Decontamination

The Federal Bureau of Investigation has released information indicating that hospitals and large shopping venues have been included in terrorist training schemes. This information adds more urgency to the need for all employees to be familiar with their facility's Emergency Management Plan. Your ability to anticipate and respond promptly can save your life and lives in your community.

Health care workers are at risk from exposure to hazardous materials when treating contaminated patients. The Occupational Safety and Health Act (OSHA) has recognized this fact and places the responsibility for ensuring a safe work environment upon the employer. This responsibility requires protection for workers, even in emergencies caused by the release (intentional or accidental) of hazardous materials.

OSHA considers hospital health care workers who receive and treat patients contaminated by hazardous substances to be "First Receivers." First receivers are a subset of "First Responders" and, as such require "First Responder" training which will allow them to perform their duties safely.

"All hospital personnel who are expected to take part in emergency responses to releases of hazardous substances must be trained in accordance with 29 CFR 1910.120. Emergency medical personnel who would decontaminate victims who were involved in a release of a hazardous substance are to be trained to the first responder operations level, 29 CFR 1910.120(q)(6)(ii), which provides instruction on the selection and use of personal protective equipment (PPE) and on basic decontamination procedures. Training does not need to be duplicated; therefore, appropriate training in PPE and decontamination procedures that a hospital currently provides can be used totally or in part to meet the requirements of HAZWOPER. Instruction for emergency medical personnel in topics under 29 CFR 1910.120(q)(6)(ii) that are not directly relevant to emergency medical care is not necessary, although employees must be trained to perform the duties and functions expected of them. This is considered a de minimis violation, which is reserved for employers who are not technically in compliance with a regulation but who provide a safe and healthful working environment for their employees" ( Clark R.1992).

Following a mass contamination event, whether biological, chemical, or radioactive, large numbers of wounded and/or contaminated victims will eventually enter the medical system. They will need:

As many as 80% of the victims may bypass the normal emergency medical service system (EMS) and self-present directly to the local Emergency Room. The challenge for your hospital will be to serve these victims without contaminating the facility. Contamination of the hospital or the staff could require the closure of the facility, eliminating a local source of treatment.

Definition: Decontamination involves the reduction of infectious or hazardous agents to an acceptable level.

Three methods of decontamination include:

Effective decontamination, rapidly and safely reduces harm, while containing and controlling the hazardous agent in order to prevent secondary exposures

What Contaminated Victims Should Expect At A Decontamination Site

Ambulatory
  • Enter a Decontamination area, usually not the ER entrance
  • Expect all personnel to be in Personal Protective Equipment (PPE) with Respiratory devices
  • Patient ID banded
  • Triage personnel will separate those that can "Self Decontaminate"
    • Young children stay with parents or guardians
    • Probably separate victims by gender
  • Directed to area for disrobing
    • all clothes and personal effects removed bagged, tagged and secured
    • up to 90% of contamination may be removed with clothing
  • Directed to shower area; may be secured area with fire engines spraying water or may be shower stalls, etc.
    • may include monitoring personnel to ensure adequate decontamination
    • shower for a minimum of 1 minute or as directed up to 15 minutes
    • tepid water if possible to improve compliance
    • start at head, work to toes
    • use high surfactant soap if available, plain water on irritated skin
    • modesty covering if possible
    • warm air or other drying mechanism to avoid hypothermia
    • scrubs or gowns to replace clothing
  • Directed to Post-Decontamination treatment area

Non-Ambulatory
  • Enter a Decontamination area, not ER entrance
  • Expect all personnel in Personal Protective Equipment (PPE) with Respiratory devices
  • Patient ID banded
  • Transfer on gurney, backboard etc.
  • Triage personnel will manage Airway, Breathing and Circulation
  • All clothes and personal effects bagged, tagged and collected
  • Transfer to shower area
  • All skin surfaces washed 1-15 minutes head-to-toe by personnel
  • Water warmed when possible to avoid hypothermia
  • Irrigate open wounds with irrigation syringe and copious amounts of saline and cover with occlusive dressings. Any existing dressing must be removed and placed in bio-hazard trash container.
  • Skin dried & covered
  • Retriage, if needed
  • Transfer to Post-Decontamination treatment area on clean stretcher
In-Hospital HAZMAT INCIDENT
  • Contain victims in area of incident until contamination is confirmed.
  • Administrative Director to be notified by area supervisor of incident site and specifics.
  • Hospital operator, notified by area supervisor, shall page ED charge nurse with HAZMAT location
  • Hospital operator shall page Safety and Security to restrict access to the site.
  • ED charge nurse and ED charge physician assign HAZMAT team for response to site ONLY if patients are identified to be immediately in danger of exposure.
  • If Emergency Department HAZMAT team required to respond within facility have the communication nurse call EMS Public Safety Communications Center to request ED “reroute” status and request Fire Department HAZMAT response per facility protocol.
  • The HAZMAT team should then dress in appropriate level of PPE for the given response. If unknown contaminant, dress in highest level of protection available.
  • The HAZMAT team responds to site bringing portable decontamination equipment OSHA BEST PRACTICES FOR HOSPITAL-BASED FIRST RECEIVERS 91 for decontamination at a safe area closest to the site of incident. - Single patient – non-ambulatory bring 2 stretchers, one with containment cover and hose and container for runoff collection. - Ambulatory – bring kiddy pools (2) and backpack sprayers or large irrigation bottles for decon wash.
  • Decon shall be completed at site (as in previously described manner) until patient is clean enough for transport to ED for more definitive decon.
  • Transport to ED shall be on the clean stretcher with a clean transport team.
  • ED HAZMAT team to complete personal decon at the incident site prior to return to ED
Source: Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. OSHA 3249-08N 2005. Retrieved 8/11/2022 from
https://www.osha.gov/sites/default/files/publications/osha3249.pdf

References

Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. OSHA 3249-08N 2005. Retrieved 8/11/2022 from
https://www.osha.gov/sites/default/files/publications/osha3249.pdf

Clark, R. (1992) OSHA. Standard Interpretations / Training requirements for hospital personnel involved in an emergency response of a hazardous substance. Retrieved 8/31/2022 from https://www.osha.gov/laws-regs/standardinterpretations/1992-10-27-1

 

©RnCeus.com