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Prevalence of and Risks for Internal Contamination among Hospital Staff Caring for a Patient Contaminated with a Fatal Dose of Polonium-210

Published online by Cambridge University Press:  02 January 2015

Olivier le Polain de Waroux ,
Sandra Cohuet ,
Louise Bishop ,
Sandra Johnson ,
Karen Shaw ,
Helen Maguire ,
André Charlett  and
Graham Fraser
Olivier le Polain de Waroux*
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom European Programme for Intervention Epidemiology Training, European Centre for Disease Control and Prevention, Stockholm, Sweden
Sandra Cohuet
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom European Programme for Intervention Epidemiology Training, European Centre for Disease Control and Prevention, Stockholm, Sweden
Louise Bishop
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom
Sandra Johnson
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom
Karen Shaw
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom
Helen Maguire
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom
André Charlett
Affiliation:
Health Protection Agency, Statistics, Modelling and Economics Department, Centre for Infections, London, United Kingdom
Graham Fraser
Affiliation:
Health Protection Agency, London and South East Regional Epidemiology Units, London, United Kingdom
*
Health Protection Agency, London Region Epidemiology Unit, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom (olivier.lepolain@hpa.org.uk)
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Abstract

Background.

Alexander Litvinenko died on November 23, 2006, from acute radiation sickness syndrome caused by ingestion of polonium-210 (210Po).

Objective.

The objective was to assess the prevalence of and risk factors for internal contamination with 210Po in healthcare workers (HCWs) caring for the contaminated patient.

Setting.

Hospital.

Participants.

HCWs who had direct contact with the patient.

Methods.

We interviewed 43 HCWs and enquired about their activities and use of personal protective equipment (PPE). Internal contamination was denned as urinary 210Po excretion above 20 mBq within 24 hours. We obtained risk ratios (RRs) for internal contamination using Poisson regression.

Results.

Thirty-seven HCWs (86%) responded, and 8 (22%) showed evidence of internal contamination, all at very low levels that were unlikely to cause adverse health outcomes. Daily care of the patient (washing and toileting the patient) was the main risk factor (RR, 3.6 [95% confidence interval (CI), 1.1-11.6]). In contrast, planned invasive procedures were not associated with a higher risk. There was some evidence of a higher risk associated with handling blood samples (RR, 3.5 [95% CI, 0.8-15.6]) and changing urine bags and/or collecting urine samples (RR, 2.7 [95% CI, 0.8-9.5]). There was also some evidence that those who reported not always using standard PPE were at higher risk than were others (RR, 2.5 [95% CI, 0.8-8.1]).

Conclusions.

The sensitive quantitative measurement enabled us to identify factors associated with contamination, which by analogy to other conditions with similar transmission mechanisms may help improve protection and preparedness in staff dealing with an ill patient who experiences an unknown illness.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 10 , October 2011 , pp. 1010 - 1015
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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