Hospitals patient decontamination

In hospitals today a wide variety of complex equipment is used in the course of patient treatment. Humidifiers, incubators, ventilators, resuscitators and other apparatus require proper maintenance and decontamination after use. Chemical disinfectants used for this purpose have in the past through misuse become contaminated with opportunist pathogens, such as Ps. aeruginosa, and ironically have contributed to, rather than reduced, the spread of cross-infection in hospital patients. Disinfectants should only be used for their intended purpose and directions for use must be followed at all times. 

The possibility of contamination may be determined in the field, en route to a treatment facility, or at the treatment facility, depending on the condition of the patient. Individuals subjected only to external contamination and not otherwise injured should be decontaminated (see Section 7.3) at a location other than a hospital. Patients who show no evidence of external contamination but have likely received... 

It is also important to consider the issue of patient decontamination. Many hospitals rely on local fire or HAZMAT resources to decontaminate patients prior to arrival at the emergency department. This model is almost always effective as the typical HAZMAT or chemical exposure is an isolated event in which a limited access/egress quarantine can be established, and in which patients can be controlled and decontaminated. However, as was demonstrated during the sarin gas attack in Tokyo, in a disaster, there is no control over the scene or scenes. Patients will self-refer to emergency departments without being decontaminated (Auf der Heide, 2006 Okumura, Suzuki, Fukuda, 1998 Okumura, Takasu, Ishimatsu, 1996). 

The past few years have seen an increase in research into procedures and protocols for patient decontamination and the development of a range of equipment to facilitate that process at the scene and in hospitals. A detailed account of recent developments in this field is provided below. Depending on the type of agent released, speedy decontamination can be a critical part of preventing or limiting harm and controlling the spread of contamination. 

UA (0258), LIN (M25865), 6545-01-176-4612. The Medical Equipment Set (MES) Chemical Agent Patient Decontamination contains supplies and equipment required to decontaminate sixty contaminated casualties with nerve, blood, and/or blister agents. The basis of issue is one per battalion aid station/treatment squad, one per treatment team, and three per Combat Support Hospital. The weight is 1046.27 lbs and cube is 90.642 cubic feet. There is no power... 

Patient decontamination, which Hazmat teams have to undertake much less often than technical decon, is to be performed when the contaminant poses a further risk to the patient or a secondary risk to response personnel. Fire and EMS publications frequently describe how patient decontamination can be done, but few of the recommendations are based on empirical research. Because little scientific documentation exists for when and how patient decontamination should be performed expeditiously and cost effectively, prehospital and hospital providers are left to doing what they think is right, rather than doing what has been proven to work best. Generally, the process involves three stages gross, secondary, and definitive decontamination. 

However effective at-scene decontamination is, a number of patients will still arrive at hospital requiring decontamination. These may be critically ill patients evacuated from the scene before treatment or after initial assessment and treatment, patients who have self-evacuated or patients who are suspected of being incompletely decontaminated. Decontamination should be carried out in teams of 2-4 and may take up to 20 minutes per patient to complete. 

Mobile Medical units with Clinic for First aid treatment Laboratory Diagnostic units operating theater hospital, specifications for treatment of patients affected by chemical agents (indication, decontamination). 

Improvement Item Mass casualty plan was not implemented initially due to communication difficulties. Communication of patient status at decontamination was not well-coordinated with Red Cross shelter representatives. Persons at shelters were registered, but if they were sent to the hospital or left with friends/family, their status was unknown. 

Of the overall chemical bum patients, the most common sites involved were the face, neck, and upper body (87%), and the eyes or eyelids were involved in 19% of overall cases [28]. In deliberate chemical assault victims, the face and neck were commonly injured, but the genital area was also involved in many victims. Acids, such as sulfuric acid, can be obtained at low cost in Jamaica. These authors note that many of the chemical assault injuries were devastating with facial destruction and blindness. Less than half of the victims decontaminated tliemselves with copious water inigation before presenting to hospital [28]. 

Nurse responders must approach contaminated sites with great caution an6 be prepared to self-decontaminate. Nurse receivers need to have a solid understanding of how to stay safe while participating in decontamination procedures and patient care at the hospital. 

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 ... 

Appropriately decontaminate and treat the patient (s) while protecting hospital staff, other patients, and visitors. 

Ideally, decontamination occurs outside the hospital by EMS providers (Johnson, 1997). If this does not occur, prepare a decontamination area for the patient. If possible, the ideal location is outdoors (see Table 26.4). If indoor decontamination is necessary, a decontamination room is the next ideal location. Indoor decontamination should occur only in cases in which a controlled indoor environment may be maintained safely. 

Some patients may be exposed to high levels of radiation that affect only a part of their bodies. For example, a scientist who places his or her fingers into the beam of an X-ray diffractometer may have very severe burns on the exposed fingers, but no other symptoms. In such cases, it may be necessary to perform skin grafts or even to amputate the fingers or hand, but the rest of the body will remain unaffected. Similarly, personnel may have hot particles fall onto their skin, giving severe radiation burns to very small areas. These patients must be decontaminated and the burns dressed at the scene, and skin grafts may be required after admission to the hospital. 

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