[Treating accident or chemical attack casualties in hospital]. / Préparer l'accueil de victimes d'accident ou d'attentat chimique à l'hôpital.

It is mandatory for all hospitals to be prepared for the occurrence of a chemical biological, radiological or nuclear (CBRN) event. This preparation requires specific investment on the part of the hospital management, as well as from the nursing teams on the frontline. Teams from Lariboisière hospital in Paris have been working on these risks for several years.

Disinfection in the laboratory: theory and practice in disinfection policy in late C19th and early C20th England.

This article examines the relationship between theory and practice in nineteenth century English public health disinfection practice. Disinfection undertaken by local authorities and practised on objects, spaces and people became an increasingly common public health practice in the last quarter of the nineteenth century, and was part of a newly developed public health system of 'stamping out' disease as described by Hardy. Despite disinfection's key role in public health policy, it has thus far not received significant investigation or historiographical attending. This article explores the development of disinfection policy at local level, highlighting that despite commentators assumptions that increasingly exacting standards of disinfection required professional oversight rather than that of the 'amateur' public, there was a significant gap between laboratory based knowledge and evidence derived from practical experience. Laboratory conditions could not replicate those found in day-to-day disinfection, and there were myriad debates about how to create a mutually understandable scientific standard for testing. Despite increasing efforts to bring local disinfection in line with new ideas promulgated by central government and disinfection researchers, the mismatches between the two meant that there was greater divergence. This tension lay at the heart of the changes in disinfection theory and practice in the second half of the nineteenth century, and illustrate the complexities of the impact of germ theory on public health policy.

[Radiation measures and trend after the Fukushima Daiichi Nuclear Power Plant accident].

The radioactive materials spread by the Fukushima Daiichi Nuclear Power Plant (NPP) accident in March, 2011 caused NPP workers to be exposed to radiation above ordinance limits. The number of workers exposed to radiation within ordinance limits is increasing. Decontamination began at many places in Fukushima, although new laws were enforced in the decontamination work, in the current situation, medical examinations for radiation are limited due to a shortage of doctors. In this paper, I introduce the ordinances on the prevention of ionizing radiation hazards and the revised points about radiation exposure doses of the NPP workers, as well as the new ordinance for decontamination.

Decontamination of high-risk animal and zoonotic pathogens.

Preparedness for the decontamination of affected environments, premises, facilities, and products is one prerequisite for an immediate response to an animal disease outbreak. Various information sources provide recommendations on how to proceed in an outbreak situation to eliminate biological contaminants and to stop the spread of the disease. In order to facilitate the identification of the right decontamination strategy, we present an overview of relevant references for a collection of pathogenic agents. The choice of pathogens is based on a survey of lists containing highly pathogenic agents and/or biological agents considered to be potential vehicles for deliberate contamination of food, feed, or farm animals. European legislation and guidelines from national and international institutions were screened to find decontamination protocols for each of the agents. Identified recommendations were evaluated with regard to their area of application, which could be facilities and equipment, wastes, food, and other animal products. The requirements of a disinfectant for large-scale incidents were gathered, and important characteristics (eg, inactivating spectrum, temperature range, toxicity to environment) of the main recommended disinfectants were summarized to assist in the choice of a suitable and efficient approach in a crisis situation induced by a specific high-risk animal or zoonotic pathogen. The literature search revealed numerous relevant recommendations but also legal gaps for certain diseases, such as Q fever or brucellosis, and legal difficulties for the use of recommended disinfectants. A lack of information about effective disinfectants was identified for some agents.

[Microbiology method validation: illustration with Bact'Alert 3D]. / Vérification sur site en microbiologie: exemple du Bact'Alert 3D (Biomérieux(©)).

As far as laboratories accreditation according to ISO 15189 is concerned, validation of each method used has to be achieved. Manufacturer's recommendations are not always helpful in this context. That's why each laboratory must proceed systematically to a logical risk analysis. Few publications are available on this subject concerning microbiology. We propose to illustrate it with the example of a blood culture automate: the Bact'Alert 3D commercialised by Biomérieux(®).

Radioactive waste management: review on clearance levels and acceptance criteria legislation, requirements and standards.

In 2011 the joint research project Metrology for Radioactive Waste Management (MetroRWM)(1) of the European Metrology Research Programme (EMRP) started with a total duration of three years. Within this project, new metrological resources for the assessment of radioactive waste, including their calibration with new reference materials traceable to national standards will be developed. This paper gives a review on national, European and international strategies as basis for science-based metrological requirements in clearance and acceptance of radioactive waste.

[Regulations for decontamination of surfaces polluted as a result of chemical accidents (concept approaches)].

The threat of industrial chemical accidents and terrorist attacks requires the development of safety regulations for the cleanup of contaminated surfaces. This paper presents principles and a methodology for the development of a new toxicological parameter, "relative value unit" (RVU) as the primary decontamination standard.

A decade of the United Kingdom sperm-washing program: untangling the transatlantic divide.

Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.

Controlling the process: legislation and guidance regulating the decontamination of medical devices.

The reprocessing of medical devices, in particular surgical instruments, is an extremely technical and highly regulated industry. There are many guidance documents, and European and international standards that cover different aspects of decontamination. This article provides an outline of the main documents covering the critical elements of reprocessing which aim to ensure that reusable medical devices are provided which are fit for purpose and safe for patient use.

Toward the framework and implementation for clearance of materials from regulated facilities.

The disposition of solid materials from nuclear facilities has been a subject of public debate for several decades. The primary concern has been the potential health effects resulting from exposure to residual radioactive materials to be released for unrestricted use. These debates have intensified in the last decade as many regulated facilities are seeking viable management decisions on the disposition of the large amounts of materials potentially containing very low levels of residual radioactivity. Such facilities include the nuclear weapons complex sites managed by the U.S. Department of Energy, commercial power plants licensed by the U.S. Nuclear Regulatory Commission (NRC), and other materials licensees regulated by the NRC or the Agreement States. Other facilities that generate radioactive material containing naturally occurring radioactive materials (NORM) or technologically enhanced NORM (TENORM) are also seeking to dispose of similar materials that may be radioactively contaminated. In contrast to the facilities operated by the DOE and the nuclear power plants licensed by the U.S. Nuclear Regulatory Commission, NORM and TENORM facilities are regulated by the individual states. Current federal laws and regulations do not specify criteria for releasing these materials that may contain residual radioactivity of either man-made or natural origin from regulatory controls. In fact, the current regulatory scheme offers no explicit provision to permit materials being released as "non-radioactive," including those that are essentially free of contamination. The only method used to date with limited success has been case-by-case evaluation and approval. In addition, there is a poorly defined and inconsistent regulatory framework for regulating NORM and TENORM. Some years ago, the International Atomic Energy Agency introduced the concept of clearance, that is, controlling releases of any such materials within the regulatory domain. This paper aims to clarify clearance as an important disposition option for solid materials, establish the framework and basis of release, and discuss resolutions regarding the implementation of such a disposition option.

Effects on instruments of the World Health Organization--recommended protocols for decontamination after possible exposure to transmissible spongiform encephalopathy-contaminated tissue.

It has been recommended by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) that rigorous decontamination protocols be used on surgical instruments that have been exposed to tissue possibly contaminated with Creutzfeldt-Jakob disease (CJD). This study was designed to examine the effects of these protocols on various types of surgical instruments. The most important conclusions are: (1) autoclaving in 1N NaOH will cause darkening of some instruments; (2) soaking in 1N NaOH at room temperature damages carbon steel but not stainless steel or titanium; (3) soaking in chlorine bleach will badly corrode gold-plated instruments and will damage some, but not all, stainless-steel instruments, especially welded and soldered joints. Damage became apparent after the first exposure and therefore long tests are not necessary to establish which instruments will be damaged.

Decontamination of medical devices: legislation and compliance to practice.

The amount of legislation and guidelines published on decontamination reflects the current attitude of politicians and the general public to the desire to reduce the risk of infection. Incidents, such as bovine spongiform encephalopathy (BSE) in cattle with the subsequent risk of transmission of variant Creutzfeldt-Jakob disease (VCJD), require greater compliance by healthcare workers to the guidance both in the hospital and the wider community. The change in care provision and the demands of government in training and education. This article will look at recent government guidance and the implications it has for clinical practice.

Belarus: towards a new post-chernobyl rehabilitation strategy.

Today, Belarus still has to deal with many problems that resulted owing to the extensive contamination of its territory after the Chernobyl accident. These problems remain omnipresent in everyday life of the affected population and have a continuous impact on the economic well being of the country. This paper describes the major changes that have been carried out in the rehabilitation strategies in Belarus since the Chernobyl accident. The evolution of the legal and administrative framework for rehabilitation and actions taken in this context over the past two decades are summarized. The continuing challenges faced by the population in the affected areas are discussed and the key principles underlying rehabilitation strategies (that are both practicable and accepted) are identified. The latter include openness, voluntary participation, collective decision-making and empowerment of local population and professionals. These principles have underpinned the development of recent national and international initiatives that are described.

The voluntary siting process, a case study in New Jersey.

The Low-Level Radioactive Waste Policy Act of 1980 and its 1985 Amendments has not provided new disposal capacity within the United States; however, sufficient disposal capacity currently exists to handle today's disposal needs. Politics, opposition groups, and public mistrust in government have combined to limit the possibilities for establishing new disposal facilities. In 2000, New Jersey (NJ and Connecticut (CT), as members of the Northeast Compact for the disposal of low-level radioactive waste, admitted South Carolina (SC) to their compact, renaming it as the "Atlantic Compact." The advantage to SC is that they are able to prevent disposal of waste from outside the Compact. The advantage to NJ and CT is that they are guaranteed waste disposal for approximately the next 50 years, or until all currently operating nuclear power plants in the states are decommissioned. This paper details the process, much of it not following the scientific method, to try to site a low-level waste facility in NJ. With the formation of the NJ Siting Board in 1987, an effort was made to locate a site using deterministic criteria; however, in 1992, the Board shifted to a voluntary process. In 1998, the Board made the determination that there was adequate capacity for waste disposal and ended active siting. In 2000, the opportunity to form the Atlantic Compact ended siting through an out-of-state solution. While it is not clear that the voluntary process would have ultimately worked in NJ, it has worked in Canada and the process may be one of the few mechanisms for the siting of any type of hazardous material disposal facility. Also, other states still have to decide what they will do after 2008 when Barnwell is no longer open to them.

Long-term stewardship of the environmental legacy at restored sites within the Department of Energy nuclear weapons complex.

It is readily apparent, as the Department of Energy Office of Environmental Management proceeds in remediating its vast network of contaminated nuclear weapons facilities, that final cleanup at many facilities will not be performed to a level allowing unrestricted use of the facility. Instead, these facilities must rely on engineering, administrative, and institutional controls to ensure the level of cleanup performed at the site remains adequately protective of public health and the environment. In order for these controls to remain effective, however, a plan for long-term stewardship of these sites must be developed that is approved by the U.S. Congress. Although this sounds simple enough for the present, serious questions remain regarding how best to implement a program of stewardship to ensure its effectiveness over time, particularly for sites with residual contamination of radionuclides with half-lives on the order of thousands of years. Individual facilities have attempted to answer these questions at the site-specific level. However, the complexities of the issues require federal support and oversight to ensure the programs implemented at each of the facilities are consistent and effective. The Department of Energy recently submitted a report to Congress outlining the extent of long-term stewardship needs at each of its facilities. As a result, the time is ripe for forward thinking Congressional action to address the relevant issues and ensure the remedy of long-term stewardship successfully carries out its intended purpose and remains protective of public health and the environment. The regulatory elements necessary for the stewardship program to succeed can only be implemented through the plenary powers of the U.S. Congress.