Pan American Health Organization · 2020
Practical guidance on cleaning, disinfection and personal protective measures for households caring for COVID-19 patients.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Households, caregivers, and health professionals advising families on home-based care of COVID-19 patients
- Evidence
- Expert consensus
- Reviewed
- 21 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO guidance provides detailed recommendations for safely cleaning and disinfecting homes where COVID-19 patients or SARS-CoV-2 carriers are being cared for. The document addresses general infection prevention measures, including patient isolation in well-ventilated rooms, hand hygiene protocols, and the use of personal protective equipment during cleaning activities.
The core recommendations focus on twice-daily cleaning and disinfection of frequently touched surfaces and patient-care areas using sodium hypochlorite solution at 0.1% concentration, allowing at least 1 minute contact time. The guidance includes detailed instructions for preparing disinfection solutions from commercially available sodium hypochlorite at various concentrations (1%, 3%, 4%, 5%, and 10%) for two primary uses: 0.05% for hand washing and laundry, and 0.1% for surface disinfection.
Additional guidance covers safe handling of patient bedding and clothing, waste disposal in double bags, toilet flushing with the lid down, and proper cleaning and disinfection of reusable personal protective equipment. The document emphasises hand washing for 40–60 seconds at critical times and safe preparation and storage of disinfection solutions.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Hand washing with soap and water for 40–60 seconds should be performed frequently, particularly before and after eating, after using the bathroom, before and after cleaning tasks, and after any contact with the patient.
- Clean frequently touched surfaces with water and soap at least twice a day, then apply sodium hypochlorite solution at 0.1% concentration, leaving the disinfectant to act for at least 1 minute before rinsing.
- Clean all surfaces in the patient's room, including night table, bed, handles and taps, with water and soap, then apply 0.1% sodium hypochlorite solution at least twice a day, allowing 1 minute contact time.
- Use personal protective equipment (mask, goggles, gloves and fluid-resistant plastic aprons) during cleaning; clean reusable items with soap and water, then disinfect with 0.1% sodium hypochlorite solution.
- For 0.1% disinfection solution: mix 100 ml sodium hypochlorite (if 1% concentration) with 1 litre water; or 30 ml (if 3%) with 1 litre; or 25 ml (if 4%) with 1 litre; or 20 ml (if 5%) with 1 litre; or 10 ml (if 10%) with 1 litre.
- Patients should be isolated in separate, single, well-ventilated rooms with windows open, with limited movement in the house and minimal sharing of spaces.
- Wash patient clothing, bedding and towels with hot water and soap, and dry thoroughly; do not shake dirty clothes and wear PPE when handling.
- Dispose of patient waste (tissues, masks, cleaning materials) in a dedicated container with bag and lid, using double bags for handling according to national regulations.
Sodium hypochlorite dilution for preparing disinfection solutions
Table extracted from the guideline
| Sodium hypochlorite concentration (as per label) | 0.05% solution: Quantity of sodium hypochlorite | 0.05% solution: Quantity of water | 0.1% solution: Quantity of sodium hypochlorite | 0.1% solution: Quantity of water |
|---|---|---|---|---|
| 1% | 50 ml (1/5 cup) | 1 L | 100 ml (2/5 cup) | 1 L |
| 3% | 16 ml (3 tsp) | 1 L | 30 ml (1 oz) | 1 L |
| 4% | 13 ml (1/2 oz) | 1 L | 25 ml | 1 L |
| 5% | 10 ml (2 tsp) | 1 L | 20 ml (4 tsp) | 1 L |
| 10% | 5 ml (1 tsp) | 1 L | 10 ml (2 tsp) | 1 L |
Source: Pan American Health Organization, Recommendations for Cleaning and Disinfection in Homes with Suspected or Confirmed Cases of COVID-19. Reproduced in summary form.
From the guideline
Verbatim
“Clean frequently touched surfaces with water and soap at least twice a day. Then, apply a sodium hypochlorite solution at 0.1% concentration, leaving the disinfection solution to act for at least 1 minute before rinsing.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As we continue to manage COVID-19 alongside other respiratory infections in Georgia, this PAHO guidance provides essential practical instructions for home-based care that remain relevant today. During the pandemic, many Georgian families cared for COVID-19 patients at home, and these evidence-based cleaning and disinfection protocols can prevent household transmission of SARS-CoV-2 and other pathogens. I would emphasise to Georgian clinicians the importance of providing patients and families with clear, specific instructions on sodium hypochlorite dilution—the detailed table in this document makes this practical, as household bleach is widely available in Georgia. The main implementation challenge is ensuring families have consistent access to basic supplies including soap, hot water for laundry, and disposable or dedicated towels, which may be limited in rural areas or socioeconomically disadvantaged households; clinicians should assess household capacity and provide appropriate support or alternative recommendations when advising home-based care.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance remains relevant for Georgia and the South Caucasus as COVID-19 continues to circulate and home-based care remains common, particularly for mild cases and in rural areas with limited healthcare facility capacity. National programmes should verify the locally available sodium hypochlorite concentrations in Georgian markets (typically household bleach ranges from 3% to 5%) and adapt the dilution instructions accordingly. Implementation requires ensuring household access to basic supplies including soap, disposable paper towels or cleanable cloth towels, adequate water supply, and affordable sodium hypochlorite products. In the South Caucasus context, consideration should be given to multi-generational households where complete patient isolation may be challenging, necessitating emphasis on the guidance regarding shared space ventilation and twice-daily surface disinfection.
Questions this guideline answers
Quick answers
How often should I clean surfaces in a home with a COVID-19 patient?
Clean frequently touched surfaces with water and soap at least twice a day, then apply 0.1% sodium hypochlorite solution and leave it to act for at least 1 minute before rinsing. This includes all surfaces in the patient's room such as the night table, bed, handles, taps, and bathroom.
How do I prepare a 0.1% sodium hypochlorite disinfection solution from household bleach?
First check the sodium hypochlorite concentration on the bleach label. For 5% bleach (common household concentration), mix 20 ml (4 teaspoons) with 1 litre of water. For 3% bleach, use 30 ml (1 oz) per litre. Prepare solutions daily and label the container clearly.
What personal protective equipment do I need when cleaning for a COVID-19 patient?
Use a mask, goggles, gloves and apron made of fluid-resistant plastic during cleaning. Keep this PPE exclusively for personal use. Clean reusable gloves, apron and goggles with soap and water, then disinfect with 0.1% sodium hypochlorite solution.
How should I handle the patient's laundry and bedding?
Place clothing, bedding, and towels in a bag to transport to the laundry area; do not shake dirty clothes. Wear PPE when handling. Wash with hot water and soap, and dry thoroughly. Keep bedding and eating utensils exclusively for the patient's use.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
Quality & accreditation
Other guidelines on this topic
- Recommendations for Cleaning and Disinfection of Homes without Suspected or Confirmed Cases, 8 May 2020
- PAHO Does Not Recommend Taking Products that Contain Chlorine Dioxide, Sodium Chlorite, Sodium Hypochlorite, or Derivatives
- Essential Medicines List for Management of Patients Admitted to Intensive Care Units with Suspected or Confirmed COVID-19 Diagnosis
- Considerations for Regulatory Oversight of Clinical Trials in the COVID-19 Pandemic
- Recommendations on Environmental Public Health for Temporary Shelters
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Household-level cleaning and disinfection procedures for homes with suspected or confirmed COVID-19 cases
- Audience
- Households, caregivers, and health professionals advising families on home-based care of COVID-19 patients
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus
- Record history
- Created 21 Oct 2026 · updated 21 Oct 2026 · next check Apr 2027
Pan American Health Organization. Recommendations for Cleaning and Disinfection in Homes with Suspected or Confirmed Cases of COVID-19. Washington, D.C.: PAHO; 2020. (PAHO/CDE/CE/COVID-19/20-0024).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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