Hospital infection prevention and control issues relevant to extensive floods

Assessment of mould remediation in a healthcare setting following extensive flooding

BACKGROUND

A new hospital building was close to completion when a large pipe carrying clean water broke, causing extensive flooding.

AIM

To determine the flood-associated fungal risk to susceptible patients who would use that building.

METHODS

Though standard flood remediation by the builders was relatively straightforward, there was no model for specialist assessment of patient risk due to the flood-associated mould growth. As levels of background airborne fungal spores can be expected to vary significantly over time, we could not use absolute levels to indicate either an excess of airborne fungal spores or successful remediation. Therefore it was decided to use weekly settle plates, exposed at the same time in flooded (test) and equivalent non-flooded (control) areas to compensate for variations in background levels. Flood-related risk was estimated by the ratio between fungal colonies on the test and control sets of settle plates, rather than absolute number.

FINDINGS

Whereas the physical flood remediation, including the use of 'anti-fungal' treatments, was completed in three weeks post flooding, fungal contamination in flooded areas took 38 weeks to return to control levels and remained so for a further six weeks of observation.

CONCLUSION

By the use of this method, we were able to assure the absence of flood-associated fungal risk to susceptible patients who would use that building. We recommend that infection prevention and control teams consider using this approach should they be faced with similar situations.

Mitigating infectious disease risks through non-stationary flood frequency analysis: a case study in Malaysia based on natural disaster reduction strategy

The occurrence of floods has the potential to escalate the transmission of infectious diseases. To enhance our comprehension of the health impacts of flooding and facilitate effective planning for mitigation strategies, it is necessary to explore the flood risk management. The variability present in hydrological records is an important and neglecting non-stationary patterns in flood data can lead to significant biases in estimating flood quantiles. Consequently, adopting a non-stationary flood frequency analysis appears to be a suitable approach to challenge the assumption of independent and identically distributed observations in the sample. This research employed the generalized extreme value (GEV) distribution to examine annual maximum flood series. To estimate non-stationary models in the flood data, several statistical tests, including the TL-moment method was utilized on the data from ten stream-flow stations in Johor, Malaysia, which revealed that two stations, namely Kahang and Lenggor, exhibited non-stationary behaviour in their annual maximum streamflow. Two non-stationary models efficiently described the data series from these two specific stations, the control of which could reduce outbreak of infectious diseases when used for controlling the development measures of the hydraulic structures. Thus, the application of these models may help prevent biased prediction of flood occurrences leading to lower number of cases infected by disease.

A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy

OBJECTIVE

To describe a polymicrobial fungal outbreak after Hurricane Sandy.

DESIGN

An observational concurrent outbreak investigation and retrospective descriptive review.

SETTING

A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually.

PATIENTS

Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit.

METHODS

An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed.

RESULTS

A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design.

CONCLUSIONS

Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections.

Water-Related Impacts of Climate Change on Agriculture and Subsequently on Public Health: A Review for Generalists with Particular Reference to Pakistan

Water-related impacts due to change in climatic conditions ranging from water scarcity to intense floods and storms are increasing in developing countries like Pakistan. Water quality and waterborne diseases like hepatitis, cholera, typhoid, malaria and dengue fever are increasing due to chaotic urbanization, industrialization, poor hygienic conditions, and inappropriate water management. The morbidity rate is high due to lack of health care facilities, especially in developing countries. Organizations linked to the Government of Pakistan (e.g., Ministry of Environment, Ministry of Climate Change, Planning and Development, Ministry of Forest, Irrigation and Public Health, Pakistan Meteorological Department, National Disaster Management, Pakistan Agricultural Research Centre, Pakistan Council for Research in Water Resources, and Global Change Impact Study Centre), United Nation organizations, provincial government departments, non-governmental organizations (e.g., Global Facility and Disaster Reduction), research centers linked to universities, and international organizations (International Institute for Sustainable Development, Food and Agriculture, Global Climate Fund and World Bank) are trying to reduce the water-related impacts of climate change, but due to lack of public awareness and health care infrastructure, the death rate is steadily increasing. This paper critically reviews the scientific studies and reports both at national and at international level benefiting generalists concerned with environmental and public health challenges. The article underlines the urgent need for water conservation, risk management, and the development of mitigation measures to cope with the water-related impacts of climate change on agriculture and subsequently on public health. Novel solutions and bioremediation methods have been presented to control environmental pollution and to promote awareness among the scientific community. The focus is on diverse strategies to handle the forthcoming challenges associated with water resources management.

Patterns of nosocomial infections, multidrug-resistant microorganisms, and mold detection after extensive black-water flooding: a survey from central Thailand

Central Thailand was severely affected by black-water flooding between September and November 2011, with resultant closure of 30 regional hospitals. Few data are available for the incidence of nosocomial infections and patterns of preflood versus postflood multidrug-resistant organisms (MDROs) and mold. We therefore conducted a survey of the hospitals in central Thailand in order to evaluate the patterns of nosocomial infections, MDROs, mold, and flood preparedness plans after these floods.

On the basis of a hospital list from the Ministry of Public Health, we identified 104 hospitals in 15 provinces of central Thailand that were affected, but not necessarily closed, by extensive floods. We designed and then conducted a survey, from July 1 through October 31, 2012, that inquired about hospital characteristics, postflood hospital preparedness plans, administrative support, institutional safely culture, incidence of nosocomial infections, and prevalence of MDROs and mold colonization or infection. All 104 secondary care (>100 beds) and tertiary care (>250 beds) hospitals in 15 central Thailand provinces were invited to participate.