During the course of events, the insurance adjuster contacted a local bio-cleaning company. The technician/owner not only cleaned up the visible blood in the upstairs bathroom, but also the fluid that had overflowed into the adjacent loft area by removing the carpet and pad. Despite his diligence in disinfecting the hardwood floors and the visible blood on the kitchen cabinets (never opening a drawer where fresh blood was later discovered), the technician never entered the basement. In addition to these surfaces, the carpet also was affected, as a little dog that had been in the home at the time of the incident had tracked blood throughout the house. After cleaning the blood from the carpet with bleach, the technician declared the job complete, charged the insurance company $1,000, and left.

The insurance adjuster was then left to grapple with the home's pervasive odor, which had not subsided in the least. The adjuster called in another service with several years of bio-cleaning experience and training related to the medical field. To finish this job, the more experienced company deemed it necessary to completely dismantle the upstairs bathroom and remove the blood-soaked underlying sub-floor, ceiling, and a small section of wall. Subsequently, the company removed a 10-foot cabinet island with an overhead custom oak light fixture, which was situated in the kitchen; eight square feet of hardwood flooring; and two square feet of sub-flooring.

In addition, the team cleaned the basement floor and the HVAC system because blood had infiltrated the return air vent on the panning. The floor joists were planed and sanded to remove contaminants and then treated and sealed. The carpet where the dog had walked also was replaced because there is generally no guarantee that contaminates can be thoroughly removed from textiles (in any case, this patch of carpet had been bleached out in polka-dot fashion from the first company's efforts). The technician went on to treat the attic, hauling away the soiled insulation and installing new insulation. The overall deodorization of this home took two full weeks, as different steps of deodorization were applied. At this point, the second company declared the job complete, submitted an invoice of more than $13,000, and dispatched a build-back crew.

Had the work not been completed by an experienced company, a serious blowfly and maggot problem would have developed, amounting to thousands of blowflies — or maybe even tens of thousands. As verified by Dr. Ralph Williams, head of forensic entomology at Purdue University, during an infestation, the flies' bloody excrement and regurgitations would touch every surface of the home, further compounding the liabilities of the cleanup work because of secondary infection potentials. As it was, the second and more-experienced company offered a greater value than the first because it removed all of the contaminants from within the home, thereby removing liabilities of others coming into contact with a potential contamination.

Making the Right Call

So what lessons should an adjuster take away from this case? How should he go about choosing an effective, reputable bio-cleaning company? There are several requirements a bio-cleaning company must meet before it can legally dispatch a technician to clean a trauma site. According to the Occupational Safety and Health Administration (OSHA), everyone who enters a site must have training in its exposure control plan, hazardous communication plan, and respirator plan. Outlined below are the basic OSHA regulations for this industry; depending on the site and the scope of work, other regulations may apply.

The employee must receive training in universal precautions, personal protective equipment (PPE), epidemiology, and material data safety sheets for the chemical compounds they will use, as well as proper use of the same. The employee should obtain further training in the proper use of engineering and work practice controls. Each technician should have a hepatitis-B vaccine 10 days before entering a work site. Because there are times when a company may have to remove a certain amount of structure, it should have a basic knowledge of both residential and commercial construction as well as containment setup. In fact, many localities require a contractor's license prior to removing structural materials and a transporter's license to rid the site of medical waste.

All states mandate that a bio-cleaning company have a contract with a medical waste disposal company so that it can properly rid itself of these materials and so a manifest can be generated to offer proof of the same. Many U.S. states do not require training and certification in the actual disciplines of this industry; instead, they rely on the OSHA regulations to oversee it. California has the Trauma Waste Practitioners Act. Louisiana also has a regulation in place, but it is said to be weak and convoluted. Other states are following suit by taking a hard look at regulation. The certifications available in this industry are generally granted from various expert individuals and associations; however, none are ANSI or IICRC-certifications at this time.

Now it should be clear what is required and why some initial investigation into a restoration company will prove to be beneficial. In the example presented earlier, the first cleanup company consisted of an ex-firefighter who felt he was qualified because he had received most of the required technical training as a firefighter. Having also worked EMS and been privy to murder and suicide situations during that time, the ex-firefighter was equipped with PPE knowledge as well as the wherewithal to maintain his composure during difficult times. Although this training might have been otherwise helpful, he lacked experience in proper cleaning techniques, construction, and how to practically apply what he learned as it pertains to this trade.

What to Look For

There are several other issues that are specific to crime scene and trauma cleanup jobs that adjusters should be aware of. Perhaps most important is deodorization, which has become a science in and of itself. Most companies do not guarantee or warranty deodorization because of the intrinsic difficulties in solving the problem. In severe cases, deodorization can take several days and steps to successfully complete.

In difficult cases, there is no magic bullet, but the IICRC does offer deodorization certification for this discipline. There have been companies that spread the belief that odor alone can contaminate and spread disease in an area or a home, but this is a false assumption. If a company espouses this misconception, be leery of its abilities as it may lack appropriate training.

A bio-cleaning company takes on certain liabilities to ensure that the area and items are cleaned or remediated from all contaminants and, of course, proper insurance coverages should be in place. Most companies have a minimum general liability umbrella of $1 million or more, and in most states pollution insurance is not required. The insured parties or their representatives can ask for a statement of procedure from the bio-cleaning company. This statement outlines the processes and chemicals used in the cleanup. Some of the savvier, highly trained companies can perform certain tests to show a great reduction of microorganisms present on surfaces. The company should have an impressive track record with other insurance companies and possibly with management companies that they can list as referrals; however, supplying the name of an individual or family as a reference would be considered a breach in privacy.

There is a difference in crime and trauma scene cleanup companies in their overall abilities and knowledge sets. A few companies in the U.S. consider themselves more as biohazard management firms and can handle or assist in tasks such as infection control and disease outbreak response for such things as meningitis. These companies have individuals who can act as consultants and handle a more serious contamination such as Creutzfeldt-Jacobs Disease (CJD), which is akin to mad-cow disease in humans. What is interesting about CJD is that it is neither a virus nor a bacterium. It is a protein called a prion, and it is very hard to kill. Certain disinfectants set it, and more than 300 degrees Fahrenheit of surface temperature heat must be administered over a period of time to kill it. Very few of us have had the occasion to clean this type of contamination. Other companies have handled anthrax and routinely clean cruise ships and restaurants for Norwalk and Novo viruses.

On the automobile side of cleanup work, adjusters should enlist the expertise of someone who has experience in working on the interiors of vehicles. Interiors can be highly technical, necessitating special tools. In other words, a novice technician should not attempt the cleanup. According to the Federal Motor Vehicle Safety Standard 207/210, the bolts holding seats and safety belts in place should never be reused, as it is a direct violation of a federal law. If wires in the vehicle are damaged during the removal of the carpeting, seating, or other interior parts, then electrical problems with the vehicle may result in the future.

Although most insurance companies do not have a preferred provider list designated for locating bio-cleaning companies, it would be good for adjusters to open up a resource database within their own companies or departments and take some time to interview each of these owners to test their overall knowledge sets. There will be times when a quick response will be imperative to help your insureds in a timely fashion.

Don M. McNulty is the owner and operator of Bio Cleaning Services of America, Inc. He can be reached at 888-229-7975, www.biocleaningservices.com.