ISO/PAS 18999:2024

Publicly
Available
Specification
ISO/PAS 18999
First edition
Healthcare organization
2024-01
management — Pandemic response
—Guidelines for respiratory
infection prevention and control in
hospitals
Management des organisations de soins de santé — Réponse en
cas de pandémie — Lignes directrices relatives à la prévention et
au contrôle des infections respiratoires dans les hôpitaux
Reference number
© ISO 2024
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Published in Switzerland
ii
Contents Page
Foreword .iv
Introduction .v
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 1
4 Separate operation of a ward dedicated to respiratory infectious diseases . 2
4.1 General .2
4.2 Principles of isolation room assignment and operation .2
5 Transportation of confirmed cases and roles of the dedicated healthcare team in a
ward dedicated to respiratory infectious diseases . 4
5.1 Patient transportation .4
5.1.1 Safe patient transportation .4
5.1.2 Roles and composition of dedicated patient transportation team .4
5.1.3 Precautions for patient transportation.5
[8]
5.1.4 Patient transportation .6
[9]
5.1.5 Detailed handling procedures .6
5.2 Roles of the dedicated healthcare team in a ward dedicated to respiratory infectious
diseases and management of visitors (or guests) .7
5.2.1 Roles and composition of the dedicated healthcare team in a ward dedicated to
respiratory infectious diseases .7
5.2.2 Management of confirmed cases and visitors (or guests) in a ward dedicated to
respiratory infectious diseases .8
6 Cleaning, disinfection and waste management . 9
6.1 Disinfection of contaminated areas (rooms and equipment) .9
[10]
6.1.1 Precautions for disinfection .9
6.1.2 Disinfection methods .9
[7][6]
6.1.3 Precautions after disinfection . 12
6.2 Waste collection . 12
6.2.1 Key measures for preventing the cross-infection of waste collectors . 12
6.2.2 Principles for medical waste disposal. 13
6.2.3 Wearing PPE during waste disposal . 13
6.2.4 Safe waste disposal . 13
Annex A (informative) Facility standards for isolation rooms in a ward dedicated to respiratory
infectious diseases . 16
Annex B (informative) Ward facility management for preventing cross-infection . 19
Annex C (informative) Terminal cleaning checklist .26
Bibliography .28

iii
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out through
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The procedures used to develop this document and those intended for its further maintenance are described
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This document was prepared by ISO/TC 304, Healthcare organization management.
Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html.

iv
Introduction
In the wake of the COVID-19 pandemic, guidelines have become necessary to prevent cross-contamination
of the respiratory tract that can occur in hospitals in a disaster situation where a respiratory infectious
disease has occurred. Therefore, this document was written to prevent cross-contamination in hospitals
due to the outbreak of common respiratory infectious diseases.
This document is intended to standardize the guidelines for the separate operation of wards dedicated to
respiratory infectious diseases; transportation of confirmed cases; and cleaning, disinfection and waste
management, etc. in order to prevent respiratory cross-infections under emergency situations caused by
respiratory infectious diseases such as COVID-19.

v
Publicly Available Specification ISO/PAS 18999:2024(en)
Healthcare organization management — Pandemic response
—Guidelines for respiratory infection prevention and control
in hospitals
1 Scope
This document provides guidelines to prevent cross-infections within a hospital, with a specific focus on the
separate operation of wards dedicated to highly contagious respiratory infectious diseases, transportation
of confirmed cases of highly contagious respiratory infectious diseases, disinfection, waste management,
etc.
This document applies to the following:
a) separate operation of wards dedicated to highly contagious respiratory infectious diseases;
b) transportation of confirmed cases of highly contagious respiratory infectious diseases and roles of the
dedicated healthcare team in a ward dedicated to highly contagious respiratory infectious diseases;
c) cleaning, disinfection, and waste management.
2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
ISO and IEC maintain terminology databases for use in standardization at the following addresses:
— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at https:// www .electropedia .org/
3.1
coronavirus
virus that is part of a large family of viruses that can cause illness in animals or humans
Note 1 to entry: In humans, several coronaviruses are known to cause respiratory infections ranging from the common
cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory
Syndrome (SARS). The coronavirus discovered in 2019 causes the coronavirus disease COVID-19.
[SOURCE: ISO 5472:2022, 3.3]
3.2
infectious disease patient
person who has tested positive in a diagnostic test for an infectious disease

3.3
negative pressure room
room in which the air pressure differential between the room and the adjacent indoor airspace directs the
air flowing into the room (i.e. room air is prevented from leaking out of the room and into adjacent areas
such as the corridor)
[SOURCE: ISO 5472:2022, 3.8]
3.4
internal corridor
corridor inside the negative pressure isolation area, which connects a patient room anteroom, corridor
anteroom, personal protective equipment (PPE) doffing room (3.5), waste disposal room (3.6), equipment
storage room (3.7), etc.
3.5
doffing room
space connected to the internal corridor (3.4), where healthcare workers who completed medical treatment
take off their PPE before entering the general area
3.6
waste disposal room
space connected to the internal corridor (3.4), where medical waste generated from treatment of inpatients
is sterilized or stored before discharge
Note 1 to entry: The waste disposal room is set to maintain a negative pressure lower than the internal corridor and a
high temperature autoclave can be installed, if necessary.
3.7
equipment storage room
space connected to the internal corridor (3.4), where mobile equipment used for the treatment of infectious
disease patients (3.2), etc. is stored or disinfected after use
3.8
HEPA filter
high efficiency particulate air filter
retentive matrix having a minimum particle-collection efficiency of 99,97 % (that is, a maximum particle
penetration of 0,03 % for 0,3 µm particles)
Note 1 to entry: See Reference [4].
[SOURCE: ISO 5472:2022, 3.6, "high efficiency particulate air filter" has been changed from a preferred term
to an admitted term; note 1 to entry has been added.]
4 Separate operation of a ward dedicated to respiratory infectious diseases
4.1 General
A ward dedicated to respiratory infectious diseases refers to a unit that is established in order to prevent the
infection of other patients and healthcare workers in the process of treating respiratory infectious disease
patients, etc. and to suppress the transmission of causative pathogens in the local community. In principle,
a negative pressure room should be operated as a single-occupancy room to curb the spread of infectious
agents within a hospital through droplets or the air. See Annex A.
4.2 Principles of isolation room assignment and operation
4.2.1
In principle, isolation rooms in a ward dedicated to respiratory infectious diseases should be operated as
a single-occupancy negative pressure room, with the aim to prevent the circulation of air from isolation
rooms occupied by confirmed cases to other areas within a hospital.
a) When no negative pressure room is available, it is necessary to prevent the circulation of air from
isolation rooms occupied by confirmed cases to other areas within the hospital as best as possible.
The criteria for air handing units (AHU) and heating, ventilation and air-conditioning (HVAC) system
are as follows (see Annex B): because the default is to circulate a mix of outside air (30 %) and inside air
(70 %), the opening rate of AHU is adjusted to prevent air mixing and to switch to a system with 100 %
outside air supply and 100 % exhaust. In case of resource-limiting settings, staff open the windows at
least three times a day for more than 30 min.
b) When no single-occupancy room is available, multi-patient rooms can be used for confirmed cases in a
ward that is completely separated from the routes of general patients.
4.2.2
Suspected cases are assigned single-occupancy negative pressure rooms in principle until testing results are
released. However, when no single-occupancy negative pressure room is available, patients with confirmed
cases can be admitted to separate single-occupancy rooms that meet the AHU criteria.
4.2.3
The priority for the assignment of negative pressure rooms is to firstly assign them to high-risk patients
in need of medical treatment, etc. The high-risk groups in terms of the priority for room assignment are as
follows:
a) patients with oxygen saturation below 90 % who require initial oxygen therapy;
b) patients with underlying diseases (chronic obstructive pulmonary disease, cardiovascular diseases,
etc.).
[5]
EXAMPLE Room assignment for confirmed cases in healthcare facilities .
1) Priority is given to positive patients that are persons under investigation (PUI) or undergoing
aerosol generating procedures (AGP).
2) Each confirmed case should be assigned to a single-occupancy negative pressure room in principle.
3) When no single-occupancy negative pressure room is available, a confirmed case should be assigned
to a multi-patient negative pressure room.
4) When no multi-patient negative pressure room is available, a confirmed case should be assigned to
a regular single-occupancy room.
5) When no regular single-occupancy room is available, a confirmed case should be assigned to a
regular multi-patient room (a minimum distance of 1 m is recommended between beds).
6) When no regular multi-patient room is available, confirmed cases should be assigned to all rooms
on a single floor in the facility.
The conditions for 3), 4), and 5) are as follows:
route: in order to ensure completely separate routes between confirmed cases and general patients, a
ward (or single floor) is operated independently when confirmed cases are admitted to regular rooms.

5 Transportation of confirmed cases and roles of the dedicated healthcare team in a
ward dedicated to respiratory infectious diseases
5.1 Patient transportation
5.1.1 Safe patient transportation
To ensure safe patient transportation, the following should be considered.
a) A patient transportation team should be organized with a minimum number of personnel when
transporting a confirmed case of a respiratory infectious disease.
b) An advance notice should be provided to the receiving healthcare facility before the arrival of a
confirmed case of a respiratory infectious disease so that proper preparations are taken prior to patient
arrival.
c) During the transportation of a confirmed case, any contact personnel should wear PPE.
d) An ambulance should be used that is prepared at the transportation location as a vehicle for
transportation.
e) A patient should be transported on a predetermined route of the shortest travel distance and time
(using designated elevators and pathways reserved exclusively for infectious disease patients).
f) When transporting a patient to a ward dedicated to respiratory infectious diseases, the route should be
blocked to prevent contact with other patients or visitors.
g) The wheelchair or transportation cart used for patient transportation should be left in the ward
dedicated to respiratory infectious diseases.
Patient transportation equipment, etc. that are left in the ward dedicated to respiratory infectious
diseases can be reused after being disinfected according to the infection control guidelines.
h) After transportation, PPE should be removed and disposed of according to 6.1.3; hand hygiene should be
[6]
performed thoroughly .
5.1.2 Roles and composition of dedicated patient transportation team
The dedicated patient transportation team for confirmed cases of respiratory infectious diseases performs
the roles outlined in Table 1.

Table 1 — Roles of dedicated patient transportation team for confirmed cases of respiratory
infectious diseases
Department or per-
Category Roles
son in charge
— Designation, cancellation, and management of hospital access and

restricted areas.
— Installing signs or signboards for restricted areas Support department
— Disinfection of surrounding environment after patient transportation, Environmental
such as designated elevators, rooms, transportation route, etc. service
Medical sup- — Wearing a N95 or its equivalent or higher-grade respirator and PPE
port (excluding access control personnel who have no direct contact with
Administration
patients and maintains a 2 m distance).
personnel in charge
of access control to
— Access control of general patients, guardians and hospital staff to the
patient transporta-
transportation route before transporting confirmed cases.
tion route
— Access control to reserved designated elevators.
— Setting up a restricted area according to the hospital policies and attaching
Administration per-
and installing signboards if necessary.
sonnel in charge of
guidance on patient
— Facility management for cancellation and reoperation of restricted
transportation and
facilities.
provision of related
support
— Disinfection of surrounding of environment.
— Wearing PPE and taking over a patient from emergency medical services
(EMS) personnel.
— In the case of a severe patient, a healthcare worker accompanies the patient Patient transpor-
during transportation. tation team (two
persons per team)
— Transporting a patient to an assigned room using transportation
equipment (negative pressure stretcher, negative pressure wheelchair,
etc.) depending on the patient’s condition.
5.1.3 Precautions for patient transportation
Matters related to patient transportation are at the discretion of healthcare workers; and these guidelines
outline specific precautions for transportation.
a) Preparations for patient transportation
1) An ambulance should be used for patient transportation (an isolation stretcher equipped with a
HEPA filter should be used, if available).
2) A patient transportation team should be organized with the minimum number of personnel (driver,
health service workers, healthcare worker, etc.); it should be verified that there is no other person
with the patient.
3) An advance notice should be provided to the receiving healthcare facility so that proper preparations
are taken prior to patient arrival.
— the following information should be delivered when requesting patient transfer, including:
— patient condition (notable information such as severity, age, underlying diseases, dialysis
status, cancer patient, mental illness, etc.);
— patient location (name of the healthcare facility, etc.);
— contact details of healthcare workers who can explain the patient’s health condition.

[4][7]
b) Considerations for infection prevention
1) Patient transportation personnel should wear PPE during patient transportation according to 5.1.1.
2) Aerosol generating procedures should be prohibited whenever possible and aerosol-generating
clinical pattern/procedures should be reduced before arriving at the hospital.
3) Any behaviour that can lead to pathogen transmission through contact during patient transportation
should be avoided, such as taking off a mask, eating food, touching the face.
4) After patient transportation, the vehicle and transportation equipment should be cleaned and
disinfected, given the possibility of pathogen transmission from the patient.
c) The patient should wear a mask during transportation, with the aim to minimize exposure through the
respiratory system or physical contact; the patient should wear a mask whenever possible.
d) Patient transportation personnel should wear a N95 or its equivalent or higher-grade respirator,
disposable long-sleeved plastic gown or protective clothing (coverall), disposable gloves, protective
goggles or face shields, and surgical hat (optional), with the aim to minimize exposure through the
respiratory system or physical contact.
[8]
5.1.4 Patient transportation
The following guidelines should be considered for the safe and efficient transportation of patients with
respiratory infectious diseases:
a) A patient should use a separate route to minimize exposure through droplets from respiratory
secretions and physical contact.
b) A patient should wear a surgical mask during inter-hospital transportation.
c) A healthcare worker should accompany a patient during transportation and wear a N95 or its equivalent
or higher-grade respirator or surgical mask, disposable long-sleeved plastic gown or protective clothing
(coverall), disposable gloves, protective goggles or face shields, and surgical hat (optional) to avoid
direct contact with the patient as best as possible.
d) In case of patient transportation to other healthcare facilities, an ambulance should be used in
consultation with a local public health center.
e) Patient information should be provided to the receiving healthcare facility in advance and a departure
time should be prearranged so that proper preparations are taken prior to the patient arrival.
[9]
5.1.5 Detailed handling procedures
The detailed handling procedure for patients to be hospitalized and outpatients or emergency room patients
is as follows.
a) Transportation of patients to be hospitalized
1) Security guards control the access of general patients, guardians and hospital staff to the
transportation route designated for confirmed cases.
2) After an ambulance arrives at the predetermined location within the hospital for confirmed cases
of respiratory infectious diseases, the patient transportation team (two persons per team) takes
over the patient.
3) After taking over the patient, the patient transportation team (two persons per team) who wears
a N95 or its equivalent or higher-grade respirator or surgical mask, long-sleeved surgical gown,
disposable gloves, protective goggles or face shields, disposal long-sleeved plastic gown, and surgical
hat (optional) transports the patient via the route designated for confirmed cases of respiratory
infectious diseases.
4) The patient is transported to the assigned room using designated elevators exclusive or designated
for confirmed cases of respiratory infectious diseases.
b) Transportation of outpatients or emergency room patients
A patient is transported to the assigned room via a shortest route using designated elevators, along
with hospital staff wearing PPE.
c) The purpose of access control to a ward dedicated to respiratory infectious disease and transportation
routes for confirmed cases is to prevent contamination and the spread of infections during patient
transportation. The following methods apply to access control:
1) when starting to operate a ward dedicated to respiratory infectious disease, all confirmed cases
who have visited the hospital’s main building are transferred to the ward and then the access
control line is installed during isolation treatment;
2) a notice of restricted areas is attached to the access control line;
3) when transporting confirmed cases, access to the patient transportation route is controlled for any
person other than personnel from the response headquarters.
5.2 Roles of the dedicated healthcare team in a ward dedicated to respiratory infectious
diseases and management of visitors (or guests)
5.2.1 Roles and composition of the dedicated healthcare team in a ward dedicated to respiratory
infectious diseases
The dedicated healthcare team performs the roles outlined in Table 2, when confirmed cases are admitted
to a ward dedicated to respiratory infectious diseases.

Table 2 — Roles of the dedicated healthcare team in the case of hospitalization of confirmed cases in
a ward dedicated to respiratory infections
Department or
Category Roles
person in charge
— Selecting and deploying personnel for the healthcare team dedicated to
General man-
respiratory infectious diseases.
agement of Emergency response
the dedicated headquarters
— Deliberating on isolation hospitalization of respiratory infectious diseases
healthcare team
and general management of infection control.
— Patient care.
Doctors
— Providing infection prevention education for patients’ guardians and Nurses
Patient care
visitors.
Laboratory person-
nel
— Various tests for diagnosis.
— Specimen tests for respiratory infectious disease patients
Radiology personnel
— Imaging tests for respiratory infectious disease patients
Doctors and nurses
and other health-
— Monitoring system operation in hospital.
care workers (e.g.,
microbiologists,
— Providing infection prevention education for hospital staff.
Infection control epidemiologists)
— Developing education materials on hospital-acquired infections.
specialized in
infection control
— Reporting new cases.
or infectious dis-
eases.
— Purchasing and supplying PPE.
— Room ventilation and sewage treatment.
Administrative Support and facili-
— Cleaning and laundry.
support ties departments
— Meal supply.
— Waste management.
5.2.2 Management of confirmed cases and visitors (or guests) in a ward dedicated to respiratory
infectious diseases
The following management of confirmed cases and visitors in a ward dedicated to respiratory infectious
diseases for infection prevention should be considered.
a) PPE is worn by any hospital staff who comes in contact with patients in a ward dedicated to respiratory
infectious diseases.
b) In principle, a respiratory infectious disease patient is assigned to a single-occupancy isolation room.
c) Experienced personnel with competency are placed in charge of patients in a ward dedicated to
respiratory infectious diseases.
d) A minimal number of personnel is given access to isolation rooms in a ward dedicated to respiratory
infectious diseases.
e) In principle, tests for an inpatient in a ward dedicated to respiratory infectious diseases are performed
separately in the patient’s room to limit the patient’s transportation for the purpose of testing, whenever
possible.
f) Designated elevators for respiratory infectious disease patients are used for transporting patients in
a ward dedicated to respiratory infectious diseases, while exercising caution to prevent sharing the
elevators with other patients. transportation routes are predetermined to minimize the risk of exposure
of other patients and healthcare workers.

g) In principle, patients’ guardians and visitors are prohibited from entering a ward dedicated to
respiratory infectious diseases.
h) Visitors to a dedicated ward are limited to family members and to the minimal extent in unavoidable
circumstances. under the guidance of healthcare workers, they wear and remove PPE; record their time
of entry and exit, name, etc. when accessing the dedicated ward; and receive education on infection
control and prevention.
i) Visitors or guests of inpatients in the dedicated ward are required to get tested for respiratory infectious
diseases before visiting a healthcare facility because they are likely to exposed to the same respiratory
infectious disease as that of the inpatient or infected by the inpatient.
6 Cleaning, disinfection and waste management
6.1 Disinfection of contaminated areas (rooms and equipment)
[10]
6.1.1 Precautions for disinfection
The following guidelines should be considered to ensure effective disinfection of contaminated areas.
a) A disinfectant suitable for the characteristics of pathogens should be selected; the disinfectant’s
concentration, application duration, and expiration date, etc. should be followed according to the
instructions for use.
b) The instructions for use of each product should be checked
c) The disinfectant should contact all surfaces of items subject to disinfection including the lumen.
d) Open disinfectants should be managed to prevent contamination.
e) Standards should be established for the storage and use of diluted disinfectant solutions to prevent
contamination.
f) Disinfection equipment, including automatic washer disinfectors, should be regularly managed and
inspected.
6.1.2 Disinfection methods
6.1.2.1 General principles
To ensure effective and safe disinfection, the following general principles should be followed.
a) Disinfection should be performed by trained personnel and dedicated personnel should be assigned to
rooms in an infectious disease ward.
b) PPE [a N95 mask or a higher-grade respirator, disposable long-sleeved plastic gown or protective
clothing (coverall), disposable gloves, protective goggles or face shields, surgical hat (optional)] should
be worn when conducting disinfection activities.
c) A room occupied by a respiratory infectious disease patient should be disinfected on a daily basis and
after patient discharge.
d) After the patient is discharged, sufficient ventilation should be ensured before conducting disinfection
activities.
e) Disinfectants should be used appropriately in the hospital according to the recommendations.

[5]
6.1.2.2 Terminal cleaning and disinfection methods
When disinfecting cleaning tools, environmental surfaces, non-permeable surfaces, etc. during terminal
cleaning, the following methods should be followed:
a) A mop soaked in cleaning or disinfectant solution and UV disinfection system should be used, instead of
a broom or vacuum cleaner, etc., in order to prevent the spraying of pathogens into the air.
b) All surfaces should be wiped down before environmental disinfection, as organic matters on
environmental surfaces can hinder proper disinfection.
c) Non-permeable surfaces (including ceilings and lights) should be wiped thoroughly using disposable
towels or a mop soaked in terminal disinfectant solution approved by health authorities.
d) Any permeable surface should be replaced when possible or immersed in disinfectant solution.
e) Disposable cleaning tools should be used when possible; or a set of cleaning tools should be dedicated
to disinfection. If reusing a cleaning tool, it should be sterilized using the appropriate disinfectant and
dried before storing.
f) After disinfection, ventilation should be performed for a minimum of two hours (air exchange rate of at
least 6 times per hour) in line with the contamination level. Then, the checklist should be reviewed to
[6]
ensure the completion of disinfection. See Annex C.
[5]
6.1.2.3 Types and usage of disinfectants
In principle, only disinfectants approved by health authorities are used.
Disinfectants used in healthcare facilities include sodium hypochlorite (1 000 ppm recommended in
References [11], [12] and [13]) and alcohol (local space only); and disinfectants proven to work on viruses
can be used.
— Sodium hypochlorite, quaternary ammonium compounds (QACs), and peroxygen compounds are
appropriate for environmental disinfection, and H O vapor, H O dry mist, etc. can also be used.
2 2 2 2
— When using sodium hypochlorite, the concentration of commercially available bleach is checked and
diluted to an effective concentration level of 0,1 % or 1 000 ppm (for a 5 % bleach concentration, dilute
20 ml of sodium hypochlorite with 1 000 ml of water).
— To ensure safety, these are performed by properly trained users, in strict compliance with manufacturer
instructions.
— When using disinfectants, the manufacturer's recommendations are observed with regard to the dilution
ratio, contact duration, handling precautions, etc.
[7]
6.1.2.4 Disinfection of patient-use areas (zones)
To ensure safe disinfection of patient-use areas, the following measures should be followed.
a) In areas (zones) used by a confirmed patient, the area should be marked where the contamination is
identified and contaminated materials should be sealed before cleaning and disinfecting to prevent
others from being exposed to contamination.
b) Windows and/or doors should be left open for ventilation before, during and after cleaning and
disinfection (at least 2 h before cleaning and disinfection).
c) PPE should be worn and the walls within arm’s reach and all frequently-touched surfaces should be
cleaned with a clean cloth (fabric, etc.) moistened with a diluted disinfectant solution; and after leaving

for a certain period of time, the surfaces should be wiped again with a cloth (fabric, etc.) dampened with
clean water.
when using disinfectants, disinfectants are not applied by compressed spraying or fogging, only
disinfectants approved by health authorities are diluted according to use recommendations, and
sufficient surface contact duration with the disinfectant is ensured.
d) Decision to resume usage: After a patient is discharged, cleaning, disinfection and appropriate
ventilation should be conducted before the next patient is admitted (see Table 3).
— although viruses are destroyed after disinfection activities, the precautions of each product should
be considered in deciding the timing to resume the usage, as the said decision cannot be applied
across the board due to the different characteristics of each disinfectant.
— in the case of disinfection using sodium hypochlorite (1 000 ppm or higher), it is recommended to
ensure sufficient ventilation until the day after disinfection. When other patients are present in the
room, disinfection methods using sodium hypochlorite are avoided.
Table 3 — Disinfection timing and criteria for resuming usage in hospitals and emergency rooms
Type Disinfection timing Criteria for resuming usage
— Immediately disinfecting environmental surfaces
contaminated with blood, bodily fluids, secretions
and excrement.
It is recommended to resume medical treatment
Hospitals — Disinfecting the environment surrounding isolated after ventilating for at least 2 h with a minimum
patient rooms at least twice a day, or at least three air change rate of 6 per hour after disinfection.
times a day for frequently-touched surfaces.
— Disinfecting after a patient is discharged.
It is recommended to resume medical treatment
Emergency When a respiratory infectious disease patient visits an
after ventilating for 4 h or more under 6 to 12 air
rooms emergency room.
changes per hour after disinfection.
6.1.2.5 Disinfection of inpatient rooms, etc.
The following guidelines should be considered to help effective disinfection.
a) Frequently-touched surfaces should be disinfected every day, e.g. a side table, desk lamp, bed rails that
are touched often, doorknobs, a phone, and the inside of a bathroom.
b) After a patient is discharged, contaminated walls, electric cords, switches, doorknobs, bed, bedsheets,
wheelchair, closet, sink, toilet, etc. should be disinfected.
c) The floor should be wiped using a disinfectant.
d) The doorknob should be cleaned with a cloth moistened with disinfectant, wiped with a clean cloth,
then allowed to air dry.
6.1.2.6 Disinfection of medical equipment
Disinfection of medical equipment is essential for infection prevention. The following precautions should be
taken into consideration when disinfecting medical equipment.
1) Medical equipment should be disinfected such as ventilators and pulse oximeters according to the
manufacturer’s recommendations.
2) When using chemical disinfectants, products that are suggested in guidelines for each disease should be
used, while ensuring the safety of any residual concentration towards the human body.

6.1.2.7 Disinfection of toilets and bathrooms
[4]
Disinfection of toilets and bathrooms should be performed (see Table 4) .
Table 4 — Disinfection of toilets and bathrooms
Items Example disinfection methods
— Closing the lid then flush the toilet.
— After putting in a set amount of disinfectant, leaving it for 10 min, and then flushing the toilet.
— Using the toilet brush to clean with a disinfectant.
Toilet
— Closing the lid and flushing the toilet again.
— Placing the used toilet brush into a bucket filled with a disinfectant for at least 30 min, and then
rinsing with water and air dry.
— Wiping the sink with a disinfectant using a general-purpose brush.
Sink
— When transporting items that must be disinfected, putting them into leak-proof bags and the
carrier wears PPE.
— Draining about 0,5 l of water into each outlet.
Sewage outlet
— Draining a disinfectant into each outlet.
[7][6]
6.1.3 Precautions after disinfection
After disinfection, the following precautions for infection prevention should be observed:
a) After completion of and disinfection work, when removing PPE, caution should be taken not to
contaminate body parts and surroundings with pathogens on all PPE.
b) PPE should be removed in the proper sequence and method, while taking caution not to contaminate
surroundings; and they should be immediately discarded in the designated medical waste container.
c) After taking off PPE, hand hygiene should be performed using an alcohol-based hand sanitizer or water
and soap.
d) All disposable PPE used in the designated medical waste container should be discarded and sealed
tightly when a certain amount is filled according to waste disposal procedures; and hands should be
washed using soap and water.
reusable protective goggles or face shields can be reused after disinfection according to the manufacturer
instructions.
e) If the staff who performed cleaning and disinfection subsequently develops a fever or respiratory
symptoms within 7 days after disinfection, this should be reported to health authorities.
6.2 Waste collection
6.2.1 Key measures for preventing the cross-infection of waste collectors
For waste collectors or recyclers, potential sources of exposure consist of having close contact with a
coworker or member of the public with respiratory infectious diseases or contacting surfaces that have been
touched or handled by a person with respiratory infectious diseases. The following key measures should be
taken to protect them and slow down the spread of diseases:
a) excluding them from duties according to the guidelines of health authorities, if they are experiencing
symptoms;
b) notifying their supervisor and following the recommended precautions of health authorities, if their
family member or cohabitant develops symptoms of respiratory infectious diseases;
c) limiting close contact with others by maintaining a distance of at least 2 m when possible;
d) practicing regular cleaning and disinfection of frequently-touched surfaces, such as steering wheels,
door handles, levers and control panels at the beginning and end of every shift and after anyone else
uses a vehicle or workstation;
e) wearing normal PPE throughout the day; they can include work gloves, eye protection (safety goggles,
etc.), work uniform or coveralls;
f) replacing work gloves immediately if they are damaged (e.g. if they are ripped or torn);
g) practicing proper hand hygiene and coughing etiquette; these are important infection control measures;
washing hands regularly with water and soap for at least 40 s or using an alcohol-based hand sanitizer
containing at least 70 % alcohol; important situations to clean hands include:
— before and after work shifts and work breaks;
— after blowing the nose, coughing or sneezing;
— after using the restroom;
— before eatin
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