Mpox: guidance for environmental cleaning and decontamination in non-healthcare settings

Who this guidance is for

This guidance is to be used in non-healthcare settings when people have been advised by the health protection team (HPT) that there has been a suspected or confirmed case of mpox within their setting. This guidance gives advice on cleaning and decontaminating, informed by local risk assessment, after the case has left the setting to prevent the spread of mpox to others who use the setting. This guidance can also be used by those advising on and planning end of isolation cleaning and decontamination of a domestic setting.

This guidance does not cover the scenario where someone is cleaning their own home, or the homes of people they visited. Advice for the public on cleaning houses where someone has been isolating as a case of mpox is included in the guidance for people with mpox who are isolating at home.

Guidance on cleaning and decontaminating in prisons and other places of detention is included in the guidance specific for these settings.

How will I know when to follow the guidance?

This guidance is only for use once a setting has been advised by their HPT that a person who had mpox has been in the setting while they were infectious.

Nothing in this guidance is intended to over-ride an employer’s responsibilities under the Health and Safety at Work etc Act 1974 or any other legislation. Before following any advice in this guidance, a workplace risk assessment must be undertaken to identify potential hazards and establish appropriate protocols, including the provision of appropriate personal protective equipment (PPE). This guidance will support the conduct of that risk assessment but does not replace it.

Background 

What is mpox

Mpox is an infectious disease caused by a virus called MPXV. MPXV is a virus from the same family as smallpox (poxviruses). There are 2 main types (called clades) of the virus: clade I and clade II. This guidance covers cleaning and decontamination for both clades of mpox.

How mpox spreads

Mpox does not spread easily between people unless there is close contact. Spread between people may occur through:

• direct contact with rash, skin lesions or scabs (including during sexual contact, kissing, cuddling or other skin-to-skin contact)
• contact with bodily fluids such as saliva, snot, mucus, semen or vaginal fluids
• contact with clothing or linens (such as bedding or towels) or other objects and surfaces used by someone with mpox

It is possible that mpox may spread between people through close and prolonged face-to-face contact such as talking, breathing, coughing, or sneezing close to one another. However, there is currently limited evidence available on this.

Further information on mpox can be found online on the Mpox: background information webpage.

Why cleaning is important 

HPTs identify people who have mpox, and then trace their movements to follow up with any people or places they have been in contact with. Effective cleaning of all the places they have been while they were infectious is one of the ways to prevent transmission of MPXV. In this guidance, these places are referred to as ‘settings’.

Poxviruses such as MPXV can survive in the environment and on different types of surfaces for up to 56 days depending on the environmental conditions. Evidence on the survival of MPXV itself is limited; however, viable MPXV has been detected on household surfaces at least 15 days after contamination of the surface.

While there is limited data on transmission of poxviruses from contaminated objects or materials other than linens such as clothing or bedding, there remains a risk that mpox can be transmitted via this route. Appropriate cleaning and disinfection can help reduce this risk.

Risk assessment

A thorough risk assessment should be undertaken with the HPT to identify potential hazards and establish appropriate decontamination protocols. Risk assessment needs to include the type of environment or setting, the number of people exposed, the duration of exposure, the time since exposure, and the general health and age of individuals. There may be exceptional situations where the risk assessment deems that decontamination may no longer be required, but this will be determined on a case-by-case basis. Occasionally, the HPT risk assessment may indicate that additional cleaning and control measures including the required level of PPE are neccessary.

All staff who are cleaning and decontaminating non-healthcare settings should be trained in donning and doffing of PPE, safe disposal of PPE, and in the use of disinfectants as required by COSHH regulations.

Cleaning and disinfection process 

Cleaning should be carried out in the following order: 

1. Clean your hands

2. Apply PPE

3. Collect waste into impermeable bags, tie securely and dispose of into usual waste stream

4. Remove contaminated clothing and linen from the environment

5. Clean and disinfect hard surfaces and equipment, for example counters, toilets, walls

6. Steam clean soft surfaces, for example cushions, cushioned chairs

7. Steam clean carpet and wash hard flooring

8. Remove PPE

9. Collect waste generated from cleaning into impermeable bags, tie securely and dispose of into usual waste stream

10. Wash your hands

Personal protective equipment (PPE) 

The PPE required for cleaning non-healthcare settings is: 

• a disposable fluid resistant long-sleeved gown 

• disposable gloves

• a fluid-resistant surgical mask

• eye protection 

While wearing PPE, keep your hands away from your face and the PPE you are wearing. Change your gloves if they become torn or heavily contaminated.

When taking off (doffing) PPE:

• PPE should be removed in an area where clean equipment cannot inadvertently be contaminated while you are taking it off
• remove your PPE carefully to prevent contaminating yourself. For example, do not touch the outside of your gown, and only touch the ties of your face mask when removing it
• wash your hands with soap and water for at least 20 seconds after cleaning, and make sure to do so immediately after removing gloves

More information on hand hygiene can be found at How to wash your hands on the NHS website.

Dispose of PPE used for cleaning (as opposed to the provision of healthcare or personal care) in your usual waste stream.

It is the responsibility of an employer to provide the PPE required by risk assessment for the job.

Contaminated clothing and linen 

Collect contaminated clothing, removable soft furnishings, and linens such as bedding and towels before the room is cleaned. Do not shake or handle these items in a manner that may disperse infectious particles (skin scales). 

If you have a commercial laundry provider, discuss with them what may need to be laundered, and whether they have the capability to safely receive and launder these items. If they cannot launder them, any contaminated items may need to be disposed of. If they can launder them, get advice from them about appropriate bagging and transportation.

You need to dispose items that have been in direct contact with the skin of someone with mpox and which are not easily washable in a home washing machine, for example duvets, pillows, or blankets. Discuss this with the owner or proprietor, and obtain permission to dispose them prior to disposal.

All other clothing and linen items should be placed carefully into a polythene bag or impermeable sack before removal from the room. Remove these items from the polythene bag into a standard washing machine while wearing PPE. Wash the items with detergent at the highest temperature possible for the material, and set to the longest wash cycle available. Avoid overloading the machine, use plenty of water, and avoid economy cycles.

After all contaminated clothing and linens have been removed, the rooms can be cleaned and disinfected using disposable equipment (for example mops with disposable heads, disposable cleaning wipes).  

Cleaning hard surfaces and equipment  

It is important to prevent the spread of dust particles that may contain viruses. To minimise this risk, avoid dry dusting or sweeping as these actions can release dust into the air. Instead, use wet cleaning methods such as using disinfectant wipes, sprays, or mopping, which are more effective at containing dust.

Clean hard surfaces by using detergent, followed by disinfection with either:

• a solution of freshly prepared bleach or sodium hypochlorite diluted to no lower than 1,000 parts per million (ppm) (0.1%) available chlorine

or

• a commercial alcohol spray, containing 70% ethanol or isopropanol

When using bleach:

• take care to prepare the correct concentration (at least 1,000 ppm or 0.1% available chlorine)
• it is recommended that the bleach has one minute contact time with the surface being disinfected
• follow the manufacturer’s instructions and do not mix cleaning products
• be aware that bleach may trigger asthma in poorly ventilated spaces
• make sure you comply with the safety data sheets and COSHH regulations
• be aware that bleach may damage some surfaces

Make sure you thoroughly clean frequently touched surfaces like tables, door handles, toilet flush handles and taps. This also includes reduced mobility assistance vehicles.

Cleaning soft surfaces 

Soft furnishings, such as carpets, sofas, curtains and mattresses can be cleaned with commercial alcohol sprays (70% ethanol or isopropanol ) while wearing full PPE as described above. Alternatively, these surfaces can be steam cleaned by individuals wearing full PPE as described above; this may need to be carried out professionally. Disinfect the steam cleaners after use, following the manufacturer’s instructions. 

Soft toys can be cleaned in a washing machine at 60 degrees Celsius (°C) or the highest temperature the fabric label symbol has on it, using the longest wash cycle available.

If the item has been heavily contaminated with body fluids it may need to be disposed of and replaced. Discuss this with the owner or proprietor, and obtain permission prior to disposal.

Waste 

All used PPE and cleaning and other waste materials need to be handled carefully to avoid dispersal of skin scales and dust. Place them into a domestic waste bag and dispose of them in the usual waste stream.

If you need any further advice, get in touch with your local waste contractor.