Decontamination for the Healthcare Professional

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Decontamination for the Healthcare Professional
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Acknowledgements

• South Carolina Area Health Education Consortium
  (AHEC)
• Funded by the Health Resources and Services
  Administration.
• Grant number 1T01HP01418-01-00
• P.I. David Garr, MD, Executive Director AHEC
• BT Project Director Beth Kennedy, Associate
  Program Director AHEC
• Core Team
• BT Co-director Ralph Shealy, MD
• BT Project Manager Deborah Stier Carson, PharmD
• BT CME Director William Simpson, MD
• IT Coordinator Liz Riccardone, MHS
• Web Master Mary Mauldin, PhD
• P.R Coordinator Nicole Brundage, MHA
• Evaluation Specialist Yvonne Michel, PhD
• Financial Director Donald Tyner, MBA

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Acknowledgment

• This material has been prepared for SC AHEC
  Bioterrorism Training Networkby
• Ralph M. Shealy, M.D., FACEPCo-Director of SC
  AHEC Bioterrorism Training Network
• Medical Director for Operations, Charleston
  County EMS
• Medical Director, Charleston County Rescue Squad

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Acknowledgements
Parts of this presentation were prepared by
Jennifer Brennan Braden, MD, MPH, at the
Northwest Center for Public Health Practice in
Seattle, WA, for the purpose of educating public
health employees in the general aspects of
bioterrorism preparedness and response. The
following people and organizations provided
information and/or support in the development of
this curriculum.
Jeff Duchin, MD Jane Koehler, DVM,
MPH Communicable Disease Control, Epidemiology
and Immunization Section Public Health - Seattle
and King County Ed Walker, MD University of
WA Department of Psychiatry
Patrick OCarroll, MD, MPH Project Coordinator
Centers for Disease Control and Prevention
Judith Yarrow Design and Editing Health Policy
and Analysis University of WA Washington State
Department of Health
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Decontamination is like changing a diaper.
Remove it from others, keep it off yourself,
and dont spread it around.
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Objectives

• List ways in which health professionals perform
  decontamination in routine practice.
• Describe the situations in which health
  professionals will need to decontaminate
  following a terrorist attack

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Objectives

• List four common cleaners used to perform area
  decontamination for biologic agents.
• Identify the most widely used agents for
  decontaminating humans
• Identify two conditions that should be met before
  beginning area decontamination following a
  biological attack

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Objectives

• Describe why it is more difficult to
  decontaminate a public facility than it is to
  decontaminate a Biosafety Level 4 laboratory.

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This presentation is for HEALTH professionals.
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Health professionals decontaminate their work
environment every day
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A few tried and true methods are adequate for
most decontamination needs.
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Our everyday cleaning and disinfecting practices
relate to naturally occurring contamination, with
organisms that are typically present in our
environment.
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Following a bioterrorism attack, contamination
may be heavy and extensive, with dangerous and
exotic organisms.
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Under normal circumstances, highly trained
technicians using specialized procedures and
sophisticated personal protection equipment are
called on to decontaminate hazardous
environments.
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Normally, community health professionals will not
be involved in decontamination procedures
following a bioterrorism event at a single site.
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Following large scale dissemination of a
dangerous biological agent, expert personnel and
resources will be so taxed that community health
professionals may be called upon to decontaminate
their own environment out of necessity.
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For this reason, it behooves you to understand
the principles of decontamination in case you are
forced by circumstances to do it on an emergency
basis.
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Environmental DecontaminationBuildings
Facilities

• Public facilities present challenges
• Can be large, with many corners crevices
• HVAC systems
• Electronic or other sensitive equipment
• Porous materials
• No standards of cleanliness

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The decision to decontaminate a building
following a bioterrorist action is a federal
case.
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Do not decontaminate a crime scene!
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Bio Lab DecontaminationAn Extreme Case

• Combination of vapor methods, surface
  decontamination, sterilization, incineration
• Space decontamination with vapor
• Paraformaldehyde
• Ethylene Oxide
• Beta-Propiolactone
• Vaporized hydrogen peroxide
• Sterilization
• Steam (autoclaving)
• Dry heat
• Ultraviolet light

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Bio Lab Decontamination

• Surface decontamination
• Chlorines
• Iodinein
• Ethyl or isopropyl alcohol
• Quarternary ammonium compounds
• Phenolic compounds
• Cresols (e.g., Lysol)
• Incineration

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Anthrax Decontamination

• Environmental decontamination
• May decrease the small risk of secondary
  aerosolization if area near spill or point of
  aerosol release is heavily contaminated with
  spores
• Personal decontamination
• If direct contact with substance alleged to be
  anthrax, wash exposed skin clothing with soap
  water

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2001 Anthrax Outbreak Antimicrobial Pesticides
for Decontamination

• Sanitizers disinfectants
• Sodium hypochlorite (bleach)
• Hydrogen peroxide and peroxyacetic acid
• Sterilants/sporicides
• Chlorine dioxide gas
• Ethylene oxide
• Paraformaldehyde

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Smallpox Decontamination

• Performed by vaccinated personnel only
• Protective clothing includes gowns, gloves, shoe
  covers, caps, masks
• Bag incinerate or autoclave protective clothing
  and cleaning equipment after use
• Immediately shower with soap water after
  contaminated protective clothing is removed
• Disinfect vacuum cleaners with a phenolic
  germicidal detergent

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Smallpox Decontamination

• Contaminated horizontal surfaces
• Wet with 5 aqueous solution of a phenolic
  germicidal detergent
• Allow to stand for at least 20 minutes
• Wet vacuum or wipe with clean cloths
• Facilities or rooms used to house patients
• Surface decontamination, as above
• Formaldehyde decontamination
• Bag incinerate or autoclave all disposable
  items
• Autoclave or launder bedding, linens, reusable
  clothing in hot water and bleach

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PlagueDecontamination

• Environmental decontamination probably not
  necessary
• Bacteria does not survive long outside host
• WHO estimate aerosol infectious for as long as
  1 hour
• Personal decontamination soap water
• Hospital rooms, equipment, bedding
• Decontamination per standard protocol

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C. Botulinum Decontamination

• Environmental decontamination
• Not necessary if area can be avoided long enough
  to allow natural degradation
• Otherwise, clean contaminated surfaces with 0.1
  hypochlorite solution
• Wear mask protective clothing
• Personal decontamination soap water

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Tularemia Decontamination

• Heavily contaminated surfaces
• Spray with 0.5 hypochlorite solution
• After 10 minutes, 70 alcohol solution can be
  used for further cleaning
• Soap water sufficient for less hazardous
  contaminations
• Personal decontamination soap water
• Standard chlorination of water systems sufficient
  to protect against water contamination

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The universal utility of soap and water for
personal decontamination should not be
overlooked!
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Summary - Microbes

• Persons having direct contact with agents of
  bioterrorist potential should wash with soap and
  water.
• Antibiotic prophylaxis may be necessary if the
  biological agent exposure involved airborne
  particles.
• Only vaccinated personnel should perform smallpox
  decontamination.

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Summary - Microbes

• The decision to sample or decontaminate a
  facility is a multi-agency decision and should
  include experts at the local, state, and federal
  levels.
• Environmental decontamination is probably not
  necessary for agents with a short survival time
  (e.g., plague, botulinum toxin), if the area can
  be avoided to allow natural degradation.

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Chemical Decontamination

• Leave it to the pros if at all possible.
• Be sure you are adequately protected before
  trying to decontaminate anything.
• Total decontamination may be impossible. Strive
  for contamination reduction.

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Chemical Decontamination

• The solution to pollution is dilution.
• Scrub with copious volumes of soap and water to
  lower concentration of hazardous chemical.
• Contain runoff if possible, but do not let
  efforts at containment stop efforts to rescue
  contaminated people.

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Chemical Decontamination

• Collect garments, shoes, personal effect. Label
  and isolate.
• Do not decontaminate these articles.
• These materials constitute evidence for a
  criminal investigation.
• Maintain chain of evidence if possible. (Help
  convict the perpetrator!)

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Chemical Decontamination

• Physical Removal
• Dilute
• Brushing and Scraping
• Absorption and Adsorption
• Heating and Freezing
• Blowing and Vacuuming
• Isolation and Disposal

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Chemical Decontamination

• Chemical Methods
• Chemical degradation
• Neutralization
• Solidification

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Chemical Decontamination

• Decontamination of the human body is done by
  physical methods brush and scrape away gross
  accumulations, then clean with soap and copiously
  quantities of water
• Chemical methods are used only on inanimate
  objects

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Emergency Medical Decontamination - Chemical

• The patient is best decontaminated in the field
  prior to transport. (Decreases absorption and
  minimizes cross-contamination.
• The patient should be removed from the
  contaminated area by rescuers with appropriate
  PPE.
• Minimize medical care in the contaminated area.

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Emergency Medical Decontamination - Chemical

• Remove and isolate contaminated clothing,
  glasses, jewelry, and shoes
• Brush away gross solid contamination
• Absorb gross liquid contamination
• Protect wounds from contamination
• Wash with mild soap and lots of water. Dilute
  and flush away contamination

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Emergency Medical Decontamination - Chemical

• Start at the face and clean toward the back and
  toward the feet. Clean the most dependent parts
  last.
• Copiously irrigate wounds
• Do not use decon solutions on tissue
• Irrigate the eyes aggressively
• Pay special attention to ears, nose, hair, nails,
  skin folds and perineal area.

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Emergency Medical Decontamination - Chemical

• Take care not to damage the skin
• Use warm water. Do not use hot water, as it
  enhances absorption.
• Cover the decontaminate patient to prevent
  hypothermia
• Fatalities must be decontaminated in the same way.

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Summary - Chemicals

• Leave it to the pros if possible.
• Do not undertake decontamination unless you are
  adequately protected yourself.
• Soap and water in large quantities is the most
  effective chemical decontamination method

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Summary - Chemicals

• Protect and preserve physical evidence. (Help
  convict the perpetrator!)
• Do not use chemical decontamination agents on the
  human body.
• Patients should be adequately decontaminated
  before transfer.

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