Key Recommendations on Water Sanitation and Hygiene: COVID-19

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Health Care Facilities

Recommendations for the Preparation of Disinfectant Solutions

This technical note presents the basic recommendations for the preparation and dilution of sodium hypochlorite for domestic use to prepare disinfecting solutions for the sanitary and domestic sector, at concentrations of 0.05%, 0.1%, and 0.5% depending cleaning and prevention needs against COVID-19 and other infectious agents.


Recommendations on Public Environmental Health in Health Care Facilities

This technical note deals with the minimum environmental public health standards in health facilities, a key component for the safety of the patient, health personnel, visitors, and companions. Recommendations are provided on safe water, sanitation, solid waste, hand washing, and cleaning and disinfection.


WASH Standards: Water, Sanitation, and Hygiene Standards in Health Care Facilities

This technical note contains indicators and minimum standards necessary for emergency response in the following topics: quantity of water, access to water, quality of water, sanitation, hygiene, solid waste, cleaning and disinfection, as well as dosages for the preparation of solutions disinfectants using sodium hypochlorite.


Ventilation in health Care Facilities: Recommendations for Heating, Ventilation, and Air Conditioning in Health Care Facilities 

Providing adequate thermal conditions and ventilation systems that prevent the dispersion of pathogens, is fundamental to protect the health of patients, caregivers and staff, and to the overall operation of sensitive equipment. This technical note presents general recommendations to prevent the transmission of SARS-CoV-2 through heating, ventilation, and air conditioning systems in ​health care facilities.


Legionella Control in Repurposed Building or Spaces in the context of the COVID-19: Preparedness and Control

Source of Legionella infection /Indoor plumbing incl.:

  • Water heaters
  • Showers, especially shower heads,
  • Water outlets, taps and faucets, especially faucet aerators
  • Toilet cisterns
  • Dead ends


Public Services

General sanitation: Recommendations of Protective Measures for Sanitation Workers. Waste Water, Municipal Waste, Recycling, and Healthcare Waste

This technical note presents the main recommendations on personal protective equipment and its use. It is aimed at personnel in the area of ​​environmental sanitation, and covers individual hygiene precautions and how to properly handle tools and equipment. It also includes indications on best practices for the protection of workers' health, guidelines for the disposal of dangerous elements for the community, and a guide for preparing sodium hypochlorite solutions for use in 0.1% disinfection.


Solid Waste: Recommendations for the Management of Solid Waste

This technical note presents recommendations for handling solid waste correctly to minimize possible secondary impacts on health and the environment. The note covers safe management measures for personnel, transportation of common waste, final disposal services of waste, special considerations for the handling of waste from health facilities to be treated outside the facility, and waste management in homes.


Environmental Public Health Recommendations for Collective Residential Places: Nursing Homes, Orphanages, and Other Collective Residential Places

This technical note presents the main recommendations for collective residential places that provide services to groups of people in vulnerable conditions, such as nursing homes and orphanages, in the areas of drinking water, hand washing, surface cleaning, laundry, ventilation, and management of solid waste. Additionally, recommendations are provided to prepare 0.05% and 0.1% sodium hypochlorite solutions, depending on the needs for cleaning and prevention against SARS-COV-2 and other infectious agents.


Recommendations for the Cleaning and Disinfection of Sites Where People are Closely Confined and Deprived of Their Liberty: Penitentiaries, Prisons, and Migrant Detention Centers

This technical note presents main considerations and recommendations regarding individual hygiene, self-care, and hand washing, and suggestions for cleaning and disinfecting places where people are confined and deprived of their liberty. Additionally, it contains recommendations for preparing 0.05% and 0.1% sodium hypochlorite solutions, depending on the needs for cleaning and prevention against SARS-COV-2 and other infectious agents.


Recommendations on Environmental Public Health for Temporary Shelters 

This technical note presents the key actions to support and protect populations that make use of shelters and transit homes during the COVID-19 emergency. It includes the promotion of hygiene and self-care measures, waste management, sanitation, cleaning and disinfection of spaces, access to safe water, hand washing, and social distancing. It also proposes activities such as the adoption of prevention measures and training against the risk of infections. 


Wastewater: Recommendations for the Management of Municipal Wastewater

This technical note presents general recommendations to avoid the transmission of SARS-VOC-2 by wastewater, guidelines for water and sanitation operators, and indications for treatment and disinfection and reuse of wastewater.


Recommendations for ventilation in nonmedical facilities

SARS-CoV-2 transmission is particularly effective in crowded, confined indoor spaces where there is poor or no ventilation. Hence, to reduce the risk of COVID-19 infection, it is key to ensure adequate ventilation and to include enhanced ventilation and filtration as components of a comprehensive plan for reopening buildings and their operations. Such plans should also consider the use of facemasks, hand hygiene, physical distancing, and communication strategies.



Recommendations for Cleaning and Disinfection of Homes without Suspected or Confirmed Cases

This technical note presents the recommendations that must be observed for the care of cleaning and disinfection of domestic environments as prevention of COVID-19 and other infectious agents. Additionally, it contains the guidelines for making disinfecting solutions at concentrations of 0.05% and 0.1%, depending on cleaning needs.


Recommendations for Cleaning and Disinfection in Homes with Suspected or Confirmed Cases of COVID-19

This technical note presents information on personal hygiene, basic infection prevention, and control measures, as well as how to take care of the person suspected of having COVID-19 or carriers of this virus as safely as possible, while avoiding the infection spreading to other household members.


Recommendations to expand access to hand washing and its proper use

Promoting handwashing is essential to minimize transmission of SARS-COV-2, the virus that causes COVID-19, and to save lives. One of the most commons ways of transmission of SARS-COV-2 is from contaminated hands touching the mouth, nose and eyes. The virus can also be transferred from one surface to another through contaminated hands. Free access and mandatory use of handwashing stations would help to minimize SARS-COV-2 transmission and save lives.


Recommendations for Cleaning and Disinfection Public Places: Supermarkets, Markets, Neighborhood Stores, Banks, Public Transport, and Other

This technical note presents the actions necessary to conduct cleaning and disinfection in public spaces and establishments, using disinfecting solutions of 0.1% sodium hypochlorite. Preventing surface contamination and maintaining adequate cleaning and disinfection conditions in public places is essential to mitigate the transmission of the virus and protect the health of workers and the general public. 


Recommendations on Chemical Safety for Cleaning and Disinfection Supplies

This technical note addresses the main safety recommendations against the handling of disinfecting agents, which, being chemical products, must be handled with due caution. Additionally, it presents a summary of cleaning elements that should not be mixed and the risks that they generate. Most cleaning products are made from chemicals. 


Recommendations for Environmental Public Health Measures during Drought and Water Conservation

This technical note contains recommendations for the public sector, the community, and health establishments to make rational use of water in conditions of low water availability due to drought.


The use of tunnels and other technologies for disinfection of humans using chemical aspersion or UV-C Light

The use of tunnels or other physical structures (booths, cabinets, gates) with disinfection aspersion, spray devices or UV-C radiation are not recommended for use on humans.


Considerations on the Spraying and Nebulization of Chemicals in Enclosed Spaces

General considerations: Biosafety requirements for contamination by infectious agents in enclosed places vary, depending on the nature of the space, the activities undertaken there, the risks involved and the materials that are handled in each workspace, whether for health or day-to-day activities. The precautions that must be taken in clinical-surgical spaces, laboratories, or places at high risk of contamination by viruses or bacteria are different from those appropriate for homes, residential spaces, or closed office workspaces.


PAHO Does Not Recommend Taking Products that Contain Chlorine Dioxide, Sodium Chlorite, Sodium Hypochlorite, or Derivatives

PAHO does not recommend oral or parenteral use of chlorine dioxide or sodium chlorite-based products for patients with suspected or diagnosed COVID-19 or for anyone else. There is no evidence of their effectiveness and the ingestion or inhalation of such products could cause serious adverse effects. 

The information included in this note reflects the available evidence at the date of publication.



Infographic: 5 steps to saving water when washing your hands

This infographic explains how to save water when washing hands in five simple steps.


Infographic: Hand washing without soap or safe and clean water

Infographic illustrating how to wash your hands correctly when there is limited access to soap and clean water. 


Video: Handwashing Without Wasting Water 

Video demonstrates how to conserve water while washing hands.

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