Presentation on theme: "Hospital Decontamination Jonathan L. Burstein, MD, FACEP HSPH-CPHP."— Presentation transcript:
Hospital Decontamination Jonathan L. Burstein, MD, FACEP HSPH-CPHP
The Problem Hundreds of patients coming in Do they need decon? Can I clean them?
The Roadmap Do I really need to do this? How can I do it? How can I protect my self and staff? How can I get it done?
Do I Really Need to Do This? The care imperative –WMD –Common events (industrial, lab) The regulatory imperative –JCAHO, OSHA The financial imperative –To get state and Federal grants The publicity imperative
Threats Weapons of mass destruction –Mainly, chemical or radioactive Fires Transportation accidents Industrial accidents Internal spills (lab, chemo, radioactives) Do a Hazard Vulnerability Analysis
Tokyo Sarin Attack
Tokyo, March 20, bags of sarin punctured in 5 subway trains 12 dead 5500 sick patients St. Lukes Hospital (520 beds) –Treated 500 patients in first hour; 640 on first day
Conyers, GA 2003
Explosives… Decon??? Madrid, 11 March 2004
Radiation Is Easily Detectable ED door monitors?
Anthrax Decon? Or Prophylaxis?
JCAHO Health Care at the Crossroads, 2003 –Emergency preparedness as key goal Environment of Care Standards –Protect employees –Protect facility –Protect patients
OSHA and Others OSHA regulates employee safety NIOSH certifies equipment CDC provides medical information EPA regulates pollution Someone will fine you… –…if you expose an employee –…if you use the wrong gear –…if you contaminate the environment
OSHA Draft Guidance eceivers_hospital.pdf eceivers_hospital.pdf In brief: –Yes, you need to do it –PAPRs –8 hour staff training minimum
Finance and Publicity Work with the government –HRSA and CDC (Focus D) money Work with industry –Financing from manufacturers Public drills look good Public evasion looks bad
Goals Need to do at least few-patient decon –At any time –With own resources May need to do or help with mass decon –Usually with help, e.g. FD –Need to practice Need to protect and train staff
UndressDeconDress 92 Mass Decontamination Units issued to Fire Departments in Massachusetts One Decon company in Each Fire District and One Decon Company protecting each hospital emergency department,
A permanent hospital decon room
Basic Requirements Contain contamination Control environment Protect staff Allow decon Contain runoff Allow cleanup or disposal Patient through-put
Standards? American Institute of Architects –For rooms NFPA and ASTM –For some field devices NIOSH eventually Really, its still caveat emptor Try before you buy
Staff PPE Levels of PPE –A: big suit, big tank –B: little suit, big tank –C: little suit, little mask –D: no suit, no mask Level A for entry Level C for known hazard Level B or C for unknown?
Level B with supplied air
Level C with PAPR
Standard (Universal) Precautions GownGlovesMask –N95 HEPA, to upgrade for plague or smallpox RESPIRATORY PRECAUTIONS Shoe covers For RAD or BIO: level D plus
Level B vs. Level C Training time –8 hours vs. 40 hours –B training requires escape bottles (OSHA) Equipment Cost –About $4000 per person for B –About $1000 per person for C But is C safe???
Case Review Sarin in Tokyo –No decon, no PPE –472 hospital workers surveyed –Over 100 symptomatic –1 admitted HSES data –44,015 events –3,455 events produced 13,149 victims –5% were admitted Annals of Emergency Medicine 42:3, September 2003
Case Review Cont. HSES –348 responder exposures Mostly PD and FD –6.6% admitted –No deaths HSES Healthcare data –11 events produced 15 HCW exposures Mix of organo, pepper, HF, chlorine, solvents –5 of these were INTERNAL to the facility –No admissions
Case Review Cont. Organophosphates –GA case (suicide): one HCW intubated, one other admitted, 2 more needed antidotes –4 anecdotal cases, no admissions Outside US –Several cases reported, no PPE, but no admissions Modeling –C is enough for compounds more volatile than sarin
Case Review Lessons Most HCW exposures are vapor Organophosphates are the most dangerous (judged by admit rate) Level C would have been enough even in these settings Govt. agencies are considering similar data, may change recommendations –VA, NIOSH, HRSA (Hospital program)
How Do I Get It Done? Needs –Money –Interested staff –Competent trainers –Institutional commitment
Money Federal –HRSA, CDC –DHS (work with public safety?) State or Local Industry Own facility