Indonesia Earthquake: Concerns About Post-operative Infections - WHO Sets Up Mechanism For Post- Operative Management

WHO is developing implementation plan of an emergency plan with the Ministry of Health to provide pre-emptive immunization of a booster dose of Tetanus-diphtheria (Td) to the entire over -15 population in the earthquake affected areas, totaling approximately 1.3 million people. Simultaneously, one dose of measles vaccine will also be administered to children 6-59 months in the same areas. This is extremely important as many have been exposed to minor cuts and open wounds, and also because communities have started clearing rubble from damaged houses which would expose many to cuts and injuries and possible exposure to tetanus. This immunization campaign has commenced in some districts and would be extended to all districts shortly. WHO is also stressing the importance of providing the standard three doses of tetanus-toxoid vaccine, as per national guidelines, for anyone who has suffered injuries.


The first suspected tetanus case, a 90-year-old patient has been referred to the Sardjito Hospital in Jogjakarta. The patient is under investigation and observation.


At the same time, WHO has sounded an alert for other possible post- surgical infections in patients in both the affected provinces of Yogyakarta and Central Java. Over 11000 patients have been treated for minor and major injuries, of whom, nearly 800 have been operated on, till 30th May. WHO's concern is that, given the pressure of the sheer numbers of people who were provided emergency care, it is now important to screen all such patients for follow-up treatment and care both in hospitals and for those who have been discharged.


A WHO-led sub-group for hospitals is to mobilize all the medical and orthopaedic experts available to form teams for follow-up with reconstruction, correction and rehabilitation surgery.


WHO is advocating the use of established principles and guidelines for patient care which include high quality hospital care, good hospital management and good waste management to minimize the risk of hospital-based infections.


Ideally, to prevent hospital-based infections, WHO recommends that patients be discharged at the earliest, followed by post-operative care at home. However, for many of the affected patients there are no homes to return to.


The local culture is very strong in community self-help. Experts are advising that where possible, patients be provided community- based rehabilitation with support from the national health authorities, NGOs and international agencies.


The area around Bantul abounds in more elderly people as many of the younger generation have left to work in other cities, or other countries. Being more frail, they are more vulnerable and are prone to infections and to delayed healing. These persons would need greater care.


Among those with no home to return to is 80-year-old Pringo Utomo, who lives alone. She has an open fracture of the leg. Her home in Be be kaan village of Bantul province is a typical Javan house, with a tiled roof. She was injured when a wall of her single floor house collapsed. Pringo lives alone, while her daughter, who lives in Jakarta, rushed down to take care of her, she now has no home to return to.


Moliyo Dati, 60, who was operated for multiple fractures in his leg at a government mobile hospital in Bantul, is a farmer who also lives in the same village. While his 24 year old son and wife live with him, he is extremely anxious about leaving the hospital as his house has been totally destroyed.


who.int/en