Pan American Health Organization · 2020
PAHO guidance on infection prevention and control through cleaning, disinfection and hygiene in custodial settings during COVID-19.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Custodial facility staff, public health professionals, corrections administrators
- Evidence
- Expert consensus
- Reviewed
- 21 Oct 2026 · GMJ
What this guideline says
GMJ summary
This Pan American Health Organization guidance addresses infection prevention and control in custodial settings—penitentiaries, prisons, and migrant detention centres—where overcrowding and limited resources heighten transmission risk. The document provides specific protocols for hand hygiene, environmental cleaning, disinfection and waste management tailored to the constraints of secure facilities.
The central recommendation is to clean and disinfect commonly used objects and frequently touched surfaces at least twice daily using water and detergent followed by 0.1% sodium hypochlorite solution left to act for at least 1 minute. Hand hygiene is emphasised with 40–60 seconds of handwashing with soap and water, or 70% alcohol gel when soap is unavailable. The guidance includes detailed mixing tables for preparing sodium hypochlorite disinfectant solutions from various stock concentrations.
Additional measures include providing hand-washing stations for all staff and detainees, ensuring good ventilation, avoiding overcrowding, and requiring staff with respiratory symptoms to remain off work. Waste contaminated with body fluids from suspected or confirmed COVID-19 cases must be placed in closed plastic bags and managed according to national solid waste regulations.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Wash hands with soap and water for 40–60 seconds at critical moments (before/after eating, food preparation, toilet use, cleaning, and handling money); use 70% alcohol gel if soap unavailable
- Clean and disinfect commonly used objects and frequently touched surfaces at least twice daily with water and detergent, then apply 0.1% sodium hypochlorite solution for at least 1 minute
- Clean toilets and showers with water and detergent, then apply 0.1% sodium hypochlorite solution for 1 minute, at least twice daily
- Use 0.05% sodium hypochlorite solution for hand-washing and laundry when soap unavailable (least recommended option due to risk of allergies and dermatitis)
- Prepare disinfectant solutions daily using specific mixing ratios: for 0.1% solution from 5% stock, mix 20 ml sodium hypochlorite with 1 litre water
- Soak cleaning utensils in 0.1% sodium hypochlorite solution for at least 1 minute
- Staff must change clothing and footwear upon facility entry; wash with soap and water as normal
- Place waste contaminated with body fluids from COVID-19 suspects/cases in closed plastic bags and manage per national solid waste regulations
Sodium Hypochlorite Disinfectant Solution Preparation
Table extracted from the guideline
| Stock concentration | For 0.05% solution (hand-washing, laundry) | For 0.1% solution (surfaces, floors, utensils) | ||
|---|---|---|---|---|
| Sodium hypochlorite | Water | Sodium hypochlorite | 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 the Cleaning and Disinfection of Sites Where People are Closely Confined and Deprived of Their Liberty: Penitentiaries, Prisons, and Migrant Detention Centers. Reproduced in summary form.
From the guideline
Verbatim
“Clean and disinfect commonly used objects and frequently touched surfaces at least twice a day.”
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 someone who has advised WHO on health and migration, I recognise the particular vulnerability of custodial populations in our region where overcrowding, limited ventilation and inadequate water supply are endemic challenges in penitentiaries and migrant detention centres. This PAHO guidance offers Georgian corrections and public health authorities concrete, implementable protocols—particularly the twice-daily disinfection schedule and standardised sodium hypochlorite preparation table—that can be integrated into existing infection prevention frameworks. I would stress to colleagues the critical recommendation that any staff member with respiratory symptoms must not attend work, which requires corrections administrators to establish sick leave policies and backup staffing that currently may not exist. The realistic caveat is that sustained implementation depends on reliable procurement of soap, sodium hypochlorite and paper towels, which in resource-constrained custodial settings often competes with other budgetary priorities and requires dedicated line items in Ministry of Corrections budgets and external donor support.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia hosts penitentiary facilities and migrant reception centres where overcrowding and resource constraints can amplify respiratory pathogen transmission. National infection prevention and control programmes should ensure custodial settings have reliable access to safe water, soap, sodium hypochlorite, and personal protective equipment. The guidance’s emphasis on twice-daily disinfection of high-touch surfaces, standardised disinfectant preparation, and staff hygiene protocols offers practical frameworks adaptable to Georgian custodial infrastructure. Coordination between the Ministry of Corrections, the Ministry of Health, and the Public Health Service is essential to implement environmental cleaning standards, respiratory symptom screening for staff, and waste management protocols for detainees with suspected infections. Georgia’s existing infection control frameworks in healthcare settings provide a foundation, but custodial environments require tailored protocols addressing security constraints, limited egress for symptomatic staff, and equitable access to hygiene supplies for detained populations.
Questions this guideline answers
Quick answers
What concentration of sodium hypochlorite should be used for surface disinfection?
Use 0.1% sodium hypochlorite solution for disinfecting surfaces, floors, toilets, showers and cleaning utensils. Apply after cleaning with water and detergent, leave for at least 1 minute, then wipe with a damp cloth. Solutions should be prepared daily.
How long should handwashing take in custodial settings?
Handwashing with soap and water should take 40–60 seconds, especially before and after eating, food preparation, toilet use, cleaning, and handling money. Hands should be dried with paper towels, which should also be used to turn off taps. If soap unavailable, use 70% alcohol gel.
How do I prepare 0.1% sodium hypochlorite solution from household bleach?
Check the sodium hypochlorite concentration on the product label. For 5% bleach (common household concentration), mix 20 ml (4 teaspoons) with 1 litre of water. For 10% bleach, mix 10 ml (2 teaspoons) with 1 litre. Prepare fresh daily, label containers clearly, and never reuse food packaging.
How should waste from COVID-19 suspects or cases be managed?
Waste contaminated with body fluids—including paper towels, toilet paper and face masks—from persons suspected or confirmed with COVID-19 should be placed in closed plastic bags and treated according to national regulations for solid waste management.
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Quality & accreditation
- ASF Hospital — Standard 18 — Sustainable Care
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Hospital — Standard 9 — Refugee & Migrant Health
- ASF Laboratory — Standard 9 — Refugee & Migrant Health
- ASF Medical Transport — Standard 8 — Refugee & Migrant Health
Other guidelines on this topic
- Recommendations for Preparing Disinfecting Solution in Health Establishments, 9 April 2020
- Requirements and technical specifications of personal protective equipment (PPE) for the novel coronavirus (2019-nCoV) in healthcare settings
- Checklist for the Management of Human Resources for Health in Response to COVID-19
- Infection prevention and control practices for care of patients in nontraditional settings with focus to the novel coronavirus (COVID-19)
- Immunization throughout the Life Course at the Primary Care Level in the Context of the COVID-19 Pandemic
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Penitentiaries, prisons, migrant detention centres
- Audience
- Custodial facility staff, public health professionals, corrections administrators
- 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 the Cleaning and Disinfection of Sites Where People are Closely Confined and Deprived of Their Liberty: Penitentiaries, Prisons, and Migrant Detention Centers. Washington, D.C.: PAHO; 2020. (PAHO/CDE/CE/COVID-19/20-0021).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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