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Haz Mat "Specialist Course"
Saturday
Feb032018

VHF - Waste Workers/Cleaning Staff/ Decontamination Group

Following the Dress-Out protocol as previously discussed, the WW/CS (Waste Workers/Cleaning Staff) will primarily be working in their isolated response area (See VHF 6). In addition to some system of transporting the fresh and used solutions from patient treatment area to their solution handling area, this response Team handles used solutions and prepares them for waste disposal or transport and creates fresh solutions for replacement.

Their operation will require more coordination as they may either be moving into clean areas throughout the facility, or transferring packaged waste to additional workers that require all the same training and CPC. Regardless of your choice of plan, this type of hazardous waste transportation will require more coordination.

Containers chosen for VHF waste will ultimately need proper shipping containers to get off-site this feature can be decided upon after the VHF waste is contained and can be safely moved about with minimal CPC. Bio-hazard bags for everything that will not puncture a plastic bag are a good choice for initial handling. After the exterior of these bags are properly bleached with your solution, they can be handled for final shipping for hazardous waste disposal. If, you handle hazardous waste on-site, only the bio-hazard bags “type” will be needed and are more easily incinerated.

After the first used solutions return to your solution preparation area the waste handling actually begins.

The Dress-out Protocol outlined in VHF – 4 must be followed by all waste workers on or off-site. These personnel are actively exposed and contaminated just as much as the medical staff performing patient treatment. Waste workers should follow the following steps while adapting them to fit their facility’s needs;

1] Place all VHF waste into bio-hazard bags or if liquids pourable containers of choice. Secure these bags or others, with some type of “seal” demonstrating a single closure. This will alert hospital employees if the contaminated waste was opened between confinement and disposal.

2] Spray bag exterior at opening with separate clean 10% bleach solution and wait 3 to 5 minutes.

3] Place this bag into second bio-hazard waste bag and seal closed.

4] Spray sealed opening with clean 10% bleach solution and wait an additional 3 minutes.

5] Transport VHF waste to storage area with a Security Escort.

6] Secure and mark Bio-Hazard Waste staging area for off-site transporters or on-site incineration.

7] Upon completion, Waste Workers shall decontaminate with 10% bleach solution, wait 3 to 5 minutes and then doff CPC.

Used waste worker CPC should be collected and placed with the VHF waste in the like manner described above. Where you decide to operate this procedure is your facilities choice. A good plan for confining the ancillary contamination is to perform this action near or in the short-term waste storage area.

It is always a good decision to secure the waste short-term storage area with security personnel. These individuals can explain the situation and avoid any ancillary contamination of uninvolved hospital workers. The complete decontamination procedure must be followed by ALL workers, including the waste workers. This detailed plan shall be outlined in the coming months.

Haz Mat Mike

 

Tuesday
Jan022018

VHF - 6 Bleach Solutions

The overall goal for preparation of your bleach solutions is one not only of concentration but of accessibility. You must choose a location where sustained replenishment of these solutions can be made over an extended period of time. This will be a permanent location in terms of the length of the emergency incident. It must be isolated from other hospital traffic, and yet close enough where delivery of prepared solutions can be distributed. Along with this, used solutions must be returned and properly handled for waste disposal. So actually you will have two (2) operations at one location. One for distribution of “fresh” solutions to the operating patient isolation areas, and one area for receiving used solutions and the preparation of waste disposal. Transportation back-and-forth, must be considered and implemented based on the size of liquid containers. If moving equipment is used it must be easily cleaned at both delivery and operation points with a minimal of disturbance to the patient care operation. Over time, hand carrying of liquid containers will exhaust staff and require frequent personnel replenishment. The more personnel involved the greater the factor of cross-contamination.

The need shall be for two (2) solutions of ordinary household bleach using a 5.0% concentration or stronger. The;

1] 1 to 10 solution is used for excreta spills and bodies (0.5% solution).

2] The 1: 100 solution is used for cleaning; materials, VHF/HCW decontamination, VHF waste bio-hazard bags (0.05% solution).

—  Bleach solutions must be prepared daily. They lose their strength after 24 hours. Anytime the odor of chlorine is not present, discard the solution. Anytime the 1:100 mixtures become cloudy or contaminated with particle matter, replace with fresh solution.

—  Note: 1:10 bleach solution is caustic. Avoid direct contact with skin and eyes. Prepare the bleach solutions in a well-ventilated area.

 

A good start point is to consider your container sizes. They must be matched to the patient care operating area. Usually, depending on your volume use,

1] Have a large container for the 1:10 solution and,

2] Smaller containers for distribution of 1:100 and 1:10 solutions.

You will also need;

3] Measuring cups for volume mixing measurements.

4] Household ordinary bleach in gallons (holds potency longer when unopened) (un-scented).

It is important to note that bleach potency drops drastically once the factory seal is opened. Opened bleach gallons should be decontaminated and used for regular cleaning duties after one (1) week of opening. They should NOT be stored for the next emergency incident after opened and partially used. Additionally, scented bleach can interfere with the potency of concentration. To insure accurate decontamination mixtures, do not use scented bleach.

Lastly; a clean water source is needed for creating mixtures.

To begin, mix;

1] One (1) part chlorine bleach to nine (9) parts water. This creates the 1:10 bleach solution.

2] Mix this solution to nine (9) parts water. The resulting solution is now 1:100.

Mark all containers CLEARLY, either 1:10 or 1:100 and distribute to the patient care and or Decontamination areas. The cleaning/waste staff MUST monitor these solutions every ½ (half) hour depending on patient care use or needs, HCW activity, and time of shift. These solutions MUST be kept contaminant free to be effective. Whenever solutions become clouded, or material laden, they must be replaced with fresh solutions.

REPEAT THIS PROCEDURE every 24 hours! (Or earlier depending on solution clarity). As VHF emergency incidents are long term patient care, as hours turn into days this becomes a critical feature. Decontamination solutions only work safely when they are pure and strong. This means the cleaning/waste staff needs staffing at a rate the same as the patient health care staff. As you can see, a VHF emergency incident becomes a long term operations with multiple staff “Teams” in a very short period of time. Be sure that your pre-planning takes all elements into account before your operational response is implemented. Next month, VHF 7 Waste worker/Cleaning Staff Dress out Standards.

                 Haz Mat Mike

 

 

Friday
Dec012017

VHF 5 - Disinfectant Solutions

          What do we need to Disinfect? Disinfection kills almost all disease causing germs. It reduces the number of microorganisms to make all equipment and surfaces safer for use. Since VHF agents are “Splash” protective reagents and NOT “airborne” exposures, every object that could make contact with or be in the close proximity of the VHF agents must be disinfected to reduce cross-contamination.

Probably the most dangerous cross-contamination issue involving VHF incidents affects the entire crew at a health care facility. In addition to the medical treatment staff, which we speak of in detail, little focus is often given to the remaining staff that is frequently left out of the operations “lime-light”. These are the support personnel that keep the behind the scenes operation looking so good to outsiders. ALL operational STAFF should disinfect. These are;

1] Laboratory Staff

2] Cleaning/Laundry Staff

3] Waste workers (Staff or Contract)

1] The hospital facility laboratory staff is the operational personnel that receive little accolades, but perform the primary task of ID (Identification). Imagine attempting hazardous material mitigation without first identifying the hazard? Your operation would end before it began in most cases, and end in failure. These folks are the ones that give the medical staff the correct information to base their treatment decision making on. The Laboratory Staff is directly included in the emergency response and need notification at the same time Emergency Room Staff are. They have the need for an isolation area to perform needed tests, the same PPE/CPC dress-out procedure, Decontamination area and procedures, all BEFORE the sample arrives in the Lab to undergo testing analysis. Your Lab Staff need direct inclusion in all emergency response operational training. After the emergency room receives notification of an incoming VHF patient, before operations begin, the laboratory MUST be notified to begin a parallel operational set-up before the patient comes into the Emergency Room Entrance.

2] In a large scale contamination, which this type of exposure will quickly become, disposable support supplies will NOT be able to sustain the operation. Either the supplies will dwindle, or too much waste to handle effectively and safely, will be sustainable in a safe protocol to resist cross-contamination expectations. Therefore, The Cleaning Laundry Staff will soon be operating at a high rate of performance and include; Staff Manpower, Equipment, Disinfection supplies, and rotational replacement for these needs on an 8hour per shift basis. Their inclusion in the initial response notification and Training, should parallel the Laboratory Staff. Disinfection Solutions (which we will discuss in the coming weeks), shall be prepared BY THE CLEANING STAFF ON-SITE. This will facilitate replenishment, supplies, isolated area for preparation, as well as proper PPE/CPC by the cleaning staff. Not only will the cleaning staff need to handle waste and laundry from the ER, isolation rooms, and laboratory, but they will need to handle their own waste from their personnel operations. This frequently encompasses an area, staff, and disposal to contractors on an epic scale which surpasses the normal hospitals operation for the cleaning staff. Remember, normal hospital operations shall be happening at the same rate and time as your emergency operations. This may double the cleaning staff needs to handle this size of a work load. Each facility is different thus demonstrating the need for massive pre-planning of work space and personnel BEFORE any patients/waste are handled.

3] Waste workers are subject to these same guidelines whether they are on-site employees or outside contractors. On-site employees may be integrated into the cleaning staff, as this type of waste operation is closely linked to the cleaning staff duties. Contractors, on the other hand, may use portable facilities temporarily located on-site at your facility, or integrate into yours if they are providing services that integrate with cleaning staff and involve more than waste removal. Either way, they typically operate under more controlled situations and are not subject to time concerns. This could be a major issue with your normal functioning. Therefore careful consideration must be made to the particulars before integrating these contractor services with your personnel. Some may not be able to integrate with your Team operations on a short notice. If this is your option, then close training and exercise operations must include your contractor.

Disinfection includes;

1] Hands and skin after contact with a VHF patient or body fluids. *Appreciate that any skin contact now designates a health care worker as exposed and becomes an isolation patient.

2] Gloved hands after each VHF patient, or infectious bodily fluids. *If it can be integrated into your CPC “ensemble’” multiple glove pairs may be effective.

3] Any re-used medical equipment after each VHF patient. *mechanical devices only IF they are moved out of the initial isolation area to be used with non-infective patients.

4] Spills of infectious body fluids on walls and floors. *Increased time for disinfection next month.

5] Patient excreta & containers contaminated by patient excreta. *Same as above.

6] Re-usable supplies such as protective clothing, patient bedding, etc., *Shipped to Laundry Team.

7] Used needles/syringes/or any invasive technology used. *Disposable must be placed and held separate from hospital bio-waste containers and area for future waste disposal.

The end game of disinfection becomes, all health facility staff – including cleaning, waste disposal, and laundry staff – who handle, disinfect, or clean VHF – contaminated supplies and equipment should wear the same level of protective clothing as those health care workers delivering direct patient care. ALL related workers are at risk for the exposure to VHF!

Next month, we shall look at the actual Bleach solution preparations used in this procedure. Join us again.

Haz Mat Mike

 

Wednesday
Nov012017

VHF 4 Dress-Out (Donning) with CPC

The idea of proper dress-out (donning) depends on the level type and duty task as well as the support system for continued use that is in place on site. What exactly does this statement mean? Once your level of protection is chosen, how will you support it? Are parts of the ensemble’ re-useable? Does some or all of it need replacement as limited (or once) use only? These questions need full answers before you implement a program, and acquire resources and personnel for continued operation over an extended period of time. There are however, beyond these pre-planning stages some commonalities that remain constant for the minimization of health care worker contamination and subsequent possible cross-contamination. There very well be many more steps you want included in YOUR dress-out plan, and these will enhance your operation to be even more efficient than the general model. This is how the decontamination process evolves to a better form. The following steps are seen as a “minimum” and must be adhered to for decontamination to safely function for the health care worker. They are;

1] Removal of body jewelry and personal items for clean and safe storage.

ALL personal items must be removed prior to dress-out and entry. This technique eliminates the loss of your personal adornments. I always tell my students when you are expecting the Haz-Mat guys to arrive they will be the ones who dress the grubbiest and are carrying multiple bottles of water with them. They know how important hydration is while wearing CPC and they have also had personal clothing and jewelry lost due to contamination. Most wear clothes they specifically purchased from discount or resale shops as they do not want to worry about their clothing being destroyed if it becomes contaminated. If you have personal items on your person that become contaminated, they will become hazardous waste. The choice is yours.

2] Removal of street clothes and acquire or “don” scrubs clothing.

For health care workers, this is the best option. These garments are easily identifiable and easily disposed of by hospital laundry personnel. They are identifying and inexpensive to replace. A good idea for your operation is too additionally offer a specified color for highly contaminated clothing and or operators. This will key-in hospital employees to the special and severe aspect of the employee’s role in your emergency operation. Choose a color that NO ONE else is allowed to wear. In this way you will minimize any cross-contamination that may occur and remove the possibility that infected garments leave the site. Whatever the choice for your facility, NO worn clothing must ever leave the hospital site. Many workers are already adapted to the wearing home of “scrubs” both to and from hospital work. This practice must not be allowed under ANY circumstance! The possibility of contamination leaving the site and entering the general population directly violates the decontamination principle!

The next step included is your travel route to the hospital exclusion zone. Going towards the initial contamination zone is not an issue. However, when you decontaminate you could be cross-contaminating the general hospital facility with residual contamination. This is why, it is always best to have a locker-room type facility next to the isolation area that contaminated patients will be seen. Here you can properly prepare contaminated scrubs for laundry or disposal and complete a full body showering before donning street clothes for exit. We will cover this more in depth in the decontamination process yet to come.

3] Enter the VHF dress-out area.

One should think; that this area will also be the end area where decontamination takes place. Therefore, it must be an area that can contain the hazardous waste AND decontaminate it, to a level that it can be safely handled towards its next step. Your bio-hazard bags will be filled in this area and decontaminated before they are sent off to the appropriate hazardous waste facility. If there are going to be multiple entries, (which there are almost certainly will) then this area itself will need isolation from the contaminated bio-hazard bags after they are filled. So almost certainly you are looking at 2 (two) different areas that need separation. In your “clean” area you will;

4] “Don” level “B” SPLASH protective garment ensemble’.

This includes respiratory protection, inner and outer gloves, and protective booties. The details of this operation are only covered in practical training and cannot effectively be explained. There are so many variations from CPC types and what the individual facility will opt to use for their employees deciding the ultimate choice.

5] Have the “buddy” system in place to seal all openings.

The buddy system is integral to all haz-mat work. Many openings cannot be seen by the wearer so a “buddy” is used to make sure that all openings from contamination are closed. Additionally, work is done with your buddy to insure that no one is left in a position where they can be injured or hurt without team knowledge. This perpetuates the “no-one-left-behind” concept. Individuals who operate without the “buddy” system are at great risk to contamination and injury. Be sure that this concept is always employed during all your hazardous work tasks.

Lastly, be sure that once a comfortable “fit” is achieved; NEVER readjust equipment inside the contamination isolation area. This will cross-contaminate yourself and expose you to the VHF. Keep all equipment inside the isolation room perpetuates your work-buddy becoming your personal logistics, supply, and decontamination assistant just as you are theirs. Next month we look at VHF 5; disinfectant solutions to be used with VHF.

           Haz Mat Mike

 

Sunday
Oct012017

VHF 3 What Ensemble’ should you choose?  

When a VHF case is suspected in a health care facility, the following SPLASH protective clothing should be worn in the isolation (Hot Zone/Exclusion Zone) area. The reason for identifying the isolation area for the patient in this manner relates to whom and where the high level of contamination exists. Obviously different response groups will have different geographical response areas; therefore they have to translate controlled hospital conditions to field ones while maintaining hazardous materials protocols for a safe response. The ensemble’ (we spoke in detail about last month) is chosen based on the hazard type and work conditions/resources that are available to the response group. When field conditions are encountered, all infrastructures must be created in-the-field whereas hospital conditions HAVE a designated infrastructure that has been pre-planned to handle all eventualities. In the field, these possible problems must be safely handled on a case-by-case basis.  This stated for all responders to a VHF incident, let’s look at the optimum situation for the hospital setting.

Inner “scrubs” that can be properly laundered under the VHF guidelines SHALL be worn. Additionally, NONE of these “scrubs” are to be removed from hospital grounds. This practice eliminates the spread of contamination outside the hospital facility and into the general public. This event would log-rhythmically increase the scope of your outbreak. As many hospital care workers have the tendency to wear their “scrubs” home from work, in this case this practice would be disastrous!

Once this practice is mastered, the issue of glove selection should be addressed. In most hazardous material situations the inner gloves are hospital care type nitrile medical exam gloves. However, in hazardous materials responses these are not used for exterior material handling. Heavier outer/chemical gloves are worn over these nitrile inner layers. Here, the hospital worker shall be using these gloves for patient handling. This is done in hospital settings for manual dexterity optimum capability as the rougher physical hazards have been removed by field response personnel. Therefore, as we progress through the decontamination system for VHF hazards, you may want to increase the number of glove pairs to fit the needs of your patient response. Through practical simulation, your group can adjust the number of pairs to custom fit your patient response. As an example; if your group decides to have multiple patients in one (1) isolation area, you may want to have as many pairs as patients so removal between patients eliminates adding gloves inside the isolation area thus reducing cross-contamination issues.

Next are “Splash” protective boots, booties, or overshoes. There are many choices and this should be a choice involving many voices within the hospital response Team. Footwear is very important as a variety of responders will be wearing them and the ability to avoid slip, trip, and falls, is of primary importance to eliminate contact with the contaminated floor except from your foot sole bottom. Not to mention regular injury from falling, causing related injuries to Team members. Remember, once a Team member is off work due to injury, this increases the work across the Team if replacement workers are not yet up-to-speed with current operating procedures.

Your Team can opt for inner walking shoes with outer “nuke boots” corrugated footie, outer chemical protective boots, overshoe goulashes’, and other options for chemical protective footwear. These all have a needed evaluation by your Team/Group to find which one will optimize your situational response. Latex nuke boots provide disposal, but this creates waste that needs treatment, whereas chemical boots & goulashes reduce waste but require decontamination and safe storage after incidents. The list and ramifications of each continue on-and-on. Each Team needs to carefully evaluate “their” particular ensemble’ to fit the organizations unique needs.

Splash protective Level “B” also is available in different forms. With booties attached, without booties attached, with hoods or without, and so on. For “Best Practices” Level “B” CPC should have attached booties and hoods for proper protection. The greatest challenge shall be with the glove attachment and face seal devices you choose. Unless you have a facility set aside for CPC storage and security, disposable suits or “limited use” designated suits is the safest approach to this problem. The dynamics involved with re-useable suits is a study all by itself and is only successful in a BSL (Bio-Safety Lab) 3 or 4 situation. This requires a permanent solely designated facility for this purpose alone.

Note; When CPC is not available or in short supply or protective styles change, adaptations must be made and used. The goal is to NOT compromise on safety while maintaining “workability”.

When dressing out in this ensemble’ negative pressure Level “C” respiratory protection is used. While this technically makes your ensemble’ Level “C”, true level “B” SCBA (Self Contained Breathing Apparatus) is much too bulky and limiting to accomplish the work task at hand. Many medical procedures cannot be halted just because your air bottle is low requiring replacement. To off-set this negative “workability” the negative pressure system is adapted. There are however, a number of issues and types that need consideration. Most medical operations will employ the N95 mask system as it interphases well with hospital environments and training requirements. Complemented with a face shield this gives added protection. Just remember that you will still have openings that can be contaminated by splash contaminants that are virus infected. One option is to employ the use of full-face APR’s (Air Purifying Respirators) using the replaceable canister style “Dog-Bone” configuration. These are a bit more bulky, but protect the wearer from contact with splash viral contaminants. The newer models are more and more streamline while increasing the effectiveness of the treatment team members. This is a good model to approach as the team member satisfies respiratory protection needs along with an added level of full-face protection avoiding face/skin splash contamination.

The choice is yours, and maximum protection for your team members should be considered before the final decision is made. Next month, we will look at the specific steps for the “Donning” of VHF Chemical Protective Clothing

                   Haz Mat Mike

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