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Hospital Decontamination Jonathan L. Burstein, MD, FACEP HSPH-CPHP.

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Presentation on theme: "Hospital Decontamination Jonathan L. Burstein, MD, FACEP HSPH-CPHP."— Presentation transcript:

1 Hospital Decontamination Jonathan L. Burstein, MD, FACEP HSPH-CPHP

2 The Problem Hundreds of patients coming in Do they need decon? Can I clean them?

3 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?

4 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

5 Threats Weapons of mass destruction –Mainly, chemical or radioactive Fires Transportation accidents Industrial accidents Internal spills (lab, chemo, radioactives) Do a Hazard Vulnerability Analysis

6 Tokyo Sarin Attack

7 Tokyo, March 20, 1995 5 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

8 Conyers, GA 2003





13 Explosives… Decon??? Madrid, 11 March 2004

14 Radiation Is Easily Detectable ED door monitors?

15 Anthrax 2001-2002 Decon? Or Prophylaxis?

16 JCAHO Health Care at the Crossroads, 2003 –Emergency preparedness as key goal Environment of Care Standards –Protect employees –Protect facility –Protect patients

17 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

18 OSHA Draft Guidance eceivers_hospital.pdf eceivers_hospital.pdf In brief: –Yes, you need to do it –PAPRs –8 hour staff training minimum

19 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

20 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

21 Decon Options Outdoors (wading pools) Tents –Outside –Inside RAM Decon TrailersIndoors –Multipurpose room –Dedicated room Slow, clumsy Quick, easy Cheap Dear



24 Decontamination Tent

25 RAM Decon

26 Hospitals Trailer

27 Local FD Trailer

28 Mass Decon Unit

29 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,

30 A permanent hospital decon room

31 Basic Requirements Contain contamination Control environment Protect staff Allow decon Contain runoff Allow cleanup or disposal Patient through-put

32 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

33 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?

34 Level B with supplied air

35 Level C with PAPR

36 C minus

37 Standard (Universal) Precautions GownGlovesMask –N95 HEPA, to upgrade for plague or smallpox RESPIRATORY PRECAUTIONS Shoe covers For RAD or BIO: level D plus

38 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???

39 Case Review Sarin in Tokyo –No decon, no PPE –472 hospital workers surveyed –Over 100 symptomatic –1 admitted HSES data 1996-1998 –44,015 events –3,455 events produced 13,149 victims –5% were admitted Annals of Emergency Medicine 42:3, September 2003

40 Case Review Cont. HSES 1996-1998 –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

41 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

42 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)

43 How Do I Get It Done? Needs –Money –Interested staff –Competent trainers –Institutional commitment

44 Money Federal –HRSA, CDC –DHS (work with public safety?) State or Local Industry Own facility

45 Staff CommittedCompetentTrainable Low turnover Present 24/7 in numbers (4 minimum) Clinical? Maintenance? Custodial? Security? Safety? All?

46 Training Internal –Hospital based External –FD-based –Industrial Refresher training built into system –Employee orienttation? Annual special teams training?

47 Institutional Commitment Doing the right thing Doing something to protect the institution Doing something for good publicity Doing something to avoid bad publicity

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