Cleaning and meal service in isolation units

April 3, 2020

USER GUIDE

Built for Zero compiled this information in response to community requests for consolidated, vetted guidance about how to safely clean isolation/quarantine spaces, provide laundry service, and deliver food.

We recommend this resource for communities that are considering using hotels, motels, or other individual units for shelter and isolation. Portions of this page may also apply to non-isolation settings that are looking for guidance on cleaning.

Given that the clinical picture of COVID-19 is ever changing, and that the information about response is changing in turn, Built for Zero anticipates there might be new information on this topic. Please keep an eye out for updated information as new resources emerge.


Prepare and Close Off the Space

Ideally, close off areas visited by the ill persons. When deciding how long to close off rooms or areas used by ill persons before beginning disinfection, consider factors such as the size of the room and the ventilation system design (including flow rate, or air changes per hour, and location of supply and exhaust vents) 

Improve the ventilation in an area or room where someone was ill or suspected to be ill with COVID-19. Because it is currently unknown how long air inside a room occupied by someone with confirmed COVID-19 remains potentially infectious, taking these steps will help shorten the time it takes respiratory droplets to be removed from the air:

  • Open outside doors and windows and use ventilating fans to increase air circulation in the area. Wait 24 hours, or as long as practical, before beginning cleaning and disinfection.
  • Open outside doors and windows to increase air circulation before cleaning and disinfection.

Provide personal cleaning supplies for an ill person’s room and bathroom, unless the room is occupied by a child or another person for whom such supplies would not be appropriate.

Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly.

Personal Sanitation and Hand Washing

Perform hand hygiene frequently. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.

Avoid touching eyes, nose, or mouth with unwashed hands.

Personal Protective Equipment

When sharing the same space, you and the patient should both use appropriate, recommended personal protective equipment (gloves and face mask) and adhere to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene).

Wear a disposable face mask and gloves when you touch or have contact with the patient’s blood, stool, or body fluids, such as saliva, sputum, nasal mucus, vomit, urine. 

When removing personal protective equipment: 

  • First remove and dispose of gloves. 
  • Then, immediately clean your hands with soap and water or alcohol-based hand sanitizer. 
  • Next, remove and dispose of face mask, and immediately clean your hands again with soap and water or alcohol-based hand sanitizer. 
  • Throw out disposable face masks and gloves after using them. Do not reuse.
  • Place all used disposable gloves, face masks, and other contaminated items in a lined container before disposing of them with other household waste. 
  • Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty.

Sources

EPA-Registered Disinfectants

  • Follow labels on cleaning products for safe and effective use. This usually includes precautions, such as wearing gloves and ensuring ventilation. Follow manufacturer’s instructions for all cleaning and disinfection products for concentration, application method and contact time, etc.
  • Most common EPA-registered household disinfectants should be effective for disinfection. A comprehensive list is here. If you don’t see the brand listed, you can also check if the product’s EPA registration number is included on the list. The EPA Reg. No. number is on the product label on the back panel of the label along with the detailed instructions for use.

Household Bleach Solutions

  • Diluted household bleach solutions (at least 1000ppm sodium hypochlorite) can be used if appropriate for the surface. 
    • Unexpired household bleach will be effective against coronaviruses when properly diluted, so ensure the product is not past its expiration date. 
    • Never mix household bleach with ammonia or any other cleanser. 
    • Follow manufacturer’s instructions for application, ensuring a contact time of at least one minute, and allowing proper ventilation during and after application. 
    • Prepare a bleach solution by mixing:
      • 5 tablespoons (1/3rd cup) bleach per gallon of water or
      • 4 teaspoons bleach per quart of water

Sources: 

Frequency

High-touch surfaces in common areas should be cleaned and disinfected daily. This includes tables, hard-backed chairs, doorknobs, light switches, phones, tablets, touch screens, remote controls, keyboards, handles, desks, toilets, sinks.

The bedroom/bathroom (e.g., soiled items and surfaces) for an ill person should be cleaned as-needed, with reduced frequency to avoid unnecessary contact.

  • If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person. If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.

Continue routine cleaning and disinfection, in accordance with this guidance, In areas where ill persons have visited or used.

Hard (Non-porous) Surfaces

  • What do I wear? Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
  • What do I use? If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
Soft (Porous) Surfaces (i.e. carpeted floor, rugs, and drapes)
  • Remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. 
  • After cleaning, launder items as appropriate in accordance with the manufacturer’s instructions. Launder items using the warmest appropriate water setting for the items and dry items completely.

Electronics

  • Remove visible contamination, if present, for electronics such as cell phones, tablets, touch screens, remote controls, and keyboards. Follow the manufacturer’s instructions for all cleaning and disinfecting products. If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.
  • Consider putting wipeable covers on electronics.

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Personal Protective Equipment

  • Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
  • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.

Steps

  • Laundry needing cleaning should be left at the door of the isolation unit.
  • Avoid shaking dirty laundry. This will minimize the possibility of dispersing virus through the air.
  • Bedding or clothes that have blood, stool, or body fluids on them should be Immediately removed and washed. 
  • If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items. Launder items as appropriate in accordance with the manufacturer’s instructions. 
  • Clothes hampers should be cleaned and disinfected according to guidance above for surfaces. If possible, place a bag liner that is either disposable or can be laundered.
  • Clean laundry can be dropped off at the door of the person who is ill.

Sources:

  • Deliver food, groceries, and basic hygiene to the door of an isolation unit. The ill person should eat/be fed in their room if possible. 
  • Consider installing physical barriers, such as clear plastic sneeze guards, to protect staff who interact with clients. For example, install a sneeze guard at the check-in desk. 
  • Use personal protective equipment and hand washing. Non-disposable food service items used should be handled with gloves and washed with hot water or in a dishwasher. Clean hands after handling used food service items.
  • Safely dispose of trash and meals. Dedicate a lined trash can for the ill person, if possible. Use gloves when removing garbage bags, handling, and disposing of trash. Wash hands after handling or disposing of trash.
  • Provide reliable communication and access. If possible, provide the patient with a phone and numbers to call if they require anything. Inform the patient that food and other basic items will be delivered to their room on a regular schedule.
  • Practice food safety. Currently there is no evidence of food, food containers, or food packaging being associated with transmission of COVID-19. But like other viruses, it is possible that the virus that causes COVID-19 can survive on surfaces or objects. For that reason, it is critical to follow the four key steps of food safety — clean, separate, cook, and chill.

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QUALITY CHECK

Learn more about our process for vetting information.

Scope

Created by Adrien Coquet from the Noun Project

What context was the data underlying this recommendation collected in?

  • Built for Zero compiled this information in response to community need for guidance about how to clean isolation/quarantine spaces and also deliver food and provide laundry service. 
  • The data that informed this resource comes from the Center for Disease Control, the Environmental Protection Agency, the Food and Drug Administration, the Occupational Safety and Health Administration, and the The Canadian Network for the Health and Housing of the Homeless.
    • The guidance published by the Canadian Network for the Health and Housing of the Homeless was written by doctors and medical professionals in Toronto, Ontario. 
  • The CDC guidance was drafted for Institutions of Higher Education and Cleaning and Disinfection for Households.

What context or question do we recommend this resource for?

  • We recommend this resource for communities that are considering using hotels, motels, or other individual units for shelter and isolation. 

What other contexts do we reasonably think this recommendation might apply to, and on what basis?

  • Parts of this resource may also apply to non-isolation settings that are looking for guidance on what to clean and with what products.

Authority

verified by Gregor Cresnar from the Noun Project

Who reviewed this data, and what are their credentials to assess it?

  • Built for Zero’s team reviewed this data to identify the most recent, non-conflicting information. 

Novelty

Time by Adrien Coquet from the Noun Project

When was the data underlying this recommendation collected?

  • This information was compiled on 3/31/2020, 4/1/2020 & 4/2/2020
    • CDC IHE and Household Guidance was last updated on 3/18/2020, 3/26/2020, respectively.
    • The EPA List of Disinfectants for Use Against SARS-CoV-2 was last updated on 4/2/2020.
    • The OSHA Guidance was published 3/2020.
    • The FDA’s 4 Steps to Food Safety was last updated on 4/12/2019.
    • The guidance produced by the Canadian Network for the Health and Housing of the Homeless was published 3/16/2020.

Do we have reason to believe the situation has materially changed since that date, or is likely to change soon?

  • Given that the clinical picture of COVID-19 is ever changing, and that the information about response is changing in turn, Built for Zero anticipates there might be new information on this topic. Please keep an eye out for follow up information as new resources emerge.

Qualifications

Error by Aleks from the Noun Project

What specific component of this resource do we recommend?

  • N/A

Are there any specific elements of this resource we do not recommend?

  • N/A

Open Questions

questions by Gregor Cresnar from the Noun Project

What elements of this resource were we unable to assess?

  • N/A

What elements of this resource do we want to know more about?

  • N/A