Exposed to Polluted Water

Question 1

Defined as any body of water that is suspected of containing chemical or biological agents in concentrations that could potentially harm an
unprotected diver and/or surface support personnel

Answer 1

Contaminated water

Question 2

Is flowing water or a closed body of water more of a concern

Answer 2

• Closed body has more concern
• Flowing allows for removal or dilution of contaminants

Question 3

In general where do most biological and chemical contaminants tend to concentrate

Answer 3

In the sediment rather than in the water column

Question 4

Contaminated water diving should be performed using

Answer 4

Appropriate PPE

Question 5

Biological contaminants in polluted water

Answer 5

(a) Harmful algal blooms (e.g., red tide),
(b) Bacteria (e.g., fecal coliforms),
(c) Viruses and parasites which could potentially harm an unprotected diver.
(d) Biological contaminants may be present in storm water runoff and pose hazards to divers and to surface support personnel, especially when diving in near shore, urban areas within 36 hours of a storm event.

Question 6

Five bacteria that most commonly produce soft tissue infections in association with exposure to water or water-related animals

Answer 6

(a) Aeromonas species
(b) Edwardsiella tarda,
(c) Erysipelothrix rhusiopathiae,
(d) Vibrio vulnificus,
(e) Mycobacterium marinum

Question 7

Trauma leading to infection in polluted water includes

Answer 7

(a) Puncture wounds due to fishhooks
(b) Fish spines and lacerations due to boat motor propeller blades
(c) A variety of other objects present in areas where sailors go wading or swimming

Question 8

Management of soft tissue infections following water exposure includes

Answer 8

(a) Assessment to determine whether treatment requires hospitalization
(b) Empiric antibiotic administration, assessment of tetanus vaccination status
(c) Assessment of tetanus vaccination status
(d) Surgical consultation for potential debridement in patients with necrotizing infections

Question 9

Medications for water exposure

Answer 9

• Cephalexin (Keflex) Dose: 250mg PO four times daily (QID)
  OR
• Clindamycin 300 mg PO q 6 hours for 7 days
• • Flagyl 500 mg 500mg PO TID for 7-10 day

Question 10

Medication if exposure to sewage – contaminated water or if soil – contaminated wound

Answer 10

• Doxycycline (100mg twice daily)
  OR