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Hospital floods highlight need for infection prevention, control
Hospital closures after extensive flooding in Thailand and United States have brought attention to the need for hospital preparedness to ensure a safe environment in hospitals when they reopen.
“There are no existing data on hospital preparedness, which posed a problem when we first encountered extensive flooding,” Anucha Apisarnthanarak, MD, of the division of infectious diseases at Thammasat University Hospital in Pratumthani, Thailand, told Infectious Disease News. “We think that sharing our experience would help others deal with hospital preparedness after floods.”
Infection prevention and control strategies are necessary to safely reopen hospitals after flooding. These plans require expertise from various disciplines, including infection prevention and control personnel. There are four infection prevention and control issues to consider: removal of flood waters, disinfection, mold remediation and restoration of adequate air flow.
After identifying the water source, the water should be pumped out. The water types include clear water, which is water from the tap or rain; gray water, which is water from sinks, showers, tubs and washers; and black water, which is water contaminated with waste from humans and animals. After the water is pumped out, remaining water should be removed with wet vacuum. Items should be inspected for water damage and discarded if necessary.
Depending on the flood water type, cleaning and disinfection should commence. Nonporous materials and semiporous items can be cleaned, but porous materials should be discarded if exposed to black water. Surfaces should be disinfected with a bleach solution and followed by air drying and high-efficiency particulate air vacuum. Evaluations should be done to examine mold damage, and affected materials should be cleaned or discarded.
Lastly, the heating, ventilation and air conditioning (HVAC) system must be examined for mold, debris and dampness. Air samples must be taken to determine HVAC contamination.
“We need to do more study on hospital flood preparedness and lessons learned from previous floods,” Apisarnthanarak said. “After the Thai floods of 2011, we found that most hospitals had a plan written, but very few exercised that plan. Research should include assessing preparedness plans on a national scale, evaluating diseases associated with floods in the community and appropriate infection control preparedness plans in resource-limited settings.”
Anucha Apisarnthanarak, MD, can be reached at: Division of Infectious Diseases, Thammasat University Hospital, Pratumthani, Thailand, 12120; email: anapisarn@yahoo.com.
Disclosure: Apisarnthanarak reported no relevant financial disclosures.
Perspective
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This article is quite relevant to our experience at NYU Langone Medical Centerwith Hurricane Sandy, when our hospital closed due to damage incurred by the storm, including significant water damage. When the storm passed, we first focused on recovery, remediation and worker safety, and then shifted to plans for safely reopening the hospital. We created processes for assessing medical supplies and equipment for disinfection vs. discard; cleaning and disinfection of patient care areas; ensuring clean water and clean air; and inspecting and cleaning the HVAC system. These were major steps performed prior to reopening, which are all steps suggested in the article. With reopening, we are collecting environmental cultures for surveillance of high-risk areas such as operating rooms and areas with immune-suppressed patients. We are also performing laboratory-based post-flood surveillance, as discussed in the article. Our efforts required coordination and teamwork across a number of groups at the medical center.
When we set out on our recovery, this article was not published. Very little published literature about flood recovery was specific to health care facilities. There were health care–specific guidance documents from the CDC, including the checklist and fact sheet referenced in this article. They were very useful, but did not discuss aspects specific to areas of the hospital that include patients particularly vulnerable to infection.
We do have an emergency operations plan that covers disasters including floods. From an infection control perspective, the flood damage and recovery efforts were outside of our usual scope of activities. Because much of the information available at the time did not directly apply to our situation, we developed our own response plans. We considered the issues described in this article and applied infection control principles in formulating our response to these key areas after flooding. Although we hadn’t dealt with these issues before in the presence of floods and contaminated water, we do deal with these issues in a different capacity on a day-to-day basis. We had to consider the principles we use to make sure that the hospitals are clean and safe and apply those principles to creating our own working plan of responding to these different areas during the disaster. So, although the flood was a novel experience, we applied the same principles we use on a daily basis to make sure the hospital was clean and safe for patients upon reopening.
It is important that all hospitals at risk for extreme weather events review their plans with all involved parties, as in our experience, a coordinated response is essential.