#179 Infection Control During Hurricanes

The devastating effects of Hurricane Helene is a sobering reminder that dental practices most have plans in place of how to prepare and respond to this type of emergency. Tune in to Part 1 where the Divas discuss the clinical aspect of dealing with a hurricane emergency. Part 2 will discuss HIPAA considerations. 

• Boil Water Advisory Plan for Dental Practices. https://orthodonticproductsonline.com/wp-content/uploads/2024/09/Dental-Office-Boil-Water-Advisory-Plan-9-10-2024.pdf
• CDC Hurricane Preparedness. https://www.cdc.gov/hurricanes/php/preparedness-and-safety-messaging/index.html

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SPEAKER_01 0:04

Welcome.

SPEAKER_02 0:05

I'm Leslie Cannon. I'm Mary Gavoni.

SPEAKER_01 0:09

I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. My name is Olivia Juan, and I'll be your moderator today. Recently, Hurricane Helene caused extreme flooding in Florida, Tennessee, North Carolina, and it highlighted the importance of planning for disasters. Some cities were completely destroyed. Our hearts go out to those who have suffered damage and especially those who have lost loved ones. As the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel or visit our website, thecompliancedivas.com. Any resources we mentioned during the episode can be found on the website. Or you can submit your questions to support at the compliancedevas.com. We also appreciate your review of the website. So with these recent disasters taking place, it really is a reminder of how critical it is to maintain a disaster plan and also have the proper policies in place on how to respond to a disaster, whether it's a hurricane or a tornado or other type disaster that could occur. Recently, I was reading an article that was well put together by the Florida Dental Association. And in that article, it mentioned that a disaster can really overwhelm a dental practice. So think about it. Affect our water, our dental records, medications that are on hand, damaging our instruments. So we see how important it is to develop a disaster plan in place and keeping it up to date. But in light of these recent disasters where there was lots of flooding to take place, we wanted to focus in on hurricane preparedness and response. We're going to talk to our diva, Mary Gavoni, about the issue of risk of failure of dams and levees when water damages a building. So I just wanted to highlight a few points that she wanted to discuss. When there's the issue of dams failing and water damage to a health care facility, it's a little bit different than simply dealing with a dwelling. For example, if the flooding damage is not mitigated properly, there's that possibility of porous items promoting the growth of mold. And mold, as we understand it, can be the cause of infection outbreaks in healthcare facilities. So it's critical that we mitigate any water damage properly. CDC recommends that any porous materials that have moisture content of greater than 20% at 72 hours after that water event should be removed. And also we should assess any leaks that occurred at the roof line or around the windows because if those are not properly mitigated, they too can be the cause of infections. And what I thought was interesting years later. So we see how serious this is in evaluating, you know, what do we do to protect ourselves and our businesses, but also the after effect. And that gives rise to the discussion of water. Leslie, can you talk to us a little bit about the risk of contaminated water during a hurricane with flooding? And how do we deal with a boil water advisory?

SPEAKER_02 5:10

Certainly, Olivia. And we think about water, that's probably the last thing we think about when one of these circumstances hits, other than can we get bogged water? We want to think about the various ways that it would affect a dental setting. Boil water advisories are issued for a number of reasons and failure or interruption in water treatment processes and positive tests for pathogens in water, compromise distribution and uh systems such as uh a water main break or other natural disasters such as flooding, hurricane, or earthquake. And I want to remind our listeners that, you know, again, as it was just mentioned, it's not just the weather-related disasters. Uh, for some of us who have uh wells at our we live in rural areas, we have a well, and that there's a compromise to that well and the integrity of water due to flooding, that's something to keep in mind, especially if a dental office is connected to the well. It brings back also to mind, Olivia, when one time I was the person that came in over the holiday break, everybody else was out on vacation. I didn't have plans, so I volunteered to come into the office and you know, check the mail and the answering machine messages. And as soon as I opened up the back door, there was two inches of water on the floor. And I didn't know how to shut off the main for the water. Well, long story short, when the company comes in that does all the water damage repair, we found or they found that there was moisture present that indicated they would have to shut, we'd have to shut the practice down and have some work done on inside of the walls because of the potential of mold growth after having wetness there for, I think it was 72 hours. So when we talk about boil water, it's not just, oh, gee, we better get bottled water and boil water on a pan. For a dental office, we need to be thinking about more than that, just that. In the setting, uh, in a dental setting, CDC does recommend that dental units use systems that treat water so that we can keep it as safe as uh drinking water agencies, uh at 500 colony forming units of heterotrophic bacteria or less. But uh, when we do have a disruption to water, uh there's some do's and don'ts that I was able to find a great checklist on the Association for Dental Safety website. I want to make sure that we include that resource in the show notes. So the do's for dental settings during boil water are contact your local water utility about water quality and any restrictions. So if you're hooked up to uh municipal water, you want to find out what's going on there. And then uh for internal use in your office, it's recommended to place signs on all the areas of the practice where municipal water enters the facility, such as sinks and restrooms, toothbrushing areas, and they give some nice examples of what you might include for your signage. It's also recommended that during a boil water advisory, reschedule patients who are immunocompromised, that have health issues where they might be affected by a boil water advisory and maybe perhaps anything that could interfere with their routine health. So for electric procedures, uh, reschedule that. Prepare boiled water by bringing tap water to a rolling boil for at least a minute and then cooling before use. Use bottled or boiled water or alcohol-based hand sanitizer for hand hygiene. We oftentimes don't think about that. And if hands, of course, are visibly soiled, we'd have to resort to soap and water, but using boiled water for using that hand hygiene technique. We also want to monitor our water quality according to the manufacturer's directions of our dental units for any time we're using an instrument washer or an ultrasonic cleaner or uh even dental unit water that we may have independent water reservoir bottles. And we also want to make sure that uh we follow manufacturers' directions of dental units for recommended isolated water source when we're not on municipal water. If there is uh directions that vary that include, for example, distilled water or non-distilled water or softened water if that's the case in your office, or filtered water or even sterile water. And also remember to turn off our reverse osmosis filtration systems or other purification systems. Um, then there's a great deal of information on what we should be aware of, not only hand hygiene, but uh when we're providing or asking patients to brush their teeth, are we using bullet bottled water for them to use that at their toothbrushing stations? Um, what are we filling self-contained dental water bottles with? Uh, ultrasonic scalar, the self-contained ultrasonic solutions. Uh, is there any water that could be perhaps introduced into those systems that might cause uh any kind of contamination? And then uh we we we want to make sure that we understand that uh when we're looking at a boil water advisory, we're looking at jeopardizing patient safety if we don't adhere to the recommendations and our own safety. Um, as I was reading through one of the other articles, there was a mention about when you do cleanup, let's say that you're in an area that has been uh considered a disaster zone by flood waters, and you volunteer with the help of the cleanup. That PPE is especially important so that you yourself are not exposed to the various different uh microorganisms that might be present in some of the water that has been affected, floodwaters that may have breached uh sewage lines or otherwise. So that's a great amount of information, and I encourage our listeners to go to the American Association for Dental Safety website and download this very good document that they put together that will help with not only boil water advisories, but return to work strategies after a prolonged shutdown or reduced operations due to these disasters.

SPEAKER_01 11:18

Leslie, thank you for covering covering that topic so beautifully. Uh, that was very concise and detailed. Linda, did you have a point that you wanted to add to that?

SPEAKER_00 11:30

Olivia, when you were talking about just buildings in general and water coming into the buildings, I remember from my corporate risk management days that they referred to that as a sick building. And so when it comes past that 72 hours, we have to be very careful that there's a lot more remediation that's needed. So here in Florida, they rely quite a bit on sandbags, um, different local buildings and businesses, depending on if they are tending to flood more easily. And so there's just a lot of little tips that can be shared to help keep the water out of your home or your business during that time. One that I learned the other night on television was just to take a big black plastic trash can, the kind we use for lawn trash, for example, um, and fill that with water. And that could serve as a like a sandbag, a buffer to keep water out. So a lot of variations on that. So it's interesting just to make sure that we keep our mind on that because it can turn into a sick building which causes illnesses for individuals, as you mentioned, Olivia, years down the line.

SPEAKER_01 12:27

Yeah, that's good information. So much to think about. And while we're picking your brain, Linda, especially that you're in the Florida area, what are your thoughts about home preparedness? You know, we think about our dental offices, but obviously when we're warned of a hurricane and we're told to evacuate or we know that it's going to hit, just like we're anticipating another hurricane. What can folks do for home preparedness?

SPEAKER_00 12:55

Olivia, this podcast couldn't be more timely. As we know, Helene just passed through about a week or 10 days ago. And as of this recording today, October 7th, we have Milton bearing down on us in the next 24 hours. So it's already a category five. So, how what can we do for home preparedness? It really begins before the storm or the danger is imminent. And I want to share a few things with our listeners that are in coastal areas. And you hurricane season, of course, there's a defined time for that here in Florida, June to the end of November. But when hurricane watches are issued, they're issued 48 hours in advance of the tropical storm force winds when they reach 74 miles per hour or greater. So at that point, when you know there's a tropical storm brewing and you're seeing that if it become a hurricane watch, then it's time to be sure that you what you've put in place for the hurricane season is up to date and you're not lacking anything. And then after that, we go into our hurricane warning because that comes 36 hours in advance of actual tropical storm force winds, and we know that it's coming and it's going to be hitting. We just don't know the exact route because that can vary depending on the wind forces and different things in the atmosphere. So right now we're looking at Milton hitting the Gulf Coast of Florida again, somewhere around the Tampa area, north of, south of, or just, or maybe even Tampa exactly. So that being said, the cleanup is not nearly finished from Helene. There's a lot of uh debris all over the streets waiting for the trucks to come and pick them up that have hasn't come completed. So when the areas flood again, that will become particularly dangerous. It'll become dangerous for those that don't evacuate and try to evacuate at the last minute to have the debris floating around. And it will become more dangerous to any first responders who try to get in the area. So there's a lot of things happening here all at once. So let's talk about repairing your home though, because there's some interesting things that we can do to be prepared. One is having just the food, water, and the essential supplies. Do you know it takes a gallon of water per person per day to be ready? So if your water's off or you have no, you can't boil the water, maybe you don't have any electricity. Um you need to have at least a gallon of water per person per day. It's good to have one week of your medications for yourself or your family. Food that you actually eat. So don't buy food that you're not going to eat for a hurricane if it's not going to do you any good. And buy food that you can eat without having um have to be able to heat it. You know, cans of tuna fish, for example, or peanut butter, things that you can use um and keep readily available. Batteries, flashlights, phone chargers, all those things are very, very important. And just having some extra precautions is you know very, very helpful in times like this. Where's your shelter? If you have to evacuate at the last minute, where's the shelter in your community that you know where you can go and be in a safe place? So I'd also like to remind our listeners, Olivia, it doesn't matter whether or not you're on a coastal area or not, as you mentioned, you know, Hurricane Helene did some devastating damage in North Carolina and Tennessee, and our hearts just go out for those folks there as well. So being prepared in other areas that you don't even anticipate it happening, it's just sad sad. So I want to just bear in mind that we keep these little things handy. And in our state here, Olivia, in the grocery stores, when they bring in the pallets of water, they don't put them on the shelves. They just leave the pallet in the middle of the front of the grocery store because people are going to come in, grab the water, okay, and go out. They don't even have time to stock the shelves. So it's there, it's all ready. So it's the plan is to be prepared in advance. Another thing to be mindful of in your home is just items in your yard. Your yard furniture, lawn decorations, and things that could whip up and blow around during the storm that could break windows or hurt somebody, keep that in mind. And then as one last resort, I'll share this tip. If you have to evacuate your home and you don't know how to protect all the belongings you can bring with you, did you know your dishwasher is can be sealed when you close it and it's a safe place to store valuables? So if you have papers you can't get to or things you can't carry, put them in extra Ziploc bags or a trash bag that you can, you know, Ziploc, so to speak, and you can put things into your dishwasher. So I learned that on a recent television um show that gave us a lot of tips. So if we have to, we have to resort to those things. Maybe you could even use your instrument washer in your office to levia to store valuables. I don't know, but on that note, I'll turn it back to you.

SPEAKER_01 17:31

I never thought about that, Linda. So you never know what kind of tips you're going to pick up on these types of podcasts. Mary was going to talk about a little bit uh preventing infectious diseases after a hurricane because we understand that there could be waterborne, food-borne, vector-borne infectious diseases after a hurricane. And it can even cause gastrointestinal, respiratory, skin, and soft tissue infections. So, as we understand the science, gastrointestinal illness can arise from contaminated food or food spoilage. So I have friends in the North Carolina area. Matter of fact, I have a dear friend who is not able to get home in Maggie Valley, and there's no way to get to her home from here. Our home was not flooded, but there was no electricity. So all the food is spoiled. But think about the issues when should you discard food? Obviously, if it's days, you know you have to throw it away, it's all ruined. But according to the guidelines for food safety, if it's been above 40 degrees for two hours or more, we should throw it away. So I've heard people say, Well, I didn't open the refrigerator door, it should still be good. No, that's not the case. Um, so if it's uh been above 40 degrees for two hours, throw it away, or there's been no power for four hours or more, throw it away. Or if it's been uncompletely thawed from a frozen state, and of course, if it's an unusual odor, color, or texture. Um, so that's an area that we want to exercise caution. But also, divas, we have reminders that we should not wade in flood waters, especially if there's open wounds. So when I think of wound, I'm thinking, okay, well, if you have an open wound on your leg, obviously you're not going to wade through the water. But what about any other breaks in the skin? Maybe with a rash, uh, dermatitis, or other little, maybe an insect bite? You know, these are all going to be invitations to enter into the body, so to speak. And also the concern about uh bottled water, as Leslie covered very beautifully, making sure we use bottled water. If we have to enter into a flooded area, you know, do we have the right kind of clothing, uh, waterproof clothing or wading boots? And then when all of this subsides, then we're worried about the mosquitoes coming. And so, what are the measures for local health departments to deal with mosquito population? So there's lots to think about in preparing for a hurricane, but also in responding to the damage. And so it's a good time for our safety coordinators who follow our program to update their policies. And Leslie, you have a thought you wanted to add.

SPEAKER_02 20:45

You know, as you were talking about the food and spoilage, it brought to mind something that appears in the article that we have from APIC that will be part of our uh show notes, that even medications, if uh post-flood, post-disaster, uh, even though they are sealed, it's recommended if they had become wet, not to use them, even though they were in a sealed container. And then one other thing that uh was brought up in this article was about tetanus shots, that if you are uh in the post-uh-disaster cleanup phase, that you may want to take a look at your history of when you have your last tetanus shot. If it's been over 10 years, certainly it's time to do it again, but you may want to check with your healthcare provider and see, because you may be exposed to various different things during your cleanup process, that that might be a good idea. I want to also just add another thought about advocating for safety preparedness. If you're the infection control coordinator in your practice, just like hospitals do, they set up a system of drills. I know that the fire departments within their own fire protection teams, they have certain drills that they follow and that they exercise so that they know that they can be ready to go at a moment's notice. Now, hospitals have codes that they use. So if there's an active shooter or if there's other uh situations that come up, everyone recognizes the code and they go immediately into action. Well, it might seem that these kinds of disasters aren't going to happen to us, or we're not gonna have a flood occur in our office, or a pipe not going to break, or they're not gonna break a water main on our street with the municipal water that comes to our practice. But these things do happen, and if they happen to you, it's best if you have a set of plans so you have a path and plan to follow, and you can do it efficiently and easily without jeopardizing anyone's safety. So I just wanted to encourage any of our infection control coordinators or office managers or office administrators or dentist employers to consider having preparedness in place for your practice, even if you never have to use it. Hopefully you never have to use it. But when things happen, don't be caught like a deer in the headlights.

SPEAKER_01 23:12

Well stated, Leslie. So true. And I've had clients that their buildings were destroyed with tornadoes, fire, flooding. And so disaster can certainly strike, and we want to know how to respond properly. And we're going to have these articles listed in the show notes. The article that was so helpful to us was Infection Controlled Mist Chaos, and that was published by the Association of Professionals in Infection Control and Epidemiology, known as APIC. And then Leslie referred to the boil water information that's published by ADS, which was formerly OSAP. I also mentioned some supplemental information that was published by Florida Dental Association about disaster preparedness for your dental practice. So lots of information that we can use as wonderful resources in putting together our own policies. We hope you have enjoyed this episode. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. We will follow up to this episode on how to be prepared when disasters strike as it relates to HIPAA compliance. Please submit your questions to support at the compliancedevas.com, and the resources that we mentioned will be available in the show notes. Thanks again for tuning in.