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How to prevent DR TB breeding grounds

Friedman, 2010

Leonie Borstlap MSF TB Infection Control Practitioner


When is a person infectious? • When undiagnosed (and untreated) • Between diagnosis and treatment initiation • When receiving inadequate treatment • When failing treatment (first and second line)


TB infection control principles

 Reducing risk of generation and exposure to infectious droplets  Reducing the concentration of infectious droplets in the air in areas where contamination of air is likely  Providing a barrier to exhalation and inhalation of infectious droplets


What are key Infection Control components? • Early and rapid diagnosis + correct treatment • Comprehensive TB care • Separation/isolation by status • Decentralised treatment and shorter inpatient stays • Occupational health screening • Education and training

Friedman, 2010


Health care facilities


Risk factors in health facilities Risk factors: • Undetected and untreated TB cases in general facilities • Undiagnosed DR cases in TB inpatient facilities High risk areas: • Sputum collection room • Laboratories • Radiology (X-ray room) • Waiting areas


Risk factors in health facilities Occupational TB risks: • • • •

Outpatient facilities General medical wards Inpatient facilities Laboratories

(Joshi et al and Menzies et al)

4.2 – 11.6 3.9 – 36.6 14.6 – 99.0 42.5 – 132.3


Decentralised TB care Large facility: - Higher probability of infectious cases and cross infection - More people exposed

2 cases = 98 exposed

10 small facilities: 2 cases = 18 exposed 80 protected = risk reduction of 82 %


Administrative controls • Prompt identification and separation of infectious cases • Cough hygiene • Patient education • TB screening and infection control training for all staff • Risk assessments for each facility and IC policy

MSF Khayelitsha, SA


Administrative controls Estimated number of bacilli liberated by:

• Talking: • Coughing: • Sneezing:

0-200 0-3,500 4,500-1,000,000

(Wells 1934, Duguid 1945, Wells/Riley 1953 et.al)


Administrative controls • Prompt identification and separation of infectious cases • Cough hygiene • Patient education • TB screening and infection control training for all staff • Risk assessments for each facility and IC policy

MSF Khayelitsha, SA


Environmental controls • • • •

Facility design and use Ventilation UV-C light Sputum booth MSF Khayelitsha, SA

MSF Khayelitsha, SA

Friedman, 2010


Personal protective controls • Respirators for staff & visitors • Paper/surgical masks for patients Friedman, 2010

MSF Khayelitsha, SA

MSF Khayelitsha, SA


Prisons


Risk factors in prisons • Undetected and/or untreated TB cases • Overcrowding • Vulnerable group (co-morbidities, malnutrition, substance abuse, poor hygiene, etc.) • Delayed case finding and poor treatment results • Limited ventilation or access to open air


Particular IC measures in prisons • Screening new arrivals • Provide access to testing and treatment • Communication with actors involved in diagnosis and treatment • Education of employees and prisoners • Maximise ventilation (natural ventilation/ceiling fans/louvers in doors & walls/roof turbine)


Further action needed…..?! • Increasing attention for dangers of institutions as breeding ground for DR TB • Liberating funds to ensure early detection, correct diagnoses and proper treatment in high transmission risk institutions • Ensuring airborne IC becomes an integral part of management of institutions


Thank you

How to prevent DR TB breeding grounds  

This presentation was made by Leonie Borstlap, MSF TB Infection Control Practitioner, at the Myanmar drug-resistant TB symposium: Turning th...

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