A case of a chlorine inhalation injury in an Ebola treatment unit

Carpenter, Adrian; Cox, Andrew T; Marion, D; Phillips, Anastasia; Ewington, Ian

doi:10.1136/jramc-2015-000501

Cited by 18 publications

(10 citation statements)

References 13 publications

(6 reference statements)

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“…Participants’ fears may have resulted from real observations. There was a reported case of a nurse experiencing respiratory distress and brief loss of consciousness after inhalation of highly concentrated chlorine gas at an Ebola treatment unit in Sierra Leone [ 28 ]. To our knowledge, public health messaging did not substantially address the fear of chlorine until May 2015 [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone

2016

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BackgroundFuture infectious disease epidemics are likely to disproportionately affect countries with weak health systems, exacerbating global vulnerability. To decrease the severity of epidemics in these settings, lessons can be drawn from the Ebola outbreak in West Africa. There is a dearth of literature on public perceptions of the public health response system that required citizens to report and treat Ebola cases. Epidemiological reports suggested that there were delays in diagnosis and treatment. The purpose of our study was to explore the barriers preventing Sierra Leoneans from trusting and using the Ebola response system during the height of the outbreak.MethodsUsing an experienced ethnographer, we conducted 30 semi-structured in-depth interviews in public spaces in Ebola-affected areas. Participants were at least age 18, spoke Krio, and reported no contact in the recent 21 days with an Ebola-infected person. We used inductive coding and noted emergent themes.FindingsMost participants feared that calling the national hotline for someone they believed had Ebola would result in that person’s death. Many stated that if they developed a fever they would assume it was not Ebola and self-medicate. Some thought the chlorine sprayed by ambulance workers was toxic. Although most knew there was a laboratory test for Ebola, some erroneously assumed the ubiquitous thermometers were the test and most did not understand the need to re-test in the presence of Ebola symptoms.ConclusionFears and misperceptions, related to lack of trust in the response system, may have delayed care-seeking during the Ebola outbreak in Sierra Leone. Protocols for future outbreak responses should incorporate dynamic, qualitative research to understand and address people’s perceptions. Strategies that enhance trust in the response system, such as community mobilization, may be particularly effective.

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Section: Discussionmentioning

confidence: 99%

Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone

2016

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“…[ 15 ]. The lower concentration may not be effective but higher concentrations have been reported to affect equipment [ 7 ] and personnel [ 16 ] and were shown to be damaging to aircraft surfaces [ 17 ]. An alternative to liquid chlorine based products for general disinfection is the use of gaseous chlorine dioxide which has been used to decontaminate hospitals and large areas previously [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Four Disinfectants against Ebola Virus on Different Materials

Smither

Phelps

Eastaugh

et al. 2016

Viruses

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The West Africa Ebola virus (EBOV) outbreak has highlighted the need for effective disinfectants capable of reducing viral load in a range of sample types, equipment and settings. Although chlorine-based products are widely used, they can also be damaging to equipment or apparatus that needs continuous use such as aircraft use for transportation of infected people. Two aircraft cleaning solutions were assessed alongside two common laboratory disinfectants in a contact kill assay with EBOV on two aircraft relevant materials representative of a porous and non-porous surface. A decimal log reduction of viral titre of 4 is required for a disinfectant to be deemed effective and two of the disinfectants fulfilled this criteria under the conditions tested. One product, Ardrox 6092, was found to perform similarly to sodium hypochlorite, but as it does not have the corrosive properties of sodium hypochlorite, it could be an alternative disinfectant solution to be used for decontamination of EBOV on sensitive apparatus.

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“…Chlorine is a toxic and irritating gas [9,14]. Due to the different concentrations, intoxication times, and individual sensitivities of the human body, acute chlorine gas inhalation can cause varying degrees of damage to the human body and even be life-threatening [11,[15][16][17]. After inhalation through the respiratory tract, the chlorine gas reacts with moisture on the mucosal surface of the respiratory tract to generate hypochlorous and hydrochloric acid [11,15].…”

Section: Discussionmentioning

confidence: 99%

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic

Lin¹,

Wu²,

Peng

et al. 2021

Preprint

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Background During the coronavirus disease 2019 (COVID-19) pandemic, many people have abused and misused disinfectants, leading to many poisoning incidents. However, there are few clinical case reports of poisoning caused by mixed household disinfectants. This study summarized the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents to improve the understanding of the disease. Methods We retrospectively analyzed the basic data, clinical symptoms, treatment methods, imaging, and other clinical data of seven patients with chlorine poisoning, caused by an improper mixture of hypochlorite bleach and acidic cleaning agents, who were admitted to the National Army Poisoning Treatment Center. Results The seven patients (three men and four women) had an average age of 48.8 years (18–67 years). The average poisoning time (time from exposure to poison to treatment) was 57 h (4–240 h). All seven patients were involved in cleaning bathrooms during the COVID-19 pandemic. Chest computed tomography scans showed bilateral lung effusions or inflammatory changes in five patients and no obvious exudation or inflammatory changes in two. The partial pressure of oxygen decreased in six patients, and respiratory failure occurred in one. Five patients had different degrees of increase in white blood cell count. For treatment, humidified oxygen therapy, non-invasive mechanical ventilation, intravenous corticosteroids, inhaled hormone, bronchial spasmolytics, antibiotics, and other symptomatic and supportive treatments were provided. The average length of hospital stay was 7 days (4–9 days). All seven patients recovered and were discharged. Conclusions Improper mixing of house disinfectants during the COVID-19 pandemic may cause damage to the respiratory system due to chlorine poisoning. Corticosteroids may improve lung exudation in severe cases. Additionally, symptomatic supportive treatment should be performed early.

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A case of a chlorine inhalation injury in an Ebola treatment unit

Cited by 18 publications

References 13 publications

Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone

Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone

Effectiveness of Four Disinfectants against Ebola Virus on Different Materials

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic

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