Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus

Page Summary

Who this is for: Healthcare personnel in any hospitals. The guidance is most relevant for hospital staff caring for a patient under investigation (PUI) or patient with confirmed Ebola virus disease (EVD).

What this is for: Guidance to help healthcare personnel follow recommended infection prevention and control practices when caring for a PUI or patient with confirmed EVD.

As part of the care of PUIs or patients with confirmed EVD, hospitals are recommended to

  • Be sure environmental services staff wear recommended personal protective equipment (PPE) to protect against direct skin and mucous membrane exposure of cleaning chemicals, contamination, and splashes or spatters during environmental cleaning and disinfection activities. If reusable heavy-duty gloves are used for cleaning and disinfecting, they should be disinfected and kept in the room or anteroom. Be sure staff are instructed in the proper use of PPE including safe removal to prevent contaminating themselves or others in the process, and that contaminated equipment is disposed of appropriately (see question 7).
  • Use an U.S. Environmental Protection Agency (EPA) registered hospital disinfectant from List L or List Q to disinfect environmental surfaces in rooms of PUIs or patients with confirmed EVD.
  • Avoid contamination of reusable porous surfaces that cannot be made single use:
    • Use only a mattress and pillow with plastic or other covering that fluids cannot get through.
    • Do not place PUIs or patients with confirmed EVD in carpeted rooms.
    • Remove all upholstered furniture and decorative curtains from patient rooms before use.
  • Routine cleaning and disinfection of the PPE doffing area. Routine cleaning of the PPE doffing area should be performed at least once per day and after the doffing of grossly contaminated PPE. Cleaning should be performed by a healthcare worker wearing clean PPE. An EPA-registered hospital disinfectant from List L or List Q should be used for disinfection. When cleaning and disinfection are complete, the healthcare worker should carefully doff PPE and perform hand hygiene.
  • To reduce exposure among staff to potentially contaminated textiles (cloth products) while laundering, discard all linens, nonfluid-impermeable pillows or mattresses, and textile privacy curtains into the waste stream and dispose of appropriately.
  • Ebola virus is classified as a Category A infectious substance regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180). Any item transported offsite for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, used healthcare products such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets; and used PPE (gowns, masks, gloves, goggles, face shields, respirators, booties, etc.) or byproducts of cleaning contaminated or suspected of being contaminated with a Category A infectious substance.6, 7 (see question 7)

Frequently Asked Questions

1. How can I determine whether a particular EPA-registered hospital disinfectant is appropriate for use in the room of a PUI or patient with confirmed EVD?

Refer to EPA’s List L or List Q for a list of appropriate disinfectants.

2. Are there special instructions for cleaning and disinfecting the room of a PUI or patient with confirmed EVD?

Daily cleaning and disinfection of hard, nonporous surfaces (high-touch surfaces such as bed rails and over bed tables, housekeeping surfaces such as floors and counters) should be done.4 Before disinfecting a surface, cleaning should be performed. In contrast to disinfection where products with specific claims are used, any cleaning product can be used for cleaning tasks. Use cleaning and disinfecting products according to label instructions. Use disposable cleaning cloths, mop cloths, and wipes, and dispose of these in leakproof bags. Use a rigid waste receptacle designed to support the bag to help minimize contamination of the bag’s exterior.

3. How should spills of blood or other body substances be managed?

The basic principles for blood or body substance spill management are outlined in the United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standards (29 CFR 1910.1030).5 CDC guidelines recommend removal of bulk spill matter, cleaning the site, and then disinfecting the site.4 For large spills, a chemical disinfectant with sufficient potency is needed to overcome the tendency of proteins in blood and other body substances to neutralize the disinfectant’s active ingredient. An EPA-registered hospital disinfectant from List L or List Q and instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids should be used according to those instructions.

4. How should disposable materials (any single-use PPE, cleaning cloths, wipes, single-use microfiber cloths, linens, food service) and linens, privacy curtains, and other textiles be managed after their use in the patient room?

These materials should be placed in leakproof containment and discarded appropriately. To minimize contamination of the exterior of the waste bag, place the bag in a rigid waste receptacle designed for this use. Incineration or autoclaving as a waste treatment process is effective in eliminating viral infectivity and provides waste minimization. If disposal requires transport offsite then this should be done in accordance with the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 CFR, Parts 171-180).67 Guidance from DOT has been released for Ebola.7

5. Is it safe for patients with EVD to use the bathroom?

Yes. Sewage handling processes in the United States are designed to inactivate infectious agents. In general, sanitary sewers may be used for the safe disposal of patient waste; however, facilities should consult state and local regulations.8

6. Are wastes generated during delivery of care to patients with EVD subject to select agent regulations?

As long as facilities treating patients with EVD follow CDC’s Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals , waste generated during delivery of care to patients with Ebola would not be subject to federal select agent regulations (See the exclusion provision 42 CFR § 73.3(d)(1)). However, this would not apply to any facility that intentionally collected or otherwise extracted Ebola virus from waste generated during the delivery of patient care.

7. Are wastes generated during delivery of care to patients with EVD subject to any special transportation requirements?

Yes, wastes contaminated or suspected to be contaminated with Ebola virus must be packaged and transported in accordance with U.S. DOT Hazardous Materials Regulations (HMR, 49 CFR, Parts 171-180).67

Once a PUI is no longer suspected to have EVD or has been ruled out for EVD, their waste materials no longer need to be managed as if contaminated with Ebola virus.

References

  1. Sagripanti JL, Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces. Arch Virol 2010; 155:2035-2039.
  2. Sagripanti JL, Lytle DC. Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Arch Virol 2011; 156:489–494.
  3. Bausch DG et al. Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. J Infect Dis 2007; 196:S142–7.
  4. CDC Guidelines for Environmental Infection Control in Healthcare Facilities [PDF – 249 pages] (see: Environmental Surfaces Section).
  5. OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030.
  6. DOT. Guidance for Transporting Ebola Contaminated Items, a Category A Infectious Substance.
  7. DOT. Hazardous Materials Regulations [49 CFR Parts 100-1999; 49 CFR 172.700; 49 CFR 173.134(a)(5)).
  8. WHO. Interim Infection Prevention and Control Guidance of Patients with Suspected or Confirmed Filovirus Hemorrhagic Fever in Health-care Settings, with Focus on Ebola. World Health Organization, Geneva, Switzerland, 2014.