As the deadly hantavirus outbreak linked to the expedition cruise ship MV Hondius continues to unfold across Europe and South Africa, infection prevention experts are warning that one of the most critical elements of the crisis remains largely absent from public discussion: cleaning and biohazard control.
At least three people have died following the outbreak, with confirmed and suspected cases spanning the Netherlands, Germany, Switzerland and the United Kingdom. The outbreak has been linked to the Andes strain of hantavirus, a rare variant capable of limited person-to-person transmission.
For the commercial cleaning industry, the unfolding situation has placed a sharp spotlight on how contaminated environments are managed during infectious disease events.
The missing piece in the outbreak response
According to ISSA senior director Gavin Macgregor-Skinner, there has been little public discussion around who is responsible for cleaning potentially contaminated spaces linked to infected passengers.
“Who is doing the cleaning? Are they trained? Do they have PPE?” he asks. “There has been no mention of who and how to clean up biohazard materials, patient urine, vomit, diarrhoea, contaminated surfaces or indoor air. Who cleans the ship? Who cleans the bus? Who cleans the plane? Who cleans the hospital rooms?”
Macgregor-Skinner said the outbreak reinforces the need for infection-prevention planning that extends well beyond patient treatment.
“We still do not have a plan on how to deal with seriously ill people on a cruise ship who have communicable diseases in the middle of the ocean,” he says. “There are scientific issues, public health issues, infection prevention and control issues, cleaning and disinfection issues.”
Cleaning mistakes can aerosolise danger
Hantavirus is primarily spread through contact with infected rodent urine, droppings or saliva. The greatest risk emerges when contaminated materials become airborne during sweeping, vacuuming or aggressive cleaning.
Macgregor-Skinner says the single biggest mistake cleaners make involves failing to stop work and reassess hazards once signs of rodent contamination are identified.
“Did that trigger a process to stop and think what are the hazards I could be exposed to, conduct a risk assessment and then mitigate the risks?” he asks.
He warns that improper cleaning methods create aerosolisation and cross-contamination risks capable of spreading harmful viral particles through indoor environments.
Industry guidance from the International Sanitary Supply Association advises cleaners to avoid dry sweeping or vacuuming rodent-contaminated spaces. Instead, contaminated materials should first be saturated with disinfectant before removal using appropriate PPE and controlled cleaning procedures.
Questions around transmission
The Andes strain involved in the outbreak remains the only hantavirus variant known to spread between humans.
Macgregor-Skinner points to a 2018 outbreak in Argentina, documented in The New England Journal of Medicine, where the virus spread rapidly across multiple waves of transmission following a birthday gathering and subsequent wake.
According to the study, infections occurred in social settings, hospitals and family environments, including among people whose contact with infected individuals appeared relatively brief.
“WHO is saying that the Andes strain of hantavirus requires close and prolonged contact,” Macgregor-Skinner said.
“But in a 2018 outbreak, this virus managed to spread readily in various settings over four successive waves.”
The World Health Organisation continues to maintain that widespread public transmission remains unlikely. Health agencies across Europe are still monitoring contacts connected to the cruise ship outbreak.
For cleaning professionals, the outbreak has become another stark reminder that frontline infection prevention begins long before a hospital admission and continues long after a patient leaves the room.
