DecontaminationDecontamination

Daniel Kollek, MD, FRCPC

Public Health CBRN course

Goals of sessionGoals of session

To provide an overview of

Decontamination and PPE

Outline of sessionOutline of session

Erroneous assumptions Decontamination concepts

– Biological vs Chemo/Radiation– People vs. Places & Objects– Hot/Warm/Cold zones– Decontamination methods– Streaming by acuity

PPE levels

Common erroneous assumptionsCommon erroneous assumptions

All contaminated victims will be decontaminated at the scene

Patients will only go to designated hospitals

Victims will arrive via the EMS system Victims at a non designated hospital can

be safely transported to the appropriate site

“Hazardous Materials” Levitin& Siegelson, Emerg. Med. Clin. Of N.Am. Vol 14 No2, May 1996, 327-348

Reasons for DecontaminationReasons for Decontamination

Prevent the spread of chemicals or biological agents from the area of initial release

Remove chemicals or radionucleides from the patient to terminate their exposure

Reduce the need for PPE among those providing care

Prevent accidental exposure to responder/receiver while removing PPE ensembles

Key concept # 1 - BiohazardsKey concept # 1 - BiohazardsStaff treating biological (infected)

patients need appropriate PPE only (as determined by routine practice & additional precautions)

Need for isolation of patients depends on pathogen and or syndrome

Infected patients do not need formal decontamination

Key concept # 2 Key concept # 2 Contaminated objects or sitesContaminated objects or sites

Need to decide if area should be closedNeed to decide if people should be

isolated or decontaminated

Suspicious object

Opened Unopened

Spilled substance or

airborne substance

No Spill andnot airborne

Leaking oily or granular substance

No leak

Evacuate areaShut ventilation

Office can be closed off

“Open concept”office

No closureNo environmental decontamination

Close work stationuntil decon or-ve test result

Close office onlyuntil decon or-ve test result

Close flooruntil decon or-ve test result

Close the site?

Suspicious object with threat

Opened Unopened

Staff exposed Staff not exposedLeaking oily or

granular substanceNo leak

Hands only;Wash hands

Shower at homeWash Hands

Wash handsShower at home

Wash Hands

Hands & clothes;Remove clothes

and shower

Gross contamination:Remove clothes

and shower

Launder clothesat home with

bleach if possible

Decontaminate the people?

Leave clothes

on site if possible

Key concept # 3Key concept # 3Methods of decontaminationMethods of decontamination

MechanicalDilutionAbsorptionDegradation

Mechanical: Clothing RemovalMechanical: Clothing Removal First step in patient decontamination Removes majority of contaminant Only form of decon necessary in vapor/aerosol exposure Should be performed outside

of treatment areas Privacy/personal space essential Clothing may need containment

Dilution: Soap & Water ShowerDilution: Soap & Water Shower

Necessary for liquid or solid contamination

Dilutes the offending agent Washes away the toxin Decreases the rate of chemical

reaction Restores normal skin pH Can usually be self-administered Consider run-off containment

Key concept # 4Key concept # 4Hot, Warm and Cold zonesHot, Warm and Cold zones

Hot ZoneContaminated area

Need PPE

Warm ZoneContamination

reduction

Cold ZoneNormal function

Key concept # 4Key concept # 4Hot, Warm and Cold zonesHot, Warm and Cold zones

Hot ZoneContaminated area

Need PPE

Warm ZoneContamination

reduction

Cold ZoneNormal function

You will be here. Public Health does not usually

decontaminate or function in the hot zone

Zone rulesZone rules

Hot ZoneContaminated area

Need PPE

Warm ZoneContamination

reduction

Cold ZoneNormal function

Control access to zones

TemporaryMorgue

Very limited treatment before decontamination

Isolate cadavers

Decontamination direction No back flow!!

Key concept # 5Key concept # 5Minor incident vs. MCIMinor incident vs. MCINot everyone needs formal

decontaminationDecontamination should be

streamed by acuity or ambulatory ability

Decontamination TriageDecontamination Triage Serious medical/chemical signs and

symptoms get urgent decontamination Moderate signs or symptoms, or confirmed

liquid exposure- delayed decontamination Minimal signs and symptoms, or vapor

exposure will follow the delayed patients No signs and symptoms, or potential for

exposure, but remain significantly concerned re contamination will be processed last- “psychological decontamination”

Chemical MCI - AmbulatoryChemical MCI - Ambulatory

Chemical MCI – Non-ambulatoryChemical MCI – Non-ambulatory

Key decon. conceptsKey decon. concepts

Protect yourself and your staff– Containment of people & contaminants– Appropriate PPE (& know how to use it!)

Define the Hot and Cold zones– Triage in or before Hot zone– Secure the perimeter– Very limited care (if at all) in Hot zone

Stream patients by acuity– Integrate the decontamination plan into the

general disaster plan Not everyone needs a shower

PPE levelsPPE levels

When response activities are conducted where atmospheric contamination is known or suspected to exist, personal protective equipment (PPE) must be worn.

Personal protective equipment is designed to prevent/reduce skin and mucous membrane contact as well as inhalation or ingestion of the chemical substance.

Protective equipment to protect the body against contact with known or anticipated chemical hazards has been divided into four categories, levels A-D.

PPE level APPE level A

This is the level you are most likely to see in the Hot Zone of a significant event.

It is entirely self contained with SCBA and fully encapsulated.

PPE level BPPE level B

This is the level you are most likely to see in the Hot Zone of a less hazardous event or in the warm zone.

It is still fully encapsulated and maybe self contained or not.

PPE level CPPE level C

This is the level you are most likely to see in the cold zone, in transit and the hospital.

Full-face or half-mask or air-purifying respirator

Chemical resistant clothing Gloves Not self contained.

PPE level DPPE level D

Used for nuisance contamination only.

It requires only coveralls or equivalent and safety shoes/boots or equivalent.

PPE levelsPPE levels

Reasons to upgrade – Known or suspected presence of dermal hazards – Occurrence or likely occurrence of gas or vapor emission – Change in work task that will increase contact or potential

contact with hazardous materials – Request of the individual performing the task

Reasons to downgrade:– New information indicating that the situation is less

hazardous than was originally thought – Change in site conditions that decreases the hazard– Change in work task that will reduce contact with hazardous

materials

SummarySummary Receiving facilities all need some form of

decontamination plan, assume everyone arrives dirty

Biological, Chemical and Radioactive contamination have different decontamination and isolation requirements

People, Places & Objects have decontamination and isolation protocols

Divide the decontamination area and the impact site into Hot/Warm/Cold zones and stream patients by acuity

PPE levels vary by the agent