Interim Guidance for Environmental Infection Control in Hospitals

Key Points

This guidance refers only to the following viral hemorrhagic fevers: Ebola, Marburg, Lassa, Crimean Congo Hemorrhagic Fever (CCHF), and the South American Hemorrhagic Fevers (i.e., those caused by Junin, Machupo, Chapare, Guanarito and Sabia viruses). Refer to the pathogen-specific pages for further information about the individual pathogens (e.g., signs and symptoms, incubation periods, routes of transmission, diagnosis, treatments).

Who this is for: Healthcare personnel in any US hospital. The guidance is most relevant for hospital staff caring for a patient who is suspected or confirmed to have one of the selected viral hemorrhagic fevers (VHFs).

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

As part of the care of patients suspected or confirmed to have one of the VHFs, hospitals are recommended to:

• Ensure healthcare personnel have been trained and evaluated in all recommended protocols to safely care for patients with VHF before they enter the patient care area.
• Ensure healthcare personnel, including 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.

• Except for Chapare virus*, these selected hemorrhagic fever viruses are classified as a Category A infectious substance. Any item that is (1) contaminated or suspected of being contaminated with a Category A infectious substance and (2) transported offsite for disposal must be packaged and transported in accordance with the U.S. Department of Transportation's (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180).
  • This may include 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 cleaning byproducts contaminated or suspected of being contaminated with a Category A infectious substance.
  • *See U.S. Interagency Planning Guidance for Handling Category A Solid Waste and Handling VHF-Associated Waste for additional details.

• Use a U.S. Environmental Protection Agency (EPA) registered hospital disinfectant from List Q (for Ebola, products from List L can also be used) to disinfect environmental surfaces. Use cleaning and disinfecting products according to label instructions.
• Routinely clean and disinfect 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. Cleaning may be achieved by having another healthcare worker who has just donned their full PPE clean the doffing area and then move from cleaner to dirtier areas within the doffing area.
  • When cleaning and disinfection are complete, the healthcare worker should carefully doff PPE and perform hand hygiene.
• Regularly clean and disinfect surfaces in the patient care area, even in the absence of visible contamination.
  • Immediately clean and disinfect any visible contamination of surfaces or equipment.
  • Clean and disinfect hard, nonporous surfaces daily, including high touch surfaces (e.g., bed rails, over bed tables), counters, and floors.
  • 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.
  • Only nurses or physicians should clean and disinfect surfaces in the patient care areas to limit the number of additional healthcare personnel who enter the room.
• 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 patients who are suspected or confirmed to have VHFs in carpeted rooms.
  • Remove all upholstered furniture and decorative curtains from patient rooms before use.
• 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.
• 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). CDC guidelines recommend removal of bulk spill matter, cleaning the site, and then disinfecting the site. 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. A U.S. EPA registered hospital disinfectant from List Q (for Ebola, products from List L can also be used) should be used according to its directions for use for cleaning and decontaminating surfaces or objects soiled with blood or body fluids.