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Haz Mat "Specialist Course"

VHF - 12 "Doffing" procedures for Dress-out and Decontamination

To collectively reach the phase of your incident where final disinfection/decontamination takes place and removes the patient treatment personnel from the Hot Zone involves two (2) concepts;

1] Technical Decontamination

2] Disinfection BEFORE removal

Technical decontamination first involves the removal of major or heavy volumes of projectile vomiting or other bodily fluid discharge from the patients which have contaminated the health care worker. These volumes must be wiped off as completely as possible and treated in the previous months’ post with 1:10 bleach solution, soaked towels, and the listed time limits. Once this has been accomplished, technical decontamination blends into “disinfection before removal” both inside the isolation area (Hot Zone) and outside this zone depending on the operational set-up you decide will work best for your facility given the physical room limitations.

Disinfection BEFORE removal involves conditions where either the massive discharges did not occur, or have been mitigated as previously noted. Unless major projectile discharge occurs, or has been mitigated, the outer gloves and booties are likely to have the most contact with VHF agents and therefore the heaviest contamination (VHF fluids during patient care) at this point.

Ideally, before leaving the Hot Zone (isolation area/patient isolation room) the procedure must follow these steps;

1] After the final 3 to 5 minute soaking of gloves in the 1:100 bleach solutions, wash in a separate bin/sink the outer gloved hands with soap and water.

2] In a clean solution or “spray” dip or soak the gloved hands in a 1:100 bleach solution for one (1) minute.

3] Step into (or keep moist with a spray) a solution bin of 1:100 bleach solution enough to cover the outer soles of your footwear. The best way to accomplish this is to begin this procedure while these other processes are taking place. This way a longer time period will and should be realized for footwear. This is because additional contamination will be accumulated on the footwear. Therefore, a longer time period should be considered for footwear saturation.

4] While this is ongoing, spray the outer CPC garment with 1:100 bleach solutions. When the entire CPC has been covered with the spray solution outer decontamination has been completed. When finished,

5] Step out of the bin/pan onto one of your clean, bleach soaked towels to dry off more completely the CPC booties soles. This clean bleach soaked towel should have been previously placed inside a bio-hazard bag or waste transportable vessel of your choice.

6] While standing on this bleach soaked cloth, remove your outer booties, remove outer gloves, and slide this ensemble down around you and into the bio-hazard waste container IN THIS ORDER

7] Lastly; step out of this area into a clean area located outside the patient treatment isolation area (Hot Zone). Deposit remaining Inner gloves into a separate bio-waste container (bio-waste bag).

Personal hygiene should be managed at this point before laundering used inner clothing and re-showering before being released from the contaminated site area.

Haz Mat Mike



VHF - 11 First Aid Exposures for Treatment Workers

In last month’s post we looked at the decontamination of large spill/patient discharges and how they affect decontamination issues for hospital treatment staff. But what if the treatment staff becomes injured as a result of patient discharge/struggle? We need to consider treatment staff injuries while in the isolation/Hot Zone treating patients. Once treatment staff becomes injured/a breach of his/her skin, he/she becomes downgraded in their operational capabilities.

First, if an injury occurs, your treatment/isolation area/ Hot Zone will need some type of another vessel or bin to immerse the injured site for 20 to 30 seconds in a 70% alcohol solution. Immersion is the best approach but due to size of your isolation areas a spray system could be considered. This site area of the injury would need to remain wet and saturated with the 70% alcohol solution for the entire 20 to 30 seconds.

Second, have the injured patient care worker flush this injured site with running water for 20 to 30 seconds. At this point, the injury can be treated with an appropriate bandage or dressing for the type of wound delivered. The dressing/bandage will then need to be wrapped with some type of cover or saran wrap arrangement as the treatment personnel will need to proceed through the decontamination/disinfection outlined for all team members at a later date.

Next, report this incident to your Team Leader for the proper corrective action. He/she will need to make arrangements after the injured worker proceeds through the decontamination process. At this point, the injured worker becomes a monitored patient. Where will he go? Can you place him in another isolated area of the hospital for an extended time? Will he go home? These are all decisions the Team leader must be prepared for, in other words it’s all about what is next? Team Leaders should be taught like Emergency Managers that whatever is happening now is already done. It’s all about what is next? These decision makers must be a step ahead of an ongoing incident.

The injured treatment worker can now proceed through the decontamination process after these decisions have been made and the appropriate steps/systems are in place.

Once this step is completed, the injured treatment personnel now become a monitored patient for VHF. Whatever the incubation period of your VHF (Ebola is 7 to 21 days) is the length of time to restrict the patient for observation. If no symptoms show themselves, additional testing is done to insure non-exposure/contamination to the VHF. Once this monitoring is completed, the health care worker can be placed back into normal rotation or return to normal duties.

Haz Mat Mike


VHF - 10 Disinfect "Spills" of infectious Body Fluids

Once inside the Hot Zone/Patient Isolation Treatment Area, patient treatment begins and soon falls into a systematic routine as we began to see last month. As some patients conditions may worsen, additional procedures will need to be taken by the patient treatment staff. These techniques will require some additional supplies inside the Hot Zone.

Unless you have specialized equipment, the best tool for large bodily spills of infected waste is the common towel. It can be moistened, it can pick up large pieces of body fluid waste, and it can be safely laundered for future use. A good supply of fresh towels should be stocked in the treatment area before patients arrive. You will also need a large volume of the 1:10 Bleach solution. Also, a supply of biohazard waste bags or other container demonstrating these types of markings for transport to the laundry facility. All containers removed from the Hot Zone must undergo the disinfection protocol outlined in the waste packaging section for handling waste off-site.

Soak a few towels in the 1:10 bleach solution. When a bodily fluid spill occurs from vomiting or patient drainage, partially wring out a soaked towel leaving it very damp. Cover the fluids preferably on the floor or flat surface and let stand covered with the damp bleach towel for 15 minutes. This means to continue treatment, this obstacle will remain and personnel will have to negotiate this hazard for 15 minutes. If multiple covered areas exist, the site could temporarily be a bit of a mine field. These areas need to be pointed out to all employees so that they may avoid stepping in them.

After 15 minutes have elapsed, pick-up the bodily fluid waste liquids and towels and place them into your designated container. Ideally, the flat surface where the spill was soaked should be washed with soap and water. Realistically, an additional towel with 1:10 bleach solution can be used to wipe up this area. If you decide not to launder appreciate that there will be an increase in disposable waste that will need to be handled to keep the Hot Zone open to work in for patient treatment. Either way, this will involve your waste handling and laundry team members. This element must be calculated into the flow of the patient treatment personnel.

In all situations, the Emergency Manager must be aware of the work flow of the personnel. This background work must be ahead of the patient treatment personnel to remain assured that the work flows without additional problems.

After these heavy spills have been picked up and the treatment area has slowed, the waste handling team can enter and clean these areas with soap and clean water. This technique is planned in to the work flow as the buildup of bleach solutions odor usually has a cumulative negative affect on patients. Usually HVAC units can be overcome with increased vapors from large spills. This will reduce the stress on patients that must remain in this area.

Haz Mat Mike


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


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