An outbreak ofhas prompted the city of San Diego to begin power washing its streets with bleach in an effort to combat the .
San Diego County officials earlier this month declared a public health emergency because of the spread of thethat has killed 15 people and hospitalized 300 more.
The region's homeless population, which often lacks adequate access to restrooms or showers, has been hit the hardest since the outbreak started last November.
Mayor Kevin Faulconer's office on Friday responded to a letter from the county government asking the city to move forward with specific sanitation actions.
A week earlier, the county gave the city five business days to respond with a plan for remedying what it called a "fecally contaminated environment" downtown.
The county will soon expand its efforts to other cities in the region, where the hepatitis A outbreak has now produced nearly 400 confirmed cases.
On Monday, crews began to use bleach-spiked water to pressure wash outdoor surfaces that may have feces, blood or bodily fluids. The virus lives in human feces and spreads if people who have used the bathroom do not properly clean their hands.
The county moved forward with its own contractor, who installed 40 hand-washing stations in areas where the homeless often gather.
In addition to regularly pressure-washing dirty city right of ways, the county also asked the city to "immediately expand access to public restrooms and wash stations within the city limits that are adjacent to at-risk populations."
The San Diego Department of Health has also been offering free hepatitis A vaccines and has vaccinated about 19,000 people since March, CBS San Diego affiliate KFMB reports.
The local advocacy group March of Voices is also asking the city for a moratorium and amnesty on tickets for arrest for actions that are related to simple survival without housing.
The new sanitation efforts were inspired by a prior campaign in Los Angeles, home to tens of thousands of homeless people.