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Interim Guidance for Cleaning International Port of Entry Detention Facilities When Pandemic Influenza is Suspected in a Detainee or Staff Member
Following are general guidelines for cleaning an International Port of Entry (IPOE) detention facility that has housed a detainee or employed a staff member who is suspected to have pandemic influenza. These guidelines provide a basic framework of response. This guidance may be modified or additional procedures may be recommended by the Centers for Disease Control and Prevention (CDC) as part of the evaluation of an ill traveler, when an influenza pandemic becomes widespread in the United States or as new information about a pandemic strain becomes available.
Influenza viruses can persist on nonporous surfaces for 24 hours or more, but quantities of the virus sufficient for human infection are likely to persist for shorter periods. Although the relative importance of virus transfer from inanimate objects to humans in spreading influenza is not known, hand transfer of the virus to the mucous membranes of the eyes, nose, and mouth resulting in infection is likely to occur. Hand hygiene1, cough etiquette and respiratory hygiene2 are the principal means of interrupting this type of transmission. Routine cleaning and disinfection practices may play a role in minimizing the spread of influenza.
Routine cleaning with soap or detergent and water to remove soil and organic matter, followed by the proper use of disinfectants are the basic components of effective environmental management of influenza. Reducing the number of influenza virus particles on a surface through these steps can reduce the chances of hand transfer of virus. A number of chemical disinfectants are readily available and effective against influenza viruses. All disinfectants marketed in the United States are required to be registered by the U.S. Environmental Protection Agency (EPA). These products must be used in accordance with their label instructions; following label instructions is necessary to achieve adequate efficacy and to avoid unreasonable adverse effects.
Environmental infection control focuses on routine and frequent cleaning and disinfection of surfaces, especially those most often touched by hands. Routine cleaning methods described in the “INS Detention Standard governing Environmental Health and Safety,” available at: http://www.ice.gov/doclib/dro/detention-standards/pdf/environmental_health_and_safety.pdf should be employed throughout the IPOE Detention Facility with special attention in certain areas specified below.
Wear non-sterile, disposable gloves that are recommended by the manufacturer of the detergent/disinfectant when preparing disinfectant and cleaning solutions and when performing cleaning tasks. Dispose of gloves as routine solid waste if they become damaged or soiled or when cleaning is completed. Never wash or reuse disposable gloves. The use of eye protection, such as a faceshield or goggles, may be required if splashing is expected. Avoid activities that may generate infectious aerosols. Cleaning activities should be supervised and inspected periodically to ensure correct procedures are followed.
Cleaning and disinfecting environmental surfaces in non-medical operations in the IPOE detention facility
- Keep housekeeping surfaces and countertops clean of visible soil 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.
- 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. Follow label instructions carefully; use conditions will vary depending on whether the detergent/disinfectant is used for cleaning or disinfection. Adhere to any safety precautions or other recommendations as directed (e.g. allowing adequate ventilation in confined areas, proper disposal of unused product or used containers).
If EPA-registered disinfectants are not available, use a dilute solution (1:100 volume/volume, approximately 600 parts per million [ppm]) of household chlorine bleach (5.25% or 6.00% sodium hypochlorite) to disinfect bathroom surfaces. To prepare this solution, add ¼ cup of bleach to a gallon of clean water, or 2 teaspoons 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 at least 3 – 5 minutes. Wear gloves to protect hands while mixing and applying bleach solution.
- Spills of bodily fluids (e.g., vomit from an ill detainee) should be handled in accordance to the procedures established in the “INS Detention Standard” governing Environmental Health and Safety, available at: http://www.ice.gov/doclib/dro/detention-standards/pdf/environmental_health_and_safety.pdf
- Since disinfectants are not registered for use on porous surfaces, removable porous upholstery, rugs and carpeting that have exposure to bodily fluids should be carefully removed and laundered in accordance with the manufacturer’s instructions or disposed of as described below. Porous upholstery and carpeting that cannot be removed may be cleaned with water and detergent. The material should then be allowed to air dry.
- When cleaning is completed, collect soiled material and gloves in a sturdy, leakproof (e.g., plastic) bag that is tied shut and not reopened. Porous materials that will be laundered can be transported in the same manner. State and local governments should be consulted for appropriate disposal decisions. Barring specific state solid or medical waste regulations to the contrary, these wastes are considered routine solid wastes that can be sent to municipal solid waste landfills without treatment.
- When cleaning is completed and gloves have been removed, immediately clean hands with soap and water or an alcohol-based hand gel. Avoid touching the face with gloved or unwashed hands3.
- Clean and disinfect commonly touched surfaces in the facility with a detergent/disinfectant in accordance with label instructions (e.g., microwaves, refrigerator door handles, door handles).
- Wipe frequently touched electronic items (e.g., remote controls) with hard surface disinfectant wipes.
Cleaning and surface disinfection practices for medical operations in the IPOE detention facility
The basic strategies for management of environmental surfaces in healthcare facilities are discussed in the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) “Guidelines for Environmental Infection Control in Health-Care Facilities,” available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm. Additional guidance is available from the World Health Organization http://www.who.int/csr/resources/publications/WHO_CDS_EPR_2007_6c.pdf. The guidance which follows is drawn from these resources.
- Frequently clean and disinfect –using disinfectants as described above - surfaces that are touched routinely by hands (e.g., doorknobs, bed rails, bedside- and over-bed tables, bathroom surfaces, safety/pull-up bars, television controls, and call buttons).
- Follow manufacturer instructions for proper use of disinfectants, especially with regards to proper product concentrations and recommended surface contact time.
- Consult medical equipment instructions for appropriate methods of cleaning and disinfection for these items, and consider using barrier coverings for equipment that may be hard to clean or has accessible electronic components.
- Clean large housekeeping surfaces (e.g., floors) in patient-care areas with detergent/disinfectants in accordance with manufacturer instructions, as per facility policy (i.e., at least daily and terminally cleaned at discharge).
- Avoid cleaning methods that produce mists or aerosols or disperse dust in patient-care areas (e.g., use wet dusting techniques, wipe application of cleaning and/or disinfectant solutions).
- Detergent and water are adequate for cleaning surfaces in nonpatient-care areas (e.g., administrative offices).
- 7. Follow facility procedures to ensure the cleanliness of cleaning and/or disinfectant solutions, rinse water, mop heads, and cloths (e.g., separate buckets for solutions and rinse water, frequent exchanges of solutions, replacing soiled mops heads and cloths with clean items, using microfiber mopping methods).
- Vacuum carpeting in public areas of health-care facilities and in general patient-care areas regularly with well-maintained equipment designed to minimize dust dispersion. Avoid placing influenza patients in rooms with carpeting if possible; use vacuums equipped with High Efficiency Particulate Air (HEPA) filtration when vacuuming carpets in influenza patient-care areas.
- Educate patients, staff, and visitors about the importance of handwashing and hand hygiene, emphasizing good practices (e.g., avoid touching nose, mouth, or eyes after touching a potentially contaminated surface or object).
Although influenza viruses can persist on porous materials, the transfer of these viruses from sheets, bedding, and clothing is not an efficient process. Therefore, management of laundry in medical operations and in the detention facility in general can be accomplished with existing procedures appropriate for these settings.
- Handle soiled clothing and linens during collection with a minimum amount of agitation.
- Healthcare workers and laundry personnel should follow established facility safety procedures (minimum recommendation is for glove use) when handling soiled linens.
- Handwashing or hand hygiene should be done after sorting laundry and adding the clothing and linens to the washer.
- Use detergents, laundry additives, and appropriate water temperature per routine laundry procedures. Follow manufacturer instructions for detergent and bleach use.
- Use a temperature setting for drying clothes and linens appropriate for the fabrics in the load.
Routine Solid Wastes and Regulated Medical Wastes from the Detention Facility
There is no evidence to suggest that either pandemic influenza virus or seasonal influenza viruses can be spread via contact with either routine solid wastes or regulated medical wastes generated either in a healthcare facility or in a home, school, or business. Therefore, current waste management strategies should continue to be used during a pandemic.
Waste from Medical Operations
- Use Standard Precautions when working with solid waste that may be contaminated with influenza virus outside of patient isolation areas.
- Use appropriate personal protective equipment (PPE) as is currently required by your state (e.g., gloves) when handling open waste containers.
- No changes in waste containment need be made during periods of influenza activity (e.g., single bag lining for routine clinic wastes, appropriate labeled containment for regulated medical wastes).
- Current medical waste treatment procedures can be used to treat regulated medical waste in accordance with state and federal regulations.
- Treated medical waste can be safely deposited in municipal solid waste landfills as per normal procedures.
Waste from the Remainder of the Facility
- Disposable tissues used to contain coughs, sneezes, or nasal discharges can be disposed of in waste receptacles; no special precautions are required. If the waste receptacles are not lined with a plastic liner, they should be cleaned as contaminated equipment each time they are emptied.
- Handwashing or hand hygiene should be done after emptying waste containers.
- State and local governments should be consulted for appropriate disposal decisions. Barring specific state solid or medical waste regulations to the contrary, these wastes are considered routine solid wastes that can be sent to municipal solid waste landfills without treatment.
For more information about environmental management of pandemic influenza virus, go to http://www.flu.gov/planning-preparedness/hospital/influenzaguidance.html.
Lists of EPA-registered disinfectants can be found at http://www.epa.gov/oppad001/chemregindex.htm.
1 When washing hands with soap and water: Wet your hands with clean running water and apply soap. Use warm water if it is available. Rub hands together to make a lather and scrub all surfaces. Continue rubbing hands for 20 seconds. Rinse hands well under running water. Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet. Remember: If soap and water are not available, use alcohol-based hand gel to clean hands. When using an alcohol-based hand gel: Apply product to the palm of one hand. Rub hands together. Rub the product over all surfaces of hands and fingers until hands are dry. (http://www.cdc.gov/flu/protect/habits/)
2 The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection: Cover the nose/mouth when coughing or sneezing; use tissues to contain respiratory secretions and dispose of them in the nearest covered waste receptacle after use; if you don't have a tissue, cough or sneeze into your upper sleeve, not your hands; perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand gel, or antiseptic handwash) after having contact with respiratory secretions and contaminated objects/materials (http://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm and http://www.cdc.gov/flu/protect/covercough.htm)
3 Employees should be trained to remove PPE to prevent self-inoculation (e.g., touching a contaminated glove and then touching one’s eyes, nose, or mouth).