title: Prevalence of and risks for internal contamination among hospital staff caring for a patient contaminated with a fatal dose of polonium-210.
abstract: BACKGROUND
  Alexander Litvinenko died on November 23, 2006, from acute radiation sickness syndrome caused by ingestion of polonium-210 (²¹⁰Po).
  
  
  OBJECTIVE
  The objective was to assess the prevalence of and risk factors for internal contamination with ²¹⁰Po in healthcare workers (HCWs) caring for the contaminated patient.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  HCWs who had direct contact with the patient.
  
  
  METHODS
  We interviewed 43 HCWs and enquired about their activities and use of personal protective equipment (PPE). Internal contamination was defined as urinary ²¹⁰Po excretion above 20 mBq within 24 hours. We obtained risk ratios (RRs) for internal contamination using Poisson regression.
  
  
  RESULTS
  Thirty-seven HCWs (86%) responded, and 8 (22%) showed evidence of internal contamination, all at very low levels that were unlikely to cause adverse health outcomes. Daily care of the patient (washing and toileting the patient) was the main risk factor (RR, 3.6 [95% confidence interval (CI), 1.1-11.6]). In contrast, planned invasive procedures were not associated with a higher risk. There was some evidence of a higher risk associated with handling blood samples (RR, 3.5 [95% CI, 0.8-15.6]) and changing urine bags and/or collecting urine samples (RR, 2.7 [95% CI, 0.8-9.5]). There was also some evidence that those who reported not always using standard PPE were at higher risk than were others (RR, 2.5 [95% CI, 0.8-8.1]).
  
  
  CONCLUSIONS
  The sensitive quantitative measurement enabled us to identify factors associated with contamination, which by analogy to other conditions with similar transmission mechanisms may help improve protection and preparedness in staff dealing with an ill patient who experiences an unknown illness.
authors.affiliation: Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom. olivier.lepolain@hpa.org.uk
authors.forename: Olivier
authors.initials: O
authors.lastname: le Polain de Waroux
authors.forename: Sandra
authors.initials: S
authors.lastname: Cohuet
authors.forename: Louise
authors.initials: L
authors.lastname: Bishop
authors.forename: Sandra
authors.initials: S
authors.lastname: Johnson
authors.forename: Karen
authors.initials: K
authors.lastname: Shaw
authors.forename: Helen
authors.initials: H
authors.lastname: Maguire
authors.forename: André
authors.initials: A
authors.lastname: Charlett
authors.forename: Graham
authors.initials: G
authors.lastname: Fraser
mesh_terms: D054508:Acute Radiation Syndrome / Q000097:blood / Q000209:etiology / Q000652:urine; D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D010564:Personnel, Hospital; D016012:Poisson Distribution; D011059:Polonium / Q000008:administration & dosage / Q000506:poisoning* / Q000652:urine; D015995:Prevalence; D011482:Protective Devices / Q000706:statistics & numerical data*; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods / Q000706:statistics & numerical data; D018788:Radioactive Hazard Release / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D011059:Polonium