Interim Guidance: Cleaning and disinfection of environmental surfaces in the context of COVID-19

Full author list

Elizabeth Bancroft (Centers for Disease Control and Prevention, US); Gregory Built, (United Nations Children's; Nizam Damani,
(Queen’s University Belfast, Belfast, UK); Fernanda Lessa, (Centers for Disease Control and Prevention, US); Shaheen Mehtar
(Stellenbosch University, Cape Town, South Africa); Molly Patrick (Centers for Disease Control and Prevention, US); Mitchell
Schwaber, (National Center for Infection Control, Israel Ministry of Health); Mark Sobsey, (University of North Carolina at Chapel
Hill, NC, US); and David Weber (University of North Carolina at Chapel Hill, NC, US);

From World Health Organization
Benedetta Allegranzi, April Baller, Ana Boischio, Ana Paula Coutinho, Jennifer DeFrance, Jorge Durand, Bruce Allan Gordan,
Rick Johnson, Margaret Montgomery, Carmen Lucia Pessoa da Silva, Madison Moon, Maria Clara Padoveze, Joanna Tempowski,
Anthony Twyman, Maria Van Kerkhove, Bassim Zayed and Masahiro Zakoji.

Content

The COVID-19 virus is transmitted mainly through close physical contact and respiratory droplets, while airborne transmission is possible during aerosol generating medical procedures. 1 At time of publication, transmission of the COVID-19 virus had not been conclusively linked to contaminated environmental surfaces in available studies. However, this interim guidance document has been informed by evidence of surface contamination in health-care settings 2 and past experiences with surface contamination that was linked to subsequent infection transmission in other coronaviruses. Therefore, this guidance aims to reduce any role that fomites might play in the transmission of COVID-19 in health-care 3 and non-health care settings. 4

[...]

Transmission of the COVID-19 virus has been linked to close contact between individuals within closed settings, such as households, health facilities, assisted living and residential institution environments. 10

[...]

Although the precise role of fomite transmission and necessity for disinfection practices outside of health-care environments is currently unknown, infection prevention and control principles designed to mitigate the spread of pathogens in health-care settings, including cleaning and disinfection practices, have been adapted in this guidance document so that they can be applied in non-health care setting environments. * In all settings, including those where cleaning and disinfection are not possible on a regular basis due to resource limitations, frequent hand washing and avoiding touching the face should be the primary prevention approaches to reduce any potential transmission associated with surface contamination. 21

The topics of current WHO interim guidance documents for non health care setting environments, including environmental cleaning and disinfection recommendations, include faith-based community settings, 12 funerary services, 13 workplaces, 14 food sector, 15 accommodation sector, 16 aviation sector, 17 maritime sector, 18 schools, 19 prisons and other places of detention. 20 † This document is not intended to be comprehensive guidance on the practice of environmental cleaning and disinfection, which is covered in other relevant guidelines.

[...]

Health workers should be made aware of cleaning schedules and cleaning completion times to make informed risk assessments when performing touch contact with surfaces and equipment, to avoid contaminating hands and equipment during patient care. 46

[...]

Non-health care settings environment

There is no evidence for equating the risk of fomite transmission of the COVID-19 virus in the hospital setting to any environment outside of hospitals. However, it is still important to reduce potential for COVID-19 virus contamination in non-healthcare settings, such as in the home, office, schools, gyms or restaurants. High-touch surfaces in these non-health care settings should be identified for priority disinfection. These include door and window handles, kitchen and food preparation areas, counter tops, bathroom surfaces, toilets and taps, touchscreen personal devices, personal computer keyboards, and work surfaces. The disinfectant and its concentration should be carefully selected to avoid damaging surfaces and to avoid or minimize toxic effects on household members or users of public spaces.

Sources

1 Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. Geneva: World
Health Organization; 2020 https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-
implications-for-ipc-precaution-recommendations, accessed 6 May 2020

2 Cheng, V.C.C., Wong, S.-C., Chen, J.H.K., Yip, C.C.Y., Chuang, V.W.M., Tsang, O.T.Y., et al, 2020. Escalating infection
control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2
in Hong Kong. Infect. Control Hosp. Epidemiol. 41, 493–498. https://doi.org/10.1017/ice.2020.58, accessed 6 May 2020

3 Lai, C.-C., Shih, T.-P., Ko, W.-C., Tang, H.-J., Hsueh, P.-R., 2020. Severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 55,
105924. https://doi.org/10.1016/j.ijantimicag.2020.105924, accessed 6 May 2020

4 Ramesh, N., Siddaiah, A., Joseph, B., 2020. Tackling corona virus disease 2019 (COVID 19) in workplaces. Indian J Occup
Environ Med 24, 16. https://doi.org/10.4103/ijoem.IJOEM_49_20, accessed 6 May 2020

10 Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Geneva: World Health Organization;
2020 https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf, accessed 10 May 2020

12 Practical considerations and recommendations for Religious Leaders and Faith-based Communities in the context of
COVID-19. Geneva: World Health Organization; 2020 https://www.who.int/publications-detail/practical-considerations-
and-recommendations-for-religious-leaders-and-faith-based-communities-in-the-context-of-covid-19, accessed 10 May
2020

13 Infection prevention and control for the safe management of a dead body in the context of COVID-19: interim guidance.
Geneva: World Health Organization; 2020 https://www.who.int/publications-detail/infection-prevention-and-control-for-
the-safe-management-of-a-dead-body-in-the-context-of-covid-19-interim-guidance, accessed 10 May 2020

14 Getting your workplace ready for COVID-19: How COVID-19 spreads. Geneva; World Health Organization; 2020
https://www.who.int/who-documents-detail/getting-your-workplace-ready-for-covid-19-how-covid-19-spreads

15 COVID-19 and food safety: Guidance for food businesses. Geneva; World Health Organization; 2020
(https://apps.who.int/iris/bitstream/handle/10665/331705/WHO-2019-nCoV-Food_Safety-2020.1-eng.pdf, accessed 10
May 2020)

16 Operational considerations for COVID-19 management in the accommodation sector. Geneva: World Health Organization;
2020 https://apps.who.int/iris/bitstream/handle/10665/331937/WHO-2019-nCoV-Hotels-2020.2-eng.pdf, accessed 10
May 2020

17 Operational considerations for managing COVID-19 cases or outbreak in aviation: interim guidance. Geneva; World
Health Organization; 2020 https://www.who.int/publications-detail/operational-considerations-for-managing-covid-19-
cases-or-outbreak-in-aviation-interim-guidance, accessed 10 May 2020

18 Operational considerations for managing COVID-19 cases or outbreaks on board ships: interim guidance. Geneva; World
Health Organization; 2020 https://www.who.int/publications-detail/operational-considerations-for-managing-covid-19-
cases-or-outbreaks-on-board-ships-interim-guidance, accessed 10 May 2020

19 Key Messages and Actions for COVID-19 Prevention and Control in Schools. Geneva; World Health Organization; 2020
https://www.who.int/docs/default-source/coronaviruse/key-messages-and-actions-for-covid-19-prevention-and-control-
in-schools-march-2020.pdf, accessed 10 May 2020

20 Preparedness, prevention and control of COVID-19 in prisons and other places of detention
http://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/publications/2020/preparedness,-
prevention-and-control-of-covid-19-in-prisons-and-other-places-of-detention-2020, accessed 10 May 2020

46 Gon, G., Dancer, S., Dreibelbis, R., Graham, W.J., Kilpatrick, C., 2020. Reducing hand recontamination of healthcare
workers during COVID-19. Infect. Control Hosp. Epidemiol. 1–2. https://doi.org/10.1017/ice.2020.111, accessed 9 May
2020