Environmental sanitation practices to control the spread  of communicable disease in passenger conveyances and terminals

This guidance is based on current available scientific evidence and are subject to review and change as new information becomes available.

Overview

The following guidance is provided by the Public Health Agency of Canada's Travelling Public Program to assist conveyances and terminal operators in determining appropriate infection control measures to be used onboard a passenger conveyance or in a terminal.  Given the millions of travellers that travel to, from and within Canada each year, and the close quarters they share for extended periods, environmental sanitation practices are especially important to reduce the risk of spreading communicable diseases. This guidance focuses on reducing the risk of transmitting illnesses that can be spread through contact with contaminated surfaces or body fluids. It does not address person-to-person or airborne transmission.

Recommendations

1. Personal hygiene:

• Wash your hands regularly and whenever they become soiled.
  • Washing hands with soap and running warm water is best, because of the removal action of soap and water on transient microorganisms.
  • Hands should be washed using soap and warm water for at least 20 seconds.
  • If soap and water are not available, an alcohol-based hand rub (ABHR) can be used.  Alcohols are the most rapidly active of all agents used in hand disinfection.  However alcohol may not be effective when there is organic material on your hands (e.g. after using the toilet).  For this reason, ABHR alone should not be used on visibly soiled hands. Use wipes to remove soil, followed by an ABHR.
• Practice proper cough and sneeze etiquette. Cover your mouth and nose with your arm to reduce the spread of germs.  If you use a tissue, dispose of it as soon as possible. Wash your hands afterwards.

2. Cleaning and disinfection procedures

Equipment

The following equipment should be available for cleaning and disinfecting. Equipment should be kept and stored together as part of a kit which can be easily accessed and transported to the area where it will be used.

• Personal protective equipment (as required by the operator's health and safety protocol)
• Disposable cloths
• Paper towels and absorbent materials
• Waste disposal bags (identified as biohazard), labels and tape
• Cleaning agents
• Appropriate hard-surface disinfectants
• Test strips for verifying disinfectant concentrations.

Disinfectants must be registered for sale in Canada with a Drug Identification Number (DIN). More information is available on Health Canada's website.

Response to public health events

Following a public health event, such as the suspected carriage of an infectious passenger or the contamination of a conveyance or terminal surface with body fluid (i.e. diarrhea, vomit, blood), the cleaning and disinfecting procedures outlined below should be followed.

Body fluids such as blood, vomit, and diarrhea may contain microorganisms that cause disease.  These fluids, and surfaces that come in contact with them, should always be considered as contaminated and should be handled with care so that diseases are not spread from one person to another.

1. Treat any body fluid as though it is infectious.
2. Where possible, restrict access to the affected area until disinfection activities are completed.
3. Put on disposable, impervious gloves.  Avoid contact with the face, especially the nose and eyes.
4. Bring all supplies needed to the affected area at the beginning of the process. This includes waste disposal bags identified as biohazard, a disinfectant that is effective against human Norovirus or an acceptable surrogate (feline calicivirus), water, paper towels, cloths and a detergent/cleaner.
5. Use paper towels to absorb material.  Place waste into waste disposal bags identified as biohazard.
6. Clean visibly soiled surfaces with water and a detergent/cleaner.  Cleaning is a critical step prior to disinfection.    Clean equipment or surfaces in a way that avoids possible generation of aerosols.  Vacuum cleaners should only be used after disinfection has taken place. 
7. Apply the disinfectant to the surface and allow the surface to air dry for a minimum of 10 minutes or as per manufacturers' instructions.  Start at one end of the affected area and move in one direction until all surfaces have been disinfected.  Do not use a circular motion.
8. Special cleaning of upholstery, carpets, or storage compartments is not required unless obviously soiled with fresh body fluids.  If a seat cover is obviously soiled with body fluids, it should be removed and discarded by the methods typically used for contaminated items.
9. Frequently replace cleaning and disinfection cloths, especially when moving from one area to another.
10. Change gloves frequently during cleaning and disinfection activities, especially if they become heavily soiled or damaged during use.
11. Dispose of soiled cleaning cloths, disinfection cloths, disposable gloves and any other item in contact with body fluids (eating utensils, linen) in a biohazard waste disposal bag.
12. Replace items such as blankets or pillows provided to affected passenger(s). Replace print materials from affected seat(s).
13. Wash hands when finished, using proper hand washing techniques:  Wash hands with soap and warm running water for at least 20 seconds. Use ABHR containing 60-90% (optimally over 70%) alcohol concentration when working in areas not equipped with hand washing facilities.  If hands are visibly soiled, use wipes to remove soil, followed by alcohol based hand sanitizers.
14. Clean and disinfect equipment that will be reused prior to storing.
15. All final biohazard waste disposal should be done according to appropriate biohazard waste protocols.

Response to a specific communicable disease may require additional procedures and precautions.

Contact the Public Health Agency of Canada at 1-833-615-2384 (ext. #7) if you have any questions.

Routine sanitation

Routine cleaning and disinfection practices play a critical role in minimizing the spread of a number of infectious diseases.  Frequently touched areas in a conveyance or terminal should be targeted for regular cleaning and disinfection.  Frequently touched areas include:

• Lavatories including doors, toilet handles, faucets and waste bins
• Luggage storage bin handles, tray backs and handles, arm rests, seatbelts, television screens, bulkheads, windows and window shades,  remote controls and aisle seat headrests
• State rooms
• Gaming machines and playing chips
• Child play areas or daycare centers (including toys)
• Service counters
• Waiting and holding areas including tables and chairs
• Food, beverage and retail service areas
• Accommodation areas
• Corridors, stairwells and elevators
• Any other common use areas (e.g. play areas)

A general or hospital disinfectant is acceptable for routine disinfection for most environmental surfaces.  Disinfectants with efficacy as a general or hospital disinfectant may have the label claims "germicide" or "kills germs".  Follow the manufacturer's instructions for the recommended dilution rates, contact times and conditions specific to the surface.

Additional information

The Public Health Agency of Canada's inspection guidelines for aircraft, trains, ferries, cruise ships and terminals detail elements that are considered to be essential to the provision of sanitary conditions as a part of normal operations. They are designed to identify public health risks related to sanitary conditions and appropriate control measures to address these risks. These are guidelines are available upon request by contacting: phac.tpp-ppv.aspc@canada.ca.