development

West Africa Regional Program, USAID

U.N. World Health Organization

pg.37 10/24/17

E. References and Resources

OIE Avian Influenza web site http://www.oie.int/eng/AVIAN INFLUENZA/home.htm Guidelines for the Survei llance of Avian Influenza Current Appendix 3.8.9. of the OIE TelTesh· ial Animal Health Code - 2005

Guidelines for slaughter of poultry for disease contro l purposes J.W. Galvin - Discussion paper

Interim Guidelines on protection of farmers and slaughterhouses workers (WHO) - WHO Regional office for the Western Pacific, Manila, 26 January 2004 File pdf

FAO Avian Influenza web site http://Www.Fao.Org/Ag/Againfo/Subjects/En/Health/Diseases

Cmds/Specia l Avian .Html

Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza (HPAI)

Guiding Principles for Highly Pathogenic Avian Influenza Surveillance and Diagnostic Networks in Asia

USAID Avian Influenza Response http://www.usaid.gov/our work/global health/home/News/news items/avian influenza.html and http://ghintranet.usaid .gov/aiunit/ and http://inside.usaid.gov/EE/avian influenza/ World Hea lth Organizatjon (WHO) Avian Influenza: Assessing the Pandemic Threat - January 2005 [PDF, 2.SMB]

See http://www.encapafrica.org/EPTM/AnnexF-AFR EPTM Mai'2005b.pdf for PEA details. A PIEE is justified as the present perceived risk does not rise to the level justified for a PEA.

Office International des Epizooties (OIE) and Food and Agriculture Organization (FAO) Guidelines.

See http://www.oie.int/eng/AVIAN_INFLUENZA/home.htm and

http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special avian.html

USAID Health's response to HPAI is found at the following web address: http://www.usaid.gov/our work/global health/home/News/news items/avian influenza.html. See http://www.irinnews.org/Avianflu.asp for a list of African countries and what each is doing to prepare itself against/for outbreak.

An up-to-date succinct listing of policies from each African country for preparing

themselves to exclude, detect, contain and deal with HPAI can be found at this

United Nations web address: http://www.irinnews.org/Avianflu.asp.

Many species of migratory birds coming to Africa from Europe, the Middle East

and Asia are thought to be susceptible. See

http://www.birdlife.org/action/science/species/avian flu/ for a statement on HPAI.

pg. 38 10/24/17

See http://www.epa.gov/pesticides/factsheets/avian flu products.htm to find a

list of 100 disinfectants currently registered by EPA for use in treating Avian

Influenza A virus in the USA. Since this is a different strain of Al than the HSNI

strain, USAID missions would invoke the "or similar use" proviso.

To search for the registration and risk data for individual disinfectant products

and chemicals in the disinfectants, see

http://www.pesticideinfo.org/lndex.html.

See

http://www.encapafrica.org/EGSSAA/currentEGSSAAsections/EGSSAA-Pt2

Ch13-SaferPesticideUse.pdf to understand pesticide safety issues in Africa

well.

See

http://www.encapafrica.org/EGSSAA/currentEGSSAAsections/EGSSAA-Pt2Ch1

2-lntegPestMngmt.pdffor ideas in developing an integrated pest management

program that reduces pesticide use in Africa.

See

http://www.encapafrica.org/EGSSAA!current EGSSAA sections/EGSSAA-Pt2Ch0

8-Healthcare-waste.pdf which is Chapter 8 on Health Care Waste of USAID

Bureau for Africa's Environmental Guidelines for Small Scale Activit ies in Africa

(EGSSAA).

See http://www.reusablebags.com/facts.php?id=8 for dealing with plastic waste, like plastic bags, containers, and the plastic syringe cyl inder. If not contaminated by pathogenic waste, plastic bags for moving and containing prod ucts can be recycled or reused, as can plastic syringe cylinders. ·

See http://environmentalrisk.cornell.edu/AgPlastics/ for information on dealing with and recycling agricultural plastics.

For a study on recycling plastics from medical and health care facilities, see

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list

uids=l2092754&dopt=Abstract. Also, plasticware that is not contaminated with

human or animal blood or other potentially infectious bio logical materia l may be

disposed of in sturdy ca rdboard boxes.

See: http://www.jhpiego.org/scripts/pubs/category detail.asp?category id=9

for specific infection prevention, quality assurance, waste management,

including incineration related issues of plastics, infectious materials, and other

wastes in healthcare facilities with limited resources,

pg. 39 10/24/17

Other important references to consult in establishing a waste management

program are "WHO's Safe Management of Wastes from Healthcare Activities"

http://www.who.int/water sanitation hea lth/publications/wastemanag/en/

For guidelines on dealing with manure, see EGSSAA Chapter 11 on Livestock Production: http://www.encapafrica.org/EGSSAA/cmTent EGSSAA sections/EGSSAA-Pt2Chl 1-Livestock.pdf.

See http:Uwww.o ie.int/eng/AVIAN INFLUENZA/home.htm (the web site of the World Organization for An imal Hea lth) for best practices in dealing with HPA/ issues, including: Methods of humane killing for disease contro l purposes and ca rcass disposal.

See http://www.frameweb.org/ev.php?ID=l3653 201&1D2=DO TOPIC to understand the conservation and biodiversity community's response to HPAI in Africa.

Information on the USA response to a potential pandemic is found at the following two sites: http://www.cdc.gov/flu/avian/ and http://www.pandemicflu.gov/.

New initiatives are underway to reduce negative environmental impacts that arise from or exacerbate disasters. Several groups are currently focusing on this issue. They include Relief Web at

http://www.reJjefweb.int/rw/lib.nsf/db900SID/DPAL-SZAHW2?0penDocument, the REA Centre at http://www.benfie ldhrc.org/disaster stud ies/rea/rea index.htm, among others.

The Pesticide Action Net work has information on toxicity and persistence in the environment for many pesticides. See http://www.pesticideinfo.org/lndex.html

For missing or unreadable product labels on registered pesticide disinfectants, the EPA pesticide product label database is found at http://oaspub.epa.gov/pestlab l/ppls.home

pg. 40 10/24/17

F. EPA list of I 00 approved pesticide disinfectants for Avian Influenza

http :l/www .eP-a.gov/pesticidcs/factsheets/avian flu products.htm downloaded May 30, 2006

These EPA-registered disinfectant products are registered and labeled wit h a cla im to inactivate "avian

influenza A" viruses on hard, non-porous surfaces. Typical sites listed on these product labels include:

veterinary premises, poultry houses, farm premises and equipment, and other Industria l and

institutional settings. Although there are no antimicrobial products registered specifically against the

HSN1 subtype of avian influenza A viruses, EPA believes that the currently registered avian influenza A

products, w hen applied in strict accordance with the label directions, will be effective against the HSN1

stra in. These disinfectants, which are typically in liquid or spray form, are available at retail

establishments, and users should look for an EPA registration number on the label (e.g., EPA Reg. No.

XXX-XX). The label wi ll also indicate if the disinfectant product is effective aga inst avian influenza A

virus. General information about disinfecting for avian flu.

Users shou ld careful ly follow the disinfection directions on the label to handle and safely use the

pest icide product and avoid harm to human health and the environment. The approved label of a

product can be found in the Pesticide Product Label System (PPLS) database label search site. To obtain

a product label, enter the EPA Registration Number of the primary product in the search query boxes

(i.e., the company identification number and the product number) of the PPLS database. Information

about the Pesticide Product Label System {PPLS) database is posted on the PPLS homepage.

I I Registration Number I Product Name

'11106-72 I Maxima 128 '11106-73 I M axima 256 lsl106-79 I Broadspec 256 '41106-81 I Maxima RTU

lsl134-65 I DC&R Disinfectant

j.J211-25 I Pheno Cen Germicidal Detergent

'71211-32 I Pheno Cen Spray Disinfectant

lsJ211-so I QS.5-5 NPB 2.5 HW

lsl211-62 I Low pH Phenolic

~1303-9 1 I Hi-Tor Germicidal

~1303-92 I Quanto Germicidal

pg.41 10/24/17

I

I I Registration Number Product Name

~1464-689 Ucarsan San itizer 420

I 13 1464-696 Ucarsan Sanitizer 4128

~1464-700 Ucarcide 14 Antimicrobia l

~1464-702 Ucarcide 42 Antimicrobia l

~1464-715 Ucarsan 442 Sanitizer

~1464-716 ' Ucarsan 414 Sanitizer

~11043-91 LpH Master Product

~11677-129 Oxonia Active

~11677-158 Vortexx

~11677-203 OXYSEPT LOI

~11839-86 BTC 2125 M 10% Solution

~11839-154 Scented 10% BTC 2125M Disinfectant

~11839-155 BTC 2125M 20% Solution

~11839-173 7.5% BTC 885 Disinfectant

~13838-36 Quat 44

~13838-37 Quat Rinse

~16836-70 Bardac 205M 7.58 I

~16836-71 : Lonza Formulation Y-59 '

~16836-75 ' Lonza Formulation S-21

~16838-77 I Lonza Formu lation S-18

~16836-78 I Lonza Formula~ion R-82

~16836-136 I Lonza Formulation S-18F

~16839-139 I Lonza Formulation R-82F

~16836-140 I Lonza Formulation S-21F

pg.42 10/24/17


~16836-152 I Lonza Formulation DC-103

~16836-233 I Bardac 205M-50

~16836-252 I Phencide 256

~16836-253 I Phenocide 128

~16836-266 I Bardac 205M-10 '

~16836-277 I Bardac 205M 1.30

~16836-278 / Bardac 205M 14.08

~16836-302 I Bardac 205M 5.2

I 44 16836-303 I Bardac 205M 7.58

~110324-56 I Maquat 256

J:-/ 10324-58 I Maquat 128

~110324-59 I Maquat 64

~110324-63 I Maquat 10

r.;-110324-67 I Maquat MQ615-AS

~1 10324-72 I Maquat 615 HD

~110324-80 I Maquat 5.SM

~110324-81 I Maquat 705M

~110324-85 I Maquat 86 M

~1 10324-94 I Maquat 20M

~110324-96 I Maquat SODS

~110324-99 I Maquat 10 I

rs;-1 10324-115 I Maquat 750 M

~110324-117 I Maquat 710 M

~110324-118 I Maquat 256 EBC

pg. 43 10/24/17


~110324-119 I Maquat 128 EBC

~110324-120 / Maquat 64 EBC

~110324-131 I MaquatA

~110324-142 I Maquat MQ2425 M 14

~110324-143 I Maquat lOB

~110324-145 I Maquat FP

~110324-162 I Maquat 2420 Citrus

~110324-164 I Maquat 256 PD

~111600-4 I Sa nox II

~111725-7 I Tek-Trol Disinfectant

~114955-33 ISMS Disinfectant Sanitizer

~134797-75 I Canine Parvovirus Disinfectant

~147371-6 / Formulation HS 6520

~147371-7 / Formulation HS 821Q

~147371-36 I HS-8670

~147371-37 I HS-2670 germicidal Cleaner

~147371-141 / Formulation HH 6520

I 77 161178-1 I D-125

~161178-2 I Public Places

~161178-4 I Public Places Towelet te

~161178-5 I CCX-151 :

~161178-6 I D-128

i

I

~166171-1 I Advantage 256

~166243-1 I Odo-Ban Ready to Use

pg. 44 10/24/ 17


~166243-2 I Odo-Ban

~166243-3 I Quik Control

~167619-9 I PJW-622

~170263-6 I Microban QGC

~170623-8 I Microban Professiona l

~170627-2 I Disinfectant DC 100

~170627-6 I Phenolic Disinfectant HG

~170627-10 I Johnson's Forward Clea ner

~170627-15 /Johnson's Blue Chip Germ icidal

~170627-21 I Virex II 128

~170627-22 I Virex RTU

~170627-23 I Virex II 64

~170627-24 I Virex II 256

~171355-1 I Virocid

~171654-6 I Virkon S

~171847-2 I Klar-Kleen

~1 81073-1 I Peridox

For fu1ther questions, contact the Antimicrobial Division hotline at 703-308-0127, 703-308-6467 (FAX)

or emai l at info [email protected].

pg. 45 10/24/17

G. PESTICIDE PROCEDURES ANALYSIS FOR HPAI DISINFECTANTS

Pesticide procedures element a: USEPA registration status of the proposed pesticide

Intent: Pesticides are registered in the U.S. by active ingred ient and by formulation. "Registration status" possibi lities of the active ingredients and the formulated products include active registration, never registered, and cancelled. USAID is effectively limited to using pesticides registered in the U.S. by the U.S. Environmental Protection Agency for the same or similar uses. Other pesticides not registered in the U.S. may be authorized, but only if the USAID program can show that no alternatives are available, as required under USAID Pest Management Guidelines for the use on non-U.S. registered pesticides.

Cost and ready avai lability of an unregistered pesticide is not sufficient reason not to use an EPA registered one. If an unregistered pesticide is required, it must first be shown to be as safe and effect ive as the EPA registered ones are. This is accomplished through an Environmental Assessment that must be approved by the Bureau Environmental Officer. Given that EPA has approved 100 different disinfectant pesticides made by a number of different companies for Al, it is unlikely that none of these would be available in a given country. Host country pesticide (and disinfectant) registration procedures must also be identified and followed, if they exist.

EPA's list of 100 disinfectant pesticide products registered for use against Avian Influenza virus in the USA is found at: http:Uwww.epa.gov/pesticides/factsheets/avian flu products.htm As EPA states on this site, "Although there are no antimicrobial products registered specifically against the HSNl subtype of avian influenza A viruses, EPA believes that the currently registered avian influenza A products, when applied in strict accordance with the label directions, wi ll be effective aga inst the HSNl strain." See http://www.fao.org/ag/AGAlnfo/subjects/en/health/d iseases-cards/avian qa.html#7 for a list of FAOrecommended products and practices.

The relevant Bureau Environmental Officer will use a three-stage process outlined above for determining the su itability of a pesticide with respect to its registration status:

1. If the product is among the 100 currently registered by USEPA for avian influenza, then the Bureau programs may use the product, so long as they have approval from the appropriate host government authorities;

2. If the product is identical in formulation to one or more of the products on the list above, then the Bureau programs may consider its use, so long as an amendment to this IEE can show that none of the 100 EPA approved pesticides are available in the country, it does not infringe on any patents, it can be shown to meet required quality control to be fu lly effective and not contain harmful contaminants, and they have approval from the appropriate host government authorities. Prior to seeking to use such a product, the operating unit should directly contact the REA and BEO to discuss the need to use of the unregistered product in question. The mission should assemble all the informat ion they can about the product in question, preferably including a product label. The registration and/or approval status by the host government must be known.

pg. 46 10/24/ 17

3. For any other disinfection product (those neither on EPA list nor with an identical formulation to an EPA approved disinfectant), prior to seeking to use a product the operating unit should directly contact the REA and BEO to discuss the need to use of the unregistered product in question. The mission should assemble all the information they can about the product in question, preferably including a product label. The registration and/or approval status by the host government must be known. Approval of such pesticides requires a 22CFR216 Environmental Assessment to justify their use.

For mission IEE: Identify and describe the product(s) selected and the EPA and local registration status for each. Follow guidance above

Pesticide procedures element b: Basis for selection of the pesticide

The main factors likely to be used in the selection of EPA approved disinfectants in USAID programs include availability, efficacy (effectiveness at killing the virus), and price. Other factors to consider include relative safety to human health and quality control considerations, such as the rel iabi lity of the manufacturer.

Some products will likely be imported from major international firms like DuPont, Dow, and others; some will be imported from third countries like India, China, South Africa and others; while still other products may be produced loca lly or regionally. Some products will be produced locally or third countries under license from the major companies. South Africa has a strong chemica ls production and distribution industry and produces many products under contact or license agreement, and distributes others.

The issues of greatest concern on choice of manufacturer will be the presence and quantity of active ingredient; that is, does the container contain w hat it claims on the label in t he same concentrations or concentration ranges? Depending upon the manufacturer as well as storage conditions and age of the product, it may or may not. If a product does not contain enough of the active ingredient, once diluted, it may not be effective against the HPAI virus. A second important concern is that if a formulation is proprietary or under patent, that USAID not support the procurement or use of products that are not manufactured by the owner or under a license.

Product quality control is confirmed in most countries by taking random samples of the product imported or to be purchased and tested to determine what is in the conta iner. This is generally done by a government laboratory but could also be contracted out to private sector labs. Most of the disinfectants are inorganic compounds that could be t ested by using color-producing reagents and relatively inexpensive colorimetric devices such as Spectrometer 20, or 'Spec 20s'.

Governments, therefore, should be supported in randomly testing disinfectant products to be imported/used aga inst HPAI

For mission IEE: Identify the product(s) selected and the basis for selection for each.

Pesticide procedures element c: Extent to which the proposed pesticide use is, or could be, part of an Integrated Pest Management (IPM) program:

The international--as well as many national-strategies being implemented t o dea l with HPAI already form an integrated program. In addition to control of the HPAI virus, most initiatives

pg. 47 10/24/17

include monitoring and surveillance, zoning and compartmentalizat ion, regulations and quarantine, vaccination, disinfection and disposa l of waste (see http://www.oie.int/eng/AVIAN INFLUENZA/home.htm).

See: http://www.encapafrica.org/EGSSAA/current EGSSAA sections/EGSSAA- Pt2Ch12-lntegPestMngmt.pdf for further ideas in reinfo rcing an integrated management program that reduces pesticide use.

For mission IEE: Some description needed of the planning and implementation context and the other activities being implemented by way of Al response.

Pesticide procedures element d: Proposed method or methods of application, including the availability of application and safety equipment:

The best information on how to apply the disinfectants safely will be found on the product or container labels. In the USA, EPA requires that all products have labels containing application and safety procedures. For products t hat are registered in the USA, use the site: http://oaspub.epa.gov/pestlabl/ppls.home to see web copies of the labels. Products not registered in the USA are also like ly to have labels with t he same type of information, as most international standards require.

See http://www.encapafrica.org/EGSSAA/currentEGSSAAsections/EGSSAA-Pt2Chl3-SaferPesticideUse.pdf to understand pesticide safety issues.

For mission IEE: Describe measures being taken to assure that appropriate application and safety equipment will be available.

Pesticide procedures element e: Any acute and long-term toxicological hazards, either human or environmental, associated with the proposed use, and measures available to minimize such hazards:

A list of chemica ls for disinfecting different items and risk avoidance is found in tables at: http:Uwww.fao.org/ag/AGAlnfo/subjects/en/health/diseases-cards/avian qa.html#7. Below is a table contain ing selected disinfectant agents, with information on USEPA acute toxicity, issues w ith human health and environment, as well as mitigating safety measures to avo id harm.

Note that most disinfectants are inorganic compounds that are only very toxic in the concentrated form in which they are sold. The critica l facto r is concentration. Most are irritants and corrosives and can harm people, equipment and environment in their most concentrated forms. Once the purchased products are diluted with water, their toxicity decreases measurably so as to not pose a great acute risk to the health of users and others who come into contact with the diluents (with the possible exceptions of formaldehyde gas and hydrochloric acid). Note also t hat most have few long-te rm or chron ic effects (except forma ldehyde which is a known ca rcinogen). Most should be used with care around open water as they may kill aquatic organisms. See Pest icide procedures element i below for a summary of human and environmental hazards from se lected disinfectant s.

Soaps and detergents, in most cases, are the most effective and least toxic alternatives readily available. Converse ly, USAID will not approve the use of highly dangerous or cancer-causing alternatives such as hydroch loric acid, forma ldehyde liquid or forma ldehyde gas. Untrained peop le should not attempt to use these products.

pg. 48 10/24/17

Expert field guidance will be needed in each country to research the acute and long-term risks of each available chemical or product. One very good source for finding risk data on individual chemicals, as well as products, is: http://www.pesticideinfo.org/lndex.html, either 'Chemical Search' or 'Product Search'. Important issues will be worker exposure route (oral, skin, eyes, inhalation), time exposed, and dose. Except for soaps, detergents and citric acid, request rapid approval from the appropriate BEO.

For mission IEE: Particular emphasis should be on the human and other resources being mobilized that will help to minimize the hazards associated with the selected chemicals.

Pesticide procedures element f: Effectiveness of the requested pesticide for the proposed use:

As noted above, the EPA has a list of pesticide disinfectants for use in control of HPAI. Expert field opinion will be required to determine what is most effective for a given country situation and local conditions. A local IEE should capture this information.

For mission IEE: Identify the evidence on which basis the mission judges the proposed product to be effective, e.g. FAQ's list, if the product is on that. It will also be important for the mission to provide assurance that the particular product being purchased is of good quality, including that it contains the full advertised concentration of active ingredient and that it is not contaminated with other ingredients. In the absence of other evidence, the program may need to include product sampling in its Al activities.

Pesticide procedures element g: Compatibility of the proposed pesticide use with target and non-target ecosystems:

Most of the compounds on the EPA list of recommended chemicals and products are not persistent; in the environment they are likely to rapidly break down. Once a specific product is selected, further information on toxicity and persistence can be found at http://www.pesticideinfo.org/lndex.html. None of the disinfectants are likely to be sprayed over large areas like insecticides might, and are therefore likely to be locally contained. The end result or benefits of eradicating the virus and saving wild birds by using disinfectants to contain transmission are likely to outweigh the risks to wild birds.

By law, the product labels of EPA approved pesticides must contain information on the impact of the disinfectant on target and non-target organisms, as well as provide use restrictions and cautions . If the label is unreadable or missing, the information on safe handling, use, and disposal can be found by entering the product registration number on the EPA website pesticide product label database at http://oaspub.epa.gov/pestlabl/ppls.home

For mission IEE: Of greatest importance in this section is to list the use restrictions and cautions for the chosen product and to commit to follow them.

Pesticide procedures element h: Conditions under which the pesticide is to be used, including climate, flora, fauna, geography, hydrology, and soils:

There is little likelihood that disinfectants will spread far from the place where they are used because of the small quantities used and the fact that disinfectants rapidly break down and are

pg. 49 10/24/17

diluted in the environment. App lication of disinfectants is likely to be limited to indoor or limitedsize outdoor settings.

For mission IEE: Nothing more needed, unless the application locale is a particularly sensitive wildlife habitat, e.g. a protected area.

Pesticide procedures element i: Availability of other pesticides or non "chemical control methods:

Pesticides, disinfectants, and antimicrobial cleaners are subject to labeling requirements under FIFRA. Detergents, including laundry detergents, that make germicidal claims are regulated by EPA and must display the EPA registration number. Dishwashing soaps that make cla ims to be germicidal wou ld normally be considered to be household cleaners and therefore be regu lated by EPA. However, to date, EPA has not registered nor reviewed any germicidal dishwashing soaps. Some germicida l dishwashing soaps are classified and labeled by the manufacturer as hand soaps, w hich means they fall under the authority of the FDA. The FDA has no current testing requirement in place for germicidal active ingred ients, so these "germicida l" labeled dishwashing products are not tested for safety or effectiveness. http://www.eco-labels.org/label.cfm?LabellD=249

All HPAI control programs shou ld focus on using EPA-registered pesticide disinfectants or nonpesticide disinfectants such as soaps, detergents and citric acid. Below is an illustrative table adapted from the Austra lian Government Decontamination Procedures Manual: http://www.animalhealthaustralia.corn.au/shadomx/apps/fms/fmsdownload.cfm?file uuid=2BSO B4BD-E62D-ECF 1-C6AB-FA2 I 896AOED7 &siteNanle=a ahc, which has been adopted by FAO on their HPAI site.

pg.SO 10/24/17

Items and Procedures for Disinfection

Item Dead b irds/carcasses Animal housing/equipment Humans Electri cal equipment Water tanks Ponds used by poultry/ducks Feed Effluent, manure H uman housing Machinery, vehicles Clothing Aircraft

Code Key

1. Soaps and detergents

2. Oxidising agents

2a. Sodium hypochlorite

2b. Calcium hypochlorite

2c. Virkon<E(on EPA's list)

3.Alkal is

3a. Sodium hydroxide (caustic soda)(NaOH). Do not use w ith alumin ium and like alloys

3 b. Sodium carbonate anhydrous (wash ing soda) (Na2C03. I 0 H20)

4. Citric Acid

5. Bury or bum or compost

6. Drain to pasture if possible

pg. 51

Disinfectant/chemical code (see codes below) 5

1, 2a, 2b, 2c, 3 1

2a, 2b, 2c 6 6 5

5, 4, 3 1, 2a, 2b, 2c I, 3 I , 2a, 2b, 2c, 3 l ,2c

Farm and fi na l concentrati on

Liquid , dilute to final 2-3% avai lable chlorine

Sol id or powder, di lute2-3% available chlorine (20 g/litre powder, 30g/l solid)

2% (20 g/litre)

2% (= 20 g/litre)

4% (=40 g/litrn) from powder l 00 g/l from crystals

0.2% (2 g/l)

-

Contact time and notes

Leave in contact 10 minutes

Not good for organic material s. 10-30 minutes contact.

Not good for organic materia ls. 10-30 minutes contact.

IOminutes. Excellent disinfecta nt

lOmins. Do not use in presence of alumi nium

lO mins. Recommended for use in presence of organic materials as above. 30 mins

30 rnins, safe for clothes and body decontamination

10/24/ 17

Human and Environmental Toxicity Hazards of

Selected Disinfectant Chemicals

Note: Keep all concentrated products away from chi ldren. For First Aid with strong irritants, do not induce vomiting. Most Class I products- once diluted-become m uch less toxic. The

greatest health risk will be for the person who mixes the concentrate with water. Also, note

that this list is NOT exhaustive.

Chemical or USEPA Toxicity Human Health Environment Safety Measures

Product Name Range for EPA-

Registered

Products

For people who mix

Benza lkonium Danger, Class I Strong irritant. Moderately the product with

water, wear rubber ch loride (one of

(as concentrated May cause skin, toxic to fish,

gloves, goggles, mask, 3 chemicals eye, lungs, and crustaceans.

found in product product)

mucous membrane Highly toxic to and protective

clothing. Avo id sold in Nigeria burns. zoop lankton.

breathing the dust. ca lled "Diskol") Use care around

aquatic

environments.

Glutara ldehyde Danger, Class I Irritant. May cause Moderately For people who mix

(one of 3 cough, skin & eye toxic to the product w ith

c1micals found (as concentrated

redness and pain. zoop lankton. water, wear rubber

in reduct so ld product)

Ingestion may Slightly toxic to gloves, goggles, mask,

in igeria cause abdomina l fish. and protective

la elled Disko l) pain, diarrhea, clothing. Use care

nausea. around aquatic

environments.

Formaldehyde Danger, Class I Strong irritant. May Slightly toxic to For peop le who mix

liquid (one of 3 (as concentrated

cause skin, eye, zoop lankton. the product with

chemica ls found lungs, and mucous Not acutely water, wear rubber

in product product)

membrane burns. toxic to other gloves, goggles, mask,

labelled Diskol) Known human aquatic and protective

carcinogen. species. clothing. Avoid See breathing the dust. formaldehyde

pg. 52 10/24/17



Registered

Products

gas below.

Soap Caution, Ingestion may lead Moderately

to stomach ache, toxic to fish. Class Ill

nausea.

Sodium Danger, Mild irritant. May Highly toxic to Mixers should wear

dodecylbenzene cause cough, sore nematodes & rubber gloves,

sulfonate Class I

throat upon f latworms. goggles, mask, and

(common (as concentrated inhalation; skin & Moderately protective clothing.

detergent product) eye redness; toxic to fish, Use care around

ingredient) diarrhea & slightly toxic aquatic

vomiting if crustaceans, environments.

ingested. worms.

Sodium Danger, Class I Irritant. May cause Highly toxic to M ixers shou ld wear

hypochlorite cough, skin & eye fish & insects. rubber gloves, (as concentrated

redness and pa in. Moderate ly goggles, mask, and product)

Ingestion may toxic to protective clot hing.

cause abdominal worms, Use extreme care

pain, sore throat, mollusks & around aquatic

diarrhea, nausea, crustaceans. environments.

vomiting.

Calcium Danger, Class I Slight irritant. Highly toxic to Mixers should wear

hypochlorite (as concentrated

Mildly corrosive to fish, rubber gloves,

eyes, mucous crustaceans, & goggles, mask, and product)

membranes. mollusks. protective clothing.

Use extreme care

around aquatic

environments.

pg.53 10/24/17



Registered

Products

Mixers should wear

Virkon, Virkon S Danger, Class I Strong irritant. Harmfu l to rubber gloves,

goggles, mask, and (which contain

(as concentrated May cause skin, aquatic protective cloth ing.

mostly eye, lungs, and environments.

potassium product)

mucous membrane Avoid breathing the

dust . Do not allow peroxymono- burns. powder to ente r sulfate) waterways.

Sodium Classes I, II, & Il l. Strong corrosive. Not acutely Mixers should wear

hydroxide Danger, May cause skin, toxic to most rubber gloves,

Warn ing, & eye, lungs, and aquatic goggles, mask, and

mucous membrane organisms. protective clothing. Caution based

burns & blisters. Avoid breath ing the on concentration dust.

Sodium Classes I, 11, & Ill. Slight irritant. May Not acute ly Use safety

ca rbonate Danger, cause irrit ation to toxic to most precautions &

Warn ing, & skin, eye, lungs, aquatic equipment when

and mucous organisms. mixing concentrated Caution based

membranes. product with water. on concentration

Citric acid Classes I, II, & Ill. Irritant. May cause Not acutely Use safety

Danger, irritation to skin, toxic to most precautions &

Warning, & eye, lungs, and aquatic equipment when

mucous organisms. mixing concentrated Caution based

membranes. product with water. on concentration

pg.54 10/24/17



Registered

Products

Hydrochloric Danger, Class I Very strong Not acutely Not for genera l use. acid Not for co rrosive. toxic to most Use only by well general use.

(as concentrated aquatic life due trained & protected

product) Will cause serious to rapid individuals. Use

acid burns and dilution upon rubber gloves, goggles

damage to skin, ent ry to water. or face shield,

eyes, lungs, and respirator cartridge

mucous mask, boots, and full

membrane. overalls.

Formaldehyde Danger, Class I Very strong Not acutely Not for genera l use. gas Not fo r co rrosive. May toxic to most Use only by well

general use. (as concentrated

cause skin, eye, aquatic life. trained & protected product)

lungs, and mucous individuals. Use

membrane burns. rubber gloves, goggles l<nown human or face shield,

ca rcinogen. resp irator cartridge

mask, boots, and f ull

overa lls.

For mission IEE: Iden tify the other disinfectants that are available to the program in question.

Pesticide procedures element j: Host country's ability to regulate or control the distribution, storage, use, and disposal of the requested pesticide.

HPAI response activities are likely to be conducted as a partnership between the host country government and multiple donors, intergovernmental agencies and non-governm ental organizations. USAID operating units should describe t he nature ofthose operations and should discuss, in that context, how the use, distribution, storage, use and disposa l of disinfectants will occur. The host country's abi lity and role should be a part of that description and discussion. For mission IEE: See discussion above.

Pesticide procedures element k: Provision for training of users and applicators.

The Bureau support for use of disinfectants should be accompanied by assurance that adequate safe use training is provided on handling, use and disposa l of disinfectants. This should likely be included as a component in broader training on HPAI management in country or regionally.

pg.SS 10/24/ 17

For mission IEE: Describe the sufficiency of training for users and applicators, and the measures the USAID program will take to provide for such training, if needed.

Pesticide procedures element I: Provision made for monitoring the use and effectiveness of this pesticide.

Monitoring of the use and effectiveness of disinfectants should be built into the monitoring and evaluation procedures for the overall HPAI response supported by USAID programs. This operation will be guided by field-based experts. Local field staff will need to look for human health and environmental issues related to disinfectant use.

For mission IEE: Describe the specific monitoring efforts that will be undertaken by the USAID-supported program, or by other partners with whom USAID is working.

pg. 56 10/24/17

H. EPA exempted disinfectants

http://www.epa.gov/fedrgstr/EPA-PEST/1996/March/Day-06/pr-577.html downloaded

May 30, 2006

Minimum risk pesticides-- {1) Exempted products. Products containing the fo llowing active in&red ients

are exempt from the requirements of FIFRA, alone or in combination with other substances listed in this

paragraph, provided that all of the criteria of this section are met.

Castor oil (U.S.P. or equivalent)

Cedar oil

Cinnamon and cinnamon oil

Citric acid

Citronella and Citronella oi l

Cloves and clove oil

Corn gluten meal

Corn oil

Cottonseed oil

Dried Blood

Eugenol

Garlic and garlic oil

Geraniol

Geranium oil

Laury! sulfate

Lemongrass oil

Linseed oil

Malic acid

Mint and mint oil

Peppermint and peppermint oil

2-Phenethyl propionate {2-phenylethyl propionate)

Potassium sorbate

Putrescent whole egg so lids

Rosemary and rosemary oil

Sesame (includes ground sesame plant) and sesame oi l

Sodium chloride (common sa lt)

Sodium lauryl sulfate

Soybean oil

Thyme and thyme oil

White pepper

Zinc metal strips (consisting solely of zinc metal and impurities)

pg. 57 10/24/17

I. Guidance for Country-level IEEs for Al Response Activities

Because the Agency's internal policy (ADS 204) requires environmental examinations at the level of

the operating unit that has managerial responsibility for an activity, this PIEE must be supplemented

by country-level EMMPs covering the Al response and Ebola activities to be supported. ltis the intent

of this PIEE to provide guidance to which such country-level IEEs can simple refer, rather than

repeat. Such country-level IE Es wi ll serve to acknowledge the guidance in this PI EE, to assign

environmental mitigation responsibilities to those parties responsible for the management of

country-level Al activities, and to address any proposed discrepancies with PIEE guidance.

pg.SB 10/24/17

J. SAFE MANAGEMENT OF WASTES FROM HEALTH-CARE ACTIVITIES

Figure 1. Routes of exposure to hazards caused by open dumping

Food chain

Animals

____., GaseatJs emissions

~substances Plants _____..

~~·

Contamination of soil and groundwater

disposal

Municipal disposal sites

j Hydrocarbons

l Heavy metals Smells

· J Organlc~substances ~

.::;. --- - - Food chain__.-/ - - ~ -_::: Cont;'minatkin ~ Oririking·Water

Pests -- -::::_::::. - -.. // Insects ,.... Infections /

Man produces waste

If a municipality or medical authority genuinely lacks the means to treat wastes before disposal, the use

of a landfil l has to be regarded as an acceptable disposal route. Allowing health-care waste to

accumulate at hospita ls or elsewhere constitutes a far higher risk of the transmission of infection than

ca reful disposa l in a municipal landfill, even if the site is not designed t o the standard used in higher

income countries. The primary objections to landfill disposa l of hazardous health-care waste especia lly

untreated waste may be cultural or religious or based on a perceived risk of the release of pathogens to

air and wate r or on the r isk of access by scavengers.

There are two distinct types of waste disposa l to land -- open dumps and sanitary landfills.

• Open dumps are characterized by the uncontrolled and scattered deposit of wastes at a site; this leads to acute pollut ion problems, fires, higher risks of disease transmission, and open access to scavengers and animals. Healthcare waste should not be deposited on or around open dumps. The risk of either people or animals coming into contact w ith infectious pathogens is obvious, with the further risk of subsequent disease t ransmission, either directly th rough wounds, inhalation, or ingestion, or indirectly through the food chain or a pathogenic host species (see Fig. 1).

pg.59 10/24/17

• Sanitary landfi lls are designed to have at least four advantages over open dumps: geological isolation of wastes from the environment, appropriate engineering preparations before the site is ready to accept wastes, staff present on site to contro l operations, and organized deposit and daily coverage of waste. Some of the rules applicable to sanitary landfills are listed in Box 1. Disposing of certain types of health-care waste (infectious waste and small quantities of pharmaceutical waste) in san itary landfills is acceptable; sanitary landfill prevents contamination of soil and of surface water and groundwater, and limits air pollution, smells, and direct contact with the public.

Box 1. Some essential elements for design and operation of sanitary landfills

• Access to site and working areas possible for waste delivery and sits vehicles. • Presence of site personnel capable of effective contro l of daily operations. • Division of the site into manageable bases appropriate ly prepared before landfill starts. • Adequate sealing of the base and sides of the site to minimize the movement of wastewater

(leachate) off the site. • Adequate mechanisms for leachate collection and treatment systems if necessary. • Organized deposit of wastes in a small area, allowing them to be spread, compacted, and

covered daily.

• Surface water collection trenches around site boundaries. • Construction of a final cover to minimize rainwater infiltration when each phase of the landfill is

completed.

Upgrading from open dumping directly to sophisticated sanitary landfills may be technical ly and

financially difficult for many municipalities. It has often been found impossible to sustain such efforts

from the available local resources. However, this is no reason for municipal authorities to abandon the

move towards safer land disposal techniques, perhaps by a gradual approach, such as that outlined in

Box 2.

In the absence of sanitary landfills; any site from a controlled dump upwards could accept health-care

waste and avoid any measurable increase in infection risk. The minimal requirements would be the

following:

• an established system for rationa l and organized deposit of wastes which could be used to dispose of health-care wastes;

• some engineering work already completed to prepare the site to retain its wastes more effectively;

• rapid buria l of the hea lth-care waste, so that as much human or animal contact as possible is avoided.

It is further recommended that health-care waste be deposited in one of the two following ways:

• In a shallow hollow excavated in mature municipal waste in the layer below the base of the working face, and immediately covered by a 2-metre layer of fresh municipal waste. Scavenging in this part of the site must be prevented. The same method is often used for hazardous solid

pg.60 10/24/17

industrial wastes; it is specifica lly intended to prevent animals and scavengers from reexcavating the deposited healthcare waste.

• In a deeper (1-2m) pit excavated in mature municipal waste (i.e. waste covered at least 3 months previously). The pit is then backfilled with the mature municipal waste that was removed. Scavenging in this part of the site must be prevented.

Alternatively, a special small burial pit cou ld be prepared to receive health-care waste only. The pit

shou ld be 2m deep and filled to a depth of 1-1.Sm. After each waste load, the waste shou ld be covered

with a soil layer 10-IScm deep. If coverage with soi l is not possible, lime may be deposited over the

waste. In case of outbreak of an especially virulent infection (such as Ebola virus), both lime and soil

cover may be added. Access to this dedicated disposal area should be restricted, and the use of a pit

would make supervision by landfill staff easier and thus prevent scavenging. A typical example of pit

design for health-care waste is shown in Fig. 2.

Box 2. Proposed pathway for gradual upgrading of landfills1

1. From open dumping to "controlled dumping". This involves reduct ion of the working area of t he site to a more manageable size (2ha for a medium-size town), covering unneeded areas of the site with soil, extinguishing fires, and agreeing rules of on-site working with scavengers if they cannot be excluded completely.

2. From controlled dumping to "engineered landfill". This involves the gradual adoption of engineering techniques to prevent surface water from entering the waste, extract and spread so ils to cover wastes, gather wastewater (leachate) into lagoons, spread and compact waste into thinner layers, prepare new pans of the landfill with excavation equipment, and isolate the waste from the surrounding geology (e.g. w ith plastic sheeting under the waste).

3. From engineered landfill to "sanitary landfill". This involves the continuing refinement with increasing design and construction complexity, of the engineering techniques begun for engineered landfill. In addition, there shou ld be landfill gas cont rol measures, environmental monitoring points and bore holes (for monitoring air and groundwater quality), a highly organized and well-tra ined work fo rce, detailed record-keeping by the site office, and, in some circumstances, on-site treatment of leachate.

1 Adapted from Rushbrook & Pugh(1997).

Before health-care wastes are sent for disposal, it is prudent to inspect Landfi ll sites to ensure that there

is sensible control of waste deposition.

Figure 2. Example of a small burial pit for health-care waste

pg. 61 10/24/ 17

_..-Security fence around the pit

When the contents reacn 50 cm or the surface

the hole is filled in with soil

Encapsulation

Sheet of wire mesh embedded

.......... / · in top fil l .. .. .. .. ' ..... .. . .. I ..... . --..- .. -.... ________ _

Earth mound to l<eep surtace water out of the pit

1 0 cm layer of soil

Disposal of health-care waste in municipal landfil ls is less advisable if it is untreated than if it is

pretreated. One option for pretreatment is encapsulation, which involves filling containers with waste,

adding an immobilizing material, and sealing the containers. The process uses either cubic boxes made

of high-density po lyethylene or metallic drums, wh ich are three-quarters filled with sharps and chemical

or pharmaceutical residues. The containers or boxes are then filled up with a medium such as plast ic

foam, bituminous sand, cement mortar, or clay material. After the medium has dried, the containers

are sealed and disposed of in landfi ll sites.

This process is relatively cheap, safe, and particularly appropriate for establishments that practice

minimal programs for the disposal of sharps and chemical or pharmaceutical residues. Encapsulation

alone is not recommended for non-sharp infectious waste, but may be used in combination with burning

of such waste. The main advantage of the process is that it is ve ry effective in reducing t he risk of

scavengers gaining access to the hazardous health-care waste.

Safe burial on hospital premises

In health-care establishments that use minimal programs for hea lthcare waste management, particularly

in remote locations, in temporary refugee encampments, or in areas experiencing exceptional hardship,

the safe burial of waste on hospital premises may be the on ly viable option available at the time.

However, certain basic rules should still be established by the hospital management:

• Access to the disposal site should be restricted to authorized personnel on ly. • The burial site should be lined with a material of low permeability, such as clay, if ava ilable. to

prevent pollution of any sha llow groundwater that may subsequently reach nearby wells. • Only hazardous health-care waste should be buried. If general hospital waste were also buried

on the premises, available space would be quickly filled up.

pg. 62 10/24/17

• Large quantities (>1 kg) of chemical wastes should not be buried at one time. Burying smaller quantities avoids serious problems of environmental pollution.

• The burial site should he managed as a landfill, with each layer of waste being covered with a layer of earth to prevent odors, as well as to prevent rodents and insects proliferat ing.

The safety of waste burial depends critically on rational operational practices. The design and use of the

burial pit are described in the previous section and illustrated in Fig. 2. The bottom of the pit should be

at least 1.5 meters higher than the groundwater level.

Land disposal of residues

After disinfection or incineration, infectious health-care waste becomes non-risk waste and may be

finally disposed of in landfill sites. However, certain types of health-care waste, such as anatomical

waste, will still have an offensive visual impact after disinfection, and this is culturally unacceptable in

many countries. Such wastes should therefore be made unrecognizable before disposal, for example by

incineration. If this is not possible, these wastes should be placed in containers before disposal.

lnertization

The process of "inertization" involves mixing waste with cement and other substances before d isposal in

order to minimize the risk of toxic substances conta ined in the waste migrating into surface water or

groundwater. It is especially suitable, for pharmaceutica ls and for incineration ashes with a high metal

content (in this case the process is also ca lled "stabilization").

For the inertization of pharmaceutica l waste, the packaging should be removed, the pharmaceuticals

ground, and a mixture of wate r, lime, and cement added. A homogeneous mass is formed and cubes

(e.g. of 1m3) or pellets are produced on site and then can be transported to a suitable storage site.

Alternatively, the homogeneous mixture can be transported in liquid state to a landfi ll and poured into

municipa l waste.

The following are typical proportions for the mixture:

65% pharmaceutical waste

15% lime

15% cement

5% water

The process is reasonably inexpensive and can be performed using relatively unsophisticated

equipment. Other than personnel, the main requirements are a grinder or road ro ller to crush t he

pharmaceuticals a concrete mixer, and supplies of cement, lime, and water.

pg. 63 10/24/ 17

The main advantages and disadvantages of the various treatment and disposal options addressed in this

handbook are outlined in Table 1.

Table 1. Summary of main advantages and disadvantages of treatment and disposal options.

Treatment/ Advantages Disadvantages

disposal

method

Rotary kiln • Adequate for all infectious waste, • High investment and operating costs. most chemical waste and pharmaceutical waste.

Pyrolylic • Very high disinfection efficiency. • Relatively high investment and

• Adequate for all infectious waste operating costs. incineration

and most pharmaceutical and chemical waste.

Single-ch amber • Good disinfection efficiency • Significant emissions of atmospheric incineration • Drastic reduction of weight and pollutants.

volume of waste. • Need for periodic removal of slag and

• The residues may be disposed of in soot .

landfills. No need for highly • Inefficiency in destroying thermally trained operators. resistant chemicals and drugs such as

• Relatively low investment and cytotoxins. operating costs.

Drum or brick • Drastic reduction of weight and • Destroys only 99% of microorganisms . incineration volume of waste. • No destruction of many chemicals and

• Very low investment and pharmaceuticals . operating costs. • Massive emission of black smoke, fly

ash, toxic flue gas, and odors. Chemical • Highly efficient disinfection under • Requires highly qualified technicians disinfection* good operating conditions. for operation of the process.

• Some chemical disinfectants are • Uses hazardous substances that relatively inexpensive. require comprehensive safety

• Drastic reduction on waste volume measures .

• Inadequate for pharmaceutica l, chemical and some types of infectious waste.

pg. 64 10/24/ 17

Table 1 continued.

Treatment/ Advantages Disadvantages

disposal

method

Wet thermal • Environmentally sound • Shredders are subject to frequent

treatment* • Drastic reduction in waste volume . breakdowns and poor functioning.

• Operation requires qualified technicians.

• Inadequate for anatomical, pharmaceutical, and chemica l waste and waste that is not readily stream-permeable.

Microwave • Good disinfection efficiency under • Relatively high investment and

irradiation appropriate operating conditions. operating costs

• Drastic reduction in waste volume. • Potential operation and maintenance

• Environmentally sound problems.

Encapsulation • Simple, low-cost, and safe • Not recommended for non-sharp

• May also be applied to infectious waste.

pharmaceuticals. Safe burying • Low costs . • Safe on ly if access to site is limited and

• Relatively safe if access to site is certa in precautions are taken.

restricted and where natural infiltration is limited.

lnertization • Relatively inexpensive. • Not applicable to infectious waste .

* May not app ly to more sophisticated, self-contained, commercial methods.

It should be kept in mind that safe on-site burial is practicable only for relatively limited periods, say 1-2

years, and for relatively small quantities of waste, say up to 5 or 10 tonnes in total. Where these

conditions are exceeded, a longer-term so lution, probably involving disposa l at a municipal so lid waste

landfill, will need to be found .

pg. 65 10/24/ 17

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