In my first post on Hospital Decontamination Operations, I mentioned that most facilities have some type of fixed decontamination room in close proximity to the Emergency Department (ED).  As they say in real estate….location, location, location.

On the surface, it makes sense that a room specifically designed to handle a contaminated patient would be located near where patients normally arrive to be seen for emergency medical care.  However, any hospital decontamination operation, either fixed or portable, should be viewed as a defensive barrier designed to protect the hospital and staff from a contaminant. Placing a “barrier” near the ED means any breach of your defensive barrier typically puts the contaminated patient in close proximity or directly in your ED.   For obvious reasons, this is the last place most hospitals want cross contamination.

Timely Response Matters
Set-up time is the key to ensuring fixed decontamination rooms actually perform as a defensive barrier.  If the patient has convenient access to needed supplies plus visual reminders of the self-decon process, the patient will get decontaminated and the ED will continue to function.  However, if a staff member has to search for a key, and then roll, push, and carry out miscellaneous pieces of equipment from the ED “storage closet,” what are the odds of a successful decon? Don’t be surprised if that patient wanders into the triage and/or ED space to seek help.

Think about it. If you spill a product on your arm and it begins to burn, how long would you patiently wait for someone to clean out their closet? Don’t expect any different from your patient.

If the contaminated patient is not able to shower by themselves and requires support from members of the Hospital Emergency Response Team (HERT), make sure there are at least two sets of Personal Protective Equipment (PPE) kept in or very near the fixed decontamination room.  I’ll talk more about equipment and supplies in a later post, which will include information about portable decontamination systems.

Features Matter
In areas where agriculture is prevalent and exposures to pesticides occur more frequently, a posted sign outside the ED entrance which directs the potentially contaminated patient to a specific area is a good idea. Smart hospitals will also provide these patients with an intercom system for initial instructions from knowledgable staff.

A common form of fixed decontamination facilities are outdoor shower arrangements.  Typical features include lighting and plumbed-in tepid water sources; and because outdoor facilities are designed for multiple people, there’s usually some form of privacy. More sophisticated facilities have laminated posters with instructions in locally prevalent languages.

Regardless of which type of fixed decontamination system in place, make certain that the application of water can be controlled.  Deluge-type fittings are great for those who can stand; however these pose significant issues if the patient is supine. Deluge fittings also are difficult for technical decontamination for staff in PPE. It’s hard to keep water out of the filter system on your Powered Air Purifying Respirators (PAPR) when standing in a downpour.

Facility personnel should be able to retrofit existing water outlets to allow for at least one coiled hose with a spray nozzle.

Practical Choices Exist
Another viable option is to identify hose bibs near entrances that could be used by patients. While far from ideal, if a coiled hose can be kept attached, the quick addition of some portable privacy screens, garbage bags for clothes, bucket, no-more tears shampoo, big sponge, towels, and scrubs equals a hasty but effective decontamination corridor.

What about containment of runoff water from an emergency decontamination operation?  In the case of a patient contaminated with radiation, it’s always advisable to try and contain the runoff.  If hospitals are within the planning zone of a nuclear power plant, they often are equipped to handle these types of patients. Local planning and protocols should exist to try and steer patients with radioactive contamination to these facilities when ever possible.  While you should always attempt to contain the runoff for all other decontamination operations, it should not be an over-riding concern when doing emergency decontamination.

Fixed decontamination facilities are great but they need to be prepared to take a patient without notice or prolonged set-up.  I’d much rather have a simple decontamination location removed from the ED and easily accessed to reduce the chance of a cross contamination from the dirty to clean area.

Have anything to add? Share your thoughts on what makes a successful decontamination facility.

Up next: How to properly staff for a Hospital Decontamination Facility.