In cleansing Ebola, hospital is disinfected but homes are purged

While expensive medical equipment used on Ebola victim Thomas Eric Duncan at Texas Presbyterian Hospital Dallas was decontaminated with disinfectants, the 60-inch TV hanging in the apartment of his fiancee was sawed in half, stuffed in a hazmat drum and incinerated.

“That Samsung was one of the hardest cuts of our lives, but we were told to get rid of everything that could be replaced and we did,” said Brad Smith, vice president of Fort Worth-based CG Environmental – the Cleaning Guys, which decontaminated Louise Troh’s home at the apartment complex where Duncan became symptomatic with vomiting and diarrhea.

This was the first time that a residence in the United States had ever been decontaminated for the Ebola virus. There were no manuals, no specific guidelines by the federal Centers for Disease Control and Prevention on what to do. In Texas, the county and city had to come up with a plan quickly to rid the place of any remaining Ebola virus, to prevent its spread while providing peace of mind to a fearful community.

The response now appears to be decontamination overkill, compared with what the CDC and other health agencies recommend for hospital disinfection.

“We’ve done lots of life-threatening jobs, but this was the unknown, and we didn’t take any risks,” Smith said.

Workers in yellow hazmat suits spent four days destroying almost everything in Troh’s apartment, which she shared with three family members. Curtains, couches, carpet and everyone’s clothing and other worldly possessions were dumped into about 155 barrels. Only passports, a family Bible and a few other sentimental items were spared.

“She’s lost everything that she owns in the apartment,” Senior Pastor George Mason of Wilshire Baptist Church told ABC News.

Troh and her family weren’t allowed outside the apartment during the first phase of the response, when Duncan’s soiled clothing, perspiration-filled sheets and other items that were in contact with his bodily fluids were removed.

“I think they were a little upset that we came inside with yellow suits and they were staying there in street clothes,” Smith said.

Neighbors weren’t briefed on what was going on.

Smith declared the job at Troh’s apartment a success, and less than a week later the Cleaning Guys were back in Dallas to decontaminate the apartment of nurse Nina Pham, who contracted Ebola while caring for Duncan.

It’s not clear who made the decision, but only hours into scrubbing the brick exterior, the Cleaning Guys were called off the job by the Texas Division of Emergency Management, which had assumed control from Dallas County and then put the Texas Commission on Environmental Quality in charge.

No reason was given, but Protect Environmental Services, a state contractor, took over. It also decontaminated the apartment of Amber Vinson, the second nurse to contract Ebola from Duncan.

CDC spokeswoman Amesheia Buckner said Wednesday that guidelines existed for decontaminating Ebola patients’ residences and the agency had given these guidelines to the states, but the CDC wouldn’t provide them to McClatchy. The state also couldn’t provide the guidelines.

In an interview, Protect Environmental Services general manager Richard Cameron said there were no specific CDC guidelines in place for how to handle residences.

But his company didn’t follow the “destroy everything in an abundance-of-caution mentality” that was used on Troh’s apartment, Cameron said. He said his employees had reviewed existing virus decontamination guidelines from the Environmental Protection Agency, the Occupational Safety and Health Administration, hospitals and various microbiology professors and laboratories, and “boiled them all down to create our own with the state and CDC.”

While Protect Environmental Services and two other hazardous-waste removal companies worked together to remove 22 55-gallon drums filled with items from Pham’s apartment and 53 drums from Vinson’s residence, the company did its best to preserve belongings of the nurses that could be disinfected and weren’t at high risk of harboring the virus, Cameron said.

There were newspaper reports that all of Pham’s personal items were destroyed, including her MacBook computer, which held all her pictures. Cameron said that was “absolutely false. The slim laptop we left on her couch.”

One of the first things his crew did was rescue Pham’s King Charles spaniel, Bentley, who was taken to a veterinary hospital. While the dog of an Ebola patient in Spain was euthanized, Bentley was quarantined and on Wednesday tested negative for Ebola.

Cameron said the workers then methodically went through Pham’s apartment, disposing of items that had a risk of having bodily fluids on them, including towels, linens, scrubs and dirty clothing.

There were more drums for Vinson’s apartment because it had carpeting, which was removed. Mattresses weren’t disposed of because they had liners on them.

Everything else was disinfected, primarily with a bleach solution, which is what most health agencies use for medical equipment and hospital surfaces. (Alcohol-based disinfectants are used on people’s skin).

The church is helping out the Troh family. Pham’s childhood friend, Sarah Strittmatter, has put together a account for Pham to help pay for replacing her possessions, as well as expenses for her parents. So far it’s raised more than $88,000. Vinson’s family hasn’t reached out for help, asking only for privacy.

Ebola belongs to the family of filoviruses, which can remain infectious outside the body for up to three weeks, according to a 2010 published study conducted in the United Kingdom. While it’s robust compared with many common viruses, it doesn’t require special chemicals to kill it, according to hospital protocols provided by the CDC and the World Health Organization.

It’s transmitted only through direct contact with body fluids, which include blood, saliva, vomit, mucus, urine, feces, sweat, semen, tears or milk. It isn’t airborne.

But with the deadliness of the disease, which has killed up to 70 percent of those who’ve contracted it in West Africa, there’s been hesitancy by some officials to say exactly what decontamination steps were taken and instead to say that CDC and other health agency guidelines are being followed.

Tyri Squyres, vice president of marketing for Frontier Airlines, told reporters that the plane on which Vinson flew from Cleveland to Dallas was decontaminated using “aggressive cleansers.”

Smith of the Cleaning Guys said the company charged $65,000 for the first day of cleaning up Troh’s apartment. He wouldn’t say how much the entire job cost or who’s footing the bill.

Cameron of Protect Environmental Services said it was expensive work. A Level A hazmat suit with air pumped into it by a tank – as is done with scuba divers – costs $1,200 to $1,800, and it can be worn only once.

Cameron wouldn’t provide the cost of cleaning both nurses’ apartments. Each of the nurses’ apartments took about a half day to decontaminate, he said.

The drums from the nurses’ apartments were transported by Veolia Environmental Services to a plant in Port Arthur, Texas, for incineration. Police escorted the trucks for the six-hour trip.

Cameron said he was working on a suggested manual on how to decontaminate residences that he’d provide to the CDC and other agencies that wanted to look at it.

Life appears back to normal around the three Dallas apartments, all within minutes of the hospital. A decorative wreath hung on Vinson’s door this week. At the apartment directly across from her, a work crew was retrofitting space for a washer and dryer. None of the workers was wearing a mask, and they said they weren’t concerned about their safety.

Neither was the man, who didn’t want to give his name, who was working on the pool behind Vinson’s apartment. “Why would I worry?” he asked. “I work with bleach.”