Post Disaster Infection Control Response - Essay Example

Post Disaster Infection Control Response Student’s Name Course Title Instructor Date Post Disaster Infection Control Response Natural disasters, crises, emergencies and catastrophes of natural both natural origin and human causes lead to massive loss of life, extensive injuries, displacement of human populations, loss of property and many more adverse effects to the community. Disasters may also lead to epidemics of communicable or infectious diseases. As Isidore, Alijunid, Kamigaki, Hammad and Oshitani (2012) explain in their article titled Preventing and Controlling Infectious Diseases after Natural Disasters, “Beyond damaging and destroying physical infrastructure, natural disasters can lead to outbreaks of infectious disease”. The relationship between epidemics of infectious diseases and natural disasters is often misconstrued to be because of the many bodies that are left lying everywhere after the disaster. However, the risk for epidemics of infectious diseases after disasters is increased by population displacement, unavailability of safe drinking water and safe food, poor sanitation facilities, crowding, compromise of sewages, overflow of chemicals into the environment and the unavailability of healthcare services [Joh07]. Epidemics of infectious diseases occurring after natural disasters or crises further endanger the lives of those that have survived the disaster and are housed in shelters and tents. Infection control is henceforth one of the most important aspects of response to natural disasters. The purpose of this paper is to provide a strategic approach to infection control in the post-natural disaster period. As the author, I assume the role of the health response coordinator and discuss in detail the strategies and rationale of the infection control response activities that will be undertaken. The paper is a problem solving discussion supported with thorough research from the vast amount of literature on disaster management and response available in online search databases and journals. The natural disaster for whose infection control strategy is discussed is a tropical cyclone of moderate strength that has struck the Australian coastal region. Problem Statement: Crisis, Disaster or Emergency According to the World Disaster’s Report, 2009: Focus on Early Warning, Early Action, more than 7,100 disasters happened in the decade 1999-2008, causing approximately 1,243,480 deaths and property damages summing up to more than one billion US dollars [Int09]. Some natural disasters that occurred in the recent past have been so destructive such that their names have remained engraved in our minds. One example of such disasters is Hurricane Katrina, which hit the Gulf and American coasts leading to mass destruction and tremendous loss of life. Another example is the Japanese earthquake which left tens of thousands dead and masses displaced. For the purposes of this paper, we assume that a hurricane with the same magnitude and intensity as Hurricane Katrina has hit the Australian Coast. In Australia, hurricanes are referred to as cyclones, so we may as well name this natural disaster as Cyclone Katrina. This cyclone has made a landfall as a powerful storm which continues to move inland while sustaining winds of about 120 mph. The cyclone has generated violent waves and massive storms that continue to surge inland leading to massive flooding in coastal cities. The surge of the massive storm and the extreme amounts of rainfall received due to the cyclone have overwhelmed the levee system and the floodwalls of the coast have been overtopped, resulting to catastrophic flooding. Due to poor disaster preparation, only about half of the population in the area affected had been evacuated to safe grounds. After the disaster has claimed about 1,000 lives, a population of about 500, 000 people is housed in temporary shelters and the remaining buildings in the severely destroyed coastal region. Due to massive flooding and destruction of premises by powerful storms carrying with them debris, the power system, road network and sewage system has been compromised. The infection control response to this problem is discussed below. Post Disaster Infection Control The first step in developing a post-disaster infection control strategy is to understand the demographic properties and the situation of the population at risk. In this case, the disaster left approximately 500,000 people housed in temporary shelters and in overcrowded buildings both inside and outside the disaster region. This population, comprising of children, women and men is at risk of communicable and infectious disease outbreaks. All responders to the disaster, including rescue officials, firemen, health officials and any other individuals are at the threat of contracting infectious diseases in case of an outbreak. In essence, all the population groups of people in the region of disaster or in the region in which evacuees are sheltered are at risk of contracting a communicable infection in the event of an outbreak. What communicable diseases are the populations of evacuees, rescue teams and responders at risk of contracting? The natural disaster discussed in this paper, Cyclone Katrina, is a hydro-meteorological disaster whose main effect is massive flooding. The public health effects of flooding are usually disease outbreaks occurring due to overcrowding of people in camps and shelters, lack of proper solid waste disposal facilities and gross contamination of water sources with toxic chemicals, sewage waste, and fecal material disposed inappropriately by the people, who lack adequate toilets (Isidore et al.,2012). Flooding also results to proliferation of mosquitoes, which are the vectors of malaria and the hemorrhagic fevers. The infectious/communicable diseases usually associated with flooding henceforth include waterborne diseases, respiratory diseases associated with overcrowding, and vector-borne diseases [Jaf11]. Diarrheal disease outbreaks occurring after disasters are normally caused by contamination of drinking water by sewage and fecal pollutants due to poor sanitation and lack of waste disposal facilities. The common diarrheal diseases that occur after disasters are cholera infections and infections with enterotoxigenic strains of Escherichia coli [Sur00]. Other waterborne infectious diseases that occur after disasters include hepatitis A and E infections [Khe05], and leptospirosis, a bacterial zoonotic infection transmitted through contact of human mucous membranes with water contaminated with leptospira bacteria from rodent urine (Jafari et al. 2011). In overcrowded areas, acute respiratory disease outbreaks may occur due to transmission from one person to another through cough droplets. Measles and meningitis infections are also contaminated from an individual to another due to overcrowding in shelters and camp sites after a disaster [Ngu06]. The vector-borne diseases that might occur in camps and shelters after a disaster include malaria, which occurs frequently after floods, rabies and cutaneous leishmaniasis (Jafari et al., 2011). Other infectious diseases, including tetanus and diseases caused by streptococci and staphylococci may infect wounds and injuries sustained during the disaster and become spread among the population at risk [PLi05]. The infection control response to Cyclone Katrina should minimize the risk of the affected population from contracting the above discussed infectious diseases. After knowing what infectious diseases can potentially cause outbreaks and epidemics after a disaster, it is important that the risk factors of the disease transmission and outbreaks are analyzed. The identification of the risk factors of infectious disease outbreaks after a disaster like Cyclone Katrina forms part of the needs assessment of the affected population. Needs assessment and risk identification are best done by visiting the affected area. In this case, as the coordinator of infection control efforts after Cyclone Katrina, I would visit the affected area and meet the affected population in order to identify the risks and evaluate their needs. The primary concern and greatest risk for infectious disease transmission after a disaster is the fact that the people are displaced. Displacement of mass populations and sheltering them in camps and temporary shelters means that they may lack access to safe drinking water and adequate functioning latrines [Joh07]. Lack of safe drinking water and latrines may also be due to extensive damage of water sources and the contamination of water sources by sewage and toxic chemicals from broken sewer lines and production plants. Another risk of communicable disease transmission is malnutrition and starvation. Lack of adequate food for the affected population results to starvation and malnutrition, which increases the risk of death from infectious diseases by weakening the immune system of the affected [PSp05]. Another factor that influences infectious disease transmission is the environment in which the affected population is sheltered. If the immediate environment of the camps or shelters where evacuees are housed is littered with sewage material or dirty contaminated water, then the people are more prone to outbreaks. The other risk factor that increases the probability of an infectious disease outbreak after a disaster is the unavailability of healthcare services. Responding to the needs of the affected population will reduce the risk of an infectious disease outbreak in the population. The greatest need of the displaced population is adequate shelter in a hygienic environment. Moving the affected population to a hygienic environment in which they are less crowded is one of the best infection control strategies. The second need of the affected people is safe drinking water. The other needs include adequate food and medical care. A good infection control strategy should factor in all these needs and provide them for the affected population as part of the plan to prevent infectious disease outbreaks. The plan to prevent infectious disease outbreaks in the population affected by Cyclone Katrina is to provide the populations needs, which involves making sure that the population is housed in a hygienic environment, have safe drinking water and adequate nutrition, have adequate latrines and toilet facilities, and have adequate medical care. Post-disaster infection control through meeting the needs of the affected population sounds simple, but there are many challenges involved. One of the greatest short-term challenges of infection control response is the inaccessibility of the affected regions and communication to the affected populations. Natural disasters usually lead to extensive destruction of all infrastructures such as roads, railway, power lines and communication lines. The end result is that rescuers and responders find it hard to access the affected regions or even communicate to the affected population. For instance, in the case of Hurricane Katrina, New Orleans was flooded by water up to 20 feet deep, meaning that all roads and railways were submerged in water, and transport was only by air. Communication was so paralyzed such that rescuers and responders had to write messages in paper, put the papers in water, and drop the bottles containing messages to the affected individuals [The05]. Other challenges to post-disaster infection control are documented in Rebmann, Wagner and Warye’s (2009) article aptly titled APIC’s Role in Emergency Management: Proceedings of the 2008 APIC Emergency Preparedness Mini-Summit. In this article, the authors explain that the challenges to post-disaster infection control include an acute lack of adequate education and training of nonhospital based healthcare workers on infection prevention, and a shortage of experts in infection prevention among the infection prevention professionals [TRe09]. In addition, the scholars explain that the public requires education on potential outbreaks of infectious diseases after disasters so that they may help in infection control (p. 344). The other challenge of infection prevention after a disaster is that many infection preventionists are required, but only some are available [TRe09]. These challenges must be mitigated in order to effectively prevent outbreaks after disasters. Post-disaster infection control requires many resources. A multi-stakeholder approach is henceforth required in order to ensure that the affected population is free from diseases and has minimal risk of developing outbreaks. Among the resources required are human resources. A great number of human infection control personnel are required in reaching out to the affected population. Many resources are also required in order to provide safe water and food. Financial resources are also required to relocate the affected population to an adequate and safe environment. These resources are accessed through a stakeholder approach to disaster management. The stakeholders in a disaster include the community, philanthropic organizations, businesses, healthcare facilities and the government. Each of these facilities contributes greatly to the management of disasters. For instance, the government can provide the facilities required to evacuate the affected population from infection-prone areas to safer areas while healthcare facilities can provide the required personnel to control and prevent infection outbreaks. Non-profit organizations and faith-based organizations also provide volunteers and other necessary resources [The05]. To effectively prevent and control any infection outbreaks due to the Cyclone Katrina, it is important that infection preventionists, healthcare workers, rescuers, and other responders such as volunteers work in good liaison with governmental response teams, NGOs and other non-profit organizations interested in helping the victims. Communication is a very important tool in coordinating the activities of the large group of responders, who are also at risk of infections while in the disaster-stricken area. To communicate effectively to this large group, a meeting of all the responders would be necessary and further communications could be done through team leaders. In communicating to the responders, emphasis should be made on their personal safety as the first priority. It is of utmost importance that all personnel involved in response to a disaster should protect themselves from infections by wearing personal protective equipment [TRe09]. Responders should also adhere to safety precautions when looking for victims and addressing the needs of the survivors. The strategies of infection prevention and control for the survivors of Cyclone Katrina are very basic because they include basically providing for the needs of the affected population while reducing the risks of disease outbreaks. The first step is to choose appropriate sites of shelter. Camps and shelters should have adequate space, have access to safe water, have power supply and be supplied with adequate toilets and latrines and proper mechanisms of solid waste management. Appropriate shelters set in appropriate sites prevent outbreaks by significantly decreasing the incidence of diarrheal diseases, vector-borne diseases, respiratory diseases, tuberculosis, meningitis, measles and other infectious diseases commonly occurring after disasters [Das07]. After selecting and planning appropriate and adequate sites and shelters, the next step is to ensure that the affected population is supplied with safe water and adequate food. Drinking water and food safety is one of crucial factors for infection prevention after a disaster. Consumption of contaminated water or use of contaminated and unhygienic water for food preparation and personal hygiene is a key cause of infections after disasters. In the event of a disaster, the affected people should be provided with adequate facilities to collect, store and use sufficient quantities of water that is safe for drinking, food preparation and personal hygiene [Vee07]. The people should also be facilitated with adequate provisions for ensuring that water would stay safe until consumption. For instance, the affected people could be provided with chlorine, which is a safe and readily available water purifier. The affected people should also be informed on how to prepare food thoroughly to prevent consumption of microbes in raw food and food that is not well cooked. After provision of adequate safe water and food supplies, the people affected by Cyclone Katrina should be provided with adequate waste disposal facilities, including latrines and sewage connections. This prevents contamination of the environment and water sources with fecal waste, which would increase the risk of an outbreak of infectious diseases. Vector control is also an important strategy. Due to a paralyzed public healthcare infrastructure and creation of environments favorable to vector breeding, vector-borne diseases such as malaria, yellow fever, trypasonomiasis, dengue fever, typhus and hemorrhagic fevers are common in disaster-stricken populations. In an article aptly titled Lessons Learned from Complex Emergencies over Past Decade, Salama, Spiegel, Talley and Waldman (2004) explain that some of the most useful vector control interventions after a disaster include spraying for malaria, use of insecticide-impregnated nets, and use of traps to control tse tse fly populations (p. 1802). Such measures would suffice to control vectors in the population stricken by cyclone Katrina. Another important infection control measure in the post-disaster period is to organize vaccination and immunization campaigns as well as provision of adequate healthcare facilities. Campaigns for immunization against measles, tetanus and diphtheria should be started immediately after a disaster to reduce the risk of an outbreak of such infections (Salama et al., 2004). In addition, supplementation with Vitamin A would suffice to boost the immunities of the affected population. Finally, healthcare access should be provided to the affected population in order to handle any cases of infectious disease and control spread through quarantine and barrier nursing. A temporary healthcare facility set up in the affected population’s camp site would be handy in providing healthcare services as well as surveillance for outbreaks. The healthcare facility would also provide counseling and support services for those that have suffered trauma and depression. The above infection control responses should be strengthened to handle the needs of the more vulnerable populations first. For instance, mosquito nets should be distributed first to pregnant women and children under the age of five because they are more vulnerable to malaria. In addition, the elderly should be given more care and attention because they are unable to appropriately manage their health by keeping hygienic and taking medication appropriately. The allocation of scarce resources in this situation may introduce an ethical dilemma where ethical decisions are required. For instance, if mosquito nets are inadequate, who would get and who will not get? It is ethical that the most vulnerable among the population should be considered first. Through a multi-stakeholder approach bringing together the government, healthcare workers, the community, non-profit organizations and philanthropic firms, the above discussed strategy would be implemented within a time-frame that allows for complete safety of both the responders and the survivors. In conclusion, infection prevention and control in response to Cyclone Katrina requires basically response to the needs of the affected population, which increase the risk of infectious disease outbreaks. The strategy to prevent infectious disease outbreaks includes providing the affected population with adequate shelter in a safe environment, provision of safe water and food, and implementation of infection control measures such as vector control and immunization of the population against diseases. In response to Cyclone Katrina, this strategy would be implemented through a multi-stakeholder approach bringing together many stakeholders in community health to support the survivors of the disaster and ensure that no more lives are lost to infectious diseases. References Dash, N., & Zhang, Y. (2007). Sheltering and Housing Recovery Following Disaster. In H. Rodriguez, E. Quarantelli, R. Dynes, W. Anderson, & P. (. Kenedy, Handbook of Disaster Research. . New York, NY: Springer . 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