Condensed Remediation Plan for Small Microbial

Condensed Remediation Plan for Small Microbial
aerobioLogical Solutions Inc.
A Condensed Remediation Plan
for Small Microbial Particles
The full document can be downloaded as a password-protected Adobe PDF document for
patients in Dr. Ritchie Shoemaker’s system. Ask your physician’s office for details. This
document is meant to educate patients. It should not be used as the complete remediation
plan since variables like architectural details may create changes for the operation of
containments. This is copyrighted material from AerobioLogical Solutions, Inc.All rights arereserved. By Greg Weatherman, CMC
INTRODUCTION
Mold is common in the natural environment and is constantly introduced to indoor
living spaces by outside air, on people, and through food. Many forms of mold may
produce mycotoxins if water activity requirements are met along with other factors.
For sensitive populations, even low levels of inhalable microbial particles can
produce adverse health effects caused by toxic or allergic properties that may occur
whether mold is dead or alive.
This mold remediation plan has been based on more than a decade of work with
sensitive patients. Although the methods may seem excessive, given practices
commonly used by other contractors and consultants, it is important to note that
industry standards are not necessarily based on scientific research. Common
practices may also be based on methods shown to be effective for whole spores or
conidia but not for particles that are much smaller and float in the air for long
periods of time. (See the studies by Gorny and by Brasel, listed in the Additional
Resources section.)
The remediation plan presented here, like other plans, is accomplished by first
creating a temporary cleanroom environment with incredibly low levels of mold.
Because it is not possible to separate harmless dust particles from those that are
harmful in a sufficient dose, all microbial particles that may contain mycotoxins
must be removed.
In order to effectively remove these particles, the structure must be cleared of all
objects except large pieces of furniture, such as dressers, china cabinets, etc.
Other items are cleaned elsewhere. Rooms with demolition activities must be
contained, with contaminated building material removed.
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All surfaces should be cleaned using HEPA vacuums and physical dust removal
cleaning methods. Heating, ventilation and air-conditioning (HVAC) and air ducts
must be cleaned. All porous surfaces must be sealed; particles lingering in the air
must be removed; the structure must have unplanned moisture intrusion corrected;
and finally post-remediation testing must verify the results.
Depending on the client’s wishes, each room in a residence may be approached
separately for demolition or moisture correction, but ultimately, the whole structure
must be addressed. It is harder to get good post-test results when you address
rooms one at a time rather than the whole structure.
BEFORE BEGINNING REMEDIATION
The contractor and the client should make every effort to fully understand this
document and to clarify any aspects that may impede successful remediation.
This plan has been developed for individuals with chemical and fragrance sensitivity
and is intended for use with only the specified products. Products should not be
substituted without the written consent of the client or a designated representative.
Web links have been provided to show the intended products and to avoid
confusion with products with similar names. Some products may be licensed to use
for a patented method such as AeroSolver®. Some products may have special
instructions such as 20 Mule Team Borax®. It is the customer’s and the contractor’s
responsibility to ensure no patent infringement occurs based on reasonable
research.
Working with the Client
Both the client and contractor must understand that the practical objective of
remediation is the physical removal of harmful, inhalable particles—because
complete removal of microbial particles is often impractical. As shown in a peerreviewed study by S.C. Wilson, sodium hypochlorite (bleach) and acetone are the
most effective methods for mycotoxin removal; but these are useful for only nonporous and non-reactive materials.
Mycotoxin removal is consequently nearly impossible for many furnishings and
personal items made from soft and porous materials. This can be emotionally and
financially difficult for the affected client. It is therefore important to involve the
client in decisions regarding the cleaning and disposal of items. It may be possible
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to store questionable contents elsewhere until the client’s health has improved or
until the client has become less sensitive enough to withstand exposure.
The client or client’s representative has a right to view the work in progress at any
time as long as remediation work is not impeded and all proper safety precautions
are followed. The contractor should assign someone to answer client questions as
they arise.
In some cases, clients may choose for financial reasons to perform certain tasks
themselves. In such cases where the contractor will not be performing all aspects of
the remediation, a legal agreement should be prepared in advance to release the
contractor’s liability for any work performed by the client and for guarantees of any
post-testing results. An attorney should be consulted for any legal questions.
Most tasks involved with remediation require specialized expertise, skills, or
equipment. However, when necessary, the following tasks may be performed by the
client:
•
•
Content removal
Surface cleaning
Contractors and consultants should treat information regarding remediation as
private medical information covered by the Health Insurance Portability and
Accountability Act HIPAA. The remediation measures were deemed medically
necessary to address the environmental issues affecting the client’s health.
Documenting Work
Contractors should document all work with digital photos—especially conditions
related to the removal of building material and any special requests. Digital photos
should be kept in the logbook or on a thumb drive.
CONTAINMENT
1. Containment Setup Guidelines
Containments should be made as small as possible to address a few square feet at
a time rather than a whole room. Negative air machines (NAMs) should be HEPA
filtered but exhausted outdoors to account for any filter leakage. Containment
should be erected with laminar airflow to the extent possible by creating an entry
for new air opposite the position of the NAM. Plastic sheeting or similar material
must be placed on the floor for demolition work. It is not necessary to cover walls
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and ceilings with plastic unless there is an opening to another area outside of
containment (critical control barrier). The air in the containment should be cleaned
similar to the final air cleaning treatment before the containment is disassembled to
prevent cross-contamination of airborne dust particles.
A tacky mat (http://www.adhesivemats.com/) should be placed at the entrance to
any containment site to prevent cross-contamination. Negative air pressure
differential containment should be erected when removing walls or removing
windows to prevent cross-contamination in the rest of the residence with higher
levels of microbial particulates.
Personal Protective Equipment (PPE). Contractors must wear all appropriate
PPE during indoor microbial remediation/demolition activities. It is the contractor’s
responsibility to ensure workers are using adequate PPE following applicable OSHA
or similar state regulations. Normally this includes a fitted respirator with a P100
particulate filter rated for organic vapors and approved by NIOSH. Protective
clothing should be used to prevent cross contamination. Non-fogging safety glasses
should be worn when there are flying particles. Disposable shoe covers
(http://www.amazon.com/Polyethylene-Covers-Static-ImperviousLinting/dp/B000E27XSG) should be worn whenever on the site: foot traffic is the
biggest cause of cross-contamination. Gloves can be used as necessary.
Waste Disposal. Waste material should be cleaned, bagged, and disposed
immediately after removal/demolition and before work commences on another
room. When removing bagged waste, the route through the structure should be
minimized, and the bags should not be dragged on the floor to avoid rupture. As
with asbestos abatement, bagged material should be placed in a second bag at the
entrance of the containment to avoid the cross-contamination of dust from the
outside of the first bag. Spraying the outside of the bagged materials with soapy
water can also suppress dust particles. Dumpsters for waste should be wet on a
regular basis to control dust.
2. Removing Contents
All contents, except large salvageable furniture, must be removed to prevent crosscontamination. Large pieces of furniture can be moved to another room or the other
side of the room as necessary.
Soft, porous furnishings and items are extremely difficult to clean, and many items
may not be salvageable if the client has severe medical issues. The remediation
contractor should provide individual estimates for challenging items so the client
can assess the costs of remediation vs. replacement. Such items include couches,
chairs, and mattresses; all absorb moisture on a daily basis, and most require
costly dismantling for cleaning.
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Decorative items used in areas where there are no constant air currents to dislodge
respirable particles are less dangerous for sensitive populations. These can be
placed in storage and cleaned by the client at a future date, especially if cost is a
concern.
Important documents should be electronically scanned and placed into storage.
Wall-to-wall carpeting is one of the last things to remove since it will protect the
sub-flooring from contamination. When removing, the carpet should first be
dampened to suppress dust particles; but care should be taken not to soak the subflooring. The carpet should then be cut, rolled, and immediately bagged. A pump
bottle (1 gallon minimum) with soapy water should be readily available to remoisten the quick-drying carpet. In areas without carpeting, a plastic sheet should
be used to protect salvageable flooring.
3. Moisture Issues
Correct moisture issues that can be quickly addressed—not including basement
waterproofing or re-grading. All required permits should be obtained and applicable
building codes should be followed. Contractors may need licensing to conduct
certain tasks. Complex repairs may require architectural engineering to ensure
effective results.
DEMOLITION
4. Demolition
Perform demolition of moldy material with containment appropriate for each
location. Use HEPA filtration equipment to keep dust levels low by having air
scrubbers or HEPA vacuums close to any activities or equipment that create high
dust levels, such as electric saws used to cut paper-faced gypsum board.
CLEANING
All rooms should be thoroughly cleaned even if there is no demolition activity.
Waste material and debris in each work area should be cleaned and removed as
soon as possible. Plan carefully to avoid cross-contaminating areas already cleaned.
Walls should be wiped before floors. Begin cleaning floors from the point farthest
from the exit and work toward the exit.
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5. General Cleaning Practices
All surfaces should be cleaned by HEPA vacuuming followed by damp wiping with a
cleaning agent that does not leave a residue. Surfaces should be visibly clean to the
point there is no visible dust when viewing surfaces with a bright light or flashlight.
All surfaces should be white glove clean.
Disinfection. It is normal to find microbial flora common to soil such as various
species of Aspergillus, Penicillium, Bacillus, and Streptomyces. Some of these
organisms produce toxins in wet environments on building materials. The four
genera listed all produce spores including the latter two which are bacteria not
addressed by most disinfectants unless they are EPA registered as “sporicidal” and
used according to label directions that are normally not appropriate for residences.
Glutaraldehyde is an example of a “sporicidal” disinfectant that may be more toxic
than the organisms targeted. The health effects from mold are generally from toxic
or allergic properties, which may occur whether mold is dead or alive. Most species
of mold cannot live at human body temperature. The contractor must understand
disinfection is impractical on many surfaces while physical removal of inhalable
particles is important.
HEPA Vacuuming. All porous or coarse surfaces should be HEPA vacuumed. Most
HEPA vacuums cannot remove all respirable particles, and because the leaked
particles are small, they are difficult to remove from the air. Unless filter efficiency
and level of filter bypass have been tested with a laser particle counter, the HEPA
vacuum should be used only for pre-cleaning. A clear sign of filtration failure is a
strong musty odor when vacuuming. Leaky HEPA vacuums can be used in a
negative air pressure differential containment area or in an area separated by a
positive air pressure differential containment. Equipment with HEPA filters should
be wrapped tightly to avoid cross-contamination when moving equipment used on a
previous job at another worksite. Contractors may be bringing more trouble to your
place from other jobs. This can also happen with airscrubbers.
Deep Cleaning Porous Surfaces. Unfinished wood surfaces (e.g., framing
lumber) and concrete surfaces in areas with visible microbial contamination should
be cleaned using highly concentrated hydrogen peroxide cleaner according to label
directions. Once dry, wood surfaces should be HEPA vacuumed. This cleaning
method also removes some stains from enzymatic browning that occurs as
microbial flora grow on surfaces such as paint and wood. This is the preferred
method to remove excess dust from concrete or sub-flooring material whose
porosity makes it difficult to clean with a HEPA vacuum.
Wet Scrubbing Other Surfaces. For most surfaces, terrycloth towels soaked with
a cleaning agent that leaves no residue can be used to scrub off residues during
pre-cleaning and before air cleaning. This will counteract electrostatic forces that
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make removing particles difficult for smooth surfaces such as finished flooring and
plastic crawlspace liners. This product has a slight odor that quickly evaporates
after application without leaving a residue. It is important to apply pressure when
wiping with the terrycloth towels since light friction enhances the particle-capturing
capability of this cleaning method. Particles are transferred to the terrycloth towels
from the surfaces. Terrycloth towels can be laundered and reused.
For surfaces with biofilms, a soft soap such as 20 Mule Team Borax®
(http://www.20muleteamlaundry.com/) can be used.
Important: Never rinse terrycloth towels in dirty water or used cleaning solution
since dirt and particles will remain on the towels. Always use clean towels so each
towel can be used to assess the level of remaining residue. Always test
inconspicuous surfaces to ensure scrubbing will not mar the surface. These products
should not be mixed with any other products.
Air Blasting. This method can be used for particles that cannot be removed with a
HEPA vacuum. It is common to use a nail gun air compressor with a triggeroperated air gun, sold at home supply stores (such as Home Depot). This should be
done outdoors in a location downwind from the structure. The surfaces will still
require cleaning by the other methods previously listed. (See S.C. Wilson,
“Techniques for Cleaning Mold-Contaminated Home Contents,” 2004).
Cleaning Paper Materials. Paper is extremely difficult to decontaminate.
Important documents should be electronically scanned and placed into storage.
Books should be HEPA-vacuumed while closed. Future use should be done in an
area where a portable HEPA filtration unit can capture any escaping particles.
6. HVAC Cleaning
The HVAC (heating, ventilation, and air-conditioning) system should be cleaned
according to National Air Duct Cleaners Association (NADCA) standards after all
building materials are demolished and all surfaces are cleaned to the point of no
visible dust. If the old HVAC units will be re-installed, the coils must be cleaned at
the same time. Sheet metal ducting and porous wooden floor joists may need to be
removed if they cannot be cleaned. Rusted ducting must be replaced. Openings into
wall voids should be inspected to ensure they are not heavily impacted with dust
build-up. Humidifiers should not be connected to HVAC fan-coil units.
The cost of dismantling and cleaning the HVAC fan-coil unit can be high, and it may
be more cost-effective to replace it. If possible, have a remediation technician work
with a licensed HVAC mechanic to mitigate differences in standards. Any retrofits or
changes in design should be carefully designed by a mechanical engineer or
equivalent as allowed by code officials and must be professionally insured.
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A final cleaning is necessary after the HVAC cleaning since this process can
disseminate additional dust particles, including microbial flora (mold).
7. Sealing and Painting Surfaces
Seal all porous surfaces with a clear, penetrating encapsulant. Clean all surfaces
with terrycloth towels dipped in warm water until residues are removed.
Concrete Surfaces. Concrete should be sealed with a clear penetrating
encapsulant using an airless paint sprayer. (Sprayers can be rented from Sunbelt
Rentals.) Concrete flooring can be encapsulated with other materials if flooring
finishes like tile will be installed in an airtight manner. This exception does not
apply for floating floor products.
Wood Surface. Dry wood surfaces should be coated with an antifungal paint
containing anionic silver if there is a moisture concern on external walls or
crawlspaces. Unless an independent inspection will be performed, do not use paint
with color pigmentation: the client must be able to view the substrate to check for
acceptable final conditions, including the removal of surface dust checked with a
flashlight. Old wood floors must be sealed with a sandable primer or oils specific to
wood flooring.
REBUILDING
Prior to final cleaning of the entire structure, the ceiling should be replaced to
protect the living space from outdoor air entering through the attic, crawlspace, or
other exterior location. The interior gypsum board should be cleaned of dust in the
same manner as other surfaces since gypsum board paper contains fragments of
microbial flora. None pose a risk to health but may create a false positive in postremediation tests. These surfaces should be painted with a drywall primer before
post-remediation verification.
All other rebuilding should occur after acceptable results are obtained in ERMI postremediation testing.
FINAL CLEANING
These procedures should followed in each area once demolition is completed, for
the whole structure once remediation is complete, and after the HVAC system has
been cleaned. Line the floor with 1-millimeter painter’s plastic to protect the floor
from particles. Once the final cleaning has been completed for each room, the
plastic should be disposed in a bag and the floor should be cleaned.
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8. Air Cleaning
Fogging. Stop all air scrubbers, negative air pressure machines (NAMs),
dehumidifiers, and fans before air cleaning. Fog the air with AeroSolver Pure Air
Cleaning Solution® using a B&G electric fogger with a flexible hose
(http://www.nikro.com/products/moreinfo.asp?i=162). Open the venturi knob four
full turns to produce droplets of approximately 50 micrometers in diameter. This
cleans the air of fine and ultrafine particles by methodically creating turbulent
coagulation (a more complex form of gradient or shear coagulation) in the
methodical way similar to how rainstorms remove pollution from the outdoor air. A
slow, gentle sweeping motion, similar to using an airless paint sprayer, should be
used to ensure effective particle removal (see www.aerosolver.com for technique).
The product should be applied at a rate of 50 square feet per minute after the mist
becomes visible. The fogging plume usually stretches 10–15 feet. When possible,
the fogger should be operated at least 7 feet away from a wall to avoid heavy
product accumulation on the wall or other surfaces.
The plastic floor liner should be removed gently after fogging to avoid creating
airborne dust.
Fogging should be done at the end of the day to allow the particles sufficient
time to settle (at least four hours) before final cleaning. If this time must be
compressed, the manufacturer can be contacted to obtain an alternative
method. The manufacturer may have faster application methods to avoid the
4-hour delay if you contact them.
Wet-Cleaning. After particles have settled, all residue should be removed from
surfaces using terrycloth towels soaked in warm water. In cold weather or high
relative humidity, use warm water.
Once surfaces are dry, use a dry Swiffer® cloths to remove any remaining particles
from all surfaces. A clean towel wiped over the surface should reveal no dust. Avoid
using HEPA vacuums in final cleaning unless they have been checked according to
the methods in Bob and Gail Brandys’ In-Field Test Methods.
After final cleaning, all floor sealing and wall painting should be done by brush or
roller. Airless paint sprayers create aerosol problems that may dislodge particles
from surfaces due to the shearing effect as high pressure air currents strike the
surfaces.
Alternative Method: HEPA-Filtered Air Scrubbers. This alternative method of
air cleaning is less effective than the fogging method. The machines clean only the
air that enters them, they create air turbulence that decreases capture efficiency,
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and particles in the respirable size ranges are typically not removed. Prior to use,
the efficacy of the machine should be checked according to the guidelines in Robert
and Gail Brandys’ In-Field Test Methods and Reference Standards for Portable High
Efficiency Air Filtation (PHEAF) Equipment (www.oehcs.com). A laser particle
counter will allow the user to assess the level of cleanliness. It may take an
indeterminate amount of time to reach the required level of cleanliness. Clean air
delivery rate (CADR) research on air-cleaning devices from University of Tulsa
indicates a minimum of 300 cubic feet per minute to achieve 80% removal for the
average room. The IICRC S520 warns that there are limited capture zones and
dead spots for HEPA airscrubbers. A minimum of four fans are required to create a
vortex around the HEPA airscrubber vented outside the area. There can be no
obstructions to the air flow near architectural details like kitchen islands, stairs,
fireplace, etc. More information can be found at the US EPA website for residential
air cleaning devices and their limitations
(http://www.epa.gov/iaq/pubs/airclean.html).
RECONSTRUCTION
9. Waterproofing
Correct outdoor waterproofing below grade to prevent future water intrusion
through basement walls. Basement window leakage will affect the ERMI testing.
You might temporarily seal them or replace them.
POST-REMEDIATION
10. Quality Analysis Tests
The following testing methods are optional and can be costly. Lab fees are
approximately $50 per dust surface sample and $300 per ERMI sample. Additional
costs include costs for mailing cassettes and consultant’s fees. The restoration
contractor cannot perform final post-remediation verification testing because of an
inherent conflict of interest.
Total Surface Dust. Samples should be taken with pre-weighed, polycarbonate
vacuum cassettes with the whole tops removed. The floor should be vacuumsampled within 24 hours after remediation. The area should be vacuum-sampled for
5 to 10 minutes per square meter on a smooth area. The person testing should
take care not to cross-contaminate the sampling area. Cassettes should be marked
and sent by chain of custody to an AIHA-accredited laboratory. Total dust results
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must be 100 milligrams per square meter or less, as prescribed in the AIHA Green
Book. It is not uncommon to get less than 10 milligrams of total dust per square
meter using our methods. This test should be done twice—after the initial
demolition and cleanup and after reconstruction.
Environmental Relative Moldiness Index (ERMI). Although the ERMI test is
valid for pre-testing an environment before remediation to assess long-term
conditions, it has limitations because resuspension of particles may be caused by
air jets, mechanical forces (even walking), and electrostatic forces. ERMI sample
collection equipment should be set out immediately after total surface dust sample
collection. However, ERMI testing should occur only after satisfactory total dust
results have been achieved. If total dust results are unsatisfactory, cleaning must
be resumed.
To collect samples, cut open large plastic bags (such as Hefty®) so the inner portion
of the bag is facing upward. The bags should cover an area of at least 20 square
meters. After one week, if the total dust test was satisfactory, use the smooth side
of Swiffer® or similar cloths (folded so the inner 1/9 is used) to take dust samples
from the plastic bags. One week allows the structure to return to normal levels of
dust introduced from the outdoors and dislodged from the structure through
shaking.
For comparison, an outdoor ERMI sample can be taken from a location upwind from
the structure and a minimum of 20 feet away to avoid contamination from the
structure. A Swiffer® cloth can be used to collect dust from a smooth surface, at
least 3 feet above the ground, that is continually washed of re-exposed to airborne
mold through rain and wind. The smooth surface of a mailbox or street sign is good
places for sample collection.
The ERMI samples should be bagged separately, marked, and sent according to the
appropriate chain of custody to Mycometrics, LLC. The lab will record the total
weight of dust collected if requested ahead of time. The target ERMI score is 2 or
less unless otherwise indicated by a treating physician because of the client’s high
sensitivity. The post-test is satisfactory even if the results are higher than the pretest if the outdoor levels are statistically similar.
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ADDITIONAL RESOURCES
Gorny, Rafael. “Fungal Fragments as Indoor Air Biocontaminants.” Applied
Environmental Microbiology 68, no. 7 (July 2002): 3522-3531.
Brandys, Robert and Gail Brandys. In-Field Test Methods and Reference Standards
for Portable High Efficiency Air Filtration (PHEAF) Equipment. www.oehcs.com
Brasel, Trevor L. “Detection of Airborne Stachybotrys chartarum Macrocyclic
Trichothecene Mycotoxins on Particulates Smaller than Conidia.” Applied
Environmental Microbiology (January 2005)
Wilson, S.C. “An Investigation in the Techniques for Cleaning Mold-Contaminated
Home Contents.” Journal of Occupational and Environmental Hygiene (July 2004).
CONTACT INFORMATION
Questions regarding this document may be directed to:
Greg Weatherman
Certified Microbial Consultant #0512048
AerobioLogical Solutions, Inc.
1300 Army Navy Drive
Arlington VA 22202-2018
[email protected]
www.aerobioLogical.com
Phone: 703-920-MOLD (6653)
Fax: 703-229-1234
Certified Microbial Consultant certification is independently awarded by the
American Council of Accredited Certifications (www.acac.org). ACAC is accredited
by the Counsel of Engineering and Scientific Specialty Board (www.cesb.org).
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