Environmental Cleaning Guidance for Potential Ebola Contamination for Non-healthcare Settings

This guidance note is intended to give advice for the cleaning and decontamination of surfaces and objects that may have been potentially infected/contaminated by a suspected or confirmed case of Ebola virus disease (EVD) in a settings other than healthcare facilities.

There is an extensive, ongoing outbreak of Ebola virus disease (EVD) in West Africa, affecting a number of countries. Such is the extent of this current outbreak, that the World Health Organization has declared the situation to be a public health emergency of international concern. It remains unlikely but not impossible that a returning traveller could introduce the disease into Ireland. Ebola is caused by infection with a virus which is spread by direct contact with blood and body fluids from infected people.

Most people who get infected with EVD have had close contact with a person with symptomatic Ebola infection and have not used appropriate personal protective equipment. The risk of acquiring Ebola virus from the environment is very low, and is negligible if appropriate personal protective equipment (gloves etc – see below) is used.

Contaminated Surfaces and objects

People infected with Ebola are infectious only once they have developed symptoms. These include fever, headache, diarrhoea and vomiting. Once symptomatic, all body fluids such as blood, urine, faeces, vomitus, sweat, saliva and semen are infectious. Using appropriate precautions, the following should be cleaned:
•All surfaces and objects which are visibly contaminated with body fluids
•All potentially contaminated areas where the suspected/confirmed Ebola case has been once he/she has become symptomatic, including toilets and other high contact surfaces such as door handles and telephones
•Clothing and linen used by the suspected/confirmed case should be set aside pending assessment by a healthcare professional

Public areas where the suspected/confirmed Ebola case has passed through and spent minimal time in (such as corridors) but which are not visibly contaminated with body fluids do not need to be specially cleaned and disinfected.

Precautions to be taken by people carrying out cleaning procedures associated with suspected and confirmed cases of Ebola
•Broken skin should be covered with waterproof dressings (eg cuts with plasters)
•Closed shoes should be worn during the cleaning procedures
•Arms and legs should be covered – long sleeves tucked into gloves and trousers tucked into socks
•Gloves should be worn and disposed of after the cleaning is completed
•Care should be taken to avoid splashing of body fluids
•Disposable cleaning materials such as mops, paper towels and cloths should be used
•Hands should be thoroughly and completely washed with soap and water after the cleaning is completed and immediately after gloves are removed.

If any clothes become splashed by body fluids, remove them immediately and shower. Soiled clothing should be managed as detailed below. Inform your GP – you will be given advice about monitoring for symptoms as appropriate. Most suspected cases are very unlikely to have Ebola infection 

Cleaning of surfaces and objects
Surfaces and objects which are not visibly soiled should be cleaned with detergent/soap and water, allowed to dry and then disinfected.

For visibly soiled surfaces and objects, body fluids should be wiped away with disposable towels until they are visibly clean, cleaned with detergent/soap and water, allowed to dry and then disinfected. Toilets, including flush and door handles, should be also be disinfected. Bleach is a suitable disinfectant. Typical household bleach needs to be diluted before use – mix1 25mls (generally 5 capfuls) to 5 litres of water. For flat surfaces like floors, bleach should be left for a few minutes before wiping off to maximise its action. Wipe dry with paper towels. Avoid direct contact between bleach and skin/eyes. Do not mix bleach with anything other than cold tap water. Put all non-essential soiled items in to impermeable waste bags, secure and put aside in a safe undisturbed place until the suspected case has been assessed by a healthcare professional.

Soft furnishings and mattresses do not need to be specially cleaned if they are not visibly soiled. If soiled, they should be put aside in an undisturbed room until the suspected case has been assessed by a healthcare professional.

Clothing, linen and other objects

Clothing, linen and other objects such as telephones should be put in to impermeable waste bags, secured and stored in a safe undisturbed place until the suspected case has been assessed by a healthcare professional.

Waste

All waste, including used cleaning equipment such as gloves, paper towels and mops, should be put into impermeable waste bags, secured and stored in a safe undisturbed place until the suspected case has been assessed by a healthcare professional. Advice on its disposal should be sought from the local Department of Public Health.

Actions after the suspected case has been assessed

Most suspected cases in the Ireland are unlikely to have Ebola. Waste and other objects including clothing should be kept aside until the suspected case has been assessed by a health care professional. This is likely to take a day or two in most circumstances. If Ebola is felt to be unlikely in the suspected case after a thorough risk assessment by a health professional , no further special action needs to be taken for the waste and isolated objects.