Decontamination

Due to the previously mentioned potential time delays in presentation after exposure, casualties presenting with syndromes due to biothreats may not require decontamination.24 Even though they may not be contaminated, the casualties may be infectious, and warrant empiric transmission-based precautions. In other situations, particularly involving weaponized biothreats delivered via aerosol or powder, decontamination may be warranted. Below are some examples that involve a re-aerosolization hazard for healthcare workers:25    

For the above examples, and when in doubt, removing clothing and washing exposed skin and hair with soap and water, followed by drying the skin and hair, is the most preferred method and is generally considered adequate decontamination for most biothreats.26  In addition, note that Reactive Skin Decontamination Lotion (RSDL) is U.S. Food and Drug Administration (FDA) cleared for the removal or neutralization of chemical warfare agents and trichothecene (T2) mycotoxins from the skin, but not other biothreats.19  However, RSDL is only FDA approved for use on intact skin, NOT on wounds; for contaminated/infected wounds, soap and water or water alone is the recommendation for decontamination. Additional discussion on decontamination is contained in Appendix C of Multiservice Tactics Techniques, and Procedures for treatment of Biological Warfare Agent Casualties and in Multiservice Tactics Techniques, and Procedures for Health Service Support in a CBRN Environment.25,26  For a “how-to” on the set-up of decontamination stations, reference the Field Management of Chemical and Biological Casualties Handbook.48