BOX 1-1
Development of Decontamination Protocols

Making the Nation Safer (2002) illustrates that much of the information required to quantify the cleanup required to safeguard public health needs in the event of a bioterrorist attack is lacking. Research should be done to fill the knowledge gaps and develop decontamination protocols (pp. 94–95):

At present there are few data on which to base decontamination procedures, particularly for biological agents. A review of the literature shows that dose–response information is often lacking or controversial, and that regulatory limits or other industrial health guidelines (which could be used to help establish the maximum concentrations of such agents for declaring a “decontaminated” environment) are generally unavailable or not applicable to public settings (Raber et al., 2001). Moreover, the correct means for identifying the presence of many biological agents are not known, nor is the significance of the presence of biological agents in the natural environment (e.g., anthrax spores are found in the soil in some parts of the United States). Research is therefore needed to determine what level of cleanup will be required to meet public health needs in the aftermath of a bioterrorist attack.

Although the lack of dose information, cleanup criteria, and decontamination protocols presents challenges to effective planning, several decontamination approaches are available. Such approaches should be combined with risk-informed decision making to establish reasonable cleanup goals for the protection of health, property, and resources. Efforts in risk assessment should determine what constitutes a safety hazard and whether decontamination is necessary. Modeling exercises are needed that take into consideration the characteristics of a particular pathogen, public perceptions of the risk that the pathogen poses to their health, the level of public acceptance of recommendations based on scientific criteria, levels of political support, time constraints in responding to the threat posed by a pathogen, and economic concerns (Raber et al., 2001).

University in Baltimore, Maryland. That group issued consensus statements on medical and public health guidelines for diagnosing, treating, and managing health effects that could result from future bioterrorist attacks. The position papers addressed some aspects of decontamination, but they did not consider the amount of cleanup necessary to meet the needs of interested and affected parties. In the absence of technically sound guidance, it is difficult to define what constitutes an adequate extent of cleanup from a public health perspective. Recent experience has shown that extensive and repeated cleanup, in the context of uncertain risk, could incur substantial costs without additional benefit.

Even though thousands of people have reentered the buildings that were decontaminated, 3 years after the attacks we still face the same fundamental

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