Patrick Moffett – Talking Dirty Part 2 with Patrick Moffett – A near death experience reflects on decades of lessons learned the hard way!

This week on IAQradio+ we focus on cleaning and restoration employee health and safety. Joining us is one of the best known industry experts Mr. Patrick Moffett. Patrick will discuss lessons learned over his years of field experience working in the trenches and will tell listeners how his near death experience shows it’s never too late to take health and safety for granted in the work restoration contractors perform. With all the attention on COVID-19 it’s easy to forget how difficult and hazardous the work our cleaning and restoration pros do every day. Now they are being asked to be emergency responders for a new threat, yet their old work has not gone away. Pat Moffett wants to spread the health and safety gospel by recounting his own brush with death after doing what started out as a typical water/sewage damage restoration project.

For more than 35 years, Patrick has been an environmental and industrial hygienist, general contractor, technical writer, lecturer and instructor specializing in the assessment and oversight of property damage remediation and the environmental clearance of property losses. His loss experience includes small but complicated losses; large losses involving schools, hospitals, shopping centers and high-rise buildings; industrial commercial properties and factory losses; catastrophic losses related to whole communities and cities; coordinating the cleanup of losses with government agencies including police, fire, hazmat, DOH, OSHA, EPA, and the State of California Department of Fish and Game.

Talking Dirty with Patrick Moffett…reflections on lessons learned and a near death experience.

For over 35 years, Patrick Moffett has been an environmental and industrial hygienist, general contractor, technical writer, lecturer and instructor specializing in the assessment and oversight of property remediation and the environmental clearance of property losses, His vast loss experience includes residential, commercial, institutional and complicated losses involving communities where he coordinated cleanup with government agencies.

After nearly succumbing to a work-related bacterial infection, Patrick courageously decided to share his experience and recommendations with the industry.

Patrick previously joined us 11 years ago on IAQRadio episode 126.

Nuggets mined from today’s episode:

We want to first cover some highlights from the first interview

1. Prior to entering the cleaning and disaster restoration field what was your experience in infection control and epidemiology?
   1. In the 1970’s I was one of the earliest EMT’s, then paramedic, and then shifted to work part time in a hospital as an infection control practitioner (ICP), where I have been a member of APIC, the Association for Infection Control Practitioners for the last 40 years.
      1. How my past experience and credentials play into todays work; when a hospital, health care, or a treatment center experiences an environmental issue, I speak JCAHO, HIPAA, and hospital infection control language, which allows the restorer to be inline with codes and regulations, allowing them to complete their work with the least of disruption.

2. What does OSHA require for remediation workers?
   1. In general, they include OSHA safety and health practices the employee will be exposed as part of their daily work.
   2. My company has spent the past 20-years developing OSHA compliance standard operation procedures (SOP) manuals and training materials cleaning and restoration contractors must have.
      1. As an OSHA 30 and 40-hour general industry trainer, I started writing SOPs for restoration contractors that were being fined by OSHA or they had their jobsite shut down because of violations or a work-related injury. Since then, I have written or customized over 800 contractors’ SOP manuals including creating-train-the-trainer programs for in-house training.
   3. Employers must follow the general industry standards, found under 1910 Occupational Safety and Health Standards https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910TableofContents

3. Vaccinations
   1. The need for vaccinations depends on work requirements. When working in the cleaning industry, it generally requires a tetanus vaccination, where often diphtheria is added to the mix.
   2. When completing water damages including sewage, CDC recommends workers having polio, typhoid fever, Hepatitis A and Hepatitis B vaccinations. https://www.cdc.gov/healthywater/global/sanitation/workers_handlingwaste.html

4. What is a Confined space?
   1. According to OSHA, a confined space is a space that meets these criteria: (1) A workspace large enough for an employee to enter and perform work; where (2) it has limited or restricted means for entry or exit; and (3) it is not designed for continuous occupancy.
   2. This describes many kinds of areas a worker can come in contact with on a daily basis whether on a construction site or remediation project, including when an employee enters an attic or crawlspace, or they construct containments to complete some form of mitigation. Unless there are other hazardous conditions, such as a lack of breathable oxygen, hazardous materials are present including electrical shock hazards, or explosive environments, the confined space illustrates what would be considered a non-permit required confined space.

5. What is a Confined Space Entry Permit?
   1. A permit-requiredconfined space may contain all of the above, plus one or more of the following:
      1. A substance that has the ability to engulf or asphyxiate the entrant;
      2. A potentially hazardous atmosphere;

• A space with inwardly converging walls within the space or a floor that slopes downward, tapering to a small cross-section; or

1. It contains any other serious safety or health hazard.

1. Once a confined space has been identified as having any one of the above four potential hazards, an employer must reassess work procedures, adapt appropriate engineering controls, provide additional worker training, have a safety supervisor on the job, post safety signs or another effective means of communication.
2. Any time an employer has workers that will be entering confined spaces, there needs to be a written program developed that outlines and instructs on the proper safety procedures for working around and occupancy of these confined spaces.
3. If the above scenarios cannot be eliminated, a permit-required confined space program must be put in place.
4. There are industry partners that train Confined Space and Permit-required Confined Space leading to Certification online, such as E-train. https://etraintoday.com/course-catalog/osha-training/confined-space-training/

6. When compared to a mold remediation, what extra steps should be taken on a sewage remediation.
   1. Prior to the coronavirus/COVID-19 pandemic, my answer would be slightly different. Meaning, my research confirms; sewage from infected persons can contain the COVID-19 virus.
   2. I would expect the remediation contractor will provide employees with additional training about: (1) worker protection; (2) an employee awareness program, which educates workers about what the coronavirus is, how it can affect their health, that they can pass the disease to coworkers and their family, etc.; (3) notify their employer that they have flu-like health conditions; (4) seek medical advice; and (5) the employer should monitor the health of the health affected employee, including other employees the infected employee came in contact with for the next 14-days.
   3. In most situations, CDC reports; the health of an infected employee will recover in 3 to 5 days, where in some situations it may require remaining off of work for up to 14 days.

7. What term do you use to refer to exposed soil found in crawlspaces?
   1. When you say exposed, you mean wet; it is saturated with fresh water; or it has been saturated by sewage?
   2. IICRC’s definition of soils entering a building including rainwater, it is Category 3.
   3. Wet soil in a crawlspace can contain pesticides, heavy metals, where when left wet for some time, it can result in the colonizing of bacteria and in some cases mold, because of organic materials are present and are degrading, including but not limited to the presence of paper, cardboard, rugs, wood and wood shavings.
   4. Wet soil can also be impacted by Category 2 and 3 water, which increases the biological load in soil.
   5. As a point of interest, I quit using the word “wet soil” years ago. Soil is a 4-letter word that I keep out of my reports, especially in insurance claims where the insurer will only pay for drying building framing.
      1. In speaking with structural and soils engineers, the soil in a crawlspace was engineered, having specific compaction, and sometimes ingredients (e.g., clay, rock and sand) mixture, to support the structure over its life.
      2. Both the footings and support members must remain in a solid state, where normal expansion occurs with temperature and humidity. However, in a water damage, where the wet “engineered ground” becomes saturated, there can be a shift (movement, racking, settlement or raise) of the foundation, flooring and walls, in the structure. The goal of the drying contractor is to mitigate all damage including removing the moisture content in engineered ground, to a point the structure is not impacted.

• In a recent case, where the ground had expansive clay, it took considerably longer to dry the ground to reduce movement of foundation piers and posts.

1. In another case, turning off the crawlspace drying system too early resulted in an increase in crawlspace moisture which then resulted in massive mold growth and warping the hardwood floor in the living space.
2. I was the expert in both of these cases to support the contractors’ work or limitations placed on them by others.

Thank you for proactively sharing your cautionary tale of near-death experience with the cleaning and restoration industry.

8. What was the specific “bug” that infected you?
   1. Before answering that question, may I set the scenario?
      1. In December of last year, I had a mild case of the flu which lingered for a while. I took cold and flu medication, where I got better, but it came back in mid-January. I expected my immune system was slightly depleted, where any environment having an increase in dust, mold spores, etc., resulted in me having more labored breathing.
      2. I wore a respirator more often including other PPE. Now, moving to the last week of January 2020, I had been the industrial hygienist for either writing the scope of work for complicated projects or providing clearance testing, I was involved with two long term death scene jobs, several sewage remediation projects, three mold remediation projects, and two fires, where occupants had to vacate their home and apartments.

• I became sick several days before the Sunday, February 2^nd Super Bowl, where I fought not to go into the hospital until the game was over.

1. Right after the game, my wife and a friend drove me to the hospital, where I was immediately admitted into the emergency room, where blood and urine was taken. It was obvious to doctor’s; my body was shutting down to an unknown infection. The first set of lab data reports confirmed, my kidney and liver were shutting down to a point, doctors injected me with a cocktail of antibiotics, not knowing which one would help me or hurt me, since my body was failing to stay alive.
2. The head doctor pulled my wife aside, letting her know; they are doing their best, but there is no guarantee I am going to make it.
3. Once stabilized, I was sent to a critical care ward, where other doctors and nurses took over. Everyone was nice and upbeat, but you saw in their face, something was seriously wrong with me.

• Several days later, laboratory results came back showing, my body was invaded with E. coli bacteria.

9. How does bacteria colonize a human host?
   1. There has to be a route of entry, such as from a cut, scratch or rash, or from having hand contact with your eyes, nose or mouth. Another route of entry is breathing in bacteria and mold that are aerosolized during remediation, cleaning and disinfection.
      1. A concern I have that I didn’t think about at the time, since your respirator is the last piece of PPE you remove, more than likely your hands are touching the contaminated facepiece, where you touch your face.
   2. What was your personal hygiene cleaning and decon procedure before your infection?
      1. Depending on the job, all my PPE is either new and disposable, or it has been cleaned and disinfected before they were brought to the jobsite.
   3. Is E. coli a robust organism?  How long does E. coli remain viable?
      1. coli in a sewage contaminated environment can remain viable (living) for weeks.
      2. Just spraying a disinfectant on E. coli bacteria will not necessarily break the cell structure down and kill it. E. coli has a strong outer envelope. Studies show, E. coli can talk to other E. coli and bond with them when they are injured.
      3. After a general cleaning, studies at the University of Edinburgh in Scotland were able to show, E. coli is able to recover continually from potentially fatal harm to its genetic material, without slowing down the rate at which it grows.
         141029145623. Researchers were surprised to find that E. coliwas able to use a combination of methods to survive repeated DNA damage. It has an in-built emergency response to ensure that DNA damage is quickly repaired. In addition, it carries out overlapping rounds of DNA replication, which enables its cells to continue to divide and reproduce. This ensures E. coli keeps multiplying as it recovers.https://www.sciencedaily.com/releases/2014/10/141029145623.htm
      4. According to James Rogers, Ph.D., director of Food Safety and Research at Consumers Reports; to kill E. coli, it requires temperatures at 160F or higher.
   4. What is a fomite?  What fomite may be commonly overlooked?
      1. A fomite is any material or surface bacteria, mold or viruses are on and can survive, including but not limited to your cell phone, shoes, remediation equipment and PPE; also including the surface you are walking on that contain bacteria, mold spores and viruses (pathogens), such as the bathroom seat you sat on, or sink fixtures you touched in washing your hands.
      2. No matter what kind of biological remediation job you are hired to mitigate, the surrounding areas including contents are often overlooked as having unseen secondary contamination issues.

13. Can you speculate on the pathway of your infection?
    1. When I was in the hospital thinking about – am I going to make through this infection or not, of course, yes, I thought about what bit me (infected me), and how I could have protected myself better, and if I make it out of here “healthy,” what am I going to do differently?
    2. I probably touched my gloves to my face; or I touched my respirator with my hands, where I then touched my face.
    3. Since then, I took all my safety gear, PPE and testing equipment out of my vehicle, where they have all been cleaned and disinfected.

14. Depending on conditions, how long can pathogenic bacteria remain viable on clothing and shoes?
    1. Part of the answer is what you are stepping into?
       1. As a child growing up on a farm environment, on a dare, stepping into a warm cow pie with bare feet was not uncommon.
       2. Would I recommend that for kids to do today? Certainly not.
    2. Not that I am becoming a freak about staying away from mold, bacteria and viruses, I am taking additional precautions to protect myself and others including my family, which includes: washing and disinfecting shoes and boots when leaving a contaminated job. If they cannot be washed and disinfected, changing shoes and boots on the job, and then plastic bagging them until I get home to wash and disinfect them.
    3. In looking back over the years, there were numerous times my personal clothing became wet, including on a sewage loss. I do not advise emergency responders and restorers to follow what I once did.
       1. The practice of the employer is to educate employees about what we are talking about;
       2. Provide employees with company standards that require them to have a “sports bag” like the one you take to the gym, having:
          1. A change of clothing including shoes or boots, socks, pants and shirt, along with
          2. Backup PPE including nitrile and work gloves, washable coveralls and disposable outer protective coveralls, eye protection, N-95 and half-face respirators. Respirators requiring cartridges, have at least one extra set of HEPA and or HEPA/organic cartridges; also
          3. A roll of toilet tissue, disposable towels, hand cleaners and sanitizers, and an emergency first-aid kit; one final thought,
          4. Have a LED head lamp with batteries that actually work.
          5. I know what you are thinking… The little sports bag I recommended; it just became 10 pounds of gear to haul around.
          6. All said, I cannot tell you how many times I am on contractor’s emergency remediation project, where I see a work-related injury where I step in to help.
             1. With my own first aid equipment and training as a prior paramedic, I treated cases of heat stress, burns, splinters, nails in shoes that pierced the foot, splashing of chemicals in eyes and face, catching fingers on tackstrips, soaked personal clothing coming out of a sewage contaminated crawlspace, respiratory disorders, and so on.

15. Could your infection have been prevented?
    1. After working in the industry for over 30 years, I became lax that my training, experience and best practices of keeping me safe were sufficient enough.
    2. I was out of the hospital two weeks where I was catching up on jobs and reports.
    3. After that, I started writing updated safety and health training procedures for cleaners and restorers, where I incorporated my experience of being infected, hospitalized and almost dying.
    4. I have a group of about 250 restorers who receive OSHA compliance updates involving worker safety, cleaning and disinfection, where these updates are added to their existing SOP and company training manual.

16. What modifications in “infection prevention behavior” have you adopted?
    1. Good question:
       1. Wash hands numerous times a day.
       2. When you cannot wash your hands, have bottles of hand cleaners and sanitizers.

• Make it a habit of wearing shoe coverings over shoes and boots.

1. When inspecting or working on a mold or fire loss, a clean water or contaminated water project, change shoes or boots before stepping into your truck or car.
2. Bottom line:
   1. Do not take contaminated shoes and boots home and cross-contaminate where you live.
   2. Wear gloves when taking off contaminated clothing, shoes and boots.
   3. Wash your hands before and after touching clothing, shoes and boots.
   4. Wash shoes and boots in warm sudsy water, using a liquid detergent such as Fabuloso, Dawn, Simple Green or Joy.

What are Your Conclusions?

17. Coronavirus/COVID-19
    1. Since the end of February, my entire life has been consumed in changing my business model to meet the need of cleaners and restorers in cleaning and disinfecting known or suspected coronavirus impacted buildings.
    2. I have a team of three individuals who have together about 400 hours in research and technical writing over 500 references, which address worker exposures and the training of employees, monitoring the health of employees who work in known or potentially infected buildings, acceptable PPE based on jobsite conditions, cleaning and disinfection methods, verification sampling and the different types of sampling.
    3. We created a webinar training program which is live and interactive, and it is unique to each employer’s needs, where afterwards, their employees can take a test leading to certification. Certification is an awareness certification showing employees are knowledgeable about industry best practices and they have attended at least a 4-hour training.
    4. What we like and have received great comments, the webinar includes a train-the-trainer program, where the cleaning or restoration contractor can take two different PowerPoints (one for employees; the second is for owners and supervisors), and a video of their company’s 4 to 5 hour webinar, and use them for future in-house training.

18. It is Interesting to See how My Experience has Evolved
    1. When I started writing about my “almost death from exposure to bacteria,” I did not realize that a month later, the coronavirus would impact all of us.
       1. It is not just “me” anymore; it is “all of us” who are impacted by viruses we cannot see, which is similar to the bacteria and viruses we cannot see on a Category 2 or a Category 3 sewage cleanup project.
    2. Our lives have changed, where my consultation with OSHA, CDC and health professionals have change my thoughts how we do business from this day forward:
       1. Office:
          1. Our office should inquire about the health of occupants and is anyone in the home or business sick with the flu or COVID-19
          2. Our office will inform the customer, our staff will be wearing respirators when entering and traveling through their building, especially when building occupants are nearby.
          3. Our office has issued instructions to employees to wash their hands before entering your home or business, using warm water and soap or a hand cleaner with a hand sanitizer.
       2. Employees:
          1. Are required to wash their hands before coming to work, before starting work, during the day before taking breaks and consuming food and drinks, before and after wearing PPE, before leaving their jobsite.
          2. Are required to use hand sanitizers and/or alcohol wipes when touching the steering wheel of trucks and cars, door handles, etc.
          3. All PPE that is not disposable and reusable is to be cleaned and disinfected before leaving the jobsite.
          4. Reusable PPE, including N-95 respirators are to be placed in Ziploc bags and marked contaminated, along with the date it was placed in the bag, the name of the jobsite and name of employee.
          5. When entering a home or business, shoes and boots are to be covered with shoe coverings.
          6. If the job requires shoes and boots to become wet or contaminated in any way, shoes and boots must be washed and disinfected before leaving the project. If this is not practical, shoes and boots are to be placed in plastic bags and technicians are to put on clean shoes or boots.
          7. Anytime an employee feels or knows they have signs of the flu, they must report this potential or known illness to management.
          8. Management may ask you to go home or seek medical advice.
       3. Wow… Thank you for allowing me to participate in the almost 11 years in time since I was last on IAQradio and today’s 126^th recording of IAQradio.
          4008. If listener’s want to contact me, my email is my name PatMoffett@att.net and cell and text is (714) 928-4008.

Added thoughts:

• LIME should not be used in crawl spaces under buildings!
• Sewage and sewage gasses may contain Covid19.

Z-Man signing off

Trivia

What is the technical term for “flesh eating disease”?

Answer:

Necrotizing fasciitis

Doug Kohnen, Eratech Environmental, Dayton, OH