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Interim Guidance for Cleaning Crew for a Truck Cab when the Driver or Helper is Visibly Ill during an Influenza Pandemic
Following are general guidelines for cleaning a truck cab after a truck arrives with a driver or helper suspected to have pandemic influenza1. 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) 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 hygiene2, cough etiquette and respiratory hygiene3 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. Influenza viruses are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial sources. 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.
Routine cleaning methods should be employed with special attention in certain areas as specified below:
- Cleaners should use appropriate personal protective equipment (PPE), such as non-sterile disposable gloves that are recommended by the manufacturer of the detergent/disinfectant, when touching contaminated surfaces or handling cleaning and disinfecting solutions. Never wash or reuse the gloves. Eye protection, such as a faceshield or goggles, may be required if splashing is expected. Avoid activities where infectious aerosols are generated. Cleaning activities should be supervised and inspected periodically to ensure correct procedures are followed.
- Many of the non-porous surfaces in the cab and associated compartments can be cleaned with detergent and water according to the vehicle manufacturer’s recommendations. Frequently touched surfaces in the interiors of the cab and associated components (examples are provided in Table 1) should be cleaned first with detergent and water and then disinfected using an EPA-registered disinfectant in accordance with the disinfectant manufacturer’s recommendations. Ensure that the surface is kept wet with the disinfectant for the full contact time recommended by the manufacturer. Follow the manufacturer’s directions for use and all safety instructions or other label recommendations (e.g., allowing adequate ventilation in confined areas such as lavatories, and proper disposal of unused product or used containers). Avoid using product application methods that cause splashing or generate aerosols.
- Disposable or reusable plastic covers can be used to protect porous surfaces such as mattresses from contamination. These covers should be discarded or cleaned as above when necessary, which may be as soon as possible after overt contamination or at the end of the shift.
- In the event of any spills of body fluids (e.g., vomit from an ill driver), follow these procedures:
- a. Immediately cover the spill with an absorbent gelling powder designed for spills of body fluids or if this is not available, disposable paper towels/cloths. Wearing non-sterile, disposable gloves that are recommended by the manufacturer of the detergent/disinfectant, place residuals, used gelling agent and waste cloths in leak-proof bags, immediately seal and carefully dispose in covered containers to avoid any spread of contamination. Hard, non-porous surfaces may then be cleaned and disinfected as described above. Large areas of contamination (e.g., 1 square foot or more) should be treated with disinfectant after removal of the body fluid with absorbent material, then cleaned and given a final disinfection. Follow the manufacturer’s directions for use and all safety instructions or other label recommendations. Ensure that the surface is kept wet with the disinfectant for the full contact time recommended by the manufacturer.
- b. Since disinfectants are not registered for use on porous surfaces, removable porous upholstery, rugs and carpeting that have been exposed to vomit or feces should be carefully removed and laundered in accordance with the manufacturer’s instructions or disposed of as described below. Porous upholstery and carpeting that can’t be removed may be initially cleaned with water and detergent. The material should then be allowed to air dry.
- Dispose of gloves and soiled material in a sturdy, leak-proof (e.g., plastic) bag that is tied shut and not reopened. Porous materials that will be laundered can be removed from the truck 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 has been completed and gloves have been removed, immediately clean hands with soap and water. If soap and water are not readily available, use an alcohol-based hand gel and wash hands with soap and water as soon as feasible. Avoid touching the face with gloved or unwashed hands4.
- Do not use compressed air and/or water under pressure for cleaning, or any other methods that can cause splashing or which might re-aerosolize infectious material. Vacuum cleaners should only be used after proper disinfection has taken place. Vacuum cleaners should be maintained to minimize dust dispersal in general and equipped with High Efficiency Particulate Air (HEPA) filters.
For the most current information about pandemic influenza, including up-to-date guidance documents and related materials, visit www.pandemicflu.gov.
For more information about environmental management of pandemic influenza virus, go to http://flu.gov/planning-preparedness/hospital/influenzaguidance.html.
Lists of EPA-registered disinfectants can be found at http://www.epa.gov/oppad001/chemregindex.htm.
Examples of Frequently-Touched Interior Surfaces:
- Cab door switches
- Cab door grab handle and surface
- Steering wheel
- Gauges and switches on dash and in sleeper
- HVAC louvers on dash and in sleeper
- Exposed dash surfaces
- Radio controls
- Seat adjustment knobs
- CB mike and knobs
- Overhead console doors and locks
- Sleeper divider curtains (vinyl)
- Cab privacy curtains (window wrap around - vinyl)
- Cup holders
- Steering column-mounted stalk controls (turn signals, cruise controls, windshield wiper)
- Manual/automatic transmission shift lever
- Seat covers (vinyl, fabric, or leather)
- Floor mats (rubber)
- Cabinet door handles
- Refrigerator doors
- Upper and lower bunk lift surfaces
- Sleeper side and back wall upholstery
- Mattresses and bedding
- Fire extinguishers
- Reflector kits
- First aid kits
- Sleeper vent window lever
- Raised roof window lever
- Skylight cover
- Adjustable reading lights in sleeper
- Air horn cable
- Seat belt buckles
1 Fleet drivers can follow standard precautions to safeguard their health, including using disposable detergent-disinfectant impregnated wipes on frequently-touched non-porous surfaces, and washing hands with soap and water or alcohol-based hand gels before eating, drinking, or smoking.
2 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 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/)
3The 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 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 )
4 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).