WHO Guide to Hygiene and Sanitation in Aviation: Best Utilization Scenarios
The WHO Guide to Hygiene and Sanitation in Aviation is best utilized for developing and implementing infection control protocols for aircraft disinfection, vector control (particularly disinsection procedures), and establishing standard operating procedures for managing infectious disease events during flight operations.
Primary Applications
Aircraft Disinfection and Sanitation Protocols
The guide provides essential technical specifications for selecting appropriate disinfectants that are both effective against pathogens and compatible with aircraft components, addressing a critical gap where basic WHO hygiene advice lacks details on available substances and standardized procedures 1.
Airlines should reference this guide when establishing protocols for disinfecting aircraft that transported passengers suspected of highly infectious diseases (e.g., Ebola, SARS, MERS-CoV), as it provides the foundational framework for safe and efficient disinfection procedures 1.
Vector Control and Disinsection
The guide is essential for implementing disinsection policies to prevent vector-borne disease transmission (malaria, yellow fever, Zika virus) through mosquitoes transported on aircraft 2.
Airlines must consult this reference when aircraft are parked at airports in endemic regions with cabin and cargo doors open during loading, as mosquitoes can enter the cabin and pose transmission risks 2.
The guide helps airlines navigate inconsistent national disinsection requirements, where some countries mandate spraying on inbound flights while others do not, creating confusion about when and how to implement vector control 2.
Emergency Response Planning
Airlines should utilize this guide when developing Emergency Response Plans for managing suspected infectious disease cases during flight, particularly for training cabin crews on infection control measures 2.
The guide supports implementation of protocols for isolating potentially infectious passengers, managing contaminated bodily fluids (vomit, blood), and communicating with ground health authorities 2.
Airlines can reference specific sections when ensuring adequate emergency medical supplies are aboard (gloves, surgical masks, biohazard disposal bags, disinfectant) as recommended for communicable disease exposure 2.
Operational Scenarios
Pre-Flight Preparations
Airlines should consult the guide when establishing ventilation system requirements, including ensuring aircraft that recirculate cabin air are fitted with 99.97% efficiency HEPA filters 2.
The guide informs protocols for ground delays lasting 30 minutes or longer with passengers on board, ensuring ventilation systems remain operational 2.
In-Flight Management
Cabin crews should be trained using this guide's principles when handling passengers who develop symptoms during flight (fever, vomiting, respiratory distress), particularly regarding universal precautions when exposed to body fluids 2.
The guide provides the framework for crew communication protocols when notifying pilots and ground health authorities about potentially infectious passengers, addressing the communication failures demonstrated in documented Ebola scenarios 2.
Post-Flight Procedures
- Airlines must reference the guide when determining appropriate disinfection procedures after transporting infectious or potentially infectious passengers, ensuring both passenger and crew safety 1.
Critical Context and Limitations
Regulatory Framework
While the guide provides technical hygiene and sanitation recommendations, it operates within the broader context of International Health Regulations (IHR), which are legally binding but contain limited specific provisions for air travel 2.
Airlines face challenges because public health guidance and legislation are often contradictory and confusing, with the WHO guide using permissive rather than mandatory language, leaving implementation to variable national policies 2.
Evidence Base Gaps
The guide should be used recognizing that the evidence base underpinning many airline-associated infectious disease control measures needs considerable strengthening 2.
Airlines implementing the guide's recommendations should understand that absolute figures for in-flight disease transmission risk are not readily available, and transmission characteristics vary by pathogen, flight duration, and aircraft type 2.
Common Pitfalls to Avoid
Do not rely solely on this guide for medical clearance decisions or passenger fitness-to-fly assessments—these require physician evaluation and vary by airline policy and national guidelines 2.
Avoid using the guide as a substitute for specific disease-focused guidelines (e.g., WHO tuberculosis and air travel guidelines provide more detailed protocols for TB-specific scenarios) 2.
Do not assume the guide provides legally enforceable standards—it offers technical recommendations that must be implemented within each country's national legislation and airline policies 2.
Airlines should not interpret the guide's hygiene recommendations as sufficient without also investing in crew training, as frontline employees are not infectious disease specialists and require specific education on recognizing and managing potential disease cases 2.