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Hospital Decontamination

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Presentation on theme: "Hospital Decontamination"— 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 Fires Transportation accidents
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. Luke’s Hospital (520 beds) Treated 500 patients in first hour; 640 on first day

8 Conyers, GA 2003





13 Explosives… Decon??? Madrid, 11 March 2004
Scenes from the 2004 Madrid train bombing. Bombings are actually a likely threat, as opposed to the NBC weapons. Explosives… Decon???

14 Radiation Is Easily Detectable
Geiger counters and ionization detectors. These devices require training, but are not that hard to use. ED door monitors?

15 Anthrax 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18 OSHA Draft Guidance In brief: Yes, you need to do it PAPR’s 8 hour staff training minimum

19 Finance and Publicity Work with the government Work with industry
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 RAM Decon Trailers Indoors
Cheap Slow, clumsy Outdoors (wading pools) Tents Outside Inside RAM Decon Trailers Indoors Multipurpose room Dedicated room Quick, easy Dear



24 Decontamination Tent

25 “RAM Decon”

26 Hospital’s Trailer

27 Local FD Trailer

28 “Mass” Decon Unit Transfer boards on center roller system
Show and explain graphic

29 Undress Decon Dress 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 NFPA and ASTM
For rooms NFPA and ASTM For some field devices NIOSH eventually Really, it’s still caveat emptor Try before you buy

33 Staff PPE Levels of PPE Level A for entry Level C for known hazard
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
Gown Gloves Mask N95 HEPA, to upgrade for plague or smallpox RESPIRATORY PRECAUTIONS Shoe covers As the example of what one needs to cope with a bio attack. Not “moonsuits”. For RAD or BIO: level D plus

38 Level B vs. Level C Training time Equipment Cost But is C safe???
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 HSES data 1996-1998 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

40 Case Review Cont. HSES 1996-1998 HSES Healthcare data
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 Outside US Modeling
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 State or Local Industry Own facility HRSA, CDC
DHS (work with public safety?) State or Local Industry Own facility

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

46 Training Internal External Refresher training built into system
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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