The contents in this document have been prepared by a wide range of experts from the cleaning and restoration industry to assist White’s Fire Smoke and Water Damage Restoration in managing the risks arising from efforts to mitigate the COVID-19 Pandemic. This Preliminary Report is based on extensive industry experience and, to the extent possible, we have incorporated guidance provided by the Centers for Disease Control and Prevention (CDC) and the U.S.
Environmental Protection Agency (EPA). While each project is unique and requires a specific work plan, White’s fire Smoke and Water Damage Restoration will consider the information contained in this document to formulate our work practices. However, this Report is preliminary, and should not be construed as, an industry standard. This is a rapidly evolving situation and more research is needed. At this point in time, it is not feasible to write definitive rules that will apply to every scenario. In certain situations, deviations from these methods may be appropriate, based on the circumstances of the project and the professional judgment of White’s Cleaning and Restoration. Anyone using this document should understand the document’s limitations, and rely on his or her judgment, or as appropriate, seek the advice of a White’s Cleaning and Restoration professional in determining the exercise of reasonable care in any situation. All persons using this document must be and remain, updated and informed about developments pertaining to COVID-19 and the restoration industry so that he/she may implement changes in procedures as appropriate, as well as adhere to all applicable federal, state, provincial and local laws and regulations.
According to the Centers for Disease Control and Prevention (CDC) “Nonpharmaceutical intervention would be the most important response strategy” to COVID-19. Their pronouncement means that infection control and home care of the affected are the key response measures. It is noted that older adults, particularly those with weakened immune systems and underlying health problems, are at a higher risk for severe COVID-19 associated illness. This means that medical facilities and eldercare accommodations are especially vulnerable to outbreaks. Infection Control Principles Decades of scientific studies and practical experience have shown that effective control of infectious agents in the population requires a nearly equal combination of adjusting people’s behavior and taking additional steps to stop the spread of contamination from surfaces. This dual approach to infection control is necessary for COVID-19, as the best available information indicates that it is spread both by direct exposure to the droplets aerosolized when an infected individual coughs or sneezes and by secondary exposure of uninfected people to objects and surfaces with residual viral particles. Secondary exposure is likely more of a problem with COVID-19 than the normal flu as some early reports from the CDC indicate that the virus may remain viable on nonporous surfaces for up to nine days as compared to one-three days for normal influenza viruses.
The recommendations in this document are designed to address secondary human transmission through the cleaning of facilities to prevent the spread of the virus from surfaces. While the exact extent of disease transmission from contact with surfaces is currently unknown, initial indications are that prolonged exposure to contaminated surfaces does lead to higher infection rates. Therefore, cleaning surfaces and applying a disinfectant are important risk mitigation techniques. During past viral outbreaks the behavior component of the infection control process has been voluntary. Individuals are reminded to stay home if they are sick, educated to cover their cough and sneeze, and encouraged to wash their hands frequently. This voluntary approach has been supplemented with CDC suggested cancellations of activities that would bring large numbers of people into close proximity; including closure of schools, colleges, sporting events and amusement venues. Containment efforts have also resulted in authorities closing bars and restaurants in many states, along with enactment of international travel restrictions. While these measures to adjust behavior will hopefully slow the spread of the virus, such efforts need to be matched with practices proven to minimize secondary transmission. White’s Cleaning and Restoration must emphasize to our clients that actions taken to reduce exposure from secondary transmission from surfaces with reservoirs of viral material must be matched with procedures to prevent recontamination. Cleaned and treated surfaces can become recontaminated in minutes if an infected individual is present and sneezes or coughs without controlling the droplet spread. Potential Services With the proper training, equipment, supplies and personal proactive gear, White’s Cleaning and restoration has experience in dealing with other hazardous microorganisms, such as sewage mitigation and mold remediation, can offer valuable services to combat COVID-19.
The most basic service will likely be enhanced cleaning of touchpoints and application of disinfectants to other surfaces. It is important that White’s Cleaning and Restoration communicates clearly and uses consistent terminology when describing our services. Because no currently available antimicrobial has been tested against the SARS-CoV-2, it is important to use the verbiage to “clean and apply disinfectant” rather than “clean and disinfect.” With no validation of a product’s effectiveness for this particular virus, there is no way for the contractor to know if the appropriate level of microbial reduction has been reached in order to meet the definition of the term “clean and disinfect”. As such, White’s Cleaning and Restoration is offering a service to clean and apply an appropriate EPA registered disinfectant in accordance with the application directions provided by the master label. Even with that distinction in language, it is clear that the cleaning of touchpoints and specialized treatment involving application of disinfectant is an essential service. Other services that White’s Cleaning and Restoration may be able to provide to clients in the medical and eldercare industries include temporary isolation of rooms or areas to create negative pressure treatment or quarantine spaces. White’s Cleaning and Restorations services to medical facilities are familiar with Infection Control Risk Assessment (ICRA) guidelines. Although ICRA guidelines apply specifically to contractors conducting construction activities, they provide important guidance on infection control measures. HEPA vacuuming and the use of HEPA filtered equipment such as air scrubbers can also improve the environment by reducing the level of airborne particulate. The removal of aerosolized particulate during the cleaning process may further improve the overall cleaning efficacy and reduce risk.
Choosing a sanitizing product can be confusing as the sudden onset of the SARS-CoV-2 virus means that commonly used antimicrobial products have not been tested or have not received a U.S. Environmental Protection Agency (EPA) registration specifically for cleaning surfaces with viral materials that cause COVID-19. In this situation, the EPA falls back on its “emerging pathogens program” to provide guidance in evaluating a product’s effectiveness in arresting the spread of the virus. Their guidance on the best practices to break the chain of infection when new microbial threats appear allows companies with existing registrations that document product effectiveness in killing similar organisms to utilize those chemicals against the new threat. Therefore, any products used by White’s Cleaning and Restoration are listed on the EPA “Emerging Pathogen/List N” or meet the requirements of the emerging pathogens procedures for enveloped viruses (the class of organism of the SARS-CoV-2 It is important to note that equipment must be scrupulously cleaned between each project. White’s will validate their equipment cleaning procedures to ensure that no microbiological contaminants will be transferred from one location to another.
The minimum personal protective equipment (PPE) recommended by the CDC for individuals potentially exposed to COVID-19 includes gloves, gowns, eye protection, and respirators. Typically, White’s Cleaning and Restoration use disposable suits with attached hoods and booties for contaminant control work. For most work conducted by White’s Restoration related to mitigation of COVID-19, CDC and Health Canada recommend an N-95 filtering face piece as minimum protection against possible exposure to the viral contaminants. If filtering face pieces are used, a full-face shield rather than safety glasses will be used in order to minimize fogging and to protect the eyes from exposure to potential contaminants. Because small actions can be important to protect workers and minimize the spread of infectious agents there are even proper, detailed, procedures for removing surgical style gloves.
The first step in cleaning and sanitizing to break the chain of COVID-19 illnesses from secondary surfaces is to remove soil and other surface contaminants. Emphasis should be placed on cleaning surfaces more likely to be touched by occupants; commonly referred to as touchpoints. Since people are not precise when touching objects, touchpoint cleaning should extend past the focused item 3-12 inches. Common touchpoints include, but are not limited to, door knobs and locks, door push bars, door edges and jambs on the side opposite the hinges, stair and ramp hand railings, cupboard handles and drawer pulls, appliance handles, light switches, table and desktops, telephones, toilet seats and flush handles, faucet handles, soap pumps, keyboards and mice, elevator buttons, credit card keypads, vending machine buttons, equipment controls, television remote controls, chair armrests, bedrails, and countertops. Touchpoints will also vary by the type of facility being cleaned. Pew tops and armrests, communion rails, confessional kneelers, altars, and holy water dispensers are touchpoints that need cleaning in churches. Toys, books, and teaching supplies will need attention in schools. Medical facilities will require an additional focus on wheelchair handles and wheel grips, computer stations, IV poles, divider curtains, blood pressure equipment, bed stands, food delivery carts, laundry and trash containers, and nurse call buttons. While not a touchpoint that typically gets addressed by White’s Cleaning and Restoration, clients should be advised to remind occupants to frequently clean their cell phones and other mobile devices during pandemics and times of increased disease transmission.
Typically, a trigger sprayer and a wiping cloth are used for cleaning most touchpoints. The specific examples provided in this section should not be considered the best methods as each situation presents its own challenges. Each project should be evaluated for procedure and methods that are appropriate to meet the goals of the client. To further reduce the potential for infection transmission, touchpoint cleaning should be paired with the application of disinfectants to the many surfaces where viral contaminants may exist. Applying appropriate antimicrobial solutions as an aerosol is an effective way to reduce microorganisms on walls, floors, and horizontal surfaces. There are numerous processes and systems that can be effective in completing large area sanitization. Many antimicrobial products currently used by White’s Cleaning and Restoration, medical, and food service industries can be utilized by adjusting the application method from trigger sprayer to pump sprayer, misting equipment, airless sprayer, electrostatic sprayer, ultralow volume (ULV) fogger, or thermal fogger. Antimicrobials and disinfectants can be used if approved by the EPA or the U.S. Food and Drug Administration (FDA) for the purpose of surface sanitization and/or listed on the EPA “Emerging Pathogen/List N” or meet the requirements of the emerging pathogens procedures for enveloped viruses (the class of organism of the SARS-CoV-2). Several steps should be completed prior to the broadscale application of disinfectants to surfaces. Return air vents should be covered to prevent migration of the disinfectant into the equipment or to other areas. While air duct cleaning can be incorporated into COVID-19 response procedures, the EPA has strict rules regarding which products can be used in HVAC systems. It is also at this time not clear that the HVAC or air conveyance system plays a role in the spread of SARS-CoV-2 virus, and the inclusion of HVAC cleaning and decontamination therefore may not be necessary. Setting up HEPA filtered negative air machines as air scrubbers can reduce the airborne particulates that get dislodged by the treatment process. After selecting an approved combination of disinfectant product and application method, the prepared disinfectant should be applied in accordance with label directions. Depending upon the facility and specific space, when walls are considered a potential touchpoint, wall surfaces should be included in the application of the disinfectant. Shelves, bookcases, file cabinets, or other fixtures may require a higher starting point. Depending on the listed product dwell time and the application method, the disinfectant may be able to be applied once or it could require multiple treatments to keep the surfaces wet the minimum time. Careful assessment of the surfaces will be necessary to prevent the product from streaking or running while keeping the surface wet for the recommended contact time. Floors and other horizontal surfaces should be treated after the product has been applied to all walls. Floor surfaces should be free of visible debris before treatment. In most cases, HEPA vacuuming of the floor surface will remove the majority of visible debris. Regular vacuuming, dust mopping, or sweeping is not recommended when cleaning to prevent COVID-19.
Post-work Project Evaluation The combination of touchpoint cleaning and application of a disinfectant to other surfaces is a proven strategy to break the chain of infection. Although these efforts are designed to affect microorganisms that are too small to see without magnification, a detailed post work visual inspection is still the first step to evaluate the effectiveness of the efforts to control COVID-19. A white cloth should be wiped over representative touchpoints that have been cleaned and should not reveal any discoloration or residue. Any visible debris deposited on the cloth (not disinfectant residue) indicates a need for recleaning of all touchpoints represented by the sample. If desired by White’s Cleaning and Restoration or the client, analytical methods can be used to supplement the visual inspection. A useful process that provides on-site results is a swab collection of surface samples using an adenosine triphosphate (ATP) meter. ATP meters do not identify viral contaminants since those organisms do not produce ATP. However, the overall reduction in biological contaminants is an excellent surrogate measure of cleanliness since selective cleaning of specific contaminants is impossible (e.g., it is not possible to clean bacteria and leave behind just the virus). Given the ability of ATP to measure general biological residue, representative testing using an ATP meter can be conducted if additional assurance of project effectiveness is necessary. Sample results should be compared to guidelines for hygiene surface testing provided by the manufacturer of the specific ATP meter. Another approach to documenting the effectiveness of the process is to utilize the ATP meter on a number of representative touchpoints prior to the start of cleaning and again at the end to compare the level of reduction that was achieved. Project Documentation Regardless of the technology and chemistry used for touchpoint cleaning and surface sanitization treatment, White’s Cleaning and Restoration will document the work to confirm that it was completed correctly. Project documentation for COVID-19 activities should include a written description and photographs of any isolation barriers set up as part of the cleaning and sanitization process. Specific personal protective equipment (PPE) for workers should be documented. Records should also be kept regarding the specific equipment used for chemical application, including the process that was used to clean the equipment prior to adding the selected antimicrobials. These records will confirm how the product was mixed if it was not a ready-to-use cleaner/sanitizer. The correct application rate is another crucial data point to be documented. Evidence of appropriate dwell time, as noted from the product label, also needs to be recorded. Finally, if the cleaning/sanitizing product requires rinsing or neutralization, the procedures to comply with that requirement should be fully explained
The information and guidance in this document were developed in collaboration with the Institute of Inspection, Cleaning and Restoration Certification (IICRC). The IICRC is the leading certification body in the cleaning and restoration industry, and an ANSI Accredited Standards Developer. For more information on the IICRC, visit www.IICRC.org. The Restoration Industry Association (RIA) is the only international, professional trade association for the cleaning and restoration industry. Its national and international member firms specialize in cleaning, treating and repairing damaged buildings and their contents. RIA sponsors education, training, and certification programs. For more information, visit www.restorationindustry.org.
Should you wish to have White’s Fire Smoke and Water Damage Restoration perform any of our Infectious Disease Cleaning and Sanitation Services please call our office 24 hours a day 7 days a week at (507)281-0212 or learn more at www.RochesterWaterDamage.com. As always we provide FREE Estimates and provide the highest level of cleaning and sanitation