Optimizing liquefaction and decontamination of sputum for DNA extraction from Mycobacterium tuberculosis.

Whole genome sequencing (WGS) can investigate the entire Mycobacterium tuberculosis (Mtb) genome but currently requires large amounts of mycobacterial DNA, necessitating culture. Culture-free Mtb WGS could revolutionize the clinical use of WGS but is hampered by the high viscosity, low mycobacterial load, and high contamination with bacterial and human DNA in sputum samples. To improve the sputum liquefaction and decontamination step prior to DNA extraction, we assessed the efficiency of Myco-TB, MycoPrep, and Sputolysin with/without TiKa-Kic in liquefying and decontaminating sputum and aimed to evaluate the effect of these approaches on mycobacterial viability, and Mtb DNA quality and quantity. Experiments using spiked sputum samples showed that Myco-TB and BD MycoPrep with standard (15 min) or increased (30 min) incubation time, but not reduced (7,5 min) incubation time performed well in liquefying and decontaminating sputum. No difference in DNA quality or quantity, contamination, or the amount of human DNA present was observed. In comparison, Sputolysin with/without TiKa-Kic was less effective for liquefaction and decontamination of sputum. PCR amplification of the human GAPDH gene after sputum treatment, showed the presence of human DNA in all samples, regardless of sputum treatment. Focused efforts are needed to deplete contaminating DNA for culture-free Mtb WGS.

Disinfection and conditions associated with thermo-assisted drying and decontamination inconsistently produce negative PRRSV rRT-PCR results on metal surfaces.

Because contaminated livestock trailers are a significant risk for transmitting viruses between herds, various methods of washing, disinfecting, and thermo-assisted drying and decontamination (TADD) have been evaluated for their effectiveness in inactivating porcine reproductive and respiratory syndrome virus (PRRSV) on contaminated surfaces. Information on when to expect negative qRT-PCR results after adequate trailer sanitation is lacking. The objective of this study was to evaluate whether there are conditions associated with washing-disinfectant-TADD procedures that will consistently produce a negative qRT-PCR result for the purpose of monitoring compliance with trailer sanitation and decontamination protocols for PRRSV on metal surfaces. 144 diamond plate aluminum coupons were spiked with PRRSV or phosphate-buffered saline (PBS) and treated with a designated disinfectant protocol. Disinfectants evaluated included multiple accelerated® hydrogen peroxide (AHP) disinfectants and a quaternary ammonium and glutaraldehyde combination disinfectant. Disinfectant was applied for 5 or 60 minutes of contact time at either 20 °C or -10 °C in a matrix of feces or PBS. All coupons were heated until the surface temperature of the coupon reached 71 °C and then held for 10 minutes to simulate TADD under field conditions. Post-treatment swabs for all treatment groups, except negative control groups, were positive by PRRSV qRT-PCR. Under the conditions evaluated in this study, consistently negative qRT-PCR results after treatments were not found. Therefore, for the purpose of monitoring compliance with trailer sanitation and decontamination protocols for PRRSV, alternatives to qRT-PCR should be explored.

The FDA Revokes Authorizations for Certain Respirators and Decontamination Systems.

Changes reflect replenished stockpiles of approved equipment.

Strategies to ensure efficient laboratory functioning while navigating through the COVID-19 crisis in developing countries: An early experience from a tertiary care centre in India.

BACKGROUND: The coronavirus disease 2019 (COVID 19) is a zoonotic viral infection that originated in Wuhan, China, in December 2019. It was declared a pandemic by the World Health Organization shortly thereafter. This pandemic is going to have a lasting impact on the functioning of pathology laboratories due to the frequent handling of potentially infectious samples by the laboratory personnel. To deal with this unprecedented situation, various national and international guidelines have been put forward outlining the precautions to be taken during sample processing from a potentially infectious patient. PURPOSE: Most of these guidelines are centered around laboratories that are a part of designated COVID 19 hospitals. However, proper protocols need to be in place in all laboratories, irrespective of whether they are a part of COVID 19 hospital or not as this would greatly reduce the risk of exposure of laboratory/hospital personnel. As part of a laboratory associated with a rural cancer hospital which is not a dedicated COVID 19 hospital, we aim to present our institute's experience in handling pathology specimens during the COVID 19 era. CONCLUSION: We hope this will address the concerns of small to medium sized laboratories and help them build an effective strategy required for protecting the laboratory personnel from risk of exposure and also ensure smooth and optimum functioning of the laboratory services.

Improved surveillance of surgical instruments reprocessing following the variant Creutzfeldt-Jakob disease crisis in England: findings from a three-year survey.

BACKGROUND: Sensitive, direct protein-detection methods are now recommended for the inspection of reprocessed reusable surgical instruments in England to reduce the risk of prion transmission. AIM: To implement an established, highly sensitive method to quantify proteinaceous residues on reprocessed instruments in a Sterile Services Department (SSD) and evaluate its potential impact on service provision. METHODS: We introduced highly sensitive epifluorescence (EDIC/EF) microscopy in a large SSD. Over three years, we periodically tested two models of washer disinfector using stainless-steel tokens spiked with mouse brain homogenate or Browne test soil for comparison. We also obtained data and feedback from staff who had been using EDIC/EF to examine almost 3000 reprocessed instruments. FINDINGS: All reprocessed test surfaces harboured residual contamination (up to 258.4 ng from 1-µg spikes). Proximity between surfaces affected decontamination efficacy and allowed cross-contamination. Up to 50 ng de novo proteinaceous contamination was deposited on control surfaces after a single automated washer disinfector (AWD) cycle. The test soil behaved differently than real tissue contamination. SSD staff observed proteinaceous residues on most reprocessed instruments using EDIC/EF, which can detect far smaller amounts than the currently accepted national threshold of 5 µg per side. CONCLUSIONS: Implementing recent national guidelines to address the prions concern proved an eye-opener. Microscopic levels of proteins remain on many reprocessed instruments. The impact most of these residues, potentially including prions, may have on subsequent patients after sterilization remains debatable. Improving surveillance capability in SSDs can support decision making and raise the standards of surgical instruments reprocessing.

Use, re-use or discard? Quantitatively defined variance in the functional integrity of N95 respirators following vaporized hydrogen peroxide decontamination during the COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 has stretched the ability of many institutions to supply needed personal protective equipment, especially N95 respirators. N95 decontamination and re-use programmes provide one potential solution to this problem. Unfortunately, a comprehensive evaluation of the effects of decontamination on the fit of various N95 models using a quantitative fit test (QNFT) approach is lacking. AIMS: To investigate the effects of up to eight rounds of vaporized hydrogen peroxide (VHP) decontamination on the fit of N95 respirators currently in use in a hospital setting, and to examine if N95 respirators worn by one user can adapt to the face shape of a second user with no compromise to fit following VHP decontamination. METHODS: The PortaCount Pro+ Respirator Fit Tester Model 8038 was used to quantitatively define functional integrity, measured by fit, of N95 respirators following decontamination with VHP. FINDINGS: There was an observable downward trend in the functional integrity of Halyard Fluidshield 46727 N95 respirators throughout eight cycles of decontamination with VHP. Functional integrity of 3M 1870 N95 respirators was reduced significantly after the respirator was worn, decontaminated with VHP, and then quantitatively fit tested on a second user. Furthermore, inconsistencies between qualitative fit test and QNFT results were uncovered that may have strong implications on the fit testing method used by institutions. CONCLUSIONS: The data revealed variability in the functional integrity of different N95 models after VHP decontamination, and exposed potential limitations of N95 decontamination and re-use programmes.

Development and evaluation of a point-of-use UV appliance for fresh produce decontamination.

In-house treatment strategy for fresh produce decontamination has not been emphasized as much as industrial washing. The most common treatment for fresh produce decontamination and cleaning at home and other point-of-use places such as cafeteria is rinsing and/or soaking in a sink. In this study, an appliance utilizing UV and agitated water to decontaminate fresh produce was developed and its effectiveness was investigated in an aim to identify optimum processing parameters. Grape tomato and spinach representing two different surface smoothness were dip-inoculated in a four-strain Salmonella cocktail to reach a final population of 5-8 log CFU/g and air-dried. The produce samples were then washed in 1 gallon tap water under varying conditions, water agitation speed (0-190 RPM), sample size (50-400 g), UV intensity (0-30 mW/cm2) and treatment time (2, 5 and 10 min). In general, increasing the agitation speed and UV intensity enhanced Salmonella inactivation for both grape tomato and spinach. Sample size significantly affected the UV inactivation of Salmonella on grape tomato, but not on spinach. The effect of extending treatment time from 2 to 10 min was insignificant for almost all the UV treatments and the controls. The effect of UV intensity and treatment time on inactivation of Salmonella on spot-inoculated grape tomato and spinach was also determined. The most severe treatment used in this study, 30 mW/cm2 UV for 10 min, resulted in >4 log reductions of Salmonella dip- or spot-inoculated on grape tomato (200 g sample size and 190 RPM agitation speed) and 3.5 log reductions of Salmonella dip- or spot-inoculated on spinach (100 g sample size and 110 RPM agitation speed). We foresee that the UV appliance developed and evaluated in this study could be further fine-tuned and optimized to eventually construct a point-of-use UV appliance that can be used at home, cafeteria, restaurants, and hospitals for fresh produce decontamination and cleaning. The UV appliance could be an inexpensive and effective tool to improve fresh produce safety.

The use of germicidal ultraviolet light, vaporized hydrogen peroxide and dry heat to decontaminate face masks and filtering respirators contaminated with a SARS-CoV-2 surrogate virus.

BACKGROUND: In the context of the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the supply of personal protective equipment remains under severe strain. To address this issue, re-use of surgical face masks and filtering facepiece respirators has been recommended; prior decontamination is paramount to their re-use. AIM: We aim to provide information on the effects of three decontamination procedures on porcine respiratory coronavirus (PRCV)-contaminated masks and respirators, presenting a stable model for infectious coronavirus decontamination of these typically single-use-only products. METHODS: Surgical masks and filtering facepiece respirator coupons and straps were inoculated with infectious PRCV and submitted to three decontamination treatments, ultraviolet (UV) irradiation, vaporized H2O2, and dry heat treatment. Viruses were recovered from sample materials and viral titres were measured in swine testicle cells. FINDINGS: UV irradiation, vaporized H2O2 and dry heat reduced infectious PRCV by more than three orders of magnitude on mask and respirator coupons and rendered it undetectable in all decontamination assays. CONCLUSION: This is the first description of stable disinfection of face masks and filtering facepiece respirators contaminated with an infectious SARS-CoV-2 surrogate using UV irradiation, vaporized H2O2 and dry heat treatment. The three methods permit demonstration of a loss of infectivity by more than three orders of magnitude of an infectious coronavirus in line with the United States Food and Drug Administration policy regarding face masks and respirators. It presents advantages of uncomplicated manipulation and utilization in a BSL2 facility, therefore being easily adaptable to other respirator and mask types.

Last-resort strategies during mask shortages: optimal design features of cloth masks and decontamination of disposable masks during the COVID-19 pandemic.

Face masks and respirators are the most widely used intervention measures for respiratory protection. In the wake of COVID-19, in response to shortages and lack of availability of surgical masks and respirators, the use of cloth masks has become a research focus. Various fabrics have been promoted with little evidence-based foundation and without guidelines on design principles for optimal performance. In these circumstances, it is essential to understand the properties, key performance factors, filter mechanisms and evidence on cloth masks materials. The general community might also need to decontaminate and reuse disposable, single-use devices as a last resort. We present an overview of the filter materials, filter mechanisms and effectiveness, key performance factors, and hydrophobicity of the common disposable masks, as well as cloth masks. We also reviewed decontamination methods for disposable respiratory devices. As an alternative to surgical masks and respirators, we recommend a cloth mask made of at least three layers (300-350 threads per inch) and adding a nylon stocking layer over the mask for a better fit. Water-resistant fabrics (polyesters/nylon), blends of fabrics and water-absorbing fabrics (cotton) should be in the outside layer, middle layer/layers and inside layer, respectively. The information outlined here will help people to navigate their choices if facing shortages of appropriate respiratory protection during the COVID-19 pandemic.

Efficacy of a hospital policy of selective digestive decontamination for carbapenem-resistant Enterobacterales carriers: prospective before-after study.

A single-centre interrupted time series quasi-experimental study was undertaken to assess whether a hospital policy of selective digestive decontamination (SDD, gentamicin/amikacin with neomycin) administered to carbapenem-resistant Enterobacterales (CRE) carriers would reduce the duration of carriage and contain the spread of CRE. No significant difference in time to CRE eradication was observed between the observation (12 months, 120 patients) and intervention (12 months, 101 patients) periods. No change in the trend of new in-hospital CRE acquisitions or bacteraemia during the intervention was detected. As such, administration of SDD to CRE carriers was not effective for the eradication of carriage or controlling in-hospital CRE transmissions.

Impact of extended use and decontamination with vaporized hydrogen peroxide on N95 respirator fit.

BACKGROUND: To address the shortage of N95 respirators in the wake of the COVID-19 pandemic, some organizations have recommended the decontamination of respirators using vaporized hydrogen peroxide (VHP) sterilizer for up to 10 times. However, these recommendations are based on studies that did not take into account the extended use of respirators, which can degrade respirator fit. METHODS: We investigated the impact of extended use and decontamination with VHP on N95 Respirator Fit. We performed a prospective cohort study to determine the number of times respirators can be decontaminated before respirator fit test failure. The primary outcome was the overall number of cycles required for half of the respirators to fail (either mechanical failure or fit test failure). RESULTS: Thirty-six participants completed 360 hours of respirator usage across 90 cycles. The median number of cycles completed by participants before respirator failure was 2. The overall number of cycles required for half of respirators to fail was 1, 3, 5, and 4 for the 3M 1860(S), 3M 1870+, Moldex 151X and ProGear 88020 respirators, respectively. CONCLUSIONS: The combination of prolonged usage and VHP decontamination was associated with early failure. Decontamination and prolonged usage of respirators must be done cautiously.

Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy.

BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.

Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review.

BACKGROUND: In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM: To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS: A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS: Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS: Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.

Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review.

BACKGROUND: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION: A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.

Mascarillas y máscaras de protección respiratoria en entorno COVID-19 / Surgical masks and respirators in COVID-19 environment

Coronavirus Disease 2019, COVID-19, es una enfermedad respiratoria causada por un coronavirus, el SARS-CoV-2. La ruta de trasmisión es a través de gotas y salpicaduras procedentes del tracto aerodigestivo de personas infectadas, así como por el contacto con superficies contaminadas y la posterior deposición en la mucosa de los ojos, nariz o boca, siendo probable su transmisión por aerosoles. Por otra parte, el trabajo dental no permite mantener una distancia de 2 metros, ni el uso por parte del paciente de mascarilla. Por esta razón, dentro del esquema de Equipos de Protección Individual (EPI), la protección respiratoria es fundamental, junto con la ocular, y con ello la selección de la mascarilla y, sobre todo, el uso que se haga de ella. La razón del presente artículo es describir los diferentes tipos de mascarillas y el uso apropiado de cada una de ellas según el objetivo buscado. Para ello, se recomendarán las mascarillas higiénicas y las quirúrgicas en usuarios generales, con la función de disminuir la trasmisión viral por medio de la minoración de la contaminación ambiental cuando es alta la trasmisión comunitaria. Las máscaras de protección respiratoria estarán indica-das en trabajadores sanitarios y otros en contacto con pacientes potencialmente infecciosos, al menos cuando los procedimientos de trabajo impliquen un riesgo elevado para el profesional

COVID-19 is a respiratory illness caused by a new coronavirus, SARS-CoV-2. The virus spreads through droplets and spray from the respiratory tracts of infected persons, and through contact with contaminated surfaces followed by touching the eyes, nose or mouth. It is also likely that the virus can be spread through aerosols. However, dentistry does not allow for a distance of two metres to be maintained, and nor does it allow for the patient to wear a mask. As such, within the scope of Personal Protective Equipment (PPE), respiratory protection is of fundamental importance, along with eye protection and the correct usage of available masks. The purpose of this article is to describe different types of masks and the appropriate use of each one according to the required need. To this end, it is recommended that hygienic and surgical masks are used with a view to decreasing viral transmission through the reduction of environmental contamination whilst community transmission is high. Respiratory protection masks will be shown on health workers and others who are in contact with potentially infectious patients, when the work involved brings with it an increased level of risk for the worker

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review.

BACKGROUND: The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse. AIM: To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse. METHODS: MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects. FINDINGS: Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. CONCLUSION: There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

Microwave-Generated Steam Decontamination of N95 Respirators Utilizing Universally Accessible Materials.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused a severe, international shortage of N95 respirators, which are essential to protect health care providers from infection. Given the contemporary limitations of the supply chain, it is imperative to identify effective means of decontaminating, reusing, and thereby conserving N95 respirator stockpiles. To be effective, decontamination must result in sterilization of the N95 respirator without impairment of respirator filtration or user fit. Although numerous methods of N95 decontamination exist, none are universally accessible. In this work, we describe a microwave-generated steam decontamination protocol for N95 respirators for use in health care systems of all sizes, geographies, and means. Using widely available glass containers, mesh from commercial produce bags, a rubber band, and a 1,100-W commercially available microwave, we constructed an effective, standardized, and reproducible means of decontaminating N95 respirators. Employing this methodology against MS2 phage, a highly conservative surrogate for SARS-CoV-2 contamination, we report an average 6-log10 plaque-forming unit (PFU) (99.9999%) and a minimum 5-log10 PFU (99.999%) reduction after a single 3-min microwave treatment. Notably, quantified respirator fit and function were preserved, even after 20 sequential cycles of microwave steam decontamination. This method provides a valuable means of effective decontamination and reuse of N95 respirators by frontline providers facing urgent need.IMPORTANCE Due to the rapid spread of coronavirus disease 2019 (COVID-19), there is an increasing shortage of protective gear necessary to keep health care providers safe from infection. As of 9 April 2020, the CDC reported 9,282 cumulative cases of COVID-19 among U.S. health care workers (CDC COVID-19 Response Team, MMWR Morb Mortal Wkly Rep 69:477-481, 2020, https://doi.org/10.15585/mmwr.mm6915e6). N95 respirators are recommended by the CDC as the ideal method of protection from COVID-19. Although N95 respirators are traditionally single use, the shortages have necessitated the need for reuse. Effective methods of N95 decontamination that do not affect the fit or filtration ability of N95 respirators are essential. Numerous methods of N95 decontamination exist; however, none are universally accessible. In this study, we describe an effective, standardized, and reproducible means of decontaminating N95 respirators using widely available materials. The N95 decontamination method described in this work will provide a valuable resource for hospitals, health care centers, and outpatient practices that are experiencing increasing shortages of N95 respirators due to the COVID-19 pandemic.

Trauma Nurses' Experience With Decontamination: Opportunities for Improvement.

Trauma patients are unique in their potential for exposure to dangerous chemicals or material, placing staff in the emergency department (ED) or trauma unit at risk for exposure themselves. The purpose of this study was to describe one centers' trauma nursing experience with decontamination and to identify opportunities for improvement. This was a cross-sectional descriptive study of decontamination practices using an anonymous online survey of trauma nurses at a single Midwestern verified Level I trauma center and burn center. A total of 82 nurses completed the survey with a 48% response rate. Overall, 57% reported having had some previous decontamination training, with ED and air transport nurse's training, knowledge, and comfort level reported as the highest and inpatient trauma nurses the lowest. A significant association was found between ED nurses and feeling the surest about their safety when caring for exposed patients (χ = 19.908, p = .018) and between hazardous materials training and receiving communication about the patient's decontamination procedures during care (χ = 8.879, p = .031). Our results show that trauma nurse decontamination training and communication, as well as confidence in knowledge and safety, vary by nursing unit. The relatively low-volume high-risk scenario of trauma decontaminations likely contributes to inpatient nurses reporting of inadequate preparedness. This requires administrative commitment to ensure that all trauma nurses receive decontamination training in orientation, as well as ongoing continuing education, skill competency checks, and simulation training. Decontaminate communication is an essential requirement of all ED trauma team handoffs and medical record documentation.