Skin decontamination cleansing

Decontamination Complete cleansing of the skin with soap and water at the earliest opportunity. If washing is impossible, use the M258A1, M258, or M291 skin decontamination kit. Symptoms may appear as late as 36 h after contact exposure, even if the skin is washed within an hour. In fact, a delay in onset of several hours is typical. Use this time to prepare for the possibility of a widespread outbreak 6-24 h after the attack. Decontaminate bulk quantities of BZ with caustic alcohol solutions. If BZ or other belladonnoids are used as free bases, decontamination will require a solvent, such as 25% ethanol, 0.1 N hydrochloric acid, or 5% acetic acid. 

Skin decontamination is performed last and generally begins with the least aggressive techniques and the mildest cleansing agents. The following steps are usually effective for intact skin decontamination efforts ... 

Treatment of skin lesions also follows decontamination and removal of clothes. Decontamination should be completed within 15 min after exposure to minimize any systemic effects. Contaminated hair should be shaved off. The decontaminating solutions should be washed off within 3-4 min to prevent additional skin injury. Sodium hypochlorite (5%) or liquid household bleach can be used. If erythema is already present, soap and water are preferred. Blisters should be left intact, but if broken, should be debrided to prevent secondary infection. Cleansing with tap water or saline and the application of dressings is done when needed. Silver sulfadiazine or mafenide acetate can be applied and the wounds treated as burn wounds. Infected skin wounds require antibiotics as appropriate. 

Metal ions are usually unable to penetrate the skin and to gain access to the circulation. However, when the skin has been broken by a wound, and when the metal ions are made net-neutral in the form of a metal complex, access from the exterior of the body to the internal circulation is a distinct possibility (Figure 6.3). Similarly, when such metal complexes are present on unbroken skin in the presence of fluids such as perspiration or organic solvents, their ability to penetrate the epidermis and reach the circulation may be greatly increased. Thus, a consideration of skin protection, of cleansing, and of decontamination is important. 

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