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Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care. Geneva: World Health Organization; 2014.

Cover of Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care

Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care.

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Annex GUse of disinfectants: alcohol and bleach

Different countries have different disinfection protocols. Health-care facilities with limited resources may not have access to a variety of hospital disinfectants, however, alcohol and bleach are acceptable chemical disinfectants if used appropriately. As with any other disinfectants, soiled surfaces need to be cleaned with water and detergent first.

G.1. Alcohol

Alcohol is effective against influenza virus (252). Ethyl alcohol (70%) is a powerful broad-spectrum germicide and is considered generally superior to isopropyl alcohol. Alcohol is often used to disinfect small surfaces (e.g. rubber stoppers of multiple-dose medication vials, and thermometers) and occasionally external surfaces of equipment (e.g. stethoscopes and ventilators). Since alcohol is flammable, limit its use as a surface disinfectant to small surface-areas and use it in well-ventilated spaces only. Prolonged and repeated use of alcohol as a disinfectant can also cause discoloration, swelling, hardening and cracking of rubber and certain plastics.

G.2. Bleach

Bleach is a strong and effective disinfectant – its active ingredient sodium hypochlorite is effective in killing bacteria, fungi and viruses, including influenza virus – but it is easily inactivated by organic material. Diluted household bleach disinfects within 10–60 minutes contact time (see Table G.1 below for concentrations and contact times), is widely available at a low cost, and is recommended for surface disinfection in health-care facilities. However, bleach irritates mucous membranes, the skin and the airways; decomposes under heat and light; and reacts easily with other chemicals. Therefore, bleach should be used with caution; ventilation should be adequate and consistent with relevant occupational health and safety guidance. Improper use of bleach, including deviation from recommended dilutions (either stronger or weaker), may reduce its effectiveness for disinfection and can injure health-care workers.

Table G.1. Sodium hypochlorite: concentration and use.

Table G.1

Sodium hypochlorite: concentration and use.

Procedures for preparing and using diluted bleach

To prepare and use diluted bleach:

  • use a mask, rubber gloves and waterproof apron; goggles also are recommended to protect the eyes from splashes;
  • mix and use bleach solutions in well-ventilated areas;
  • mix bleach with cold water (hot water decomposes the sodium hypochlorite and renders it ineffective);
  • if using bleach containing 5% sodium hypochlorite, dilute it to 0.05%, as shown in Table G.1 below.

Precautions for the use of bleach

  • Bleach can corrode metals and damage painted surfaces.
  • Avoid touching the eyes. If bleach gets into the eyes, immediately rinse with water for at least 15 minutes, and consult a physician.
  • Do not use bleach together with other household detergents, because this reduces its effectiveness and can cause dangerous chemical reactions. For example, a toxic gas is produced when bleach is mixed with acidic detergents, such as those used for toilet cleaning, and this gas can cause death or injury. If necessary, use detergents first, and rinse thoroughly with water before using bleach for disinfection.
  • Undiluted bleach emits a toxic gas when exposed to sunlight; thus, store bleach in a cool, shaded place, out of the reach of children.
  • Sodium hypochlorite decomposes with time. To ensure its effectiveness, purchase recently produced bleach, and avoid over-stocking.
  • If using diluted bleach, prepare the diluted solution fresh daily. Label and date it, and discard unused mixtures 24 hours after preparation.
  • Organic materials inactivate bleach; clean surfaces so that they are clear of organic materials before disinfection with bleach.
  • Keep diluted bleach covered and protected from sunlight, and if possible in a dark container, and out of the reach of children.
Copyright © World Health Organization 2014.

All rights reserved. Publications of the World Health Organization are available on the WHO web site ( or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

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Bookshelf ID: NBK214356


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