Practical Guidance Considerations for Healthy Facility Management: Disinfection and Decontamination Guide for Schools and Commercial Buildings

Introduction

GreenWorks Environmental, LLC (GWE) is an Indoor Air Quality (IAQ) Firm comprised of Building Biologists who can address all issues that degrade IAQ. GWE works with a wide variety of buildings, structures, and facilities: residential homes and small commercial operations to larger complex corporate campuses, health care facilities, manufacturing, and fleet services. This makes them uniquely qualified to help a variety of facilities with their disinfection and decontamination concerns. Helping facilities re-open, maintain a Healthy Environment going forward, and designing a customized, practical approach is their core deliverable.

Phased Protocol

GWE follow’s a multi-phase protocol developed from appropriate State and Federal Agencies, national business associations and coupled with good practical common-sense considerations. Getting one’s facility re-opened should not involve a “reinventing the wheel” approach. More of a “pivot-approach” utilizing resources already vetted and tailored to the specific needs of the facility in question. Health Care facilities have different needs than do general office environments which need to be accounted for.

Agency Resources

The agencies GWE references range from professional associations (like the US Chamber of Commerce) to State and Federal Agencies (like NJ & NY Departments of Health and the Centers for Disease Control (CDC)). But most importantly, the information is distilled down into a customized, practical approach to the individual facility’s needs.

The New Normal

Regardless of what disinfection and decontamination measures are being undertaken, facilities will have to adapt to a “new normal” going forward. Those that embrace the change will fare better than those who refuse to change. GWE is confident that those operators who look at this as an “opportunity” will excel with maintaining their facility.

Let us know how we can help.

Phase 1: Janitorial Systems / Procedures

Documentation of cleaning procedures and independent verification is essential in ensuring a consistently healthy facility. Not only does this prevent cross-contamination, but it sets the stage for effective disinfection which improves overall facility hygiene.

The Power of the Written Word

There’s usually some sort of written “Janitorial Procedure” consisting of detailed descriptions of cleaning procedures, personal protective equipment (PPE) to be used,  follow-up / material checklists, product safety data sheets for chemicals being used, etc. that is being followed. GWE reviews those procedures and advises of any deficient areas that must be corrected to ensure adequate cleaning and disinfection.

Top 10 Deficiencies GWE Encounters

1. Training – Is the janitorial team adequately trained with certifications displayed and continuing education maintained.
2. Equipment Maintenance – Improper maintenance and cleaning of facility maintenance equipment.
3. Cleanser Discrepancies – Use of cleansers not listed in procedures, diluted cleansers, unauthorized substitutions, etc.
4. Personal Protective Equipment (PPE) – Loose procedures versus what is being used on the floor.
5. Accountability / Validation – Trust is something that is earned, but you maintain trust by independent verification.
6. Communication Systems – Between the Facility and the janitorial team is essential in ensuring promises, emergencies, and changes to procedures are kept up with.
7. Material Disposal – Not properly disposing of hazardous materials.
8. Outdated Chemicals / Procedures – Are all chemicals within their expiration date? When’s the last time you looked over the current procedure in place?
9. Assigned Areas – Without assigned areas, high traffic locations may be missed or not accounted for.
10. Lack of Resources – Make sure all equipment, chemicals, supplies, etc. that are required for proper maintenance & decontamination are provided for all involved.

1.01 Disinfection Tracking Log

Staff should be provided tracking methods to adhere to for cleaning documenting who and when. Create a log to assign workers to places and protocols to areas. Then, create a daily (visible) check log of the areas cleaned to ensure staff is following protocol. This allows staff to know the employer is taking steps to ensure their safety.

Sample: Area Accountability Chart

Sample: Cleaning / Disinfection Log

Cleaning and Disinfection Log Template, NYC Health

Phase 2: Disinfection Options

A review of the facility disinfection arsenal is critical. Disinfecting using EPA’s Disinfectant List-N for use against SARS-CoV-2 or other industry endorsed / peer-reviewed products are of primary importance with regards to procedural validity.  

When disinfecting a space, there are Four Factors to keep in mind:  

1. Product Efficacy
2. Surface Types
3. Mode of Application
4. Contact Time

2.01 Product Efficacy

Product efficacy refers to how well the product disinfects for viral pathogens (like COVID-19). Many of the products included on List N have not specifically been tested against COVID-19, however, they have been proven to kill a “harder-to-kill” pathogen than Coronavirus. Be skeptical in challenging times of products lacking EPA endorsement that often flood the market. Although they might be just as effective, there may only be independent / peer-reviewed studies as to their efficacy against SARS-CoV-2. Also, compare product efficacy to material compatibility. Many disinfectants are not suitable for certain materials.

2.02 Surface Types

Different surfaces require different cleaning and disinfection approaches to ensure adequate decontamination The EPA’s List N addresses the following surface types:

1. Hard Surfaces – Generally can be disinfected with ease.
2. Soft Surfaces – Like carpets and curtains require extra special attention.
3. Electronics – Difficult to cleanse with traditional approaches. Fogs work best.
4. Food Contact Surfaces – Extra care via post disinfection water rinse.

What other “surfaces” exist that should be addressed?

2.03 Mode of Application

Each disinfectant product has a different formulation type to consider when picking your disinfectant. In the example below, the “Formulation Type” is a fog/mist, meaning you need the appropriate fogger to apply the product. Binary Ionization Technology (BIT) Solution (Hydrogen Peroxide) is the disinfectant used in the SteraMist machine.

Other formulation types include:

1. “Ready-to-Use” wipes
2. Electrostatic spray
3. Liquid
4. ULV

Each of these formulation types has a different method of application, and each method of application has its positives and negatives. “Ready-to-Use”, liquid, and wipe products can be easily applied with a pump sprayer, rag, or other cleaning devices. Mists and electrostatic sprays require specially made equipment to apply the product.

Although additional equipment is required, mists and foggers allow you to rapidly disinfect a space, without dirtying any towels and minimal human error. The TOMI SteraMist and Clorox electrostatic sprayer offer some of the best product delivery methods giving good coverage and reducing human error.

2.04 Contact Time

Contact or “Dwell Time” is the most important disinfection factor (and the most abused). This is the time the product must be in contact with the surface to induce an effective “Kill Rate.” Some disinfectants have a contact time as short as 1 minute, while most require up to 15 minutes of remaining in place and wet to be effective. Then you can wipe the surfaces.

Phase 3: Validate

How do you know your staff has done an efficient job of disinfecting? An independent /  3rd party validator can confirm the effectiveness of a treatment by a variety of quick tests that give a quantifiable result. Adenine Tri-Phosphate (ATP) machines are a good example. ATP is the energy-carrying molecule found in all living cells. Testing surfaces for the presence of ATP will help determine surface cleanliness. With more pathogens on a surface, there will be a higher ATP presence.

3.01 Cleanliness Sampling

There are a few different immediate result testing devices GWE uses:

1. ATP Pen (3M Clean-Trace) – A ten-minute test that is color-coded. If it’s green it’s clean. But this method does not test specifically for COVID-19. GWE recommends this to check for overall facility cleanliness.
2. ATP Monitor (Hygenia Hygiene Monitoring Meter) – Gives a quantifiable ATP presence. A rating of greater than 30 indicates the surface needs more cleaning and / or disinfecting, while a number below 30 indicates a clean surface. A result of less than 10 indicates the surface is hospital-level clean.
3. Particle Counter (particles Plus) – Used to determine the cleanliness of a space-based on particle saturation. Rather than testing a surface, it detects the size and number of particles present in the air to ensure air cleanliness
4. Hydrogen Peroxide Monitors – Strips or ionic devices that detect the concentration of Hydrogen Peroxide (H2O2) to ensure adequate saturation.

3.02 Sampling for COVID-19

Some laboratories have developed a quick 24-hour COVID-19 surface test. This type of sampling should be minimally included in your weekly routine, to ensure no asymptomatic staff has brought the virus into the building. It can also be used after a confirmed positive case to ensure total decontamination. This type of sample tests for RNA from both broken and intact viruses on a surface.

3.03 Advanced Sampling / Environmental Monitoring

There are many different ways to validate and monitor environmental stressors. The use of biological indicator strips, pads, and swabs are industry standards where real-time monitoring solutions are now practical considerations. Here are a few types of advanced sampling tools to consider:

1. Biological Spore Strips – Strips inoculated with difficult to kill bacteria is placed in the room to be decontaminated. If the bacteria on the strip is killed, every other microbe was killed as well. 2-Week Test for Presence / Absence
2. Gel Pads (Glove Fingertip Touch Test) – 5-day test to assess the biological cleanliness of surfaces. Nitrile gloves touch an area(s) and transfer material to pads that is then incubated for visible presence/absence of organisms.
3. Coronavirus Testing (Swabs) – For the presence of Coronavirus, that can take anywhere from 4-8 days.

And for those facilities who want to make environmental / facility hygiene an integral part of their operational Health & Safety protocol and overall business strategy:

1. Real-Time Environmental Monitoring – Technology has advanced to the point that wireless Real-Time Monitoring sensors are available that can be hooked to central computers and shared with the staff and the public. Facility environmental conditions are reported in real-time and monitored continuously.

These systems currently monitor a range of environmental stressors like temperature, humidity, some VOC’s (formaldehyde), particles (P2.5), CO, CO2s, Water, etc. The EPA has even rolled this technology into Homeland Security.

Phase 4: Interim / Hotspot Management

Cleaning and disinfecting of high touch surfaces is necessary daily after buildings close and all personnel evacuate the building. These daily cleaning spots include, but are not limited to:

• Offices
• Bathrooms
• Common areas
• Shared electronic equipment
• Doorknobs
• Edge of tables
• Fridges/microwaves
• Stairway handrails
• Light switches
• Handles

These high touch / high traffic areas are the most vulnerable to contamination. Cleaning should be done daily by the janitorial staff. Keep in mind any outdoor benches/tables that are used that may require cleaning regularly as well. It is recommended to clean high traffic areas (such as bathrooms) twice a day. Other high traffic areas such as breakrooms should be cleaned after hours.

4.01 Confirmed Positive

What do you do in the case of a confirmed positive? Here’s our protocol for a confirmed positive case, adapted from the CDC.

1. Close off all areas visited by the ill person. Err on the side of caution and assume the positive case visited more areas than not.
2. Open exterior windows/doors to allow space to ventilate for 24 hours. Use air scrubbers/ventilation fans to help filter air and circulate. Note: How do I  get an air scrubber? Call GreenWorks! We have air scrubbers available to rent.
3. Follow standard protocol steps; clean the area of dirt and debris first. A HEPA vacuum may be necessary for areas of high traffic with a high debris load.
4. Disinfect all high touch surfaces in and around the space. Focus on the high touch areas but rooms should be fogged and decontaminated.

GWE can provide Rapid Decontamination service if hot spots are identified that need immediate decon beyond what a Janitorial Team can provide. A SteraMist treatment will allow for Rapid Decon of surfaces to entire rooms (Protocol is attached).

4.02 Longer-Term Solutions

There are some longer-term solutions that can be installed in buildings to help decrease the spread of COVID-19. These solutions include

1. Mobile / Portable Air Purifiers – Such as the Austin Air Machine, removes a wide range of airborne particles, including viruses that are 0.1 microns and larger bacteria along with chemicals, VOCs, gases, and odors.
2. HVAC In-Line Purification System – The use of UV fogging and dry Hydrogen Peroxide in HVAC systems have been shown to reduce microbial loads in air and be effective air treatment systems.
3. HEPA Filter Upgrade – If compatible, upgrade to HEPA / Merv13 filters (or better) for the HVAC systems. Don’t forget replacement procedures.
4. Surface Coatings – You can extend the life of your disinfection and decontamination with the use of chemical and/or biological surface coatings. These are effective in protecting surfaces from the re-colonization of harmful viruses and bacteria. The biological coatings are living organisms that help with overall decontamination. As they are not a “chemical” they are not eligible for List-N registration. So keep an open mind. You can read more about coatings here.

4.03 Building Reopening Guidelines

Reopening buildings after an extended period can be more challenging than one may think. Many times, facilities had inherent underlying issues to start with that have been degrading facility hygiene that has gone unnoticeable. Here are a few things GWE looks for to keep in mind when the building has been shut-down for a couple of months and you are planning to re-open:

1. Microbial Growth – Can occur when closed buildings have shut off their HVAC system and elevated humidity is allowed to accumulate. Maintaining indoor humidity and keeping the HVAC system running will help prevent any mold growth.
2. Water Intrusion – Leaks and flooding (Windows, walls, basements, ceilings/roofs, hot water heaters fail, floor drains, etc), standing water, condensation, etc. often present danger by increasing the growth and spread of microbial organisms. Molds in particular are an emerging concern.
3. Sewage Backup – It happens at the most inopportune time, the main city sewer line to the building backs up and contaminates the building. Nothing worse than coming back to a building that has had raw sewage fermenting in the basement for several months.
4. Stagnant Water Systems – A Water Management Program should be implemented for the building’s water system to ensure Legionella does not become a problem. The CDC has a toolkit to help with the details.
5. Stagnant Air / Odors – Buildings closed off often accumulate Volatile Organic Compounds (VOC) from building material off-gassing, vapor intrusion, etc. Assessing air quality will be helpful.
6. Rodent Infestation – It’s amazing how fast a rodent infestation (mice, rats, bats, birds, etc.) can develop. Especially when the building has been sitting vacant for several months

Should any of the above items present themselves, a full microbial investigation for the facility should be undertaken to ensure all deficient areas are accounted for? Many times, an outside set of “professional eyes” is best at spotting these areas in need of attention.

Phase 5: Continual Education and Communication

The last and arguably the most important phase is continual education and communication to staff, customers, or anyone else who may enter the facility.

5.01 Educational Fliers, Documents, and Notes

The CDC has created dozens of documents and fliers that relay your message of cleanliness and good facility hygiene. These downloadable print resources should be placed in high traffic areas around the building. Having a validation schedule posted will not only keep the disinfection staff on their toes but can communicate to staff the steps the building has been taking to ensure their safety.

GWE likes to use “This Area Has Been Last Disinfected” stick-able notes when decontaminating and helping with “peace of mind” concerns. These simple notes help communicate the cleanliness of the area and that the janitorial team is doing its job.

5.02 Technology

There are Technology Apps that are making it easier for consumers to check the validity of disinfectants against Coronavirus. The EPA recently launched their “List-N Tool: COVID-19 Disinfectants” for public usage.

Many facilities have their own apps that can be modified to include their own disinfection protocol. This could also help facilities “differentiate” themselves from their competitors. Learn more about what the EPA is doing here.

5.03 Other Relevant Resources

As our knowledge of emerging viral pathogens increases so does the list of available resources. Always keep an eye out for new information that is better, more effective, easier to use than what we currently have. The following list of agencies offers excellent resources and go-to guides for general information.

Unique facility needs may be best addressed by an outside consultant.

EPA – Environmental Protection Agency 

• List N: Disinfectants for Use Against SARS-CoV-2 (COVID-19)
• Six Steps for Safe and Effective Disinfectant Use
• Indoor Air and Coronavirus
• Air Cleaners, HVAC Filters, and Coronavirus

CDC – Centers for Disease Control and Prevention 

• Guidance for Cleaning And Disinfecting
• Cleaning and Disinfecting your Facility
• Reopening Buildings After Shutdown

• For parents: “Checklist: Planning for In-Person Classes”
• For schools: “Considerations for K-12 Schools: Readiness and Planning”
• FAQ for Schools and Childcare Programs

NJDOH – New Jersey Department of Health 

• NJ Reopening Guidance and Restrictions

• Contact Tracing
• NJ Travel and Transportation

NYDOH – New York Department of Health 

• NY Interim Guidance for Cleaning & Disinfection of Public & Private Facilities
• NYC COVID-19 Cleaning & Disinfecting Log Template

United States Chamber of Commerce 

• Reopening Business
• Ready to Reopen? Playbook for your Small Business
• Coronavirus Resources and Guides Toolkit

Appendix

6.01 GWE Disinfection Overview: SteraMist Standard Operating Procedure

Basic SOP for application of microbial decontamination services. Individual adjustments will be applied based upon the specific needs of the facility.

1. Facility Cleansing Protocol – Provide a GWE copy of the Health and Safety / Janitorial protocol. SteraMist treatment is meant to supplement existing protocols
2. Fire Alarm / Security System – Fire alarm off & security system addressed.
3. People, Plants & Pets – Remove from areas to be treated
4. HVAC System – Turned off and duct openings (Supply & Return) sealed as needed to contain the space. Not needed if the entire area is being treated.
5. Containment – Erect containment via pole system and plastic (as needed)
6. Plenum / Interstitial Space – Assess for impacts, treatment not part of SOP
7. Scope of Work – Confirm to ensure all is being addressed as needed.
8. Set-Up Equipment – Set-Up SteraMist system with applicator gun placement
9. Set-Up Testing – Adhere to H2O2 indicator or biological spore strips to the treatment area (if validation is required).
10. Closed Areas Addressed – Treatment only effective if the surface exposed. Filing cabinets are often a High Contact Area that is often closed and shielded from the SteraMist cleansing mist. Hand treatment of these cabinets is often needed.
11. Program BIT Computer – Input critical treatment area measurements & run the program. Troubleshoot as needed.
12. Check Levels – Check hydrogen peroxide levels to ensure saturation.
13. Dwell Time – Let treated area dwell ensuring mortality goals achieved (15 min)
14. Air Scrubbers – Ensure air scrubbers/fans auto engage to vent space.
15. Occupy Space – Check peroxide levels to ensure sufficiently reduced.
16. Reoccupy Space – Remove containment/equipment. Space safe to reoccupy.