Consensus statement: risk of nosocomial organophosphate poisoning in emergency departments.

There is great concern regarding the risk of nosocomial poisoning in staff caring for the organophosphate (OP) pesticide poisoned patient in prehospital, ED and intensive care settings. In many instances, elaborate nursing practices including the use of personal pro- tective equipment (PPE) have been developed in order to reduce this risk. Elsewhere, HAZMAT responses have been instituted in response to OP poisoning and resulted in closures of highways and EDs with the result that the victim has been denied access to standard hospital and transport facilities. Such actions compromise not only the care of the poison- ing victim but that of others reliant on those health care facilities and systems. We will briefly review the evidence in the literature regarding nosocomial OP poisoning, examine some of the reasons why sym- ptoms occur amongst staff treating OP-poisoned pati- ents and provide consensus guidelines on reasonable precautions that should be taken when managing these patients. The clinical features of OP pesticide poisoning arise as a result of cholinesterase inhibition. Significant poisoning almost always occurs in the context of ingestion and can be confirmed by assays of either red cell or plasma cholinesterase activity. The poisoning