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AnthraxIsolation and DecontaminationStandard precautions for healthcare workers. Avoid invasive procedures or autopsy; but if performed, all instruments and proximate environment should be thoroughly disinfected with a sporicidal agent (e.g., hypochlorite). Decontamination of Persons Exposed to AnthraxAccording to guidelines from the Association for Professionals in Infection Control and Epidemiology (APIC) and the CDC (see References: APIC/CDC 1999):
Decontamination of EnvironmentsConcerns regarding environmental contamination involve both primary and secondary aerosolization.
Determining the extent of remediation necessary for contaminated environments remains controversial. Ideally, the remediation effort should be timely and cost-effective and protect the public health (see References: Martin 2010: Anthrax as an agent of bioterrorism). A process for determining what level of contamination is acceptable has been proposed as follows (see References: Price 2009):
During the 2001 anthrax attacks, the Environmental Protection Agency (EPA) assessed the potential for secondary aerosolization inside the Hart office building by conducting environmental sampling under semiquiescent (minimal activity) conditions and under simulated active office conditions (see References: Weis 2002).
During the 2001 US anthrax outbreak, several buildings underwent environmental decontamination to eliminate the risk of potential secondary aerosolization. In the setting of a bioterrorism attack, the EPA is charged with directing cleanup activities and providing the necessary technical expertise to guide such efforts. The EPA used several methods and technologies to decontaminate buildings during the 2001 outbreak (ie, chlorine dioxide, decontamination foam, ethylene oxide). Cleanup plans generally involve the following:
Until the recent anthrax attack, experience with decontamination of buildings after contamination with weapons-grade anthrax spores was limited. Questions regarding the best methods for decontamination in such situations still remain (see References: Spotts Whitney 2003). In addition, reasonable standards for cleanup effectiveness remain to be established (see References: Canter 2005). Paraformaldehyde (with Bacillus subtilis as the indicator) has been used to decontaminate laboratories. The chlorine dioxide fumigation approach used after the 2001 postal anthrax attacks is expensive and can preclude reoccupation of contaminated buildings for many years. Wein and colleagues compared this approach to a strategy of HEPA vacuuming, HEPA air cleaners, and vaccination of building occupants (see References: Wein 2005). They found in a simulated outdoor release in lower Manhattan that the HEPA/vaccine method would require less time, cost less, and reduce solid waste problems associated with disposal of contaminated carpets and upholstery. However, the details of the massive cleanup operation modeled by the study depend on many factors related to the attack itself, which obviously cannot be accurately predicted. Furthermore, vaccination of reoccupants may not be a practical or acceptable approach. Vaporized hydrogen peroxide (Vaprox) may represent a new method for decontamination of buildings or other enclosed areas. The EPA has granted vaporized hydrogen peroxide an emergency exemption for the specific use of anthrax decontamination. Available data showed that the gas significantly reduced bacterial spore populations under specific conditions (see References: EPA 2007). Several hypochlorite-containing household products on the market were found to be effective in decontaminating milk or similar food products contaminated by spores to allow safe disposal (see References: Black 2008). A combination of high temperature (90°C to 95°C) and hydrogen peroxide also could be used to inactivate B anthracis spores (see References: Xu 2008). |