Crew arrives to clean quarantined Texas apartment

F-1 Let's see what they remove from that apartment.

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particles during sorting. (see Fenner, F, Henderson DA, Arita I, Ježek Z, Ladnyi

A. Reusable medical equipment

Reusable medical equipment should be cleaned with a 5% aqueous solution of a

phenolic germicidal detergent then decontaminated using one of the following

methods. The method selected should be based on manufacturer recommendations

for decontamination of the equipment.

1. Autoclave decontamination- Manufacturers standard protocols for autoclave

decontamination may be used.

2. Ethylene oxide decontamination - Equipment that must be decontaminated

using this method should be bagged in plastic bags that are permeable to

gaseous ethylene oxide. Humidify the material to be sterilized by injecting

water into the plastic-bagged material to produce a relative humidity of 50-

70%. Place the bags into an ethylene oxide sterilizer and allow an exposure of

at least 24 hours at a concentration of at least 800 mg per liter ethylene oxide.

The equipment should be allowed to fully aerate after ethylene oxide

decontamination.

3. Solution soak decontamination - Soak equipment in a 5% aqueous solution of

a phenolic germicidal detergent (e.g. industrial strength Lysol or Amphyl, )

for at least 1 hour.

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B. Medical waste

Medical waste should be bagged in appropriately marked biohazard bags and

incinerated or autoclaved on-site if possible. Alternatively, if on-site autoclaving

and incineration is not possible, medical waste may be transported to an

appropriate facility for autoclaving or incineration. If incineration takes place in

an area other than the facility, the outside of the bag should be sprayed with a

suitable disinfectant (e.g. Lysol, household bleach) prior to transportation to the

area for incineration. All personnel involved in handling, transportation, and

disposal of medical waste from facilities where confirmed or potential smallpox

patients are housed must have recent vaccination (within 3 years).

C. Surfaces

Contaminated horizontal surfaces may be decontaminated using a 5% aqueous

solution of a phenolic germicidal detergent (e.g. industrial strength Lysol,

Amphyl, or other commercial decontamination solution). All surfaces should be

thoroughly wet with the solution. Allow the solution to stand for at least 20

minutes then wet vacuum or wipe with clean cloths or disposable wipes. If a wet

vacuum is not available or practical and mops are used, disposable mop heads

should be used for no more than 500 sq. ft. of floor area. The cloths or disposable

wipes, mop heads, vacuum cleaner contents, and protective clothing worn by the

decontamination personnel should be bagged and incinerated or autoclaved. If

needed because of material shortages, re-useable protective clothing and cleaning

materials that can be laundered may be bagged then laundered using hot water

(71ºC) and bleach as outlined above. The vacuum cleaner should also be

disinfected with a phenolic germicidal detergent (e.g. industrial strength Lysol,

Amphyl, or other commercial decontamination solution) after use to further

disinfect the non-disposable parts of the vacuum cleaner (nozzle, hose, etc.).

D. Protective clothing, bedding, linens, etc.

Contaminated protective clothing should be bagged immediately after removal

and then incinerated or autoclaved. However, if needed due to shortages of

protective clothing, reuseable protective clothing that can be laundered may be

bagged then laundered using hot water (71ºC) and bleach as outlined above.

Bedding, linens, clothing, or other reusable cloth materials may be autoclaved or

laundered using hot water (71ºC) and bleach as outlined above.

E. Room/Facility

Facilities or rooms that were used to house smallpox patients should be

decontaminated once they are no longer used to house such patients. Once surface

decontamination has been done, formaldehyde decontamination should be

performed if possible. Formaldehyde decontamination should only be performed

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by personnel experienced with this method of decontamination. An Amphyl

fogger following manufacturer recommended procedures, may also be used. All

disposable items should be bagged and incinerated or autoclaved.

1. All horizontal surfaces, furniture, fixtures, and walls should be

decontaminated as outlined in C above.

2. All mattresses, mattress covers, pillows, curtains, clothing, and other

removable cloth items should be bagged and autoclaved, incinerated, or

laundered in hot water (71ºC) and bleach as described.

3. Items that should not be autoclaved or incinerated should be bagged and

decontaminated using ethylene oxide as outlined above.

4. Place paraformaldehyde in water in an electric deep-fat fryer in each of the

spaces to be decontaminated (an electric skillet is a suitable substitution if

a deep fat fryer is not available).

The amount of paraformaldehyde to be used should be sufficient to dose

Per approximately 1200 cu. ft. The relative humidity of the space should

be between 50% and 60% for best disinfection. The recommended

5. Open all drawers and doors within the area(s) to be decontaminated.

6. Remove all equipment, devices, or materials that may not withstand

exposure to paraformaldehyde and decontaminate by using one of the

other methods outlined above (whichever method is appropriate for the

equipment, device, or material) or by thoroughly wiping down with a 5%

aqueous phenolic germicidal detergent (e.g. Lysol, Amphyl).

7. Seal the room/facility to be decontaminated with masking or “duct” tape

as paraformadehyde diffuses readily.

8. Turn off ventilation in the room/facility during decontamination.

9. Cover supply-air grilles with plastic and seal them with tape. Seal the

exhaust-air duct downstream from the air filter in the same manner.

10. Set the deep-fat fryer(s) or electric skillet(s) to operate at approximately

11. Use a timer to turn the unit(s) off after 2 hours.

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12. Allow at least 12 hours to pass before entering the room/facility after the

vaporization unit(s) have been turned off.

A portable self-contained breathing apparatus must be used if it is

necessary to enter the space within 24 hours unless the room/facility has

been completely aired out and formadehyde levels have been checked.

13. After the room/facility has been aired to remove vapors, ventilation may

be turned back on and personnel may enter the room.

If smallpox patients are housed in their own homes, the above procedure for

paraformadehyde decontamination may be impossible or impractical. At a

minimum, the following decontamination procedures should be performed:

1. All disposable items that came into contact with the smallpox patient should

be bagged and incinerated. If incineration takes place in an area other than the

home where the patient was housed, the outside of the bag should be sprayed

with a suitable disinfectant (e.g. Lysol, household bleach) prior to

transportation to the area for incineration.

2. Bedding, linens, clothing, curtains, or other cloth material that came into

contact with the smallpox patient should be transported in biohazard bags to

be laundered using hot water (71ºC) and bleach or incinerated (see step 1

above).

3. Surfaces, furniture, fixtures, and walls should be thoroughly cleaned with a

5% aqueous solution of a phenolic germicidal detergent (e.g. Lysol, Amphyl).

4. Carpets and upholstery should be cleaned using a 5% aqueous solution of a

phenolic germicidal detergent (e.g. Lysol, Amphyl).

F. Vehicles (e.g. ambulance)

Ambulances should be decontaminated after transporting a smallpox patient(s)

before re-use to transport non-smallpox patients.

If possible, decontamination using wet cleaning followed by paraformadehyde or

an Amphyl fogger as outlined above should be performed. Formaldehyde

decontamination may be done by placing the fry pan directly inside the sealed

vehicle or by driving the vehicle into a closed space (which can be made

reasonably air-tight), opening all doors and inside spaces of the vehicle and

placing the fry pan inside the sealed space.

If either the formaldehyde or Amphyl fogger methods are not possible, wet

decontamination and cleaning of the entire passenger compartment and all door

handles should be done as outlined below:

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1. All items that can be incinerated or autoclaved should be bagged and

processed by one of these methods.

2. Heat-sensitive, reusable items should be sterilized using ethylene oxide as

outlined above.

3. Larger items (such as the stretcher) should be decontaminated at the same

time as the ambulance.

with a 5% aqueous solution of a phenolic germicidal detergent (e.g. Lysol,

5. Allow the solution to stand on all surfaces for at least 20 minutes.

6. Wet vacuum or wet clean with clean cloths, disposable wipes, or mops with

disposable mop heads, all surfaces inside the ambulance and all outside door

handles

7. Vacuum cleaner contents, cloths or disposable wipes, mop heads, and

protective clothing worn by the decontamination personnel should be bagged

and incinerated, autoclaved, or laundered as outlined above.

8. The vacuum cleaner should be disinfected with a phenolic germicidal

detergent (e.g. Lysol, Amphyl, or other commercial decontamination solution)

after use.

The above procedures may not be possible for private vehicles used to transport

smallpox patients. At a minimum, the following decontamination procedures

should be performed:

1. All disposable items in the vehicle should be bagged and incinerated.

2. All surfaces in the vehicle should be thoroughly wiped down with a 5%

aqueous solution of a phenolic germicidal detergent (e.g. Lysol, Amphyl, or

other commercial decontamination solution). The solution should be allowed

to remain on the surfaces for at least 20 minutes before being removed.

3. Carpets and upholstery should be cleaned using a 5% aqueous solution of a

phenolic germicidal detergent (e.g. Lysol, Amphyl, or other commercial

decontamination solution). The solution should be allowed to remain on the

carpets and upholstery for at least 20 minutes before being wiped off. Cloth

upholstery should be allowed to completely dry before use.

4. All outside door handles should be thoroughly cleaned using a 5% aqueous

solution of a phenolic germicidal detergent (e.g. Lysol, Amphyl, or other

commercial decontamination solution). The solution should be allowed to

remain on the door handles for at least 20 minutes before being wiped off.

5. Cloth material used to wipe down the inside of the vehicle should be

laundered using hot water (7 1ºC) and bleach or bagged and incinerated (see

above).