A systematic methodology for selecting decontamination strategies following a biocontamination event.

Decontamination and recovery of a facility or outdoor area after a wide-area biological incident involving a highly persistent agent (eg, Bacillus anthracis spores) is a complex process that requires extensive information and significant resources, which are likely to be limited, particularly if multiple facilities or areas are affected. This article proposes a systematic methodology for evaluating information to select the decontamination or alternative treatments that optimize use of resources if decontamination is required for the facility or area. The methodology covers a wide range of approaches, including volumetric and surface decontamination, monitored natural attenuation, and seal and abandon strategies. A proposed trade-off analysis can help decision makers understand the relative appropriateness, efficacy, and labor, skill, and cost requirements of the various decontamination methods for the particular facility or area needing treatment--whether alone or as part of a larger decontamination effort. Because the state of decontamination knowledge and technology continues to evolve rapidly, the methodology presented here is designed to accommodate new strategies and materials and changing information.

[1]  M. Wilcox,et al.  Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. , 2005, Intensive & critical care nursing.

[2]  David J. Weber,et al.  Disinfection and Sterilization In Healthcare Facilities , 2004 .

[3]  M. Wilcox,et al.  Hospital disinfectants and spore formation by Clostridium difficile , 2000, The Lancet.

[4]  P. Setlow,et al.  Treatment with oxidizing agents damages the inner membrane of spores of Bacillus subtilis and sensitizes spores to subsequent stress , 2004, Journal of applied microbiology.

[5]  N. Weightman,et al.  Problems with the decontamination of dental handpieces and other intra-oral dental equipment in hospitals. , 2004, The Journal of hospital infection.

[6]  C. Franco,et al.  Environmental decontamination following a large-scale bioterrorism attack: federal progress and remaining gaps. , 2010, Biosecurity and bioterrorism : biodefense strategy, practice, and science.

[7]  H. Maarleveld,et al.  Infection control measures to limit the spread of Clostridium difficile. , 2008, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[8]  M. Wilcox,et al.  Efficacy of Hospital Cleaning Agents and Germicides Against Epidemic Clostridium difficile Strains , 2007, Infection Control & Hospital Epidemiology.

[9]  M. Wilcox,et al.  A case-control study of community-associated Clostridium difficile infection. , 2008, The Journal of antimicrobial chemotherapy.

[10]  Robert S. Radvanovsky,et al.  National Response Framework , 2009 .

[11]  I. Odenholt,et al.  Activity of Three Disinfectants and Acidified Nitrite Against Clostridium difficile Spores , 2003, Infection Control & Hospital Epidemiology.

[12]  M. Rodgers,et al.  Decision Support Tool for the Management of Debris from Homeland Security Incidents , 2007 .

[13]  M. Wilcox,et al.  Clostridium difficile and chlorine-releasing disinfectants , 2008, The Lancet.

[14]  M. Wilcox,et al.  In vitro activity of new generation fluoroquinolones against genotypically distinct and indistinguishable Clostridium difficile isolates. , 2000, The Journal of antimicrobial chemotherapy.

[15]  M. Dunowska,et al.  The effect of Virkon S fogging on survival of Salmonella enterica and Staphylococcus aureus on surfaces in a veterinary teaching hospital. , 2005, Veterinary microbiology.

[16]  M. Miller Agency , 2010 .

[17]  P. Wutzler,et al.  Monopercitric acid--a new disinfectant with excellent activity towards clostridial spores. , 2005, The Journal of hospital infection.

[18]  M. Wilcox,et al.  Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection. , 2003, The Journal of hospital infection.

[19]  James A Mulholland,et al.  Emissions study of co-firing waste carpet in a rotary kiln. , 2004, Journal of environmental management.

[20]  R. Freeman,et al.  National Clostridium difficile Standards Group: Report to the Department of Health. , 2004, The Journal of hospital infection.

[21]  S. Nardoni,et al.  Susceptibility of Microsporum canis isolated from domestic animals against a commercially available enilconazole in fumigant form , 2004 .

[22]  M. Dettenkofer,et al.  Detergent versus hypochlorite cleaning and Clostridium difficile infection. , 2004, The Journal of hospital infection.

[23]  Robert G. Knowlton,et al.  Analysis of decontamination strategies following a wide-area biological release in a metropolitan area. , 2010 .

[24]  S. Sattar,et al.  Activity of selected oxidizing microbicides against the spores of Clostridium difficile: relevance to environmental control. , 2005, American journal of infection control.