Skin Decontamination in Real-World Incidents: A Scoping Review

Introduction: Skin decontamination is lifesaving for patients and an essential safety element of critical systems. However, its application varies widely, with scarce patient and system outcomes limited to individual reports. This scoping review explored methods, outcomes, and lessons learned from real-world skin decontamination. Methods: Pubmed, Embase, and CINAHL databases, and gray literature were searched for articles on real-world skin decontamination of chemical, biological, radiological, or nuclear casualties. References and citations from included manuscripts were manually searched. Details of incidents, casualties, setting, and method of decontamination, casualty and system condition pre- and post-decontamination, and lessons learned were extracted using a predefined form and summarized. Results: Of 1,496 articles found, 954 were screened. Of 95 articles to be assessed for eligibility, 16 published after 2020 were evaluated, and four were included in this interim report. All were case reports describing single casualties from isolated incidents, with one reporting eight healthcare workers undergoing decontamination (n=13). The dermal contaminants were organophosphate (casualty n=9), sulfuric acid, fentanyl, and lidocaine. The decontamination agents were soap and water in the three former contaminations and unspecified for lidocaine. Pre-decontamination primary casualty conditions included hypoxia and drowsiness in organophosphate, sulfuric acid, and lidocaine contamination, with improvement post-decontamination in the latter. All patients recovered fully and were discharged from the hospital. Personal protective equipment (PPE) included gloves and gowns, with no respiratory protection specified. Eight healthcare workers were secondarily exposed to organophosphate, including one with severe symptoms requiring atropine and pralidoxime. Lessons learned were the low risk of organophosphate secondary contamination and the prolonged half-life of transdermal lidocaine. Conclusion: This scoping review summarized real-world skin decontamination using soap and water for common chemical contaminants with favorable outcomes. Contaminant-specific considerations like secondary exposure and pharmacokinetics can inform PPE and toxicological treatment. A further 79 articles will be assessed for a full report.