Bioterrorism: Infection Control Help

Article excerpt

On April 24, 1997, Washington D.C. hosted an unwanted event that awoke the nation. Employees at the B'nai B'rith Building, which houses an international Jewish organization, found a package with a broken petri dish leaking an unknown reddish substance. The words "Anthrax" and "Yersinia, a.k.a. Bubonic Plague," stared back at them from small labels on the plastic containers. Their desperate phone call for help sparked an invasion. Firemen arrived in Level A and Level B suits. An army of public safety officers and vehicles encircled the building. Even worse, emergency personnel stripped 16 workers down to their underwear and decontaminated them while CNN broadcasted the scene live to millions of watchers around the world. Inside the building, 100 workers unfortunate enough to be in the building that day were forced to shelter in place or stay in their offices for hours as the petri dish was rushed to Bethesda Naval Research Facility for examination.

Fortunately, nine hours later, analysis of the petri dish contents turned out negative for anthrax and bubonic plague. The quarantined employees were allowed to go home. With the White House only blocks away from the incident, however, questions started flowing, and phone calls were made.

If such an incident were to happen today, three years later, the same flood of questions might be directed to the military hospitals in the area. So the Infection Control Service (ICS) at Walter Reed Army Medical Center (WRAMC) located in Washington, D.C., wanted to be ready with the appropriate information. ICS's mission is to "identify and reduce the risk of acquiring and transmitting infections among patients, staff, visitors, and others that have contact with patients."

The ICS staff, including Lieutenant Colonel Suzanne E. Johnson and Infection Control Nurses Bernice Friedman and Carol Vamvakias, soon realized that they needed a good, quick, easy-to-use source of information from which to answer questions and that such a source was not readily available. The Association for Professionals in Infection Control (APIC) recently had published a document that covered four of the more common bioterrorism agents. Also, the U.S. Army Medical Research Institute of Infectious Diseases (U.S. AMRIID) at Fort Detrick in Maryland had issued several manuals and books on chemical and bioterrorism issues. One book in particular, Medical Management of Biological Casualties, proved very helpful, with pages of information on different biological agents and protocols for treating and preventing casualties.

After reviewing these documents and a few others, the ICS staff at WRAMC decided to create a tool for bioterrorism infection control and to make it "as simple as possible" (Figure 1). They began by collating information already produced in various public and government publications onto a one-page protocol sheet titled "Bioterrorism: Infection Control Practices for Patient Management." The sheet categorized a number of feared agents, including those threatened at the B'nai B'rith Building, into three groups: bacterial agents, viruses, and biological toxins. For each agent, they delineated six "infection control groups": isolation precautions, patient placement, patient transport, cleaning and disinfection of equipment, discharge management, and postmortem care. …