The University of Hong Kong Recommendations on Cleaning / Disinfection for Infection Control

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1 The University of Hong Kong Recommendations on Cleaning / Disinfection for Infection Control Author University Health Service, The University of Hong Kong Approved By Task Force on Infectious Diseases, The University of Hong Kong Effective Date May 20, 2013 Version 1 (May 20, 2013)

2 Recommendations on Cleaning / Disinfection for Page Page 1 of 16 Table of Contents Page 1 Alert Response Level 2 A. Cleaning/ Disinfection Standard 2 B. Self- Protective Measures for Cleaning Staff 4 C. General Inspection 5 2 Serious Response Level 7 A. Cleaning/ Disinfection Standard 7 B. Self- Protective Measures for Cleaning Staff 9 C. General Inspection 10 3 Emergency Response Level 12 A. Cleaning/ Disinfection Standard 12 B. Self- Protective Measures for Cleaning Staff 14 C. General Inspection 15

3 Recommendations on Cleaning / Disinfection for Page Page 2 of 16 Recommendations on Cleaning / Disinfection for Infection Control There are Three Response levels in HKSAR Government s Preparedness Plan for Influenza Pandemic (2012): 1. Alert Response Level 2. Serious Response Level 3. Emergency Response Level 1. Alert Response Level Alert Response Level corresponds to a situation where the risk of a novel influenza virus causing new and serious health impact in Hong Kong is LOW. HKU Cleaning / Disinfection Recommendations at Alert Response Level After cleaning and disinfection with diluted bleach, it is necessary to re-wipe with clean water in 15 to 30 minutes unless specified. A. Cleaning / Disinfection Standard 1. Lift cars and escalators Disinfect and wipe clean lift cars, escalator handrails with a cloth soaked with diluted household bleach (1 part of bleach with 99 parts of water) regularly. 2. Lobby entrance areas Disinfect and wipe clean main building entrances, doorknobs and handles, security locks and buttons with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 3. Enquiry counters Disinfect and wipe clean counter surfaces, commonly used stationary with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 4. Corridors, staircases and floors Disinfect and mop clean corridors, staircases and floors with diluted household bleach (1 part of bleach to 99 parts of water) regularly;

4 Recommendations on Cleaning / Disinfection for Page Page 3 of Public facilities Disinfect and wipe clean public facilities such as chairs, resting area, public phones, vending machines, information kiosks and handrails with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 6. Outdoor environmental surface Clean the potentially contaminated environmental surfaces regularly and rinse with water in 30 minutes. e.g. floor, platform, stairs with diluted household bleach (1 part of bleach to 49 parts of water). If contaminated by dead birds or their excreta, use 1:4 diluted household bleach. Leave the bleach for 30 minutes and then rinse with water. 7. Workplace Disinfect and wipe clean commonly-used furniture and equipment, including telephones, window handles, intercoms, computer keyboards, printers, fax machines, trolleys with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Clear and clean dustbins regularly with protective gloves and surgical mask on. Vacuum carpets regularly. Disinfect and mop floors with diluted household bleach (1:99) regularly and keep it dry. 8. Lecture theatres and classrooms (in active use) Disinfect and wipe clean all desks and chairs with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Vacuum carpets regularly. Disinfect and mop floors with diluted household bleach (1:99) regularly. 9. Toilets Disinfect and wipe clean the lids, seats and rims of the toilets with a cloth soaked with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Disinfect and wipe clean hand soap dispensers, toilet roll dispensers, hand dryers and cubicle doorknobs with diluted household bleach (1:99) regularly. Pour some household bleach into the toilet bowels weekly or place

5 Recommendations on Cleaning / Disinfection for Page Page 4 of 16 self-dissolving bleach block in the main flushing water tanks. Pour diluted household bleach (1:99) into urinals weekly. Pour about half a litre of water into each floor drain outlet at least once a week. Then pour a teaspoon of diluted household bleach (1:99) into the drain outlet. Wait for 30 to 60 minutes to allow disinfection by bleach solution to take effect. Finally, pour another half a litre of water into the drain. Make sure the trap is not dry. 10. Refuse collection rooms Disinfect and wash floors, walls and collection bins with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 11. Washing facilities drains Pour about half a litre of water into all the drain outlets including drain outlets of less frequently used facilities at least once a week. Then pour a teaspoon of diluted household bleach (1:99) into the drain outlet. Wait for 30 to 60 minutes to allow disinfection by bleach solution to take effect. Finally, pour another half a litre of water into the drain outlet again to prevent the odour of bleach solution coming out. Make sure the trap is not dry. 12. Public transport Clean the bus compartments, seats guardrails, air ducts and vents with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Clean the bus air-conditioning system and filters with diluted household bleach. No pets and animals are allowed on buses. B. Self-Protective Measures for Cleaning Staff (a) Routine Cleaning/Disinfection Wear surgical face mask and cleaning gloves. Wash hands before and after wearing the mask and gloves. Wash hands before and after touching the mask. Replace the mask 1-2 times per day or as soon as it has become damaged/ contaminated. Dispose the used mask into a plastic or paper bag and then to a covered bin. Clean the cleaning cloth with bleach after cleaning/disinfection as

6 Recommendations on Cleaning / Disinfection for Page Page 5 of 16 appropriate. Wash hands with liquid soap frequently, particularly so after each cleaning operation. If cleaning respiratory secretions, vomitus, excreta or body fluid, use 1:49 diluted household bleach solution. Leave the bleach for 30 minutes, then rinse with water. If contaminated by blood, use 1:4 diluted household bleach. Leave the bleach for 10 minutes, then rinse with water. (b) Routine Cleaning/Disinfection of high risk areas e.g. patient toilets Wear surgical face mask, cleaning gloves and goggles. Wear disposable plastic apron. Wash hands before and after wearing the mask and gloves. Wash hands before and after touching the mask. Replace the mask after each cleaning or as soon as it has become damaged/ contaminated. Dispose the used mask into a plastic bag and put same into a covered bin. Clean the cleaning cloth with bleach after cleaning/disinfection as appropriate. Wash hands with liquid soap frequently, particularly so after each cleaning operation. Take a shower from hair to toe and change clothes at the close of each working day. If cleaning respiratory secretions, vomitus, excreta or body fluid, clean the visible matter with disposable absorbent material wetted with 1:49 diluted household bleach solution. Leave for 10 minutes, then rinse with water. If contaminated by blood, clean the visible matter with disposable absorbent material wetted with 1:4 diluted household bleach. Leave for 10 minutes, then rinse with water. C. General Inspection Ensure soil and waste pipes function properly. Any abnormal water splashing should be reported for rectification. Ensure the drain pipes have no cracks or defects. Repair immediately if there is defect in the trap or foul odour coming out from the drain outlets. Ensure refuse is not accumulated in common areas such as corridors, rooftops, staircases or lift pits.

7 Recommendations on Cleaning / Disinfection for Page Page 6 of 16 Look for signs of pest infestation (e.g. rodent droppings, cockroaches, stagnant water) and, if present, clean immediately. Engage pest control if necessary. Ensure all water storage tanks are properly covered and that there is no overflow. Ensure all ventilation system function properly and are cleaned and maintained regularly to prevent accumulation of dust and dirt.

8 Recommendations on Cleaning / Disinfection for Page Page 7 of Serious Response Level Serious Response Level corresponds to a situation where the risk of a novel influenza virus causing new and serious impact to human health in Hong Kong is MODERATE. HKU Cleaning / Disinfection Recommendations at Serious Response Level After cleaning and disinfection with diluted bleach, it is necessary to re-wipe with clean water in 15 to 30 minutes unless specified. A. Cleaning / Disinfection Standard 1. Lift cars and escalators Disinfect and wipe clean lift cars, escalator handrails with a cloth soaked with diluted household bleach (1 part of bleach with 99 parts of water) regularly. 2. Lobby entrance areas Disinfect and wipe clean main building entrances, doorknobs and handles, security locks and buttons with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 3. Enquiry counters Disinfect and wipe clean counter surfaces, commonly used stationary with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 4. Corridors, staircases and floors Disinfect and mop clean corridors, staircases and floors with diluted household bleach (1 part of bleach to 99 parts of water) regularly; 5. Public facilities Disinfect and wipe clean public facilities such as chairs, resting area, public phones, vending machines, information kiosks and handrails with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 6. Outdoor environmental surface Clean the potentially contaminated environmental surfaces regularly and rinse with water in 30 minutes. e.g. floor, platform, stairs with diluted

9 Recommendations on Cleaning / Disinfection for Page Page 8 of 16 household bleach (1 part of bleach to 49 parts of water). If contaminated by dead birds or their excreta, use 1:4 diluted household bleach. Leave the bleach for 30 minutes and then rinse with water. 7. Workplace Disinfect and wipe clean commonly-used furniture and equipment, including telephones, window handles, intercoms, computer keyboards, printers, fax machines, trolleys with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Clear and clean dustbins regularly with protective gloves and surgical mask on. Vacuum carpets regularly. Disinfect and mop floors with diluted household bleach (1:99) regularly and keep it dry. 8. Lecture theatres and classrooms (in active use) Disinfect and wipe clean all desks and chairs with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Vacuum carpets regularly. Disinfect and mop floors with diluted household bleach (1:99) regularly. 9. Toilets Disinfect and wipe clean the lids, seats and rims of the toilets with a cloth soaked with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Disinfect and wipe clean hand soap dispensers, toilet roll dispensers, hand dryers and cubicle doorknobs with diluted household bleach (1:99) regularly. Pour some household bleach into the toilet bowels weekly or place self-dissolving bleach block in the main flushing water tanks. Pour diluted household bleach (1:99) into urinals weekly. Pour about half a litre of water into each floor drain outlet at least once a week. Then pour a teaspoon of diluted household bleach (1:99) into the drain outlet. Wait for 30 to 60 minutes to allow disinfection by bleach solution to take effect. Finally, pour another half a litre of water into the drain. Make sure the trap is not dry.

10 Recommendations on Cleaning / Disinfection for Page Page 9 of Refuse collection rooms Disinfect and wash floors, walls and collection bins with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 11. Washing facilities drains Pour about half a litre of water into all the drain outlets including drain outlets of less frequently used facilities at least once a week. Then pour a teaspoon of diluted household bleach (1:99) into the drain outlet. Wait for 30 to 60 minutes to allow disinfection by bleach solution to take effect. Finally, pour another half a litre of water into the drain outlet again to prevent the odour of bleach solution coming out. Make sure the trap is not dry. 12. Public transport Clean the bus compartments, seats guardrails, air ducts and vents with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Clean the bus air-conditioning system and filters with diluted household bleach. No pets and animals are allowed on buses. B. Self-Protective Measures for Cleaning Staff (a) Routine Cleaning/Disinfection Wear surgical face mask and cleaning gloves. Wash hands before and after wearing the mask and gloves. Wash hands before and after touching the mask. Replace the mask 1-2 times per day or as soon as it has become damaged/ contaminated. Dispose the used mask into a plastic or paper bag and then to a covered bin. Clean the cleaning cloth with bleach after cleaning/disinfection as appropriate. Wash hands with liquid soap frequently, particularly so after each cleaning operation. If cleaning respiratory secretions, vomitus, excreta or body fluid, use 1:49 diluted household bleach solution. Leave the bleach for 30 minutes, then rinse with water. If contaminated by blood, use 1:4 diluted household bleach. Leave the bleach for 10 minutes, then rinse with water.

11 Recommendations on Cleaning / Disinfection for Page Page 10 of 16 (b) Routine Cleaning/Disinfection of high risk areas e.g. patient toilets Wear surgical face mask, cleaning gloves and goggles. Wear disposable plastic apron. Wash hands before and after wearing the mask and gloves. Wash hands before and after touching the mask. Replace the mask after each cleaning or as soon as it has become damaged/ contaminated. Dispose the used mask into a plastic bag and put same into a covered bin. Clean the cleaning cloth with bleach after cleaning/disinfection as appropriate. Wash hands with liquid soap frequently, particularly so after each cleaning operation. Take a shower from hair to toe and change clothes at the close of each working day. If cleaning respiratory secretions, vomitus, excreta or body fluid, clean the visible matter with disposable absorbent material wetted with 1:49 diluted household bleach solution. Leave for 10 minutes, then rinse with water. If contaminated by blood, clean the visible matter with disposable absorbent material wetted with 1:4 diluted household bleach. Leave for 10 minutes, then rinse with water. (c) Cleaning/Disinfection of Areas with Suspected or Confirmed Cases (as advised by CHP or UHS) Wear Full Personal Protective Equipment (PPE): type of mask as advised by CHP or UHS, overall protective clothings, gloves, goggles and shoe protection. Follow gowning and degowning procedure. Take a shower from hair to toe and change clothes at the close of each working day. C. General Inspection Ensure soil and waste pipes function properly. Any abnormal water splashing should be reported for rectification. Ensure the drain pipes have no cracks or defects. Repair immediately if there is defect in the trap or foul odour coming out from the drain outlets. Ensure refuse is not accumulated in common areas such as corridors,

12 Recommendations on Cleaning / Disinfection for Page Page 11 of 16 rooftops, staircases or lift pits. Look for signs of pest infestation (e.g. rodent droppings, cockroaches, stagnant water) and, if present, clean immediately. Engage pest control if necessary. Ensure all water storage tanks are properly covered and that there is no overflow. Ensure all ventilation system function properly and are cleaned and maintained regularly to prevent accumulation of dust and dirt.

13 Recommendations on Cleaning / Disinfection for Page Page 12 of Emergency Response Level Emergency Response Level corresponds to a situation where the risk of a novel influenza virus causing new and serious impact to human health in Hong Kong is HIGH and IMMINENT. HKU Cleaning / Disinfection Recommendations at Emergency Response Level After cleaning and disinfection with diluted bleach, it is necessary to re-wipe with clean water in 15 to 30 minutes unless specified. A. Cleaning / Disinfection Standard 1. Lift cars and escalators Disinfect and wipe clean lift cars, escalator handrails with a cloth soaked with diluted household bleach (1 part of bleach with 99 parts of water) every 2 hours. 2. Lobby entrance areas Disinfect and wipe clean main building entrances, doorknobs and handles, security locks and buttons with diluted household bleach (1 part of bleach to 99 parts of water) every 2 hours. 3. Enquiry counters Disinfect and wipe clean counter surfaces, commonly used stationary with diluted household bleach (1 part of bleach to 99 parts of water) every 2 hours. 4. Corridors, staircases and floors Disinfect and mop clean corridors, staircases and floors with diluted household bleach (1 part of bleach to 99 parts of water) regularly; 5. Public facilities Disinfect and wipe clean public facilities such as chairs, resting area, public phones, vending machines, information kiosks and handrails with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 6. Outdoor environmental surface Clean the potentially contaminated environmental surfaces daily and rinse

14 Recommendations on Cleaning / Disinfection for Page Page 13 of 16 with water in 30 minutes. e.g. floor, platform, stairs with diluted household bleach (1 part of bleach to 49 parts of water). If contaminated by dead birds or their excreta, use 1:4 diluted household bleach. Leave the bleach for 30 minutes and then rinse with water. 7. Workplace Disinfect and wipe clean commonly-used furniture and equipment, including telephones, window handles, intercoms, computer keyboards, printers, fax machines, trolleys with diluted household bleach (1 part of bleach to 99 parts of water) daily and increase the frequency as circumstances required. Clear and clean dustbins regularly with protective gloves and surgical mask on. Vacuum carpets daily and increase the frequency as circumstances required. Disinfect and mop floors with diluted household bleach (1:99) regularly and keep it dry. 8. Lecture theatres and classrooms (in active use) Disinfect and wipe clean all desks and chairs with diluted household bleach (1 part of bleach to 99 parts of water) regularly and increase the frequency as circumstances required. Vacuum carpets daily. Disinfect and mop floors with diluted household bleach (1:99) daily and increase the frequency as circumstances required. 9. Toilets Disinfect and wipe clean the lids, seats and rims of the toilets with a cloth soaked with diluted household bleach (1 part of bleach to 99 parts of water) regularly. Disinfect and wipe clean hand soap dispensers, toilet roll dispensers, hand dryers and cubicle doorknobs with diluted household bleach (1:99) regularly. Pour some household bleach into the toilet bowels weekly or place self-dissolving bleach block in the main flushing water tanks. Pour diluted household bleach (1:99) into urinals weekly. Pour about half a litre of water into each floor drain outlet at least once a week. Then pour a teaspoon of diluted household bleach (1:99) into the

15 Recommendations on Cleaning / Disinfection for Page Page 14 of 16 drain outlet. Wait for 30 to 60 minutes to allow disinfection by bleach solution to take effect. Finally, pour another half a litre of water into the drain. Make sure the trap is not dry. 10. Refuse collection rooms Disinfect and wash floors, walls and collection bins with diluted household bleach (1 part of bleach to 99 parts of water) regularly. 11. Washing facilities drains Pour about half a litre of water into all the drain outlets including drain outlets of less frequently used facilities at least once a week. Then pour a teaspoon of diluted household bleach (1:99) into the drain outlet. Wait for 30 to 60 minutes to allow disinfection by bleach solution to take effect. Finally, pour another half a litre of water into the drain outlet again to prevent the odour of bleach solution coming out. Make sure the trap is not dry. 12. Public transport Clean the bus compartments, seats guardrails, air ducts and vents with diluted household bleach (1 part of bleach to 99 parts of water) daily. Clean the bus air-conditioning system and filters with diluted household bleach. No pets and animals are allowed on buses. B. Self-Protective Measures for Cleaning Staff (a) Routine Cleaning/Disinfection Wear surgical face mask and cleaning gloves. Wash hands before and after wearing the mask and gloves. Wash hands before and after touching the mask. Replace the mask 1-2 times per day or as soon as it has become damaged/ contaminated. Wear disposable plastic apron for toilet cleaning and change daily. Dispose the used mask into a plastic or paper bag and then into a covered bin. Clean the cleaning cloth with bleach after cleaning/disinfection as appropriate. Wash hands with liquid soap frequently, particularly so after each cleaning

16 Recommendations on Cleaning / Disinfection for Page Page 15 of 16 operation. If cleaning respiratory secretions, vomitus, excreta or body fluid, use 1:49 diluted household bleach solution. Leave the bleach for 30 minutes, then rinse with water. If contaminated by blood, use 1:4 diluted household bleach. Leave the bleach for 10 minutes, then rinse with water. (b) Cleaning/Disinfection of Areas with Suspected or Confirmed Cases (as advised by CHP or UHS) Wear Full Personal Protective Equipment (PPE): type of mask as advised by CHP or UHS, overall protective clothings, gloves, goggles and shoe protection. Follow gowning and degowning procedure. Take a shower from hair to toe and change clothes at the close of each working day. C. General Inspection Ensure soil and waste pipes function properly. Any abnormal water splashing should be reported for rectification. Ensure the drain pipes have no cracks or defects. Repair immediately if there is defect in the trap or foul odour coming out from the drain outlets. Ensure refuse is not accumulated in common areas such as corridors, rooftops, staircases or lift pits. Look for signs of pest infestation (e.g. rodent droppings, cockroaches, stagnant water) and, if present, clean immediately. Engage pest control if necessary. Ensure all water storage tanks are properly covered and that there is no overflow. Ensure all ventilation system function properly and are cleaned and maintained regularly to prevent accumulation of dust and dirt.