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Hospital Management of RAM Contaminated Patients
René Michel, M.S., RSO
VA San Diego Healthcare System, La Jolla, CA 92161
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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
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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
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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
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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
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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
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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
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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
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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
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Preparing the Area
The arrival of patients contaminated with RAM can occur any time.What to do now?
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Preparing the Area (cont.)
Radiological Emergency protocol
Stay calm
Top priority: medical condition
No significant threat to caregivers
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Preparing the Area (cont.)
If possible,
Use a separate entrance
Lay plastic/paper in path
Cover floors
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Preparing the Area (cont.)
Lay paper on path
Cover ½ of hallway
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Preparing the Area (cont.)
Tape edges and seams securely
Some facilities have non-porous floors and choose not to cover
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Preparing the Area (cont.)
No exit without survey
Remove equipment needed elsewhere
No normal "come and go"
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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.
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Preparing the Area (cont.)
You will also need:
Waste containers, large, plastic lined
Several waterproof sheets
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Preparing the Area (cont.)
Most contamination is found in clothing
Wrap in sheet; then GO!
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Removing Contaminated Clothing
Treat life threatening problems first
When medically stable, remove clothing
Approximately 80% of contamination is removed by disrobing patient
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Removing Contaminated Clothing (cont.)
Careful techniques prevent spread of contamination
Protect face from splashes
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Removing Contaminated Clothing (cont.)
Shoes are a likely spot for contamination
Plastic prevents direct contact
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Removing Contaminated Clothing (cont.)
Cut clothes from the head towards the feet
Do it carefully and don't use the cut and rip method
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Removing Contaminated Clothing (cont.)
Roll clothes outward
Keep contamination away from patient
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Removing Contaminated Clothing (cont.)
Change outer gloves before log rolling patient
Change outer gloves whenever you suspect you have handled contaminated material
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Removing Contaminated Clothing (cont.)
Log roll
Protect cervical spine, if necessary
Fold sheet over clothing
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Removing Contaminated Clothing (cont.)
Complete log roll
Roll sheet from head to feet
Keep contaminated material away from patient's skin and airway
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Removing Contaminated Clothing (cont.)
Remove contaminated material from immediate area
Survey patient's back for contamination
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Removing Contaminated Clothing (cont.)
Double bag contaminated linens and clothes
Remove from immediate area
Keep in designated holding area
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Removing Contaminated Clothing (cont.)
Medical problems come first
Treat life threatening problems immediately
If patient is stable, remove clothing and survey for radioactive contamination
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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
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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
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Surveying For Radioactive Contamination (cont.)
Avoid alarming the patient
Document areas of contamination on an anatomical chart
Remove contaminated clothing
Decontaminate
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Surveying For Radioactive Contamination (cont.)
Patient discharge
Clean paper path
Clean stretcher
Clean team members
May walk to control line with clean foot covers
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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
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Decontaminating A Wound (cont.)
Remove dressing with tongs
Bag wound dressing
Label with name, date, time and meter readings
Remove from immediate area
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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
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Decontaminating A Wound (cont.)
Drape area with water proof drapes
Tape edges of drapes to skin
Direct run off into lined garbage can
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Decontaminating A Wound (cont.)
Wash and irrigate wound
Avoid high pressure flushing
Only blot wound one time with each 4x4
Do not spread contamination
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Decontaminating A Wound (cont.)
Cover and protect wound
Remove drapes and pads
Place clean chucks
Bandage and wrap decontaminated wound
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Decontaminating Intact Skin
Define the area of contamination
Mark the area of contamination
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Decontaminating Intact Skin (cont.)
Drape the area
Tape edges of drape
Protect clean areas from splashes
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Decontaminating Intact Skin (cont.)
Use a pad, mild detergent and water
Clean team member passes pads to caregiver
Clean outside to in
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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
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Decontaminating A Wound (cont.)
Medical treatment comes first
Decontaminate open wounds first, then in and around body orifices and finally intact skin