Decontamination Process/Goals AVERA MCKENNAN Decontamination Process/Goals PRESENTED BY: KaraJo Schneekloth, Nuclear Medicine Technologist and Traci Hollingshead, Radiation Safety Officer April 10, 2014

Decontamination Process/Goals Information presented is based on Avera McKennan’s policies and procedures developed from Centers for Disease Control and Prevention 2005 Radiological Terrorism Emergency Management Guide for Clinicians and Guidance for Radiation Accident Management (REAC/TS)

Radiation Principles Radiation cannot be detected by the human senses. A radiological survey conducted with specialized equipment is the only way to confirm the presence of radiation. If a terrorist event involves the use of radioactive material, both patient exposure and contamination must be assessed.

Radiation Principles Exposure occurs when a person is near a radiation source. People exposed to a source of radiation can suffer radiation illness if their dose is high enough, but they do not become radioactive. For example, an x-ray machine is a source of radiation exposure. A person does not become radioactive or pose a risk to others following a chest x-ray.

Radiation Principles Contamination occurs externally when loose particles of radioactive material are deposited on surfaces, skin, or clothing. Internal contamination occurs when radioactive particles are inhaled, ingested, or lodged in an open wound.

Radiation Principles Contaminated patients should be decontaminated as soon as possible, without delaying critical care. Patients who have been exposed to radiation, but are not contaminated with radioactive material, do not need to be decontaminated.

Notification and Accident Verification When the hospital receives a call that a radiation accident victim or victims are to be admitted, a planned course of action should be followed. The individual receiving the call should get as much information as possible, including the following. Number of accident victims Each victim’s medical status and mechanism of injury If victims have been surveyed for contamination Radiological status of victims (exposed vs. contaminated) Identity of contaminant, if known Estimated time of arrival

Sample Radiological Emergency Response Team Team coordinator Leads, advises, and coordinates Emergency physician Diagnose, treats, and provides emergency medical care Triage officer Performs triage Nurse Assists physician Technical recorder Records and documents medical and radiological data Radiation safety officer Supervises all aspects of monitoring and contamination control Radiation safety personnel Monitors patient and area and advises on contamination control, maintains survey equipment Public information officer Releases accident information to public media Administrator Coordinates hospital response and assures normal hospital operations Security personnel Secures the radiation emergency area and controls crowds Maintenance personnel Aids in preparation of the radiation emergency area for contamination control Laboratory technician Lab draws, analysis of samples

Staff Protection Guidelines Establish a triage area Base the location on your hospital’s disaster plan and the anticipated number of casualties. If possible, select a location near an outside entrance. Restrict access to the controlled area. Establish a contamination area and clean area separated by a buffer zone. Prevent tracking of contaminants by covering floor areas and monitoring at exits of controlled areas. Control lines should be established at the entrance to the triage area. A wide strip of tape on the floor at the entrance should be marked clearly to differentiate the controlled (contaminated) from the non-controlled (uncontaminated) side and the buffer zone.

Staff Protection Guidelines Use strict isolation precautions, including protective clothing and double bagging. Remove contaminated outer garments when leaving the contaminated area. Monitor anyone and anything leaving the controlled area. Control waste by using large, plastic-lined containers for clothing, linens, dressings, etc. Change instruments, outer gloves, drapes, etc. when they become contaminated. Use waterproof materials to limit the spread of contaminated liquids (waterproof drapes).

Staff Protection Guidelines Use standard precautions Follow standard guidelines for protection from microbiological contamination. Surgical masks should be adequate. N95 masks, if available, are recommended. Survey hands and clothing at frequent intervals with a radiation meter. Due to fetal sensitivity to radiation, assign pregnant staff to other duties.

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Patient arrival and triage During triage, consideration is given to medical and radiological problems. Serious medical problems always have priority over radiological concerns, and immediate attention is directed to life-threatening problems. Addressing contamination issues should not delay treatment of life-threatening injuries. It is highly unlikely that the levels of radioactivity associated with a contaminated patient would pose a significant health risk to care providers. In certain rare instances, the presence of imbedded radioactive fragments or large amounts of external contamination may require expedited decontamination. Always include in-house radiation professionals on the response team.

Patient arrival and triage Non-contaminated patients are admitted to the usual treatment area and can be cared for like any other emergency case. A specifically prepared treatment area is not needed. Following attention to medical needs, question the patient to determine the possibility of radiation exposure from an external source.

Patient arrival and triage Contaminated patients are admitted to a specially prepared area. When in doubt, a critically injured patient should be taken immediately into the prepared area. If the victim’s condition allows, an initial brief radiological survey can be performed to determine if the victim is contaminated. A more thorough survey will be performed once life-threatening problems are addressed.

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Decontamination Guidelines Survey the patient with a radiation meter Perform surveys using consistent technique and trained personnel. Note exceptionally large amounts of surface or imbedded radioactive material. Handle radioactive objects with forceps and store in lead containers. Record location and level of any contamination found.

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Decontamination Guidelines Remove patient clothing Carefully cut and roll clothing away from the face to contain the contamination. Double-bag clothing using radioactive hazardous waste guidelines, label and save as evidence. Repeat patient survey and record levels.

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Decontamination Guidelines Cleanse contaminated areas Wash wounds first with saline or water. If facial contamination is present, flush eyes, nose, and ears, and rinse mouth. Gently cleanse intact skin with soap and water, starting outside the contaminated area and washing inward. Do not irritate or abrade the skin.

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Documentation In addition to routine medical records, note survey readings, samples taken (and time), descriptions of the accident, and effectiveness of decontamination. Take care to note pre-existing conditions such as rashes, healing wounds, or scars. This information will be extremely valuable to medical consultants and health physicists in reconstructing the accident accurately and making a prognosis.

Patient Safety Routine precautions for patient safety should not be forgotten. Be especially alert for potential falls or slips on wet floors, excessive heating or chilling, and any electrical hazards.

Patient comfort and emotional support A patient involved in a radiation accident needs explanations of procedures and actions being taken (isolation, use of survey meters, taking of samples, decontamination, etc.) in the radiation emergency area. A knowledgeable person should answer the patient’s questions and provide reassurance. Preferably, this person should be the attending physician who continues to treat the patient until discharge.

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