What are the recommended medical interventions for individuals exposed to flood water?

Medical Management of Flood Water Exposure

Immediate Decontamination

For individuals exposed to flood water, immediately wash all exposed skin thoroughly with soap and water, remove all contaminated clothing, and irrigate eyes with clean water for at least 15 minutes if ocular exposure occurred. 1

Skin Decontamination Protocol

• Remove all contaminated clothing immediately to prevent continued exposure 1
• Wash all exposed skin thoroughly with soap and water as soon as possible - this is the primary decontamination method 1
• For visibly soiled hands or skin contaminated with organic material, use soap and bottled water if municipal water supply is compromised 1, 2
• If hands are not visibly soiled, alcohol-based hand rub is acceptable for hand hygiene 1, 2

Eye Decontamination

• If eyes were exposed to flood water, irrigate immediately with copious amounts of clean water for at least 15 minutes 1
• Ensure proper technique to avoid contaminating the unaffected eye 3

Wound Assessment and Management

Inspect all skin carefully for open wounds, abrasions, or breaks in skin integrity, as any breach exposed to flood water creates high risk for serious infection. 1

• Document the extent and location of any traumatic injuries 1
• Any open wounds exposed to flood water require copious irrigation with clean water 1
• Wounds exposed to flood water are at risk for polymicrobial infections including typical skin flora, enteric organisms, and aquatic pathogens 4

Surveillance for Infectious Complications

Maintain heightened vigilance for development of skin and systemic infections over the following 2-4 weeks after flood exposure. 1

Bacterial Infections to Monitor

• Common bacterial pathogens: Staphylococcus and Streptococcus species causing cellulitis and wound infections 1, 5
• Atypical bacterial infections are greatly increased after flood exposure 1, 5:
  • Vibrio vulnificus (saltwater/brackish water exposure) - may present as necrotizing fasciitis with hemorrhagic bullae; requires doxycycline or quinolone plus third-generation cephalosporin and surgical debridement 5
  • Aeromonas species (freshwater exposure) - can cause necrotizing fasciitis and sepsis, particularly in immunocompromised or cirrhotic patients 5
  • Chromobacterium violaceum (stagnant/muddy water) - produces unique violet pigment on culture; treat with carbapenem 5
  • Melioidosis (Burkholderia pseudomallei) - seen in Southeast Asia/Australia; treat with ceftazidime or carbapenem plus TMP/SMX for 2 weeks, then TMP/SMX for at least 3 months 5

Atypical Mycobacterial Infections

• Nontuberculous mycobacterial infections typically produce indolent cutaneous infections, possibly showing sporotrichoid spread 1, 5
• These infections may occur even after traumatic wounds have healed 4

Leptospirosis

• Waterborne zoonosis often prevalent after flooding 5
• Fort Bragg fever variant produces distinctive erythematous papular rash on shins 5
• Treat with doxycycline; volume and potassium repletion may be necessary if renal involvement exists 5

Fungal Infections

• Both typical and atypical fungal infections increase after flooding, including dermatophytosis, chromoblastomycosis, blastomycosis, and mucormycosis 5
• Delayed fungal infections can occur even after wounds heal 4

Other Infectious Risks

• Gastrointestinal and respiratory infections are most frequently reported 6
• Vector-borne diseases may increase due to expanded habitat for parasites and vectors 5

Non-Infectious Complications

• Immersion injuries: miliaria, immersion foot syndromes 5
• Contact dermatitis: both irritant and allergic types from chemical exposures 5
• Traumatic wounds and animal bites 5
• Exacerbation of pre-existing skin conditions (atopic dermatitis, psoriasis, alopecia areata) due to stress or medication unavailability 5

Common Pitfalls

• Delaying decontamination - immediate washing is critical to minimize infection risk 1
• Inadequate wound irrigation - all open wounds require copious irrigation regardless of size 1
• Failure to maintain surveillance - infections may develop days to weeks after exposure, including delayed mycobacterial and fungal infections 4
• Underestimating risk in immunocompromised patients - these individuals are at highest risk for severe infections like necrotizing fasciitis and sepsis from aquatic organisms 5