**Interim Recommendations for Cleanup of Commercial and Residential
Buildings Following *Bacillus anthracis* Spore Release **

# 1. Introduction

I.  This document provides interim recommendations for clean up after a
    release of *Bacillus anthracis (B.anthracis)*. The U.S.
    Environmental Protection Agency (EPA) has primary authority in
    matters concerning environmental hazards and cleanup. EPA reviewed
    and commented on this guidance document.

The issues involved in cleanup of a workplace, residence or other type
of structure contaminated by *B. anthracis* spores vary significantly
from place to place. These differences preclude the development of
universal recommendations. Decisions regarding a strategy for cleanup
must be based on each situation. Consult with the EPA, state or local
health departments, the manufacturers of building contents, building
owners or managers and others, as needed. This document provides
information and guidance regarding issues that must be considered for
cleanup of a contaminated building. The key issues covered here include:
the conduct of a site assessment, development of a cleanup plan,
selection of cleaning materials and disinfectants, selection of personal
protective equipment, and disposal of contaminated solid waste and
liquids.

2.  **Site Assessment and Cleanup Plan **

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I.  **2.1 Site Assessment **

The site assessment includes an evaluation of the extent of the problem
and confirmation of the presence of *B. anthracis*. Protection of
personnel performing the assessment is a primary concern (). The site
assessment includes a qualitative overview:

1.  \$ How the *B. anthracis* was brought into the facility or dwelling
    (e.g., through a mail package, air handler, or other mechanism).

2.  \$ Possible pathways by which *B. anthracis* could have spread.

3.  \$ The type of environmental surfaces (e.g., ceiling tiles, walls,
    counters, floor covers, air ducts, furnishings, etc.) involved.

4.  \$ The location and extent of contamination, evidence for spread of
    contamination, and potential for re-distribution.

5.  \$ The need for and appropriateness of occupying uncontaminated
    areas during cleanup.

Part of the site assessment includes the collection of environmental
samples to confirm the presence of *B. anthracis*. Strategy and methods
for conducting environmental sample collection are specified in the
following CDC publications: Guidelines for Developing an Environmental
Sampling Strategy for *Bacillus anthracis* in Mail-Processing Facilities
and Procedures for Collecting Surface Environmental Samples for
Culturing *Bacillus anthracis* (). Procedures to package samples for
transport to testing laboratories are specified in CDC publication:
Packaging Critical Biologic Agents ().

If *B. anthracis* contamination is confirmed and occupancy necessary, a
professional remediator, in consultation with local public health and
law enforcement authorities and building managers or owners, should
develop a comprehensive remediation plan that meets environmental and
occupational health objectives. The site remediation plan must include
safety and infection control procedures that protect cleanup workers
inside and outside the area, and includes site and task-specific work
plans for post-remediation sampling, contaminated area isolation,
recovery of critical items, remediation and verification sampling. These
interim recommendations describe administrative, engineering,
housekeeping controls, and personal protective equipment (PPE) issues
essential to building cleanup procedures that should be addressed within
a site remediation plan.

I.  **2.2 Cleanup Procedures**

II. **2.2.1 General guidance **

Overall approaches to cleanup vary depending on whether contamination is
localized or occurs throughout the building. There is no single
procedure or guideline for disinfection of spaces and materials
contaminated with *B. anthracis*. Judgment based on a thorough
understanding of the extent of the original contamination is used to
define the degree of cleaning required. It is likely that a single
cleaning approach will not be suitable for all local and building-wide
*B. anthracis* contamination scenarios.

The selection of cleanup option(s) should be based and prioritized on:

-   Biocidal performance on non-porous and porous vertical and
    horizontal surfaces

-   Compatibility with the contaminated material to minimize the
    creation of additional hazardous conditions

-   Ability to minimize generation of hazardous waste

-   Minimization of post-cleanup adverse health effects

-   Effectiveness of cleanup options

All cleanup strategies should be developed by a team of qualified
experts with experience in biological and or infectious disease control
with input from the building owner/operator, architect, employees and
other knowledgeable persons most familiar with the design, layout, and
operation of the building structure and processes. The strategy for
cleanup should be reviewed and approved by local public health and
safety authorities.

**2.2.2 Administrative Controls**

I.  Worker safety and health during the cleanup of a site contaminated
    with *B. anthracis *is covered under a number of regulations that
    should be followed by the employer. A key standard is **29 CFR.**
    Hazardous Waste Operations and Emergency Response (HAZWOPER
    --1910.0120 ). Employer responsibilities include, but are not
    limited to, the following key items:

-   Develop a comprehensive site-specific health and safety plan in
    consultation with local public safety and health authorities prior
    to implementing any remediation activities.

-   Develop a medical surveillance program

-   Develop a personal protective equipment program

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-   Ensure that all remediation workers who will be wearing respirators
    have a current respirator fit test (**29 CFR.** Respiratory
    Protection. - 1910.134 ).

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-   Ensure that remediation workers have received appropriate safety and
    infection control training and in-service education. All designated
    decontamination team members should have the following minimum
    training experience:

    -   40 hour hazardous waste operations training.

    -   Basic hazard communication training concerning *B. anthracis*
        and the specific decontamination chemicals to be used on the
        site.

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-   Develop strategies for security and emergency response in
    consultation with local public safety and public health officials
    prior to beginning cleanup activities.

Other recommended administrative controls:

-   Develop strategies to restrict the number of persons entering,
    working or adjacent to contaminated sites to limit exposure to
    aerosolized particles generated during cleanup and disposal
    operations.

-   Due to the possibility of breaches of personal protective equipment
    and exposure of workers, CDC recommends that decontamination/cleanup
    workers receive antimicrobial prophylaxis. Prophylaxis will entail
    the use of standard regimens starting in conjunction with or prior
    to the time of first entry into a contaminated site and continuing
    for 60 days after final opportunity for exposure. The current
    recommended regimens (for adults) are as follows:

Ciprofloxacin, 500 mg by mouth every 12 hours, or

Doxycycline, 100 mg by mouth every 12 hours

A medical protocol should be developed to implement prophylaxis, and the
program should be under the supervision of an experienced physician.
These recommendations may be modified as additional information becomes
available (Centers for Disease Control and Prevention. (2001)
Antimicrobial Prophylaxis to Prevent Anthrax Among
Decontamination/CleanupWorkers Responding to an Intentional Distribution
of *B. anthracis*).

-   For workers who may have prolonged or repeated employment on sites
    potentially contaminated with *B. anthracis*, CDC recommends routine
    vaccination with anthrax vaccine adsorbed (AVA). Consultation with
    an experienced physician should be made before receiving the
    vaccine. Immunization consists of three subcutaneous injections
    given 2 weeks apart, followed by three additional subcutaneous
    injections at 6,12, and 18 months.

    -   (Centers for Disease Control and Prevention: FAQ's about
        Anthrax: ;

    -   Centers for Disease Control and Prevention (2000) )

# 2.2.3 Engineering Controls

Develop strategies to minimize the aerosolization of *B. anthracis* to
reduce the risk of inhalation anthrax, the most severe form of the
disease. Engineering controls must be in place to prevent operating
machinery and air-conditioning (HVAC) systems from spreading spores, and
to prevent the redistribution of spores by personnel and equipment,
removal of PPE, as well as waste collection, storage, transport and
disposal activities.

I.  **2.3.4 Personal Protective Equipment **

Personnel entering the area to conduct sampling or cleanup activities
will wear the level and type of personal protective equipment (PPE)
appropriate to the expected hazard. Protective clothing (including
chemical protective coveralls, shoe covers, and gloves) prevents skin
exposure to spores or to disinfectant, and prevents contamination of
street clothes. Eye protection must be used to prevent splash exposure
to disinfectants (a full‑facepiece respirator provides splash
protection). Respiratory protection must be selected in accordance with
the level of respiratory exposure hazard (biological & chemical). The
Permissible Exposure Limit (PEL), Recommended Exposure Limit (REL) and
the Immediately Dangerous to Life and Health values for selected
fumigants are noted in Appendix A. Refer to the following standards and
recommendations for additional guidance:

-   **29 CFR.** Hazardous Waste Operations and Emergency Response
    (HAZWOPER) --1910.0120 )

-   **29 CFR. **General Requirements** - **Personal Protective Equipment
    ;

-   **29 CFR.** Respiratory Protection. - 1910.134 ;

-   **29 CFR. **Hand Protection. - 1910.138 ;

-   Protecting Investigators Performing Environmental Sampling for
    *Bacillus anthracis*: Personal Protective Equipment. ).

-   Eye Safety: Emergency Response & Disaster Recovery

-   Interim Recommendations for the Selection and Use of Protective
    Clothing and Respirators Against Biological Agents

As personnel leave the contaminated area, they must remove their
protective clothing in a manner that will not spread *B. anthracis*
spores that may be on their protective clothing and equipment. PPE can
be cleaned with a 1:9 household bleach and water. For disposal of dirty
cleaning solutions, cleaning supplies and PPE see Section 4:Disposal of
Waste Materials/Wastewater.

5.  **Housekeeping Controls**

The following housekeeping controls should be considered for effective
cleanup:

-   Develop a cleanup strategy, or combination of cleanup strategies to
    address the surface type to be cleaned (e.g. hard surface, porous
    material, or fabric).

-   Select disinfectants based upon the proven effectiveness against the
    spore form of the *B. anthracis*. The microbial and sporicidal
    effectiveness of disinfectants are dependent upon the use of the
    appropriate concentration, contact time, temperature, and pH range.

-   Select cleanup strategies on the effectiveness of the
    disinfectant(s) to kill or inactivate *B. anthracis* spores on
    various surfaces (see above). Consideration of secondary effects,
    such as chemical/thermolytic reactions, staining and fading,
    out-gassing and odor, corrosion of metals, and electronics
    compatibility, should receive lower priority than the effectiveness
    of the disinfectant(s).

-   Clean with gentle motions.*** Do not*** clean surfaces using
    compressed air or methods that can generate dust and re-aerosolize
    spores.

-   Clean contaminated areas with wet techniques. ***Avoid ***dry
    sweeping and dusting.

-   Dispose of nonessential materials prior to cleanup to improve
    effectiveness of building cleanup. See Section 4.

-   Handle all contaminated waste materials consistent with local
    medical waste regulations. See Section 4.

-   Wash hands thoroughly with soap and water as soon as possible after
    removing PPE, and before eating.

-   Analyze and interpret results of post-cleanup environmental sampling
    to evaluate the effectiveness of the cleanup procedure. Local
    authorities using the pre-cleaning criteria should conduct this
    step.

I.  **2.2.6 Specific Housekeeping Procedures**

2.2.6.1 Separating \"clean\" and \"dirty\" areas*** ***

Depending upon the size of the contaminated area, the types of surfaces,
and the extent of contamination, it may be necessary to isolate or
seal-off the contaminated area to prevent the spread of spores by the
movement of people or equipment. Based on the recent results
demonstrating the ability of *B. anthracis* spores to be re-aerosolized
during normal office activities, cordoning off a contaminated area is
not recommended.

To isolate or seal-off the contaminated area the following is
recommended:

-   Use impervious plastic (e.g., 6 mil - polypropylene) sheeting to
    devise temporary barriers.

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-   Maintain, using tape, tight seals at the full perimeter of temporary
    walls and at ceiling height in the same way that areas are sealed
    off for asbestos abatement and dust control during building
    renovation (**29 CFR. **Asbestos - 1926.1101, Section G, Part 4. for
    temporary barrier construction guidance).

-   Seal windows and air vents serving the area using plastic sheeting
    and tape to control the risk of dust dispersal and recirculation

-   Keep the area under negative air pressure to prevent the outward
    flow of air to produce a higher level of isolation. Portable
    high-efficiency particulate air (HEPA)-filtered negative air units
    can be used to produce negative pressure environment. This equipment
    may be leased or purchased.

I.  2.2.6.2 Pre‑cleaning

Standard institutional cleaning practices recommend that surfaces be
cleaned prior to disinfection. Any dirt or other material on the surface
to be cleaned will decrease the efficacy of disinfectant solutions.

Use the following procedures to pre‑clean most surfaces:

-   Wet wipe surfaces with a cleaning solution of detergent and water to
    remove existing organic load.

-   Focus on walls and horizontal surfaces. Avoid aggressive
    pre-cleaning (use gentle actions) to prevent the re-aerosolization
    of dust that may contain spores.

For a grossly contaminated area (visible powder) use the following
procedures:

-   Gently flood the contaminated area with a solution of 1 part
    household bleach in 9 parts water

-   Let the solution stand for 30 minutes minimum

-   Clean with the detergent and water solution.

For disposal of dirty cleaning solutions, cleaning supplies and PPE see
Section 4: Disposal of Waste Materials/Wastewater.

I.  2.2.6.3 HEPA-filtered Vacuuming Equipment for Surface Cleaning

II. If vacuum equipment is used in remediation, select heavy-duty
    industrial type

III. vacuums manufactured for hazardous dust abatement activities, with
     sufficient

IV. vacuum strength and durability, and equipped and maintained with
    effective high efficiency particulate (HEPA) filters. HEPA vacuuming
    has been proposed for dust reduction for fabric-covered furniture,
    carpets, electronic equipment, artifacts and other fixed surfaces;
    however, the efficacy of this method is not proven in *B. anthracis*
    remediation activities or laboratory settings. Central, one pass,
    HEPA vacuum system might be preferable to portable vacuum units
    since exhaust air will not blow more dust into the air or
    re-distribute dust into previously cleaned areas. Engineering
    controls, such as isolation tents, must be in place to minimize the
    generation of dust when changing pre-filters and HEPA filter
    materials contained in the vacuums.

V.  **Note: **HEPA vacuuming alone, whether done once or repeated
    several times, may not be sufficient to clean up porous, portable or
    fixed surfaces. See Section 3: Disinfection Methods. Vacuuming of
    carpet may prove to be particularly problematic and both time and
    labor intensive. Filter materials should be collected, stored, and
    disposed in compliance with applicable hazardous solid waste
    regulations see Section 4.

VI. ** 3. Disinfection Methods**

Several methods exist for cleanup. The following options can be
considered by public health authorities to determine the cleanup method
necessary for a safe and acceptable environment.

**3.1 Simple Cleaning**

The steps described for pre-cleaning may remove much of the *B.
anthracis* load from the contaminated surfaces, but is unlikely to
result in adequate surface cleaning.

I.  **3.2 Sodium hypochlorite solution**

To make a solution of sodium hypochlorite mix 1 part household bleach to
9 parts water. This solution will be used to flood non‑porous surfaces.
Using the bleach solution further reduces viable spore load. Porous
surfaces, such as carpets, fabric drapes, acoustical ceiling tile and
wallpaper, can be treated with the bleach solution but must be removed
and properly discarded after treatment. See details in Appendix B.

**Note:** Exposure to sodium hypochlorite solution may cause a number of
health effects:

-   Inhalation: Irritation to the respiratory tract (nose and throat);
    symptoms may include coughing and sore throat

-   Ingestion: Nausea, vomiting

-   Skin contact: Skin irritation

-   Eye contact: Severe irritation and damage, particularly at high
    concentration

-   Aggravation of pre-existing conditions: Persons with chronic
    respiratory disease such as asthma, chronic bronchitis/obstructive
    lung disease, or heart disease may be more susceptible.

**Note: **Some common institutional cleaning agents should never be used
together with bleach solutions. For example, bleach forms toxic gases
when mixed with certain products such as .

a.  **3.3 Disinfecting with Gaseous Formaldehyde using Paraformaldehyde
    crystals**

Gaseous formaldehyde is used to disinfect large contaminated spaces
(such as rooms or buildings). See Appendix C for detailed procedures.

**Note: **Formaldehyde is a potential carcinogen, so this method should
be used only if no other option is practical or realistic. OSHA
standards for Formaldehyde should be followed (**CFR 29** -- 1910.1048
).

I.  **3.4 Other Options for Disinfecting Building Areas**

II. Consideration should be given to innovative technologies when
    current technologies and strategies have shown limited success,
    could create significant

III. financial hardships or unacceptable disruptions of vital services.
     The selection and use of these alternative agents and methods
     should be undertaken in consultation with appropriate public health
     authorities.

IV. Other potentially feasible disinfecting methods and techniques are
    currently under investigation. The use of ozone, ionizing and
    non-ionizing radiation, ultraviolent light, gas fumigants, and other
    than formaldehyde and other alternative disinfecting agents not
    addressed in this document are not currently recommended by the CDC
    due to unknown or unproven microbial and or sporicidal
    effectiveness, and the feasibility of these agents or application
    methods on environmental surfaces in buildings. This determination
    may change in the future as additional information becomes
    available.

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4.  ** Disposal of Contaminated Solid and Liquid Wastes**

All *B. anthracis*-contaminated solid waste and liquids must be handled
in a manner no less stringent than specified medical waste regulations.
Biological wastes, including *B. anthracis*-contaminated materials, are
governed under Resource Conservation and Recovery Act (RCRA) ); and,
State, Territory and Tribal environmental agencies are also authorized
to control the location and method of disposal of *B.
anthracis*-contaminated materials. For information on disposal of
medical waste by state, contact the RCRA, Superfund & EPCRA Call Center
at 1-800-424-9346. In addition, the release of *B. anthracis* into the
environment as a result of a bio-terrorist event triggers reportable
quantity notifications established under CERCLA and, therefore, must be
reported to the National Response Center (1-800-424-8802).

I.  ** 5.0 Special considerations**

II. 5.1 Special Needs for Equipment

Some objects with internal cooling ventilation fans (e.g., desktop
computers) draw cooling air into the case and may include filters or
electrostatic methods to control dust intake. These filters or the
equipment chassis may be reservoirs of contamination. If contamination
is a concern, store the equipment in a sealed plastic bag prior to
environmental cleanup, and consult the equipment\'s manufacturer for
disinfectant compatibility issues.

5.2 Heating, Ventilation, and Air Conditioning Systems

Some *B. anthracis* incidents, particularly those involving spores that
are particularly likely to become airborne, may contaminate air ducts
and other parts of heating, ventilation, and HVAC systems, including
filters. Filters for HVAC systems serving contaminated areas should be
removed and replaced. The filters should be bagged and labeled
appropriately for incineration. Personnel performing these operations
should wear personal protective equipment specified for cleanup.

The HVAC ducts, particularly exhaust ducts, serving the contaminated
area should be sampled for contamination. HVAC dampers should be sampled
if an outside source is suspected. At a minimum, vacuum samples should
be collected from HVAC system filters, and wipe samples should be
collected from room supply registers and return grills. If HVAC ducts
are contaminated, they must be cleaned and disinfected. If mechanical
cleaning and disinfection are not possible, gaseous disinfection may be
needed. Cleanup of fiberglass-lined duct work with biocides is of
concern due to the fact that spores may have been deposited in the
organic material built up in the duct work. Organic material interferes
with the biocidal activity of fumigants, disinfectants and chemical
germicides. In addition, spores may become trapped in the insulating
materials, and depending upon the penetration of the fumigant, may or
may not be fully killed or inactivated.

## 5.3 Shoes, Apparel and Linen

Contaminated shoes, apparel and linen may be discarded in compliance
with local and State regulations for the disposal of pathological waste,
or they may be retained for disinfection. Do NOT launder contaminated
clothing at home. If kept for re-use, contaminated clothing should be
placed into autoclave bags for autoclaving or disinfecting following
infection control guidelines for the collection, transport, and
treatment of biohazard materials.

Dry cleaning cannot be relied on to disinfect clothing contaminated with
*B. anthracis*. Although little is known about the effectiveness of dry
cleaning in destroying bacteria and other microorganisms, it has been
found to be ineffective against some viruses, which are often less hardy
than spores. **Draft: Project #138 -- FAQs on Handling and Cleanup
(Anthrax)**

5.4 Rodent and Insect Vector Control

Cross contamination by crawling and flying insects and rodents may be
possible. A vector control program should be implemented to the extent
feasible based on a site-specific vector control assessment. Control
programs should be developed in consultation with local licensed pest
control authorities and implemented, if possible, prior to any
structural fumigation. Any rodents eradicated through this control
program should be collected for disposal, sealed in labeled plastic bag,
and incinerated. Personnel handling dead rodents should wear appropriate
PPE and follow standard infection control precautions.

5.5 Pets and Other Animals

Pets and other animals may be exposed to *B. anthracis* and should be
quarantined on-site as promptly as possible. It may be feasible to
perform animal cleaning for some species. Animals dying after exposure
should not be handled and should be reported to public health
authorities. Issues related to disinfection, vaccination, prophylaxis,
duration of quarantine, or the decision to euthanize, animals are beyond
the scope of this guideline and should be initiated only in consultation
with a knowledgeable veterinarian, and in compliance with local, State
and international public health regulations or guidelines such as those
contained in WHO Guidelines for the Surveillance and Control of Anthrax
in Human and Animals, 3^rd^ edition ().

5.6 Chemical Sensitive Artifacts, Artwork and Antiquities

## If damage to artifacts, artwork and antiques from cleanup is a concern, store the artifacts in an appropriate and secure location in sealed plastic bags (double bag, if possible) or other appropriate protective container, and label with biohazard warning labels prior to environmental cleanup. Consult appropriate equipment manufacturer, art restoration, or other experts for guidance on effect of cleaning and disinfection measures on the integrity of these items.

**6.0 Public Notifications, Property Transfer and Other Record Keeping**

Related to cleanup and waste disposal activities, the property owner or
manager may be subject to public notification and health and safety
placarding regulations, and hazardous waste manifesting, occupational
health/OSHA, or veterinary record keeping requirements. Other local
property recording and recordkeeping requirements related to property
transfer may be instituted by various other local authorities. Owners or
managers should consult legal counsel to determine their
responsibilities and to fully understand compliance requirements.

** 7.0. Post‑Cleaning Testing, Verification and Notification Prior to
Re-entry**

I.  ** **

II. Wipe samples or vacuum samples will be collected in a representative
    sample of cleaned areas (see separate guidance document for
    sampling). Each of these areas should be sampled using the same
    method by which it was sampled before cleaning. Local authorities
    should interpret the results of post-cleaning environmental
    sampling. If any of these post‑cleaning samples show residual
    contamination, those areas should be cleaned again Prior to
    recleaning, areas without contamination should be isolated from the
    areas with residual contamination as described in Section 2.2.6.1,
    cleaned and resampled.

# The owner or manager of the building is responsible for notification of local unions, management associations, and employees as soon as possible of the results of post-decontamination sampling.

Decontamination verification is required prior to re-entry and
occupation of the premises. Based on current information, the safety of
the public or workers cannot be assured if *B. anthracis*-contamination
is present in the building.

** 8.0 Interim Custodial Cleaning Procedures for Non-Contaminated Areas
Adjacent to Contaminated Spaces**

These guidelines are for routine cleaning and disposition of trash in
areas and facilities adjacent to but not identified as contaminated with
*B. anthracis*. The cleaning of areas adjacent to contaminated spaces
should be specified in the written site-specific safety and infection
control plan previously described.

**8.1** **Custodial Procedures**

-   **Optional protective equipment - **Custodians and waste handlers
    may choose to wear a properly fitted, NIOSH-approved filtering face
    piece respirator (N-95) and nitrile or vinyl gloves for comfort. PPE
    should be inspected frequently, and worn out or damaged gloves and
    respirators can be placed in the trash.

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-   **Reducing dust - **Use wet methods or a vacuum cleaner equipped
    with a high efficiency particulate (HEPA) filter. For wet mopping or
    wiping, a 10% bleach solution (1-1/2 cups of household chlorine
    bleach in 1 gallon of water or 1 part bleach to 9 parts water) can
    be used. Avoid dry mopping or sweeping.

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-   **Changing vacuum bags** - Keep dust to a minimum when changing
    vacuum bags. Put the full vacuum bag gently in a plastic bag. Seal
    the plastic bag and put it in the trash.

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-   **Trash removal** - Put trash into a plastic bag and seal the bag.
    Incinerate or bury trash in a sanitary landfill. Concern about *B.
    anthracis* contamination in locations not experiencing a hazardous
    materials incident does not justify identifying the trash as
    biohazardous waste unless the waste actually does contain
    pathological waste as defined in OSHA Bloodborne Pathogens Standard
    (29 CFR Part 1910.1030 ).

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-   **Integration of existing safety and disaster plans** -
    Pre-contamination emergency preparedness and security plans and
    procedures should be reviewed and revised if needed. In any location
    experiencing a hazardous materials incident, HAZMAT procedures
    should be followed.

-   **Personal hygiene habits for custodians and trash handlers**

-   Cover any open wounds, cuts, scratches, rashes.

-   Don't eat, drink, smoke, or chew gum while working.** **

-   Never reach where you can't see. If you are cut or stabbed by a
    sharp object while handling trash, immediately wash the area with
    soap and water, and report it as soon as possible to your
    supervisor. Seek medical treatment.

-   Wash hands after custodial and trash handling work, and before
    eating.

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**Appendix A. Permissible and Recommended Exposure Limits and IDLH^1^
values for Selected Chemical Fumigants**

+----------------+----------------+----------------+----------------+
| **Disinfectant | **NIOSH        | **Immediately  | **OSHA         |
| Agent**        | Recommended    | Dangerous to   | Permissible    |
|                | Exposure Limit | Life and       | Level (PEL)**  |
|                | (REL)**        | Health         |                |
|                |                | (IDLH)^1^**    |                |
+----------------+----------------+----------------+----------------+
|                |                |                |                |
+----------------+----------------+----------------+----------------+
| Chlorine       | 0.1 ppm TWA^2^ | 5 ppm          | 0.1 ppm TWA    |
| Dioxide        |                |                |                |
+----------------+----------------+----------------+----------------+
| Ethylene Oxide | \<0.1 ppm TWA  | 800 ppm        | 1 ppm TWA      |
+----------------+----------------+----------------+----------------+
| Formaldehyde   | 0.016 ppm TWA  | 20 ppm         | 0.75 ppm TWA   |
|                |                |                |                |
|                | 0.1 ppm 15 min |                |                |
+----------------+----------------+----------------+----------------+
| Glutaraldehyde | 0.2 ppm        | None           | 0.2 ppm        |
|                | Ceiling        | established    | Ceiling        |
+----------------+----------------+----------------+----------------+
| Hydrogen       | 1.00 ppm TWA   | 1.00 ppm       | 75 ppm TWA     |
| peroxide       |                |                |                |
+----------------+----------------+----------------+----------------+
| Peracetic acid | None           | None           | None           |
|                | established    | established    | established    |
+----------------+----------------+----------------+----------------+
| ß-p            | Carcinogen     | Carcinogen     | Carcinogen     |
| ropiolactone§¥ |                |                |                |
+----------------+----------------+----------------+----------------+
| Propylene      | None           | 400 ppm        | 100 ppm TWA    |
| Oxide          | established    |                |                |
+----------------+----------------+----------------+----------------+
|                |                |                |                |
+----------------+----------------+----------------+----------------+
| Ozone          | 0.1 ppm        | 5 ppm          | 0.1 ppm TWA    |
|                | Ceiling        |                |                |
+----------------+----------------+----------------+----------------+
|                |                |                |                |
+----------------+----------------+----------------+----------------+

^1^Immediately Dangerous to Life and Health (IDLH) - The current NIOSH
definition for an immediately dangerous to life or health condition, as
given in the NIOSH Respirator Decision Logic \[NIOSH 1987\], is a
situation \"that poses a threat of exposure to airborne contaminants
when that exposure is likely to cause death or immediate or delayed
permanent adverse health effects or prevent escape from such an
environment.\" It is also stated that the purpose of establishing an
IDLH is to \"ensure that the worker can escape from a given contaminated
environment in the event of failure of the respiratory protection
equipment.

^2^TWA- Time weighted average usually over a 10 hr period.

§ Designated as a carcinogen.

¥ TLV 0.5 ppm; 1.5 mg/m^3^

** Appendix B. Cleanup Procedures **

**Using Sodium Hypochlorite Solution**

I.  **1. Cleanup of non‑porous surfaces** (e.g., work surfaces, computer
    equipment, file cabinets, vinyl floors, painted walls, and ceilings)

II. 

### 1.1 General Precautions

-   Stage materials and equipment as necessary to begin the cleaning
    effort.

-   Begin work only after a personnel decontamination station is
    installed and personnel are trained.

-   Ensure personnel appropriately select, don, use, doff, and maintain
    their PPE as outlined in the site-specific safety and infection
    control plan.

-   Ensure that medical management plans, including any required
    prophylaxis and medical monitoring are in place and being
    implemented.

-   Bleach forms toxic gases when mixed with acidic substances such as ,
    , , or vinegar. **Do not** mix bleach with other cleaners.

-   Turn off electrical devices prior to cleaning. Liquid cleaners and
    disinfectants should not used on electrical appliances while they
    are plugged into an electrical source.

# 1.2 Cleanup methods

-   Preclean all surfaces of concern

-   Prepare cleaning solution using liquid household bleach (5.25% to
    6.15% solution.)

    -   Add 1 part bleach to 9 parts water, resulting in a solution
        containing 5,250 to 6,150 parts per million (ppm) free available
        chlorine. The final solution should have a pH range between 6
        and 8.

    -   Prepare solution immediately before use

    -   Do not store solution because storage reduces the free available
        chlorine and the disinfectant ability.

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-   Apply the solution to the contaminated surface. If using a spray
    applicator, set the spray applicator on Amist@ or at a 45 degree or
    higher spread and spray 6 to 8 inches away from the surface. This
    prevents reaerosolizing the spores.

-   Leave the solution on the surface for a **minimum of 10 minutes
    **(contact time).

-   Rinse (wipe) the cleaned areas with a solution of water and sodium
    thiosulphate (20 grams thiosulphate to 1‑gallon of water) to
    neutralize the bleach. This will help protect the surfaces and
    prevent chlorine from interfering with cultures of samples collected
    after cleaning.

-   Rinse (wipe) surfaces with clean water to remove any residue.

# 1.3 Post-Cleanup methods

-   Dispose of materials used in the cleanup (bleach, moistened cloths,
    sponges) as other normal household wastes.** **

-   Remove PPE in reverse order of donning, removing the outer pair of
    surgical gloves, chemical protective coveralls, shoe covers, and
    respirator. The last item to be removed is the second pair of
    surgical gloves. Used clothing should be bagged and labeled for
    disposal. See Section 4: Solid Waste Disposal.

-   Wash hands immediately with soap and warm water for at least 30
    seconds after removing PPE.

**2. Disposal of items with porous surfaces (e.g., carpeting,
cloth‑covered furniture) **

### 2.1 General Precautions

-   Stage materials and equipment as necessary to begin the cleaning
    effort.

-   Begin work only after a personnel decontamination station is
    installed and personnel are trained.

-   Ensure personnel appropriately select, don, use, doff, and maintain
    their PPE as outlined in the site-specific safety and infection
    control plan.

-   Ensure that medical management plans, including any required
    prophylaxis and medical monitoring are in place and being
    implemented.

-   Bleach forms toxic gases when mixed with acidic substances such as ,
    , , or vinegar. **Do not** mix bleach with other cleaners.

-   Turn off electrical devices prior to cleaning. Liquid cleaners and
    disinfectants should not used on electrical appliances while they
    are plugged into an electrical source.

** 2.2 Cleanup Methods**

-   Treat in place contaminated carpeted and cloth‑covered areas or
    materials by applying the bleach solution until the surface is
    moist.

-   Remove and dispose of treated material(s) as solid waste.

# 2.3 Post-Cleanup methods

-   Dispose of materials used in the cleanup (bleach, moistened cloths,
    sponges) as other normal household wastes.** **

-   Remove PPE in reverse order of donning, removing the outer pair of
    surgical gloves, chemical protective coveralls, shoe covers, and
    respirator. The last item to be removed is the second pair of
    surgical gloves. Used clothing should be bagged and labeled for
    disposal. See Section 4:Solid Waste Disposal.

-   Wash hands immediately with soap and warm water for at least 30
    seconds after removing PPE.

-   Vacuum carpets outside the contaminated area with an appropriate
    HEPA-filtered vacuum or shampoo carpet.

#### Appendix C.

#### Cleanup Procedures Using Gaseous Formaldehyde

Commercial devices are available that automate the gaseous formaldehyde
cleanup is abstracted from U.S. Army Medical Research Institute for
Infectious Diseases Regulation 385‑17 and from Class II (Laminar Flow)
Biohazard Cabinetry, National Sanitation Foundation International,
Standard 49, 1992, Annex G.

**Note**: Formaldehyde should be handled with caution. Porous materials
may out-gas formaldehyde for extended periods. Formaldehyde is a
potential carcinogen, so this method should be used only if no other
option is practical or feasible. Follow OSHA Regulations as specified**
CFR 29 **1910.1048**. **

**1. Pre cleanup Methods**

-   Pre-clean the area to remove dust and dirt with disinfectant soaked
    cloth.

-   Bag, label and remove all trash for final disposal.

-   Remove desk blotters and bag for final disposal.

-   Empty and leave all desk drawers open.

-   Sterilize with paraformaldehyde essential papers and books, if
    desired.

2.  **Room Preparation**

    -   Cover supply and exhaust duct openings with plastic and
        tape‑sealed edges in areas where the ventilation system cannot
        be shut down because it is being shared with another area, or

    -   Shut down the system or throttle it back to minimum flow through
        the system in areas where the ventilation system is not shared
        with another area

    -   Label (room number, location, etc.) and place biological
        indicators (spore strips containing spores of *­Bacillus
        subtilis*) through out the area being fumigated.

-   Maintain relative humidity at 60%; add water to the fry pans
    designated for water if it falls below 60%.

-   Maintain room temperature at 25 °C.

-   Pour 1 gallon of liquid disinfectant with proven efficacy against
    *B. anthracis* or a solution of one part 5% sodium hypochlorite
    (household bleach) and nine parts water into each floor or sink
    drain in affected area.

-   Post warning signs indicating a formaldehyde hazard on the outside
    of the doors to the clean change room.

2.  **Preparation of the Paraformaldehyde and Disinfection**

    1.  Weigh out paraformaldehyde. Calculate the amount of
        paraformaldehyde required as follows:

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I.  Multiply the volume of area to be cleaned in feet cubed (ft^3^) by
    0.3 grams (g)/ft^3^ and divide the answer by the percentage of
    formaldehyde in the paraformaldehyde to be used for the cleanup.

II. [Example:]{.underline} An area with the measurements 10 ft (length)
    by 15 ft (wide) by 12 ft (height) has a volume of 1,800 ft^3^. The
    paraformaldehyde used contains 91% formaldehyde. The amount of
    paraformaldehyde needed is (1,800 ft^3^ x 0.3 g/ft^3^) divided by
    (0.91) = 594 g.

    1.  Weigh out ammonium bicarbonate. Calculate the amount of ammonium
        bicarbonate required as follows:

Multiply the grams of paraformaldehyde determined in Step 3.2 by 1.1.

[Example:]{.underline} In the example in Step 3.1, 594 g of
paraformaldehyde is needed. The amount of ammonium bicarbonate needed

is (594 g) x (1.1) = 653 g.

1.  Plug electric fry pans into interval timers, and place them in the
    areas to be cleaned. Turn them to their maximum temperature (420°
    F), and check that they operate correctly.

2.  Put on a full‑face respirator equipped with an industrial canister
    approved by the National Institute for Occupational Safety and
    Health (NIOSH)/Mine Safety and Health Administrations (MSHA) for use
    with formaldehyde.

3.  Place pre‑weighed ammonium bicarbonate into electric fry pans
    designated for ammonium bicarbonate and pre-weighed paraformaldehyde
    into electric fry pans designated for paraformaldehyde. Do not place
    more than 908 g ammonium bicarbonate or paraformaldehyde in any one
    fry pan.

4.  Set the time fry pans containing paraformaldehyde and water are to
    turn on.

5.  Set the timers of the fry pans containing paraformaldehyde and water
    to turn off 2 hours after the start time (production time). The
    contact time for the formaldehyde gas is 10 hours.

6.  Set the timer of the fry pans containing ammonium bicarbonate to
    turn on 12 hours after the start of the fumigation (10 hours after
    the formaldehyde frying pans have turned off); set the timers to
    turn off the fry pans 1 hour later. The production time and contact
    times for ammonium bicarbonate is 1 hour each.

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4.  **Re-entry into Disinfected Area**

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I.  4.1 Enter the disinfected area only under the following conditions:

-   Two hours after the fry pan containing ammonium bicarbonate was set
    to turn on (or one hour after it shut off)

-   Only personnel wearing Level A protection (a vapor protective suit
    constructed of materials resistant to formaldehyde breakthrough for
    more than 8 hours plus a self-contained breathing apparatus) with
    emergency rescue personnel equipped with the same PPE standing by.

    2.  Take formaldehyde readings using a direct reading meter from
        several locations.

I.  If the formaldehyde level is below 0.5 ppm, equipment used during
    the disinfection process may be removed without respiratory
    protection. If readings are above 0.5 ppm, respirator protection
    must be worn inside the disinfected area until after the area is
    washed down and formaldehyde levels are below 0.5 ppm. Enter the
    disinfected area only while wearing a NIOSH-approved, full-face
    respirator equipped with canisters specifically approved for
    protection against formaldehyde vapor in combination with a
    particulate filter.

    2.  Collect spore strips from the area cleaned in addition to post
        cleanup environmental sampling for *B. anthracis*. Spore strips
        in addition to a positive control should be incubated for a 72
        hr period and read at 24, 48 and 72 hrs. If the results of the
        spore strips are POSITIVE in other than the positive control
        then cleanup must be repeated. If spore strips are NEGATIVE in
        combination with post cleanup environmental sampling the area
        can be considered biologically cleaned.

    3.  Wash down the disinfected area to remove formaldehyde residue.
        PPE worn during wash down should be a NIOSH-approved, full-face
        respirator equipped with canisters specifically approved for
        protection against formaldehyde vapor in combination with a
        particulate filter, long-sleeve shirt, long pants, protective
        gloves, rubber boots and rubber apron.

    4.  Continue air monitoring during the wash down process for the
        area with a direct reading meter. Respiratory protection
        equipment as described in paragraph 4.4 must be worn until
        formaldehyde levels fall below 0.5 ppm.

    5.  Once the ambient formaldehyde levels fall below 0.5 ppm, and if
        supply and exhaust ducts have been sealed, they can be
        uncovered. If the ventilation system had been shut down or
        throttled back, notify the facility manager to adjust
        ventilation system to normal operating conditions

    6.  Collect electric fry pans, timers, and other equipment used in
        the cleanup.

    7.  Monitor the formaldehyde level until it is at levels in
        compliance with state and federal exposure standards.

Table 1

Production and Contact Time for Fumigation with Formaldehyde

+--------------+-----------------+--------------+------------------+
| Fumigant     | Production Time | Contact time | Time to Rentry   |
+--------------+-----------------+--------------+------------------+
|              |                 |              |                  |
+--------------+-----------------+--------------+------------------+
| Formaldehyde | 2 hours         | 10 hours     | 13 hours after   |
|              |                 |              | beginning of     |
|              |                 |              | production time  |
|              |                 |              | for formaldehyde |
+--------------+-----------------+--------------+------------------+
|              |                 |              |                  |
+--------------+-----------------+--------------+------------------+
| Ammonium     | 1 hour          | 1 hour       | See above        |
|              |                 |              |                  |
| Bicarbonate  |                 |              |                  |
+--------------+-----------------+--------------+------------------+
|              |                 |              |                  |
+--------------+-----------------+--------------+------------------+