TB infection control is a combination of measures aimed at minimizing the risk of TB transmission within populations, that is groups of people.
Doctors and other health care workers who provide care for patients with TB, must follow TB infection control procedures to ensure that TB infection is not passed from one person to another.
The following has been said about hospitals in India.
The hospital is the last place where you would expect to get sick. It is where you go to get help. But a lot of people do contract TB while they are in hospital. They come in for something else and leave the hospital having TB as well.1“Frightening injection sends never-ending pain throughout your body”, www.health24.com
In Mumbai it has been found that around 10% of municipal health posts in the city need major structural changes to prevent transmission of TB among patients and hospital staff. A study of around 140 clinics to find out whether they followed the central government guidelines, recommended the addition of new floors and windows to improve ventilation at these centres. At the remaining 90% of facilities simple yet practically feasible changes were recommended.
Suggestions included the rearrangement of tables so that the air flow is in the direction of doctor to patient. Sliding windows were removed, and an opening was created in the ceiling. Exhaust fans and pedestal fans were installed to improve air ventilation. The study showed how simple practical solutions can help cut down the risk of transmission
An example of effective changes being made is at a dispensary in Santacruz (East). The dispensary treats seven multi drug resistant TB patients and 21 drug sensitive TB patients. The 70 other daily visitors, who come to the dispensary’s outpatient department were at risk of getting infected with TB.2“Revamp Mumbai’s civic clinics to prevent spread of airborne diseases says study, Hindustan Times, 14 February 2018 www.hindustantimes.com/mumbai-news/civic-clinics-in-mumbai-need-revamp-to-prevent-spread-of-airborne-diseases-study/
We rearranged the tables and opened the windows. We also have separate entrances for TB patients, to reduce the rate of transmission. Daksha Shah, civic TB officer
It is not just in resource poor countries that TB transmission occurs in hospitals. In 2012 it was reported that a patient in the UK had become infected with TB and had died, as a result of receiving kidney dialysis when sitting next to another patient with infectious TB.3Exclusive: patient deaths spark tuberculosis investigation, Health Service Journal, 12 October 2012 www.hsj.co.uk
Every country should have infection control guidance which clearly needs to take into account local settings and resources, as well as the numbers of people being provided with care.
The term health care facility is usually used to refer to a physical building or set of buildings, such as a hospital. A health care setting, to which TB infection control must also apply, is any establishment, whether private or public, that is engaged in direct patient care on site. A health care setting is any place where health care workers might share air space with people with TB disease or in which health care workers might be in contact with clinical specimens.
Various setting types might be present in a single facility. Health care settings include inpatient settings, outpatient settings, and non traditional facility based settings. People working in health care settings have a higher incidence of TB than the general population.
There are various levels of TB infection control depending on whether a facility or setting is being considered.
Facility level measures for TB infection control should include
The basis of TB infection control in health care settings is early and rapid diagnosis, and the proper management of TB patients.
Infection control guidance must not only be written but also implemented. The implementation of administrative and environmental controls, and the use of personal protective equipment, has been shown to reduce the transmission of TB in health care settings.
So the organization of TB infection control at the level of health care setting can be considered as being in three parts, administrative controls, environmental controls, and respiratory protection controls. The most important part of TB infection control is the use of administrative measures to reduce the risk of exposure to people who might have TB disease.
Administrative measures should include
There are also environmental controls which are an important part of TB infection control. Environmental controls are controls which prevent and reduce the concentration of infectious droplets.
Environmental controls are of two types
Although environmental controls can include major work such as the rebuilding of certain areas, and ventilation improvements such as ducting, they can also include simpler measures such as those given in the example from India above.
There is finally the use of respiratory protective equipment. This consists of the use of protective equipment in situations that pose a high risk of exposure to TB disease. Use of respiratory protection equipment can further reduce the risk for exposure of health care workers to infectious droplets that have been expelled into the air from a patient with infectious TB disease.
The following measures can be taken to reduce the risk for exposure
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WHO Policy on TB Infection Control in Health Care Facilities, Congregate Settings and Households, 2009, http://www.who.int/tb/publications/2009/infection_control/en/
CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005 https://www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm
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|1.||↑||“Frightening injection sends never-ending pain throughout your body”, www.health24.com|
|2.||↑||“Revamp Mumbai’s civic clinics to prevent spread of airborne diseases says study, Hindustan Times, 14 February 2018 www.hindustantimes.com/mumbai-news/civic-clinics-in-mumbai-need-revamp-to-prevent-spread-of-airborne-diseases-study/|
|3.||↑||Exclusive: patient deaths spark tuberculosis investigation, Health Service Journal, 12 October 2012 www.hsj.co.uk|