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PubMed1983

1976 Hanford americium exposure incident: external decontamination procedures.

An accident resulted in the deposition on an injured workman's skin surfaces, in acid-burned areas and in lacerations, of something in excess of 6 mCi 241Am. This paper describes the external decontamination procedures used, the change in americium content of the skin during the course of treatment, and some of the unusual problems encountered from the extrusion of foreign material and flaking of skin and scar tissue.

Accidents, Occupational↗
PubMed2003

Decontaminating the nasal passages.

Nasal decontamination may be indicated when the anterior nasal passages are contaminated with highly radioactive material or radioactive material with either irritating or toxic properties. Nasal irrigation (wash, rinse, douche, lavage) is an established technique used for other conditions and can be applied in these cases. This paper discusses the rationale and use of nasal irrigation and how to perform the technique.

Decontamination↗
PubMed2003

Is it safe to work with iodine-131 if you are pregnant? A risk assessment for nuclear medicine staff involved with cleaning and decontamination.

In the UK, Regulation 8(5) of the Ionising Radiation Regulations 1999 (In: Work with ionising radiation. London: HSE Books, 2000) requires employers to ensure that the dose to the foetus of a pregnant worker is unlikely to exceed 1 mSv. Risk assessments are required which are capable of predicting the total foetal dose. Work involving 131I is a particular problem. Foetal dose coefficients from the maternal intake of 131I for all stages of pregnancy have been published (Phipps AW, Smith TJ, Fell TP, Harrison JD. Doses to the embryo/fetus and neonate from intake of radionuclides by the mother. NRPB contract research report 397/2001. Didcot, Oxon.: National Radiological Protection Board (NRPB), 2001. Available on website www.hse.gov.uk/research/crr_pdf/2001/crr01397.pdf), and range from 0.08 microSv x kBq(-1) at conception to 55 microSv x kBq(-1) at week 35. This paper examines one aspect of work in a nuclear medicine department in which the source of 131I is uncontrolled to determine whether the risk assessment indicates that restrictions should apply to a pregnant member of staff. Following in-patient treatment with 131I, rooms are checked and decontaminated before being decontrolled. Cleaning staff were monitored immediately after the cleaning process with hand-held detectors and by whole-body monitoring. Total body contamination ranged up to 3.2 kBq; after a change of clothing, the maximum remaining activity was 0.68 kBq. Acquired contamination correlated with the total activity administered to the patient. Hand-held monitoring rarely detected contamination. Whole-body monitoring indicated that the levels of contamination encountered could lead to a dose limit for the foetus being exceeded. These levels are very difficult to detect with hand-held monitoring. The conclusion to be drawn is that pregnant staff should be excluded from situations in which accidents could arise, or where the source of 131I is uncontrolled or unpredictable.

Abnormalities, Radiation-Induced↗
PubMed2005

Prevention of acquired infections in intubated patients with the combination of two decontamination regimens.

OBJECTIVE: The use of topical polymyxin and tobramycin to prevent intensive care infections is controversial. Moreover, these antibiotics are ineffective against methicillin-resistant Staphylococcus aureus. A decontamination regimen using mupirocin and chlorhexidine could prevent acquired infections, including those involving S. aureus. Because these two regimens could have a complementary role, we evaluated their effects when given both alone and combined. DESIGN: The authors conducted a multiple-center, placebo-controlled, randomized, double-blind study performed according to a 2 x 2 factorial design. SETTING: The study was conducted at three polyvalent medical intensive care units at university-affiliated hospitals in France. PATIENTS: Adult patients (age, > or =18 yrs) intubated for <48 hrs who were likely to be ventilated for >48 hrs. INTERVENTION: Two regimens were used: topical administration of polymyxin/tobramycin (or placebo) and nasal mupirocin with chlorhexidine body washing (or nasal placebo with liquid soap). The patients (n = 515) received polymyxin/tobramycin alone (n = 130), mupirocin/chlorhexidine alone (n = 130), both regimens (n = 129), or all placebos (n = 126) for the period of mechanical ventilation plus 24 hrs. MEASUREMENTS AND MAIN RESULTS: The incidence of total infections acquired from the date of randomization until the termination date of study treatments plus 48 hrs was assessed. There were fewer acquired infections with both regimens than with polymyxin/tobramycin alone (odds ratio, 0.44; 95% confidence interval, 0.26-0.75; p = .003), mupirocin/chlorhexidine alone (0.43; 0.25-0.73; p = .002), or all placebos (0.42; 0.25-0.72; p = .001). There were no differences between polymyxin/tobramycin alone (0.95; 0.59-1.54; p = .84) and mupirocin/chlorhexidine alone (0.98; 0.60-1.58; p = .92) vs. all placebos. The probability of freedom from infection was higher with both regimens than with polymyxin/tobramycin alone (p = .002), mupirocin/chlorhexidine alone (p < .001), or all placebos (p < .001). Infection rates were also significantly lower with both regimens than with polymyxin/tobramycin alone (p = .017), mupirocin/chlorhexidine alone (p < .001), or all placebos (p < .001). CONCLUSION: Acquired infections were substantially reduced by mupirocin/chlorhexidine plus polymyxin/tobramycin, whereas each regimen given alone was ineffective. Whether both regimens could increase Candida infections deserves further investigation.

Administration, Intranasal↗
PubMed2005

Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract: a randomized, placebo-controlled, double-blind trial.

OBJECTIVE: To evaluate whether selective digestive decontamination (SDD) reduces mortality from any cause, and the incidence of pneumonia among patients with severe burns. SUMMARY BACKGROUND DATA: SDD is a prophylactic strategy to reduce infectious morbidity and mortality in critically ill patients. Two meta-analyses and a recent randomized controlled trial demonstrated a mortality reduction varying between 20% and 40%. But this technique has never been properly evaluated in severely burned patients. METHODS: The design of this single-center trial was randomized, double blind, placebo controlled. Patients with burns > or =20% of total body surface and/or suspected inhalation injury were enrolled and assigned to receive SDD or placebo for the total duration of treatment in the burn intensive care unit (ICU). RESULTS: One hundred seventeen patients were randomized and 107 were analyzed (53 in the SDD group and 54 in the placebo group). The ICU mortality was 27.8% in the placebo group and 9.4% in the SDD group in the burn ICU. Treatment with SDD was associated with a significant reduction in mortality both in the burn ICU (risk ratio 0.25; 95% CI 0.08 to 0.76) and in the hospital (risk ratio 0.28; 95% CI 0.10 to 0.80), following adjustment for predicted mortality. The incidence of pneumonia was significantly higher in the placebo group: 30.8 and 17.0 pneumonias per 1000 ventilation days (P = 0.03) in placebo and SDD group, respectively. CONCLUSIONS: Treatment with SDD reduces mortality and pneumonia incidence in patients with severe burns.

Adult↗
PubMed1994

An in-vitro meat model for the immediate bactericidal effect of lactic acid decontamination on meat surfaces.

An in-vitro model of the lactic acid decontamination (LAD) of meat is described. As LAD is a disinfection rather than a preservation process the model is based on the inactivation kinetics of bacteria in a suspension of pork skin. The model takes account of interfering factors present in nature, such as microbial interactions, leaching of organic material from the meat surfaces and buffering activity.

Animals↗
PubMed1993

Decontamination methods for cytotoxic drugs. 1. Use of a bioluminescent technique to monitor the inactivation of methotrexate with chlorine-based agents.

A new microbial bioluminescence assay has been used to monitor the loss of mutagenicity on inactivation of methotrexate by active chlorine-based agents. The drug was degraded to products that were non-active in this mutagen detection system, in agreement with previously described work. Presept granules appear to be a suitable alternative to sodium hypochlorite for inactivating solutions and surface spills of methotrexate. The bioluminescence assay appears to have potential for monitoring clean-up and decontamination procedures in areas where cytotoxic agents are used.

Biological Assay↗
PubMed1987

Use of risk assessment methods in the certification of decontaminated buildings.

Accidental events such as fires, explosions, and leaks often result in large-scale contaminations of buildings with toxic chemicals. After decontamination, the certification for original use requires testing for residual contamination. The two basic kinds of sampling plans in use up to recently both fall short of the required performance. Their deficiencies are analyzed in terms of the scientific questions implicit in both the sampling plan and the subsequent statistical evaluation. A sampling strategy of a new kind is proposed and discussed in the same context. It is motivated by concern for the long-term safety of the building's occupants and is, therefore, based on factors important in risk assessment. Three different sampling plans are derived in the framework of this methodology, two of which have already been used in actual certification proceedings.

Algorithms↗
PubMed1989

[Selective decontamination of intestinal flora with oral aztreonam in compromised children].

Effects of oral aztreonam on fecal flora were studied in 6 compromised children. Their ages ranged from 4 to 14 years. Daily doses of aztreonam were 10 to 30 mg/kg. The stool specimens were obtained before the treatment, on day 5 to 7 of aztreonam use and 2 to 5 days after the cessation of treatment. The counts of enterobacteria decreased from 10(7.7) to 10(4.4) per gram of wet feces (p less than 0.01), and bifidobacteria also decreased from 10(10.2) to 10(8.4) per gram of wet feces (p less than 0.01) during aztreonam administration. Those of streptococci increased from 10(2.9) to 10(9.4) per gram of wet feces (p less than 0.001). The other anaerobic organisms showed no marked change. Based upon the above results, we conclude that oral administration of aztreonam may be useful for selective decontamination of intestinal flora in compromised hosts.

Administration, Oral↗
PubMed1991

[Clinical significance of gastrointestinal decontamination under protected environment].

Many infections are caused by the patient's own oro-intestinal microbial flora under a protected environment. Thirty-eight patients with acute leukemia and two patients with blast crisis of chronic myelocytic leukemia were treated under a protected environment with or without prophylactic antibiotics. Antibiotics used for decontamination were vancomycin (V), polymyxin B (P) and nystatin (N). The number of patients in the VPN, PN and the no antibiotic group were 13, 13 and 14, respectively. While the intestinal microbial flora was almost completely eliminated in VPN group, the number of bacteria decreased slightly in PN group. The mean number of pharyngeal and anorectal bacterial species decreased most markedly in the VPN group, but there were no significant differences among the three groups. The number of febrile days was significantly lower in the VPN and PN group than the no antibiotics group with neutrophil counts of less than 100 microliters. The average number of episodes of infection per patient was lowest in VPN group and highest in the no antibiotic group. These data indicate that VPN administration is effective for eliminating intestinal bacterial flora and resultantly protecting endogenous infections.

Adolescent↗
PubMed2006

Effect of a selective decontamination of the digestive tract regimen including parenteral cefepime on establishment of intestinal colonization with vancomycin-resistant Enterococcus spp. and Klebsiella pneumoniae in mice.

In mice, a selective decontamination of the digestive tract regimen consisting of orogastric tobramycin, polymyxin E, and amphotericin B in combination with subcutaneous cefepime inhibited gram-negative bacilli, including Klebsiella pneumoniae, and did not promote vancomycin-resistant Enterococcus spp. (VRE) colonization. However, concurrent administration of subcutaneous ampicillin-sulbactam resulted in promotion of VRE.

Animals↗
PubMed2004

Comparisons of protocols for decontamination of environmental ice samples for biological and molecular examinations.

Drilling and laboratory manipulations of glacial ice cores introduce contemporary microbes and biomolecules onto the cores. We report herein a systematic comparative study of several decontamination protocols. Only treatment with 5% sodium hypochlorite eliminated all external contaminating microbes and nucleic acids while maintaining the integrity of those within the cores.

Colony Count, Microbial↗
PubMed2006

Value of the chlorhexidine decontamination method for recovery of nontuberculous mycobacteria from sputum samples of patients with cystic fibrosis.

The chlorhexidine method was compared to the N-acetyl-l-cysteine-NaOH-oxalic acid decontamination method currently recommended for the recovery of nontuberculous mycobacteria (NTM) from patients with cystic fibrosis. Sputum samples (n = 827) treated with chlorhexidine yielded twice as many NTM-positive cultures as those treated by the reference method (54 [6.50%] versus 27 [3.25%]; P < 0.0001) despite a higher contamination rate (20% versus 14.2%; P = 0.0017).

Acetylcysteine↗
PubMed1991

Outbreak of gut colonization by Pseudomonas aeruginosa in immunocompromised children undergoing total digestive decontamination: analysis by pulsed-field electrophoresis.

We analyzed an outbreak of gut colonization by Pseudomonas aeruginosa occurring in an intensive care hematology unit by using conventional typing methods and pulsed-field electrophoresis. In October and November 1989, the feces of four immunocompromised children undergoing total digestive decontamination were colonized by P. aeruginosa. Ten isolates were obtained from the gut flora in pure culture. Retrospective investigations found that one P. aeruginosa isolate from stools of one of the patients was already present at high counts 6 months before the outbreak. This patient had been discharged from the unit in May 1989 and had been readmitted concomitantly with the outbreak. Only pulsed-field electrophoresis could demonstrate that a single epidemic strain was present in the fecal flora of the children. This strain had probably been brought into the unit by the patient with chronic fecal carriage.

Anti-Bacterial Agents↗
PubMed1999

Gastric decontamination--a view for the millennium.

The management of acute poisoning remains an important part of accident and emergency (A&E) care. Three gastric decontamination procedures have been widely used: gastric lavage, ipecac, and activated charcoal. Their role has recently been reviewed and position statements developed by working groups of the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. These have important implications for A&E, as they indicate that activated charcoal is now the agent of choice for most poisons, but than in most situations it is probably only effective if given within an hour of overdose. Ipecac is effectively obsolete and gastric lavage has a narrow range of indications, principally for potentially serious amounts of agents not adsorbed by charcoal. Protocols for care of overdose patients should be modified accordingly.

Acute Disease↗
PubMed2003

Decontamination issues and perceived reliability of the laryngoscope--a clinician's perspective.

The laryngoscope is identified as a potential vector for cross-infection. Case reports are presented, as are reports of bacterial and occult blood contamination of laryngoscope blades and handles. Infection control policies covering laryngoscope blade and handle processing are outlined relative to procedures of a teaching hospital department. Repeated decontamination of laryngoscope blades has resulted in a perceived decrease in reliability. This is reflected in a departmental survey where 86% of respondents consider the standard laryngoscope is only intermittently reliable and that there is room for improvement.

Anesthesiology↗
PubMed2006

Studies on the decontamination of surfaces exposed to cytotoxic drugs in chemotherapy workstations.

OBJECTIVE: The aim of this study was to examine the removal and deactivation of cytotoxic contamination from surfaces of a pharmaceutical isolator workstation. METHODS: Three marker cytotoxic drugs were evaluated in three phases using decontamination technologies currently available in the pharmaceutical and healthcare environments. Phase I investigated the physical removal of contamination by detergents. Phase II and III investigated the effectiveness of detergents and Vaporised Hydrogen Peroxide (VHP) in degrading cytotoxic drugs, respectively. RESULTS: 5-Flurouracil, doxorubicin and cyclophosphamide were removed from a surface by wiping with detergents. VHP and alkaline detergents caused degradation of doxorubicin. The observed effect with detergent cleaning was pH dependent, but neither of the technologies applied had any effect on the chemical stability of 5-flurouracil and cyclophosphamide under the conditions tested.

Antineoplastic Agents↗
PubMedDate not supplied

Decontamination of medical devices: legislation and compliance to practice.

The amount of legislation and guidelines published on decontamination reflects the current attitude of politicians and the general public to the desire to reduce the risk of infection. Incidents, such as bovine spongiform encephalopathy (BSE) in cattle with the subsequent risk of transmission of variant Creutzfeldt-Jakob disease (VCJD), require greater compliance by healthcare workers to the guidance both in the hospital and the wider community. The change in care provision and the demands of government in training and education. This article will look at recent government guidance and the implications it has for clinical practice.

Decontamination↗