title: Healthcare-associated infections and their prevention after extensive flooding.
abstract: OBJECTIVE
  This review will focus on the epidemiology of healthcare-associated infections (HAIs) after extensive blackwater flooding as well as preventive measures.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Additional studies are needed to evaluate the epidemiology of flood-related HAIs and the optimal surveillance and control methods following extensive flooding.
authors.affiliation: Division of Infectious Diseases, Thammasat University Hospital, Pratumthani, Thailand. anapisarn@yahoo.com
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Clovus Glen
authors.initials: CG
authors.lastname: Mayhall
mesh_terms: D055868:Floods; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000209:etiology*; D062486:Public Health Surveillance