Hospitals contamination incidents

Deaths as the result of acute exposure by ingestion of endrin have been observed in humans in a variety of incidents. In 1967, in Doha, Qatar, and Hofuf in Saudi Arabia, 874 people were hospitalized after an acute exposure to endrin-contaminated flour which resulted in 26 known deaths (Weeks 1967). Deaths occurred within 12 hours of the onset of symptoms of toxicity (convulsions, loss of consciousness, headache, nausea, vomiting) however, recovery of survivors was rapid. Concentrations of endrin in bread eaten by victims ranged from 48 to 1,807 ppm (Curley et al. 1970). The contaminated flour used to make the bread contained 2,153-3,367 ppm endrin. 

A patient who consumed endrin-contaminated bread had serum levels of endrin of 0.053 ppm (0.053 mg/L) no endrin was detected in cerebrospinal fluid. The sample was taken 30 minutes after a convulsion (Coble et al. 1967). In another bread poisoning incident, blood from patients hospitalized with acute symptoms contained 0.007-0.032 ppm of endrin. Tissues taken at autopsy (elapsed time not specified) contained endrin at the following concentrations stomach wall, 0.16 ppm liver, 0.685 ppm and kidney, 0.116 ppm (Curley et al. 1970). 

When a patient presents to the ED, the nurse must ascertain that an exposure has taken place. Nurses should suspect chemical exposures for any mass casualty incident in which multiple ill persons with similar clinical complaints (point-source exposure) seek treatment at about the same time or in persons who are exposed to common ventilation systems or unusual patterns of death or illness. The ED may or may not receive notification in advance that a chemical explosion or leak has occurred. In either case, ED health care providers have the following three primary goals in treating a patient who has been exposed to a hazardous material and may be contaminated or who has not undergone adequate decontamination before arrival at the hospital ... 

Since 1995, the Chemical and Nuclear Engineering Department of the Polytechnic University of Valencia in Spain has been working on the application of membrane technology to the treatment of low and medium level radioactive liquid wastes. In this chapter, we describe two practical cases of radioactive liquid waste treatment using membrane processes the treatment of Cs-contaminated water generated after a radioactive incident in a stainless steel production factory, and the treatment of 1 liquid wastes from nuclear medicine services at hospitals. 

Higher rates of contamination are invariably seen in products after opening and use and, among these, medicines used in hospitals are more likely to be contaminated than those used in the general community. The Public Health Laboratory Service Report of 1971 expressed concern at the overall incidence of contamination in non-sterile products used on hospital wards (327 of 1220 samples) and the proportion of samples found to be heavily contaminated (18% in excess of 104 CFU per g or per ml). Notably, the presence of Ps. aeruginosa in 2.7% of samples (mainly oral alkaline mixtures) was considered to be highly undesirable. 

Victims of chemical contamination need prompt and effective treatment, both at the scene of the incident and in hospital. Ambulance or emergency medical services and hospital emergency rooms provide the front line health response and most will already have tried and tested contingency arrangements for accidental chemical releases - often referred to as HAZMAT or HAZCHEM (hazardous materials and hazardous chemicals) protocols. Whether for an accidental or deliberate chemical release contingency arrangements need to address the following key objectives ... 

All hospital plans should include provisions for a proportionate response to the arrival of contaminated casualties, with procedures for rapid lock-down and establishing entry and exit restrictions. Most ambulance service plans already provide for sending an immediate alert to all hospitals designated to receive casualties whenever a major incident is declared. Although patients may have already self-evacuated before the emergency services arrive, ambulance plans should also provide for warning all... 

Contaminated patients pose a hazard to their attendants. Secondary contamination by contact with liquids or solids, e.g. powders, is an obvious risk, while off-gassing of volatile agents from clothing is, perhaps, less obvious. However, it was noted in the Tokyo subway incident (see Chapter 13) that hospital staff developed miosis as a result of exposure to sarin (GB) given off by patients clothing. The patients had themselves not been exposed to liquid sarin but only to sarin vapour and yet enough had been adsorbed... 

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