Introduction:
Cruise ships are settings where diverse populations interact, with risk of developing infections of various etiologies. The most frequent causes of infection are respiratory and gastrointestinal pathogens¹. Viral gastroenteritis is caused mainly by norovirus, which is resistant to disinfectant and has the ability of persisting in the environment for several weeks². Plenty of evidence has accumulated on the role of contaminated environmental surfaces in the transmission of pathogens. Cleaning and disinfection for both porous and nonporous environmental surfaces constitute a significant factor in preventing transmission of infectious disease^3-6.

Methods:
We conducted ship site visits to observe the implementation of cleaning and disinfection practices in a real-world setting. The company’s existing protocols, Standard Operating Procedures (SOPs), and training materials were obtained and reviewed in order to gain useful insights. Focus groups were conducted among cruise ship crew, officers and managers to understand in-depth the daily routine cleaning and disinfection procedures, barriers, challenges and good practices.

Results:
The following challenges were identified: consistency in delivering training, difficulties describing in detail certain parts of SOPs, defining indicators for measuring outcomes of monitoring environmental surface cleaning and disinfection as part of an audit system, difficulties in standardising chemical products’ mixing instructions especially in automatic dispensers, measuring contact time with a timer.

Conclusions:
Challenges could be addressed by the following recommended measures: provision of detailed SOPs describing all steps in cleaning and disinfection process, production of new training materials and if possible incorporating videos, defining quantitative and qualitative indicators to monitor the success of disinfection, equip staff with timers. A toolkit for systematic monitoring of surface cleaning and disinfection will be produced by HEALTHY SAILING project in an attempt to address these challenges.