Preventing Healthcare-Associated Infections After Flooding
Preventing Healthcare-Associated Infections After Flooding
Purpose of review: This review will focus on the epidemiology of healthcare-associated infections (HAIs) after extensive blackwater flooding as well as preventive measures.
Recent findings: There is evidence suggesting an increased incidence of HAIs and pseudo-outbreaks due to molds after extensive flooding in healthcare facilities. However, there is no strong evidence of an increased incidence of typical nosocomial infections (i.e., ventilator-associated pneumonia, healthcare-associated pneumonia, central line-associated bloodstream infection and catheter-associated urinary tract infections). The prevalence of multidrug-resistant organisms may decrease after extensive flooding, due to repeated and thorough environmental cleaning prior to re-opening hospitals. Contamination of hospital water sources by enteric Gram-negative bacteria (e.g., Aeromonas species), Legionella species and nontuberculous Mycobacterium species in flood-affected hospitals has been reported. Surveillance is an important initial step to detect potential outbreaks/pseudo-outbreaks of HAIs. Hospital preparedness policies before extensive flooding, particularly with environmental cleaning and mold remediation, are key to reducing the risk of flood-related HAIs. These policies are still lacking in most hospitals in countries that have experienced or are at risk for extensive flooding, which argues for nationwide policies to strengthen preparedness planning.
Summary: Additional studies are needed to evaluate the epidemiology of flood-related HAIs and the optimal surveillance and control methods following extensive flooding.
Extensive flooding can cause physical and economic damage to a healthcare facility. Due to the impact of global climate change, it is predictable that extensive floods will increase in frequency and intensity in the years to come. Flood damage can be extremely severe, and there is consistent evidence of an increase in the incidence of floods globally over the past several decades. Flood water has been categorized into clear, gray, or black water depending on the level of contamination. Clear water refers to tap water or rainwater, whereas gray water refers to water from sinks, showers, tubs, and washers. Blackwater, which is the main focus of this review, refers to flood water contaminated with human and animal waste (e.g., river water, raw sewage, sea water). It is known that outbreaks of communicable diseases, such as water-borne diseases (e.g., diarrhea, leptospirosis and hepatitis), airborne/droplet diseases (e.g., influenza, measles, tuberculosis), vector-borne diseases (e.g., malaria, dengue fever), and contamination of wounds (e.g., Gram-negative enteric bacteria, tetanus, zygomycosis) are more likely after specific disasters (e.g., extensive floods, tsunamis, tornados, earthquakes). Risk factors for these outbreaks include population displacement, overcrowding, standing water after flooding, poor sanitation conditions, postdisaster injuries and low vaccination coverage prior to the flood. Limited data is available concerning the impact of HAIs after extensive flooding due to blackwater. We reviewed the evidence of HAIs occurring after extensive blackwater flooding stratified according to type of pathogens.
Abstract and Introduction
Abstract
Purpose of review: This review will focus on the epidemiology of healthcare-associated infections (HAIs) after extensive blackwater flooding as well as preventive measures.
Recent findings: There is evidence suggesting an increased incidence of HAIs and pseudo-outbreaks due to molds after extensive flooding in healthcare facilities. However, there is no strong evidence of an increased incidence of typical nosocomial infections (i.e., ventilator-associated pneumonia, healthcare-associated pneumonia, central line-associated bloodstream infection and catheter-associated urinary tract infections). The prevalence of multidrug-resistant organisms may decrease after extensive flooding, due to repeated and thorough environmental cleaning prior to re-opening hospitals. Contamination of hospital water sources by enteric Gram-negative bacteria (e.g., Aeromonas species), Legionella species and nontuberculous Mycobacterium species in flood-affected hospitals has been reported. Surveillance is an important initial step to detect potential outbreaks/pseudo-outbreaks of HAIs. Hospital preparedness policies before extensive flooding, particularly with environmental cleaning and mold remediation, are key to reducing the risk of flood-related HAIs. These policies are still lacking in most hospitals in countries that have experienced or are at risk for extensive flooding, which argues for nationwide policies to strengthen preparedness planning.
Summary: Additional studies are needed to evaluate the epidemiology of flood-related HAIs and the optimal surveillance and control methods following extensive flooding.
Introduction
Extensive flooding can cause physical and economic damage to a healthcare facility. Due to the impact of global climate change, it is predictable that extensive floods will increase in frequency and intensity in the years to come. Flood damage can be extremely severe, and there is consistent evidence of an increase in the incidence of floods globally over the past several decades. Flood water has been categorized into clear, gray, or black water depending on the level of contamination. Clear water refers to tap water or rainwater, whereas gray water refers to water from sinks, showers, tubs, and washers. Blackwater, which is the main focus of this review, refers to flood water contaminated with human and animal waste (e.g., river water, raw sewage, sea water). It is known that outbreaks of communicable diseases, such as water-borne diseases (e.g., diarrhea, leptospirosis and hepatitis), airborne/droplet diseases (e.g., influenza, measles, tuberculosis), vector-borne diseases (e.g., malaria, dengue fever), and contamination of wounds (e.g., Gram-negative enteric bacteria, tetanus, zygomycosis) are more likely after specific disasters (e.g., extensive floods, tsunamis, tornados, earthquakes). Risk factors for these outbreaks include population displacement, overcrowding, standing water after flooding, poor sanitation conditions, postdisaster injuries and low vaccination coverage prior to the flood. Limited data is available concerning the impact of HAIs after extensive flooding due to blackwater. We reviewed the evidence of HAIs occurring after extensive blackwater flooding stratified according to type of pathogens.
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