Persistent biological agents may require decontamination. Successful decontamination of sites, equipment, people, and/or animals requires specialized response planning and protocols, trained personnel, personal protection supplies and equipment such as PPE (e.g., masks, gloves, respirators), disinfectants/chemicals (e.g., bleach), and specialized equipment (e.g., tents, handwashing stations).
Site and equipment decontamination procedures will vary based on the nature of the incident since pathogens differ in susceptibility to decontaminant solutions/treatments, some of which are effective only on certain surface types (e.g., porous vs. nonporous). Depending on site characteristics, a variety of decontamination treatments may be used. For example, buildings may be fumigated, vacuumed, sprayed with a bleach solution, washed, scrubbed, or rinsed. In general, equipment will be treated with peroxide, exposed to ultraviolet light, or autoclaved. Decontamination support is further discussed in KPF 4: Augment Provision of Mass Care and Human Services to the Affected Population.
The need for human decontamination in a biological incident is rare since, in many cases, a biological incident may go unnoticed for several days (refer to KPF 1: Detect and Characterize the Threat), during which time contaminated people will have bathed and changed clothes, and the biological agent may have naturally decayed. In natural incidents, decontamination is not useful because quarantine of the exposed is the best measure to prevent spread of disease from one person to another (and the infected person will constantly re-contaminate themselves). However, when the release event is “announced” (for example, if there is an announced attack or a “white powder incident”), personal decontamination procedures would be initiated. Then, individuals with suspected contamination and/or exposure to a biological agent would be thoroughly rinsed, with clothing and personal items removed for separate decontamination. Success in these efforts requires attention to crowd control, cultural sensitivities around privacy/modesty, the needs of individuals with disabilities, non-ambulatory populations, and other considerations. Following decontamination, individuals should be given information on potential symptoms, advised to monitor themselves, family members, and other acquaintances for these symptoms, and guided to follow-up care, should symptoms develop. Consultations between public health and animal health officials should occur to determine whether companion and service animal decontamination is needed and whether it would follow human decontamination efforts, using similar procedures.
3.4.1 Plan for Decontamination Challenges
Site and equipment decontamination efforts may face challenges associated with the selection of an appropriate decontamination method(s), and the availability of time, materials, and trained personnel needed for the method selected. For some biological agents, contamination could result in long-term or even permanent closure of buildings or public spaces as site decontamination may take an extended period of time.68 Effective site decontamination relies on environmental sampling to identify the boundaries of contamination. In a biological incident, laboratory results for environmental samples may not be available quickly, especially when laboratory capacities are stretched to perform analysis on clinical samples. Further, testing needs may be complex, as determining the presence of the agent in the site or on equipment is not enough; rather, knowing whether any agent present is still infectious is key for understanding remaining risk, and this determination generally requires growth of the agent in culture.
Dedicated hazardous materials (HAZMAT) teams with additional containment and cleanup capabilities can augment the response. In major jurisdictions, these teams will follow quickly on the heels of initial responding units; however, this specialized response capability will vary significantly by jurisdiction.
Management/containment and safe storage of contaminated waste, including wastewater run-off from human, animal, and equipment decontamination activities, will pose additional challenges due to storage limitations and the requirement for processing by specially licensed facilities. Waste management considerations are discussed further in KPF 6: Augment Essential Services to Achieve Recovery Outcomes.
Clearance Goals
Clearance goals are goals or criteria for human, animal, or site cleanup and decontamination that describe the amount of residual contaminant remaining in an area, on an item, or on a person following cleanup activities that is deemed to pose “acceptable” risks to human, animal, and/or environmental health. “Clearance” of a person, area, item, or infrastructure indicates these criteria have been met. Unlike chemical or radiological incidents, where there is some amount of residual material that does not pose a risk to human, animal, and environmental health, in biological incidents, a single, viable pathogen can infect a host and lead to disease. Therefore, the presence of any viable pathogen in an area following a biological incident typically is enough to keep that area closed. In this instance, clearance goals are based on the number or extent of samples that must not contain viable pathogen in order to presume the area is not contaminated. Clearance goals will be set by experts and community leaders, stakeholders, and authorities with this in mind; once set, timely and clear communication of clearance guidelines to the affected community will help reduce public anxiety and improve the effectiveness and efficiency of post-incident response and recovery activities. Even so, limited availability of resources, such as personnel, PPE, and testing and detection equipment, may impact the community’s ability to achieve clearance goals.
What Will You Need to Know?
- If contamination is widespread, which aspects of critical infrastructure should be prioritized for decontamination?
- Who is responsible for setting local clearance goals?
- How are critical areas for decontamination identified?
- Who are the local or state agencies with regulatory authority? Who holds local authority for remediating public and/or private buildings?
- What are the decontamination resources (equipment, personnel, etc.) in your region?
- What are their capabilities and capacities?
- Who will you contact?
- Does your jurisdiction have a HAZMAT team? If so, are they trained for biological incidents?
- What locations in your community are available and accessible for staging decontamination?
- What are their capacity/capability limitations? How many stations will you need to service your population?
- What additional considerations will be required for decontamination of those with disabilities, including those who are non-ambulatory?
- What veterinary services will you need for animal decontamination?
- What type of decontamination support can you offer small businesses?
- What are the legal requirements for biohazardous waste disposal for the involved agent?
- How will you know if the chemicals used for decontamination affect the environment?
- Which SMEs, organizations, or agencies will you collaborate with to plan for environmental recovery after decontamination?
- What local facilities are available for safe storage of decontamination waste/materials?
- What biohazardous waste disposal facilities are located in your region, including licensed contractors/facilities? Is there an established MOU or MOA?
- What are their capabilities and capacities?
- Is sufficient transportation service support available? If not, how/where will you obtain service?
- How will contaminated remains be handled?
- What are the laws regarding transportation of select agents in your region? What entities are available to transport select agents in your region?