Biomedical Engineering Reference
In-Depth Information
are unrealistic for an acute-care environment—
and recent OSHA interpretations support this.
Level B ensembles (splash protection with
self-contained or supplied-air breathing appa-
ratus) offer substantial respiratory protection,
but there is little evidence that it is necessary
in this setting, and the additional equipment
weight, maintenance, and potential claustro-
phobic reaction of its users may make it dele-
terious. In addition, regulatory, financial, and
training requirements for Level B are likely to
render it both prohibitive and ineffective. Self-
referring patients arriving at an ED under their
own power are likely to have minimal if any
contamination (as distinct from exposure) and
are well removed from the site of initial contact;
effective decontamination training and equip-
ment make Level C (splash protection with air-
purifying respirators) appropriate for the great
majority of incidents. Clearer guidelines and
national consensus standards are essential; the
White House's National Strategy for Home-
land Security [47] tasked the (EPA) with devel-
oping standards for decontamination equipment
and procedures, but the EPA's Strategic Plan
for Homeland Security [48] does not indi-
cate a focus on hospital activities. Hick et al.
[49] lucidly summarized recent interpretations,
considerations, and justifications for Level C
PPE in healthcare settings until more definitive
standards are promulgated. OSHA has issued
comprehensive and functional best practices
for “first receivers” [49A] (the first hospital
providers to make contact with patients from a
large-scale external event), but at this writing
they have not been formally adopted as stan-
dards.
baseline and would be limited to facilities
capable of implementing and maintaining the
training and regulatory upkeep.
Plan to provide staff with chemoprophylaxis
and/or immunizations as indicated
: Whether
chemoprophylaxis and/or immunizations come
from internal stocks (most likely for initial use),
locally cached supplies, or the material from
the Strategic National Stockpile (SNS) [51],
internal and community plans and policies and
must specify priority distribution for critical
staff and must include procedures for doing so.
Cities participating in a Metropolitan Medical
Response System contract are required to incor-
porate caches and SNS deliveries into their
plan, but they must specify priority recipients.
•
•
Consider staff families in plans
: tisthe
unusual healthcare employee who will be
satisfied with individual protection that does
not cover the family. Plans providing for
employee chemoprophylaxis and/or immuniza-
tions should include distribution to employee
families; this will complicate planning and
implementation but will help achieve the goal
of having staff available to perform critical
functions.
1.17 Exercises
Exercises, traditionally (and still) a JCAHO
requirement, are now part of the HRSA National
Bioterrorism Hospital Preparedness Plan as well.
Beyond compliance issues, exercise are an excel-
lent method of testing plans, training, and
equipment—but only if the exercises are designed
and conducted with that intent. This requires that
hospitals:
Level C is still a step up
: The decision to
use Level C protection does not encompass
an escape from OSHA standards for respira-
tory protection; [50] it requires personnel using
respirators to undergo medical screening, fit-
testing (not necessary if hooded positive air-
purifying respirators are used), training, and
refreshers. Certain circumstances could justify
Level B PPE, but this would be beyond the
•
•
Base exercises on realistic plans and models
:
Start at manageable scales and build on demon-
strated principles and procedures. An exer-
cise where everything goes great can be just
as counterproductive as one where every-
thing
fails
. Exercises should focus on specific
measurable objectives and be conducted real-
istically. Pre-exercise warning should be mini-
mized, and all shifts should be involved as
