1. Chemical and Biological Decontamination The University of South Alabama Center for Strategic Health Innovation
© University of South Alabama Center For Strategic Health Innovation. All Rights Reserved.
These slides are a part of the ARRTC program and cannot be reproduced for commercial purposes.

2. Chemical/Biological Release
Acute and Delayed toxicity
Routes of Exposure
Inhalation**
Absorption
Ingestion
Through open wound/Injection
Local and systemic effects of exposure
Dose response as it relates to risk assessment
Synergistic effects of combined substances
Assessment and use of toxicology information
Relationship of proper decontamination to higher mortality and morbidity
Alteration of triage patients as they relate to toxically exposed patients
Levels of Personal Protective Equipment needed

3. Chemical Decontamination

4. Hospital Responsibilities
According to JCAHO and OSHA, emergency departments (EDs) and emergency medical services (EMS) are responsible for managing potential chemical disasters (accidental and acts of terrorism)
Three primary goals for hospitals exist during a chemical incident:
Isolate the chemical contamination
Appropriately decontaminate and treat the patient(s) while protecting hospital staff, other patients, and visitors
Reestablish normal services as quickly as possible

5. Five Major Classes of Chemical Warfare Agents
Nerve agents—tabun, sarin, soman, GF, and VX
Cyanide gas
Vesicants—sulfur mustard and lewisite
Pulmonary agents—phosgene and chlorine
Riot control agents—aka: tear gas; mace (CN), pepper spray, and CS

6. Goals of Decontamination
Goals include:
Reduce the amount of the agent
Remove the agent
Prevent further contamination of the environment
Remember:
The safety of the staff is highest priority
Decontamination needs to occur as quickly as possible
There is a direct relationship between contact time and effect (severity of signs and symptoms)

7. Methods of Decontamination
Three basic methods—
Physical removal
Flushing with water or aqueous solution
Absorbent materials
M291 Resin
Chemical methods
Water/soap wash
Oxidation
Hydrolysis
Hydrolyzing agents

8. Decontamination Procedures
Assessment and “Size-up” incident
Scene control/establishment of perimeter(s)
Identify agent (if possible)
Chemical detection paper can detect and identify airborne chemical warfare agents. The paper is impregnated with dyes sensitive to different types of chemical warfare agent, and will indicate which type of agent is present by its corresponding pigment signal.
Determine the level of PPE required and don gear
Prepare Decontamination area (Set-up Zones)
Control access to the decontamination site as well as the hospital

9. Decontamination Procedures
Setting up Decontamination Zones
Three distinct zones must be established:
Hot Zone Warm Zone Cold Zone

10. Decontamination Procedures

11. Decontamination Procedures
Preparing decontamination area into zones
Warm zone should be outside of facility
Downwind of clean area (approximately yards); not near facility air intake
Area for decontamination triage
Receptacles for contaminated clothing, valuables, and contaminated supplies
Source of water (warm water is best, especially in cold climate areas), soap, and towels
Tape to demarcate zones (dirty and clean areas)
Screens for privacy or segregation by gender (if possible)
Collection systems for runoff water
Chemical agent monitoring (CAM) supplies

12. Decontamination Procedures
Overview of Decontamination of victim(s):
Is personnel, time, and equipment intensive
Patient may be litter-bound or ambulatory
Remove all clothing (reduces agent by 80-90%)
Place all clothing and valuables in a bag
Place these bags in a larger collection container (do not let bags touch the outside of the container)
Wet skin, and wash down with soap and water (pay attention to hair, face, hands) for at least 5 – 10 minutes; then RINSE! RINSE! RINSE!
Check for the presence of agent by using CAM or M-8 paper; If positive, decontaminate again
If negative, relocate to clean area, don dry clothing

13. Mass Decontamination

14. Decontamination Procedures: Selecting a Decontamination Agent
Many substances have been evaluated for their usefulness in skin decontamination.
The most common problems with potential decontaminants are irritation of the skin, toxicity, ineffectiveness, or high cost. Recognized desirable traits of a skin decontaminant include the following:
Neutralization of all agents
Safety (compound to be both nontoxic and non-corrosive)
Ease of application by hand
Readily available
Rapid action
Non-production of toxic end products
Stability in long-term storage
Short-term stability (after issue to unit/individual)
Affordability
Non-enhancement of percutaneous agent absorption
No irritability
Hypoallergenicity
Ease of disposal

15. Decontamination Procedures: Selecting a Decontamination Agent
Liquid Decontamination Agent of Choice:
Household bleach (Hypochlorite)--inexpensive
Two concentrations commonly used
0.5% solution —works by physically removing, oxidizing, and/or hydrolysis of the agent.
Can be used to decontaminate the skin and soft-tissue injuries
Must be rinsed thoroughly from the skin
Should not be used for penetrating wounds leading into a cavity (e.g., abdominal and chest wounds) or in the eyes
5.0% solution —works by physically removing, oxidizing, and/or hydrolysis of the agent
Should only be used to decontaminate inanimate objects

16. Decontamination Procedures: Selecting a Decontamination Agent
Dry Decontamination Agent of Choice:
Chloride of lime and magnesium oxide—this mixture creates a powder (must be finely ground) that provides both absorption and neutralization agents.
The powder can be used to decontaminate skin and equipment.
Flour—effective against GD, VX, and HD. The flour is applied to the skin then wiped off with wet tissue paper.
M291 Resin—developed and used by the military; is the best skin decontamination agent known; used for spot decontamination only.

17. Biological Decontamination

18. Biological Exposure
Biological weapons may expose people to bacteria, viruses, or toxins as fine airborne particles.
Biological agents are infectious through one or more of the following mechanisms of exposure, depending upon the particular type of agent:
inhalation, with infection through respiratory mucosa or lung tissues;
ingestion;
contact with the mucous membranes of the eyes, or nasal tissues;
penetration of the skin through open cuts (even very small cuts and abrasions of which employees might be unaware).

19. Typical Biological Warfare Agents
Anthrax
Staphylococcal Enterotoxin B (SEB)
Bubonic/Pnuemonic Plague
Cholera
Smallpox
Other bio-engineered agents

20. Decontamination of Biological Agents
Environment infected with a biological agent can be decontaminated with a diluted solution of household bleach (sodium hypochorite).
If agent is a virulent bio-agent, full strength sodium hypochorite may be used.
Although not all types of bio-agents will be immediately killed by bleach, it may prevent the spread of the contaminant