1. Infectious Materials Transportation
Today, we’re going to talk about safe transportation of infectious materials. The Department of Transportation says that most incidents involving hazardous substances like infectious materials are the result of human error. This means that most incidents can be prevented if you know proper safety procedures and follow the requirements of the infectious materials transportation regulations. The more you know about infectious materials transportation, the safer you’ll be personally and the safer the shipments you’re involved with will be as well.

2. Session Objectives
Understand infectious materials transportation regulations
Know which materials are regulated
Follow proper working and packaging procedures
Handle infectious materials safely
Know how to report incidents
Take proper security precautions
The main objective of this session is to help you understand the requirements of the infectious materials transportation regulations and the ways you can help prevent transportation incidents involving these hazardous materials. By the time this session is over, you should be able to:
Understand the basic requirements of the infectious materials transportation regulations;
Know which materials are regulated;
Follow proper procedures for packing and marking packages of infectious materials;
Handle infectious materials safely;
Know how to report incidents involving infectious materials; and
Take proper security precautions to protect shipments.

3. Infectious Materials Transportation Regulations
Hazardous Materials Regulations (HMR)
Regulated hazardous materials
Hazardous materials classifications
Regulated infectious materials (Division 6.2)
HMR recently revised
The U.S. Department of Transportation—DOT—regulates the transportation of hazardous materials throughout the country. The regulations are known as the Hazardous Materials Regulations, or HMR. The HMR can be found in the Code of Federal Regulations at 49 CFR Parts
The HMR applies to any material DOT determines is capable of posing an unreasonable risk to health, safety, or property when transported by air, highway, rail, or water anywhere in the United States.
The HMR has divided all regulated hazardous materials into nine classes. Classes include such substances as flammable liquids, radioactive materials, explosives, and gases. Also included in Class 6 are toxic and infectious materials.
Infectious materials are specifically classified as Division 6.2 hazardous materials. Infectious materials are defined as any material known to contain or suspected of containing a pathogen that causes disease in humans or animals—for example, bacteria, viruses, fungi, and parasites.
In recent years the HMR has been revised to make the U.S. infectious materials transportation regulations consistent with international standards. DOT says that the regulations now ensure an acceptable level of safety for the transportation of infectious materials worldwide.

4. Categories of Infectious Materials
Category A
Category B
The HMR establishes a two-tiered system for classification of infectious materials. Category A includes infectious materials capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals.
Category A materials pose the highest degree of risk of infection. Examples of Category A infectious materials include Ebola virus, HIV cultures, avian flu virus cultures, and Hantavirus. Cultures of diseases that affect animals such as foot and mouth disease and swine fever are also classified as Category A infectious materials.
Category B includes infectious materials that generally aren’t capable of causing permanent disability or life-threatening or fatal disease in humans or animals. This category includes infectious substances transported for diagnostic or investigational purposes.
Think about the infectious materials you have to deal with on the job. What category are they? What is the degree of risk when handling them?
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5. Types of Regulated Infectious Materials
Biological products
Cultures
Patient specimens
The following materials may be regulated under the HMR if pathogens are present—or may be present—and they pose a risk to humans or animals.
Biological products include products used in the prevention, treatment, or cure of human or animal diseases. Among regulated biological products are viruses, therapeutic serums, toxins, antitoxins, vaccines, blood, blood components or derivatives, and allergenic products.
Cultures are defined under the HMR as infectious materials containing a pathogen that has been intentionally created in a laboratory.
Patient specimens include any human or animal materials collected and transported for research, diagnosis, or investigational purposes—or for the prevention or treatment of disease. Patient specimens that may be regulated include those which are known or believed to be infected. Regulated specimens might include such items as blood, tissues, and tissue swabs, and samples of human or animal secretions or excretions, such as potentially infected urine or feces.

6. Types of Regulated Infectious Materials (cont.)
Regulated medical wastes
Sharps
Used healthcare products
Regulated medical wastes are identified as waste or reusable material derived from the medical treatment of animals or humans—which includes diagnosis and immunization—or from biomedical research, which includes the production and testing of biological products.
Sharps means any object contaminated with a pathogen or that may become contaminated with a pathogen through handling or during transportation and also capable of cutting or penetrating skin or a packaging material. Sharps include needles, syringes, scalpels, broken glass, culture slides, culture dishes, broken capillary tubes, broken rigid plastic, and exposed ends of dental wires.
Used healthcare products include medical, diagnostic, or research devices or equipment. Also included are personal care products used by consumers, medical professionals, or pharmaceutical providers that don’t meet the definition of a patient specimen, biological product, or regulated medical waste, but are contaminated with potentially infectious body fluids or materials.
Think about the materials you deal with on the job. Do they include any of these types of regulated materials?

7. Exceptions Patient specimens with low likelihood of pathogens
Substances without infectious materials
Materials with neutralized pathogens
Dried blood spots or blood for transfusions
Tissues or organs for transplantation
Low-risk environmental samples
Not all biological materials are regulated under HMR, however. The regulations recognize any number of exceptions. For example:
Patient specimens for which there is a minimal likelihood that pathogens are present;
Substances that don’t contain infectious materials or substances that are unlikely to cause disease in humans or animals;
Materials in which any pathogens have been neutralized or inactivated so that they are no longer a health risk;
Dried blood spots collected by applying a drop of blood onto absorbent material, or blood or blood components that have been collected for transfusions;
Tissues or organs intended for transplantation; and
Environmental samples—including food and water samples—that are not considered to pose a significant risk of infection.
Can you think of any biological materials that you handle that would be considered exceptions to HMR requirements?

8. Packing Requirements Use triple packaging
Individually wrap multiple primary items
Use absorbent material for liquid infectious substances
Enclose itemized list of contents
Triple packaging is required for Category A infectious materials. Packaging must consist of the following components:
Watertight primary receptacle;
Watertight secondary packaging; and
Rigid outer packaging of adequate strength for its capacity, mass, and intended use.
If multiple fragile primary receptacles are placed in a single secondary packaging, they must be either wrapped individually or separated to prevent contact between them.
For a liquid infectious substance, an absorbent material must be placed between the primary receptacle, or receptacles, and the secondary packaging. The absorbent material must be sufficient to absorb the entire contents of all primary receptacles in the package.
An itemized list of contents must be enclosed between the secondary packaging and the outer packaging.
Image coutesy of All-Pak

9. Packing Requirements (cont.)
For materials shipped:
At normal temperature
Refrigerated or frozen
In liquid nitrogen
Image coutesy of All-Pak
For infectious materials shipped at regular air temperature, the primary receptacle must be glass, metal, or plastic and have a leakproof seal.
For infectious substances shipped refrigerated or frozen, the ice, dry ice, or other refrigerant must be placed around the secondary packaging or in an overpack. Interior supports must be provided to secure the secondary packaging in the original position after the ice or dry ice has melted. If ice is used, the outer packaging or overpack must be leakproof. If dry ice is used, the outer packaging or overpack must permit the release of carbon dioxide gas.
Infectious substances shipped in liquid nitrogen must be packed in metal vacuum insulated vessels or flasks vented to the atmosphere to prevent any increase in pressure within the packaging. The use of safety relief valves, check valves, frangible discs, or similar devices in the vent lines is prohibited. Fill and discharge openings must be protected against the entry of foreign materials that might cause an increase in the internal pressure.
Think about the packing requirements for Category A infectious materials. Do you always follow the HMR requirements exactly?
Image courtesy of All-Pak

10. Packing Requirements Use triple packaging Protect primary receptacles
Secure secondary packaging
Prevent release of infectious materials
Fill and close according to manufacturer’s instructions
Triple packaging consisting of a primary receptacle, a secondary packaging, and a rigid outer packaging must also be used for Category B infectious materials.
Primary receptacles must be packed in secondary packaging in such a way that under normal conditions of transport they cannot break, be punctured, or leak into the secondary packaging.
Secondary packaging must be secured in rigid outer packaging with suitable cushioning material such that any leakage of the contents will not impair the protective properties of the cushioning material or the outer packaging.
The completed package must be designed, constructed, maintained, filled, and closed so that under conditions normally encountered in transportation, including removal from a pallet or overpack for subsequent handling, there will be no release of infectious materials into the environment.
Packages of Class B infectious materials must be filled and closed in accordance with the information provided by the packaging manufacturer or distributor.

11. Packing Requirements (cont.)
Must be leakproof
Use absorbent material
Air shipment must withstand pressure changes
Image coutesy of All-Pak
Liquid Category B infectious materials must be packed to conform to the following provisions:
Primary receptacle and secondary packaging must be leakproof.
Absorbent material must be placed between the primary receptacle and secondary packaging. If several fragile primary receptacles are placed in a single secondary packaging, they must be either individually wrapped or separated to prevent contact between them. The absorbent material must be of sufficient quantity to absorb the entire contents of the primary receptacles and not compromise the integrity of the cushioning material or the outer packaging.
For shipments by aircraft, packaging must be capable of withstanding changes in air pressure, and quantities shipped are limited.
Image coutesy of All-Pak

12. Packing Requirements (cont.)
Must be siftproof
Individually wrap fragile primary receptacles
Pack liquids as Category B material
Solid Category B infectious materials must be packed according to the following provisions:
The primary receptacle must be siftproof.
If several fragile primary receptacles are placed in a single secondary packaging, they must be either individually wrapped or separated to prevent contact between them.
If there is any liquid present in the primary receptacle during transportation, then the material must be packed in accordance with requirements for liquid Category B materials. A solid material that may become liquid during transportation must also be packed as a liquid Category B material.
Think about the packing requirements for Category B infectious materials. Do you always follow the HMR requirements exactly?
Image courtesy of Exakt-pak

13. Marking and Labeling Requirements: General
Durable
In English
Sharply contrasting background color
Unobscured by other labels
Located away from other markings
Generally speaking, markings required on packages containing infectious materials must be:
Durable and printed on or affixed to the surface of a package or printed on a label, tag, or sign;
In English;
Displayed on a background of sharply contrasting color;
Unobscured by other labels or attachments; and
Located away from any other markings—such as advertising—that could substantially reduce the effectiveness of the markings related to the infectious materials contained in the package.
Think about these marking requirements and why they are important in preventing accidents involving packages of infectious materials.

14. Marking and Labeling Requirements: General
The following markings should be placed on packages containing Category A infectious materials:
Class 6 infectious substance hazard label; including the words “Infectious substance, affecting humans UN2814” or “Infectious substance, affecting animals UN2900”; 
Proper shipping name and United Nations—UN—ID number;
The name and phone number of the person responsible for handling emergency calls while the material is in transport; and
UN package certification mark.
Think about the specific marking and labeling requirements for packages of Category A infectious substances. Do you know all the information that must be included and how it should be marked on the package?

15. Marking and Labeling Requirements
The following markings should be placed on packages containing Category B infectious materials:
Class 6 infectious substance hazard label; including the words “Biological substance, Category B”;
Proper shipping name and UN ID number;
Name and phone number of person responsible in case of emergency during transport; and
When either Category A or B packages are placed in an overpack, the required package markings must be either clearly visible or reproduced on the outside of the overpack.
Think about the specific marking and labeling requirements for packages of Category B infectious substances. Do you know all the information that must be included and how it should be marked on the package?

16. Shipping Papers Shipping name Hazard class/division ID number
Emergency response phone number
Quantity by weight or volume
Shipper’s certification
The shipping papers that accompany shipments of infectious materials must include all the information necessary to identify the material being shipped and the hazards. Shipping papers must show the following basic information:
Proper shipping name of the infectious material;
Hazard class/division—which for infectious materials is Class 6, Division 6.2;
Material ID number—which for infectious materials is a designation beginning with the letters “UN,” followed by four numbers;
An emergency response phone number;
Total quantity by weight or volume of materials; and
The shipper’s certification stating that the shipment is properly packaged, marked, labeled, and classified.
Are you familiar with all the information that must be included in shipping papers that accompany shipments of infectious materials?

17. HMR Requirements: Q& A Q. A. Q. A. Q. A.
What hazard class/division designates infectious materials?
Division 6.2
What are the two categories of infectious wastes, and which is most hazardous?
Category A and B; Category A is most hazardous
What is the basic packing requirement for both categories of infectious materials?
Triple packaging A. Q. A.
Let’s see how much you remember about some of the information we’ve just covered. Read each question and decide the correct answer.
What hazard class/division designates infectious materials?
What are the two categories of infectious wastes, and which is most hazardous?
What is the basic packing requirement for both categories of infectious materials?
How did you do? Did you get all the answers right? Q. A.

18. HMR Requirements Do you understand: Basic HMR requirements?
Which materials are regulated?
Packing requirements?
Marking and labeling requirements?
Information required on shipping papers?
Now it’s time to ask yourself if you understand the information presented in the previous slides. For example, do you understand what we’ve discussed about:
Basic HMR requirements?
Which materials are regulated?
Packing requirements?
Marking and labeling requirements?
Information required on shipping papers?
Understanding all this information will help you perform your job and help us comply with the requirements of the infectious material transportation regulations.
Let’s continue to the next slide now and talk about safe handling of infectious materials.

19. Safe Handling: Packing
Wear appropriate PPE
Follow HMR packing requirements
Use approved packing materials
Know manufacturer’s specifications
Make sure packages are well-sealed
Mark and label packages correctly
Safe handling of infectious materials is essential to avoid contact with substances that could make you sick.
To prevent contact, always wear appropriate PPE when packing infectious materials. This may include eye protection, gloves, and protective clothing. In some cases, additional PPE may also be required.
Be sure to follow all HMR packing requirements.
Use approved packing materials.
Familiarize yourself with the packaging manufacturer’s specifications and don’t overfill packages.
Make sure packages are well-sealed.
And finally, ensure that they are correctly marked and labeled.
Think about the safety procedures you need to follow if you pack infectious materials for shipment.

20. Safe Handling: Loading and Unloading
Handle packages carefully
Stack and secure packages
Be careful using material handling equipment
Report any damaged packages
When loading or unloading shipments of infectious materials be sure to:
Handle packages carefully;
Stack and secure packages so that they can’t topple over;
Take care when using material handling equipment to avoid accidents that could damage packages and cause a release of infectious materials; and
Report any damaged packages right away.
Think about the safety procedures you need to follow if you load or unload shipments of infectious materials.

21. Incident Reporting Report major incidents Make telephone report when:
Someone killed or hospitalized
Public is evacuated
Major shutdown
Airplane flight pattern altered
Suspected contamination
Major incidents involving infectious materials must be reported as soon as possible—but no later than 12 hours—after the incident. These incidents must generally be reported by telephone to the National Response Center (NRC). Notice involving infectious materials, however, may also be given by phone to the director of the Centers for Disease Control and Prevention (CDC).
A telephone report is required whenever any of the following occurs during the course of transportation of an infectious material—including during loading, unloading, and temporary storage:
A person is killed or is hospitalized;
The general public is evacuated for one hour or more;
A major transportation artery or facility is closed or shut down for one hour or more;
The operation flight pattern or routine of an aircraft is altered; or
Suspected contamination occurs involving an infectious substance other than a diagnostic specimen or regulated medical waste.

22. Incident Reporting (cont.)
Name and phone number of reporting person
Name and address of employer
Date, time, and location
Extent of injuries
Shipping information
Type and nature
Each notice must include the following information:
Name and phone number of the person reporting incident;
Name and address of employer;
Date, time, and location of incident;
The extent of injuries, if any;
Division, proper shipping name, and quantity of infectious materials involved; and
Type of incident, nature of infectious materials involvement, and whether a continuing danger to life exists at the scene.
Do you know the proper procedure for reporting an infectious materials transportation incident?

23. Security Precautions Be familiar with procedures
Don’t talk to outsiders about shipments
Follow procedures as trained
Stay alert to risks
The HMR includes sections that detail security rules for transporters of hazardous materials. Although security is generally more of an issue with large volumes of highly hazardous chemicals, the transportation of extremely hazardous Category A infectious materials also raises security concerns. The following security precautions should be taken to protect shipments:
Be familiar with the facility’s security plan and procedures.
Don’t talk to outsiders about shipments, facilities, or any other security-related information.
Follow all security procedures exactly as you have been trained to do.
Stay alert to security risks, pay attention to details, and never let down your guard.
© BLR®—Business & Legal Resources 1501

24. Security Precautions (cont.)
Keep up to date on risks and precautions
Report suspicious activities or individuals
Verify paperwork
Verify identity of carriers and drivers
You should also:
Keep up to date on new information about security risks or precautions.
Report suspicious activities or individuals.
Verify all paperwork and require that pickups and deliveries be handled only by appointment with known transporters.
Verify the identity of carriers and drivers before loading infectious materials.
Are you familiar with the organization’s security plan for transportation of hazardous materials? You should be.
© BLR®—Business & Legal Resources 1501

25. Safe Work Practices: True or False?
Try to squeeze as much into each package as possible.
Report any damaged packages right away.
Only report infectious materials incidents that occur when materials are in transport.
You don’t need to know about the organization’s security plan or procedures unless you’re in security.
Now let’s try a quick true/false quiz to test your knowledge of the information presented in the previous slides. Let’s begin.
Try to squeeze as much into each infectious materials package as possible. True or false? packing.
Report any damaged packages right away. True or false?
Only report infectious materials incidents that occur when materials are in transport. True or false?
You don’t need to know about the organization’s security plan or procedures unless you work in security. True or false?
How did you do? Did you get all the answers right?

26. Safe Work Practices Do you understand: Safe packing procedures?
Loading and unloading precautions?
Incident reporting requirements?
Security precautions?
Do you understand the information presented in the previous slides? Do you understand what we’ve said about:
Safe packing procedures?
Loading and unloading precautions?
Incident reporting requirements?
Security precautions?
It’s important for you to understand all this information so that you can assist in the safe transportation of infectious materials.
Now let’s conclude the session with some key points to remember.

27. Key Points to Remember
Transportation of infectious materials may involve significant risks.
You must understand and follow regulations for handling shipments safely.
You also need to know how to perform your specific job duties safely to avoid incidents.
Your safety and the safety of others depends on your knowledge and good judgment when handling infectious materials.
Here are the main points to remember from this session on infectious materials transportation:
Transportation of infectious materials may involve significant risks.
You must understand and follow the regulations for handling shipments safely.
You also need to know how to perform your specific job duties safely to avoid incidents.
Your safety and the safety of others depends on your knowledge and good judgment when handling infectious materials.
This concludes the Infectious Materials Transportation training session.