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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