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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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