Overview of Chemical Decontamination
Dealing with an incident where many people have been exposed to dangerous chemicals might seem very overwhelming, thankfully, these kind of incidents are rare. Mostly, doctors who provide immediate care may see one or a few individuals coming to the hospital after being exposed to unsafe chemicals. Emergency medical staff are well equipped to handle these cases, but even they need time to get ready. This means that there’s a good chance that people hurt by such chemicals, will reach a hospital before they have been properly cleaned up.
Being exposed to chemicals can harm tissues or organs, depending on how much of the chemical the body was exposed to and for how long. Certain harmful materials can still be toxic even after the person isn’t near the source of the chemical any more. Generally, chemical exposure causes harm faster than exposure to harmful radiation or biological threats. Since the longer the exposure to the harmful substance, the more severe the injury, it’s extremely important to remove the chemical as fast as possible to prevent more harm. It also helps protect hospital staff from exposure.
If the chemical is particularly harmful, it can make the area of the hospital treating the patients unusable, so it’s important to start cleaning off the patients before they enter the hospital if possible. The decontamination process should ideally begin before getting to the hospital, but this might not always be possible. This review will focus on cleaning off patients at the hospital itself.
Most hospitals may not have as much equipment or as much training as specialized hazardous materials emergency medical services teams. Still, it’s worthwhile for hospitals to know about options for personal protective equipment, which can protect healthcare providers from exposure to chemicals, even if they may not have these tools available.
Equipment used for Chemical Decontamination
Personal protective equipment, often shortened to PPE, acts as a shield between the person wearing it and the surrounding environment, or another person who may have been exposed to something harmful. There are different levels of PPE, marked as A, B, C, and D, and each provides a different degree of safety. It protects various parts of the body, including the respiratory system (the nose and lungs), the body, eyes, face, hands and feet. The top level, level A, offers the most protection, but usually, healthcare facilities like hospitals and clinics won’t have anything beyond level C.
Level A is for situations with a high risk of exposure to harmful substances that may be in vapors or particles. This could include areas where there’s bad ventilation, and the air is not safe to breathe, or places where there’s a high chance of your skin coming into contact with something dangerous. As the highest level of protection, Level A PPE is totally sealed off and resistant against vapor. The equipment used for Level A protection includes a special full face breathing apparatus, a protective suit that encloses the whole body, gloves and boots that resist chemicals, and an extra disposable suit that goes over the top of everything.
Level B is mainly used by specially trained emergency response teams that handle hazardous materials, and you won’t usually find this in a healthcare facility. It also includes a self-contained breathing apparatus, like Level A, but unlike Level A, level B is not resistant to vapor. It’s used in situations where there’s not enough oxygen or if there are harmful vapors present, but these vapors won’t harm your skin. Its equipment includes the breathing apparatus, chemical-resistant clothing with a hood and a face shield, gloves that resist chemicals, and steel-toed boots covered by a disposable layer.
Most healthcare facilities use Level C PPE. It’s used when there are likely to be harmful substances in the air or a chance of hazardous liquids splashing onto someone. The main difference between Level B and C is that Level C doesn’t have a self-contained breathing apparatus. Hospitals like emergency departments should have Level C PPE stocked and ready to use quickly. It includes an air purifying respirator that could be full-faced or a half mask, chemical-resistant clothing with a hood and a face shield, gloves that resist chemicals, and steel-toed boots with a disposable cover.
Level D offers the least protection and is used when there’s no known dangerous substance in the air. There’s no risk of inhaling or touching something harmful. However, it’s typically the first level of PPE used when someone arrives at a healthcare facility. That’s why it’s important for healthcare workers to be able to quickly put on extra protection if needed. It includes a face shield, safety glasses or goggles to protect against chemical splashes, gloves, footwear, and a work uniform.
What Else Should I Know About Chemical Decontamination?
In an ideal world, emergency services would be able to clean up any harmful substances on victims before they reach the hospital. The general rule of thumb among experts is that this clean-up should happen within a minute of the person being exposed to the harmful substance, if possible. However, some people might not call emergency services or may go directly to the hospital for help. It’s crucial for healthcare staff to avoid moving the patient to a treatment area or starting care right away as this may expose other people and the hospital to the harmful substance, as seen in the Aum Shinrikyo Tokyo subway attack in 1995. Here’s a simple, step-by-step way to clean up the harmful substance:
Step One: The first thing healthcare providers should do is put on Personal Protective Equipment (PPE), which helps prevent them from being exposed to the harmful substance.
Step Two: The person’s clothes should be removed as quickly as possible. Clothes can hold onto harmful substances, particularly if they’re liquid. Trying to clean a person while they’re still dressed can intensify their exposure to the harmful substance. Previous research suggested that taking off clothes reduces chemical contamination to a great extent. A quick removal of clothing is really important with harmful liquid substances. The clothes must be removed outside the treatment area to prevent the hospital from becoming contaminated. Patients should be given disposable clothes, bedsheets, or gowns afterward. Also, the clothes must be kept in a sealed and marked plastic bag to avoid the harmful substance leaking out.
Step Three: The harmful substance should be removed or neutralized. Once they’re disrobed, any dust or particles on their skin should be brushed away before washing. After that, the person should be washed with water, or sometimes a special clean-up product if available. Certain harmful chemicals might not be easily removed with water only, so a mild soap can be used to enhance removal of those chemicals. Prolonged exposure to water, however, could make it easier for some chemicals to be absorbed into the body. One detailed report reveals that the best washing time is 90 seconds, and using a soft cloth to clean all skin surfaces can lead to an additional 20% improvement in cleanliness. Wounds should be carefully cleaned as well using a balanced salt solution like Lactated Ringers or Saline to avoid pain and further damage.
Some resources recommend diluted bleach to enhance clean up, but even very diluted bleach can irritate eyes and wounds. A soap and water mixture is nearly as effective and safer for use – unless water is limited, in which case, a brief rinse off after bleach application is okay.
In some cases, a special lotion known as RSDL can be used to neutralize several harmful substances and back up the washing process. It has been designed to remove several agents, including chemicals used in military attack, although the supply might not be enough for a full body decontamination and should be used on face, neck, hands and inner surface of protective gear. There are also other options for chemical clean-up available in some countries, including some that have shown promise in cleaning up chemical burns to skin and eyes.
