Infection Control in Health Care Facilities In ResourceLimited Settings

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Infection Control in Health Care Facilities In
Resource-Limited Settings

• Kayla Laserson
• TLC Course
• April 2001

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Background (1)

• Studies have shown that health care workers (HCW)
  caring for TB patients are at risk for TB
  infection and disease
• Risk is greatest in those HCW with the closest
  and longest duration of contact with the TB
  patient
• Non-existent or ineffective TB infection control
  (IC) facilitates TB transmission in health care
  facilities

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Background (2)

• Inexpensive IC measures can be implemented to
  help reduce transmission of TB in health care
  facilities at district and referral level
  hospitals
• The risk of patient and HCW acquisition of TB
  could be significantly reduced if governments,
  health authorities, and HCWs themselves make IC
  a priority

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Background (3)

• WHO convened a working group to produce
• Guidelines for the Prevention of TB in Health
  Care Facilities in Resource-Limited Settings
• WHO/CDC/TB/99.269

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Infection Control Measures

• There are three levels of IC measures
• Administrative (managerial)
• Environmental
• Personal Respiratory Protection
• Administrative controls are the most important
  since environmental and personal respiratory
  protection will not work in the absence of
  administrative controls

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Where IC Measures Impact

• Each level works at a different point in the
  transmission process
• Administrative (managerial)
• Reduces HCW and patient exposure
• Environmental
• Reduces the concentration of infectious droplet
  nuclei
• Personal Respiratory Protection
• Protects HCWs in areas where the concentration of
  droplet nuclei cannot be adequately reduced by
  administrative and environmental controls

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Infection Control Priorities

• First priority Administrative Controls
• Second Priority Environmental Controls
• Third Priority Personal Respiratory Protection

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Administrative Controls

• Early and rapid diagnosis of infectious TB
  patients
• TB should be suspected in patients with TB
  symptoms and/or TB risk factors
• Suspect TB patients should be prioritized in
  outpatient settings to reduce exposure in waiting
  areas
• Prompt separation/ isolation of infectious TB
  Patients
• Collection of sputum in well-ventilated areas

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Administrative Controls

• Prompt initiation of anti-TB Rx
• Education of patients to cover their mouths
• Assessment of the risk of transmission in the
  facility
• Development of an IC plan for facility (1
  individual should be assigned responsibility)
• Training of HCWs

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Environmental Controls

• Use of open windows and fans to maximize natural
  ventilation and control of the direction of
  airflow
• Use of exhaust systems, UV, HEPA filtration
  systems

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Personal Respiratory Protection

• Least effective of IC measures
• Special mask made out of material that filters
  small particles (95 filtration efficiency for
  particles 0.3 microns in diameter) and good face
  fit expensive
• Type of surgical mask (cloth, paper) commonly
  used by HCW will NOT filter out infectious
  droplet nuclei useful to put on patient to
  prevent generation of nuclei

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Personal Respiratory Protection

• Should only be used in specialized high-risk
  settings when all other IC measures have been
  implemented
• Isolation rooms
• Bronchoscopy suites
• Sputum-induction
• Autopsy suites

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Conclusion

• HCWs are a vital resource in the fight against
  TB
• The measures presented here are cost-effective
  and can be directly implemented in
  resource-limited settings
• Efforts should be made to implement these
  strategies to prevent nosocomial transmission of
  TB