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Safety
Bioterrorism Agents and Barrier Protection
Janie Thomas
Publish Date: October 10, 2007   |  Tags:   Patient Safety

Janie Thomas, RN, BSN, MA If a bioterrorist event were to occur in your area, your facility could be used as a triage unit. Here's how to safely handle and contain potentially lethal materials.

Janie Thomas, RN, BSN, MA\ Standard precautions
The CDC's Standard Precautions are available at writeOutLink("www.cdc.gov/ncidod/hip/ISOLAT/std_prec_excerpt.htm",1). They apply to blood and other body fluids, skin not intact and mucous membranes, and are designed to reduce the risk of transmitting infectious organisms. All recommendations are 1B - strongly recommended for implementation and supported by some experimental, clinical or epidemiologic studies and strong theoretical rationale. The Standard Precautions cover nine areas.

1. Handwashing. In the event of an outbreak, use antimicrobial or antiseptic agents immediately after any patient contact. Wash hands immediately after you remove gloves; wash hands and other skin immediately if you come into contact with blood or other body fluids.

2. Gloves. Wear clean gloves at all times, changing them between tasks. Latex is the gold standard for quality, barrier protection, fit and economy in gloves. Low protein, powder-free gloves would be the best selection for any bioterrorist agent.

For healthcare workers who are allergic to natural rubber latex, many other synthetic materials maintain an appropriate barrier against bioterrorist agents. Choices include nitrile (this material comes in examination gloves only) neoprene (or polychloroprene; manufactured in both exam and surgical gloves) polyisoprene (the newest material on the market has barrier properties that are fair to good; it would not be acceptable for use with a bioterrorist agent) and PVC (commonly known as vinyl; it's also unnacceptable to use with a bioterrorist agent, as studies show 63 percent of these exam gloves leak after normal use).

3. Mask, eye protection and face shield. Wear all three in any situation in which patient body fluids might be splashed. A visor and a mask with a .01-micron filter are advisable.

Thumbnail Sketches of Six Key Bioterrorism Agents

The CDC has grouped bioterrorism agents into three categories - from most likely to least likely: A, B and C - based on the likelihood of their use as a biological weapon. Here's a rundown of the precautions you'd need to take for six biological agents in category A.

  • Anthrax. Of the three routes of exposure - inhalation, cutaneous and gastrointestinal - the one that is of greatest concern as a bioweapon is inhalational anthrax. Administer antibiotics to anyone exposed or potentially exposed before symptoms arise; 60 days without the vaccine, and 30 days if they've had the vaccine. It is not contagious, so those who were not originally exposed to the release do not require prophylaxis. Infection control measures would include standard precautions.
  • Smallpox. There are several strains, and it is very stable in the environment. Humans are the only natural reservoirs for the virus that causes smallpox. Person-to-person transmission occurs via air or direct contact with an infected person. The virus can also be spread through contaminated bedding and clothing. Infection control measures include standard precautions, airborne precautions and contact precautions. You can home isolate potential victims to prevent nosocomial spread.
  • Plague. Plague can have three different forms: bubonic, septicemic and pneumonic. The third is the most feared as a bioterrorist weapon because, used in an aerosolized attack, it could infect thousands of people, and mortality is very high. Take standard, contact and droplet precautions.
  • Tularemia. This naturally occurring disease is transmitted to humans through contact with infected animals, or from the bite of arthropods that have fed on infected animals. There are six forms of tularemia, classified by clinical presentation and determined by route of exposure; pneumonic tularemia is considered one of the diseases most likely to be encountered in a bioterrorism event. Take standard precautions.
  • Botulism. A rare disease, the man-made inhalational form is likely to be used in a bioterrorism attack, although dissemination through contaminated food could also occur. Infection control measures would include standard precautions.
  • Viral hemorrhagic fevers. This term covers a diverse group of viruses, all of which share similar clinical signs and symptoms. Transmission to humans under natural conditions is through contact with infected arthropods or infected animal reservoirs. There is no natural occurrence of these diseases in the United States and they are relatively unstable in the environment. You would need to take standard, contact precautions, airborne precautions and droplet precautions.

- Janie Thomas, RN, BSN, MA

Janie Thomas, RN, BSN, M\A 4. Gown. Wear an appropriate gown, removing a soiled one as soon as possible. According to Plymouth Meeting, Pa.-based ECRI, you should wear at minimum a gown that provides what the organization calls Level C protection. Materials that provide this degree of protection are uncoated, spun-bonded and good for particulate and fiber exposure. This is roughly equivalent to a Level 2 gown, as prescribed in the voluntary standards for manufacturers produced by the Association for the Advancement of Medical Instrumentations, the FDA and the American Society for Testing and Materials. Even better would be a gown that provides Level B protection (equivalent to Level 3 in the voluntary standards) this material will be spun-bonded and coated with some type of plastic, which provides good chemical and fluid resistance.

5. Patient-care equipment. Wear proper PPE to handle soiled patient-care equipment. Avoid contact with patients when handling used, soiled patient-care equipment that's in contact with a patient, such as IVs, linens and blood-pressure cuffs. Such equipment should be either reprocessed according to accepted methods before the next use or disposed of properly.

6. Environmental control. Ensure thorough cleaning and disinfection of all surfaces, especially beds, chairs and other surfaces touched often by patients. If you're cleaning blood or other bodily fluids, contain the contamination in the immediate area; use disinfectants that are EPA- and OSHA-approved for such applications. Air should flow from clean to dirty to prevent airborne spread of disease.

7. Linen. Handle soiled linens so that they don't spread infectious materials and so that you're in accordance with disposal policy and local law.

8. Occupational health and bloodborne pathogens. Follow recommendations for preventing sharps injuries; avoiding potential injuries helps prevent resultant infections. Use alternatives to mouth-to-mouth resuscitation if such an action is needed.

9. Patient placement. An infectious patient should be in a private room. When moving a patient to another room, issue him barrier protection (such as a mask) to avoid his infecting staff and other patients he may come into contact with during the move, which should be as direct a route as possible.

Adjunct recommendations
Each of these recommendations is also category 1B.

  • Airborne precautions. Keep patients in private rooms with negative air pressure and at least a half-dozen air exchanges per hour. Both healthcare workers and the patient should wear respiratory protection; minimize patient transport. See writeOutLink("www.cdc.gov/ncidod/hip/ISOLAT/airborne_prec_excerpt.htm",1) for more.
  • Contact precautions. Put the patient in a private room; follow specialized hand hygiene and gown protocols; limit patient movement; and dedicate patient-care equipment if possible. Go to writeOutLink("www.cdc.gov/ncidod/hip/ISOLAT/contact_prec_excerpt.htm",1).
  • Droplet precautions. Droplets do not remain suspended in air, so these requirements don't include prophylactic ventilation measures. They do include placing the patient in a private room; wearing a mask within three feet of the patient; and minimizing transport and masking the patient during transport. Visit writeOutLink("www.cdc.gov/ncidod/hip/ISOLAT/droplet_prec_excerpt.htm",1) for more.

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