Cleaning and disinfection plans during an influenza outbreak
Cleaning and disinfection plans are an important facility consideration during an influenza outbreak.
The influenza virus can live as long as eight hours on some surfaces. Proper cleaning and disinfection are effective ways to minimize the spread of the virus through surface contact. Whether you have in-house janitorial staff or a contract cleaning service, it is important to have a comprehensive cleaning plan to help ensure all parties understand their responsibilities.
Planning is a critical component to a cleaning and disinfection program. To be effective, the plan should address four important components:
• Areas to be cleaned/disinfected
• Frequency of cleaning
• Cleaning/disinfection materials that will be used
• Material-specific cleaning procedures and techniques
Each cleaning/disinfection material has specific procedures for use that enhances its effectiveness. These materials specific procedures must be integrated into your routine cleaning and disinfection plan. Finally, the cleaning and disinfection plan should be clearly documented in writing and communicated to all interested parties.
Areas to be cleaned - Guidance from the U.S. Centers for Disease Control (CDC) indicates that routine cleaning will be appropriate for most areas. Certain high traffic areas such as the ones listed below may need additional cleaning (as often as several times daily):
• Door knobs
• Elevator buttons
• Light switches
• Faucet handles
• Publicly used telephones
• Computer monitors, mice and keyboards
• Counter tops and conference tables
• Cafeteria tables, coffee pots and vending equipment
Cleaning frequency - The use of regular cleaning and disinfection materials should be sufficient in most instances. The cleaning frequency for each area should be covered specifically in the plan and should match the significance of the cleaning and disinfection task. For example, the cleaning plan for a hospital emergency room would be different from that for an office or retail occupancy. For more frequent cleaning, you may also wish to provide disinfecting wipes for employees and have them available at high traffic areas such as conference rooms, shared workspaces and in the cafeteria. In office spaces such as desks and cubicles, disinfectant wipes and sprays may be used on surfaces.
Cleaning procedures - For personal safety, it is important that all janitorial staff or cleaning service providers receive training on all items in the plan, including the use of appropriate personal protective equipment (PPE) such as gloves and goggles per manufacturer's recommendations. This training should also include specific processes, requirements for each area cleaned and how they will address the increased cleaning needed during an influenza outbreak. Cleaning during a flu outbreak consists of normal cleaning procedures with the use of detergent cleaners and disinfection with products that are effective at disinfecting type A influenza virus. The following are cleaning guidance excerpted from the CDC document, Interim Guidance on Environmental Management of Pandemic Influenza Virus, as shown at: http://www.pandemicflu.gov/professional/hospital/influenzaguidance.html
Cleaning with soap or detergent in water is the first step in surface treatment. Cleaning will remove soil and organic matter that would otherwise reduce the effectiveness of the disinfection step that follows. There is no indication for cleaning procedures that differ from what is done routinely. Any commercially available soap or detergent can be used. Water can be cold or warm, or as recommended on the label of the cleaning product used (if a specific temperature is listed).
For cleaning of critical areas in regulated facilities such as in hospital and food processing facilities, inquire about the need for validation of cleaning protocols for effectiveness.
Cleaning chemicals and disinfectants - Influenza viruses can be inactivated by many low or intermediate level disinfectants containing any of thefollowing ingredients:
• Chlorine or hypochlorite compounds
• Quaternary ammonium compounds
• Peroxygen compounds
Use of disinfectants registered by the U.S. Environmental Protection Agency (EPA) is recommended whenever these are available. Lists of all registered disinfectants can be found at: http://www.epa.gov/oppad001/chemregindex.htm. Many, if not all, of these products indicate potency for several target pathogens on the label. There are approximately 400 registered disinfectants with human influenza A and/or B listed on the product label, and all will inactivate influenza viruses when used according to manufacturer instructions.
Contracted services - Service level agreements are important for both the facility owner-operator and the cleaning service. This helps avoid any potential misunderstanding and disputes about responsibilities and expectations for each party. An effective service level agreement should be in writing and should include as a minimum, the four key areas described earlier. They include areas to be cleaned/disinfected, frequency of cleaning, materials that will be used and material-specific cleaning procedures and techniques. Additional items should be added to address any specific situations as they apply to your location and contract. It is strongly advised that a competent legal counsel review the terms and conditions of a service level agreement.
In addition, it is important to confirm who will perform any special cleaning, such as if an individual becomes sick while at your facility, and communicate these special cleaning plans to appropriate personnel. In-house janitorial staff or outside cleaning contractors should also have contingency plans that include what they would do if an influenza outbreak affects their own workforce and operations.
Other considerations - The adherence to good personal hygiene, proper hand hygiene, respiratory hygiene, and cough etiquette is especially important for preventing the spread of influenza in the workplace and non-healthcare settings in the community. As part of influenza control strategy during early stages of a moderate or severe influenza outbreak, schools may dismiss classes, and businesses may consider implementing social distancing. Regular cleaning for non-healthcare settings focuses on most surfaces and targeted use of disinfection for surfaces touched frequently by hand:
• Keep housekeeping surfaces and countertops clean of visible soil by cleaning with detergents and water or proprietary cleaners, followed by rinsing with water. Repeated application of disinfectants to table and desktop surfaces is unnecessary. Frequent use of room air deodorizers to disinfect the air is not recommended.
• Follow label instructions carefully when using disinfectants and cleaners, noting any hazard advisories and indications for using personal protective items (such as household gloves). Do not mix disinfectants and cleaners unless the labels indicate it is safe to do so. Combining certain products (such as chlorine bleach and ammonia cleaners) can be harmful, resulting in serious injury or death.
• Clean and disinfect bathroom surfaces on a regular basis using EPA-registered detergent/disinfectants. Alternatively, clean surfaces first with detergent and water and then disinfect with an EPA-registered disinfectant in accordance with manufacturer instructions. (Note: Disinfectant products available in grocery stores or hardware stores are all EPA-registered.)
• If EPA-registered disinfectants are not available, CDC suggests using a dilute solution (1:100 volume/volume, approximately 600 parts per million [ppm]) of household chlorine bleach (sodium hypochlorite) to disinfect bathroom surfaces. To prepare this solution, add ¼ cup of bleach to a gallon of clean water, or 1 tablespoon of bleach to a quart of clean water. Apply to a cleaned surface, preferably with a cloth moistened with the bleach solution, and allow the surface to remain wet for minimally 3 – 5 minutes.
• Wipe frequently touched electronic items (e.g., remote controls, hand-held gaming devices) with hand sanitizer cloths.
Cleaning and disinfection plans are a critical part of minimizing the spread of the influenza virus during an outbreak. An effective plan outlines what will be cleaned, the frequency of cleaning, the materials/techniques to be used and the manner in which janitorial staff or outside cleaning providers will be trained. These cleaning procedures/requirements should be clearly outlined and understood in any agreements developed. The use of proper materials, techniques and clear cleaning plans will support a facility's pandemic response efforts. Additional information can be found in the references noted below.
1. US CDC Seasonal Flu Information for Business and Employers: Web. Web accessed 08 January 2013. http://www.cdc.gov/flu/business/
2. US CDC, Interim Guidance on Environmental Management of Pandemic Influenza Virus: Web. Web accessed 08 January 2013. http://www.pandemicflu.gov/professional/hospital/influenzaguidance.html
3. CleanLink. H1N1 Fact Sheet for Cleaning Professionals. Web. Web accessed 08 January 2013. : http://www.cleanlink.com/cp/article/H1N1-Fact-Sheet-For-Cleaning-Professionals--10915
4. FacilitiesNet. H1N1 Facts: What Facility Managers Need to Know About Swine Flu. Web. Web accessed 08 January 2013. http://www.facilitiesnet.com/emergencypreparedness/topic/H1N1-Facts-What-Facility-Managers-Need-To-Know-About-Swine-Flu--19930