National Center for Emerging and Zoonotic Infectious Diseases

Environmental Cleaning in Healthcare Facilities In the Context of COVID-19

Molly Patrick, MEng

Environmental Engineer

US Centers for Disease Control and Prevention

International Infection Control Program

Global Webinar Series

25 June 2020

Disclosure

I have no financial relationships with commercial entities producing healthcare related products and/or services

Disclaimer

The content of this presentation references the new research and current recommendations in WHO guidance. The content is subject to revision as new evidence on COVID-19 becomes available.

Objectives

▪ Provide brief overview of role of environmental reservoirs (fomites) and environmental cleaning in control of COVID-19

▪ Review key resources for environmental cleaning in context of COVID-19

▪ Emphasize the key messages for environmental cleaning in context of COVID-19

Importance of environmental cleaning in control of COVID-19

▪ Main transmission mode is respiratory droplets (droplet transmission)

▪ Droplets may also land on environmental surfaces – the immediate environment of an

infected individual could serve as a reservoir (contact transmission)

▪ Environmental cleaning and hand hygiene key interventions

Chain of Infection Environmental

cleaning

Hand hygiene

What do we know about environmental survival of SARS-CoV-2? ▪ SARS-CoV-2 (laboratory studies):

– 2-7 days (wood 2 days; plastic and stainless steel 7 days) (Chin et al, 2020)

– ~ 4 days (plastic and stainless steel) (van Doremalen et al, 2020)

▪ Many clinically important healthcare pathogens can survive on surfaces for days to possibly months– Laboratory-based studies

▪ Actual survival based on temperature, humidity, surface type and other factors

(Dancer, 2014 adapted from Kramer, 2006)

(van Doremalen et al, 2020)

What do we know about coronaviruses susceptibility to disinfectants? ▪ Human coronaviruses (laboratory

study): – 0.1% sodium hypochlorite

– 62-71% ethanol

▪ US EPA List N – https://www.epa.gov/pesticide-registration/list-n-

disinfectants-use-against-sars-cov-2-covid-19

▪ Enveloped viruses highly susceptible to disinfectants

▪ Need to consider other healthcare pathogens when selecting disinfectants

Global technical resources – environmental cleaning in context of COVID-19

▪ WHO Interim guidance

– Healthcare and community

– Methods• Disinfectants

• Frequency

• Best practices

▪ Global Webinars– https://www.washinhcf.org/resource/covid-19-webinar-series-environmental-cleaning/

– https://www.youtube.com/watch?v=lGg5yhZnrnw&feature=youtu.be

Key documents for general environmental cleaning in all healthcare settings

Other resources

Source: https://vietnamtimes.org.vn/more-covid-mobile-disinfection-chambers-launched-in-vietnam-18593.html

Source: PAHO -https://iris.paho.org/handle/10665.2/52066https://iris.paho.org/handle/10665.2/433

Source: ICAN -https://www.icanetwork.co.za/download/guidelines/PositionStatement_disinfection_humans_v2.pdf

LSHTM Hygiene Hub -https://resources.hygienehub.info/en/collections/2270357-surfaces-and-disinfection

Key messages for environmental cleaning in context of COVID-19

1. Environmental cleaning can mitigate the spread of COVID-19 in healthcare settings (contact transmission route)

2. SARS-CoV-2 can survive on some environmental surfaces for days, but environmental survival is low compared to many other important healthcare-associated pathogens

3. Environmental cleaning using existing best practice methods and strategies is effective against SARS-CoV-2

4. SARS-CoV-2 is susceptible to standard cleaning and disinfectant products (enveloped virus)

References ▪ CDC and ICAN (2019) Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US

Department of Health and Human Services, CDC; 2019. Available at: https://www.cdc.gov/hai/prevent/resource-limited/index.html

▪ EPA (2020) https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19

▪ WHO (2020) https://www.who.int/publications/i/item/cleaning-and-disinfection-of-environmental-surfaces-inthe-context-of-covid-19

▪ WHO (2020) https://www.who.int/publications/i/item/water-sanitation-hygiene-and-waste-management-for-the-covid-19-virus-interim-guidance

▪ WHO (2019) Implementation manual to prevent and control the spread of carbapenem-resistant organisms at the national and health care facility level https://apps.who.int/iris/bitstream/handle/10665/312226/WHO-UHC-SDS-2019.6-eng.pdf

▪ WHO (2008) Essential environmental health standards in health care. https://www.who.int/water_sanitation_health/publications/ehs_hc/en/

▪ Chin, A.W.H., Chu, J.T.S., Perera, M.R.A., Hui, K.P.Y., Yen, H.-L., Chan, M.C.W., et al., 2020. Stability of SARS-CoV-2 in different environmental conditions. The Lancet Microbe S2666524720300033. (https://doi.org/10.1016/S2666-5247(20)30003-3)

▪ Dancer S.J., 2014. Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination. Clinical Microbiology Reviews 27 (4). doi:10.1128/CMR.00020-14

▪ van Doremalen, N., Bushmaker, T., Morris, D.H., Holbrook, M.G., Gamble, A., Williamson, B.N., et al., 2020. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 382, 1564–1567. (https://doi.org/10.1056/NEJMc2004973)

▪ Ye, G., Lin, H., Chen, L., Wang, S., Zeng, Z., Wang, W., et al., 2020. Environmental contamination of the SARS-CoV-2 in healthcare premises: An urgent call for protection for healthcare workers (preprint). Infectious Diseases (except HIV/AIDS). (https://doi.org/10.1101/2020.03.11.20034546 )

For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.