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Interim Guidance for Ebola Virus Cleaning, Disinfection, and Waste Disposal in Commercial Passenger Aircraft

This guidance addresses the rare event of a traveler having symptoms consistent with Ebola being present on a commercial passenger aircraft and later being confirmed to have Ebola. A traveler exhibiting symptoms consistent with late-stage Ebola on a commercial passenger aircraft is more likely to have a different sickness than Ebola.

What flights this applies to: This guidance applies to commercial passenger flights arriving in the United States and all domestic flights within the United States.

Who this is for: Airlines and airline employers with personnel working on passenger aircraft that may transport a sick traveler with symptoms consistent with Ebola on a flight; also airlines and contract companies whose staff may clean, disinfect, and remove contaminated waste from an aircraft with a traveler who, after the flight was completed, was tested and lab-confirmed to have Ebola.

How to use: Use these recommendations 1) to develop a protocol for handling a traveler exhibiting symptoms consistent with Ebola while in flight, 2) to guide personnel in cleaning and disinfecting the aircraft after a flight, and 3) as a reference for effective disinfectant products and relevant employee federal regulations. This guidance does not relieve any person of the obligation to comply with all applicable FAA regulations.

Related guidance: CDC’s Preventing Spread of Disease on Commercial Aircraft: Guidance for Cabin Crew details general infection control precautions and management of a sick traveler in-flight. This guidance provides additional guidance on cleaning, disinfection, and waste disposal procedures.

Assessment of Travelers

  • Airlines should ensure that their personnel are trained to carefully observe travelers and question them regarding exposures and symptoms.
  • Has the passenger had exposure to Ebola, i.e., lived in or traveled to a country (not including the transit through an airport) where widespread transmission of Ebola is occurring, had contact with an individual with lab-confirmed Ebola, or been identified by public health authorities as having contact with a patient with confirmed Ebola?
  • Does the passenger have symptoms consistent with Ebola (fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding)?
  • If the passenger answers YES to both the exposure and symptom questions, the airline should immediately follow CDC’s Airline Guidance for Reporting Death/ Illness. If the sick traveler answers NO, the airline should follow routine procedures.

Key Points

  • Airlines should review their emergency operations protocols to ensure they clearly reflect the lines of communication between the aircraft and airline dispatch, as well as between the airline and air traffic control, the destination and departure airports, and public health and/or other assigned authorities, in the event a traveler begins to have symptoms consistent with Ebola during a flight.
  • Airlines should also ensure that all relevant personnel are familiar with the procedures applicable in the event that a sick traveler with symptoms consistent with Ebola is identified on board a flight, either during or after the flight.

Routine practices regardless of the presence of a sick traveler

  • Airlines should remind airline personnel to follow careful hygiene practices and infection control procedures, such as washing hands regularly with soap and water or an alcohol-based hand sanitizer with at least 60% alcohol.
  • Airlines should direct the airline personnel and/or designated cleaning crew to clean the passenger aircraft using detergent and/or airline-specified disinfectant and/or refer to the “Guide to Hygiene and Sanitation in Aviation” developed by the World Health Organization (WHO) [PDF – 71 pages]. Any cleaner and disinfectant should not adversely affect the aircraft.
  • Per federal regulations, reporting death or illness is required. Reporting tools for airlines, cabin crew, and pilots are available in the Airline Guidance for Reporting Death/Illness.

Lavatory wastes: Airlines should share the CDC’s Interim Guidance for Managers and Workers Handling Untreated Sewage from Individuals with Ebola in the United States and Frequently Asked Questions for Managers and Workers Handling Untreated Sewage from Suspected or Confirmed Individuals with Ebola in the U.S. Personnel should routinely handle lavatory wastes using proper personal protective equipment (PPE) and hygiene practices for all flights, regardless of the presence of a passenger with symptoms consistent with Ebola. In relation to fecal and urine wastes found in lavatory’s, there has been no evidence to date that Ebola can be transmitted via exposure to sewage (Weber and Rutala 2001 [PDF – 11 pages]).

While in flight

  • If the traveler is considered to have had exposure to Ebola and is exhibiting symptoms consistent with Ebola, yet has NO gastrointestinal (e.g., diarrhea, vomiting) or hemorrhagic symptoms (e.g., bleeding) while he or she was on the passenger aircraft, the traveler is not likely to have contaminated the cabin environment. The airline crew and/or designated cleaning crew should apply routine cleaning procedures for the passenger aircraft while following the recommendations in Preventing Spread of Disease on Commercial Aircraft: Guidance for Cabin Crew.
    • If possible, isolate the sick traveler by creating space between the sick traveler and the other travelers, or by moving the other travelers to open seats. This is an extra safety precaution in case the sick traveler begins to have “wet symptoms” of diarrhea, vomiting, and/or bleeding.
  • If the traveler is considered to have had exposure to Ebola and is exhibiting symptoms consistent with Ebola, has gastrointestinal or hemorrhagic symptoms, then aircraft personnel should isolate the ill traveler by creating space between the ill traveler and the other travelers, or by moving other travelers to open seats, if possible. Additionally, aircraft personnel should apply safety practices and infection control, and follow proper waste management procedures until the destination airport is reached (CDC Guidance for Cabin Crew).
    • Airlines should refer to CDC’s Guidance for Cabin Crew and the IATA Guidance for Suspected Communicable Disease [PDF – 3 pages] for management of an ill traveler if Ebola is suspected.
    • The airline ground personnel should contact local public health and/or assigned authorities for Ebola emergency response at the aircraft’s destination, following the CDC Airline Guidance for Reporting Death/ Illness. Airline personnel and travelers should not directly handle contaminated materials or touch any body fluids or soiled surfaces and materials. However, in the event the body fluids need to be contained, airline personnel should use the Universal Precaution Kit: (1) don (put on) the supplied PPE (e.g., gloves, apron, and face mask), (2) follow the manufacturer’s instructions and carefully apply the solidifier to the fluids, so as to not create splashes or droplets, (3) without touching the contaminated materials, apply absorbent material to cover the solidified materials, and (4) ensure that the contaminated area is isolated until the destination is reached. Airline personnel, using an assistant if needed, should then (1) carefully doff (remove) PPE to avoid contaminating his/herself or their clothes, (2) dispose of the PPE is the designated waste for biohazardous material (double-bagged), and (3) clean hands using soap and water (if visibly soiled) or alcohol sanitizer.
    • The airline, the airport operators, ground handling agents, and potentially the local public health and/or assigned authorities for Ebola emergency response, should have a coordinated plan describing actions needed for the traveler(s) and the passenger aircraft once at the destination (e.g., quarantine, Ebola lab test). This would be similar to recommendations in the “Guide to Hygiene and Sanitation in Aviation” developed by the World Health Organization (WHO) [PDF – 71 pages] regarding communicable diseases cleaning and disinfection of facilities (Chapter 3.1).

After the flight

  • The approach for cleaning and disinfecting the aircraft depends on the symptoms of the ill traveler with Ebola at the time they were on the passenger aircraft.
    1. For an ill traveler who had exposure to Ebola and symptoms consistent with Ebola but NO gastrointestinal or hemorrhagic symptoms, routine cleaning and laundering can be conducted by airline personnel or designated cleaning crew/environmental services employees because the traveler should not have contaminated the environment. To date, there is no documented evidence of Ebola virus or other hemorrhagic fever viruses (e.g., Marburg, Lassa, etc.) being transmitted on an aircraft.
    2. For an ill traveler who had exposure to Ebola and symptoms consistent with Ebola, including gastrointestinal or hemorrhagic symptoms, refer to the CDC Ebola Guidance for Airlines and specifically the guidance for airline cleaning personnel section, as well as the CDC Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft. Note that contaminated waste should be disposed of in a biohazard bag if available or a secured plastic bag labeled as biohazard.
    3. In the event a sick traveler, lab-confirmed for Ebola after the flight and had gastrointestinal or hemorrhagic symptoms while on the passenger aircraft, the aircraft should be taken out of service immediately. The aircraft should then be assessed by public health and/or assigned authorities or a contract company to determine the proper cleaning, disinfecting, and disposal procedures.
      • The public health authorities can assist in finding a qualified contract company to clean and disinfect the aircraft. Any contract company conducting such work must comply with its state’s Ebola policies and with OSHA standards for, among others that may apply, bloodborne pathogens (29 CFR 1910.1030), personal protective equipment (PPE) (29 CFR 1910.132), respiratory protection (29 CFR 1910.134), and hazard communication (29 CFR 1910.1200) (e.g., for chemical hazards). In states that operate their own occupational safety and health programs, different or additional requirements may exist. Only areas that were contaminated with diarrhea, vomit, blood, and/or other body fluids, will need to be cleaned and disinfected.
      • The contract company should use an Environmental Protection Agency (EPA)-registered hospital disinfectant (or professional product) with a label claim against a non-enveloped virus, such as norovirus, rotavirus, adenovirus, or poliovirus, according to manufacturer’s instructions. Currently, no EPA-registered disinfectant products will have a statement on the label that specifically says it can kill Ebola virus. However, any EPA-registered hospital disinfectant (or professional product) that is effective against a non-enveloped virus will also be effective against Ebola virus. One simple way to identify an appropriate product effective against Ebola virus is to use a product with a label claim against non-enveloped viruses, such as those included in EPA’s List L: Disinfectants for Use Against the Ebola Virus. As certain disinfectants may be incompatible with aircraft components, any disinfectant used on board an aircraft should be cleared as acceptable for the aircraft.

Recommendations for the contract company that cleans and disinfects the aircraft

Additional Airline Considerations

  • A U.S. Department of Transportation rule permits airlines to deny boarding to air travelers with serious contagious diseases that could spread during flight, including travelers with symptoms that could be Ebola. This rule applies to all flights of U.S. airlines and to direct flights (no change of aircraft) to or from the United States by foreign airlines. (See Department of Transportation Title 14 Code of Federal Regulations [PDF – 136 pages], Part 382)
  • The International Air Transport Association (IATA) [PDF – 3 pages] provides guidelines for the cabin crew to assess a traveler with suspected communicable disease.
  • The Federal Aviation Administration has investigated vaporized hydrogen peroxide technology as a potential biocide; this may be considered as an option for disinfection of a passenger aircraft (see FAA documents in the Resources section).

Definitions

Table 1. Interim guidance summary for cleaning, disinfecting, and waste disposal in commercial passenger aircraft where during the flight a traveler exhibited symptoms consistent with Ebola and was identified to have the appropriate exposures or lab-confirmed to have Ebola after the flight.

Category When used Disinfection and Disposal Training and PPE
Cleaning by airline- designated cleaning crew
  • Traveler who had exposure to Ebola and symptoms consistent with Ebola but NO gastrointestinal (e.g., diarrhea, vomiting) and/or no hemorrhagic (bleeding) symptoms
  • Airline designated cleaning crew can use routine cleaning and disinfection with detergent and/or disinfectant cleared for the aircraft
  • Airline designated cleaning crew can discard waste as normal
  • PPE as required by airline and disinfectant product manufacturer’s instructions
Cleaning by airline- designated cleaning crew, specifically following CDC guidelines
  • Traveler who had exposure to Ebola and symptoms consistent with Ebola including gastrointestinal (e.g., diarrhea, vomiting) and/or no hemorrhagic (bleeding) symptoms
  • PPE as required by airline and disinfectant product manufacturer’s instructions
Cleaning by contract company
  • Traveler with lab-confirmed Ebola who had diarrhea, vomiting, and/or unexplained bleeding
  • Contact local public health or assigned authorities
  • Contract company should conduct decontamination and disposal procedures
  • Contract company should follow OSHA, DOT, and State and Applicable Local regulations as described

Resources

illustration of colorful DNA strand behind the text - CDC uses next-generation sequencing to identify hemorrhagic fever viruses in bats

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