Threat of Secondary Chemical Contamination of Emergency Departments and Personnel: An Uncommon but Recurrent Problem

Abstract

Objective To analyze hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments (EDs). Secondary contamination of EDs may occur when a patient, exposed to a hazardous chemical, is not decontaminated before arrival at the ED and when ED staff is not wearing appropriate personal protective equipment. This can result in adverse health outcomes among department personnel, other patients, and visitors. Even events without actual secondary contamination risk can be real in their consequences and require the decontamination of the ED and/or its occupants, evacuation, or temporary ED shut-down. Methods Events involving secondary contamination were identified using the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substances Incidence Program during 2007–2013. Results Five incidents involving involved the threat of secondary contamination (0.02% of all events reported to the surveillance systems [n=33,001]) were detected and are described. Four incidents involved suspected secondary contamination in which the facility was evacuated or shut down. Conclusions These results suggest that while rare, incidents involving secondary contamination continue to present a hazard for emergency departments. Suggested best practices to avoid secondary contamination have been described. Hospitals should be made aware of the risks associated with secondary contamination and the need to proactively train and equip staff to perform decontamination.

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

“…More so, as routine tasks significantly impact the time, logistic, and manpower resources of most systems, developing and sustaining such readiness for events that do not occur frequently, it proves to be even more ambitious and complex. Contrary to the reluctance to invest efforts in ensuring emergency preparedness, the results of not being prepared can be devastating, and can lead to severe costs in human lives, damage to the environment, and collapse of infrastructure, as well as social and political calamities [2,4]. Thus, there is a need to design and implement mechanisms that may encourage both medical facilities and authorities to build their preparedness prior to the materialization of adversities, and to maintain it effectively over time [5,32,38,39].…”

“…Mass casualty incidents that involve hazardous materials may be detrimental to the functional continuity of emergency departments (EDs), leading to chaos, confusion, miscommunication, lack of coordination, and misinformation [13,14]. The presentation of casualties exposed to such materials in the ED, if not immediately identified as a toxicological incident, may cause secondary contamination of both medical personnel and infrastructure, resulting in dysfunction of the ED [4,5]. Exceptional or unpleasant odors or non-specific symptomatology among healthcare workers have also been known to lead to the closing of hospitals' EDs [7,15,16].…”

“…Though most mass casualty incidents that occurred globally in the past two decades were of a "conventional" nature, i.e., consisted mostly of trauma victims, numerous events occurred as a result of chemical, toxicological, radiological, or biological (CBRN) threats that were caused either accidentally or were intentionally dispersed among populated communities [3]. The potential devastation that may be caused by the manifestation of CBRN threats necessitates continued readiness, but as they require a varied operational mode compared to routine activities, they present a highly complex challenge to all healthcare systems [4]. Even a single patient that presents to an emergency department (ED) after being exposed to hazardous materials may cause extreme havoc, secondary contamination of medical personnel, full evacuation of the ED, and subsequent interruption or shutdown of operations for a limited or extended period of time [4,5].…”

“…The potential devastation that may be caused by the manifestation of CBRN threats necessitates continued readiness, but as they require a varied operational mode compared to routine activities, they present a highly complex challenge to all healthcare systems [4]. Even a single patient that presents to an emergency department (ED) after being exposed to hazardous materials may cause extreme havoc, secondary contamination of medical personnel, full evacuation of the ED, and subsequent interruption or shutdown of operations for a limited or extended period of time [4,5].…”

“…In the past decade, the international community witnessed several MCIs that resulted from the use of toxicological and/or chemical agents [5,6]. Although this emergent threat has taxed the capacities of diverse societies and potentially may transpire in any community, to date it is perceived as occurring only infrequently, and thus constitutes a potential though uncommon risk [4].…”