Infection Control in Tanzania

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Infection Control in Tanzania

• Dr. Peter C. Mgosha (MPH,)
• MINISTRY OF HEALTH AND SOCIAL WELFARE
• NATIONAL AIDS COTROL PROGRAMME
• P.O.BOX 11857
• DAR Es SALAAM TANZANIA

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Out line Presentation

• Tanzania profile
• Background
• TB/HIV notification
• TB/HIV Achievements
• Strategies for TB infection control

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Tanzania profile

• One of the 3-5 East African Countries
• Population 38.7m (38,710,723)
• Above 15 yrs 21.7m (21,710,169)
• Under 5 yrs 7.2 m (7,215,011)
  

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Background HIV fueling TB epidemic in Tanzania
Source NTLP, 2008
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Cumulative notified TB cases. Cumulative
TB/HIV cases. Started CPT Started ART
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Achievements

• Scaling-up started in 2005
• Service mechanisms based on pilot sites
• Recording and reporting system
• TB manuals have been reviewed
• Training materials developed
• Needs assessment tool developed
• TB/HIV policy developed
• ARV provision in TB clinics is a key
• TB screening tool to all PLHA developed and is in
  use

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Achievement cont.

• Basic TB/HIV activities
• DCT(PITC)-81
• Referral of patients
• Recording and reporting
• Screening of TB from HIV services
• Provision of ARV in TB clinic
• One Dar es Salaam based district (Temeke)
• 10 districts under CDC support
• 45 districts in GF-ATM round 3 support
• 36 districts in GF-ATM round 6 support

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Achievements cont

• 25 districts until Dec, 2006
• By July, 2007, 70 districts
• By June, 2008, TB/HIV activities covered the
  whole country TB/HIV officers recruited
• Community involvement-(Post TB cases club
  MUKIKUTE-Temeke)

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The infection control Strategies

• Based on
• A Administrative measures
• Assigning responsibility for TB infection
  control in the setting
• Conducting a TB risk assessment of the setting
• Developing and instituting a written TB infection
  control plan to ensure prompt detection, airborne
  precautions
• Treatment of persons who have suspected or
  confirmed TB disease
• Ensuring the timely availability of recommended
  laboratory processing, testing, and reporting of
  results to the ordering physician

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• A Administrative control Measures cont.
• Implementing effective work practices for the
  management of patients with suspected or
  confirmed TB disease
• Ensuring proper cleaning and sterilization or
  disinfection of potentially contaminated
  equipment
• Training and educating health facility staff
  (HFS) and evaluating HFS who are at risk for TB
  disease or who might be exposed to M.
  tuberculosis
• Using appropriate signage advising respiratory
  hygiene and cough etiquette and coordinating
  efforts with the council health management teams
  and regional health management teams

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B Environmental Control Measures

• Ventilation patterns
• Windows and doors are routinely kept open and any
  ventilation produced by the fans are usually
  directed to the air flow outside the waiting room
  throughout the windows and the doors.
• Open areas are dedicated to be waiting rooms

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C Personal protection

• Personal Respiratory Protection- HCW encouraged
  to wear N-95 respirator any time entering the MDR
  TB ward respirators have to closely fit to the
  face to prevent leakage around the edges
• Baseline TB screening- To prevent the
  occupational risk, regular TB screening of HCW is
  a recommended activity especially for certain
  health categories particularly exposed to active
  TB cases. e.g. CTC
• HCW identified as having active TB disease should
  be removed from the unit where they are providing
  service, regardless of the type of department
• Provider initiated counselling and testing (PICT)
• Occupational HIV exposure and post exposure
  management

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C Personal protection cont

• Disinfectants and waste management are usually
  maintained to all H/C Departments
• Encouraging laboratories to have at least two
  rooms, one for reception and the other one for
  performing the test.
• The preparations should be performed in a well
  ventilated room with sunlight.
• Laboratory safety precautions of handling
  specimen-wear gloves, wearing laboratory coats
  should be
• followed.

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C Personal protection cont

• TB Lab (e.g. Muhimbili National Hospital) smear,
  culture and Drug Susceptibility test (DST) are
  performed in a safety cabinet class II with
  double/single filter.
• Culture media, sputum containers and glass slides
  are autoclaved or burned in the incinerator prior
  to disposal.

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Challenges

• Suboptimal TB infection control at HF (suboptimal
  early identification of TB suspects, separation
  of TB suspects/cases, cough hygiene education ,
  room ventilation)
• Absence of TB infection control plan of the HF
• Low awareness on TB infection control among HCW
• Shortage of HR
• Stigma
• Lack of national TB IC guideline/SOP and training
  
• Package
• Absence of IPT guideline/SOP

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Way-forward

• Developing TB IC national guidelines/SOP
• Developed TB IC training package
• Developed TB IC posters targeted to HCWs
• Developed Cough Hygiene posters targeted to
• patients
• - Developing IPT guideline/SOP
• Recruiting more TB/HIV officers to coordinate
  TB/HIV collaborative activities in districts

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• MATERIAL AVAILABLE

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