Transcript AVERA MCKENNAN Decontamination Process/Goals PRESENTED BY: KaraJo Schneekloth, Nuclear Medicine Technologist and Traci Hollingshead, Radiation Safety Officer April 10, 2014

AVERA MCKENNAN
Decontamination
Process/Goals
PRESENTED BY:
KaraJo Schneekloth, Nuclear Medicine Technologist
and
Traci Hollingshead, Radiation Safety Officer
April 10, 2014
Decontamination
Process/Goals
• Information presented is based on Avera
McKennan’s policies and procedures
developed from Centers for Disease Control
and Prevention 2005 Radiological Terrorism
Emergency Management Guide for Clinicians
and Guidance for Radiation Accident
Management (REAC/TS)
Radiation Principles
• Radiation cannot be detected by the human
senses. A radiological survey conducted with
specialized equipment is the only way to
confirm the presence of radiation.
• If a terrorist event involves the use of
radioactive material, both patient exposure
and contamination must be assessed.
Radiation Principles
• Exposure occurs when a person is near a
radiation source. People exposed to a
source of radiation can suffer radiation illness
if their dose is high enough, but they do not
become radioactive.
• For example, an x-ray machine is a source of
radiation exposure. A person does not
become radioactive or pose a risk to others
following a chest x-ray.
Radiation Principles
• Contamination occurs externally when loose
particles of radioactive material are deposited
on surfaces, skin, or clothing.
• Internal contamination occurs when
radioactive particles are inhaled, ingested, or
lodged in an open wound.
Radiation Principles
• Contaminated patients should be
decontaminated as soon as possible, without
delaying critical care.
• Patients who have been exposed to radiation,
but are not contaminated with radioactive
material, do not need to be decontaminated.
Notification and Accident
Verification
• When the hospital receives a call that a radiation
accident victim or victims are to be admitted, a
planned course of action should be followed.
• The individual receiving the call should get as much
information as possible, including the following.
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Number of accident victims
Each victim’s medical status and mechanism of injury
If victims have been surveyed for contamination
Radiological status of victims (exposed vs. contaminated)
Identity of contaminant, if known
Estimated time of arrival
Sample Radiological Emergency
Response Team
Team coordinator
Leads, advises, and coordinates
Emergency
physician
Diagnose, treats, and provides
emergency medical care
Triage officer
Performs triage
Nurse
Assists physician
Technical recorder
Records and documents medical
and radiological data
Radiation safety
officer
Supervises all aspects of monitoring and
contamination control
Radiation safety
personnel
Monitors patient and area and
advises on contamination control,
maintains survey equipment
Public information
officer
Releases accident information to public
media
Administrator
Coordinates hospital response and
assures normal hospital operations
Security personnel
Secures the radiation emergency area
and controls crowds
Maintenance personnel
Aids in preparation of the radiation
emergency area for contamination
control
Laboratory
technician
Lab draws, analysis of samples
Staff Protection Guidelines
• Establish a triage area
• Base the location on your hospital’s disaster plan and the
anticipated number of casualties. If possible, select a location
near an outside entrance.
• Restrict access to the controlled area.
• Establish a contamination area and clean area separated by a
buffer zone.
• Prevent tracking of contaminants by covering floor areas and
monitoring at exits of controlled areas.
• Control lines should be established at the entrance to the triage
area. A wide strip of tape on the floor at the entrance should be
marked clearly to differentiate the controlled (contaminated)
from the non-controlled (uncontaminated) side and the buffer
zone.
Staff Protection Guidelines
• Use strict isolation precautions, including protective clothing and
double bagging. Remove contaminated outer garments when
leaving the contaminated area.
• Monitor anyone and anything leaving the controlled area.
• Control waste by using large, plastic-lined containers for
clothing, linens, dressings, etc.
• Change instruments, outer gloves, drapes, etc. when they
become contaminated.
• Use waterproof materials to limit the spread of contaminated
liquids (waterproof drapes).
Staff Protection Guidelines
• Use standard precautions
• Follow standard guidelines for protection from
microbiological contamination.
• Surgical masks should be adequate.
• N95 masks, if available, are recommended.
• Survey hands and clothing at frequent intervals with a
radiation meter.
• Due to fetal sensitivity to radiation, assign pregnant
staff to other duties.
Dressing to Prevent the
Spread of Contamination
Patient arrival and triage
• During triage, consideration is given to medical and radiological
problems. Serious medical problems always have priority over
radiological concerns, and immediate attention is directed to lifethreatening problems.
• Addressing contamination issues should not delay treatment of
life-threatening injuries.
• It is highly unlikely that the levels of radioactivity associated with
a contaminated patient would pose a significant health risk to
care providers.
• In certain rare instances, the presence of imbedded radioactive
fragments or large amounts of external contamination may
require expedited decontamination.
• Always include in-house radiation professionals on the response
team.
Patient arrival and triage
• Non-contaminated patients are admitted to the
usual treatment area and can be cared for like any
other emergency case.
• A specifically prepared treatment area is not needed.
• Following attention to medical needs, question the
patient to determine the possibility of radiation
exposure from an external source.
Patient arrival and triage
• Contaminated patients are admitted to a specially
prepared area.
• When in doubt, a critically injured patient should be
taken immediately into the prepared area.
• If the victim’s condition allows, an initial brief
radiological survey can be performed to determine if
the victim is contaminated.
• A more thorough survey will be performed once lifethreatening problems are addressed.
Separate Entrances for Patients
Decontamination Guidelines
• Survey the patient with a radiation meter
• Perform surveys using consistent technique and
trained personnel.
• Note exceptionally large amounts of surface or
imbedded radioactive material.
• Handle radioactive objects with forceps and store in
lead containers.
• Record location and level of any contamination
found.
Decontamination Guidelines
Decontamination Guidelines
• Remove patient clothing
• Carefully cut and roll clothing away from the face to
contain the contamination.
• Double-bag clothing using radioactive hazardous
waste guidelines, label and save as evidence.
• Repeat patient survey and record levels.
Decontamination Guidelines
Decontamination Guidelines
• Cleanse contaminated areas
• Wash wounds first with saline or water.
• If facial contamination is present, flush eyes, nose,
and ears, and rinse mouth.
• Gently cleanse intact skin with soap and water,
starting outside the contaminated area and washing
inward.
• Do not irritate or abrade the skin.
Decontamination Guidelines
Documentation
• In addition to routine medical records, note survey
readings, samples taken (and time), descriptions of
the accident, and effectiveness of decontamination.
• Take care to note pre-existing conditions such as
rashes, healing wounds, or scars.
• This information will be extremely valuable to medical
consultants and health physicists in reconstructing
the accident accurately and making a prognosis.
Patient Safety
• Routine precautions for patient safety should not be
forgotten.
• Be especially alert for potential falls or slips on wet
floors, excessive heating or chilling, and any
electrical hazards.
Patient comfort and
emotional support
• A patient involved in a radiation accident needs
explanations of procedures and actions being taken
(isolation, use of survey meters, taking of samples,
decontamination, etc.) in the radiation emergency
area.
• A knowledgeable person should answer the patient’s
questions and provide reassurance. Preferably, this
person should be the attending physician who
continues to treat the patient until discharge.
Video
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Avera
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McKennan
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