Manitoba Health, Seniors and Active Living (MHSAL) Ebola Virus Disease (EVD) Environmental Cleaning/Disinfection Guidelines for Community Settings

Transcription

1 Purpse Manitba Health, Senirs and Active Living (MHSAL) T prvide directin fr cleaning and disinfecting envirnments in the cmmunity that may be expsed t Ebla virus and t reduce pprtunities fr cmmunity transmissin f via cntact with Ebla virus cntaminated fmites. This dcument is intended t be used by public health fficials (Medical Officers f Health, Public Health Inspectrs, Public Health Nurses and ther emplyees f Manitba Health, Senirs and Active Living [MHSAL] and/r Reginal Health Authrities). Scpe This guideline deals with the management f bld and/r ther bdy fluid spills and envirnmental cleaning and disinfectin in cmmunity settings, such as in private hmes, wrkplaces, physician ffices, and public places used by an individual diagnsed with EVD. This infrmatin nly applies t a setting where there is a symptmatic persn under investigatin fr EVD, r a persn with labratry cnfirmed EVD. Level f Cleaning and Disinfectin Required Once an individual has been cnfirmed t have EVD, the methd f disinfecting the residence r ther cmmunity setting depends n the symptms f the individual at the time they were in the applicable lcatin: Cleaning/Disinfectin by Residents r Regular Cleaning Staff (in Other Cmmunity Settings) The envirnment is nt cnsidered cntaminated if the individual with EVD had ONLY a fever and did nt have gastrintestinal (e.g., diarrhea, vmiting) r hemrrhagic (e.g., bleeding) symptms. Other husehld members r regular cleaning staff can clean and launder as usual using detergent and/r disinfectant, and it is nt necessary t have the setting cleaned by a cntract cleaning cmpany. NOTE: If preferred, a cntract cleaning cmpany can be hired t perfrm the cleaning/disinfectin. Cleaning/Disinfectin by Cntract Cleaning Cmpany The envirnment is cnsidered cntaminated if the individual with EVD had a fever AND gastrintestinal (e.g., diarrhea, vmiting) r hemrrhagic (e.g., bleeding) symptms. Public Health and/r assigned authrities shuld cntact a cntract cleaning cmpany wh will assess the setting and determine the prper disinfectin and dispsal prcedures. Other individuals (e.g., husehld residents, staff) shuld avid June 2017 Page 1

2 cntaminated rms and areas in the setting until after the cmpletin f the assessment and disinfectin. In this situatin, ther residents r individuals in the lcatin shuld nt handle cntaminated materials, and shuld nt tuch any bdy fluids r siled surfaces and materials. If this is nt pssible (i.e. majrity f setting is cntaminated) then ther residents r individuals may be required t leave the residence/setting altgether, until it has been cmpletely disinfected. All cleaning and disinfecting is t be dne ONLY by the cntract cleaning cmpany. Table 1. Decisin Making Chart fr Ebla Virus Cleaning and Disinfectin in Cmmunity Settings Categry Criteria Disinfectin and Dispsal Cleaning/disinfectin by Setting where an Residents r regular residents/staff f the individual with EVD cleaning staff can clean setting had a fever ONLY and and launder as usual NOTE: If preferred a NO ther symptms using husehld cntract cleaning detergent and/r cmpany can be hired t disinfectant. perfrm the wrk Waste can be discarded Cleaning/disinfectin by cntract cleaning cmpany Setting where a persn with Ebla had a fever AND additinal symptm(s) including diarrhea, vmiting, bleeding as usual Residence members r prperty wners shuld NOT handle cntaminated materials Cntact lcal Public Health r assigned authrities Cntract cleaning cmpany shall cnduct disinfectin and dispsal prcedures Training and PPE N training required Fllw cleaning/ disinfectant prduct instructins Cntract cleaning cmpanies shall fllw municipal, prvincial and federal plicies Fr settings that are cleaned by husehld members r regular cleaning staff, infrmatin regarding prper cleaning, disinfectin and dispsal shuld be prvided by a Public Health Nurse (PHN). Fr cleaning by a cntract cleaning cmpany, infrmatin regarding prper cleaning, disinfectin and dispsal is prvided by a Public Health Inspectr (PHI). All f the fllwing instructins apply ONLY t settings that are cntaminated by bdy fluids and require disinfectin by a cntract cleaning cmpany. They d NOT apply t settings that are cleaned by residents r ther regular cleaning staff. June 2017 Page 2

3 Selectin f Cleaning Cntractrs Cleaning f Ebla virus cntaminated envirnments shuld be cnducted by a cleaning cntractr wh is cmpetent in cleaning, disinfecting, handling and discarding infectius agents, and has experience in cleaning bihazards and/r trauma scenes. The cntractr(s) must cmply with all applicable Occupatinal Health and Safety (OSH) legislatin. The cleaning cntract cmpany is respnsible fr prviding a safe system f wrk, and selecting and prviding persnal prtective equipment (PPE) t prtect its wrkers frm expsure t the Ebla virus and frm chemical hazards due t the cleaning and disinfectin agents. The cmpany is als respnsible fr prviding wrkers with prper instructin, training and supervisin. This includes: Safe putting n and remving f PPE using a methdical sequence, hand hygiene and a trained bserver/mnitr Safe use f PPE (e.g. nt t tuch r adjust PPE when wrking in the cntaminated area) Onging training f putting n and remving f PPE accrding t their apprved prcedures Safe management f accidental expsure (e.g. accidental cntact with bld/bdy substances, PPE failure) Maintaining a lg f staff wh have been in the cntaminated envirnment and cmmunicate this with the public health authrities Staff frm the MHSAL Health Prtectin Unit and/r Office f Disaster Management can assist in finding a qualified cntract cleaning cmpany. Principles f Cleaning and Disinfecting Overview f Cleaning Prcess Remve grssly cntaminated items. Clean up bld r ther bdy fluid spills fllwing the spill management prcess. Clean the tilet, using an apprpriate disinfectant Perfrm final cleaning and disinfectin using an apprpriate disinfectant. Stre and dispse f bimedical waste, accrding t Transprtatin f Dangerus Gds (TDG) regulatins. June 2017 Page 3

4 Nn-prus Surfaces (e.g. dr handles, tile flrs): Health Canada recmmends prducts with the fllwing apprved criteria: Registered in Canada with a Drug Identificatin Number (DIN) Labeled as a brad spectrum virucide claim and/r acknwledge effective testing against any f: Adenvirus type 5, Bvine Parvvirus, Canine Parvvirus and Plivirus type 1. Prus Surfaces (e.g. linens, carpet, mattress, pillws): Fllw prcedure fr Grssly Cntaminated Items belw. Cleaning and Disinfectin Prcess Passenger Vehicles A vehicle that has transprted a symptmatic individual suspected f having EVD shuld be quarantined after all passengers and staff have disembarked. If the symptmatic individual tests psitive fr Ebla virus, cleaning and disinfectin must be undertaken n all areas in the vehicle that ptentially were cntaminated by the case during travel. The public health authrities will take a detailed histry n the mvements f the case while in transit t determine ptentially cntaminated areas. Apprpriate PPE shuld always be used when cleaning and disinfecting vehicles ptentially cntaminated with Ebla virus. Only peple wh have been trained in the crrect use f PPE shuld undertake cleaning and disinfectin f the vehicle using an apprpriate disinfectant as described abve. Grssly Cntaminated Items If items are grssly cntaminated (e.g. seats r carpets cvered in bld r ther bdy fluids) and difficult t clean prperly, they need t be remved and treated as bimedical waste. The items shuld be cleaned and disinfected as much as pssible prir t remval t reduce the biburden. The items shuld then be placed in a leak-prf cntainer. The cntainer shuld be stred in a rm that is nt being used until it can be cllected fr dispsal. The cntainer shuld be transprted accrding t Transprtatin f Dangerus Gds (TDG) regulatins. Individuals remving these items (if different frm the cntract cleaning cmpany) need t be instructed in the safe use f PPE prir t June 2017 Page 4

5 cmmencing remval. A trained bserver shuld als be n-site t ensure there are n breaches. Bld r Other Bdy Fluid Spills If the cntract cleaning cmpany has prcedures that differ frm thse described belw, the alternate prcedures must be apprved in advance by the public health authrities. i. Put n apprpriate PPE fr EVD and begin cleaning/disinfectin prcess (described belw) as sn as aersls have been allwed t settle. ii. Gather and use apprpriate tls (e.g., tngs r frceps) fr spills invlving sharps r brken glass. iii. Establish a spill parameter (cntain the spill and sectin ff area immediately, as apprpriate). iv. Clean spill area remving the rganic material, cleaning the area, and disinfecting the area. Gently cver the spill with dry absrbent pad(s); remve rganic material. Discard in bimedical waste cntainer. Cver spills f ptentially cntaminated material frm the utside-in with an incntinence/absrbent pad saturated with disinfectant. Allw pad(s) t sak fr the required cntact time specified n the prduct label. D nt splash r spray disinfectant. Wipe up with absrbent material saked in disinfectant. Clean spill frm utside-in. Start at ne end f the affected area and mve in ne directin until all surfaces have been cleaned. D nt use a circular mtin. v. Dispse as bimedical waste. vi. Disinfect after cleaning by puring disinfectant directly nt the spill area. Cver and saturate the spill area. Refer t prduct label fr required cntact time. Wipe the area with dispsable absrbent material and dispse f as bimedical waste. Remve uter glves with cautin and discard. D nt remve ther PPE until finished cleaning. vii. Mp area with disinfectant using a fresh mp head. viii. Allw the surface t air dry cmpletely. June 2017 Page 5

6 Cleaning the tilet Add apprved disinfectant r bleach tablets t achieve a 5000 ppm disinfectant strength (i.e. five bleach tablets = 5 x 1000 ppm). Fllw manufacturer s instructins fr cntact disinfectin time. After disinfectin time, ensure the tilet lid is dwn and flush. The tilet s surface and the flr shuld be cleaned with an apprved disinfectant after flushing. If the tilet is visibly siled after flushing, treat the tilet as a spill and fllw spill management prcesses. Final Clean and Disinfectin Cleaning shuld be perfrmed using a damp clth. D nt dry sweep r dust. Avid cleaning methds that create splashes and aersls. Use tls, such as tngs frm a spill kit, as much as pssible rather than ding clean-up wrk directly with glved hands. Wipes hlding dust and mp heads shuld be discarded as bimedical waste. D nt shake t clean. Clean and disinfect. Clean: Hrizntal wrk surfaces and frequently tuched surfaces (such as drknbs, light switches, tap handles, bathrm and kitchen areas) thrughly with a husehld detergent and water using a wipe and then rinse. Flr areas with a husehld detergent and water, using a mp, and then rinse. Disinfect*: Hrizntal wrk surfaces and frequently tuched surfaces thrughly with apprved disinfectant using a wipe. Flrs with apprved disinfectant with a fresh mp head. *If using hypchlrite t disinfect, it must be made fresh. Pur apprved disinfectant int a cntainer fr surface cleaning and in a clean bucket fr mpping. D nt use disinfectants in spray bttles. Dispse f all cleaning equipment including buckets, mp handles, mp heads, June 2017 Page 6

7 Strage and Dispsal f Waste clths int the bimedical waste. After cleaning and disinfectin wrk is cmplete, remve PPE and dispse f as bimedical waste with a trained bserver/mnitr present. Perfrm hand hygiene after remval f PPE. Prus materials (e.g. linens, carpet, mattress, pillws) shuld be prperly cntained and dispsed f as bimedical waste, accrding t TDG regulatins (Class 6.2, UN2814, Categry A). This requires using a leak-prf primary bag, which is sealed and then placed inside a leak-prf secndary bag, which is als sealed and then placed in a rigid uter packaging. Stre the prperly cntained cntaminated material in a rm that is nt being used until it can be cllected fr dispsal. If there have been n spills, the rm shuld be cleaned and disinfected with apprved disinfectant as per nrmal cleaning prtcls. If there has been a spill, fllw the spill management prcess. REFERENCES Sagripanti et al. (2010). Persistence in darkness f virulent alphaviruses, Ebla virus, and Lassa virus depsited n slid surfaces. Arch Virl 2010; 155: CDC (2014). Interim Guidance fr the U.S. Residence Decntaminatin fr Ebla Virus Disease and Remval f Cntaminated Waste. Retrieved n January 7, 2015 frm: OSHA (2015). Safety and Health Tpics: Ebla. Retrieved January 14, 2015 frm: Queensland Gvernment (2014). Interim guidelines fr Ebla virus disease envirnmental cleaning in a cmmunity setting. Retrieved n January 7, 2015 frm: US Army Public Health Cmmand (2014). Disinfectin and Dispsal f husehld gds belnging t patients infected with Ebla virus disease. Retrieved n January 7, 20 Disinfectin_and_Dispsal_f_Husehld_Gds.p June 2017 Page 7