Title: Improving the operational effectiveness of skin decontamination in exposure to toxic chemicals
Funder: Department of Health and Social Care

Abstract: This theme will develop the evidence-base for effective decontamination. We will also develop expert guidance and protocols for use by PHE’s emergency response functions, particularly PHE’s role in the new Emergency Coordination of Scientific Advice (ECOSA) network. Significant research gaps identified by the Global Health Security Action Group’s (GHSAG) Patient Decontamination Working Group will be addressed, including consideration of the impact of public communication strategies and psychosocial issues on the effective management of mass casualty incidents involving decontamination. Work will proceed in two strands. In the first, laboratory evaluation of existing and novel methods for conducting decontamination in acute chemical emergencies will be conducted, led by the University of Newcastle. Specific objectives of this strand are: Short term: 1) Identify factors affecting transfer of toxic chemicals (including radionuclides) from contaminated surfaces (including contaminated clothing) to skin. 2) Measure the rate and extent of percutaneous absorption following skin contamination resulting from contact with contaminated surfaces and quantify the influence of vehicle carry over effects and other factors. 3) Identify optimum approaches for decontamination of skin following contact with surfaces. Medium term: 1) Evaluate the effectiveness of novel and standard decontamination methods for removal of skin surface dose and reducing percutaneous absorption and penetration. 2) Evaluate the extent of delayed absorption following inefficient decontamination of skin surface, wash-in effects and stratum corneum reservoir effects following application of standard and novel decontamination techniques. 3) Quantify the influence of re-robing on absorption from inefficiently decontaminated skin. Long term: 1) Make quantitative predictions of the extent of dose redistribution following standard and novel decontamination methods for a range of toxic chemicals, and establish effects of dose redistribution on percutaneous absorption. 2) Quantify the extent of transfer of residual chemicals from contaminated skin before and after decontamination and during disrobing to other surfaces (skin, clothing etc). 3) Evaluate the utility of extant and newly developed mathematical modelling approaches for the prediction of percutaneous absorption and efficiency of decontamination The second strand, led by PHE in collaboration with the University of Newcastle, will involve field testing of novel strategies for decontamination, informed by laboratory evaluation and analysis of ‘perceived best practice’, using human volunteer studies. These activities will incorporate evaluation of operational processes and casualty management strategies, including the impact of communications and psychosocial issues on decontamination outcomes. Specific objectives are:Short-term: 1) Identify optimal strategies for conducting decontamination during mass casualty incidents and evaluate existing protocols against a range of potential scenarios. 2) Assess the potential psychosocial impact of major incidents involving decontamination of the public and the likely public acceptability of decontamination interventions, such as disrobing and showering. 3) Develop best practice guidance and protocols to facilitate rapid intervention by responding agencies to reduce the physical and psychological impact of contamination on the public and emergency responders. Medium-term: 1) Assess the efficacy of novel decontamination methods identified through laboratory evaluation in human volunteer trials with simulant contaminants. 2) Evaluate the impact of responder communication strategies on decontamination efficiency (operational processing times and casualty flow rates), effectiveness (removal of simulant contaminants) and public experiences of decontamination using existing and/or novel decontamination interventions. Long-term: 1) Work with emergency responders and hospital and healthcare staff to incorporate new approaches and reinforce evidence-based best practice for the management of casualties during incidents involving decontamination, particularly those involving a large number of affected casualties. 2) Identify and disseminate key performance criteria for successful training and exercising in emergency decontamination and monitor uptake and adherence with stakeholders and partners.


Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: SKIN