Screening and Treatment of Tuberculosis

Screening and Treatment of Tuberculosis

Infection Control in Tuberculosis

General measures

1. Patients with suspected /confirmed respiratory tuberculosis, regardless of the sputum status, should not be admitted to an open ward containing immune-compromised patients, transplant or oncology patients until pronounced non-infectious by the physician in charge, preferably in consultation with the Microbiologist.

2. The Infection Control Team should be informed. Staff and visitors who are non-immune should be warned of the risk.

3. Duration of infection control precautions in pulmonary TB should be for two weeks after start of effective antimicrobial treatment and sputum microscopy should be negative for AFB. In immunosuppressed patients duration of infection control should be till sputum microscopy is negative for AFB.

Infection control precautions

Isolation

Isolate in a single room with negative air flow ventilation in relation to the surrounding areas. As there are no negative pressure rooms available in Sri Lankan hospitals, a room with 2 strong exhaust fans could be used instead. Alternatively, a single room with good ventilation may be used.

1. Room with a washbasin and preferably, with an attached toilet

2. The door must be kept closed at all times. Preferably self-closing doors.

3. Ensure adequate supply of hand wash antiseptics and single use towels.

4. Ensure a clinical waste bag is kept inside the room.

5. A sputum mug containing 5% Phenol (Lysol) for sputum should be provided. This is ideally autoclaved before disposal. If facilities are not available for autoclaving they should be disposed of by burning or deep burying after disinfection using 5% phenol or 1% hypochorite for 30 min.

Currently provide the disposable plastic cup to collect the sputum and send them for incineration.

6. Visitors should be restricted, as far as possible.

Babies of sputum positive mothers need not be separated from the mothers and breastfeeding should be continued with the baby on prophylactic INAH therapy, with the mother wearing a mask.

Protective clothing

1. Gloves are not usually necessary, but should be worn for contact with respiratory secretions or contaminated articles.

2. Plastic aprons and gowns should be worn for contact with patients and their environment to avoid contamination of clothing.

3. Ordinary surgical masks do not provide the required level of protection. If the Particulate Filter

Respirator (PFR) masks are available, they can be used. Surgical masks could be given to patients

with uncontrolled cough to reduce aerosol spread. Wearing a mask for the staff is recommended when direct exposure to respiratory secretions is unavoidable. eg: during physiotherapy or bronchoscopy. Masks should be close fitting. Wearing a mask is not a substitute for good infection control.

Hand hygiene

1. Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient.

2. Wash hands thoroughly with an antiseptic and dry with a single use towel.

Equipment

1. Ideally, Disposable respiratory equipment and accessories should be used. o Where this is not possible, they should be thoroughly cleaned and disinfected or sterilized before reuse.

Movements

1. Limit movement within the hospital,

eg to X-ray department, to a minimum

Contact tracing

1. Contact tracing is an integral part of the routine management of the patients with tuberculosis. The person responsible for local contact tracing should be named by the hospital authorities.

Hospital Infection Control Manual © SLCM / 2005

TB Clinic at NIMH

A clinic has started at NIMH premises, to screen and continue treatment for Tuberculosis liaised with the National Programme for Tuberculosis Control and Chest Diseases (NPTCCD) and MO chest clinic attached to Colombo East Base Hospital. A Medical Officer from NPTCCD visits once a week for the above clinic.

1. All the patients residing in long term wards are screened for TB and start treatment for newly diagnosed patients.

2. Previously diagnosed patients are followed up at the clinic and continue the treatment.