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Avian Flu Pandemic Plan
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Avian Flu Plan: Appendices > Appendix E <- You Are Here

Appendix E: Protocol for Cleaning and Disinfection of Environmental Surfaces During an Avian Influenza Pandemic [PDF]

Prepared by the Department of Environmental Safety (DES)
Latest Version of Protocol: August 12, 2008

NOTE of CAUTION: Since information related to Pandemic Influenza or Avian Influenza is subject to frequent and significant changes, readers of this document should check with DES to ensure they have the most recent version.

  1. Characteristics of Influenza Transmission

    Human influenza is transmitted from person-to-person primarily via virus-laden droplets (particles > 5 um in diameter) that are generated when infected persons cough, sneeze or speak. These large droplets can be directly deposited onto the mucosal surfaces of the respiratory tract of susceptible persons who are near (i.e., typically within 3 feet) of the droplet source. Transmission may also occur through direct and indirect contact with infectious respiratory secretions. Asymptomatic individuals in early stages of influenza could be infectious to others. However, the route of transmission of Avian Influenza in humans is unknown at this time.

  2. Definitions

    Cleaning: a form of decontamination that renders an environmental surface safe to handle or use by removing organic matter, salts, and visible soils, all of which interfere with microbial inactivation. The physical action of scrubbing with detergents and surfactants and rinsing with water removes large numbers of microorganisms from surfaces. Cleaning is the necessary first step of any disinfection process.

    Disinfection: to kill or inhibit microorganism activity on hard non-porous surfaces. Disinfectants must be mixed, applied to a surface uniformly and remain wet and in contact with the surface or equipment according to manufacturer�s directions. Widespread spraying or other application of disinfectants may create exposures to patients and workers and should be avoided.

  3. Protocol for Cleaning and Disinfection of Environmental Surfaces

    1. It is the intent of the University to follow all requirements and assess all recommendations from federal, state and local agencies that are involved in pandemic and Avian Influenza planning.

    2. The Avian Influenza virus is very sensitive to detergents. Cleaning thoroughly with detergent cleaners and water is adequate for most non-healthcare locations.

    3. Cleaning and disinfection cannot be relied on as the primary means to control the spread of influenza virus. Infection control practices must include hand hygiene (hand washing), respiratory etiquette, proper disposal of tissues and maintaining distance from sick individuals (at least three feet).

      1. In-patient and ambulatory care settings (e.g., Health Center) including alternative healthcare settings if / when established.

        1. Follow normal facility procedures for cleaning of environmental surfaces using an EPA-registered hospital grade detergent-disinfectant with label claims as an avian influenza disinfectant to clean patient-occupied rooms. Give special attention to frequently touched surfaces (e.g., bedrails, bedside tables, TV controls, telephones, lavatory surfaces, doorknobs) and visibly soiled surfaces. Floors and other horizontal surfaces should be cleaned regularly. No special treatment is necessary for window curtains, ceilings and walls unless there is evidence of visible soiling.

        2. Follow facility procedures for regular cleaning of non-patient locations.

        3. Clean and disinfect spills of blood and body fluids in accordance with Standard Precautions and the Bloodborne Pathogens Standard.

        4. Follow manufacturer�s recommendations for use-dilution, contact time and precautions for handling of cleaning product.

        5. Do not spray disinfectants. This is a potentially dangerous practice that has no proven disease control benefit.

        6. Medical and non-medical solid waste must be contained and disposed of in accordance with standard facility procedures and state and federal regulations. Gloves should be worn when handling waste or waste containers. Wash hands after removing gloves.

        7. Soiled linen and laundry should be placed into a laundry bag in the patient�s room and contained in a manner that prevents the bag from opening during transport. Gloves and gown should be worn when directly handling and transporting soiled linen and laundry. Do not shake or otherwise handle soiled linen and laundry that might create an opportunity for disease transmission. Wash hands after removing gloves.

        8. Dishes and eating utensils should be washed in a dishwasher at appropriate water temperature. Disposable dishes and utensils should be discarded with general waste. Gloves should be worn when handling patient trays, dishes and utensils.

        9. Follow standard facility practices for cleaning, disinfecting and sterilizing patient-care equipment and medical devices.

      2. Residence Halls, Offices, Service Areas, Classrooms, Public Areas or Other Locations That Are Not Used as Alternative Healthcare Settings

        1. Transmission of influenza from contaminated hard surfaces is unlikely but cannot be ruled out. Hand hygiene is the most important method to prevent the transmission of the influenza virus.

        2. Normal facility cleaning procedures for environmental surfaces should be followed using standard cleaning products. During a local outbreak, surfaces that are frequently touched with hands such as sinks, doorknobs, railings and counters may be added to cleaning schedule in place of floor care. Use of disinfectants in non-healthcare workplaces is not considered to be necessary.

        3. Individual employees and students may want to consider regular cleaning of their phones and keyboards particularly if they are shared with others or used by the public.

        4. There is no evidence to support the efficacy of widespread disinfection of the environment or air. Widespread application or spraying of disinfectants is an unsafe practice and must be avoided.

        5. Gloves should be worn when handling waste or waste containers.

      3. Vehicles Used for Medical Transport (e.g., police cars, buses, other state vehicles)

        1. Follow normal cleaning procedures. Pay special attention to visibly soiled surfaces.

        2. During a local outbreak, clean surfaces that are frequently touched with the hands using an EPA-registered hospital grade disinfectant with label claims as an Avian Influenza disinfectant.

        3. Clean and disinfect spills of blood and body fluids in accordance with Standard Precautions and the Bloodborne Pathogens Standard.

        4. Allow time for the vehicle to air out following disinfection to prevent concentrated exposure to driver or patients.

    4. Vehicles Not Used for Medical Transport

      Follow normal cleaning products and procedures for vehicles.

    5. Conditions for Use of Disinfectants

      1. If a disinfectant is used, it should be an EPA-registered product with label claims as an avian influenza disinfectant. The EPA list is available at http://www.epa.gov/pesticides/factsheets/avian_flu_products.htm. Healthcare settings should select an EPA-registered hospital grade detergent-disinfectant.

      2. Routine use of bleach should be avoided as it is corrosive to metals, damaging to environmental surfaces, is inactivated by organic matter, has no detergent (cleaning) benefit and is toxic.

      3. Personal protective equipment should be worn when applying cleaning products. This includes gloves as well as goggles if splashing or spraying is possible. In patient-occupied rooms, a surgical or procedure mask may be worn.

      4. DES should be consulted before applying disinfectants in large quantities or in enclosed areas.

      5. Material Safety Data Sheet must be available for all products used.

    Table 1. Summary of environmental disinfection by building category and Avian Flu phases.

    NOTE: UMD Level correspond with the following U.S. Government Response Stages/local conditions:
    Level 1: U.S. Government Response Stage 2/3
    Level 2: U.S. Government Response Stage 4
    Level 3: U.S. Government Response Stage 5 or Confirmed local community outbreak
    Level 4: U.S. Government Response Stage 5 or Confirmed local community outbreak
      All academic and residential buildings, except University Health Center and alternative hospital settings University Health Center (and alternative hospital settings, if established.) Vehicles designated for emergency medical transport.
    Environmental cleaning and disinfection Level 1–Procure, store, and provide sufficient and accessible soap, alcohol-based hand hygiene products (Note 1), tissues and receptacles for their disposal.  No special cleaning procedures or products.

    Level 2–Same as Level 1.

    Level 3–Same as Level 2.

    Level 4–Same as Level 3.
    Level 1–No additional cleaning procedures or products needed above those used at Level 0.

    Level 2–Same as Level 1.

    Level 3–Same as Level 2.

    Level 4–Follow facility procedures and include regular cleaning of patient-occupied rooms. Use any EPA-registered hospital detergent-disinfectant. Give special attention to frequently touched surfaces (e.g., bedrails, bedside and over-bed tables, TV controls, call buttons, telephones, lavatory surfaces including safety/pull-up bars, doorknobs, commodes, ventilator surfaces) in addition to floors and other horizontal surfaces.
    Level 1–Not applicable

    Level 2–Not applicable

    Level 3&4 –Use any EPA-registered hospital detergent-disinfectant to clean frequently-touched non-porous surfaces. Blood and certain other body fluid spills must be handled in accordance with Bloodborne Pathogens procedures.

    Note: 1. Hand hygiene products: Use only hand sanitizers that contain alcohol (~60%), such as Purell, Nexcare (3M), Germ-X, Avant, Bacdown, Decon-Hand, Alcare foamed alcohol.

  4. Reference Sources:

    Occupational Safety and Health Administration (OSHA)
    Department of Health and Human Services, Centers for Disease Control & Prevention (CDC)
    Food and Drug Administration (FDA)
    World Health Organization (WHO)
    Implementation Plan for the National Strategy for Pandemic Influenza

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