Hospital Management of RAM Contaminated Patients

René Michel, M.S., RSO

VA San Diego Healthcare System, La Jolla, CA 92161

Introduction

RAM are among the many hazardous substances hospitals may have to deal with after certain accidents. It is important for hospitals to be prepared should radiation accidents occur in their communities.This presentation provides an overview of VASDHS’ decontamination procedures.

Potential Emergency

Scenarios:

1) Power Plant

2) Research Lab

3) Terrorism

Introduction (cont.)

Topics addressed during this presentation include procedures for:

1. Donning PPE

2. Preparing Decon Areas

3. Removing Contaminated Clothing

4. Surveying for Contamination

5. Decontamination of Skin and Open Wounds

Introduction (cont.)

VASDHS’ Training Program

1. Initial for new Decon Team Members

2. Annual Refresher

3. Training includes slide shows, demonstrations

4. Exercises are performed regularly

Dressing To Prevent the Spread of Radioactive Contamination

Very similar to the universal precautions already in place Give yourself a layer of clothing to keep your own clothes and body from becoming contaminated

Dressing (cont.)

2

Start with an ordinary set of scrubs

Shoe covers are worn over the shoes and come up under the pants leg

Tape the pants hem to the shoe cover

Make a folded tab in the end of your tape

Dressing (cont.)

2

Then we put on a surgical gown as an outer cover

It helps to assist one another with getting it all tied up.

It also helps minimizing mistakes

Dressing (cont.)

2

Double glove (blue and white) is recommended

Blue for you and white for the patient

The blue pair of gloves goes under the sleeve of the gown and is taped to the sleeve

The white glove goes on over top of the blue

Dressing (cont.)

Don a hat and a mask

A mask is as much for the patient's protection as the caregiver's

A face shield or a pair of goggles can be used to provide splash protection

Preparing the Area

The arrival of patients contaminated with RAM can occur any time.What to do now?

Preparing the Area (cont.)

Radiological Emergency protocol

Stay calm

Top priority: medical condition

No significant threat to caregivers

Preparing the Area (cont.)

If possible,

Use a separate entrance

Lay plastic/paper in path

Cover floors

Preparing the Area (cont.)

Lay paper on path

Cover ½ of hallway

Preparing the Area (cont.)

Tape edges and seams securely

Some facilities have non-porous floors and choose not to cover

Preparing the Area (cont.)

No exit without survey

Remove equipment needed elsewhere

No normal "come and go"

Preparing the Area (cont.)

Survey meter

Warning signs & security tape

Supply cart

Supply Cart Materials: Extra 4 x 4's Small and large

sample bags ABD pads Drapes and tape Irrigation solution, etc.

Preparing the Area (cont.)

You will also need:

Waste containers, large, plastic lined

Several waterproof sheets

Preparing the Area (cont.)

Most contamination is found in clothing

Wrap in sheet; then GO!

Removing Contaminated Clothing

Treat life threatening problems first

When medically stable, remove clothing

Approximately 80% of contamination is removed by disrobing patient

Removing Contaminated Clothing (cont.)

Careful techniques prevent spread of contamination

Protect face from splashes

Removing Contaminated Clothing (cont.)

Shoes are a likely spot for contamination

Plastic prevents direct contact

Removing Contaminated Clothing (cont.)

Cut clothes from the head towards the feet

Do it carefully and don't use the cut and rip method

Removing Contaminated Clothing (cont.)

Roll clothes outward

Keep contamination away from patient

Removing Contaminated Clothing (cont.)

Change outer gloves before log rolling patient

Change outer gloves whenever you suspect you have handled contaminated material

Removing Contaminated Clothing (cont.)

Log roll

Protect cervical spine, if necessary

Fold sheet over clothing

Removing Contaminated Clothing (cont.)

Complete log roll

Roll sheet from head to feet

Keep contaminated material away from patient's skin and airway

Removing Contaminated Clothing (cont.)

Remove contaminated material from immediate area

Survey patient's back for contamination

Removing Contaminated Clothing (cont.)

Double bag contaminated linens and clothes

Remove from immediate area

Keep in designated holding area

Removing Contaminated Clothing (cont.)

Medical problems come first

Treat life threatening problems immediately

If patient is stable, remove clothing and survey for radioactive contamination

Surveying For Radioactive Contamination

GM radiation instrument

Radiation induces electric pulses which are counted by the meter

Make reading in counts per minute (CPM)

Document background radiation

Surveying For Radioactive Contamination (cont.)

Probe held ~1 cm from surface

Move at a rate of 2 to 4 cm per second

Document readings in CPM

Log roll to survey the back

Surveying For Radioactive Contamination (cont.)

Avoid alarming the patient

Document areas of contamination on an anatomical chart

Remove contaminated clothing

Decontaminate

Surveying For Radioactive Contamination (cont.)

Patient discharge

Clean paper path

Clean stretcher

Clean team members

May walk to control line with clean foot covers

Decontaminating A Wound

Radioactive contamination in an open wound presents a pathway for internal contamination

Always treat life threatening medical needs first

Removing contaminated clothes when appropriate

Decontaminating A Wound (cont.)

Remove dressing with tongs

Bag wound dressing

Label with name, date, time and meter readings

Remove from immediate area

Surveying For Radioactive Contamination (cont.)

Survey and define area of contamination at wound site

Document initial reading in cpm

Washing out radioactive contamination similar to normal wound cleaning

cover surrounding clean skin so contamination is not spread

Decontaminating A Wound (cont.)

Drape area with water proof drapes

Tape edges of drapes to skin

Direct run off into lined garbage can

Decontaminating A Wound (cont.)

Wash and irrigate wound

Avoid high pressure flushing

Only blot wound one time with each 4x4

Do not spread contamination

Decontaminating A Wound (cont.)

Cover and protect wound

Remove drapes and pads

Place clean chucks

Bandage and wrap decontaminated wound

Decontaminating Intact Skin

Define the area of contamination

Mark the area of contamination

Decontaminating Intact Skin (cont.)

Drape the area

Tape edges of drape

Protect clean areas from splashes

Decontaminating Intact Skin (cont.)

Use a pad, mild detergent and water

Clean team member passes pads to caregiver

Clean outside to in

Decontaminating A Wound (cont.)

Blot once and carefully discard pad

Protect area while removing drapes

Resurvey area

If residual contamination is left, repeat the process

Decontaminating A Wound (cont.)

Medical treatment comes first

Decontaminate open wounds first, then in and around body orifices and finally intact skin

Any questions?

René Michel

(858) 642-1059

rene.michel@va.gov