Nothing disrupts your life like sewage backup or overflow. It Stinks! In the next couple of blog posts we will explore why a sewage loss is so-so bad. (Yes, besides the obvious) We often times have clients that have a simple sewage back up contained to the bathroom and are reluctant to have us follow proper sanitization and cleaning processes. That is code for: I really don’t want to replace drywall and flooring just because “a little doo-doo has been sitting in my bathroom for several hours or days.” Yes! Really clients do say this… read on… and you’ll never thinking twice about incorporating proper sanitization and cleaning protocols.
When a building is contaminated with sewage backing up from the septic lines, or flooding of a building occurs that involves sewage, a serious threat to human health exists. Extensive damage to contents and structural materials will occur immediately or in time without appropriate action. If time passes extensive contamination and permeation of absorbent materials such as concrete, paper, gypsum and wood will occur. This penetration with organic matter (sewage) and water leads to the growth of potentially ailment-causing (or opportunistic) microorganisms. These kinds of bacterial organisms may pose a serious health risk to occupants of the building. Organic matter and water-saturated materials can be used as platform for growth of microorganisms that are lethal to humans and are hazardous to materials.
Some of the questions to be answered in this situation include the following: What are the effects of the initial contamination of the building, its contents, and the health and welfare of its occupants? To thoroughly clean up the contamination and repair the damage, what is needed? Should the whole building or just a part of the building be evacuated and for how long should this last? Can semi-porous materials be sanitized and freed from contamination, or should they be replaced? What is the trade-offs of using insufficient measures to remediate the damage? What are the indicators that help show when the building is safe or not safe for people to move it? What procedures should be used to test for these indicators? What is the effect of the sewage damage on other systems, especially the air changing systems (ACS) and the heating, ventilating, and air conditioning (HVAC) systems in the build environment?
There are several factors that are related to the remediation of the problem. Among these are the nature of the contamination, the types of water-damaged materials (organic or synthetic; porous, semi porous, or nonporous), the sewage micro flora (pathogens and allergens), organic matter load, water volume, and impact of ambient outdoor temperature and humidity on the indoor environment. Of major concern is the survival of sewage-borne micro flora (viral, bacterial, fungal, parasitic, and their potential transmission to
humans. The potential exists for some fungal and bacterial contaminants to establish an ecological niche and present a health risk from chronic exposure for some time after the event.
Now What?
The factors that determine the extent of contamination within the building include the volume and the solids content of the sewage backflow, whether flooding is isolated or involves other areas as well, and how long the contamination has been in place. The assumption must be that potential pathogens are present in the contamination. Such microbial contamination includes bacteria, fungi, viruses, and parasites. This lists the micro flora that may be found in raw, untreated sewage and the diseases that these organisms have the potential to cause. Also, hypersensitivity lung disease has been shown to be caused by repeated flooding of homes with sewer water.
The routes of exposure of the building occupants to these pathogens are contact, ingestion, and inhalation. An incomplete or inadequate job of cleaning and disinfection may leave residue that can be a substrate for disease-causing microorganisms. Occupants may be infected by contacting contaminated surfaces, with inadvertent transmission from hands to mouth, or aerosolization of contamination may result in the inhalation of microorganisms or their products (e.g., endotoxins). Residue and microbial contaminants also can be tracked by occupants’ feet to other parts of the building.
Another aspect of health impact is that the conditions caused by sewage backflow are conductive to the growth of nonsewage microorganisms. These conditions include wetness, humidity, and organic matter. Microorganisms, which exist in various life stages in both indoor and outdoor environments, would then have the opportunity for exponential population growth. These species can produce bioaerosols, which are potential sources for disease. For example, mold allergy is a common source of indoor air symptoms and complaints.
In regard to the susceptibility of building occupants, those individuals whose immune systems are in some way compromised (i.e., immune and compromised), or who are otherwise susceptible due to age, medication, or underlying illness, are considered to be at greater risk of contracting potentially fatal infections than those individuals who are healthy.
Next time we will explore the General Precautions for Sewage Contamination on Residential Property.
Monday, May 24, 2010
Monday, May 3, 2010
Trauma Restoration Industry Part three
Today we continue our final part of the three part series on the Trauma Restoration Industry.
The safety and health of employees performing this type of work is paramount to ServiceMaster Anytime. The risks from exposure are high to both the person exposed as well as the business owner who is ultimately responsible for that employee’s proper training and safety. In specific instances where there is exposure to Hepatitis and/or AIDS, the outcome can be catastrophic.
We minimize these risks however by being aware of what these risks are and by providing the proper training, equipment and resources to those employees involved.
OSHA (Occupational Safety & Health Administration) writes the laws that apply to this type work and mandates enforcement of those laws. Penalties are severe and in some cases where employer negligence is determined, those fines can even close down a business.
OSHA Requirements
OSHA requires that the following minimum standards are in place before any person or business should attempt to engage in trauma restoration services:
1. Completion of a certified bloodborne pathogen course and maintain the proper documents at the cost of the employer.
2. Immunizations to receive the following: Hepatitis B vaccination series including the final blood test commonly known as a “Titer Test”. (Every 9 yrs.)Tetanus booster. (Every 7 yrs.)
3. Maintain the proper Material Data Safety Sheets (MSDS) for all chemicals in use including “over- the- counter” chemicals.
4. Provide the proper training, safety equipment, protective uniforms, chemicals, tools and supplies at no charge to all employees performing this work.
5. Provide and maintain the following OSHA documents: Bloodborne Pathogens Standard, Guidelines for Prevention, Exposure Control Plan and the company safety manual.
Trauma Technicians are some of the best trained employees available in the cleaning industry. Historically, these positions have been filled by paramedics, ambulance attendants, fireman and medical workers. Trauma Technicians encounter more emotionally trauma disturbing situations, are placed in more potentially dangerous environments and are exposed to more direct health risks than the average cleaning worker.
Personal Protective Equipment (PPE)
It is critical to the safety of the technician that proper PPE or Personal Protective Equipment be utilized when working in trauma cleanup. The following is a list of the most often used PPE.
Rubber boots, Disposable shoe covers, Disposable Tyvek® body suit w/hood (large), Disposable Tyvek Coveralls, Face shields, Plastic goggles, Eye wash solution, Rubber gloves (heavy), Nitrile butyl rubber (NBR) gloves or equivalent. For underneath the Rubber gloves, Air purifying respirators. (Full or half face with acid gasses/organic vapor cartridges), Disposable particle masks Polysporin ointment (individually wrapped single-use packages)
All production personnel suit up in appropriate PPE. PPE must be chosen based on the clean-up to be conducted. The Technicians must always wear latex gloves #9 or equivalent. Whenever there is a chance for splashing of blood or OPIM (Other Potentially Infectious Materials), Tyvek coverall and face shields or masks and goggles must be worn. When scraping dried blood or OPIM, masks and goggles must be worn. For large blood spills, disposable shoe covers should be worn.
Cleaning Processes
There are many steps to the decontamination and restoration of a trauma site. We start with meeting with the customer. Most of the time this meeting takes place on site but may well take place off site if odor and other emotional concerns are present.
When the supervisor responds to the customer’s call to discuss the exposure, the customer may not be able to discuss specifics or the extent of exposure. Above all else, we remain sensitive to the customer and the situation. If the trauma scene is also a crime scene, the supervisor will also obtain a written release from the police before further action is taken. The supervisor walks through the trauma site reviewing the specifics of the loss. The supervisor also inspects all other rooms at the trauma site into which first responders may unknowingly have transferred contamination or bodily fluids or OPIM (Other Potentially Infectious Materials.) The customer may not want to or need to be present to accompany the Supervisor on the walk-through of the trauma site. The Supervisor clarifies the expectations with the customer so there are no unexpected situations to come up. Supervisor outlines for the customer the basic steps the team will take. The supervisor explains the general cost structure agreeing to provide a more specific cost estimate after the walk-through. The supervisor will brief the technician(s) on job specifics that impact the equipment, tools, products and supplies needed.
What can we clean and what must be destroyed through proper and legal procedures.
First we will determine if the room contents are contaminated with blood or OPMI and if they must be disposed. If so, we will sort the hazardous from the non-hazardous materials and pack the contents. All contents will be inventoried. Since disposing of infectious waste is costly, sorting the hazardous from the non-hazardous materials will save the customer expense. We are often asked to dispose of items that are not contaminated by direct contact with blood or OPMI but are within the trauma site. We then document which items have been disposed of and this will become part of the file as required by OSHA #29 CFR 1910.20.
Then we remove the contaminated materials that cannot be restored. We remove surface coverings (e.g. flooring, countertops, wallboard, carpet, etc.) and dismantle structural components (e.g. studs, sub-flooring) contaminated with blood that cannot either be completely cleaned and de-stained or be adequately cleaned and encapsulated with a sealer. All contaminated portions of soft surface items such as sofas, cushions, mattresses, etc. must be removed and properly disposed of in biomed containers.
The hard-surface contents that are contaminated with blood and OPIM must be cleaned with an appropriate detergent and disinfected with a tuberculocidal disinfectant before being returned to the customer. Hard-surface contents may include the following types of surfaces: Metal, Plastic, Finished wood, Stone and Glass. The hard-surface contents at the trauma site that have not been contaminated by blood or OPIM may be cleaned and disinfected. This process provides the customer with a safe and healthy environment while saving production time and product expense.
Structural Materials
The walls and ceiling materials are cleaned and disinfected, as well the flooring materials. Then we disinfect with a secondary cleaning product and rinse thoroughly in preparation for sealing. Occasionally, stains cannot be completely removed; in these cases we seal the structural material using a pigmented shellac sealer. If the blood or OPIM has heavily saturated the structural material, we advise that the material be removed and replaced.
Structural materials may also have been damaged by the trauma. We carefully inspect materials and remove any bodily fragments like bone or teeth and store these appropriately. We only remove bullet fragments if a signed “Authorization to Begin Work” form has been received. Otherwise, we will wait for removal instructions from authorities. ServiceMaster Anytime is a fully licensed General Contractor so we are prepared to repair or replace any damaged structural materials for the customer.
Clean, deodorize and sanitize soft surfaces.
The customer may request that a contaminated carpet or rug be cleaned and returned. We highly discourage this practice because of the potential for infectious residue. However, the rug is the customer’s property and they may insist that we comply with their wishes. We let the customer know that the chances of complete stain removal are remote. If the customer still insists, we will obtain a “release” for our records.
Upholstered Furniture
The customer may also request that a contaminated piece of upholstery be cleaned and returned. We discourage this practice as well. Even though, thorough cleaning does reduce the risk of leaving a bloodborne pathogen on the fabric surface where it can be passed to another person. We also let the customer know that the chances of complete stain removal are remote. If the customer still insist, a “release” for our records.
Inspection of all work.
Inspection plays the most important role of all the action steps in the trauma restoration cleaning process. The customer expects the area or home returned to normal and they deserve perfection.
Without exception, the following inspection guidelines are followed:
The Technician self-inspects the item or surface immediately upon completion of cleaning. Then the Technician requests peer or a supervisor to inspect the area, this is done to ensure through cleaning is completed. We inspect what we expect. If any problem is found, the inspector verbalizes the oversight to the technician. The Technician will then clean the entire item or surface again. The technician then self-inspects the item or surface, asks for peer or supervisor inspection and the process continues until satisfactory inspection is confirmed. The Supervisor re-inspects the entire job site prior to opening trauma site to traffic. At the end of the job, the Supervisor and customer inspect together to ensure complete satisfaction.
Transition Steps from Work Area to Shop
The Technician(s) inventory and discard all contaminated disposables used for cleaning (e.g. towels, paper goods, etc.) in sealed biomed boxes or trauma barrels. Technician(s) clean and disinfect all boots worn during restoration work that will be used to walk through uncontaminated areas. Used Caution/Warning tape is discarded in biomed boxes.
The Technicians return equipment, tools, products, supplies, biomed boxes and trauma barrels to the production vehicle via the traffic lane runners. The Technician(s) remove traffic-lane paper and tape and discard in remaining biomed boxes. All production personnel remove all reusable personal protective gear and place in remaining biomed box marked “TO BE DISINFECTED” and seal that box. All disposable personal protective gear should now be removed and placed in the remaining biomed box. The Technician(s) seal and load all remaining biomed boxes into vehicle.
The Crew members must wash their hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other bodily fluids to which universal precautions apply. Hands should always be washed after gloves are removed, even if the gloves appear to be intact.
Final Clean-up and Paperwork at the Shop
The Technician(s) unload all biomed boxes and/or trauma barrels into a secure area and disinfect the outside of trauma barrels. After the Technician(s) put on fresh disposable gloves, they’ll unload contaminated equipment, tools, chemicals and supplies and place them in an isolated area to be disinfected. Folding tables are set up as a workstation and the process of disinfecting the contaminated equipment, tools, product containers and supplies is completed.
Hopefully we have provided a good understanding of the Trauma Restoration industry. Trauma work is a carefully performed process, although with sadness, it is a process triggered by an event. We can’t emphasize enough how important it is that the correct and legal protocols be applied and followed. We really want people to understand and know about Trauma Restoration because without the proper guidance and advocacy, families often face the cleanup themselves because they are unaware of the services that Trauma Practitioners perform. This can be an emotional hardship for the family but consequently, when a self clean up occurs; it is often handled badly or illegally. Our community landfills are common dumping grounds for infectious and contaminated waste that should never have ended up there. Proper disposal of blood borne pathogens and any cleaning clothes and tools must be handled correctly and in full compliance with laws and regulations.
The safety and health of employees performing this type of work is paramount to ServiceMaster Anytime. The risks from exposure are high to both the person exposed as well as the business owner who is ultimately responsible for that employee’s proper training and safety. In specific instances where there is exposure to Hepatitis and/or AIDS, the outcome can be catastrophic.
We minimize these risks however by being aware of what these risks are and by providing the proper training, equipment and resources to those employees involved.
OSHA (Occupational Safety & Health Administration) writes the laws that apply to this type work and mandates enforcement of those laws. Penalties are severe and in some cases where employer negligence is determined, those fines can even close down a business.
OSHA Requirements
OSHA requires that the following minimum standards are in place before any person or business should attempt to engage in trauma restoration services:
1. Completion of a certified bloodborne pathogen course and maintain the proper documents at the cost of the employer.
2. Immunizations to receive the following: Hepatitis B vaccination series including the final blood test commonly known as a “Titer Test”. (Every 9 yrs.)Tetanus booster. (Every 7 yrs.)
3. Maintain the proper Material Data Safety Sheets (MSDS) for all chemicals in use including “over- the- counter” chemicals.
4. Provide the proper training, safety equipment, protective uniforms, chemicals, tools and supplies at no charge to all employees performing this work.
5. Provide and maintain the following OSHA documents: Bloodborne Pathogens Standard, Guidelines for Prevention, Exposure Control Plan and the company safety manual.
Trauma Technicians are some of the best trained employees available in the cleaning industry. Historically, these positions have been filled by paramedics, ambulance attendants, fireman and medical workers. Trauma Technicians encounter more emotionally trauma disturbing situations, are placed in more potentially dangerous environments and are exposed to more direct health risks than the average cleaning worker.
Personal Protective Equipment (PPE)
It is critical to the safety of the technician that proper PPE or Personal Protective Equipment be utilized when working in trauma cleanup. The following is a list of the most often used PPE.
Rubber boots, Disposable shoe covers, Disposable Tyvek® body suit w/hood (large), Disposable Tyvek Coveralls, Face shields, Plastic goggles, Eye wash solution, Rubber gloves (heavy), Nitrile butyl rubber (NBR) gloves or equivalent. For underneath the Rubber gloves, Air purifying respirators. (Full or half face with acid gasses/organic vapor cartridges), Disposable particle masks Polysporin ointment (individually wrapped single-use packages)
All production personnel suit up in appropriate PPE. PPE must be chosen based on the clean-up to be conducted. The Technicians must always wear latex gloves #9 or equivalent. Whenever there is a chance for splashing of blood or OPIM (Other Potentially Infectious Materials), Tyvek coverall and face shields or masks and goggles must be worn. When scraping dried blood or OPIM, masks and goggles must be worn. For large blood spills, disposable shoe covers should be worn.
Cleaning Processes
There are many steps to the decontamination and restoration of a trauma site. We start with meeting with the customer. Most of the time this meeting takes place on site but may well take place off site if odor and other emotional concerns are present.
When the supervisor responds to the customer’s call to discuss the exposure, the customer may not be able to discuss specifics or the extent of exposure. Above all else, we remain sensitive to the customer and the situation. If the trauma scene is also a crime scene, the supervisor will also obtain a written release from the police before further action is taken. The supervisor walks through the trauma site reviewing the specifics of the loss. The supervisor also inspects all other rooms at the trauma site into which first responders may unknowingly have transferred contamination or bodily fluids or OPIM (Other Potentially Infectious Materials.) The customer may not want to or need to be present to accompany the Supervisor on the walk-through of the trauma site. The Supervisor clarifies the expectations with the customer so there are no unexpected situations to come up. Supervisor outlines for the customer the basic steps the team will take. The supervisor explains the general cost structure agreeing to provide a more specific cost estimate after the walk-through. The supervisor will brief the technician(s) on job specifics that impact the equipment, tools, products and supplies needed.
What can we clean and what must be destroyed through proper and legal procedures.
First we will determine if the room contents are contaminated with blood or OPMI and if they must be disposed. If so, we will sort the hazardous from the non-hazardous materials and pack the contents. All contents will be inventoried. Since disposing of infectious waste is costly, sorting the hazardous from the non-hazardous materials will save the customer expense. We are often asked to dispose of items that are not contaminated by direct contact with blood or OPMI but are within the trauma site. We then document which items have been disposed of and this will become part of the file as required by OSHA #29 CFR 1910.20.
Then we remove the contaminated materials that cannot be restored. We remove surface coverings (e.g. flooring, countertops, wallboard, carpet, etc.) and dismantle structural components (e.g. studs, sub-flooring) contaminated with blood that cannot either be completely cleaned and de-stained or be adequately cleaned and encapsulated with a sealer. All contaminated portions of soft surface items such as sofas, cushions, mattresses, etc. must be removed and properly disposed of in biomed containers.
The hard-surface contents that are contaminated with blood and OPIM must be cleaned with an appropriate detergent and disinfected with a tuberculocidal disinfectant before being returned to the customer. Hard-surface contents may include the following types of surfaces: Metal, Plastic, Finished wood, Stone and Glass. The hard-surface contents at the trauma site that have not been contaminated by blood or OPIM may be cleaned and disinfected. This process provides the customer with a safe and healthy environment while saving production time and product expense.
Structural Materials
The walls and ceiling materials are cleaned and disinfected, as well the flooring materials. Then we disinfect with a secondary cleaning product and rinse thoroughly in preparation for sealing. Occasionally, stains cannot be completely removed; in these cases we seal the structural material using a pigmented shellac sealer. If the blood or OPIM has heavily saturated the structural material, we advise that the material be removed and replaced.
Structural materials may also have been damaged by the trauma. We carefully inspect materials and remove any bodily fragments like bone or teeth and store these appropriately. We only remove bullet fragments if a signed “Authorization to Begin Work” form has been received. Otherwise, we will wait for removal instructions from authorities. ServiceMaster Anytime is a fully licensed General Contractor so we are prepared to repair or replace any damaged structural materials for the customer.
Clean, deodorize and sanitize soft surfaces.
The customer may request that a contaminated carpet or rug be cleaned and returned. We highly discourage this practice because of the potential for infectious residue. However, the rug is the customer’s property and they may insist that we comply with their wishes. We let the customer know that the chances of complete stain removal are remote. If the customer still insists, we will obtain a “release” for our records.
Upholstered Furniture
The customer may also request that a contaminated piece of upholstery be cleaned and returned. We discourage this practice as well. Even though, thorough cleaning does reduce the risk of leaving a bloodborne pathogen on the fabric surface where it can be passed to another person. We also let the customer know that the chances of complete stain removal are remote. If the customer still insist, a “release” for our records.
Inspection of all work.
Inspection plays the most important role of all the action steps in the trauma restoration cleaning process. The customer expects the area or home returned to normal and they deserve perfection.
Without exception, the following inspection guidelines are followed:
The Technician self-inspects the item or surface immediately upon completion of cleaning. Then the Technician requests peer or a supervisor to inspect the area, this is done to ensure through cleaning is completed. We inspect what we expect. If any problem is found, the inspector verbalizes the oversight to the technician. The Technician will then clean the entire item or surface again. The technician then self-inspects the item or surface, asks for peer or supervisor inspection and the process continues until satisfactory inspection is confirmed. The Supervisor re-inspects the entire job site prior to opening trauma site to traffic. At the end of the job, the Supervisor and customer inspect together to ensure complete satisfaction.
Transition Steps from Work Area to Shop
The Technician(s) inventory and discard all contaminated disposables used for cleaning (e.g. towels, paper goods, etc.) in sealed biomed boxes or trauma barrels. Technician(s) clean and disinfect all boots worn during restoration work that will be used to walk through uncontaminated areas. Used Caution/Warning tape is discarded in biomed boxes.
The Technicians return equipment, tools, products, supplies, biomed boxes and trauma barrels to the production vehicle via the traffic lane runners. The Technician(s) remove traffic-lane paper and tape and discard in remaining biomed boxes. All production personnel remove all reusable personal protective gear and place in remaining biomed box marked “TO BE DISINFECTED” and seal that box. All disposable personal protective gear should now be removed and placed in the remaining biomed box. The Technician(s) seal and load all remaining biomed boxes into vehicle.
The Crew members must wash their hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other bodily fluids to which universal precautions apply. Hands should always be washed after gloves are removed, even if the gloves appear to be intact.
Final Clean-up and Paperwork at the Shop
The Technician(s) unload all biomed boxes and/or trauma barrels into a secure area and disinfect the outside of trauma barrels. After the Technician(s) put on fresh disposable gloves, they’ll unload contaminated equipment, tools, chemicals and supplies and place them in an isolated area to be disinfected. Folding tables are set up as a workstation and the process of disinfecting the contaminated equipment, tools, product containers and supplies is completed.
Hopefully we have provided a good understanding of the Trauma Restoration industry. Trauma work is a carefully performed process, although with sadness, it is a process triggered by an event. We can’t emphasize enough how important it is that the correct and legal protocols be applied and followed. We really want people to understand and know about Trauma Restoration because without the proper guidance and advocacy, families often face the cleanup themselves because they are unaware of the services that Trauma Practitioners perform. This can be an emotional hardship for the family but consequently, when a self clean up occurs; it is often handled badly or illegally. Our community landfills are common dumping grounds for infectious and contaminated waste that should never have ended up there. Proper disposal of blood borne pathogens and any cleaning clothes and tools must be handled correctly and in full compliance with laws and regulations.
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