Facing the Upcoming Crisis Now: All Hands On Deck!

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Introduction

About two million patients acquire at least one healthcare-associated infection (HAI) in the United States (US) each year. Approximately 90,000 of these patients will die (Stone). It has been estimated that as much as 70% of HAIs are preventable, and thus should not occur (Pronovost).  Most healthcare facilities have been increasing efforts to reduce HAIs over the last two to three decades, but we are not even close to where we need to be.  

Significant amounts of time and money have been funneled into HAI reduction efforts by healthcare facilities and government agencies. With the direct cost of HAIs to US hospitals estimated to be between $28 billion and $45 billion a year, it is also worth the effort and cost of successfully implemented enhanced preventative measures (Stone). More importantly we are trying to save the lives of someone’s parent, spouse, child, friend, or colleague, and prevent the long term suffering and reduced quality of life endured by a large percentage of HAI survivors. It is worth the personal daily effort it takes for HAI prevention perfection.  

A Critical Time

  1. Between 2010 – 2030 the US population will increase by 42%; 1 in 5 residents will be age 65 or older; and as is the case for all elderly, they will be more vulnerable to infection, but their demands for heart, hip, knee, eye, shoulder, and spine surgeries will increase from two [hip] to six [knees] times the current number. A challenging time is about to hit healthcare as multiple circumstances converge to exert increasing pressure on healthcare infection prevention efforts over the next 10-20 years. Each topic below needs an in depth discussion to really understand how impactful this convergence will be, but here we can only list them. 
  1. Escalating numbers of patients with obesity and/or diabetes that increasing their vulnerability to infection
  1. Accelerating frequency of emerging new pathogens against which we will have no immunity. According to the World Health Organization (WHO), “new infectious disease pathogens are emerging at a rate never before seen with 40 new pathogens in the last 40 years!”
  1. Increasing number of natural disasters, urban crowding, resource depletion, climate changes
  1. Growing number of individuals and families refusing vaccinations
  1. Failing infectious disease treatment and cure capability due to:
  • the need for new diagnostic techniques to identify & treatment methods for infections caused by biofilms, small colony variants (SCV), persister cells, and anaerobic infections as they are prominent and need to be addressed differently than acute infections 
  • resistance of pathogens to treatment antibiotics and drugs
  • plummeting research and development efforts into new antibiotics and drug treatments

Emphasizing the seriousness of these converging pressures, experts have said:

  • “Many common infections will no longer have a cure and, once again, could kill unabated” (WHO)
  • “A simple cut to your finger could leave you fighting for your life.” (BBC)
  • “The most basic operations – getting an appendix removed or a hip replacement – could become deadly.” (BBC)
  • “Cancer treatments and organ transplants could kill you. Childbirth could once again become a deadly moment in a woman’s life.” (BBC)
  • “Opportunistic infections – those that often hit the elderly when they are already ill and vulnerable in hospital – are one of the main concerns.” (BBC )

Although this may seem a harsh introduction to an article on cleaning and disinfection, it is used to personalize the importance of whatever we can do to prevent infections initially, and the spread of the pathogens from those who acquire an infection. Because, from the pathogens’ point of view, they will find any means they can to transfer from an infected patient to another vulnerable patient in order to sustain their own existence and disperse their species. But how to get to that next patient? 

Depending on the infectious pathogen type and the disease symptoms caused, they may be propelled in droplets or aerosols when the patient coughs, is speaking, vomiting, or has diarrhea. Alternatively, after touching the patient or contaminated surfaces around the patient, a healthcare provider (HCP) may unknowingly “pick-up” some of those hitchhiking pathogens and transport them to the nurses’ station, a surface or device in another room, or directly to another patient. For the pathogen, it’s their instinct to survive, their prime directive – whatever it takes! 

Environmental Services (EVS)

Over the last two decades, the environment around patients has been more highly scrutinized as a possible source of infectious pathogens. It has been confirmed that both non-porous and porous items can be highly contaminated with pathogenic microorganisms. When devices, objects, gloved hands, bare hands, etc., contact these surfaces they themselves become contaminated and can transport the clinging pathogens to vulnerable patient. Studies have revealed that bacteria, viruses, fungi, and spores remain infectious on dry inanimate surfaces for hours, days, weeks, months, and even years

(Kramer, Ledwoch, Casanova, Bonilla). Their longevity tremendously increases the opportunities for them to be carried to another host — unless those surfaces have just been cleaned and disinfected. Given that EVS processes each room once in 24 hours, it is highly improbable that the surface has been disinfected just prior to any given contact event. 

Studies have determined that after a patient infected with Acinetobacter baumannii, vancomycin resistant enterococcus (VRE), methicillin resistant Staphylococcus aureus (MRSA) or Clostridium difficle, is discharged, and the room terminally cleaned and disinfected, the next patient assigned to that room will be at significantly increased risk for an HAI caused by that specific pathogen. Similar levels of risk were calculated to apply to patients who share a room with a patient infected with any of these same pathogens. (Cohen, Vickery)

Authors of a 4 country study identified still infectious bacteria including their antibiotic-resistant forms in biofilms on hospital patient room surfaces. Their conclusion: “More frequent and better cleaning [is] needed to remove biofilms and MDROs [multi-drug related organisms] from hospital surfaces and the environment.” (Anwar)

So, how can we remove contamination from surfaces in a timely manner? We could have EVS hire more staff that keep rotating through the rooms each and every day, but that would be cost prohibitive, cause excessive foot traffic, and still end up with surfaces not being cleaned and disinfected just before someone touches it.

There may be antimicrobial surfaces that reduce the number of microorganisms in extensive testing, but it is unlikely that their surface-bound antimicrobials will be able to reach the microbes present within or atop organic substances dispersed from the patient, from meal remnants, etc. 

There must be a more effective and timely solution!

First, EVS must have: 

  • enough well trained staff, to perform daily and terminal cleaning/disinfection well
  • enough time allotted to EVS staff to perform their tasks correctly and completely
  • the most appropriate disinfectants for the targeted pathogens and are also compatible with the surfaces being disinfected
  • a monitoring system to provide them with immediate feedback on the effectiveness of their cleaning and disinfecting tasks
  • positive association and frequent communication with their own leadership and with the Infection Preventionist team
  • the partnership and assistance of nursing, dietary, and all other staff who work in clinical areas of the facility. I have said this for years, and even penned a slogan:

“Grab a Wipe and Swipe! It Takes Seconds, It Saves Lives!”

But, that’s all I did — talk for years.

Separately, others have figured it out and, with the entire facility staff, performed the work!

United States: A True Multiple Facility-Wise Success Story and Example

Now retired Nancy Metternich was the EVS manager of Cedar Community, who oversaw a staff of 31. They were responsible for the laundry and cleaning of a 229 bed healthcare center and 155 apartments at two assisted living centers at Cedar Community in West Bend, Wisconsin. That in itself was a huge accomplishment.  

However, she and her team knew, that not long after EVS has cleaned the patient’s room, surfaces around the patient would again become contaminated. They knew, it would not be long before a tray, a chart, a glucose monitor, a TV remote, or some other item was placed on one of the contaminated surfaces. After it became contaminated, someone would pick it up, contaminating their hands and attire before they transported the clinging microorganisms to the next patient, touch screen, nurses’ station, etc. 

When a patient down the hall becomes infected with the same pathogen as the patient in the room our “transporter” had been in a few days before, he or she could confidently make the relieved statement, “It couldn’t have been me; I never touched either one of those patients!” Ignorance is bliss.

Metternich’s staff could not be in each room 24/7, so how did she address this type of serious everyday problem? She had appropriate disinfectant canisters placed at every bedside. Nurses were trained to use them for spills, on equipment after use, on surfaces before and after procedures. They understood why it really must be those that need to be in the room that make certain they do not carry pathogens out with them.

Metternich also knew that different disinfectants can damage different materials. This was a hard-earned lesson when, early on in their efforts, nurses grabbed the bleach canisters and used the wipes on the readout screens, severely damaging the equipment. Additional in-service training was conducted and more obvious differences made in the dispensers to better identify material incompatibility.  Different canisters were placed on the computer carts, in the nursing stations, in offices, in rehabilitation rooms, etc.  They focused on making it easy for staff to do it right…and hard to do it wrong!

England: Addressing MRSA infections by attacking contamination near the patient

Garvey also used an “all-hands-on-deck” cleaning and disinfection approach. Initially, between 2013 and 2016, staff used a two canister system: first a wipe with a detergent solution, followed with an alcohol wipe.  The two canister system took time, was somewhat messy, and was not always performed. In 2016, they switched to a one- wipe cleaner-disinfectant system. In the year following the change, the number of MRSA acquisitions across the University Hospitals Birmingham system in England fell from 20.7 to 9.4 per 100,000 patient bed days. 

Garvey noted that moving from a two-wipe to a one-wipe system simplified the process for very busy staff making the task simpler and more convenient. “The combination wipes fit well with a human factors approach, being available at the point of use and maximizing the opportunity for correct practice.” 

What are some of the most important things to remember when selecting a disinfectant?

1) Cleaning: Whether as a separate process or as a cleaner/disinfectant one-wipe system, cleaning is extremely important.

Surfaces soiled with organic substances such as mucus, saliva, blood, feces, urine, pus, or food will deactivate many disinfectants preventing them from being effective against the pathogens they are expected to destroy. Additionally, some disinfectants will literally “fix” organic substances to surfaces. For example, high concentrations of alcohol are known to fix blood onto surfaces much like glue. This makes it extremely difficult for future cleaning procedures to completely remove the stuck-on organics, while providing bacteria a protected food supply where they can multiply, initiate biofilm formation, and share resistance capability with co-inhabitants under the stuck-on blood/organics.

To prevent this sealed in microbial habitat, clean before using a disinfectant, or use an Environmental Protection Agency (EPA) registered cleaner/disinfectant approved for hospital use with strict compliance to the manufacturer’s instructions for use (IFU). The cleaner/disinfectants can save time and eliminate the risk of carrying potentially pathogen-contaminated detergent wipes, cleaning rags and open detergent buckets into multiple rooms.

Exception: Large volume pooled blood, spills, solid waste all need to be removed before normal cleaning/disinfection can continue (e.g., spill kits, “sop-up” forceps).  

2) Disinfectant capability:

Hospital disinfectants:

Disinfectants used in hospital environments, must be EPA registered and approved for hospital use. Hospitals using other disinfectants will receive an infraction if noted during surveys.  The EPA looks at many different requirements when assessing an application both for registration of a disinfectant and for its safe use in hospital environments. Their requirements for microbial “kill” are listed in the “EPA Product Performance Test Guidelines, OCSPP 810.2200: Disinfectants for Use on Environmental Surfaces, Guidance for Efficacy Testing”.

It surprises many to learn that a disinfectant only has to kill two microorganisms to pass the EPA efficacy testing to quality for that portion hospital-use approval.  Those microorganisms are: Staphylococcus aureus (ATCC 6538) and Pseudomonas aeruginosa (ATCC 15442). No more bacteria required. No viruses. No fungus. No Mycobacterium (e.g. M. tuberculosis -TB).  Just two specific bacteria!

Hospitals must determine what they need:

EPA expects that hospitals will review and list those pathogens that have caused infections in their facility and add those identified by the Centers for Disease Control and Prevention (CDC) as significant threats.  

CDC and WHO have developed a list of infectious bacteria referred to as ESKAPE pathogens. These bacteria are responsible for the majority of HAIs throughout the world. The CDC states that over 2/3rds of HAIs in the United States are caused by these ESKAPE pathogens. Each pathogen is aggressively virulent in both its antibiotic sensitive and resistant forms.  However, because they are capable of surviving attempts to treat the patient, antibiotic-resistant forms are selectively becoming a higher percentage of each of the ESKAPE pathogens. (Indrawattana) These are extremely important to include on your list.

EXCAPE Pathogen

E Enterococcus faecium
S Staphylococcus aureus
K Klebsiella Pneumoniae
A Acinetobacter baumannii
P Pseudomonas aeruginosa
E Enterobacter aerogenes

Hospitals also need to consider threats that appear to be affecting some geographical locations more than others. For example, due to the growing number of individuals and families refusing vaccinations against historically devastating infections, we expect to face serious school, city and regional outbreaks of infectious viral and bacterial diseases we are not used to treating. These diseases include: 

  • Viral: chickenpox, measles, mumps, rubella, polio, rotavirus, hepatitis A, hepatitis B, and influenza (includes both enveloped and non-enveloped viruses)
  • Bacterial: diphtheria, whooping cough, and several causes of meningitis, pneumonia, and bloodstream infections

Specialty focus hospitals caring for cancer, AIDS, burn, and transplant patients, must also make certain they include several fungal species, as these severely immune-compromised patients are extremely vulnerable. For more generalized hospital facilities, the primary fungal pathogens are Candida spp.

Disinfectant efficacy:

Once a facility has compiled the list of pathogens they want to be prepared for, they can select the EPA registered disinfectants approved for hospitals that also list efficacy against those bacteria, fungi and viruses. (Note: in a number of cases, the pathogens are so virulent that testing facilities are required to use surrogates that have the similar disinfectant susceptibility levels. The EPA must approve of the surrogates selected)    

To enable disinfectant manufacturers to list the microorganisms against which they have been tested, the EPA has specific test methods and efficacy requirements. These are described in the same EPA document noted earlier: OCSPP 810.220. There is a section for each of the following:

  • Bactericidal (in addition to the required S. aureus and P. aeruginosa)
  • Virucidal (recommend both enveloped and non-enveloped)
  • Fungicidal
  • Tuberculocidal

As noted, EPA registered disinfectants approved for use in hospitals are not required to have a tuberculocidal claim. The Occupational Safety and Health Administration (OSHA) historically required a tuberculocidal disinfectant (or bleach) for all blood spills and contaminated surfaces under initial Bloodborne Pathogens ruling in 1991 after it was determined that HIV and HBV were transmitted via infected blood. That ruling was revised in 2001 [OSHA: 1910.1030(d)(4)(ii)(A)].

The revision allows the use of diluted bleach and disinfectants proven effective against HIV and HBV to be used on equipment and surfaces contaminated with blood and other potentially infectious materials (OPIM) “provided that such surfaces have not become contaminated with agent(s) or volumes of or concentrations of, agent(s) for which higher level disinfection is recommended”(OSHA). 

HOWEVER, because tuberculocidal disinfectants have a “higher level of kill”, many facilities use them for most disinfection tasks in hospitals. Used in compliance with their IFU, EPA registered, hospital approved tuberculocidal disinfectants will destroy not only HIV and HBV, but most other pathogens as well, except spores and, as is the case with some formulations, a few fungi and non-enveloped viruses. Selecting a tuberculocidal disinfectant just takes a lot of the worry and disinfectant “shopping” off the table. 

Check the approved claims to make certain they are not missing the fungi and non-enveloped viruses of concern for your facility. Make certain the disinfectant’s IFU is followed perfectly from concentration and pH requirements, to the length of time it stays in wet contact with the surface being disinfected. 

3) Disinfectant material compatibility

A disinfectant that only requires a short contact time and is effective over the broad spectrum of pathogens outlined above appears to be the perfect choice.  But if it is incompatible with the material on which it is used, a whole spectrum of damages can occur.

Discoloration: The damage may be “just” discoloration such as bleaching out bright colors, dulling of shiny or painted surfaces, yellowing of white fixtures. These may be deemed acceptable as long as the items are still usable or just look too awful.  However, there are many items that can functionally be impaired by discoloration. For example, permanent hazing of monitor screens or of clear plastic window panels where viewing is impaired after incompatible disinfectants are used making them useless. 

Swelling, hardening, cracking: Disinfection of surfaces with incompatible disinfectants can cause plastics to develop fine invisible cracks referred to as crazing. Repeated disinfection further deepens and enlarges the cracks until they are visible.  At this stage the material becomes weaker.  If load-bearing, it may break. If still functioning, the cracks provide places into which blood and other body fluids can seep and pathogens can find protection with a food supply triggering biofilm formation.  Whether the material incompatibility mars aesthetics, ruins functionality, or creates places for pathogens to multiply becoming pathogen reservoirs, they can be expensive damaged items to replace.

Electronics: Repeated disinfection of items such as monitoring leads, wiring, cell phones, data entry devices, scanners, and remotes, can “fry” delicate circuitry if they have not been shown to be compatible to these material. When in question about the compatibility disinfectants with electrical components being disinfected, call the device manufacturer’s technical support department and document their response. 

Metal corrosion: Some disinfectants corrode galvanized steel, stainless steel, aluminum, brass, and/or chrome fixtures. Confirm compatibility.

Altered hard surface texture: In addition to discoloration, dulling,  electrical damage, and corrosion, disinfectants may alter the surface texture of nonporous materials such as plastics, acrylics, wood, and hard vinyl, from smooth and shiny to rough textured with cracks and pitting. Laminate adhesives can degrade with the use of incompatible disinfectants causing areas of separation and buckling. This type of damage is usually unacceptable as far as comfort, appearance and usability. It also provides the perfect opportunity for organic debris to fall into, moisture to persist, and bacteria to establish biofilms within the damage-created cracks and material separations. 

Confirm disinfectant compatibility. For the most extensive list of compatibility and incompatibility, download EPA documentation on the EPA registered disinfectant. 

Damage to flexible and porous materials: By far, the majority of EPA registered disinfectants approved for hospital use have been formulated for use on nonporous surfaces. Most are not compatible for use on porous, thin-film or soft supple type materials such as vinyl, polyurethane, natural rubber, plastic films, or nylon used, for example in hospital furniture, curtains, mattresses, and protective mattress covers. Disinfection with incompatible disinfectants can harden these materials, create fine cracks, peeling, flaking and tears providing access points for blood, other bodily fluids, and pathogens to seep into enabling future sources of infection to survive and multiply within the material.  

Alert on Mattresses

Bed: The FDA has received over 700 reports of stained, peeling and cracked bed mattresses. Yet, the FDA stated that this is an industry-wide problem and for the most part, hospitals are not reporting the damages. In fact inspections have revealed that over one third of bed mattresses fail. 

Surgical table mattress: Between 2011 and 2013, the FDA received 458 FDA reports of contaminated operating room mattresses. The mattresses were reported to be worn and cracked obviously capable of letting blood & body fluids leak inside to support microbial growth and biofilm formation within the surgical table mattresses.  If saline or water seeps into the mattress before or during surgery, the fluids provide an easy exit from the mattress to the patient during the procedure.

Disinfectants safe for porous materials: Check to make certain that the disinfectant is not only EPA registered and approved for hospital use, but that the manufacturer also lists it as compatible with the porous materials you will be disinfecting. Most often, these will be quaternary ammonium based disinfectants (Quats). Historically, Quats have been compatible with non-porous and porous materials in healthcare, but were typically slower and had a narrower microbial kill range than aggressive disinfectants used primarily on non-porous materials.  

However, quat formulation adjustments over the years have decreased kill times dramatically while increasing the spectrum of pathogens killed in many of the newer formulations. Some are now approved for the full range of bactericidal (ESKAPE pathogens), fungicidal, viricidal (both enveloped and non-enveloped viruses) as well as tuberculocidal. These are the quaternary ammonium/alcohol-based formulations (also known as alcohol quats). 

As a cautionary general rule, for cleaning/disinfectant combinations, a level of alcohol of about 20% is needed for the faster, expanded kill and dry times. However, higher than 20% alcohol concentrations can “fix” blood and other organic substances onto the surfaces being cleaned, and with repeated use tend to “dry-out” plastics and porous materials on mattresses and furniture causing them to harden and crack. 

Survey infractions: Visibly noted damage that creates opportunities for pathogen reservoirs are being sighted as infractions by surveyors.  More importantly, they place current and future patients at risk for infection.

Fluid-barrier mattress protectors have been shown to make a big difference in preserving the quality and safety of the mattress and thus the future patients. A total mattress cover that is impermeable to fluids, can be surface disinfected at any time as well washed as laundry without special delicate requirements is best.  Of course, confirm the disinfectant addresses the target pathogens and is compatible with the barrier material.

In Summary

Hospitals are soon to be pressured with increasing numbers of patients, most of whom will be the more vulnerable to infections, including the elderly, obese, and diabetic patients. The increase in vulnerable patients will occur at the same time we are confronted with failing treatment options for those who acquire infections. The best way to avert this crisis is to prevent infections before they occur. 

We now know that enhanced disinfection methods can be one of our most effective efforts of preventing healthcare-associated infections.

Enhanced disinfection starts with selection of highly effective disinfectants effective against all ESKAPE pathogens specified by CDC, as well as being viricidal (enveloped and non-enveloped viruses), fungicidal, tuberculocidal or sporicidal as needed. Each disinfectant must be compatibility with each of the items to be disinfected whether they are porous or non-porous.

Nurses, and other staff who attend to the patient should clean and disinfect the surfaces they will contact both before and after they accomplish their task. The most convenient method with the highest compliance and, it appears, the greatest reduction in targeted infections, has become the use of cleaner-disinfectant canisters at point of use. 

Make it easy to do the right thing!

We really do need to do this! Rally all hospital staff to participate in preventing pathogen transmission by being part of the disinfection brigade:

Grab a Wipe and Swipe! It Takes Seconds, It Saves Lives!

References and Resources

  • Anwar, Sarah: SHEA Spring Conference https://www.contagionlive.com/news/researchers-study-mdro-presence-in-biofilms-collected-from-hospitals-in-4-countries (SHEA spring conference poster summary: Contagion Live Newsletter, Sarah Anwar (April, 2017).
  • Association for Professionals in Infection Control and Epidemiology (APIC) Support tools: PowerPoint courses “ready to present”, infographics, flash cards, best practice “how-to-dos”, and checklists for Environmental Services: https://apic.org/Resources/Topic-specific-infection-prevention/Environmental-services
  • ASTM International. Standard Test Method for Assessing the Ability of Pre-Wetted Towelette to Remove and Transfer Bacterial Contamination on Hard, Non-Porous Environmental surfaces. Using the Wiperator. Method E2967-15, ASTM International, W. Conshohocken, PA, USA.
  • BBC News, Health: Analysis: Antibiotic Apocalypse. J Gallagher, Health editor BBC News Website: https://www.bbc.com/news/health-21702647
  • Bhalla A, Pultz NJ, Gries DM. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol. 2004;25(2):164–7.
  • Bonilla HF, Zervos MJ, Kauffman CA. Long-term survival of vancomycin-resistant Enterococcus faecium on a contaminated surface. Infect Control Hosp Epidemiol. 1996;17(12):770-2.
  • Casanova LM, Jeon S, Rutala WA. Effects of air temperature and relative humidity on coronavirus survival on surfaces. Applied Environ Microbiol 2010; 76:2712.
  • Centers for Disease Control and Prevention (CDC): Covers for hospital bed mattresses: Learn how to keep them safe. 2017; accessed 3/11/2019: https://www.fda.gov/medicaldevices/productsandmedicalprocedures/generalhospitaldevicesandsupplies/ho spitalbeds/ucm585737.htm
  • Cohen B, Cohen CC, Loyland B, Larson EL. Transmission of health care-associated infections from roommates and prior room occupants: a systematic review. Clin Epidemiol 2017; 9:297-310.
  • Garvey MI, Wilkinson MAC, Bradley CW. Wiping out MRSA: effect of introducing a universal disinfectant wipe in a large UK teaching hospital. Antimicrobe Resist Infect Control 2018; 7:155.
  • Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006; 6:130.
  • Ledwoch K, Dancer SJ, Otter JA. Beware biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multi-centre study. J Hosp Infect2018;100(3): e47-e56.
  • Mitchell BG, Hall L, White N. An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial. Lancet Infect Dis. 2019; (published online March 8): http://dx.doi.org/10.1016/S1473-3099(18)30714-X
  • Occupational Safety & Health Administration (OSHA), Frequently Asked Questions: What does OSHA currently accept as “appropriate” disinfectants to prevent spread of HIV and HBV? (Bloodborne Pathogens update): https://www.osha.gov/html/faq-bbp.html and OSHA Standard Interpretations #1910.1030, February 28, 1997:  https://www.osha.gov/laws-regs/standardinterpretations/1997-02-28-1 and question Q35 of OSHA’s FAQ concerning the current Bloodborne Pathogens Standard: https://www.osha.gov/laws-regs/standardinterpretations/1993-02-01-0
  • Pronovost P, Needham D, Berenholtz S. An intervention to decrease catheter-related bloodstream infections in the ICU. NEJM 2006;355(26):2725–32.
  • Santajit S, Indrawattana N. Mechanisms of antimicrobial resistance in ESKAPE pathogens. Biomed Res Int 2016; 2016:2475067:1-8.
  • Stone PW. Economic burden of healthcare-associated infections: an American perspective,” Expert Review of Pharmaco-economics & Outcomes Research, 2014;9(5):417-22. https://www.ncbi.nlm.nih.gov/pmc/articles/
  • United States Census Bureau: The Next Four Decades: The older population in the United States: 2010 to 2050 Population Estimates and Projections. U.S. Department of Commerce Economics and Statistics Administration U.S. Census Bureau. Current Population Report by GK Vincent & VA Velkoff, Issued May 2010: https://www.census.gov/prod/2010pubs/p25-1138.pdf
  • Environmental Protection Agency (EPA) of the United States. EPA Product Performance Test Guidelines, OCSPP 810.2200: Disinfectants for Use on Environmental Surfaces, Guidance for Efficacy Testing. Accessed March 30, 2019: https://www.regulations.gov/document?D=EPA-HQ-OPPT-2009-0150-0036 and OCSPP 810-2400: Disinfectants and Sanitizers for Use on Fabrics and Textiles-Efficacy Data Requirements: http://www.regulations.gov/document?=EPA-HQ-OPPT-2009-0150-0024%20(2).pdf
  • Vickery K, Deva A, Jacombs A. Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit. J Hosp Infect 2012;80(1):52-5.
  • World Health Organization (WHO). International spread of disease threatens public health security. World Health Report 2007:  https://www.who.int/mediacentre/news/releases/2007/pr44/en/

Does Cleaning Mold from Carpet Work?

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There is considerable confusion in the minds of restoration professionals regarding the proper approach to carpets that are part of a water loss where visible fungal growth is present. While it is the practice of many organizations to clean carpets subjected to Category 3 water loss, despite the potential for sickness from biological contamination in the water that is extracted prior to cleaning, there is greater hesitation in addressing wet carpet with visible colonies of fungus. Part of this hesitation lies in the nagging concern that standard cleaning protocols for carpets may not be removing all the fungal organisms. Unless the mold is properly removed, the restoration contractor is failing in their duty to return the structure to a pre-loss condition.

Real World Test

In the fall of 2018, an opportunity to evaluate the effectiveness of carpet cleaning procedures and chemistry for fungal contamination situations became avail-able to Wonder Makers Environmental. One of our clients had a good-sized office building (approximately 14,000 square feet) that was dormant as they awaited a new tenant. The maintenance staff checked the building on a monthly basis to make sure no problems arose and were surprised in September when they entered and were immediately assaulted with a dank, musty odor. Moving from the tiled vestibule to the main part of the structure revealed the source of the odor: fungal growth on the carpet in virtually every part of the building.

Since mold contamination is the symptom, the maintenance crew began looking for the cause; some source of water intrusion or high humidity. Soon, they were walking on squishy carpet and following the water trail back to a water heater closet. Although the review sched-ule confirmed the leak was less than 30 days old, conditions in the building suggested the water heater had been mal-functioning for weeks.

Images one through five provide some representative images of the condition of the building with one of the most obvious signs that water had been coming out of the heater for quite some time: the presence of mushrooms growing from the carpet. The main lobby shown in figures one and two had the most fungal colonies as well as the colonies that were largest in size. Many of the fungal colonies on the carpet throughout the building showed various colors, but laboratory analysis indicated they were primarily Aspergillus/Penicillium-like molds.

Initial Assessment

After conducting a general survey of the structure and shutting off the source to the water heater, the decision was made to have a professional assessment of the situation conducted. In addition to a visual review, both representative air and surface samples were collected in order to form the basis for a scope of work.

At first glance, the results of the spore trap air samples were not that “bad”. The indoor fungal levels were all lower than the comparison outdoor sample. How-ever, a deeper review told the real story.

The high outdoor spore level was typical for the location and the season with nearly 90 percent of the recovered mold spores identified as ascospores, basidiospores, and Cladosporium. The mold most prevalent on the carpet, Aspergillus/Penicillium-like spores, accounted for less than 5 percent of the outside spore load. In contrast, the percentage of Aspergillus/Penicillium-like spores found on the interior sample ranged from 10 to 51 percent of the total. These high per-centages in the air samples were an obvious reflection of the presence of those types of molds on the floor. The extent of mold on the carpet resulted in the laboratory classifying the contamination as “Category 5”, their most serious rating.

The analysis sheet also noted that the floor sample, which was collected with a Bio-Tape, contained fungal material estimated at an astound-ing 90-99 percent of the sample constituents. It further indicated that 50 per-cent of the fungal materials were spores of Aspergillus/Penicillium-like molds and the other 50 percent were hyphal mate-rial. Overall, a very high level of spore producing structures was observed.

The good news in the situation was the fact that the carpet is a commercial grade with no natural fibers glued directly to the concrete slab. The small area of carpet around the water heater that was soaked and supporting mush-room growth was slated to be removed as part of the mold remediation of the mechanical closet. But, that amounted to only 500 square feet, with the rest of the carpet supporting mold growth due to elevated levels of humidity in the building.

The Remediation Approach

All of this data led to the decision to clean the majority of the carpet rather than remove it. Nevertheless, the cleaning had to be conducted as a mold remediation project to guarantee the safety of the remediation crew and to ensure the carpet was returned to a “pre-loss condition”. Given that approach, the well-respected mold remediation method of “HEPA sandwich” cleaning was adopted into the project work procedures (HEPA sandwich refers to a three-step cleaning process with wet cleaning “sandwiched” between two thorough cleanings with a HEPA-filtered vacuum).

The work procedures indicated that the initial HEPA vacuuming of the carpet should be conducted by individuals trained in mold remediation procedures and with the individuals utilizing appropriate personal protective equipment.  Protective body covering, gloves, and respiratory protection with an N-100 filtering face piece were laid out as the minimum safety gear. The carpet cleaning also involved the removal of all unnecessary materials from the areas to be cleaned; especially the debris in some of the offices and hallways.

Since HEPA vacuuming with overlap-ping strokes of the vacuum floor tool was designated as the initial response to the mold, the work procedures were adamant that no beater bar or other attachments that create substantial agitation would be used. Following the initial vacuuming, hot water extraction of the previously vacuumed carpet using an EPA-registered antimicrobial specifically designed for carpet cleaning was re-quired. Use of a truck mount system was strongly recommended in order to apply hotter water and greater extraction suction to the carpet than what is normally provided by portable units.

The third piece of the sandwich in-volved quick drying of the cleaned carpets through the use of dehumidifiers, HEPA filtered negative air machines set up to run as air scrubbers, and floor fans. A second HEPA vacuuming of the carpets once they were confirmed to be dry was also conducted.

Product Selection

Finding an EPA-registered antimicrobial specifically designed for carpet cleaning that would work effectively on mold was tricky. After reviewing a presentation by three professors at Georgia State University entitled “Cleaning-Sanitizing of Carpet Tile: Protocol Development and Health Perspectives”, a decision was made to utilize a two-part cleaner called Bio-Oxygen Carpet Cleaner manufactured by Artemis Bio-Solutions Inc.* Figure 6 shows the results from one of the tests conducted using that product which indicates no microbial growth occurred following the cleaning.

The building owner turned execution of the work procedures over to a local SERVPRO franchise. Figure 7 shows the key step in the middle of the HEPA sandwich underway. Note the HEPA air scrubber operating in place to both collect airborne spores that may have been liberated by the hot water extraction and to provide a source of air movement to accelerate the drying of the carpet.

Post-sanitizing culture of IPS 48 carpet

Impressive Results

Once the carpet cleaning was finished, the cleaned areas were subjected to a detailed visual inspection. Seven of the eight areas were exceptionally clean and sampling of those sections of the build-ing was done. One of the areas failed the visual review, but not because of the cleaning protocol. The workers conducting the remediation in the negative pressure enclosure used an inside hallway for access; their foot traffic on the newly cleaned carpet forced a re-cleaning of that section of the building.

Figures 8 and 9 are photos of the post remediation sampling.

Post Remediation - Photo 7
Post Remediation - Photo 8
Post Remediation - Photo 9

Once again both spore trap air samples and Bio-Tape surface sample were collected following the visual inspection. The spore trap samples were taken at floor level rather than the normal breathing zone height in order to create a worst case scenario in regards to the carpet cleaning. In the main lobby, the area most heavily impacted with carpet mold, the air sample results went from 6,028 spores per cubic meter of air (s/m3) with 5,500 0f those being Aspergillus/Penicillium-like spores to 48 total s/m3 with zero Aspergillus/Penicillium-like spores. The surface sample results were equally as impressive.

While this is only a single case study, the approach taken and the information collected should serve as a clear indication that mold contaminated carpets can be successfully cleaned. The key lessons of using personal protective equipment for workers involved in the initial HEPA vacuuming, treating the work as a mold remediation project, and choosing the equipment and chemicals that have a documented history of success in eradicating fungal contamination are ones that can benefit the entire industry.

BioSheen, Artemis Clean Home that Became a Bio-Hazard Due to Unattended Death

Wood Dale, Illinois-based Artemis Bio-Solutions, LLC (Artemis) has announced the addition of Jeff Jones to its organization. Jones will lead a new training division for Artemis, which will feature a new, multi-level, bio-risk mitigation training institute with professional accreditations. Jeff’s wife and business partner, Lori Jones has also joined Artemis.

Jones is the Founder of Oklahoma City-based Bio-Sheen Services, LLC. He is regarded as one of the nation’s top forensic cleaning experts and a popular keynote speaker nationally on the topic. He also holds Master Trainer and Director of Forensic Operations designations for the Global Biorisk Advisory Council (GBAC), and was instrumental in developing its online training program for ISSA (International Sanitary Supply Association).

“Artemis is thrilled to have Jeff on board and the expertise he brings,” said Brad Smith, Vice President, Artemis Bio-Solutions. “Jeff’s a big proponent of our products, and we feel the same about helping more people gain a higher level of expertise in our industry.”

“We’re not talking about a spot on the carpet,” Jones said. “Some of these people will be responding to very hazardous environments. Safety is our prime directive. I want people to leave this training with the knowledge, skill sets and empowerment to make the world a better place. That’s the mission.”

“We have an unprecedented need to train people to properly clean and disinfect facilities. And who better to learn from than one of the very best,” said Clay Hernandez, National Director of Technical Sales and Training at Artemis.

Together, Hernandez and Jones are fast-tracking an early June debut of the program. It will be a multi-level program spanning four days, featuring a combination of intensive classroom learning and real-life, situational hands-on application of that knowledge.

The Value of Health

In the last 20 years, mold remediation has gone from the “new kid on the block” to an established  subsection of the restoration industry. However, one of the things that sets mold remediation apart from responding to water losses and fires is the medical component tot many mold cases. In an odd twist, as we get and keep our buildings cleaner, and spend more time inside, a larger percentage of individuals develop sensitivities to indoor contaminants such as mold. A review of the current medical data explains that the percentage of the population with genetic predisposition to mild mold sensitivity is nearly 20%. Of that group, 1-3 % can develop a much more severe sensitivity to mold exposure.

Mold Sensitivity Is a Reality

Sadly, the trigger to real health problems for individuals who do not know that they are genetically susceptible to mold issues is often a poor mold remediation project. Whether the sensitivity comes about because of a long-term exposure to smaller amounts of mold from an undiagnosed or unaddressed water/mold issue, or a big exposure from poor remediation which is not properly isolated, the medical effects are real. In addition to typical allergy symptoms such as watery eyes, runny nose, sneezing, coughing, and headaches, people that become sensitized to mold can experience a whole range of seemingly unconnected symptoms. It is not uncommon for the mold sensitized individuals to experience debilitating symptoms such as excessive fatigue, abdominal issues, mood swings, blurred vision, memory and concentration problems, vertigo and balance issues, and a host of other problems.

(Illustration 1 is an expanded list of symptoms often experienced by individuals who become sensitized to mold, but it is by no means complete.)

While there is a growing cadre of medical professionals who recognize the importance of diagnosing mold sensitivities and controlling exposure to fungal contaminants, such health problems are not yet in the mainstream of the consciousness of medical professionals. The frustration that mold sensitized individuals go through in finding the right medical professional to assist them is matched only by the frustration they experience with mold remediation contractors who do not understand that remediation for mold sensitized individuals is different than most other projects. Although the same primary steps are completed, the remediation effort has to be done with attention to detail that is far greater than standard remediation and reconstruction work.

A Specialized Niche for Mold Remediation Contractors

If improper or incomplete mold remediation actually causes the sensitization, the remediation contractor needs to respond properly. Once the sensitization has occurred, the first step in assisting the ill individual is to stop dismissingthe client’s concerns as bogus. For mold professionals who want to properly evaluate and correct the problems that bedevil sensitized individuals, it is critical that they work with, or assemble, a team to assist the sensitized occupant (see Illustration 2). Indeed, some of the most successful remediation contractors and consultants currently working with mold sensitized individuals are the ones who have carefully evaluated the resources in the area and assembled a team of like-minded professionals who have the goal of helping these especially vulnerable clients get through the process as safely as possible.

Although substantial progress has been made in the last two decades in developing appropriate procedures, industry guidelines, and even regulations regarding mold remediation, most of those efforts have been directed toward remediation that produces an environment that is safe for typical occupants. However, experience has shown that such “standard” remediation projects, even when done in full compliance with the current industry standard of care, often are not enough to create a safe environment for individuals who have become sensitized to mold.

The most common problem with typical mold remediation projects is that the scope is not broad enough. Illustration 3 shows the large variety of different factors that need to be addressed when dealing with mold sensitized individuals. Too often, a mold remediation project deals with the visible source and fails to address secondary contamination of contents, unimpacted surfaces, the HVAC system, and even the overall performance of the structure. Restoration contractors that also have a rebuild division can find the work with mold sensitized individuals to be both challenging and rewarding because they can fix the existing problems and make corrections to the structure that prevents problems from developing in the future.

Most projects involving mold sensitized individuals require a full structure cleaning as one of the last steps. Specifically, after the source material removal, HVAC cleaning, and content decontamination have been addressed, residual contamination remains. Adjustments to the standard “HEPA sandwich cleaning technique” are often required to meet the stringent standards utilized to evaluate the effectiveness of a full house cleaning for mold sensitized individuals.

One of the most critical aspects of working successfully with sensitized individuals is knowing that the typical criteria used to evaluate project success are generally not good enough. Comparing indoor spore levels to out­of-doors and having fewer inside often fails to bring relief to the client because the contractor is returning

the structure to a “normal fungal environment.” However, sensitized individuals generally have to have an environment after the work is completed which is clearer than normal. Although a variety of techniques can be used to evaluate the work area and/or whole structure after cleaning, the criteria used to gauge the results needs to be clearer understood by all the parties before work begins.

Another important factor that should not be overlooked is that a quick glance at the chart reinforces the importance of developing the team approach in addressing the multiple problems of the client. Too often, the contractor who wants to help, and shows some competence in this specialized area, becomes “the answer” for the client. That quickly will put the restoration contractor in the dangerous position of trying to answer questions that should be addressed by medical professionals, assessors, and even a banker.

The Problem Is Real, Contractors Can Help and Add to Their Book of Business

A small subset of mold remediation assessors and contractors have figured out how to be successful in

the specialty market of mold remediation for sensitized individuals. Rather than just being frustrated by the mold situation that is often described as in”.olving a “crazy” person, these assessors and remediators have built on the standard remediation protocols to make them more effective for individuals who are physically unable to tolerate even small amounts of fungal contamination.

There are many sampling options that can be used for projects with sensitized individuals. Regardless of the inspection/sampling technique, clear endpoints have to be established and communicated before work begins.

Air samples can include:

  • Particle counter
  • Culture plates that collect spores
  • by impaction or settlfng
  • Spore trap using different types of cassettes
  • Electronic instruments that actually categorize mold spores as compared to dust (such as Instascope)

Surface samples can include:

  • Environmental Relative Moldiness Index (ERMI)
  • Tape lift

Surface samples can’t include:

  • Nasal swabs for viable spores
  • Urine samples for Mycotoxins

Fighting Pathogens on the Front Lines of a Pandemic: Microbial Warriors Program Proves a Timely Solution

If the last year and a half has proven anything, it is that the world is changing around us quicker than we can imagine. Here at PuroClean, in our world-class training academy, our mission is to arm our franchise owners with the tools and training they need to remain ahead of the game in this very unique new world.

Late last year, looking at the future of the research and development within the industry, I reached out to my colleague and friend from Artemis Biorisk Training Academy, Certified Bio-Forensic Restoration Specialist Jeff Jones, to talk innovation.

As a Certified Forensic Operator, Jeff brings more than 50 years of field experience in forensic restoration to the table. Jeff is a former U.S. Army soldier, and former SWAT team leader, and the youngest person to ever attend the FBI Academy in Quantico, Va. Jeff developed a course called the Microbial Warriors training program and in working together, we’ve been able to bring this groundbreaking, one-of-a-kind, specialized process to communities across the country. A valued asset, Jeff has helped members of the PuroClean network learn how to restore properties affected by biohazardous and infectious agents. As we sat down to look at how to introduce his Microbial Warriors course to our PuroClean owners, there were many moving parts that were taken into consideration.

We know that in many cases, when we are called to complete these types of jobs, the customer who makes a call for services is going through a particularly traumatic event. Whether it is the passing of a loved one or cleaning up a graphic scene inside someone’s home or business, there is a psychological consideration that must accompany our teams to complete this work. From our customer service agents to our owners and technicians, the most important aspect of this type of work is to consider the person on the other end of the phone and help alleviate any stresses related to the incident in a professional yet caring way.

Furthermore, while Microbial Warriors training teaches the specific processes involved in the actual cleaning, we must also consider what the work we are doing means for our customers and their families in their properties as it affects their lives. 

Microbial Warrior Experience Training
Microbial Warrior Experience Training

Upon graduation from this program, PuroClean franchise owners and their technicians return to their communities with a refined skillset, able to tackle more comprehensive forms of biohazard remediation. The course covered the specialized techniques to properly handle pathogens, hoarding, crime scenes, human waste and unattended death sites resulting in human decomposition, but it also incorporates ways to confront the more difficult human elements and the psychology that goes into this part of our work. 

The inaugural graduating class of the Microbial Warier Experience
The inaugural graduating class of the Microbial Warier Experience

As a national service brand with more than 360 franchise locations in North America, professionals at PuroClean handle biohazard situations almost daily. With our rapid response timing of under two hours, our industry is built on the efficiency of our technicians arriving on site ready to perform the task at hand quickly and effectively. While the Microbial Warriors niche skillset that Jeff developed is not one that any person particularly wishes to have to use, we recognize that those who can perform these services serve a vital role in the restoration industry in the reality of what communities’ face all over the country. 

As the end is not yet in sight of the COVID-19 pandemic, this course comes at a timely point in our onboarding and training of new owners to develop the important work our business leaders completed during 2020. This past year, more than ever, maintaining the home free of infection became a priority for families around the globe. COVID-19 and other infectious pathogens have posed a threat to the health of millions, reminding us of the importance of being proactive in our cleaning procedures and training. At PuroClean, this notion is especially important because people rely on our teams to carry out these services, and our constant training allows the company to do just that. Jeff was a valued asset for the development and execution of this inaugural class, as he is a past president of the Restoration Industry Association (RIA) and has served as chairman of its forensic council. I’m so proud of our graduates and am honored that Jeff could be a part of the way we educate our leaders, really taking our training to the next level in so many ways.  A new future lies ahead, and thanks to an innovative mindset and partners like Jeff, our network is ready. It is important to note, that the success of this class was made possible with the help of our key partners Contec, Foam-It, Kleenrite, MAXAIR, Artemis Bio-solutions and Serum. A solid team can accomplish more together than they would individually. This is why so many success stories come from companies who find business partners to help them reach their goals and provide the best training. A mutual passion is a good way of cementing bonds between partners.

Artemis Bio-risk Training Academy Pilots The Microbial Warrior Experience At PuroClean

The new Artemis Bio-risk Training Academy (ABTA) wasted no time in piloting its new  four-day forensic restoration training program. The Microbial Warrior Experience™  presented by Jeff and Lori Jones debuted June 3 through June 6, 2021 at the PuroClean  Training Center in Tamarac, Florida. A dozen PuroClean franchisees, as well as  representatives from KleenRite attended.  

“I thought it went extremely well,” said Clay Hernandez, National Director of Technical  Sales and Training at Artemis. “Jeff has developed and delivered programs like this  before, and he certainly has a rare talent for grabbing an audience’s attention.”  

“Not only was the instructor phenomenal and his methodology effective, but his  enthusiasm for what he does affected us all,” said Karen Argus, PuroClean of Stuart, FL.  “We spent the first two days learning the process, the reasons for the process, and we  were shown firsthand what that process looks like at an actual job.”  

“If I were giving the class a score, I would give it an A+,” Argus added.  

“We are very thankful to PuroClean for hosting us at their training facility,” Jeff Jones  said. “We are passionate about sharing not only what we know, but how to do it safely.  

“Forensic restoration isn’t just crime and trauma situations,” Jeff added. “It’s also about  unsanitary dwellings aka hoarders, dealing with infectious disease, bio-terrorism,  contamination from animals; it’s the complete remediation of contaminated structures to  pre-event conditions.”  

Jeff Jones is one of the nation’s top forensic cleaning experts. He founded BioSheen  Services, LLC of Oklahoma and Texas with Lori Jones. Along with the Microbial Warrior  Experience™ curriculum, Jeff and Lori created the Certified Forensic Operator®  designation, which attendees earn along with other additional designations.  

Jones’ Microbial Warrior Experience™ is an equally applied combination of in-class  education and hands-on application. The curriculum spans everything from  communicating with family members following an event, to a simulated forensic  restoration scenario where attendees must actually don full PPE and restore a setting to  a safe, bio-hazard free condition.  

“We will probably do one or two more pilots before year-end and take what we’ve  learned and apply it to the program,” Hernandez said. “But we couldn’t be happier with  how the inaugural class went and for having a great organization like PuroClean to be  able to share it with first.” 

To learn more about the Artemis Bio-risk Training Academy and news about the next  Microbial Warrior Experience, call 630-359-4090.  

Jeff Jones Joins Artemis To Launch New Bio-Risk Training Institute

Wood Dale, Illinois-based Artemis Bio-Solutions, LLC (Artemis) has announced the addition of Jeff Jones to its organization. Jones will lead a new training division for Artemis, which will feature a new, multi-level, bio-risk mitigation training institute with professional accreditations. Jeff’s wife and business partner, Lori Jones has also joined Artemis.

Jones is the Founder of Oklahoma City-based Bio-Sheen Services, LLC. He is regarded as one of the nation’s top forensic cleaning experts and a popular keynote speaker nationally on the topic. He also holds Master Trainer and Director of Forensic Operations designations for the Global Biorisk Advisory Council (GBAC), and was instrumental in developing its online training program for ISSA (International Sanitary Supply Association).

“Artemis is thrilled to have Jeff on board and the expertise he brings,” said Brad Smith, Vice President, Artemis Bio-Solutions. “Jeff’s a big proponent of our products, and we feel the same about helping more people gain a higher level of expertise in our industry.”

“We’re not talking about a spot on the carpet,” Jones said. “Some of these people will be responding to very hazardous environments. Safety is our prime directive. I want people to leave this training with the knowledge, skill sets and empowerment to make the world a better place. That’s the mission.”

“We have an unprecedented need to train people to properly clean and disinfect facilities. And who better to learn from than one of the very best,” said Clay Hernandez, National Director of Technical Sales and Training at Artemis.

Together, Hernandez and Jones are fast-tracking an early June debut of the program. It will be a multi-level program spanning four days, featuring a combination of intensive classroom learning and real-life, situational hands-on application of that knowledge.

Meet the Artemis Bio-Solutions Leadership Team at the 2021 Experience Conference and Exhibition


The industry’s best expo for cleaning and restoration know-how, equipment and products is fast approaching and Team Artemis will be there just inside the main entrance at Booth 629.

April 19 – 21
Embassy Suites by Hilton
Charleston Airport Hotel & Charleston Area Convention Center
Charleston, SC

On Monday, April 19, at 3:15pm see industry colleague and Certified Bio-Forensic Restoration Specialist®, Jeff Jones co-deliver the keynote address: Parabellum Microbe: Prepare for Microbial Warfare. Here, Jeff presents critical information about the Professional Protocols and Procedures of Forensic Restoration to safely conduct basic operations as caretakers of the human condition.

After Jeff’s keynote, stop by our booth (629) between 4:30pm and 7:30pm to meet the Artemis team, including Brad Smith, Clay Hernandez, and Kim Sutherland to find out what’s new at Artemis (there’s a lot to talk about) and grab a freebie.

EXHIBITION HOURS:
– Monday, April 19th – 4:30 – 7:30 pm
– Tuesday, April 20th – 2:30 – 5:30 pm
– Wednesday, April 21st – 12:00 – 3:00 pm

On Tuesday morning, April 20, at 9:35am, Clay Hernandez hosts: How To Make The Right Decisions About Disinfectant Delivery Systems. In this session, Clay details the latest thinking for attendees on disinfectant application devices, new EPA requirements,
and the use of PPE as it applies to specific application systems.

We hope to see you there!

Artemis Bio-Solutions to Host Webinar on Using Chemical Disinfectants for Pandemic Response

Michael Pinto, CSP, CMP will lead the presentation. Pinto has authored more than 230 articles and several books related to the remediation industry.

Artemis Bio-Solutions will host an interactive webinar on Wednesday, Nov. 18 at 2:00 PM Eastern Standard Time to educate people on the proper use of chemical disinfectants, with an emphasis on their use for response to the coronavirus pandemic.  Titled, Understanding Chemical Disinfectants and Using Them Properly for Pandemic Response, the program will be led by industry expert, Michael Pinto, and last approximately one hour.

Register now for the free webinar.

Participants can expect a fast-moving program that covers important aspects of using antimicrobial chemicals, including the types of hazards these chemicals can address, the different classes of chemicals that can be used as disinfectants, proper application methods and tips for using antimicrobials more effectively, precautions to be taken when applying disinfectants and using chemical disinfectants in response to large remediation projects, including the current pandemic.

During the online event, participants can ask questions through an interactive Q & A feature, and Pinto will answer following his presentation.  

Artemis Bio-Solutions is a leading provider of chemical disinfectants, decontaminants, sanitizers and equipment used by professional remediators and restoration companies, U.S. Federal agencies, schools, medical facilities, restaurants, corporations and other people at home to maintain healthy environments. 

Restoration and Remediation Industry Veteran Clay Hernandez Joins Artemis Bio-Solutions

WOOD DALE, Ill., Sept. 8, 2020 — Clay Hernandez has been named National Director of Technical Sales & Training at Artemis Bio-Solutions, LLC, the bio-technology company that manufactures and markets advanced, safe and effective disinfectants, decontaminants, deodorizers and sanitizers.

Hernandez will lend his 16 years of field experience in the professional restoration and remediation industry to Artemis’ current customers by recommending the most effective uses of the company’s products. He also will direct technical sales and training efforts on Artemis products, and effective disinfection and decontamination techniques and protocols, to people both inside and outside the company.

Hernandez will be based at the company’s Wood Dale, Ill. facility.

Prior to joining Artemis, Hernandez was Division Manager, Signal Restoration Services, where he directed the company’s coronavirus pandemic field response efforts. He previously held leading roles at EcoShield Microbial Protection Systems, Innovative Decon Solutions and Service Master 24 Hour.  Hernandez is a licensed Mold Assessor and Mold Remediator in the State of Florida.

Hernandez holds a number of industry licenses and certifications, including: Florida Mold Assessor, Florida Mold Remediator, GBAC Certified Technical Operator, IICRC WDR, IICRC ASD, Crime and Trauma Scene Bio-Recovery Technician, Renovation Best Practices in Health System Facilities, HAZWOPER 40-Hour and LEAD Renovator. 

“Clay brings a wealth of experience and knowledge to us that I know our customers will appreciate,” said Brad Smith, Artemis’ Vice President, Sales and Business Development. “We know that he’ll make a tremendous, positive impact that will help grow our business.”

“I have been a client of Artemis Bio-Solutions for over 10 years and have been using the Sandia National Lab’s formulations since 2006,” said Hernandez. “I am looking forward to working with such a great group of individuals and growing the company by providing products and equipment to create safer, heathier, more sustainable environments for people across the globe.”

Headquartered in Houston, with sales and warehouse operations in Wood Dale, Ill., Artemis Bio-Solutions manufactures and markets a full line of high-quality, technologically advanced disinfectants, decontaminants, deodorizers and sanitizers. The company also provides proven application protocols and equipment, and it maintains a network of strategic partners to provide environmental cleaning and disinfection services, emergency response services, staff training and certification.

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