Decontamination

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Status Brief

History/Origins:

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:

Problems/Challenges:

Proposals:

2002

Bentham, Martin, “5,000 body bags ordered in case of terrorist chemical attack Government orders 120,000 decontamination suits to be ready for distribution ‘in minutes“. SUNDAY TELEGRAPH, December 8, 2002

  1. “THE GOVERNMENT is buying more than 120,000 decontamination suits to protect people from a terrorist chemical or biological attack on potential targets across Britain such as Trafalgar Square.”
  2. “Thousands of decontamination showers, shelters, stretchers and other equipment are also being ordered – as well as 5,000 body bags. The equipment, which is intended to be available by the middle of next year at the latest, will be stored at 16 locations, ready to be distributed within minutes of a terrorist attack.”
  3. “Philip Ward, the managing director of Ferno UK, the country’s leading manufacturer of emergency and rescue equipment, said that his company was among those bidding for the contracts, which were for “huge” quantities that were “getting bigger by the day.”
  4. “One batch of contracts, which is about to be awarded, is for 120,000 pre-decontamination suits, to be used immediately after a chemical or biological attack. The contracts will also provide 100,000 post-decontamination suits to be worn by people after their initial treatment. Industry officials say the 20,000 difference reflects the number of deaths likely to occur.”
  5. “The treatment, said Mr Ward, would begin with each victim stripping and putting on a pre-decontamination suit. Their clothes would be placed in a separate bag for incineration. Swabs would then be provided for the victims to clean out orifices which could contain traces of the chemical, before each person passed through a shower – set up in shelters at the site of the attack – to wash off the substance. Finally, post-decontamination suits would be given to reclothe the victims.”
  6. “Other equipment required by the Government includes 50,000 decontamination shelters, 2,000 stretchers, 2,000 evacuation chairs and 5,000 body bags.He said, however, that pounds 56 million had been allocated this year to prepare for potentially catastrophic terrorist incidents. Some of the money would buy decontamination equipment, which would be held by the fire service.”

Decontamination, Public Health, Bioterrorism, Emergency Response

2003

Snyder, James, “Role of the Hospital-Based Microbiology Laboratory in Preparation for and Response to a Bioterrorism Event,” Journal of Clinical Microbiology. pg. 1-4, Vol. 41, No.1. Jan. 2003

  1. “The main role of the hospital-based clinical microbiology laboratory in support of a biothreat, biocrime, or act of bioterrorism is to “raise suspicion” when a targeted agent is suspected in a human specimen.”(Pg. 1)
  2. “These plans include the following: (i) criteria for distinguishing the type of bioterroism event; (ii) information regarding access to and utilization of the LRN, including diagnostic testing protocols; (iii) safety guidelines; (iv) communication and notification protocols…” (Pg. 1)
  3. “Therefore, risk assessment becomes the responsibility of the clinical microbiologist, infection control personnel, hospital risk management office, and infectious disease physicians.” (Pg. 3)
  4. “The laboratory, preferably the laboratory director, must establish and include in the laboratory bioterrorism response plan a notification policy that is enacted when a suspicious isolate cannot be ruled out and must be referred to the next higher level laboratory for confirmation of the organism’s identity.” (Pg. 3)

Public Health, Bioterrorism, CDC, Lab Safety, Biodetection, Biodefense, Biosafety, Biosecurity, Decontamination, Personnel Reliability

 

Barbaro, Michael, “A Worst-Case Enterprise; Md. Firm Busy Making Decontamination Shelters” The Washington Post. March 13, 2003.

  1. “The doomsday shower can sanitize 800 people an hour. It boasts separate rinse stations for contaminated men and women. It can be set up by four people in less than 10 minutes. And storage is a cinch: It takes up about as much space as a typical washing machine.”
  2. “TVI Corp. of Glenn Dale says it can’t keep up with back orders for its decontamination shelters, even after doubling its workforce to about 90 last year. Sales of its shelter, which sells for around $ 88,000, nearly tripled in 2002.”
  3. “But TVI’s flagship product is the High Throughput Mass Decontamination Shelter, a car-wash-like structure for humans that has at least 50 shower nozzles threaded into its vinyl interior, a hot water pump and soap dispensers. It is designed to be attached to a fire hose and has at least three shower lanes to separate men, women and the incapacitated after an attack.”
  4. “The product is designed for particular situations. If a “dirty” nuclear bomb is detonated or a biochemical agent is released, for example, people who flee the scene before being decontaminated would risk exposing others to the danger. The shelters would be used to rapidly contain the threat.”
  5. “The decontamination shelters operate on a simple principle.“You just cream people with water,” said Thomas D. Gibson, a lieutenant with the hazardous materials team at the National Institutes of Health campus in Bethesda.”
  6. “”Decontamination is the same whether you are talking about chemical, biological or radiological agents,” said Clendenin, the Massachusetts fire official. “Soap and water is never a bad thing.””

Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology

 

Goldstein, Avram, “Progress Cited on Health Threat; ‘We’re Worlds Better Prepared,’ City Official SaysThe Washington Post, April 17, 2003.

  1. “They are buying protective gear; expanding drug, food and water stockpiles; adding or enhancing decontamination facilities outside emergency rooms; and creating patient isolation rooms to help control a smallpox outbreak.”
  2. “The city has set up an elaborate incident command center that is so new it hasn’t been seen by Mayor Anthony A. Williams (D), said Feseha Woldu, acting administrator of the D.C. Emergency Health and Medical Services Administration.”
  3. “The District has expanded its epidemiology staff to eight and assigned nearly 60 city workers to bioterrorism preparedness. Meanwhile, hundreds of private doctors and nurses have volunteered to deliver health care services or to provide information to the public by phone or computer if called upon by the city.”
  4. “”We live in the No. 1 terrorist target in the world,” said Jeffrey A. Elting, medical director for bioterrorism response coordination at the D.C. Hospital Association. That stark reality has spurred much of the cooperation, he said.”
  5. “The best example is a radio system that enables all hospitals to communicate if telephone service is interrupted, allowing them to rapidly exchange information on their capacity to accept new patients and lend each other equipment and supplies. It also would let public health officials broadcast messages to hospitals regarding the dimensions and type of event. The system is tested a few times a day, when roll is called.”
  6. “The survey found that, on average, hospitals can generate their own electric power for 5.8 days. Without outside help, surveyed hospitals said, they had enough food to last 4.7 days, water for 2.5 days, and medical supplies for 7.1 days.”
  7. “At Providence Hospital, officials are buying 20 protective full-body suits, including respirators, so doctors and nurses can safely and rapidly care for people contaminated by dangerous chemicals or pathogens. They also are buying a mobile decontamination unit where patients exposed to hazardous substances can shower.”
  8. “If a smallpox outbreak occurred, Providence has 12 patient rooms and a 16-bed unit that can be isolated to keep a virus from spreading to unprotected patients and staff. The hospital also has eight portable HEPA (High Efficiency Particulate Air) filtration units that can convert a room or even a plastic tent to a temporary isolation unit.”
  9. “He said the hospital does not want to use the inflatable decontamination units they already have because they take too long to set up — 18 minutes.”
  10. “Wuerker said 12 people have been vaccinated for smallpox, including himself, and another 12 are scheduled. With that many first-line responders, he said, all 5,000 hospital workers could be vaccinated quickly to prepare for an outbreak.”
  11. “Exactly which surge facilities might be needed and when is unpredictable and depends on the exact location and nature of and attack, officials say. Instructions and guidance would be offered by public health officials through electronic and print media, they say.”

Vaccination, Decontamination, Bioterrorism, Public Health, Emergency Response, Biotechnology

 

Editors, “Hospitals are not prepared for terrorThe Toronto Star. January 31, 2003.

  1. “Decontamination of chemically or radiologically contaminated patients, ideally prior to entering the health-care facility, is a critical step in the delivery of care. Only 18 of 59 hospitals (30 per cent) had a decontamination area or a plan to establish one.”
  2. “The ideal system defines two areas: one where contaminated patients arrive for decontamination (the “hot” zone) and one where decontaminated patients receive care (the “cold” zone). Absence of this kind of system indicates a potentially ineffective plan. In our survey, only five emergency rooms (8 per cent) with a decontamination plan had a hot/cold system. This raises the concern that, even among hospitals with decontamination plans, the systems may not be sufficient.”
  3. “Emergency departments that have no decontamination plan must provide protective equipment so staff can function at relatively low risk. But only 41 per cent of the emergency department surveyed had protective coveralls and only 19 per cent had either gas masks”
  4. “Health regions often plan to store drugs in a central repository and deliver them when requested. This may not work in a true event”
  5. “Preparedness for chemical agents requires a readily available stock of antidotes. In this survey, we asked specifically about atropine, cyanide kits, and benzodiazepines and pralidoxime (for nerve agents). Most sites surveyed had inadequate supplies on hand. This is worrisome because, terrorism aside, these antidotes are also useful for patients with toxic ingestions”

Decontamination, Bioterrorism, Public Health, Emergency Response

2004

Bevelacqua, Armando, “THE NEW HAZ-MAT QUESTION: WHAT ARE YOUR BIOLOGICAL CAPABILITIES?“. Pen Well Publishing Co. November 2004.

  1. “In some cases, fire response personnel used levels of protection specifically designed for chemical entry (level B and level A encapsulation), multiple alarms to handle one ounce of powder assumed to have hazardous qualities, and countless .support resources, in some places, powder found outside donut shops and funnel cake stands bad tire response personnel dressed in level A just for a cleanup.” (Pg. 1)
  2. “We must have protocols in place—actions that are followed and performed in conjunction with the public health service. A biological event is a public health response, and a health representative must be involved with the education, training, and tactical response so the system can act as one.” (Pg. 1)
  3. “A relationship must be established with the local Federal Bureau of Investigation’s weapons of mass destruction (WMD) coordinator to obtain guidance and collaboration in support of procedure and documentation” (Pg. 2)
  4. “The key issue to consider is if the environment has been identified strictly as a chemical or a potential biological. The fundamental answer comes from the air-monitoring/ detection systems within the response agency” (Pg. 3)
  5. “Joint Hazard Assessment Teams” (JHAT). JHAT teams are comprised of two haz-mat with a law enforcement representative [additional strike teams have developed into three-person teams comprised of a haz-mat person, an Explosive Ordinance Disposal (EOD). and a law enforcement crime scene officer or intelligence unit representative” (Pg. 3)

Bioterrorism, Decontamination, Public Health, Quarantine, Emergency Response

2005

Lowell, Jennifer, “Identifying Sources of Human Exposure to PlagueJournal of Clinical Microbiology. Pg. 650-656. Vol. 43, No. 2.

  1. “Approximately 3,000 human cases occur worldwide annually, with 12 to 15 cases reported each year in the western United States”
  2. “Two of the primary objectives of routine epidemiology plague investigations are to identify the source of human exposure and to assess the exposure site for potential continuing risk.”
  3. “The use of molecular epidemiological techniques in these investigations has been particularly difficult for Y. pestis because of its apparent lack of genetic variation.”
  4. “When combined with epidemiologic information, judicious use of genetic data from nonhuman organisms is highly attractive because of the power of DNA-based analyses to identify exposure sources.”

Public Health, Pandemic, Plague, Decontamination, Biodetection, Bioterrorism, Biodefense, Biosafety

 

Rose, Laura, “Chlorine Inactivation of Bacterial Bioterrorism Agents“. Applied and Environmental Microbiology. Pg. 566-568, Vol. 71, No.1

  1. “Currently, chlorination is the most common method of disinfecting drinking water in the United States. (Pg. 1)
  2. “The Bacillus anthracis spores were less susceptible to cholorine disinfection than the gram-negative organisms.” (Pg. 1)

Anthrax, Public Health, Emergency Response, Decontamination, Bioterrorism, Biosafety, Chemical

 

Editors, “PATIENT DECONTAMINATION RECOMMENDATIONS FOR HOSPITALSEMSA. July 2005.
http://www.calhospitalprepare.org/sites/epbackup.org/files/resources/DecontaminationRecommendationsforHospitals_0.pdf

  1. “In the case of a medical radiation emergency, response and recovery radiation exposure limits should be established to preserve lifesaving capabilities while taking into consideration risk to staff and facility operation.” (Pg. 13)
  2. “After removal of contaminated clothing, patients should be instructed (or assisted if necessary) to immediately shower with soap and water. Potentially harmful practices, such as bathing patients with bleach solutions, are unnecessary and should be avoided” (Pg. 17)
  3. “Patient clothing should be handled only by personnel wearing appropriate personal protective equipment, and placed in an impervious bag to prevent further environmental contamination.” (Pg. 17)
  4. “Gloves should be worn when contact with blood or body fluids is anticipated. Gloves should be removed immediately, without touching non-contaminated surfaces, as soon as the patient care task is complete.” (Pg. 17- 18)
  5. “Facial protection should be worn when performing patient care tasks likely to generate splashing or spraying of blood and body fluids onto the mucous membranes of the face.” (Pg. 18)
  6. “Disposable fluid-repelling gowns should be worn to protect skin and clothing” (Pg. 18)
  7. “Hospitals should plan for decontamination operations that will not exceed their capacity, but should also develop a contingency plan for mass decontamination when patient numbers do exceed their capacity.” (Pg 19)
  8. “Ensure large quantities of water are available for decontamination in order to dilute the agent as much as possible. Direct excess waste water to the sanitary sewer and immediately notify the POTW and/or MS4.” (PG. 21)

Decontamination, Public Health, Quarantine, Nuclear, Biosecurity, Biosafety, Biotechnology, CDC, Bioterrorism, Biodefense

 

Knauss, Tim, “U.N. to Get Bioterror Agent Decontamination SystemsNTI. Dec. 13, 2005.
http://gsn.nti.org/gsn/GSN_20051213_1084CFA2.php

  1. “Two $60,000 machines capable of cleansing mail of anthrax and other biological agents were completed”
  2. “BioDefense said independent tests confirm that the system, which was created after the September 2001 al-Qaeda attacks, is capable of eliminating anthrax, smallpox, ricin, HIV, influenza, botulism and the plague”

Bioterrorism, Biodefense, Public Health, Anthrax, Smallpox, Ricin, Decontamination, al-Qaeda

2008

Snyder, Michael and Sobieski, Thomas, “Decontamination Operations in a Mass Casualty ScenarioJoint Force Quarterly. 2008.

  1. “principles of decontamination that also apply to a nuclear detonation scenario: expect a 5:1 ratio of unaffected to affected casualties, decontaminate as soon as possible, disrobing is decontamination: top to bottom, more is better, water flushing generally is the best mass decontamination method, after known exposure to a liquid agent, first responders must self-decontaminate as soon as possible to avoid serious effects” (Pg. 2)
  2. “DSCA environment require special considerations by military CBRN planners in the following areas: determining who needs to be decontaminated, multisite operations, integration of decontamination operations with other plans, disposition of runoff, disposition of personal effects, accountability, crowd control.” (Pg. 3)
  3. “It is reasonable to assume that not everyone within the evacuation zone would be contaminated. Identifying those who are “clean” would greatly reduce the resources needed and expended” (Pg. 3)
  4. “To respond to the magnitude of need, several mass decontamination sites probably would be established around the plume perimeter.” (Pg. 4)
  5. “Successful decontamination operations include planning initial medical triage and follow-on medical care, as well as providing subsequent transport, clothing, food, and shelter to all those who process through prescreening.” (Pg. 4)
  6. “Keeping large groups orderly is essential for effective mass decontamination operations. Local law enforcement would vector victims to the various mass decontamination sites established upwind of the blast and outside the projected plume path.” (Pg. 4)

Decontamination, Emergency Response, Bioterrorism, Public Health, Homeland Security, Quarantine

2009

Zukas, Walter, Cabrera, Catherine, Harper, James, Kunz, et al.Assessment of Nanotechnology for Chemical Biological Defense,” in Nanoscience and Nanotechnology for Chemical and Biological Defense, Chapter 9, American Chemical Society, Washington DC, 2009.

  1. ”The term nanotechnology generally refers to the evolving body of tools and knowledge that allow manipulation of material structures at the scale of approximately 10-100 nanometers and to understand the relationship between nanometer scale features and the macroscopic properties of materials.  Rapid progress in the development of analytical tools to probe the nanometer scale and to manipulate materials at this scale has led to a dramatic increase in the number and diversity of research programs on nanoscience and technology.”  P. 10
  2. ”…the deeply scaled dimensions of nanoparticles enhance the surface-area-to-volume ratio, and suitable surface chemistry can then lead to highly efficient sensing schemes or catalytic reactions.” P. 10
  3. ”…sorption-based detection is the one most suited for application of nanotechnology.  ….on the nanoscale of living systems, all sensing and molecular recognition functions are based on sorption of some sort, suggesting that man-made sensing systems aimed at mimicking biological systems will most likely use this mechanism.  When a molecule adsorbs [SIC] to a surface it not only changes the mass at the surface, but it can also impart changes in the electrical, optical, and/or luminescent properties, all of which have been explored as mechanisms for chemical sensing.  High surface-area-to-volume ratio nanostructures generally exhibit amplified responses to these properties, leading to sensor demonstrations with unprecedented sensitivity.” P. 10
  4. ”Nanotechnology may also play a role in development of non-caustic decontamination treatments.  Most non-caustic decontamination chemicals exhibit slower reaction rates with agents than caustic chemicals such as bleach or sodium hydroxide.” P. 10
  5. ”CB agents pose extreme challenges for detection, protection, and decontamination.  Their characteristic feature is their high lethality, so that even minute amounts (micrograms to milligrams) can constitute a lethal dose.  Therefore, the fundamental challenge of CBD is to develop products which are highly sensitive, selective, and efficient.  Sensors must detect agents at levels well below LD50, and still having extremely low levels of false alarms.” P. 12
  6. ”Calometric means to detect this heat would obviate the need for engineering fluorescent centers into the receptor, and could result for a whole new class of sensors, but other detection methods may also be feasible.” P. 14
  7. ”The vast majority of nanotechnology-based CB sensor research has focused on ultra-sensitive transducers such as nanowires, nanotubes, and cantilevers (14-16).  However, sensing elements are only useful if particles of interest are present in the sample volume being interrogated; as the volume decreases, the effective concentration in the sample must increase (17).” P. 14
  8. ”Nano-permeable membranes (NPMs), especially those based on carbon nanontubes, have been the focus of extensive research.  Recently, several groups have reported that the transport of water through nanotube pores is [SIC] orders of magnitude higher than predicted by classical hydrodynamic theories (87-89). … The field appears to have excellent potential to yield substantial valuable results from an investment focused on projects specifically tailored to address chem/bio protection, and the long-standing need for permselective membranes with improved water transport and high selectivity.” P. 18
  9. ”The recommendation is to focus on projects that seek to extend these results to applications of direct relevance to CBD (e.g. chemical and biological agent prophylaxis, vaccines, diagnostics, and treatments) and that seek to demonstrate that the nanoscale features of these methods to offer revolutionary capability improvements when compared to traditional approaches.” P. 18

Chemical, Chemical Surveillance, Biodetection, Biosurveillance, Vaccination, Decontamination

 

Hartz, Marlena, “Scientists Develop CW Decontamination WipeNTI. March 11, 2009.  http://gsn.nti.org/gsn/nw_20090311_1277.php

  1. “A Texas-based team has used federal funding to create a wipe that would neutralize chemical warfare materials released in a terrorist attack”
  2. “The thin sheet of carbon is included with a lotion-soaked sponge in a kit that could be distributed to U.S. military personnel and first responders. The items could be used to remove chemical agents from equipment, skin and even eyes and open wounds”

Decontamination, Bioterrorism, Public Health, Emergency Response, Military

 

Kuomikakis, Bill, Ho, Jim and Duncan, Scott, “Anthrax Letters: Personal Exposure, Building Contamination, and Effectiveness of Immediate Mitigation Measures,” Journal of Occupational and Environmental Hygiene, 7:2, 71-79. First Published on December 15, 2009.

  1. “This report is the first detailed and quantitative study of potential mitigation procedures intended to deal with anthrax letters using a simulated anthrax letter release within an actual office building.”
  2. “Several scenarios were devised to examine the effects of personnel movement on these characteristics as well as determining the effects of some potential mitigation techniques and published response guidelines for anthrax letters.”
  3. “Following each trial, all samplers as well as the table and chair at the release point were cleaned with 10% household bleach solution. At the completion of each scenario, extensive decontamination was performed.”
  4. “Opening a spore-containing letter at the release point resulted in a rapid increase in the spore aerosol concentration in less that 1 min after beginning to open the letter.”
  5. “The strategies tested in this study all proved to be ineffective, clearly demonstrating the extreme difficulties posed in attempting to respond to anthrax letter incidents.”
  6. “The rapid spread of spores outside the office where the letter was opened would make it difficult to devise a practical quick response protocol to prevent the spread.”
  7. “Based on this work we believe that existing response guidelines should be reassessed to provide a scientific basis on whether the procedures achieve the intended mitigation.”

Anthrax, Decontamination, Emergency Response, Biodefense

2010

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