CHECKLIST
Checklist for terminal cleaning and decontamination of Ebola Care Facilities March 2015
District / County Facility name
______________________ ______________________ ______________________
Location Managed by
______________________ ______________________
Number of beds ______________________ Tel. number E-mail ______________________ ______________________
Assessor’s name
______________________
Notes • This checklisti includes the necessary steps for terminal waste management, cleaning and decontamination processes.
• The following agencies and officers should be identified for the inspection of the facility before, during and after terminal cleaning and decontamination.
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Ministry of Health or relevant authority Project officer IPC officer Cleaners Water, sanitation and hygiene officer Occupational health and safety officer (if available) Laundry staff (optional) Waste handler Security guards
• The facility should NOT be reopened for other purposes until the safe completion of the process, documented by use of the checklist.
• For psychological reasons, it is suggested to repaint the walls and/or refresh furniture, if possible. • Spraying rooms with disinfectants is not recommended. It is a potentially dangerous practice with no proven disease control benefit and the disinfectant may not reach all desired surfaces. Spraying may be acceptable outdoors when it is the only feasible option or considered when necessary to disinfect sand or gravel floors. When spraying is used, cleaning with water and detergent to mechanically remove the contaminants and organic matter should precede it. After spraying of disinfectant, it may necessary also to ensure that it is properly distributed on the surfaces. Cleaners undertaking spraying should wear full PPE. i
This checklist is a tool recommended for use by the intended user and the information collected is not being used for CDC data collection instrument. CDC does not intend on collecting this information. © World Health Organization 2015. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO/EVD/Guidance/Strategy/15.2
1. Daily check of appropriate personal protective equipment (PPE)ii when performing cleaning and decontamination activities; cleaners/hygienists must wear full PPE in the red zone Yes 1.1 1.2 Double gloves worn (non-sterile examination gloves and heavy duty gloves) Disposable gown or coverall made of fluidresistant fabric worn that covers clothing and exposed skin A disposable, waterproof apron worn over the gown If a disposable apron is not available, a heavy duty, reusable waterproof apron may be used with appropriate cleaning and disinfection after use A fluid-resistant medical/surgical mask worn, with a structured design that does not collapse against the mouth (e.g., duckbill, cup shape) Eye protection (either goggles or face shield) worn to completely cover the mucous membranes of eyes, mouth and nose Waterproof boots (e.g., rubber/gum boots) worn No Comments
1.3 1.4
1.5
1.6
1.7
ii
Cleaners/hygienists/others must wear full PPE In the red (high risk) zone for all activities taking place before or during terminal cleaning and decontamination.
Checklist for terminal cleaning and decontamination of Ebola Care Facilities
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2. Inspection prior to cleaning and disinfection Yes 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 PPE available (according to list in section 5) Appropriate area for putting on PPE Appropriate area for removal of PPE Appropriate area for storage of cleaned and decontaminated medical devices and equipment Appropriate area for decontamination Disinfectants available (e.g., chlorine solution 0.5% and alcohol) Detergents available Cleaning equipment available Disinfection equipment available (e.g., cups or other equipment to correctly make chlorine solutions) Plastic bags available to separate clean and decontaminated equipment Adequate amount of safe portable water available on site Leak-proof bags available Sharps containers available All surfaces visually inspected for sign of wear and tear, decay or overall disrepair (e.g., mattresses, furniture, equipment) and labelled All non-intact objects/equipment are safely disposed of and incinerated All objects/equipment made of porous/absorbable material and without intact plastic cover are safely disposed of and incinerated Tent-like structures with surfaces that show visible signs of wear or breakdown are considered contaminated waste and incinerated All intact objects/equipment suitable for cleaning and decontamination identified and labelled iv iii
No
Comments
2.10 2.11 2.12 2.13 2.14
2.15 2.16
2.17
2.18
iii
Clean area equipped with a body size mirror, poster on steps for putting on PPE, hand hygiene station, and good stocks of equipment. Area equipped with a body size mirror, poster on PPE removal steps, hand hygiene station, equipment for decontamination and waste bin. iv
Checklist for terminal cleaning and decontamination of Ebola Care Facilities
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3. Environmental cleaning and decontamination (daily checks during procedures) Yes 3.1 3.2 Cleaners in the red zone wear full PPE Cleaners in the green zone wear a disposable gown, heavy duty gloves, mask, face shield, and boots as a minimum All environmental surfaces (including furniture, walls, doors, etc.) and objects are first cleaned with water and a detergent with a moistened cloth All environmental surfaces are then thoroughly disinfected using a 0.5% chlorine solution and wipes and rags Spills including blood, other body fluids, secretions or excretions, are removed by covering with a rag or paper towel. Then they are wiped up and the waste, rags or towel put into a laundry container for laundering, or a waste bucket designated as infectious waste for disposal. Using moistened cloths and wipes, the area is then cleaned with water and a detergent and then disinfected with a 0.5% chlorine solution (i.e., a solution containing 5000 ppm available free chlorine) or another suitable disinfectant. Fresh cleaning and disinfectant solutions (if locally prepared) are prepared daily Cleaning solutions and equipment are changed and refreshed every 2-3 hours during use Cleaning is carried out from “clean” areas to “dirty” areas Surfaces are allowed to dry naturally Dry sweeping with a broom is not performed Rags holding dust are not shaken out No Comments
3.3
3.4
3.5
3.6 3.7 3.8 3.9 3.10 3.11
Checklist for terminal cleaning and decontamination of Ebola Care Facilities
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4. Water, sanitation and hygiene (WASH) facility principles for terminal cleaning and decontamination 4.1 4.1a 4.1b
WASH inspection prior to decommissioning Adequate amount of water available on site (between 200-300 litres per bed per day) Are there any septic tanks to be desludged? (A tank to be reused should only be emptied if it is over two-thirds full – see Section 6.3 of guidance document) Is there a need for a vehicle to move and transport oversized and/or heavy materials (truck, cranes)? Has a sanitary survey been conducted of the water points used by the Ebola treatment centre? Are there any hazardous chemicals that will need safe removal/disposal (e.g., chlorine)?
Yes
No
Comments
4.1c
4.1d 4.1e
4.2 4.2.1 4.2.1a 4.2.1b 4.2.1c 4.2.1d 4.2.1e 4.2.2 4.2.2a 4.2.2b 4.2.3 4.2.3a
WASH inspection after decommissioning Temporary latrines Superstructures disinfected Superstructures dismantled Latrine materials to be reused are disinfected and safely stored Latrine pit backfilled to ground level Latrine pit site clearly demarcated Existing permanent latrines (e.g., in schools, health centres) Superstructures cleaned and disinfected Slab/toilet cleaned and disinfected Septic tanks If the tank is not to be reused: • The tank is properly sealed, backfilled and clearly demarcated • The inspection chamber is dismantled and sealed with concrete If the septic tank is functioning and to be reused: • The tank is less than two-thirds full No faecal waste visible on site Yes No Comments Yes No Comments v
Yes
No
Comments
4.2.3b 4.2.3c
v
A structure built on top of a latrine; e.g., the timber frame, wood frame, aluminum frame and the roof.
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4.2.4 4.2.4a 4.2.4b 4.2.4c 4.2.4d 4.2.4e 4.2.5 4.2.5a 4.2.5b 4.2.5c 4.2.6 4.2.6a 4.2.6b 4.2.6c 4.2.7 4.2.7a 4.2.7b 4.2.7c 4.2.8 4.2.8a 4.2.8b 4.2.8c 4.2.9 4.2.9a 4.2.9b 4.2.9c
Temporary showers Superstructures disinfected Superstructure dismantled Shower materials to be reused are disinfected and safely stored Soakaway pits disinfected Soakaway pits backfilled Permanent showers Showers disinfected Soakaway pits disinfected Drainage channels backfilled Water facilities Water pipes and taps disinfected Water pipes and taps dismantled Exterior of water tanks disinfected Solid waste No visible waste in green zone waste disposal site No visible waste in red zone waste disposal site Disposal pits (sharps, organics and ash) properly backfilled and sealed WASH-related chemicals No lime, chlorine or other hazardous material and/or their containers found on the site Local community satisfied with decontamination Equipment inspected by a WASH engineer prior to repurposing Pipe network Pipe networks disinfected with 0.5% chlorine Water network flushed with a pumping system If the site is dismantled, the pipes are removed to an approved dumping site
Yes
No
Comments
Yes
No
Comments
Yes
No
Comments
Yes
No
Comments
Yes
No
Comments
Yes
No
Comments
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5. Occupational health and safety (OHS) risks for decommissioning procedures 5.1 5.1a 5.1b 5.1c 5.1d 5.1e 5.2 5.2a 5.2b 5.2c 5.3 5.3a Inspection before decommissioning OHS hazard assessment completed Written OHS mitigation plan OHS training of decommissioning workers completed First aid officer identified and necessary supplies available Written plan for necessary medical treatment of injuries and exposures Inspection during decommissioning Daily OHS briefing completed Appropriate PPE available All daily injuries and exposures documented Inspection after decommissioning A method in place to collect the following information: • Outcomes of all injuries and exposures • Any illness occurring during and within 30 days of the end of decommissioning work • Any hazardous materials or chemicals left onsite Report OHS lessons learnt and recommendations Yes No Comments Yes No Comments Yes No Comments
5.3b
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6. Operations 6.1 6.1a 6.2b Preparation pre-assessment List of PPE, chlorine and detergent, tools required (e.g., hammer, demarcation tape, plastic mesh) List of equipment and decision on future destination (e.g., donation, incineration, landfill, reuse) Briefing on the infrastructure Definition of roles and responsibilities within the team Initial decommission plan and timeframe available Identification of “clean” zone Required topics for training identified and listed Agreement with the community to initiate the decommissioning process Preparation phase assessment Assess the condition of equipment Assess infrastructures and report areas that show visible sign of decay or breakdown Assess needs for lifting and moving devices Arrange servicing and recertification by qualified staff, where necessary, for equipment to be repurposed Preparation phase post-assessment Revision of initial decommission plan and timeframe Revision of list of equipment and decision on its future destination (e.g., donation, incineration, landfill, reuse) Training pre-decontamination conducted Risks assessed and mitigation in place Yes No Comments Yes No Comments Yes No Comments
6.1c 6.1d 6.1e 6.1f 6.1g 6.1h 6.2 6.2a 6.2b 6.2c 6.2d
6.3 6.3a 6.3b
6.3c 6.3d
Checklist for terminal cleaning and decontamination of Ebola Care Facilities
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7. Final steps (to reopen/repurpose the facility) Yes 7.a 7.b 7.c 7.d 7.e 7.f 7.g If a burning pit is used, close off with cement when all procedures are concluded Final list of material and equipment and actions taken (e.g., donation, incineration, landfill, reuse) Site plans including underground masonry structures, water points, pits and waste area Deviation from the initial waste management plan Photo journal Lessons learned and recommendations The IPC officer who conducted the pre-inspection has visually inspected all surfaces and decontaminated objects and confirmed that they have been properly cleaned and disinfected using a specific checklist An appointed government official responsible for the repurposed structure has inspected the facility to determine if any additional repairs or painting are required No Comments
7.h
Checklist for terminal cleaning and decontamination of Ebola Care Facilities
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