Presentation on theme: "Hospital Decontamination"— Presentation transcript:
1Hospital Decontamination Jonathan L. Burstein, MD, FACEPHSPH-CPHP
2The Problem Hundreds of patients coming in Do they need decon? Can I clean them?
3The 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?
4Do I Really Need to Do This? The care imperativeWMDCommon events (industrial, lab)The regulatory imperativeJCAHO, OSHAThe financial imperativeTo get state and Federal grantsThe publicity imperative
5Threats Weapons of mass destruction Fires Transportation accidents Mainly, chemical or radioactiveFiresTransportation accidentsIndustrial accidentsInternal spills (lab, chemo, radioactives)Do a Hazard Vulnerability Analysis
16JCAHO “Health Care at the Crossroads”, 2003 Emergency preparedness as key goalEnvironment of Care StandardsProtect employeesProtect facilityProtect patients
17OSHA and Others OSHA regulates employee safety NIOSH “certifies” equipmentCDC provides medical informationEPA regulates pollutionSomeone will fine you……if you expose an employee…if you use the wrong gear…if you contaminate the environment
18OSHA Draft GuidanceIn brief:Yes, you need to do itPAPR’s8 hour staff training minimum
19Finance and Publicity Work with the government Work with industry HRSA and CDC (Focus D) moneyWork with industryFinancing from manufacturersPublic drills look goodPublic evasion looks bad
20Goals Need to do at least few-patient decon At any timeWith own resourcesMay need to do or help with mass deconUsually with help, e.g. FDNeed to practiceNeed to protect and train staff
31Basic Requirements Contain contamination Control environment Protect staffAllow deconContain runoffAllow cleanup or disposalPatient through-put
32Standards? American Institute of Architects NFPA and ASTM For roomsNFPA and ASTMFor some field devicesNIOSH eventuallyReally, it’s still caveat emptorTry before you buy
33Staff PPE Levels of PPE Level A for entry Level C for known hazard A: big suit, big tankB: little suit, big tankC: little suit, little maskD: no suit, no maskLevel A for entryLevel C for known hazardLevel B or C for unknown?
37Standard (Universal) Precautions GownGlovesMaskN95 HEPA, to upgrade for plague or smallpoxRESPIRATORY PRECAUTIONSShoe coversAs the example of what one needs to cope with a bio attack. Not “moonsuits”.For RAD or BIO: level D plus
38Level B vs. Level C Training time Equipment Cost But is C safe??? 8 hours vs. 40 hoursB training requires escape bottles (OSHA)Equipment CostAbout $4000 per person for BAbout $1000 per person for CBut is C safe???
39Case Review Sarin in Tokyo HSES data 1996-1998 No decon, no PPE 472 hospital workers surveyedOver 100 symptomatic1 admittedHSES data44,015 events3,455 events produced 13,149 victims5% were admittedAnnals of Emergency Medicine 42:3, September 2003
40Case Review Cont. HSES 1996-1998 HSES Healthcare data 348 responder exposuresMostly PD and FD6.6% admittedNo deathsHSES Healthcare data11 events produced 15 HCW exposuresMix of organo, pepper, HF, chlorine, solvents5 of these were INTERNAL to the facilityNo admissions
41Case Review Cont. Organophosphates Outside US Modeling GA case (suicide): one HCW intubated, one other admitted, 2 more needed antidotes4 anecdotal cases, no admissionsOutside USSeveral cases reported, no PPE, but no admissionsModelingC is enough for compounds more volatile than sarin
42Case 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 settingsGovt. agencies are considering similar data, may change recommendationsVA, NIOSH, HRSA (Hospital program)
43How Do I Get It Done? Needs Money Interested staff Competent trainers Institutional commitment
44Money Federal State or Local Industry Own facility HRSA, CDC DHS (work with public safety?)State or LocalIndustryOwn facility