Cleaning and Disinfection

Guidelines for Environmental Cleaning and Disinfection of Public Toilets in Non-Healthcare Premises

Released on 19 September 2021

1. Introduction

1.1.This document provides guidance by National Environment Agency (NEA), of Singapore, to assist owners or operators of non-healthcare premises to carry out effective cleaning and disinfection of public toilets to reduce the risk of transmission of COVID-19 and other infectious diseases to members of public and the housekeeping staff.

1.2.Vomitus, mucous discharge and faeces are known to carry the COVID-19 virus (SARS-CoV-2) and the virus can be spread easily through contaminated surfaces or bioaerosols in the air. Coughing, sneezing, spitting, and clearing of nasal discharge in the toilet sink by an infected person could generate bioaerosols containing the virus and contaminate surrounding surfaces. NEA has also found the virus in the wastewater in toilet floor gully U-traps, which discharges water from the toilet sinks. Installation of one-way-valves and frequent disinfection of the wastewater in the sink and floor gully U-traps are highly recommended to reduce the risk of virus aerosolisation from wastewater.

1.3.If the environment is contaminated, the process of cleaning must be performed correctly and safely to reduce the risk to housekeeping staff acquiring the disease. Housekeeping staff/ attendants shall also not be routinely stationed in the toilet to minimise exposure.

1.4.This guidance focuses on safe and effective cleaning and disinfection to protect the housekeeping staff and users of public toilets.

1.5.The principles of safe cleaning are:

  1. Wearing of personal protective equipment (PPE),
  2. Disinfection of potential infectious matter in sinks, U traps, and floor traps before cleaning.
  3. Tools such as cloths used for “dirty areas” such as toilet bowls and cubicles should not be used in “cleaner areas” such as door handles.
  4. Cloths are to be disinfected regularly, especially when moving from one area (e.g. wash basin/sink/countertop) to another (e.g. high touch surfaces).
  5. Proper disinfection of washing tools after use.
  6. Proper removal of PPE when cleaning is completed and avoid eating in clothes or PPE worn during cleaning.

2. Guidance on Personal Protection Equipment (PPE):

2.1. Level of PPE for housekeeping staff servicing public toilets should correspond to level of risk. High risk refers to toilets that are likely used by infected persons, while low risk toilets are used by the general community. Operators servicing public toilets should supply the PPE listed in table 1 to housekeeping staff.

Table 1: PPE recommendations based on risk level.

Work Requirements Risk level PPE Recommendations  
 

Cleaning of sinks, basins, bidets, toilet bowls, faucets and showers, floor traps or activity that generate splashes/water droplets 

 Low  
  • Surgical mask
  • Hair cover and eye protection ( goggles or face shield)
  • Water-resistant disposable gown or reusable apron#
  •  Disposable gloves or rubber gloves#

(Change to a new surgical mask if soiled between cleaning)

 High* Full PPE:
  • N95 mask
  • Water-resistant disposable gloves
  • Disposable gown
  • Hair cover and eye protection (goggles or face shield)
  • Working shoes#, Rubber boots#

#Reusable apron and rubber gloves shall be cleaned and dried after use. Rubber boots and working shoes may be disinfected by wiping with an appropriate disinfectant.
*Guidelines for “Environmental Cleaning and Disinfection of Areas Exposed to Confirmed Case(s) of COVID-19 in Non-Healthcare Premises” if places had been visited by COVID-19 confirmed case.

Cleaning procedure:

2.2. Shut the toilet for cleaning:

  • Where possible, close off the toilet from the public before carrying out cleaning. This is to prevent unsuspecting persons from being exposed to aerosols or water splashes during the cleaning process.

2.3. Wearing PPE and preparation of disinfectant

  •  Before cleaning starts, put on a pair of gloves, N95 or surgical mask, hair cover, eye goggles or face shield and an apron or a disposable gown.
  • Avoid touching face, mouth, nose, and eyes during clean-up.
  • Gloves shall be removed and discarded if they become soiled or damaged and be replaced with a new pair.
  • Reusable rubber gloves shall be cleaned with appropriate disinfectant after each use and replaced if damaged.
  • Prepare the disinfectant for surface cleaning according to manufacturer’s recommendations or bleach solution (For bleach, dilute to 1000ppm or 0.1% sodium hypochlorite; bleach solutions with 5.25-6.00% sodium hypochlorite can be diluted with 1-part bleach in 49 parts water). Alcohol (75%) or other disinfectant listed in NEA list of active ingredients for surface disinfectiona can be used for surfaces where the use of bleach is not suitable.
  • Prepare bleach for disinfecting of sink U-trap, gully floor trap, urinal, and toilet bowl (dilute to 5000ppm or 0.5% sodium hypochlorite; bleach solutions with 5.25-6.00% sodium hypochlorite can be diluted with 1-part bleach in 9 parts water).
  • Bleach shall not be mixed with other household detergents as this reduces its effectiveness in disinfection and causes chemical reactions. Diluted bleach shall be used within 24 hours after preparation as decomposition increases with time if left unused.

2.4. Disinfecting of wash basin U-trap and floor trap before cleaning

  • Sink U-trap and toilet floor gully U-trap shall be disinfected to reduce the risk of aerosolisation from wastewater before cleaning starts.
  • For disinfection of sink U-trap, pour a cup (approximately 250mL) of 0.5% bleach solution into the sink.
  • NEA recommends the use of one-way valve for toilet floor gully U-traps.
  • For disinfection of toilet floor gully U-trap, pour 2 cups (approximately 500mL) of 0.5% bleach solution into the floor trap.
  • Allow contact time of at least 5 minutes before cleaning.

Figure 1: Example of a one-way valve for toilet floor gully trap.

Figure 1 - Example of a one-way valve for toilet floor gully trap

2.5. General Surface cleaning

  •  Clean the door handles, taps, bidet shower, countertops, basins, mirrors, basins and the paper and soap dispensers in the toilet with a wet cloth and the prepared disinfecting solution.
  • Wipe the mirrors, vanity tops and basins from “clean” to “dirty” surfaces.
  • Wipe the cubicles from top to bottom
  • Cloth shall be rinsed with disinfectant (with appropriate contact time) before moving to the next surface. Change to a new cloth if necessary. For high-risk areas, the use of disposable cloths is encouraged.
  • Litter shall be picked up with a sturdy tong.
  • After surface cleaning, disinfect all cloths and tongs with an appropriate disinfectant and leave it for the recommended contact time.

2.6. Cleaning of Urinals and toilet bowls

    • Flush toilet bowls/ urinals with lids closed first if bio/faecal matter is present.
    • Disinfect the walls and insides of the urinal and toilet bowl with an appropriate disinfectant using a squirt bottle. Gently squeeze the squirt bottle to minimise splash. Avoid using spray bottles as it generate aerosols. (if using bleach, prepare 0.5% bleach solution, leave it for 10 minutes before flushing)
    • Apply detergent on the urinals and toilet bowl.
    • Brush the inside of toilet bowls/urinals and flush with lids closed.
    • If scrubbing is required, put on the long cleaning gloves (covered to elbow).
    • Use brush to remove stain around the toilet bowls/ urinals with detergent or appropriate cleaning chemical.
    • Soak the brush with 0.1% bleach, leaving it for 10 minutes before rinsing with water.
    • Apply disinfectant on a cloth and clean the exterior surfaces of toilet bowls/urinals, from “clean” to “dirty” surfaces. Do not use cloth for cleaning other areas and disinfect after each use.
    • Recommend cleaning of toilet bowls in the order from cleanest to dirtiest: 1. water tank and flushing knob, 2. top cover 3. seat ring  4. Lower toilet seat.
    • Leave to air-dry

    2.7. Clean/ Disinfect Litter Bin

    • Remove bin liner and avoid picking the litter form the bin liner
    • Apply disinfectant on a different cloth.
    • Wipe the litter bin from “clean” to “dirty” surfaces.

    2.8. Cleaning of Floors

    • Fill a bucket with an attached wringer with disinfectant solution.
    • Dip the mop head into bucket with disinfectant solution, wring dry and mop the floor from the entrance/ exit towards the toilet interior (clean to dirty zone).
    • A steady sweeping/ wiping motion is recommended to prevent splashing.
    • After moping. Prepare a bucket of fresh disinfectant solution to disinfect the mop head. Soak mop head into bucket and observe appropriate contact time. Separately use a disinfectant-soaked cloth to wipe the mop handle.
    • All cleaned surfaces shall be allowed to air-dry as damp surfaces may attract contaminants
    • The bucket used for mopping should have a wringer attached. Mops should not be hand-wrung.
    • Used equipment including cloths and mops should be disinfected with appropriate disinfectant after each use and air dried

    2.9. Movement of Housekeeping staff and removal of PPE

    • Housekeeping staff/ attendants shall not be stationed in the toilet. This is to reduce risk of exposure to undiagnosed COVID-19 infected individuals using the toilet facility.
    • If cleaning of toilets is in the same zone, (e.g. Male, Female and Disabled toilet), staff can wear the same PPE and only change disposable gloves when necessary.
    • If movement across the premises is required (e.g. between different floors or different wings of a building), remove gown, face shield, gloves, and hair cover (if applicable). Change to a new mask if it is soiled. Change to a new pair of gloves before moving to the next location.
    • Steps for removing PPE after cleaning:
    1. Designate a “Clean Zone” (e.g. Near the entrance of the toilet) to remove PPE.
    2. Remove dirty glove, clean hands (hand sanitiser or wash with soap).
    3. Remove disposable gown by breaking the neck lace and folding the disposable gown outwards and discard as general waste. For reusable apron, fold the apron outwards and place in an appropriate laundry bag. Apron shall be disinfected by soaking in an appropriate disinfectant (refer to section 3.2) before washing. There shall be no contact from the outer gown/apron with the working clothes.
    4. Wipe the face shield with an appropriate disinfectant
    5. Remove the face shield and place them in a clean compartment or zip-lock bag.
    6. For rubber boots and working shoes, wipe down with an appropriate disinfectant and allow to dry.
    7. Wash hands and arms with soap after degowning.

    2.10. Cleaning body fluids spills such as vomitus, blood

    • Cleaning team can refer to NEA published guidance chapter 2: Incidence Response Cleaning and Disinfection.

    Additional good practices:

    • Color code cloths to differentiate the areas used for cleaning (e.g. cloth for litter bins shall not be used for cubicles, mirrors, vanity tops).
    • If bleach solution is used for cleaning, rinse the surface with water.
    • A good cleaning plan should comprise both routine and periodic cleaning operations to ensure that all areas are thoroughly cleaned and disinfected regularly.
    • Premise owners shall study the footfall in the toilets to determine the frequency of toilet cleaning required. Operators are encouraged to carry out cleaning and disinfection before and after peak hours.
    • Periodic cleaning may be scheduled once every 3 months or as and when required depending on several factors such as human footfall.
    • Periodic cleaning operations shall cover all surfaces that can be reached within the toilets including those areas covered under routine cleaning. Examples are walls or vertical surfaces. Visible stains on walls or vertical surfaces shall be cleaned and disinfected as and when required.
    • Periodic cleaning operations shall also include areas that are not easily accessible and are not covered by routine cleaning. Examples are lighting, pipes, exhaust fans, air con diffuser.
    • Periodic cleaning operations may also require intense cleaning techniques for areas covered under routine cleaning, such as scouring and disinfection for urinals and toilet bowls.

    a List of Household Products and Active Ingredients for Surface Disinfection of the COVID-19 Virus
    https://www.nea.gov.sg/our-services/public-cleanliness/environmental-cleaning-guidelines/guidelines/interim-list-of-household-products-and-active-ingredients-for-disinfection-of-covid-19

    b Environmental Sanitation for High-Risk Non-Healthcare Premises in Singapore

    References

    [1] Guidance on public health measures for Covid-19 in stay-home notice dedicated facilities, government quarantine facilities and swab isolation facilities, MOH, April 2021.

    [2] Guidelines for Environmental Cleaning and Disinfection of Areas Exposed to Confirmed Case(s) of COVID-19 in Non-Healthcare Premises, NEA, June 2021

    [3] List of Household Products and Active Ingredients for Surface Disinfection of the COVID-19 Virus, NEA, Feb 2020

    [4] Standard Operating Procedure Cleaning of toilet facility, Department of Tourism, Sport and Culture, Parks and Wildlife Division, Northern Territory, Australia, April 2020.

    [5] Cleaning guidelines for prevention of Covid-19 infections, Finish Institute of Occupational Health, Finland, January 2021.

    [6] Environmental Sanitation for High-Risk Non-Healthcare Premises in Singapore  Technical Guide, March 2021