Chapter SC2: Decontamination Principles: Prevention of Dermal, Ophthalmic, and Inhalational Absorption

INTRODUCTION

Decontamination is a term that describes limiting or minimizing the exposure of a patient to a xenobiotic. This involves removal of a xenobiotic by physical means or by chemical neutralization before it can be systemically absorbed. Despite limited controlled studies assessing its efficacy, decontamination remains the mainstay of initial treatment for a patient exposed to a potentially harmful xenobiotic. Decontamination strategies in toxicology often refer to gastrointestinal (GI) techniques to minimize absorption or enhance elimination in orally poisoned patients (Chaps. 5 and 6). These same principles apply to other exposure routes where local or systemic absorption and toxicity occur, including dermal, ophthalmic, and pulmonary routes. An important point to note is that as opposed to GI decontamination, in which initial patient assessment and management always comes first, in the case of dermal and pulmonary contamination, in which there is risk for contamination and harm to health care personnel, the use of appropriate personal protective equipment (PPE) is paramount before initiation of patient decontamination. The benefits of decontamination to remove or neutralize a xenobiotic are severalfold and include (1) prevention of further absorption and toxicity in exposed patients, (2) prevention of secondary contamination of other staff or equipment, and (3) prevention of contamination of the health care facility and other patients.

An organized approach to decontamination is required following the release of hazardous materials. Unintentional release of hazardous materials occurs at industrial sites, chemical manufacturing plants, pipelines, and waste sites.²⁵ Also, the threat of terrorist attack using hazardous materials mandates that the health care community be prepared to effectively manage these situations in a safe and efficient manner that optimally treats patients while at the same time maintains the safety of the health care providers.

This Special Consideration focuses on situations that require health care facility–based dermal, ophthalmic, and pulmonary decontamination. The approach to the decontamination process is discussed, but the acute medical management of specific local and systemic toxicities is covered in other chapters. Dealing with mass casualty events and the incident command system, as well as prehospital decontamination are covered in detail elsewhere (Chap. 132). In addition, approaches to patient triage, runoff control, and isolation requirements are not covered here.

HAZARDOUS MATERIALS

Typically, decontamination efforts are initiated by first responders, including hazardous materials teams (HAZMAT), who respond to the site of initial xenobiotic release. However, in an instance when emergency medical services (EMS) is unable or uncertain how to decontaminate a patient or for patients who self-present to the hospital, it is prudent that health care providers are prepared to carry out effective decontamination. In fact, up to 80% of patients from a scene of xenobiotic release self-present to a hospital without undergoing any prior decontamination, mandating that hospital personnel have the appropriate knowledge and follow an organized approach to patient decontamination to ensure their personal safety and the safety of ...