title: Threat of Secondary Chemical Contamination of Emergency Departments and Personnel: An Uncommon but Recurrent Problem.
abstract: OBJECTIVE
  To analyze acute hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments (EDs). Secondary contamination of EDs may occur when a patient exposed to a hazardous chemical is not decontaminated before arrival at the ED and when ED staff are not wearing appropriate personal protective equipment. This can result in adverse health outcomes among department personnel, other patients, and visitors. Even events without actual secondary contamination risk can be real in their consequences and require the decontamination of the ED or its occupants, evacuation, or temporary shutdown of the ED.
  
  
  METHODS
  Events involving secondary contamination were identified by using the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substance Incidents Program from 2007 to 2013.
  
  
  RESULTS
  Five incidents involving the threat of secondary contamination (0.02% of all events reported to the surveillance systems [n=33,001]) were detected and are described. Four incidents involved suspected secondary contamination in which the facility was evacuated or shut down.
  
  
  CONCLUSIONS
  These results suggest that although rare, incidents involving secondary contamination continue to present a hazard for emergency departments. Suggested best practices to avoid secondary contamination have been described. Hospitals should be made aware of the risks associated with secondary contamination and the need to proactively train and equip staff to perform decontamination.
authors.affiliation: 1Division of Toxicology and Human Health Sciences,Agency for Toxic Substances and Disease Registry,Atlanta,Georgia.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Larson
authors.affiliation: 1Division of Toxicology and Human Health Sciences,Agency for Toxic Substances and Disease Registry,Atlanta,Georgia.
authors.forename: Maureen F
authors.initials: MF
authors.lastname: Orr
authors.affiliation: 1Division of Toxicology and Human Health Sciences,Agency for Toxic Substances and Disease Registry,Atlanta,Georgia.
authors.forename: Erik
authors.initials: E
authors.lastname: Auf der Heide
authors.affiliation: 1Division of Toxicology and Human Health Sciences,Agency for Toxic Substances and Disease Registry,Atlanta,Georgia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wu
authors.affiliation: 2Communicable and Environmental Diseases and Emergency Preparedness,Tennessee Department of Health,Nashville,Tennessee.
authors.forename: Sutapa
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: 1Division of Toxicology and Human Health Sciences,Agency for Toxic Substances and Disease Registry,Atlanta,Georgia.
authors.forename: D Kevin
authors.initials: DK
authors.lastname: Horton
mesh_terms: D055884:Chemical Hazard Release / Q000706:statistics & numerical data*; D003666:Decontamination / Q000379:methods*; D004189:Disaster Planning / Q000379:methods*; D004636:Emergency Service, Hospital / Q000592:standards*; D015386:Hazardous Substances / Q000009:adverse effects / Q000633:toxicity*; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control*; D018570:Risk Assessment; D017751:Safety Management / Q000379:methods / Q000592:standards
chemical_list: D015386:Hazardous Substances
keywords: decontamination; emergency service; hazardous substances; hospital