A wound-dressing room that still smells of the Mun River

(A typical scenario based on situations we see often; names and details are illustrative.)

Nurse Ann is a registered nurse who directs a subdistrict health promoting hospital, known in Thailand as a Ro Pho So Tho, in Warin Chamrap district, Ubon Ratchathani. Her small health centre sits not far from the Mun River and serves several thousand people across a cluster of villages: older adults who collect blood pressure and diabetes medicines each month, pregnant women attending antenatal checks, toddlers due for vaccinations, and bedridden patients her team visits at home.

This year the Mun overflowed and water stood about sixty centimetres deep inside the building for almost two weeks. The team moved to a temporary service point in a hilltop temple pavilion. They examined patients on folding tables, dressed wounds under torchlight and handed out medicine from plastic crates they had rescued just in time. Everyone was exhausted, yet they kept smiling for the villagers.

When the water receded, Ann returned with her staff and village health volunteers. Mud lay thick across the waiting-room floor. Foam-padded waiting chairs were swollen. The lower filing cabinets holding patient records were soaked through. A tide line ran across the tiled walls of the dressing room, and the base of a dental chair bought only last year was caked in silt. The team spent almost a week washing, scrubbing and wiping. The floors shone again, but every morning a damp, river-mud smell still hung in the dressing room and the medical supply store.

"We're a health facility," Ann told her team. "If a patient comes in to have a wound dressed and goes home with an infection, what do we say to the village?" That question is at the heart of this article. Small facilities such as private clinics and subdistrict health centres in Ubon Ratchathani, Sukhothai, Ayutthaya, Pathum Thani, Nonthaburi, Chiang Mai or Hat Yai have to meet a higher standard of cleanliness than an ordinary home, because the people who walk through the door are already vulnerable. Reopening after a flood takes more than "cleaning it well." Below we look at the hidden germs, who is most at risk, which approaches fall short, and where ozone disinfection fills a gap in a health facility's recovery plan.

The germs hiding in a health facility after the water goes down

A flooded clinic differs from a flooded house in one crucial way: many of the people using the building have weakened immunity, open wounds, or procedures that give germs a way into the body. A microbe that might only cause a sneeze at home can become a wound infection in a dressing room. These are the main groups to take seriously.

1. Airborne mold: a danger for immunocompromised patients

Aspergillus is a mold found everywhere in the environment, and it grows readily on wet walls, ceiling boards, paper and other soaked materials. For a healthy person, breathing in a few spores may cause little trouble. For patients with weakened immunity, such as people receiving chemotherapy, people with advanced HIV, those on immune-suppressing drugs or people with poorly controlled diabetes, spores can cause lung infections that are difficult to treat. That is why large hospitals take airborne mold control very seriously, and small facilities should be equally aware.

In clinics and health centres, mold favours the medical records room where paper absorbs water, the supply store full of cardboard boxes, ceiling boards above examination rooms, the lower walls of waiting areas and foam-padded waiting chairs. The WHO and the US CDC advise cleaning and drying flooded materials within 24 to 48 hours to limit mold growth. In reality, facilities that sat underwater for days have usually already missed that window.

2. Moisture-loving bacteria: a risk to wounds and equipment

Bacteria that thrive in water and damp places, such as Pseudomonas and other Gram-negative organisms, are commonly found in sinks, drains, contaminated solution bottles and surfaces that stay wet. They are well-known causes of wound infections and healthcare-associated infections. When floodwater contaminates a building's plumbing and drains, the risk in dressing rooms, injection rooms and dental rooms rises noticeably.

3. Germs from sewage and wastewater

Floodwater often carries organisms from septic tanks and sewers, including E. coli, Salmonella, Shigella and intestinal viruses, which then settle on floors, counters and furniture. They cause diarrhoea, abdominal pain, vomiting and fever. Older adults and small children who wait a long time to be seen can pick them up from stair rails, chair arms and the queue-ticket counter.

4. Leptospirosis and other post-flood infections patients bring in

After a flood, health centres are the front line for leptospirosis, known locally as rat urine disease, which typically causes a sudden high fever and severe calf pain after wading through water. They also see diarrhoea, skin infections, athlete's foot and conjunctivitis. At the same time, staff who wade in to clean the building are at risk of leptospirosis themselves. Any staff member with fever and calf pain needs medical assessment straight away. A clean building, a separate screening area and fewer environmental germ sources protect both other patients and the staff.

Who is most at risk while a facility is not fully restored?

• Older adults with chronic diseases such as diabetes, hypertension, kidney disease or COPD, who attend regularly.
• Patients with wounds, especially diabetic foot ulcers and pressure sores that need ongoing dressing.
• Pregnant women and new mothers attending antenatal and postnatal checks.
• Infants and young children coming for scheduled vaccinations and sitting in the same waiting room as feverish patients.
• Immunocompromised patients, including those with cancer, those on immunosuppressants and people with advanced HIV.
• Health workers who work long hours in damp, contaminated conditions for weeks on end.

What happens when a facility reopens before it is truly ready

Health of patients and staff

The most troubling risk is a patient who comes in to treat one condition and leaves carrying another infection. A wound that should heal in two weeks can become inflamed and spread. A patient with asthma or emphysema may flare up after sitting in a waiting room full of spores. Staff who work in a stuffy, damp room every day start developing allergies, lingering coughs and more sick days, just when the community needs them most.

Money and assets

Medical supplies, consumables and equipment are expensive. If damp and mold are allowed to spread, wooden cabinets, chairs, bed curtains and some equipment may be ruined and need replacing. For a private clinic, every closed day is lost income while rent, salaries and equipment instalments keep running.

Time and continuity of care

Patients with chronic diseases who go weeks without medication risk complications. Children whose vaccinations are postponed are exposed to preventable diseases. Reopening quickly matters, but reopening and then closing again because of hygiene problems loses even more time.

Trust and standards

Villagers notice immediately when a room smells musty or when dark stains appear on an exam room wall. A facility the community has always trusted may be questioned. A private clinic may receive negative online reviews, and public units must be ready for infection-control inspections by supervising agencies.

Families and community

A subdistrict health centre is the first place rural families turn to. If it stays closed, people must travel far to the district hospital, paying for transport and losing a day's work, and some simply stop seeking care, with long-term consequences for the whole household.

Why routine washing and wiping still leave gaps in a health facility

Health workers are already skilled at cleaning and disinfection, but post-flood conditions bring specific limits that routine methods do not overcome.

1. Surface disinfectants only work where they are applied. Hospital disinfectants perform well on cleaned surfaces, but they do not deal with spores in the air, in ceiling voids, behind medicine cabinets or inside foam chairs.
2. The flooded area is bigger than a small team can wipe thoroughly. A health centre may have only a handful of staff who must keep seeing patients at the same time. Wiping every corner repeatedly is close to impossible.
3. Using strong chlorine in closed rooms creates harsh fumes that irritate the lungs of respiratory patients and staff, and mixing it with some cleaners can release dangerous gases.
4. Running fans to drive out damp speeds drying, but where mold has already started, the airflow carries spores into dressing rooms and supply stores that should be the cleanest areas of all.
5. Painting over stains or putting up new wall coverings makes rooms look ready, yet mold inside the wall returns within weeks, just when everyone thinks the job is done.
6. Air fresheners or odour blocks mask the smell for a while, but the cause remains, and fragrance in an exam room is unsuitable for sensitive patients.

What a health facility needs is an additional step that addresses germs in the air and in places hands cannot reach, leaves no residue on exam couches or dispensing counters, and can be completed quickly enough not to delay reopening further.

WHD ozone disinfection for clinics and health centres

World Health Disinfection (WHD) provides residential and building ozone disinfection, including for hospitals and healthcare facilities. Ozone (O3) is a strongly oxidising gas. Released into a sealed room, it breaks down the cell structures of viruses, bacteria and mold and breaks apart odour-causing molecules. It then reverts to oxygen (O2), leaving no chemical residue on exam couches, dental chairs or dispensing counters.

The company states that its process has been tested by Thailand's Department of Medical Sciences and Intertek (UK), eliminating 99.99% of viruses, bacteria and mold according to the test results the company has received. Facility managers can request the certification documents for their recovery plan or reports to a supervising agency.

Essential points to understand: ozone treatment takes place only in an empty, closed space. Patients, staff, pets and plants must leave the zone completely, and nobody returns until the rest and ventilation period set by the team has passed. Ozone is a step after mud removal, washing and drying. It does not replace infection-control cleaning, it does not replace the approved sterilisation of medical instruments, and it does not make flood-damaged medicines or vaccines usable again. Medicines and supplies that touched floodwater or were stored at the wrong temperature must be handled according to public health guidance.

How the work is done in a health facility

1. Survey and prioritise. The team walks the site with the person responsible for infection control and zones it into dressing room, injection room, exam rooms, dental room, supply store, records room, waiting area and toilets, putting procedure rooms first.
2. Prepare. Confirm zones are washed and dry; move medicines, vaccines and temperature-controlled items out according to guidance; open empty cupboards and drawers; close doors and windows; post no-entry signs.
3. Fill. The generator runs until the concentration suits the room volume.
4. Contact time. The room stays sealed while ozone works on air and surfaces. A typical cycle is about 30 minutes per zone.
5. Rest and ventilate. Ozone reverts to oxygen and the room is aired before staff go back in.
6. Handover. The team flags areas where moisture should still be monitored so the facility can plan repairs or a repeat treatment if needed.

After reopening, facilities can maintain high-touch points with a medical-grade disinfectant such as Chemgene. When an ozone job is 15,000 baht or more, WHD also includes a free medical-grade disinfectant spray.

10 reasons clinics and health centres choose ozone before reopening

1. Cleaner air in procedure rooms. Dressing and injection rooms need clean air, not just a wiped counter.
2. Reaches ceiling voids, behind medicine cabinets and under exam couches, where a small team lacks the time and hands to wipe every crevice.
3. No residue on surfaces patients touch. Ozone reverts to oxygen, which suits rooms used by sensitive patients. Read about chemical residue.
4. Treats musty and mud odours at the source, so patients sense straight away that the facility is ready to care for them.
5. Tested by credible bodies: the Department of Medical Sciences and Intertek (UK), according to the test results the company has received.
6. Short cycles of about 30 minutes per zone that can be scheduled outside service hours or on holidays. See the service details.
7. Supports existing infection control. It does not replace it; it fills the part surface disinfectants cannot reach.
8. Protects staff by reducing exposure to spores and germs at work when everyone is tired and immunity may be lower.
9. Documented action to support reports to supervising agencies and to reassure the community. Request a quotation.
10. A team experienced in demanding buildings such as hospitals and hotels, familiar with clean-zone separation and work sequencing.

Before and after: a facility patients feel confident returning to

Example case: a shophouse clinic in Hat Yai and its ten-day reopening plan

(An illustrative example to explain the process, not a verified customer review.)

Dr Ton runs a general medical clinic in a two-storey shophouse near a market in Hat Yai, Songkhla. The ground floor holds reception, the waiting area, two exam rooms and a small dressing room; upstairs are the medicine store and staff room. During a major flood, water nearly one metre deep sat on the ground floor for five days. Fortunately, the team carried medicines and expensive equipment upstairs in time.

Days 1 to 3: Staff in boots and rubber gloves removed the mud and threw out all the swollen foam waiting chairs. Bed curtains were taken down and hot-washed. Tiled floors and walls were washed with clean water and detergent. Every medical instrument left on the ground floor was checked and reprocessed through standard sterilisation. Wet medicines were separated for disposal.

Days 4 to 6: An electrician inspected the wiring. A builder cut out the swollen lower section of partition walls in the exam rooms and left the frame to dry, with a dehumidifier running alongside open ventilation. A technician cleaned every air conditioner.

Day 7: The WHD team surveyed the clinic and zoned it into dressing room, exam rooms, waiting area and upstairs medicine store, treating one zone at a time with nobody in the building. After the rest and ventilation period, staff went back in to set up equipment.

Days 8 to 10: Wipeable plastic chairs replaced the foam ones, wall moisture was checked daily, and the clinic posted on its page exactly what had been done before reopening.

In this example, what mattered most to Dr Ton was not skipping steps. Ozone did not let him skip washing, repairs or instrument sterilisation, but it closed the gap on air and hidden corners, giving him the confidence to tell his regular patients, most of them older adults with chronic conditions, that they could come back for care.

Health facility flood recovery checklist: before and after ozone

Safety and initial assessment

• Cut the power and have an electrician inspect the system, including sockets for vaccine fridges and medical equipment.
• Cleaning staff wear boots, rubber gloves, masks and eye protection.
• Photograph damage and list damaged equipment, medicines and supplies for reporting or insurance.
• Set up a temporary service point or referral arrangements while the facility is closed.

Medicines, vaccines and instruments

• Separate medicines and supplies that touched floodwater or were stored at the wrong temperature, and handle them according to public health guidance.
• Check vaccine fridge temperature logs; after long outages, consult the person responsible for vaccines before use.
• Reprocess instruments that require sterilisation through the facility's standard procedure; room ozone does not replace this.

Building and surfaces

• Remove mud and wash floors, walls, counters and furniture with clean water and detergent.
• Aim to dry within 24 to 48 hours, using dehumidifiers where available.
• Discard foam chairs, curtains and absorbent materials soaked in contaminated water; cut out swollen partitions or insulation.
• Clean air conditioners and check sink drains in procedure rooms.
• Dry or back up wet medical records according to your organisation's document rules.

Ozone day and afterwards

• Confirm no patients, staff or plants remain in the zone and post no-entry signs on every door.
• Re-enter only after the team confirms the rest and ventilation period is complete.
• Disinfect high-touch points daily with products suitable for healthcare settings.
• Screen patients with fever, diarrhoea or rashes separately from vaccination and antenatal visitors.
• Watch for damp patches or mold returning during the first month and monitor staff health.

Frequently asked questions

Can the medicine store be treated with ozone?

Move medicines, vaccines and items needing temperature or humidity control out first, following your agency's guidance, then treat the empty room to deal with mold and odour in cabinets, shelves and air before returning usable stock.

Can ozone replace sterilising medical instruments?

No. Instruments that require sterilisation must go through the facility's standard process. Room ozone reduces germs in the building's air and surfaces; it is a separate step.

How long must we close for ozone treatment?

A typical cycle is about 30 minutes per zone, plus preparation and ventilation time. Several zones can be done back to back on a holiday or outside service hours.

What about bedridden patients staying in the building?

They must be moved out of the zone being treated; ozone is never used in an occupied room. The team will sequence zones so patients can be moved safely into areas that are already finished.

A staff member has fever and calf pain after the clean-up. What should they do?

See a doctor immediately and mention wading through floodwater, since this may be leptospirosis, which needs prompt treatment.

Can public agencies request procurement documents?

Yes. Contact WHD to arrange a site survey, a quotation and the company's test certification for your procurement process.

Let your facility be the community's refuge again

Talk to the WHD team about ozone disinfection for your clinic, subdistrict health centre or healthcare facility after the flood.

Book Clinic Ozone Disinfection

Call 065-556-6294 · LINE @whd268 · Email worldhealthdisinfection@gmail.com

Related services and reading

• Residential and building ozone disinfection
• Chemgene medical-grade disinfectant
• Disinfection services for organisations
• Certification documents

References

• World Health Organization fact sheets
• CDC: Floods and Your Health