The Janitors' Closet

Don't jump to conclusions

We're doing COVID-19 disinfections, and also focusing on ongoing disinfection to protect our regular janitorial clients from the novel coronavirus, so I try to keep on top of the whole field.

An article on the subject in Cleaning and Maintenance Management well illustrates the dangers of drawing conclusions without considering all possibilities.

The lead paragraph notes an increase in hospital acquired infections (HAI) and the suggestion that the cause might be the CDC's decision to suspend, for several months, its mandatory inspection and infection reporting program. Make sense, and should you read just the first paragraph, that might be the conclusion you'd draw.

But the article also immediately mentions that hospitals are quite stressed (both staff and facility) by the flood of viral patients, which could well account for the increase (even in janitorial, when we're overworked and under stress, we make mistakes).  Further, folks with minor ailments are tending to avoid hospitals these days; thus, only the "sickest of the sick" check in, and are likely more prone to complications - such as HAIs. And, finally, the study was based on only two hospitals.

Make a habit of reading, not just the headline or the lead paragraph, but the whole article.

A COVID-19 question

Given our decades old focus on cleaning for health, we've lately developed something of a focus on COVID and coronavirus decontamination - both in our ongoing commercial cleaning, and in providing quick response to both clients and the general public in event of a virus exposure in a given facility.  Thus, I try to keep abreast of developments of knowledge of the virus, and of its implications.  And I think a bit about it.

Here's something I've not seen addressed.

In Arizona, as in most jurisdictions, we approximate numbers of infected individuals, over time, by looking at the most recent percentages of infected in our daily "virus present" test results.  Now, those tests - the nasal swabs and so on - report whether the subject has "live" viruses currently in his system, and thus is currently "sick" and able to infect.  This has nothing to do with any antibodies he might have in his system.  If we see, as we have lately, a 15% infection rate, we conclude that 15% of the population has been infected and will shortly be immune (or dead).  We need something like a 60 or 70% percent immune rate for "herd immunity", so we've a long way to go.

But: If I tested negative today, there is no way of knowing (from that test) if I'd had the virus, perhaps with no symptoms, some time ago, and am, while now not sick, immune.  There are some unknown number of immune folks out there that we're not counting. 

For example, if we assume that an average infection lasts 30 days (likely over-generous), and we've been seeing similar positive results for 4 months (120 days), then, all else being equal, our immune rate, when the current crop recovers, is more like 60%.  And thus we're closer to herd immunity than we might think.

The only way to know is to test, randomly, for antibodies.  And we're not doing that.

 

Social costs of COVID-19

In between providing commercial janitorial, with an emphasis on pathogen, including COVID-19, control, and doing a good bit of specifically Coronavirus disinfection service, I'm noticing much less opportunity for any social and creative endeavor.

There is much social interaction that we've lost in this time of lockdowns.  The old 4th of July photo is of the Scottsdale Trombone Choir, which I've played in for 30-some years, and managed for a few.  I've also played for years in the Salt River Brass Band, and in an amateur concert band.  All the groups are on hold for the foreseeable future.  Our audiences - free admission  for two of the  groups and ticketed, generally through a season subscription, with Salt River, are no longer enjoying live music, and are doubtless getting a bit stir crazy, with few places to go.  Our musicians lack the comradery, and the challenge, of preparing and performing rigorous music for a discerning audience, and of honing, and enjoying, their skills. 

None of these losses, both to people and to society, figure prominently in economic stats, or in much of anything else.  But they are nonetheless real, and hurtful.

Further, it looks like the virus is not going away anytime soon.  Current thinking is that immunity after recovery is both fleeting and fragile, so the "herd immunity" we've been awaiting is unlikely.  And, since a vaccine depends on the same bodily reactions as does one's post recovery immunity, the benefit from a vaccine, should we get one, is similarly likely to be both fleeting and fragile.

This all might be the "new normal".  Should we give up much of what makes life worth living to, sometimes, avoid the disease?

 

The importance of fast response to COVID-19 decontamination requests

As you might expect, a business experiencing a COVID-19 coronavirus exposure most often needs to address the situation by disinfecting or decontaminating the facility at once (some refer to this as a "COVID deep clean"); one might send employees home today, but likely wants to open for business tomorrow.

We've trained and equipped three service techs, and three supervisory personnel (yours truly included) for COVID-19 decontamination jobs; we can generally respond same day, after office hours.  Disinfection is usually best done after hours because the client's staff, or customers, ought not inhale a large volume of the disinfectant; we setup our technicians with full protective gear, including goggles (not just safety glasses) and face mask, but we can't count on our client's folks being protected.  Our disinfectant requires a bit of dwell time (10 minutes wet), but won't be an issue for the client's employees next morning.

In passing, best practice on learning of a recent exposure in your facility would be to air the place out (tiny droplets containing the COVID virus can remain airborne for hours, and you want to dilute that air as much as possible) and spray or wipe down any possible contaminated surfaces with a good disinfectant, with a viral kill claim, observing the proper dwell time.

Here's a bit on our decontamination protocols, both how we're cleaning and disinfecting ongoing as part of our usual janitorial service (Level 1) and how we address an exposure incident (Level 3).

 

Our ongoing, every night, response to COVID-19

Quite early on in the pandemic, to better disinfect our client facilities, we transitioned from dry dusting most office surfaces to fully damp wiping with an effective viricide.  The move was facilitated by our acquisition of Sphergo wiping tools (we moved early, before major shortages hit).  In our crew's hands, the tool allows an even application of sanitizer, "wall to wall".  It also requires a more clutter and paper free office environment than is traditional; our clients were universally helpful in "de-cluttering". This step is quite effective against viruses, and will catch most anything accessible via damp wiping.

These are our "marching orders" for our nightly janitorial crews:

First, wipe the cleared surfaces of furniture, fixtures, touchpoints (doorknobs and push plates, doorframes, convex wall corners, controls – alarm, A/C, elevator) using Sphergo pad holders for plainer surfaces and microfiber cloth for non-plainer, each thoroughly saturated with Johnson/Diversey AlphaHP; Second, in restrooms, lunchrooms and exam/procedure rooms, after cleaning, mist Virex256 on all surfaces, fixtures, equipment and touchpoints. For both AlphaHP and Virex256, insure a minimum 10 minutes (wet) dwell time on all surfaces.

As always, wear surgical gloves; goggles when mixing chemicals; surgical masks not just in restrooms and health care facilities, but fully on any job.

Note: If bio or other hazardous fluids are present, report the condition to CBN supervisor; use authorized protective gear including surgical gloves, face shield, surgical mask and full protective clothing if necessary, and follow CBN Bio-hazard Protocol on cleaning and disposal.  Refer to and follow robing/disrobing procedures.

Finally, we equipped to do a thorough one-shot Coronavirus disinfection ("covid-19 deep clean", or remediation).

Civility

Received a  note from a janitorial client, and a long-time friend:

    "At the car wash, I entered the outside waiting area and slid a chair further from next to a waiting lady, giving her a courteous friendly smile. Seated - I realized and said “Oh, when I moved the chair I gave a smile. But you couldn’t see because I’m wearing a mask.”  She smiled “That's okay. I could see it in your eyes.” Gee!

Well, it's nice to know that friendliness still works during mask time."

 

Developing a Decontamination Protocol

Like most everyone, our folks at CBN are doing are our best to navigate the unique health and disinfection challenges posed by COVID-19.

We've had some useful "bottom up" contributions: for instance, quite early on, several of our commercial janitorial crews began misting our quat-based disinfectant onto their vehicle door handles, steering wheels and so on, on exiting each client facility, right after disposing of their gloves.  Hadn't yet thought of that; ofttimes it's the fellow on the pointy end of the spear who comes up with the real world application.  Our computer hardware tech, with a background in nuclear subs and then in nuclear power plant inspections, contributed a first-rate video on PPE disrobing.  An old friend, with a background in defense industry engineering, offered a stash of N-95 masks he just happened to have squirreled away.

Back during the Eboli scare, we'd stocked up on first rate gloves and bunny suits, serious disinfectant, goggles and surgical masks, so we started ahead of much of the industry.  We grabbed accouple hundred clear facemasks when a vendor offered them, and tracked down a substantial supply of our long acting hand barrier lotion, quite effective against bacteria and somewhat against viruses - a good second step after washing or using an alcohol gel.

We've developed our "COVID-19 Decontamination Protocol" while talking to clients to assess their needs, consulting out product suppliers and industry sources (while obtaining certification, with emphasis on SARS-CoV-2/COVID 19, from ISSA's Global Biorisk Advisory Council program), getting ongoing feedback from our disinfection technicians as they "felt their way" through our first decontamination jobs, and doing a whole lot of interesting, but late night, online sleuthing.  While rolling out our program over the last few weeks, we've further developed it, and doubtless will continue to do so.

Early on, I looked into the Clorox360 electrostatic system, the current go-to decontamination tool.  My mistake was in taking a week or so to research the science behind it; while I was researching, word got around about the device, and a wave of orders overwhelmed the factory.  I could have been at the front of the wave if I'd acted immediately.  It should have been here over two months ago; I'm still waiting.

You can find the latest edition of our decontamination protocols on our website; nothing is proprietary.  Use it in good health! (And holler at me with any suggestions!)

Hate to say it, given all the suffering abroad, but finding new and better ways to protect our folks and to help out customers has been quite interesting and, kind of fun.

UPDATE - just got the Clorox360 system in. Hooray!

Blocking critical equipment

Reuters reports that the US government will block exports of critical medical equipment, including respirators, N95 masks, and gloves.  This seems to me to be one of the most counter-productive initiatives floated in the current crisis.

We import much more such equipment than we export.  Much of it from China.  

China's move will likely be to prevent export of such items, and perhaps other stuff as well, to the US.  She can direct those exports to countries most in need, including those that the US has just stiffed.  Perhaps even donate the stuff, with appropriate photo ops.

So the US has less gear, the desperate world more, China scores big as a responsible, compassionate nation, and the US is the bad guy.

Further, the bulk of generic drugs used in the US come from India.  Much of the precursor chemicals come to India from China.  What could possibly go wrong?

Just in passing, I'm still waiting delivery of my Clorox360 electrostatic disinfectant sprayer, bought weeks ago to better disinfect many of the healthcare and other critical facilities we provide janitorial service to.  The rumor is that FEMA (or somebody) may well be redirecting production.  A lot of folks downstream can get hurt when we ignore rules and agreements, and govern by fiat.  Sometimes it might be necessary to do so, but it's best to think long and hard first.

Keeping doctors away from hard hit areas

One sees stories of areas hard hit by CCOVID-19 begging for more doctors, nurses and other health care professionals.  You'd think they'd welcome folks from other states.  But only a bit over a dozen states have (temporarily) relaxed state licensing laws that allow only those licensed in a given state to work in that state.  You'd think it would be, roughly, 50 states instead.

All states license a fair number of occupations, from doctors and lawyers to barbers (in Arizona, its close to 80 occupations).  The requirements often seem onerous, and the bureaucratic delays unreasonable.  A bit ago, I noticed articles in the local media, within a week of one another, of an acute general practice physician shortage in Arizona, and a multi-month backlog in processing applications for "foreign" - that is, out of state - physicians to be considered by the state board.  To acquire an Arizona barber's license, you need some 1200 hours in the classroom, and around $20,000.00.  Almost looks like an incumbent protection device.

Arizona has been inching into less licensing.  We require licensing agencies to justify their regs, if asked.  We ease restrictions for military spouses being transferred in to the state, who want to keep working in their chosen field.  And we're the first state (of several) to accept out of state licenses.

If the current crisis pushes us all in a better direction, there may be a bit of a silver lining around a very dark cloud.

Listen to the folks on the job

Our janitorial and floor crews have generally been quite careful about using protective equipment (gloves, goggles, sanitizer) but, as one might imagine, they're currently even a bit more focused.  Several of our crews, independently, started misting Virex II 256, our Johnson/Diversey disinfectant, on their vehicle touchpoints (door frame and handle, steering wheel, gear shift, seat belt buckle and so on) on exiting client facilities and at end of the shift.  (They remove and dispose of their gloves after exiting each facility, so the vehicle shouldn't be a problem, but you never know.)  A couple of our folks mentioned it to my ops manager, who quickly passed the advice around to everyone else.

I might have thought of it eventually, but I hadn't thought of it then.

Reminds me, just a bit, of the lesson learned by the loss of our carrier Lexington in the Coral Sea, in May of 1942.  She took several hits but could have survived, but for fires spreading from the aviation gas pipes running from the bunkers up to various points on the hangar deck.  Sailors transferred to other carriers brought that knowledge along, and directly our carriers would evacuate the aviation gas lines, and fill them with carbon dioxide, if an attack seemed imminent. Our officers, all the way to the top, were willing to learn from the fellows "in the trenches".

The Japanese never adopted the technique, and lost carriers as a result.  Their navy was quite hierarchical; an officer, let alone a captain, would rarely listen to an enlisted man; and the enlisted men were much too subservient to even attempt.

Listen to the folks on the job.