Peracetic acid-based disinfectant is the most appropriate solution for a biological decontamination procedure of responders and healthcare workers in the field environment.

AIMS: An effective decontamination procedure of personnel wearing personal protective equipment is required by CBRN responders and healthcare workers when dealing with biological warfare agents or natural outbreaks caused by highly contagious pathogens. This study aimed to identify critical factors affecting the efficacy of peracetic acid (PAA)-based disinfectants and products containing either hydrogen peroxide or sodium hypochlorite under the same conditions. METHODS AND RESULTS: The influence of concentration, application (contact) time, erroneous human behaviour, interfering substance, technical assets and weather conditions on disinfection efficacy against Bacillus subtilis spores were assessed in 14 experimental groups. Residual contamination of protective suits was measured to provide responders with readily understandable information (up to 100 colony forming units classified a suit as disinfected). Weather conditions, short application time and erroneous human behaviour substantially affected the effectiveness of PAAs (P < 0·05). Non-PAA-based disinfectants (either liquid or foam) did not reach comparable efficacy (P < 0·001). CONCLUSIONS: Peracetic acid was effective at a concentration of 6400-8200 ppm and an application time of 4 min. SIGNIFICANCE AND IMPACT OF THE STUDY: The study provides operationally relevant data for the use of PAA-based disinfectants in preparedness planning and management of biological incidents and natural outbreaks.

Decontamination of CBRN units contaminated by highly contagious biological agents.

A decontamination process plays a key role in management of biological incidents. While decontamination of surfaces and buildings located in the hot zone can be usually postponed until an agent is confirmed and an adequate planning phase is established, personnel wearing personal protective equipment must be decontaminated prior to their final exit from the hot zone. Because CBRN units require the shortest possible duration of this procedure, many factors must be considered, including concentration of biological agents, precleaning, disinfectant formulae, its concentration and spectrum of efficacy, contact time, external conditions (temperature, pH, relative humidity, soil load), technical assets used for decontamination, decontaminated surface (compatibility, pores), and staff performance. Experimental tests with surrogates of biological agents are thus necessary to identify above-mentioned points. Once an optimal decontamination procedure is recognized, a field rehearsal must follow and the method using a surrogate must be implemented into a training process of CBRN units.

Maternal death in pregnancy from HELLP syndrome. A report of three medico-legal autopsy cases with special reference to distinctive histopathological alterations.

Maternal death from HELLP syndrome, a complication of (pre-) eclampsia during pregnancy or postpartum, is rarely encountered in forensic pathology. We report three cases of HELLP syndrome with fatal outcome putting the main focus on the histopathological features of the disease. We found an almost identical histopathological pattern in the liver (periportal coagulation necrosis, hepatic haemorrhages sharply demarcated by an extended fibrin network from the surrounding unaffected liver parenchyma, focal leukostasis in liver sinusoids and swelling of Kupffer's cells, absence of inflammatory cellular infiltrates in liver plates, lack of fatty transformation of hepatocytes) and kidneys (bloodless glomeruli with swollen and vacuolated intracapillary cells, cigar-shaped capillary loops, enlarged glomerular tufts with herniation of capillary loops into the proximal convoluted tubules, swelling of mesangial cells) in all three cases. The histopathological alterations in the liver and kidneys can be considered characteristic for the disease and their presence may enable the forensic pathologist to establish the definite post-mortem diagnosis of HELLP syndrome in questionable cases.