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Haz Mat "Specialist Course"

VHF - 9 Disinfection in the Hot Zone

VHF – 9 Disinfection in the Hot Zone

When working in proper PPE/CPC inside the Hot Zone, which for your purposes is the isolation room/area of patient treatment, you have already satisfied the dress-out safety protocols and are now wholly concerned with actual VHF safety when treating these victims. Under ideal conditions, the highest area of contamination on your person should be the hands and feet. Since the feet/bootie concern is handled upon decontamination and Hot Zone exit, the hands present an additional issue from patient to patient contact if more than one patient is being treated in your theater.

If you likely do have more than one patient to care for, it soon is impossible to wear the number of glove layers to remove layers between patients for very long. During extended treatment, the solution is either to rinse/disinfect existing gloves, or cross contaminate between patients. Cross-contamination for many transmissible medical reasons is ineffective for proper patient care. Therefore, proper cleaning must be undertaken between patients while using the same medical gloves.

Install inside the isolation/treatment area an open bin container large enough to rinse and swirl gloved hands containing your original 1:10 bleach solution mixture. In between touching equipment or making contact with a different patient, rinse/swirl (slowly) your gloved hands in this mixture for one (1) minute before switching between patients. Repeat this procedure every time you change from patient to patient. This will eliminate cross-contamination between patients in your isolation ward.

This shall be an almost continuous process for you as the caregiver on an increasing basis. As patients become sicker they will require multiple contacts between your staff until they reach the stage where the illness creates the inability to move about and pain becomes overwhelming. During this time, blood and discharge is likely to increase and become higher in volume. This will become a challenge for your disinfection process.

When your treatment gloves are visibly soiled, they must be lightly washed in soapy water before the bleach solution is used. This means that a second vessel bin (containing soapy water) must be placed in the Hot Zone isolation/treatment area before patient treatment has begun. These “bins” can be accomplished within the isolation area by having multiple sinks if available.

Whichever system is used, when these bins/sinks become contaminated they must either be serviced by your bio-waste personnel or Hot Zone/isolation patient treatment personnel. If your facility has a chemical drain system for this continuum, treatment staff may safely drain the contaminated sinks and re-fil them with fresh soapy water and fresh 10% bleach water solution.

The issue of drying gloves creates its own set of issues. If your staff decides to use paper towel, laundry towels, or a blow air dry system each has downsides. When using towels, paper one-use is recommended, however this creates a huge amount of waste that must be handled on-site. This may increase the work load on your waste handling staff. Be sure to account for this increase in work load to your personnel numbers and rotation system. Re-use toweling decreases waste but increases waste worker load as these towels now need to be appropriately laundered using the waste worker guidelines. Lastly, an air blow dry system alleviates these stresses, but may negatively affect your negative pressure isolation area. Depending on your location and operational set-up, each of these hand dry systems may fit into your operation. Choose wisely,

Haz Mat Mike




VHF - 8 Security Personnel

Following the VHF Dress-Out protocol (see VHF-4) security personnel need to follow this directive if they intend to secure sick individuals due to pandemic infection spread. These individuals shall be part of the VHF Team as these protocols are accepted by the medical facility. They shall be responsible for the facility security operation as these CDC protocols are chosen in the name of public health.

The first step in hospital management is to assess and decide IF the receiving facility IS going to treat these patients AND secure the public health throughout the situation. The hospital needs to decide ahead of time IF they shall direct patient care on behalf of CDC security guidelines. This is a tough decision, as the hospital security team will become federal law enforcement by proxy throughout the life of the incident. Hospital coordinators need to carefully decide how they plan to deliver this service. If they decide to protect the general health of the public during a VHF incident, The Security Team needs to join the VHF Team.

The first step is to appreciate the fact that the security team member is solely activated to secure terrified patients to the facilities treatment area. Additionally, they shall be responsible to seal this area from the rest of the hospital facility. In their capacity they must be aware of the disease potential and be trained in the VHF Dress-Out protocol. The ability for them to contract this disease while securing patients is the same risk as patient caregivers. Once this has been accomplished, they shall follow the VHF Dress-Out protocol before patients arrive at the hospital.

The security team will need to come up with directives as to which areas in the hospital need separation from the treatment area. The patient/health-care worker through ways must be separated to prevent the contaminated patient from accessing them. This will isolate those health care workers involved in this response from contaminating the rest of the facility. Once these passages have been identified they will need to be sealed off with a minimum of 6 mil visqueen in addition to secured doorways. These doorways should be covered with the visqueen and taped shut at the edges to secure the visqueen. The interior edges facing the contaminated treatment area should be sprayed with the 10% blech spray solution and repeated to keep these edges moist. Periodic re-spraying shall be necessary by the security team member.

A minimum of one security team member must remain at these locations throughout the incident event. This means rotation of personnel for rest breaks and shift replacement will need to be accounted for. VHF patients when first exposed are well enough to act on the terror of impending death to their person. Once the severity of their disease becomes realized by them they may panic and attempt to escape. They must NOT access any uncontaminated areas of the facility otherwise contamination of this lethal agent shall spread. Within hours of symptoms, the patient soon becomes too ill to attempt an escape and is permanently ambulatory. They will not be able to run or move due to the illness after a period of time. This time period may vary from patient-to-patient.

If the patient does escape the treatment area and attempt to run out of the facility, or towards an unknown place of safety due to hysteria, they must be physically captured by the security team before they break through your secured visqueen boundaries. They then must be restrained and returned to the treatment area.

After this has been accomplished by the security team, the officer must go through the full decontamination protocol set down for the rest of the health-care team.

The final step before returning to the security post is for the officer to redress in appropriate CPC before resuming his/her post. This needs to occur for each attempted escape of any individual contaminated with the VHF virus. Back-up considerations to a patient break-out should be considered as varying layers of hospital facility VHF treatment boundaries. If a patient does escape, there should be a second secured access barrier. If not, the waste removal team can mobilize as an expanded site decontamination team and spray down the affected area with the 10% bleach solution.

As you can imagine, the planning for various security breaches can account for a large amount of planning between hospital treatment and the security detail.

Haz Mat Mike



VHF - 7 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



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




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


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