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A. Introduction
The ECONA network of Esporta operators are receiving inquires on a daily basis about the ability of the Esporta Wash System to assist in the effort to help stop the spread of infectious agents such as the current mutation of the corona virus that is developing into a pandemic. While effective infection control has many components, cleaning and sanitizing surfaces and soft goods to break the chain of infection is as important as having people cover their cough and wash their hands frequently.

While hard surfaces can be cleaned and sanitized in a simple straightforward way; effectively cleaning soft goods is more difficult. Past testing has shown that the Esporta Wash System is significantly more effective at removing harmful bacteria and other micro-organisms than standard laundry processes; especially on those items that have multiple layers or internal padding. Building on that proven effectiveness, these procedures have been developed to assist members of the ECONA network in utilizing their skills to help arrest the spread of infectious contaminants.

Although the desire to assist clients and the general community who are facing the threat of an epidemic is laudable, the first priority in such situations should always be placed on protecting the health and safety of your own crew members. As such, any network member that is not able or willing to follow these guidelines should refrain from offering cleaning services for items known or suspected of harboring infectious agents. Questions about any of the material in this paper should be directed to Daryl Nestibo at daryl.nestibo@esporta.ca.

B. Background Information On The Corona  Virus Disease
In late 2019 a new mutation of a corona virus was first detected in China. This latest mutation of a class of viral agents known for causing respiratory disease in people and animals quickly became a concern because of the infection rate and the serious nature of the disease it was causing. The virus was named “SARS-CoV-2” by the World Health Organization (WHO). It was given this moniker because this mutation is similar to the 2003 Coronavirus that led to the description of Severe Acute Respiratory Syndrome (SARS). Although the actual viral contaminant is called SARS-CoV-2, the term most familiar to the public is the name of the specific disease it causes is named “coronavirus disease 2019” (abbreviated “COVID-19”).
 
At the time that this procedure was developed, COVID-19 had been confirmed in over 100 countries and it appeared imminent that the WHO would announce that it had progressed from an epidemic in many countries to a pandemic. While intense efforts are focused on addressing the disease from a pharmaceutical standpoint, no vaccine to protect against this very contagious virus is currently available. According to the US Center for Disease Control (CDC) “Nonpharmaceutical intervention would be the most important response strategy” to COVID-19. In layman’s terms that means infection control and home care of the affected are the key.

COVID-19 is both similar and different from the regular flu. Like any flu virus COVID-19 appears to transmit itself very similarly through both direct contact with the virus by breathing cough and sneeze droplets from infected individuals and through secondary contact with surfaces where the sneeze residue has landed. One of the main differences is that typical flu viruses only survive on surfaces for a few hours, or several days at the most. Research from the CDC indicates that COVID- 19 stays viable on uncleaned surfaces for up to nine days.

Despite the actual infection rate still being unknown, it is clear that COVID-19 is more likely to cause serious health effects and fatalities in people 60 or older. This means that eldercare facilities are especially vulnerable to outbreaks.

C. Recommended Equipment/Supplies

1. Sheet plastic and isolation supplies such as Zipwall 12, 4-pack
2. Metal work station or sturdy metal folding table such as ULINE model H-5601
3. Two step-on-to-open trash cans such as ULINE model H-2670
4. Negative air machine and plastic lay-flat exhaust tubing such as  Dri-Eaz DefendAir HEPA 500 Air Scrubber or
   Aeroclean 2000 "ECONO" Negative Air Machine #9143
5. Hydroxyl radical generator such as Odorox Oasis
6. Foaming equipment such as FOAM-iT model F1.5L or F5.OL-PSG
7. Nonporous transport cart with lid such as ULINE set with model numbers H-1954 and H-3526
8. Heavy duty water soluble laundry bags such as Extra Packaging Corporation’s model 1228390.510
9. Clear and black heavy duty (6 mil) trash bags such as Plastic Place model CON50X6
10. Pump station of hand sanitizer
11. Pump station of hand lotion
12. Antimicrobial cleaner capable of foaming that does not use quaternary ammonium compounds such as Benefect Botanical Decon 30 or Sporicidin PeridoxRTU Sporicidal Disinfectant and Cleaner
13. Disposable microfiber wipes and mop such as Contec PREMIRA Microfiber Mop Starter Kit

D. Personal Protective Equipment
The minimum PPE recommended by the CDC for individuals potentially exposed to COVID-19 includes: gloves, gowns, eye protection, and respirators. Typically workers in the restoration industry use disposable suits with attached hoods and booties for contaminant control work. However, since the Esporta is effective in removing microbiological contaminants using washable medical style “scrubs” consisting of top, pants, and cap matched with disposable shoe covers is both cost effective and protective of the environment. Such outerwear can be purchased oversized and worn on top of street clothes when handling potentially contaminated soft goods, or worn as a replacement for street clothes if a controlled changing area is available adjacent to the wash area. Disposable or washable lab coats or full front treatment gowns with long sleeves that tie in back could also be used for body covering.

A full face negative pressure respirator or hood style powered air purifying respirator (PAPR) with HEPA filters can be used to provide respiratory and eye protection in one device. As an alternative, filtering facepiece respirators (CDC and Health Canada recommend an N-95 but an N-100 is recommended for Esporta operators) and safety glasses or face shield can be used with the benefit that they are generally considered to be more comfortable than an elastomeric respirator. If filtering face pieces are used a full face shield rather than safety glasses is recommended. Any respiratory protection assigned to ECONA team members must be done in compliance with OSHA or Health Canada regulations including medical evaluation, fit testing, training, and a written program.

Disposable personal protective equipment (in addition to filtering face pieces if they are used in lieu of elastomeric or hood respirators) includes surgical style gloves made from nitrile and shoe covers.
 

E. Preparing The Esporta Wash Center
For soft goods potentially contaminated with COVID-19 the Esporta Wash System should be isolated from the rest of the work space. If it is in a separate room such isolation is as simple as controlling access and air movement in that room. Otherwise semi-permanent isolation walls with zippered access door(s) will have to be installed out of plastic sheeting and support materials (poles, framing, fencing, etc.). Any entry should be constructed with dual zippers and a hang flap on the wash side of the barrier to facilitate the movement of covered carts of soft goods.

Whether an existing room or isolation barriers is utilized, preparation for washing COVID-19 materials begins with removing any extraneous clutter in the wash area. Keep surfaces clear to improve the speed and effectiveness of surface decontamination.

In the isolated Esporta work area set up a HEPA filtered negative air machine as an air scrubber (recirculating air in the space by passing it through the filters. Add a “tail” to the exhaust using lay flat tubing tied off at the end. Extend the tubing above/across the front of the Esporta equipment and cut half-moon slits in the tubing so that the air is directed down over the front of the machine. Set up a hydroxyl generator to run in the wash area. Placement of the hydroxyl generator near the Esporta equipment is preferred, even if that means that the generator is hung from the wall or put on a solid shelf. The air scrubber and hydroxyl generator should be run continuously while potentially contaminated products are being processed and for at least 48 hours after the last load is finished.

Once the primary engineering controls are in place and have been tested, set up the metal work table with the foamer, microfiber cloths, hand sanitizer, and hand lotion. Some water soluble bags and plastic disposal bags should also be in the work area. Arrange the two garbage cans with foot control lids nearby so that one can has a water soluble bag liner for washable PPE and the other can has a trash bag liner for disposable PPE and the exterior bags that will be thrown out after the soft goods in the inner water soluble bags have been loaded into the Esporta cages.

Move the transport cart(s) with lids into the work area to ensure that the doorway, zipper barrier or other pathway allows convenient movement. Then reposition the covered transport carts in the delivery area.

F. Collecting The Soft Goods
Potentially contaminated soft goods collected onsite should be inventoried and packaged by individuals wearing appropriate PPE. The goods should be placed in water soluble bags and then double bagged/sealed into clear trash bags. Black trash bags should be used only for items to be disposed of, either from the collection site or at the wash station.

Sealed bags should be transported to the wash center in an enclosed vehicle. If a vehicle is used where the materials are in the same space as the vehicle occupants (i.e., van) a plastic isolation barrier should be installed.

At the wash center the bags should be unloaded directly into the covered cart(s) and the cart(s) moved to the isolated wash area by individuals wearing PPE.
 

G. Handling Collected Goods At The Wash Center
Workers operating in the wash area should don appropriate PPE. When the Esporta is ready for loading, the covered cart should be wheeled next to the equipment. As the cages are advanced, one or more bags of contents are carefully opened and the intact water soluble bags placed into the cage. The outer trash bag is then carefully put into the lidded, lined trash can.
Once the machine is loaded and the wash sequence started, the operator should use the foamer and microfiber cloths to clean and sanitize the outside of the Esporta, especially the door handle mechanism. The cleaning process should then continue by foaming and wiping the inside and outside of the cart, the work station, and the exterior of the trash/PPE cans.

At the end of each shift the same cleaning regimen should be completed along with a foam/wipe of the plastic flap/zipper door and the floor, as well as the transport vehicle.

H. Cleaning Procedures
The cleaning recipe for soft goods potentially contaminated with COVID-19 is a modified sewage wash. In this case, in keeping with the standard of care for forensic restoration, a sanitizer is added at the start of the first cycle in order to minimize any spread of viral particles in the wash water.


I. Drying/Finishing
Since the impacted surfaces have been cleaned and sanitized after the Esporta was loaded and closed they can safely be used to sort/prep items from the Esporta. The combination of Esporta wash action and chemistry eliminates or denatures the microbial contaminants. Therefore, washed items can be handled as normal. Still, out of an abundance of caution, it is recommended that PPE be used until the items have been dried.
 

J. Post Cleaning
Standard testing using an ATP meter should be conducted. While ATP meters do not accurately react to viral organisms, the overall reduction in biological contaminants is an excellent surrogate measure of cleanliness as selective cleaning of specific contaminants is impossible (i.e., it is not possible to clean the mold and bacteria and leave behind the virus).
 

K. Documentation
After adapting these recommendations to the specific circumstances of each ECONA facility, it is recommended that the finalized set-up and process steps be documented in writing and supported by photographs. A checklist of primary activities should then be printed and posted in the wash area for the benefit of the operators.

The checklist can also be set up as a batch form and used with the sample results as documentation for the customer.
 

L. About The Author
This document was developed for the ECONA Network by Wonder Makers Environmental. Michael Pinto was the primary author. Michael’s credentials include earned titles as a Certified Safety Professional, Safety Management Specialist, Forensic Operator, Certified Mold Professional and many other state and federal certifications in the areas of asbestos, lead, indoor air quality and infection control. He was one of the primary authors/editors of the Guidelines For Professional Forensic Restoration by the Restoration Industry Association; as well as the author of over 240 published articles. Michael has an extensive knowledge of the Esporta System and its capabilities, having conducted extensive testing of the equipment and chemicals to evaluate its effectiveness in cleaning environmental contaminants from soft goods.