Interim Guidance for Cleaning Passenger and Cargo Vessels during an Influenza Pandemic

Following are general guidelines for cleaning a passenger or cargo vessel that has carried a traveler (passenger or crew) who is suspected to have pandemic influenza. The purpose of these guidelines is to provide a basic framework of response. This document is directed toward those individuals who are responsible for shipboard health and safety. This guidance may be modified or additional procedures may be recommended by the Centers for Disease Control and Prevention (CDC) as part of the evaluation of an ill traveler, when an influenza pandemic is identified anywhere in the world or in the United States, or as new information about a pandemic strain becomes available.

This guideline does not address issues such as influenza surveillance, treatment, isolation, or chemoprophylaxis guidelines for shipboard use. Those issues are addressed in the CDC document “Preliminary Guidelines for the Prevention and Control of Influenza-Like Illness Among Passengers and Crew Members on Cruise Ships.” That document is available on-line.

Influenza viruses can persist on nonporous surfaces for 24 hours or more, but quantities of the virus sufficient for human infection are likely to persist for shorter periods. Although the relative importance of virus transfer from inanimate objects to humans in spreading influenza is not known, hand transfer of the virus to the mucous membranes of the eyes, nose, and mouth resulting in infection is likely to occur. Hand hygiene¹, cough etiquette and respiratory hygiene² are the principal means of interrupting this transmission. Routine cleaning and disinfection practices also play a role in minimizing the spread of influenza.

The basic components of effective environmental management of influenza include routine cleaning with soap or detergent in water to remove soil and organic matter, followed by the proper use of disinfectants. Reducing the number of influenza virus particles on a surface through these steps can reduce the chances of hand transfer of virus. Influenza viruses are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial sources. Disinfectants marketed in the United States are required to be registered by the U.S. Environmental Protection Agency (EPA). These products must be used in accordance with their label instructions; following label instructions is necessary to achieve adequate efficacy and to avoid unreasonable adverse effects.

Routine cleaning methods should be employed throughout the vessel with special attention in certain areas as specified below:

1. Cleaning personnel should wear non-sterile, disposable gloves that are recommended by the manufacturer of the detergent/disinfectant while cleaning or handling cleaning and disinfecting solutions. The use of sterile gloves is not required. Never wash or reuse the gloves. Avoid activities that generate infectious aerosols. Eye protection, such as a faceshield or goggles, may be required if splashing is expected.
2. Use only EPA-registered disinfectants (including detergent/disinfectants) with label claims for influenza A virus. Clean the surface first with detergent and water, and then apply the disinfectant as instructed on the disinfectant manufacturer’s label. Ensure adequate contact time for effective disinfection. Adhere to any safety precautions or other label recommendations as directed (e.g., allowing adequate ventilation in confined areas such as lavatories and proper disposal of unused product or used containers). Avoid using product application methods that cause splashing or generate aerosols. Use only EPA-registered food contact products on sites where consumable food products are placed and stored in kitchens and restaurants.
3. Cleaning activities should be supervised and inspected periodically to ensure correct procedures are followed to minimize the risk of cross-contamination from “dirty” to “clean” areas.
4. Cleaning and disinfection procedures should cover all areas, for example:
   All passenger and crew public areas, including:
   • Restaurants, kitchens
   • Public toilets
   • Bars, lounges
   • Showrooms
   • Casinos, game rooms, and similar facilities
5. All passenger and crew private areas, including:
   • Cabins and bathrooms
   • All crew toilets
6. Procedures should include cleaning and disinfection of all nonporous general hand contact surfaces, for example:
   • Door handles
   • Hand rails
   • Elevator buttons
   • Telephones
   • Keyboards
   • Tabletops
   • Chair arms, hand rails
   • Toilet flush handles
   • Faucet handles
   • Equipment handles
   • Slot machines
   • Sports equipment and other similar equipment
7. Procedures should cover indoor facilities, for example:
   • Gymnasiums
   • Swimming pool decks
   • Lounge chairs
   • Children’s clubs, nurseries and similar facilities
8. Outdoor facilities need only be cleaned. Swimming pools should be properly chlorinated.
9. Emesis (vomit), or feces should be immediately covered with an absorbent gelling powder (designed for spills of bodily fluids) or if this is not available, disposable paper towels/cloths. Wearing impermeable, disposable gloves that are recommended by the manufacturer of the detergent/disinfectant, place residuals, used gelling agent and waste cloths in leak-proof bags, immediately seal and carefully dispose in covered containers to avoid any spread of contamination. Hard, nonporous surfaces may then be cleaned and disinfected as described above. Large areas of emesis or fecal contamination (e.g., covering a floor tile or larger) should be treated with disinfectant after removal of the substance with absorbent material, then cleaned and given a final disinfection.
10. Since disinfectants are not registered for use on porous surfaces, removable porous upholstery, rugs and carpeting that have exposure to emesis, or feces should be carefully removed and laundered in accordance with the manufacturer’s instructions or disposed of as described below. Porous upholstery and carpeting that can’t be removed may be initially cleaned with water and detergent. The material should then be allowed to air dry.
11. When cleaning is completed, collect soiled material and gloves in a sturdy, leak-proof (e.g., plastic) bag that is tied shut and not reopened. Porous materials that will be laundered can be transported in the same manner. State and local governments should be consulted for appropriate disposal decisions. Barring specific state solid or medical waste regulations to the contrary, these wastes are considered routine solid wastes that can be sent to municipal solid waste landfills without treatment.
12. When cleaning is completed and gloves have been removed, immediately clean hands with soap and water or an alcohol-based hand gel. Avoid touching the face with gloved or unwashed hands³.
13. Do not use compressed air and/or water under pressure for cleaning, or any other methods that can cause splashing or which might re-aerosolize infectious material. Vacuum cleaners should only be used after disinfection has taken place. Vacuum cleaners should be maintained to minimize dust dispersal in general and equipped with High Efficiency Particulate Air (HEPA) filters.
14. Laundry can be managed with existing procedures. Although influenza viruses can persist on porous materials, the transfer of these viruses from sheets, bedding, and clothing is not as efficient a process compared to that involving a nonporous surface.
    • Handle soiled clothing and linens during collection with a minimum amount of agitation.
    • Custodial workers and laundry personnel should follow established facility safety procedures (minimum recommendation is for glove use) when handling soiled linens.
    • Hand washing or hand hygiene should be done after sorting laundry and adding the clothing and linens to the washer.
    • Use detergents, laundry additives, and appropriate water temperature as per routine laundry procedures. Follow manufacturer instructions for detergent and bleach use.
    • Use a temperature setting for drying clothes and linens appropriate for the fabrics in the load.

¹ When washing hands with soap and water: Wet your hands with clean running water and apply soap. Use warm water if it is available. Rub hands together to make a lather and scrub all surfaces. Continue rubbing hands for 20 seconds. Rinse hands well under running water. Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet. Remember: If soap and water are not available, use alcohol-based gel to clean hands. When using an alcohol-based hand gel: Apply product to the palm of one hand. Rub hands together. Rub the product over all surfaces of hands and fingers until hands are dry.

²The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection: Cover the nose/mouth when coughing or sneezing; use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use; if you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands; perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand gel, or antiseptic handwash) after having contact with respiratory secretions and contaminated objects/materials.

³ Employees should be trained to remove PPE to prevent self-inoculation (e.g., touching a contaminated glove and then touching one’s eyes, nose, or mouth).