A client who states that he may have been contaminated by anthrax arrives at the ED. The following actions are part of the ED protocol for possible anthrax exposure or infection. Which action will you take first?
A. Assess the client for signs of infection
B. Notify hospital security personnel about the client
C. Escort the client to a decontamination room
D. Administer ciprofloxacin (Cipro) 250 mg PO
Correct Answer: C. Escort the client to a decontamination room
To prevent contamination of staff or other clients by anthrax, decontamination of the client by removal and disposal of clothing and showering is the initial action in possible anthrax exposure. Clients should remove contaminated clothing and store it in labeled, plastic bags. Clothing should be handled as little as possible to avoid agitation. Clients should shower thoroughly with soap and water.
Option A: Assessment of the client for signs of infection should be done before decontamination. Initial symptoms of inhalation anthrax are mild and nonspecific and may include fever, malaise, fatigue, and a mild cough or chest discomfort; acute symptoms of respiratory distress, fever, and shock follow, with death occurring shortly thereafter.
Option B: Notification of security personnel is necessary in the case of possible bioterrorism, but this should occur before decontaminating and caring for the client. During the 2001 anthrax outbreak, the New York City Department of Health and Mental Hygiene established the Cutaneous Anthrax Rapid Referral System for rapid referral and early diagnosis of anthrax cases (Redd 2005). This system functioned to efficiently assess patients but also provided a mechanism for rapid centralized reporting, which could be a good surveillance model in the setting of known mass exposure to anthrax.
Option D: According to the CDC guidelines, antibiotics should be administered only if there are signs of infection or the contaminating substance tests positive for anthrax. Early initiation of appropriate antibiotics is paramount for patient survival of IA. Initial therapy for adults with IA due to a strain with unknown antibiotic susceptibilities should include ciprofloxacin OR doxycycline PLUS one or two additional antibiotics effective against anthrax.