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In the event of a water-related disaster such as a flood, surveillance should be heightened for waterborne parasites and bacteria, according to a plan developed by infection control professionals in New Jersey.1 Surveillance should be maintained in a practical, feasible manner even though ICPs will probably be assigned to other disaster-related duties, the plan notes. Here are some additional talking points regarding surveillance in such a situation:
• Problems specific to water supply disruption and contamination must be identified, assessed, and acted upon in a timely manner. Intensive surveillance for gastrointestinal symptoms should be performed on both inpatients and outpatients. The most likely pathogens expected to cause illness would be parasites such as Giardia and Cryptosporidium, and bacteria such as E.coli and Shigella.
• Credible surveillance data provide the best method for stopping rumors and focusing attention on real health problems. Decide who is to collect and analyze the data, and for how long.
• Keeping a log or line list of problems, observations, decisions, and actions is critically important. Each entry should be timed and dated. This record will be invaluable if problems that require complex interventions and written reports develop.
• Outbreaks of communicable diseases after water disruption are unusual. However, the incidence of diseases that were present before a water disruption may increase because of lack of sanitation or overcrowding in shelters. Increases in infectious diseases that were not present before the disruption are not a problem, so mass vaccination programs are unnecessary. Immunization status should be obtained and any necessary vaccine should be administered based on exposure and risk.
• Patients’ wounds should be evaluated for tetanus immunization, just as they would at any other time of injury. Puncture wounds, or wounds contaminated with feces, soil, or saliva, should be evaluated by a doctor to determine whether a tetanus booster is necessary based on individual records.
1. Drapchak J, Ferrer L, Leschek J, et al. Recommenda-tions for Safe Practices during Water Supply Disruption and/or Contamination in Healthcare Facilities. New Jersey; 2001.