Interim Guidance for U.S. Residence Decontamination for Ebola and Removal of Contaminated Waste

Page Summary

Who this is for: Public health, state and/or local authorities who may have to decontaminate or arrange for a contract company to decontaminate a U.S. residence and remove contaminated waste because someone living there was confirmed to have Ebola virus disease (EVD).

Members of the general public who have concerns regarding their residence and environmental contamination because a member of the residence, whether owned or rented, had a confirmed case of EVD should contact local public health and/or assigned authorities for Ebola emergency response in their location. If the public health and/or assigned authorities cannot be reached, please call the CDC Emergency Operations Center at: 1-770-488-7100.

What this is for: These recommendations list effective disinfectant products and procedures, guidance for contract companies to follow in dealing with contaminated wastes, and guidance on how to use personal protective equipment (PPE).

How to use: Use this document for guidance on decontaminating a residence and disposing of waste that could be contaminated.

Key Points

Effective disinfectant product(s): Currently, no EPA-registered hospital disinfectant products state on the label that the product can kill Ebola virus. Use Environmental Protection Agency (EPA)-registered hospital disinfectants with label claims for hospital disinfection (or the equivalent microbial pathogen claims) and claims against nonenveloped viruses (norovirus, rotavirus, adenovirus, poliovirus). These products are broadly antiviral and capable of inactivating both enveloped and nonenveloped viruses, including Ebola virus. These disinfectants should be used in accordance with the manufacturer’s labeled instructions.

One simple way to identify an appropriate product effective against Ebola virus is to use a product included in EPA’s List L: Disinfectants for Use Against the Ebola Virus.
Level of cleaning and decontamination: Once a person has been confirmed to have EVD, the way to decontaminate the residence depends on the person’s symptoms at the time they were in the residence:
- Cleaning by residents – If the person with EVD had only a fever with no gastrointestinal (diarrhea, vomiting) or hemorrhagic (bleeding) symptoms while he or she was in the residence, the person should not be contaminating their environment. The remaining members of the residence can clean and launder as normal using detergent and/or disinfectant.
- Cleaning by a contract company – If the person with EVD had a fever AND diarrhea, vomiting, and/or unexplained bleeding, public health and/or assigned authorities may need to contact a contract company that will assess the residence to determine the proper decontamination and disposal procedures. Remaining members of the residence should avoid contaminated rooms and areas until after the completion of the assessment and decontamination.
Which contract companies can conduct the cleaning? Companies with experience in cleaning biohazard and crimes scenes can conduct the cleaning. OSHA provides guidance for cleaning and decontaminating in non-healthcare settings. Any contract company conducting such work must comply with its state’s Ebola policies and with OSHA standards for, among others that may apply, bloodborne pathogens (29 CFR 1910.1030), PPE (29 CFR 1910.132), respiratory protection (29 CFR 1910.134), and hazard communication (29 CFR 1910.1200) (for example, for chemical hazards). In states that operate their own occupational safety and health programs, different or additional requirements may exist.
Transport of waste: Ebola-contaminated waste (materials that cannot be decontaminated and were in contact with the person with EVD having fever AND diarrhea, vomiting, and/or unexplained bleeding) must be packaged and transported in accordance with regulations on the transportation of Ebola-contaminated items provided by the U.S. Department of Transportation (DOT): U.S. DOT Hazardous Materials Regulation for Category A Infectious Substance. If a contract company is handling the waste, requirements in OSHA standards, including Bloodborne Pathogens (29 CFR 1910.1030) may also apply.

Definitions

Contract company: A company hired to complete a needed task. In regard to decontaminating residences of Ebola virus, the contract company is specialized in decontaminating, handling, and discarding of toxic chemicals and infectious agents, with experience in cleaning biohazard or crime scenes, and complies with all health and safety regulations. These companies may be certified through such associations as the National Institute of Decontamination Specialists (NIDS), Institute of Inspection, Cleaning and Restoration Certification (IICRC), American Bio Recovery Association (ABRA), or complete training as outlined in the OSHA Hazardous Waste Operations and Emergency Response Standard (HAZWOPER).
Disinfection product: A product that will make certain biological agents inactive. Specific to Ebola, use an EPA-registered hospital disinfectant or one with the equivalent microbial pathogen claims that also have a label claim against a nonenveloped virus. Such products are included in EPA’s List L: Disinfectants for Use Against the Ebola Virus.
Personal Protective Equipment (PPE): Equipment worn to prevent exposure to hazardous substances (chemicals, infectious agents, particles). For Ebola decontamination, the level of PPE will vary because of the contamination level and chemicals used for cleaning and decontaminating. Refer to the OSHA PPE Selection Matrix for Occupational Exposure to Ebola Virus for appropriate PPE and related recommendations in CDC's Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing).

Decontamination and waste disposal – Determined by the symptoms of the person with EVD while they were within the residence

Remaining members of residences where a person with Ebola only had a fever with no gastrointestinal (diarrhea, vomiting) or hemorrhagic (bleeding) symptoms can clean and launder as normal because the individual should not be contaminating their environment.
Remaining members of residences where a person with EVD had a fever AND diarrhea, vomiting, and/or unexplained bleeding should have local public health and/or assigned authorities for Ebola emergency response managing the decontamination and waste disposal through a contract company. Members of the residence (or property owners, if the residence is rented) should not handle contaminated materials; do not touch any body fluids or soiled surfaces and materials.

The public health authorities can assist in finding a qualified contract company. Any contract company conducting such work must comply with its state’s Ebola policies and with OSHA standards for, among others that may apply, bloodborne pathogens (29 CFR 1910.1030), PPE (29 CFR 1910.132), respiratory protection (29 CFR 1910.134), and hazard communication (29 CFR 1910.1200) (for example, for chemical hazards). In states that operate their own occupational safety and health programs, different or additional requirements may exist. The contract company will assess the residence to determine the proper decontamination and disposal procedures. Only areas/rooms with contamination from diarrhea, vomiting, unexplained bleeding, and/or other body fluids will need to be cleaned and disinfected.

Recommendations for contract companies about disinfectants, training requirements, PPE, and waste removal

Recommendations for the contract company to follow are described in CDC's Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus and OSHA Fact Sheet 3756 on Cleaning and Decontamination of Ebola on Surfaces – Guidance for Workers and Employers in Non-Healthcare/ Non-Laboratory Settings.

For nonporous surfaces (door handles, tile floors), use an EPA-registered hospital disinfectant or a disinfectant with equivalent microbial pathogen claims according to manufacturer’s instructions with a label claim against a nonenveloped virus, such as norovirus, rotavirus, adenovirus, or poliovirus. One simple way to identify an appropriate product effective against Ebola virus is to use a product included in EPA’s List L: Disinfectants for Use Against the Ebola Virus. Any EPA-registered disinfectant that is effective against a nonenveloped virus will also be effective against Ebola virus.
Porous materials (linens, carpet, mattress, pillows) should be properly contained and disposed of according to regulations set by the state where the waste is located. Store the properly contained contaminated material in a room that is not being used until it can be collected for disposal. Additional CDC recommendations for Ebola Medical Waste Management provides further information about safe handling and disposal of medical waste from patients under investigation or patients with confirmed EVD.
Waste contaminated with Ebola virus must be packaged and transported in accordance to U.S. DOT Hazardous Materials Regulations (HMR, 49 CFR, Parts 171-180). If a contract company is handling the waste, requirements in OSHA standards, including Bloodborne Pathogens (29 CFR 1910.1030) may also apply.

Contract company requirements and PPE (biological and chemical): Contract company employees must be properly trained. The contract company is responsible for selecting and providing PPE to protect their workers from exposure to Ebola and to chemical hazards from the cleaning and disinfectant agents. Refer to the OSHA PPE Selection Matrix for assistance in determining the appropriate PPE. Where respiratory hazards exist, such as from aerosolized viral particles or chemicals used in cleaning and disinfection, workers must use NIOSH-approved respirators, be fit-tested before using respirators, and be medically cleared. (Note: Medical clearance for respirators is determined by the institution, which may involve a questionnaire for screening, physical examination and spirometry, and/or chest X-ray).

OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030)

OSHA Personal Protective Equipment (29 CFR 1910.132)

OSHA Respiratory Protection (29 CFR 1910.134)

Hazard Communication Standards (29 CFR 1910.1200)

Biological – PPE recommendations for contract companies are the same as those in the CDC. See Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) and OSHA Fact Sheet 3756 on Cleaning and Decontamination of Ebola on Surfaces – Guidance for Workers and Employers in Non-Healthcare/ Non-Laboratory Settings.
Chemical – Contract companies are required to have completed OSHA training for Hazard Communication Standards and should follow OSHA/ NIOSH guidelines for “Protecting Workers Who Use Cleaning Chemicals.”

Table. Interim Guidance Summary for Decontamination and Waste Disposal in a U.S. Residence Where a Person Has EVD

Category	Definition	Decontamination and Disposal	Training and PPE
Cleaning by residents	Residence where a person with EVD only had a fever and no gastrointestinal (diarrhea, vomiting) and/or no hemorrhagic (bleeding) symptoms	Residents can clean and launder normally, using detergent and/or disinfectant Residents can discard waste as normal	No training required Follow detergent and disinfectant product manufacturer’s instructions
Cleaning by contract company	Residence where a person with EVD had a fever AND diarrhea, vomiting, and/or unexplained bleeding	Members of the residence or property owners should NOT handle contaminated materials Contact local public health or assigned authorities Contract company should conduct decontamination and disposal procedures	Contract company should follow local state policies, and comply with OSHA standards and federal guidelines as appropriate