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•m,<; "'l\ili;C - l'l.H'"i:rYMINISTRY OF HEALTH-ETHIOPIA

Cleaning and disinfection Protocol for COVI -19

Second Version

June, 1020

Routine environmental cleaningo Cleaning refers to the removal of dirt and impurities, including germs, from

surfaces. Cleaning alone does not kill germs. But by removing the kerms, it

decreases their number and therefore any risk of spreading infection

o Cleaning is an essential part of disinfection. Organic matter can inactivate many

disinfectants. Cleaning reduces the soil load, allowing the disinfectant tJ work.

o Disinfecting works by using chemicals to kill germs on surfaces. ThJ process

does not necessarily clean dirty surfaces or remove germs. But killi / g germs

rernaining on a surface after cleaning further reduces any risk of spreading

infection.o Removal of germs such as the virus that causes COVID-19 requires horough

cleaning followed by disinfection.

o The length of time that the virus that cause COVID-19 survives on inanimate

surfaces will vary depending on factors such as the amount of contaminated

body fluid - such as respiratory droplets - present and envir I nmental

temperature and humidity.

o In general, coronaviruses are unlikely to survive for long once droplets

produced by coughing or sneezing dry out. It is good practice to routinely

clean surfaces: Clean frequently touched surfaces with

Cleaning and disinfection protocol for COVID-19

Detergent solution (see diagram below). Clean general surfaces and

fittings when visibly soiled and immediately after any spillage.

Frequently touched surfaces

,i

Floors,ceilings, walls .. etc

Door handles, bedrails,table tops, lightswitches etc

Deteregent solutions can be used

Detergent impregnated wipes mayused

Detergent solutions are adeqaute for dleaning surfacesand non patient care arers.

Damp mopping is preferable to dry rnoppingswalls and ceiling should be cleaned wh n visibly soiled ordirtywindow curtain should be regulary cha ged or cleanedsinks and basins should be cleaned in re ular basis

Cleaning and disinfection protocol for COVID-19

Information for cleaning staffso Cleaning staff should be informed to avoid touching their face, especially their

mouth, nose, and eyes when cleaning.

o Cleaning staff should wear heavy duty glove and a surgical mask plus eye

protection or a face shield while cleaning.

o Cleaners should use alcohol-based hand rub or wash their hands with water

and soap before putting on and after removing gloves.

o Alcohol-based hand rub or washing hands with water and soap should also be

used before and after removing the surgical mask and ey_e protection.

o The disinfectant used should be one for which the manufacturer claims. Iantiviral activity, meaning it can kill the virus such as chlorine-based

disinfectants, which are commonly used.

o If there is visible contamination with respiratory secretions or other body fluid,

the cleaners should wear a full length disposable gown in additio' to the

surgical mask, eye protection -and heavy; duty gloves.

o Advice should be sought from health professionals on correct procedures for

wearing Personal protective equipment (PPE).

Social contact environmentsSocial contact environments include transport vehicles, shopping centres an private

·'businesses etc. The risk of transmission of COVID-19 in the social and non-health

care work settings can be minimised through a good standard of general hygJne. This

includes:

o Promoting cough etiquette and respiratory hygiene.

o Routine cleaning of frequently touched hard surfaces with detergent/

disinfectant solution/ wipe.

0use and

drainage

o Training staff on use of alcohol-based hand rub and proper hand washing

steps.o Consider signs to ask customers to only touch what they intend to purchase

Cleaning and Disinfection after Personssuspected/Confirmed with COVID-19 have eenin the Facility1. School, day-care Center, office, or other facility that does nothouse people overnight:

o Close off areas used by the ill persons and wait as long as practical before

beginning cleaning and disinfection to minimize potential for expbsure to

respiratory droplets.

o Open outside doors and windows to increase air circulation in the area.

o Cleaning staff should clean and disinfect all areas (e.g., offices, bathro ms, and

common areas) used by the ill persons, focusing especially on fiequently

touched surfaces.

2. At a facility that does house people overnight:o Close off areas used by the patient.

o Open outside doors and windows to increase air circulation in the area and

then- begin cleaning and disinfection.

o Cleaning staff should clean and disinfect all areas (e.g., offices, bathro<fms, and

common areas) used by the COVID-19 patient focusing espedially on

frequently touched surfaces.

o If surfaces are dirty, they should be cleaned using a detergent or soap a d water

prior to disinfection.

3. Cleaning and Disinfection of Households with People Isolated inHome Care (e.g. Suspected/Confirmed to have COVID-19)

o Clean and disinfect high-touch surfaces daily in household common areas

(e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles,

desks, toilets, sinks)o In the bedroom/bathroom dedicated for an ill person: consider reducing

cleaning frequency to as-needed (e.g., soiled items and surfaces) to avoid

unnecessary contact with the ill person.

o As much as possible, an ill person should stay in a specific room nd away

from other people in their home

o The caregiver can provide personal cleaning supplies for an ill Rerso 's room

and bathroom, unless the room is occupied by child 0.r another pG:rson for

whom such supplies would not be appropriate. These supplies incluJe tissues,

paper towels, and cleaners.

o If a separate bathroom is not available, the bathroom should be cleaned and

disinfected after each use by an ill person.

o If this is not possible, the caregiver should wait as long as practical after use by

an ill person to clean and disinfect the high-touch surfaces

Hand hygiene and other preventive measures

o Household members should clean hands often, including immediately after

removing gloves and after contact with an ill person, by washing hahds with

soap and water for 40 seconds.

o If soap and water are not available and hands are not visibly dirty, an alcohol-' 'based hand sanitizer that contains more than 70% alcohol may e used.

However, if hands are visibly dirty, always wash hands with soap and jater.

o Household members should follow normal preventive actions while at work

and home including recommended hand hygiene and avoiding touching eyes,

nose, or mouth with unwashed hands. Additional. key times to de /n hands

• Before eating or preparing food

• After contact with animals or pets

• Before and after providing routine care for another person who

needs assistance (e.g. a child)

o The ill person should eat/be fed in their room if possible. Non-disposable

food service items used should be handled with gloves and washed with hot

water or in a dishwasher. Clean hands after handling used food service items.

o If possible, dedicate a lined trash can for the ill person.

o Use gloves when removing garbage bags, handling, and disposing oftrash

How to clean and disinfect

Surfaceso Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should

be discarded properly as hazardous waste after each cleaning. If reusable

gloves are used, those gloves should be, dedicated for cleaning and disinfection

of surfaces for COVID-19 and should not be used for other purposes.

o Clean hands immediately after gloves are removed.

o If surfaces are dirty, they should be cleaned using a detergent or soap a d water

prior to disinfection.

o For disinfection, diluted household bleach solutions (in 1 hand bleach to 9

hand water mix), alcohol solutions with at least 70% alcohol, a! d most

common disinfectants should be effective.

o Diluted household blea.ch solu~ons can be ~se~ if appropriate for ~e .srface.

o Follow manufacturer's mstrucnons for application and proper ventilati In.

o Check to ensure the product is expired or not.

o Never mix household bleach /Berekina/ with ammonia or any other cleanser

or hot water

o . Unexpired household 0.5% concentration bleach will be effective against; .. (r'\'P. ~y,, . .

,, . ·~w\\l·M11~tlaviruses when properly diluted.

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o For soft (porous) surfaces such as carpeted floor, rugs, and drapes, removeIvisible contamination if present and clean with appropriate cleaners indicated

for use on these surfaces.

Healthcare settings

Patient areas

o Clean and disinfect frequently touched surfaces with detergent and disinfectant

wipe/solution between each episode of patient care (according ,J normal

infection prevention and control practice).

o Take care to clean/disinfect surfaces in areas that patients have directly in

contact with or have been exposed to respiratory droplets.

o Comply with hand hygiene at critical times.

Non-patient areas

o Perform routine cleaning of frequently touched surfac s with

detergent/disinfectant solution/wipe at least daily or when visibly dir

o Floors should be cleaned using a detergent solution

Inpatient care

o Clean and disinfect frequently touched surfaces with detergent and disinfectantI

wipe/solution at least daily or more frequently in high intensity (e.g. ICU)

o Clean and disinfect equipment after each use (as per normal infection

prevention and control practice).

o Clean and disinfect surfaces that have been in direct contact with or ex osed to

respiratory droplets between each patient episode.

Health-care setting: Recommended frequency of cleaning of environmlntal

s~.~f~ces, according to the patient areas with suspected or confirmed

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Patient area Additional Guid 'neeFrequency

Screening/ triage area At least twice daily Focus on high-touch

surfaces, then floors

(last)

Inpatient rooms

cohort - occupied

I At least twice daily,

preferably three times

daily, in particular for

high-touch surfaces

Outpatient I After each patient visit

(in particular for high­

touch surfaces) and at

least once daily terminal

clean

ambulatory care rooms

At least twice daily

Focus on high- ouch

surfaces, starting with

shared/common

surfaces, then molve to

each patient bedl use

new cloth for each bedI

if possible; then floors

(last)

High-touch surfaces to

be disinfected after

each patient visit

Once daily low-touch

surfaces, high-Jauch

surfaces, floors (ij thatI

order); waste and linens

~::o;::ou;:::i:::and disinfected

High-touch s 1faces

including railings and

equipment in hallrays,

then floors (last)

Patient bathrooms/ Private: at least twice

daily Shared toilets: at

least three times daily

High-touch surfaces,

including door hahdles,

light switches, coubters,toilets Private patient

room toilet:faucets, then sink

bowls, then toilet and

finally floor (in that

order)

General cleaning

sharing oilets

staff and

Many disinfectants are active against enveloped viruses, such as the COVI -19virus, including commonly used hospital disinfectants. Currently, WHO

recommends using:-

o 70% ethyl alcohol to disinfect small areas between uses, such as eusable

dedicated equipment (for example, thermometers);

o Sodium hypochlorite at 0.5% (equivalent to 5000 ppm) for disinfecting

surfaces

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. -r.." ~~ rl:'1 .<§'-::..o:.~' · . ry should be done and surfaces m all environments in "Thich

; ~;t ~ c\:\_D-19 cases receive care (for example, treatment units) should bei. ~'!c, ;~ -;.,::-,0...~(,,"~1: ~~"clea"ned at least once a day and when a patient is discharged.

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Cleaning and disinfection protocol for COVID-19

All individuals dealing with soiled bedding, towels and clothes from patients with

COVID-19 infection should:-

o Wear appropriate PPE before touching it, including heavy duty gloves, a

mask, eye protection (goggles or a face shield), a long-sleeved gown, hn apron

if the gown is not fluid resistant, and boots or closed shoes an1 should

perform hand hygiene after exposure to blood or body fluids Jr.d after

removing PPE.

o Soiled linen should be placed in clearly labelled, leak-proof bags or

containers, after carefully removing any solid excrement and putting it in a

covered bucket to be disposed of in a toilet or latrine.

o Machine washing with warm water at 60-90° C with laundry detergent is

recommended.

o The laundry can then be dried according to routine procedures. If machine

washing is not possible, linens can be soaked in hot water and soap in a large

drum using a stick to stir and being careful to avoid splashing.

o The drum sliould then be emptied, and the linens soaked in 0.05% chlorine

for approximately 30 minutes. Finally, the laundry should be rinsed with

clean water and the linens allowed to dry fully in sunlight.

o If excreta are on surfaces (such as linens or the floor), the excreta s ould be

carefully removed with towels and immediately safely disposed o in the

latrine. If the towels are single use, they should be treated as infectious waste;

if they are reusable, they should be treated as soiled linens. Socked wlth 0.5%

. .., , ·;;;t2'.f,1~~:~c: chlorine for 10 minutes. The area should then be cleaned and di infected· · ~~:if.'\ 11.r.'1.r4;~~@~ 1.f· ith 0.5% chlorine solution~ / ~,;.:.,* '-i-:::,

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Streets

•Cleaning and disinfection protocol for COVID-19

o Current evidence shows that streets and sidewalks are not conside ,ed to be

reservoirs of infection for COVID-19.

o Spraying or fumigation of outdoor spaces, such as streets or markletplaces,

is not recommended to kill the COVID-19 virus or other pdthogens.

Because:

• The disinfectant effectiveness is restricted by dirt and debris, and it

is not feasible to manually clean and remove all organic ma ter from

such spaces.

• The disinfection is even less effective on porous surfaces such as

sidewalks and unpaved walkways.

• It is unlikely that chemical spraying would adequately cover surfaces

allowing the required contact time to inactivate pathogens

• In addition, spraying disinfectants, even outdoors, can be harmful

for human health.

• Spraying with chlorine based disinfectants can even lie more

dangerous because it may aerosolize the virus.

Long truck vehicles

o Vehicles, like other outdoor environmental components, can be

contaminated by SARS-CoV-2 when the infected person respiratory

droplets in contact with surfaces of the car or if the contaminat !d hands

and other body parts with the virus get in contact with parts of the ehicle.

o Frequently touched surfaces of the car need to be cleaned and disinfected.

. ...,~ ,:;;. At the minimum, those commonly touched surfaces in the cal at the_. ,1·\ll.,.,.,.,, ;,le: .. I

'

;~~1-G·~\ '71.rJ7~~eginning and end of each shift and between carrying passengers iWho are

* ~ ' / t; · sibly sick need to be disinfected.~ 1 . +-:r-; ~ ?... .. ,; ·. .......... -r:::-

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Cleaning and disinfection protocol for COVID-19

o It is strongly recommended that for a long drive trucks, we need to clean

and disinfect frequently touched surfaces on a routine basis such as in the

truck cab (driver door handle, steering wheel, seat belt and buckle, arm and

headrest, seat cover, turn signal, wiper controls, dashboard, air duots, radio,

and temperature controls), in the sleeper berth (light switches, mattress

tray, temperature controls, and other flat surfaces).

o The long truck should be cleaned and disinfected at PoEs and final

destination before de-loading.

• All frequently touched parts of the truck should be disin ,ected by

wiping using a 0.5% chlorine solution wet damped cloth o through

flooding with 0.5% chlorine solution and rinsing using dete gent and

water.

• Sensitive parts of the long truck should be disinfected usi ng 70%

alcohol.

• Other parts of the truck should be washed using detergent arid water.

Spraying ofDisinfectant in a General Eriviroriment, Health C· reSetting and Dead Body Management in the Context of COVI 1 -19

For in indoor spaces, routine application of disinfectants to environmental surfaces

by spraying or fogging,is not recommended for COVID19. This is because:

o 1liese pqctices are not in line with decontamination and disinfectionprocedures as recommended. i.e : I

• Cleaning comes before disinfection as disinfectant work efficiently onclean surfaces: in spraying disinfectants, the pre-requisites of cllaning isnot met, especially in streets, public venues and healthcare facili~es, thismay lead to inactivation of the disinfectant ; this inactivation is igher inpresence of organic substances

• Spaying pressure may led to dispersion of virus in the surroundings.J,.lrl\'I! .1~,,

11with no guaranty of contact time between the virus ind the

...• ~\)1,t.·l·,1-t, ~r.'.' • • I,._,~~~ "'~~!(.,-. disinfectantsf/~~\ .. /\. 7i. Spraying environmental surfaces in both health-care and non-he th careJ. -p~- -zrR J.~ .· ettings such as patient households with disinfectants may not be. 0 (9 ..~ . '4 . \, *

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effective in removing organic material and may miss surfaces shielded by

objects, folded fabrics or surfaces with intricate designs.

o Spraying disinfectants can result in risks to the eyes, respiratory or skinirritation and the resulting health effects.

o Most disinfectants are not friendly to the environment thus can pollute it;

o Logistics and resources used to the spraying procedure can be as igned toother need and contribute to save means for more efficient evidence-based

practices; ~

Regarding public spaces, it is important to remember that a risk ana11sis mustalways be carried out before disinfecting; this would save us from 'the numerouswastage in progress or in prospect for useless and ineffective disinfection.

Prevention and Control for the safe management of a dead body in the contextof COVID-19 do not require spraying or' disinfectants; if disinfectants Jre to beapplied, this should be done with a cloth or wipe that has been soaked in disihfectant.

Spraying individuals with disinfectants (such as in a tunnel, cabinet, or , hamber)is not recommended under any circumstances. This could be physi1ally andpsychologically harmful and would not reduce an infected person's ability o spreadthe virus through droplets or contact. Moreover, spraying individuals with chlorineand other toxic chemicals could result in eye and skin irritation, bronchospas due toinhalation, and gastrointestinal effects such as nausea and vomiting.

•Cleaning and disinfection protocol for COVID-19

• Annex: How to prepare a bleach solution(0.5°/o chlorine solution)

1. Formula for making a dilute solution from a concentrated solution

• Check concentration (% concentrate) of the chlorine solution.

• Determine total parts ofwater using the formula below.

r% Concentrate l

Total Parts (TP)of water= - 1% Dilute

• Mix 1part concentrated bleach with the total parts water required. I

Example: Make a dilute solution (0.5%) from 5% concentrated solution

STEP 1: Calculate TP water

f 5 % rTotal Parts (TP)of water= --. - 10.5 %

= 9

STEP 2: Take 1 part concentrated solution and add to 9 pars water.

2. Formula for making a dilute solution form a dry powder

• Check concentration(% concentrate) of the powder you are using.

• Determine amount of chlorine (gm.) to be add in a liter of wa er using

the formula below.

r% Dilute lGmfLi: = * 1000

% Concentrate

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Example: Make a dilute chlorine solution (0.5%) from a concentrated powder

(35%)

•

STEP 1: Calculate grams/liter:

Gm/Lit = rO.S % l• * 1,00035%

= 14.2 gm/lit

STEP 2: Add 14.2 grams to 1 liter ofwater

Table 2. Volume of chlorine and water needed for preparing bleach sol ition

Concentration ofcommercially availableh ochlorite solution

Required chlorineConcentration

5%0.50%

1

To re are 1000 mlBleach in ml water injml

400 I 600200 800100 90050 950

100 900200 800

10%2

Preparation of'.dilute solutions of bleachin owder

Strength of bleachingowder Volume ofwater

1 litre20%

1 litre

25%

Desired concentration0.50%

1%2%5%10%0.50%1% 1402% [805% 200

I

10 400I

0.50% 1171% ,32% 167I

5% 16710 $33

I

1 litre

1 litre 0.50% .14

10

~4.3~8.5/71/143

1%

70% 2%5%

•Cleaning and disinfection protocol for COVID-19