Infection Control Today - 06/2004: Are You Prepared

Are You Prepared for a Mass-Contamination Event at Your Facility?

By Lori Hagen, CPHQ

All over the United States, healthcare facilities are focusing their attention on how to prepare for incidents in which mass decontamination would be necessary. In these times, a healthcare organization must be prepared to respond to a terrorist attack involving weapons of mass destruction that could occur in their community. When facilities are reviewing their preparedness, they must work with the resources within their community and surrounding area. Preparation for how to handle a mass decontamination event requires planning, training, and organization. There is no way to predict the contaminant, whether it be nuclear, biological, or chemical.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has standards requiring that emergency management plans specifically identify procedures which address preparation, response, and recovery from emergencies in hospitals and other medical facilities. The healthcare organization must develop these plans through the completion of a hazards-vulnerability analysis. JCAHO standard EC.4.10 states that the hospital addresses emergency management. The following are some of the elements of performance:

  • The plan provides for processes for notifying external authorities of emergencies, including possible community emergencies identified by the hospital (for example, evidence of a possible bioterrorist attack).
  • The plan identifies means for radioactive, biological, and chemical contamination and isolation.
  • The plan identifies specific procedures that describe mitigation. Mitigation activities are those activities a hospital undertakes in attempting to lessen the severity and impact of a potential emergency.

As you can see, it is important for medical centers to review current JCAHO standards. The plan on handling decontamination of individuals if there is a mass casualty event with contaminants is just one part of preparedness.

Decontamination is the process of removing biological, nuclear, and/or chemical residue from victims, staff, first-responders, and possibly even the physical plant of your facility. It is very important to provide education on how to handle suspected contaminated patients to protect the facility. If the emergency room gets contaminated, then it will be of no further use in treating patients.

Therefore, the first line of defense is to protect the facility and its staff. If an area of the hospital becomes contaminated, both the area and the air-handling systems must be isolated; it is critical for staff to understand this.

Our medical center has four core members of the DECON team who have identified functions. The team consists of an industrial hygienist (leader and detection), a registered nurse with infection control and military experience (administrative), a plant-operations specialist with a military background (operations), and an emergency room nurse practitioner (medical).

They have all completed the HAZMAT/Weapons of Mass Destruction (WMD) Awareness/Operations-Level Hospital Decontamination Train-the- Trainer course. This core team is responsible for such key elements as equipment and supply issues, education and training, and controlling the disaster flow/treatment.

This core team is providing a four-hour awareness- level training to the staff in our facility who have been identified as staff members who might be seeing patients who are potentially contaminated first. These front-line individuals include, but are not limited to, staff in the emergency room, at information desks, in urgent care, and members of the facility police. This training is designed to educate the first contact personnel about recognizing possible contamination threats and being able to take the appropriate steps to protect themselves, staff, patients, and the medical center.

Most medical staff members have the natural response to provide an immediate and emergent response. But in the case of possible contaminated victims, staff must be educated to stop and take two steps back. Staff must protect themselves and the medical center. This point is stressed to medical center employees, as the facility must be protected from contamination. If a patient is suspected of being contaminated, he or she should be taken out the same way they came into the medical center or out the closest exit. The staff must be educated about the importance of activating the emergency response plan in this situation.

Outdoor decontamination protects staff, equipment, and other patients from being contaminated. If victims are kept outside, there must be an organized plan on how the facility will decontaminate and treat them. Of course, in an emergency situation, many victims may inundate a facility, which will make contamination difficult to contain. Some medical centers may utilize a small, quickly deployable shower unit to decontaminate one or a few victims; however, for mass decontamination, the larger inflatable shelters with DECON capabilities must be set up rapidly.

The operations-level training is provided to the group of approximately 30 volunteers who will serve as the facility DECON team. These personnel are trained to set up the decontamination system, wear the decontamination suits with respirators, and properly decontaminate victims. These volunteer staff members will respond to the medical center in the case of a possible mass-decontamination event.

When possible, the best place for a decontamination area is outside the main facility. This team has strategically decided the placement of a rapidly deployable tent structure equipped with a decontamination system. An outdoor mass-casualty decontamination system capable of decontaminating ambulatory and non-ambulatory casualties is utilized. The facility should consider such issues as wind direction, placement near the emergency room, traffic control, and entry points. The source of water-supply hook-up must be identified. Depending on the number of victims, there could be a lot of water used which must be contained and isolated.

The DECON team members in the hot zone and warm zone will wear the appropriate protective equipment. The DECON team members providing decontamination will wear hoods, gloves, and chemical protective suits to protect themselves from contact with the hazardous material. They also will use air-purifying cartridges for respiratory protection. The appropriate level of protection should be reviewed related to the task. Patients should perform as much of the decontamination as possible to decrease cross-contamination. After they are decontaminated in the hot zone, they are moved to the warm zone for further decontamination; they are then moved to the clean treatment area.

Depending on the number of individuals that are possibly contaminated, there will be some degree of confusion and hysteria. It will be important for healthcare facility staff to identify a plan to control the scene as much as possible. It is key to control the contamination.

The facility will continue to learn and make changes to its decontamination plan, and the requirement for drills will promote continuous improvement in this process. It is impossible to predict what will happen if this type of event happens in your facility. The more training and education that is provided will only prove to be beneficial. Another key element is the coordinating and communication of medical centers with their local, county, and state emergency preparedness officials.

Lori Hagen, CPHQ, is a member of the DECON team at the James H. Quillen VAMC in Mountain Home, Tenn. along with Doug Dulaney, Dale Shoop, and Dan Knell.

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