Skin and eye decontamination after exposure to chemical agents

OBJECTIVE. Emergency Department visits due to skin or ocular exposure to chemical agents (CAs) are now part of everyday life. The aim of this review is to describe the evidence supporting the practice of skin and ocular decontamination following these incidents and identify the most effective decontamination agent or method in terms of toxicity reduction and absence of side
effects.
MATERIAL AND METHODS. We followed the general guidelines of the PRISMA standard. A document search was conducted across 2 databases (PubMed and ISI Web of Knowledge) using the following keywords: (“skin decontamination” OR “ocular decontamination”) AND (“chemical exposure” OR “chemical agents”). In a second phase, a more specific search was conducted to identify documents referencing the use of diphoterine or hexafluorine, with the following keywords : (“Diphoterine” OR “Hexafluorine” AND “skin decontamination” OR “ocular decontamination” OR “chemical exposure” OR “chemical agents”). The same strategy was applied using the search engines of 2 Spanish journals devoted to emergency medicine (EMERGENCIAS and REUE), introducing the same keywords in Spanish.
RESULTS. Initially, a total of 392 documents were identified, but after applying the exclusion criteria only 44 documents were eventually evaluated. The removal of contaminated clothing and the immediate initiation of decontamination are the most universally accepted measures. Solid CAs are best decontaminated by scraping or brushing. For liquid forms, water is the decontaminant of choice. Lipid-soluble agents are better decontaminated with water and soap. After exposure to chemical weapons (CWs), initial measures should include the removal of clothing and dry decontamination. Although low-quality evidence studies
surround specific decontaminants, such as diphoterine or hexafluorine, some show more favorable results vs water.
CONCLUSIONS. Early decontamination remains the key factor in reducing injuries after chemical exposure. Dry decontamination is highly effective with solid products and CWs. For liquid CAs, water or water with soap are the most effective and accessible options.