For General Healthcare Settings in West Africa: Safely Cleaning and Disinfecting Areas Used by Patients Under Investigation (PUIs) or Patients with Confirmed Ebola Virus Disease (EVD)

Key Points

• Regular cleaning and disinfection of the healthcare facility and proper management of waste generated during patient care are important components of infection control and prevention for any disease, and can prevent new infections among healthcare staff and other patients.
• Areas with patients with EVD and the waste generated by taking care of patients with EVD may be sources of infection. Patient areas should be appropriately cleaned and disinfected, and waste should be disposed of properly.
• Cleaning can be a high-risk activity; any person conducting any cleaning and disinfection of any area potentially contaminated by Ebola MUST follow recommended guidelines and wear recommended personal protective equipment (PPE) for cleaners.

Environmental Cleaning, Disinfection, and Waste Management

The areas used by patients with EVD in a healthcare setting and the waste generated by taking care of patients with EVD are potential sources of infection. Areas used by patients with EVD can contain spilled body fluids, as well as general medical waste such as needles and soiled sheets. Proper cleaning and disinfection of these areas, along with proper management of this waste, can prevent new infections among healthcare staff and other patients.

EVD is most often transmitted through direct contact with the blood or body fluids (blood, vomit, feces, urine, saliva, semen) of a person with EVD, or through exposure to objects (such as needles) that have been contaminated with infected blood or body fluids. The role of the environment in Ebola transmission has not been well established, but limited laboratory studies indicate that under favorable conditions Ebola virus can remain alive on solid surfaces, and concentrations of the living virus decline over several days.^{1, 2}

Although the risk of infection from exposure to areas used by patients with EVD and to the waste generated by taking care of patients with EVD is small, these areas and waste may be sources of infection. Because of this, they need proper cleaning, disinfection, and disposal. Cleaning involves removing all visible dirt and debris from a surface or object. Disinfection involves cleaning using strong (0.5%) chlorine solution.

Regular cleaning and disinfection of the healthcare facility and proper management of waste generated by taking care of patients are important components of infection control and prevention for any disease.

Materials Needed for Cleaning, Disinfecting, and Managing Waste

• Soap
• Water
• Strong (0.5%) chlorine solution
• Spray bottles
• Pour bottles
• Disposable towels
• Garbage bags
• Rubbish bin
• Buckets to collect toilet waste
• PPE

General Guidelines for Cleaning

The first principle of environmental cleaning, disinfection, and waste management is safety. Staff involved in cleaning activities may be exposed to Ebola from both human and hospital wastes. Cleaning is a high-risk activity and must be done carefully. Splashes while cleaning and improper waste disposal can further spread infection. Therefore, a limited number of staff should be dedicated to cleaning and disinfecting the facility. Any person – whether ancillary staff or healthcare workers – conducting any cleaning and disinfection of any area potentially contaminated by EVD MUST follow recommended guidelines and wear recommended PPE for cleaners.

Before cleaning, know these general precautions:

PPE

• Before cleaning, ALWAYS put on Cleaners’ PPE, which consists of the following items:
  • Rubber boots
  • Impermeable gown
  • Face mask
  • Face shield or goggles
  • Two pairs of gloves [outer pair being reusable rubber gloves]
  • Apron
• PPE must be put on, worn, and removed correctly every time it is used. See CDC’s guidance on PPE.
• Practice good hand hygiene at all times.

Hand Hygiene

• Gloves should always be worn while cleaning.
• Perform hand hygiene each time you touch something potentially contaminated with infectious material, such as blood, vomit, feces, urine, saliva, or semen.
  • Gloved hands should be disinfected with strong (0.5%) chlorine solution.
  • Bare hands should be washed with soap and water. Mild (0.05%) chlorine solution or alcohol-based hand sanitizer can also be used.
• Perform hand hygiene after every activity, whether it is washing a patient, giving the patient food or medicine, or preparing a body for burial.

Cleaning and Storage

• Make sure that all sharps, vials, and ampoules have been disposed of in a sharps container.
• Make sure buckets, cleaning, and medical materials are stored in their proper places.
• Do not leave items lying on the floor.

Other Cleaning Guidelines

• Always clean patient care areas in a systematic fashion: dirtiest areas should be cleaned first, followed by more clean areas.
• Always use wet towels when cleaning the floor in patient care areas.
  • Do not dry sweep. Sweeping can cause infectious droplets to go into the air.
• Always use disposable towels and mops to clean.
• Always pour chlorine onto disposable towels. Never dip disposable towels into a bucket of chlorine; dipping a dirty towel into a clean chlorine solution will make the solution less effective.

Important Reminders

• Cleaning (removing all visible dirt and debris from a surface or object) must always come before disinfection (cleaning using strong [0.5%] chlorine solution). Disinfection is less effective when dirt and body fluids are present.
• A set of cleaning equipment must be dedicated for use only in the isolation area.
  • Once cleaning equipment enters the isolation area, it should be removed only for its disposal.
• Review and practice putting on and removing PPE before using it during cleaning. See CDC’s guidance on PPE.

Daily Cleaning Staff Duties

• Mix all cleaning solutions, including chlorine solutions, daily. Solution remaining at the end of the day should be discarded. (See CDC’s instructions on how to make cleaning solutions.)
• Clean and disinfect reusable medical equipment after each patient. Such items include nondisposable thermometers, stethoscopes, blood pressure cuffs, and tourniquets.
• Clean and disinfect nondisposable PPE components at the end of each day. Such items include boots and goggles.
• Clean and disinfect surfaces at least twice daily. Typical surfaces include tables, chairs, and bedrails.
• Clean and disinfect latrines at least twice daily.
• Dispose of medical waste properly. Sharps containers should be collected and disposed of in accordance with the facility waste management policy when they become three-quarters (3/4 or 75%) full.
• Soiled laundry should be handled as if it is infectious, and should be burned.

References

1. Sagripanti JL, Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces. Arch Virol 2010; 155:2035-2039.
2. Sagripanti JL, Lytle DC. Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Arch Virol 2011; 156:489–494.