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Guide to Hygiene and Sanitation in Aviation. 3rd edition. Geneva: World Health Organization; 2009.

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Guide to Hygiene and Sanitation in Aviation. 3rd edition.

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3CLEANING AND DISINFECTION OF FACILITIES

3.1. Background

This chapter covers cleaning and disinfection procedures for both airports and aircraft.

Cleaning refers primarily to the removal of visible dirt or particles; however, the cleaning process and some products used for cleaning also result in disinfection. Cleaning is normally undertaken on a routine and frequent basis. In this chapter, the primary process of removal of visible dirt and particles is referred to as “cleaning”, even if some disinfection occurs at the same time.

Disinfection refers to specific measures taken to control, deactivate or kill infectious agents, such as viruses and bacteria. Disinfection is normally undertaken on an infrequent basis, during periodic maintenance checks or after a public health event, such as the suspected carriage of an infectious passenger. Disinfection is usually preceded by cleaning of the affected area, and this is assumed to occur when “disinfection” is referred to in this chapter.

In 2006, over 2 billion passengers were carried by airlines operating scheduled flights (ICAO, 2006). This fact indicates that commercial air transport is potentially an efficient means for spreading communicable disease widely by surface contact and proximity to infected persons.

Possible routes of infection transmission that might occur on board aircraft fall into three categories:

  1. directly inhaled respiratory droplets, suspended airborne particles, or both;
  2. direct contact with faecal matter, blood or other body fluids;
  3. contact with respiratory secretions, faecal matter or body fluids deposited on surfaces or, for maintenance crews, entrained in ventilation systems.

The main source of infection for other travellers is from an infected person, and proximity to an infected person is an important risk factor for airborne infection. Once an infected person has left the scene, most of the risk from droplet exposure will have been removed. The residence time of suspended airborne particles may be longer and will depend on the particles' mass and on the ventilation rate/air circulation patterns in the cabin (ANSI/ASHRAE, 2008).

Airborne exposure aside, there is a concern that the agent of disease (pathogen) can remain in the airport or aircraft environment by contaminating common surfaces (e.g. fomites) after the infected traveller has departed. However, the guidance in this chapter is directed primarily at the second and third possible routes of transmission. The cause of illness for an individual traveller may not be known immediately and possibly not for some time afterwards; in many cases, the diagnosis may never be known. This guidance therefore adopts a “universal precaution” approach that treats all respiratory secretions, faeces, blood and other body fluids as potentially infectious.

Sometimes, a case of communicable disease is known only several days (or longer) after the infected person has travelled and may have deposited pathogens on surfaces in the airport or on the aircraft. The risk of infection upon contact with such contaminated surfaces will depend on the viability of the organism, the number of organisms, whether the surface has been properly cleaned and/or disinfected, whether the pathogen is touched and transferred and also the susceptibility of the traveller. Frequent hand washing reduces the risk. As time passes and as a result of routine cleaning activities, the risk that any transmissible pathogens remain in place reduces, even without specific disinfection procedures.

There may be epidemiological information available to guide the public health response, such as an outbreak occurring at the origin of the flight (e.g. the 2003 episode of SARS). In such instances, public health experts recommend specific measures targeted at a particular pathogen.

To reduce the risk of transfer of pathogens from an infected person to others via surfaces or inanimate objects on the aircraft or in the airport, it is necessary for aircraft and airport operators and ground handling agents to have a coordinated plan in place to deal with the arrival of an affected 1 aircraft having carried such a traveller or the presence of a person with a communicable disease in the airport. For aircraft, the plan needs to take into account the unusual features of the aircraft cabin in comparison with a ground-based facility. For airports, the plan should address the challenge of managing potential contamination in a large public space, such as the terminal building. Such plans should also address potential contamination of an aircraft or airport with an infectious agent that is not transmitted person to person. Considering that it may be difficult to identify an aircraft carrying an infected person, the focus should be on (a) the assumption that all aircraft are periodically occupied by infected travellers and therefore require routine and frequent cleaning and disinfection and (b) the fact that certain events (e.g. persistent coughing on board) may increase the risk of disease transmission and that such incidents should be investigated so that, if a case of communicable disease is suspected, it leads to specific disinfection measures.

Disinfectants tend to be oxidizers, and the interior of an aircraft contains many materials susceptible to damage from cleaning products and disinfectants. Metals used in the construction of the aircraft may corrode upon exposure to such products, safety-critical cables and wires may deteriorate on exposure and aircraft furnishings may have their fire resistance properties reduced. It is therefore necessary to exercise caution in selecting suitable products and before applying these products in aircraft. It is important to protect the health of the cleaning personnel and to ensure effective action; therefore, manufacturer's instructions must be followed carefully.

It is essential to provide a hygienic environment for travellers. Areas where food is prepared, stored and served, any surfaces commonly touched by people and washroom facilities, among others, should be kept free from contaminants that might compromise human health, even when there is no identified outbreak of disease. Prevention or mitigation of disease transmission is the goal. Hygienic conditions also minimize the likelihood of infestation by rodents, as vectors of disease.

3.1.1. International Health Regulations (2005)

According to the IHR (2005), States (competent authorities) must ensure, to the extent practicable, that traveller facilities at their international airports and on aircraft are kept free of sources of infection and contamination. In addition, capacity to adopt control measures, such as cleaning and disinfection, should be in place, with oversight by the competent authority, to prevent the spread of disease and its agents at airports and on aircraft.

If indications of a public health risk, including sources of infection and contamination, are found on board an international aircraft, the aircraft may be required to undergo health measures, such as disinfection, disinsection or decontamination, as appropriate, that are necessary to control risk and to prevent spread of disease (Article 27).

Health measures “shall be carried out so as to avoid injury and as far as possible discomfort to persons, or damage to the environment in a way which impacts on public health, or damage to baggage, cargo, containers, conveyances, goods or postal parcels” (Article 22) and “initiated and completed without delay, and applied in a transparent and non-discriminatory manner” (Article 42).

3.1.2. Critical aspects and rationale of cleaning and disinfection programmes

The critical aspects of cleaning and disinfection programmes include the availability of cleaning schedules and procedures for timely and effective airport and aircraft routine cleaning by designated personnel; procedures for disinfecting after an event; effective cleaning and disinfecting agents that are not detrimental to aircraft materials; appropriate personal protective equipment; and adequate training for designated personnel.

There are several reasons why cleaning and disinfection programmes are critical to ensuring a sanitary environment in airports and on aircraft, which, in turn, ensures that air travellers are exposed to minimum risk. Schedules and procedures for routine, effective airport and aircraft cleaning (and disinfection measures in higher-risk areas, when necessary) are vital in maintaining a hygienic environment. The availability of procedures for disinfecting after an event 2 is also critical, as body fluids, such as respiratory secretions, blood, vomit and faeces, may contain infectious agents that could be transmitted, if not properly contained.

Cleaning and disinfection on aircraft require special attention, as it is necessary to use agents that are not corrosive or otherwise detrimental to aircraft components. For this reason, not all effective cleaning and disinfecting agents can be used in the aircraft cabin.

Cleaning crews 3 need to be adequately trained so they understand and respect the procedures that will ensure effectiveness of the cleaning and disinfecting agents, use the proper personal protective equipment, prevent contamination of other areas and minimize occupational health and safety risks to personnel.

Unlike the routine procedure, post-event disinfection is not a frequent practice, and the requirements are likely to differ. It is therefore particularly important that the training emphasizes these “event-driven” procedures for the cleaning crew, because they will not be as familiar as routine cleaning procedures.

As noted above, competent authorities have responsibilities to ensure that international airports and aircraft are kept free of sources of infection and contamination (Article 22.1(a,b,c,d,e,g)). The competent authority needs to exercise oversight over cleaning and disinfection programmes so that its obligations under the IHR (2005) are fulfilled. Under the IHR (2005), the competent authorities are responsible for supervising service providers relating to travellers, baggage, cargo, containers, conveyances and goods at points of entry, including with inspections and medical examinations, as necessary. They are also responsible for supervision of disinfection, disinsection and decontamination of conveyances, as well as baggage, cargo, containers and goods under the IHR (2005). Finally, they are responsible for the supervision of the removal and safe disposal of any contaminated water or food, human or animal dejecta, wastewater and any other contaminated matter from a conveyance (Article 22.1(c,e–f)). In the context of conveyances (as well as baggage, cargo and goods) arriving from affected areas, the competent authorities are responsible for monitoring them so that they are free of sources of infection or contamination (Article 22.1(a)).

3.2. Guidelines

This section provides user-targeted information and guidance, identifying responsibilities and providing examples of practices that can control risks. Six specific Guidelines (situations to aim for and maintain) are presented, each of which is accompanied by a set of Indicators (measures for whether the guidelines are met) and Guidance notes (advice on applying the guidelines and indicators in practice, highlighting the most important aspects that need to be considered when setting priorities for action).

3.2.1. Airports: Routine cleaning and disinfection

3.2.1.1. Guideline 3.1: Sanitary condition of airports

Guideline 3.1—Airports are kept in a sanitary condition at all times.

Indicators for Guideline 3.1
  1. A documented, tested and updated routine cleaning programme exists, ensuring that premises are regularly and hygienically cleaned.
  2. An appropriate number of trained personnel are available, in relation to the volume and complexity of the airport facilities and cleaning procedures.
  3. Personal protective techniques and equipment are used by personnel: related equipment and information (operational procedures for its use) are available.
  4. Cleaning equipment and supplies are available in relation to the volume and complexity of the airport facilities and cleaning procedures.
  5. Cleaning equipment is properly identified and satisfactorily maintained and stored in a designated storage area.
Guidance notes for Guideline 3.1

Several aspects of routine cleaning should be taken into account:

  • Programmes for routine cleaning should take into account the volume of passengers (e.g. peak periods, heavily used areas) and the complexity of activities at the airports (e.g. hair salons and spas, food establishments and washroom facilities) and personnel using the terminal and other facilities.
  • Airport operators should be prepared to adjust their routine cleaning programmes if a public health risk is detected and/or if advised to do so by public health authorities.
  • The routine cleaning programme should be conducted by, or be under the oversight of, the competent authority.
  • During high-volume periods within the airport, increased frequency of cleaning should be considered to remove excessive accumulation of waste and debris resulting from the increased use of the airport facilities, especially washrooms.
  • Precautionary cleaning, including the use of disinfectant products, of certain targeted areas of the airport may be advised if diseases of concern (e.g. norovirus or cholera) are prevalent in the airport community or at the departure points of a significant number of travellers.
  • A routine cleaning programme should consider aspects that are specific to particular areas of an airport. Guidance can be found in Annex E.
  • A routine cleaning programme should be periodically reviewed and updated, as needed.

3.2.1.2. Guideline 3.2: Design and construction of airports

Guideline 3.2—Airports are designed and constructed in a manner that facilitates proper cleaning and disinfection.

Indicator for Guideline 3.2
  1. Facilities are designed and constructed of suitable materials (e.g. impervious, smooth and without seams) to facilitate cleaning and to reduce the risk of harbouring insects, rodents and other vectors.
Guidance notes for Guideline 3.2

Several aspects of airport design and construction should be taken into account:

  • Proper design will minimize the amount of accumulated debris and waste and reduce opportunities for survival of vectors and reservoirs of disease, such as rodents and insects.
  • Washrooms designed without doors and with automatic faucets (taps) using “electronic eyes” (which automatically control the flow of the water to the faucet) are preferable, as they will reduce contact with hands/fingers.
  • Providing paper wipes for hand drying will reduce the risk of cross-contamination, especially when dispensed using “electronic eyes” (hand dryers can promote spread of pathogens).

3.2.2. Airports: Disinfection after an event

3.2.2.1. Guideline 3.3: Post-event disinfection procedures for airports

Guideline 3.3—Post-event disinfection procedures are in place to prevent the spread of disease and contain contamination at the source.

Indicators for Guideline 3.3
  1. Standard operating procedures are documented and in place for timely disinfection after an event, according to technical requirements, and are subject to periodic revision based on emerging evidence of efficacy.
  2. An appropriate number of trained personnel are available, in relation to the volume and complexity of the airport facilities and need for post-event cleaning/disinfection procedures.
  3. Personal protective equipment and techniques are used by personnel, and related equipment and information (operational procedures for its use) are available.
  4. Adequate equipment and supplies are available in relation to the volume and complexity of the airport facilities and disinfection procedures that may be needed after an event.
  5. Disinfecting equipment is identified, properly maintained and stored in a designated storage area for post-event use.
Guidance notes for Guideline 3.3
1. Standard operating procedures

The disinfection procedure for flat surfaces (e.g. floors, tables, sinks) should be as follows:

  • If required, control pedestrian traffic through the area by directing people away from the site, posting a sign or putting up barrier tape.
  • Put on protective gloves.
  • Wear eye protection if a danger from splashing exists.
  • Prepare the sanitizing solution of bleach according to product specifications.
  • Open a biohazard bag, and put it near the spill site. If a biohazard bag is not available, label the regular waste bag as “biohazard”.
  • Using paper towels or an absorbent material, clean up the soiled material and excess liquid and place into the biohazard bag.
  • Change gloves if they become visibly soiled.
  • Clean the area (remove solids and soak up liquid waste). Pour detergent solution around the spill site, and use paper towels to move the liquid into the dirty area. Once the area is wet, use the paper towels to clean the area and discard into the biohazard bag.
  • Cover the site with clean paper towels, and pour the bleach solution onto the paper towels. Wait an appropriate time, as indicated in the product instructions.
  • Remove the paper towels to the biohazard bag.
  • Rinse with water, and dry the surface. Put all paper towels into the biohazard bag.
  • Remove gloves, and place them into the biohazard bag.
  • Seal used biohazard bag, and ensure proper transport and final disposal.
  • Wash hands.
3. Personal protective equipment

Those responsible for cleaning up vomit, human excreta and other potentially infectious materials should protect themselves with appropriate personal protective equipment, such as gloves and protective clothing, according to standard operating procedures.

4. Equipment and supplies

The following materials should be preassembled in a spill cleanup kit:

  • garbage bags and masking tape;
  • disposable gloves;
  • eye protection;
  • mop;
  • paper towel and/or absorbent material;
  • detergent solution;
  • water;
  • sanitizing agent, such as bleach tablets (Presept, 0.5 g sodium dichloroisocyanurate tablets) or 5% domestic liquid bleach;
  • signs, barrier tape (optional).

3.2.3. Aircraft: Routine cleaning and disinfection

3.2.3.1. Guideline 3.4: Sanitary condition of aircraft

Guideline 3.4—Aircraft are kept in a sanitary condition at all times.

Indicators for Guideline 3.4
  1. A documented, tested and updated routine cleaning programme is available, ensuring that aircraft are regularly and hygienically cleaned.
  2. An appropriate number of trained personnel are available, taking into account cleaning procedures, the type of aircraft (e.g. passenger or cargo), the aircraft size and the ground time (stopover time) of the aircraft.
  3. Personal protective techniques and equipment are used by personnel, and related equipment and information (operational procedures for its use) are available.
  4. Cleaning equipment and supplies are available, taking into account the type (e.g. passenger or cargo), size and ground time (stopover time) of aircraft and cleaning procedures.
  5. For aircraft safety and to protect aircraft equipment, the operator's engineering department is consulted on cleaning procedures and agents used.
Guidance notes for Guideline 3.4
1. Routine cleaning programme

The following factors should be considered when designing a programme for routine cleaning:

  • Programmes for routine cleaning should take into account the type (e.g. passenger or cargo), size and ground time (stopover time) of aircraft.
  • An example of an aircraft routine cleaning schedule can be found in Annex F; the physical areas for which cleaning is specified in Annex F should be so included in the aircraft operator's cleaning programme.
  • Aircraft operators should be prepared to adjust their routine cleaning programmes if a public health risk is detected and/or if advised to do so by public health authorities.
  • Information concerning aircraft cleaning and disinfection should be available to those concerned, upon request.
  • Precautionary cleaning of certain targeted areas of the aircraft, including the use of disinfectant products, may be advised by the public health authority if certain diseases of concern (e.g. norovirus or cholera) are prevalent at the departure points.
5. Cleaning procedures and agents

The operator's engineering department provides a technical review of each cleaning and disinfecting product used, based on manufacturer's recommendations (approved products are normally listed in the aircraft maintenance manual). The use of methods and materials recommended by the operator's engineering department should be mandatory, and public health authorities should consider the aviation aspects when developing specific national standards and technical guidance, to avoid safety-related issues.

3.2.3.2. Guideline 3.5: Design and construction of aircraft

Guideline 3.5—Aircraft are designed and constructed in a manner that facilitates proper cleaning and disinfection.

Indicator for Guideline 3.5
  1. Aircraft interiors are designed and constructed of suitable materials (e.g. impervious, smooth and without seams) to facilitate cleaning and to reduce the risk of harbouring insects, rodents and other vectors.
Guidance notes for Guideline 3.5
1. Design and construction of aircraft interiors

Several aspects of aircraft design and construction should be taken into account:

  • Proper design will minimize the amount of accumulation of debris and waste and reduce opportunities for survival of vectors and reservoirs of disease, such as rodents and insects.
  • Lavatories designed with automatic faucets (taps) using “electronic eyes” (that automatically control the flow of the water to the faucet) will reduce contact with hands/fingers.
  • Provide disposable paper wipes for hand drying to reduce the risk of cross-contamination.

3.2.4. Aircraft: Disinfection after an event

3.2.4.1. Guideline 3.6: Post-event disinfection procedures for aircraft

Guideline 3.6—Aircraft disinfection procedures are in place to prevent the spread of disease and contain infection and contamination at the source.

Indicators for Guideline 3.6
  1. Standard operational procedures are documented and in place for timely application of disinfection procedures, according to technical requirements, and are subject to periodic revision based on emerging evidence of efficacy.
  2. An appropriate number of trained personnel are available, taking into account the type (e.g. passenger or cargo), size and ground time (stopover time) of aircraft and disinfection procedures.
  3. Personal protective equipment and techniques are used by personnel, and related equipment is available.
  4. Disinfection equipment and supplies are available, taking into account the type (e.g. passenger or cargo), size and ground time (stopover time) of aircraft and disinfection procedures.
Guidance notes for Guideline 3.6

In general, routine cleaning of contaminated surfaces with soap or detergent and water (after use of a spill cleanup kit, if necessary) to remove soil and organic matter, followed by the proper use of disinfectants to inactivate any remaining organisms, constitutes effective environmental management of suspected agents. Reducing the number of infectious agents on a surface by these steps minimizes the chances of transferring them via contaminated hands. The agents that cause the communicable diseases of public health concern are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial markets. However, care must be taken when using disinfectants on board aircraft because of the potentially harmful effects of such agents on aircraft components. The recommended attributes for post-event aircraft disinfectants are listed in Annex G.

Only disinfectants (including detergent/disinfectants) that are nationally approved for use on aircraft against any of the agents of concern and that have been approved by the original equipment (aircraft) manufacturer should be used.

Body fluids/substances (e.g. vomit from the ill traveller) should first be taken up from overtly contaminated surfaces by using an absorbent material, which should then be disposed of. Large areas contaminated with body fluids/substances (e.g. covering most of a tray table) should be treated with disinfectant after removal with absorbent material, then cleaned and given a final disinfection. Since disinfectants are not registered for use on porous surfaces, seat covers and carpeting with a significant contaminated area should be removed carefully, placed in a labelled, sealed plastic bag and laundered in accordance with the manufacturer's instructions, or they should be destroyed. In case of seat contamination that has penetrated the seat cover, the underlying seat upholstery may need to be removed for adequate disinfection.

1. Standard disinfection procedures

A disinfection procedure should include the following steps:

  • Put on protective gloves.
  • Wear eye protection if a danger from splashing exists.
  • Open a biohazard bag, and place it near the site of contamination. If a biohazard bag is not available, label a regular waste bag as “biohazard”.
  • The following surfaces should be cleaned and then disinfected at the seat of the suspected case(s), adjacent seat(s) in the same row, adjacent row(s) and other areas, as noted below:

    Seat area

    -

    armrests

    -

    seatbacks (the plastic and/or metal part)

    -

    tray tables

    -

    seatbelt latches

    -

    light and air controls, cabin crew call button and overhead compartment handles

    -

    adjacent walls and windows

    -

    individual video monitor

    Lavatories

    -

    lavatory or lavatories used by the sick traveller: door handle, locking device, toilet seat, faucet (tap), washbasin, adjacent walls and counter.

  • Clean the area of soil (remove solids and soak up liquid waste). Apply the disinfectant (see below) according to procedures approved by the original equipment manufacturer and as instructed on the disinfectant manufacturer's label. Once the area is wet, use paper towels to clean the area, and discard paper towels into the biohazard bag.
  • Use a suitable disinfectant. Studies of hydrogen peroxide–based disinfectants containing additives such as surfactants and chelators have shown good results in scientific studies, and some industries already using these products are reporting excellent results. Ethanol has also been found to be an effective and suitable disinfectant for aircraft. However, other materials could be considered if they are approved or registered for surface disinfection and sanitization on aircraft by an appropriate government or independent organization.
  • Ensure adequate contact time between the disinfectant and the surface for destruction of microorganisms. Adhere to any safety precautions as directed (e.g. ensure adequate ventilation in confined areas such as lavatories, and avoid splashing or generating unintended aerosols).
  • Change gloves that become visibly soiled.
  • Remove any affected portion of carpet.
  • Rinse the surface with water, and dry. Put all paper towels into the biohazard bag.
  • Remove gloves, and place them into the biohazard bag.
  • Seal the used biohazard bag, and ensure its proper transport and final disposal.
  • When cleaning and disinfecting are complete and gloves have been removed, immediately clean hands with soap and water or an alcohol-based hand rub. Avoid touching the face with gloved or unwashed hands.
  • Do not use compressed air and/or water under pressure for cleaning, or any other methods that can cause splashing or might reaerosolize infectious material. Vacuum cleaners should be used only after proper disinfection has taken place.
  • Operation of the aircraft's environmental control system at least until the suspect traveller has disembarked or until the disembarkation process is complete may also contribute to interrupting transmission of infectious material and should be performed if consistent with safety factors. Otherwise, ventilation should be provided from a ground source.
3. Personal protective equipment

Those responsible for cleaning up vomit, human excreta and other potentially infectious materials should protect themselves with appropriate personal protective equipment, such as gloves and protective clothing, according to standard operating procedure requirements.

4. Disinfection equipment and supplies

The following materials should be preassembled in a spill cleanup kit:

  • biohazard bags; if a biohazard bag is not available, label the regular waste bag as “biohazard”;
  • disposable gloves (non-latex materials to avoid risk of allergic reaction can be considered);
  • eye protection;
  • paper towels;
  • detergent solution;
  • water;
  • disinfectant;
  • signs as necessary to isolate the area.

Note: For the duration of the flight, used airsickness bags should be stored in the waste bin of one lavatory. They should not be flushed down the toilet, and a notice to this effect should be placed in the lavatory. They should be removed from the aircraft by the toilet servicing team and disposed of along with the aircraft toilet wastes. If a specific receptacle is used on the aircraft for storage of used airsickness containers, it should be thoroughly cleaned, washed and disinfected after each use and treated in the same manner as portable toilet containers.

Footnotes

1

An affected aircraft refers to one that carries sources of infection or contamination, so as to constitute a public health risk (see IHR (2005) Definitions). Aircraft affected due to criminal activity are outside the scope of the Guide.

2

An “event” means a “manifestation of disease or an occurrence that creates a potential for disease” (IHR (2005), Article 1). This may include, for example, the presence in an airport, or carriage by air, of a suspected case of communicable disease.

3

“Cleaning crew” refers to designated personnel that may undertake cleaning and/or disinfection.

Copyright © World Health Organization 2009.

All rights reserved. Publications of the World Health Organization can be obtained 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). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

Bookshelf ID: NBK310712

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