Infection Control Risk Assessment of Indonesian Satellite Health Clinics Caring for Displaced Survivors of the December 2005 Tsunami

Background: On Sunday, December 26, 2005 a massive earthquake struck off the western coast of Sumatra, Indonesia triggering an explosive tsunami. More than 175,000 died and over 1.7 million people were displaced and relocated to temporary homes, shelters or camps. Many villages were completely destroyed and the community infrastructure, including health care services, was decimated. Disaster relief funds supported the construction of small prototype satellite health clinics to care for those displaced. Objective: In 2007 many people remained in “temporary” shelters and the clinics continued to provide their health care needs so a quality of care survey, including an infection control risk assessment, was conducted in the clinics. Methods: A team of American and Indonesian nurses and physicians conducted surveys in 10 health clinics in the Aceh Baret and Nagan Raya districts. A health clinic assessment tool was developed and piloted prior to use. The survey included on-site observations, record reviews and staff interviews. The infection control risk assessment focused on hand hygiene, availability of running water, screening and triage of patients, sharps safety, medical waste, personal protective equipment, occupational exposure to blood and body fluid procedures, environmental cleanliness, disinfection and knowledge of infectious disease transmission including avian influenza. The team also had the opportunity to visit and conduct an infection control assessment in one of the district hospitals. Results: Three areas for immediate improvement/intervention emerged. 1.) In 2004, medical care supplies and equipment poured into the region from around the world. The clinics received some equipment, such as tabletop sterilizers. This assessment found that the majority of clinic staff had inadequate knowledge of sterilization process and procedures and most clinics had few or no additional supplies to operate the device safely; 2.) Each clinic incinerated its own medical waste, including sharps. There were no policies or procedures guiding the practice and extremely dangerous conditions were observed at 2 clinics; 3.) Staff orientation and infection control education was limited or non-existent in all but 2 of the clinics. Conclusions: Disaster relief is a complex process measured not in months but years. Rebuilding the health care system to care for people who have experienced catastrophic loss of life and property is a slow, deliberate process requiring extensive resources. Even small improvements in infection control practices and procedures can help prevent infection and occupational exposures.