THE GROSSLY UNSANITARY CLAIM
Description of Problem
One of the most unpleasant situations faced by the restoration specialist is that of the grossly unsanitary loss. This situation develops when extremely high levels of micro-organisms, usually with high levels of organic contamination, are present in the indoor environment, especially for an extended period. Some loss types that may be in this category:
* sewage backups, especially from the main line
* rising water floods
* clean source with long-term exposure (level of contamination actually reached during a given period depends on temperature and materials present, among other factors)
* large quantity of rotting meat, as when the electricity goes off for an extended period in a freezer or grocery store
* trauma claims, involving dead human bodies or accidents that lead to human blood or other potentially infectious body fluids contaminating structural or contents materials.
Despite the wide variety of perils that can create such a situation, once the situation has appeared, they all require similar procedures for effective decontamination. Comparable quantitative levels of microbial contamination are likely to be found, regardless of the source of the contamination. The largest difference is likely to be in the species of micro-organisms found. Sewage and trauma claims are more likely to have high levels of pathogenic (causing specific disease) organisms.
There are three levels of Grossly Unsanitary Losses:
* Level 1 (minor). A small volume of contamination originating in the environment (not coming in from outside) contaminates one specific location consisting of non-absorbent materials, and does not penetrate into the building structure. An example would be a small toilet overflow onto a sheet vinyl bathroom floor. Little risk to health if dealt with properly.
* Level 2 (moderate). A moderate volume of contamination originating in the environment that spreads farther, penetrating the structure (walls, subfloor) to a minor extent. Absorbent materials such as particle board, carpet and cushion are affected. Example: A somewhat larger volume toilet overflow that wets out wall bases, carpet, etc. Greater health risk potential than for Level 1.
* Level 3 (severe). A large volume of contaminant (originating outside the environment) saturates all structural materials and furnishings. Examples: Main-line sewage backup, river flooding, dead body or trauma situation. Severe health risk potential to restoration workers as well as to those who may reoccupy the structure following restoration. Trauma claims require handling as per OSHA Bloodborne Pathogens standards.
NOTE: The procedures listed below are for normal frame construction buildings. They do not specifically address the problem of contamination found in crawlspaces, HVAC systems, etc. Innovative decontamination procedures and/or extensive demolition may be required in such areas or when construction methods vary from standard.
DESCRIPTION OF SOLUTION
TEN STEP PROGRAM FOR CLEANUP OF A GROSSLY UNSANITARY LOSS
1. KNOCKDOWN APPLICATION OF AN ANTIMICROBIAL AGENT
Purpose: Reduce the level of contamination somewhat and slow its spread into unaffected areas. This application will not kill all microbes!
Implementation: Heavy (one gallon per 100-200 square feet of affected surface) spray application of an appropriate antimicrobial to all affected surfaces (walls, floors, carpet, furnishings, etc.) Depending on degree of contamination and types of materials present, the appropriate agent may range from a properly diluted "quat" to a 1/2% solution of sodium hypochlorite (chlorine bleach). (See Which Antimicrobial Agent Should I Use in this manual.) Use a Hydro-Force type or electric sprayer with an 8005 or larger tip size to minimize atomization and speed processing.
2. WATER EXTRACTION / GROSS RESIDUE REMOVAL
Purpose: Many of these situations will have large amounts of water, solid and semi-solid organic substances obscuring the materials. To analyze which materials are salvageable, this gross residue must be removed.
Implementation: Pressure washing and immediate water removal with high volume vacuum is often the most effective technique for removing large amounts of silt and sewage residue. Truckmounts work great! Use a pickup tool appropriate to the type of surface on which you are working. Dispose of waste water properly, usually back into the sanitary sewer system. Processing of very large areas or heavy residue can be accelerated by the use of a higher volume pressure washer, up to 5 gpm. (Volume is more important than pressure for this step.) Meter an appropriate antimicrobial into the pressure washing solution at a proper dilution rate.
3. ANALYZE ALL MATERIALS FOR PERMEANCE AND CONTAMINATION LEVELS
Purpose: Decide which materials WILL NOT be restorable, which WILL be restorable, and which are "iffy." Follow two important rules when making these determinations:
A. All salvageable materials must be thoroughly cleaned and sanitized.
B. Materials for which thorough cleaning and sanitization is impossible or impractical (including most porous materials) should be removed and replaced, unless extraordinary efforts are economically justifiable (such as for valuable Oriental rugs.) When materials require removal from the structure, the logical time to do so is immediately after the determination has been made. It is far more cost-effective to demolish and remove wet materials than to spend the money for the additional drying equipment necessary to dry these materials in place, and then remove them after drying. In addition, wet materials create less dust, reducing spread of contamination into additional areas.
Implementation: Examine each material type to determine whether salvage efforts are advisable.
Porous materials (permeance factor > 10; such as carpet, cushion, drywall, paper, upholstery, particle board, etc.) are seldom restorable.
Non-porous materials (permeance factor <1; such as plastics, vinyl sheet flooring, ceramics, glass, etc.) are usually restorable unless they have become contaminated from behind or below.
Semi-porous materials (permeance factor between 1 and 10; such as solid wood framing materials) may or may not be restorable. Examine each individually examined and make a decision.
4. DEMOLITION & DISPOSAL OF UNRESTORABLE MATERIALS
Purpose: Remove non restorable materials from structure to accelerate drying and minimize contaminant loads.
Implementation: Airborne contaminant levels will be highest during this stage. Take extra care with PPE, particularly respirators. Isolate the airspace in which demolition is being done from the rest of the structure to minimize spread of contaminants into previously unaffected areas. Check local regulations for requirements as to transport and disposal of contaminated materials.
5. HIGH-PRESSURE WASH ALL SURFACES WITH ANTIMICROBIAL SOLUTION
Purpose: Physically flush loose and remove from structure as much organic contamination as possible. A high pressure water jet is more effective at flushing contaminants out of small structural crevices than any other feasible cleaning method. Antimicrobial solution continues killing of micro-organisms.
Implementation: Using high pressure (3000 psi) and volume (4-5 gpm) during this stage drastically increases both processing speed and effectiveness. Pay special attention to cracks, crevices and areas difficult to access effectively (such as under or behind base plates, between framing members, etc.) Take appropriate steps to control waste water spread from puddling and overspray. Use a high-volume vacuum system to recover solution from floors and other surfaces. Dispose of waste water properly.
6. EXTRACT ALL POSSIBLE WATER FROM STRUCTURE
Purpose: Vacuum up all possible water to minimize cost of drying.
Implementation: See standard water damage procedures.
7. PRIMARY ANTIMICROBIAL APPLICATION
Purpose: Most antimicrobials are highly effective only on clean, non-porous surfaces, so this application is the one that will do by far the most good.
Implementation: Heavy (200-300 square feet / gallon) direct-spray application to all affected surfaces. Use a highly effective product such as: a solution of 12 ounces household chlorine bleach and 4 ounces of "quat" per gallon of solution, a chlorine dioxide solution (Oxine®), or a phenolic product such as Microban® or SteriFab®. Apply carefully and meticulously to all surfaces, especially those areas to which effective access is difficult. Allow sufficient dwell time (minimum 10 minutes). Apply using proper spray equipment as discussed under Step 1 above.
8. DRY USING DEHUMIDIFIERS AND AIRMOVERS
Purpose: Return structural materials to Equilibrium Moisture Content (EMC).
Implementation: Similar procedures to those required for any other water damage. An open drying system is acceptable if weather and security considerations permit. Often, the amount of demolition and sanitation already done allows a greater use of Temperature Control (Heat) in drying than is usually advisable.
9. WHEN ALL MATERIALS HAVE REACHED EMC, SCOPE FOR REPAIRS
Purpose: Determine what additional procedures are necessary to return the newly sanitized structure to pre-loss condition.
Implementation: The exact repairs needed frequently cannot be determined until structure is completely dry, due to warping and splitting that often takes place during the very last stages of drying. Accurate determination of EMC requires the proper use of appropriate moisture testing meters.
10. CONSIDER SURFACE AND AIR TESTING TO ENSURE RETURN TO HEALTHFUL CONDITION BEFORE RECONSTRUCTION BEGINS
Purpose: Reassure the insured. Make sure proper results have actually been achieved. Limit liability for the contractor.
Implementation: Find an Industrial Hygienist or Environmental Consultant with appropriate credentials for these types of situations. Have them perform appropriate tests to determine whether you have achieved adequate results. For sewage the appropriate test is usually that for fecal coliform bacteria. The tests appropriate for other types of situations will vary. If your consultant doesn't know what the appropriate test is, he or she is not the proper person for you to use!
CAUTIONS
The Grossly Unsanitary Claim has all the potential problems found on every claim. In addition, the following problems often arise to complicate the issue even more.
1. Lack of insurance coverage, especially on sewage backups. This may lead the insured (or in this case the not-insured) to request your help in dealing with the situation to the best of your ability, even though funds are unavailable to do the job properly. Doing so, to help people in an untenable situation, is very tempting. However, it can lead to lawsuits, non-payment and other problems. Be careful!
2. Even when coverage is available, adjusters may view their responsibility as ending when the esthetics of the situation have been dealt with (it looks good, it smells good). Unfortunately, acceptable esthetics do not by any means guarantee the return of the property to a healthful condition. Even when a project is properly scoped, some adjusters may feel unnecessary work is being suggested. Some have even suggested that return to healthful conditions is not (and should not be) the responsibility of the insurer.
3. Few people have an accurate understanding of the potential risks involved. This may cause people to exaggerate the risks, or more often, to not pay sufficient attention to them.
4. These situations often represent a significant health risk. In some cases, occupants, restorers and others have had massive allergic or toxic shock symptoms after only a few minutes of exposure, sometimes leading to hospitalization or even death. Other people have contracted such diseases as Hepatitis B or suffered allergic or immune response reactions resulting in long-term health effects.
5. This type of loss causes an increase in psychological stress for the insured, even above that found in a more "normal" restoration situation.
6. Improperly mitigated structures may allow fungi and other microflora to "colonize" the structure, developing an ecological niche and "sinking roots." Once this has happened, complete removal becomes extremely difficult. "Sick building syndrome" is very likely to develop as a result. In severe cases, owners have been forced to abandon large commercial buildings as unusable.
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