Module 3 - TB Infection control incbo

Transcription

1 Module 3 - TB Infection control incbo TB Infectioncontrol Sirkku Grierson Numberof slides from: StopTB TB infection control for national managers, 2009 Varvara Ivanchenko, Paul Jensen: TB IC courses in Murmansk and St. Petersbur, 2011, 2012

2 Whatis TB infectioncontrol? Module 3 Policies and procedures, to minimize the risk of M. tuberculosis transmission in health care and congregate settings from client, worker or visitor to client, worker or visitor.

3 Whocouldbea sourceof TB here? Client, staff, other person whohasunidentified TB orwhois not taking his TB drugs reqularily Canhe/shespread TB to others. How? Whoare exposedto TB?

4 Factorsaffectingriskof transmission Module 3 Environmentsize of room and ventilation Infectiousness Exposure length and proximity of contact, susceptibility

5 One of the peoplein the picture has infectious TB. Is the riskof transmission HIGH orlow

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9 TB infectioncontrolmeasures Module3 Administrative controls Environmental controls Respiratory protection controls

10 A hierarchy of control measures Module3 Administrative controls (impacts the largest number of people); policies and practices to reduce risk of exposure by preventing the generation of droplet nuclei containing M. tuberculosis in the air; Environmental controls;engineering systems to prevent the spread and reduce the amount of TB in the air; Respiratory-protection controls; use of respiratory protective equipment to further protect personnel who must work in environments with contaminated air

11 Managerialactivities Module3 Assigning responsibility for IC Training staff Conducting TB IC assessment Surveillance of TB disease among staff Developing a written infection control plan Use of spaces, renovation, construction Development of policies and protocols Implementing, monitoring, evaluating and revising TB IC plan and measures routinely

12 How facility design, renovation, and use can reduce the risk of TB transmission Module 3 Topic 3.1 Infection control indoors 1. Reduce crowding 2. Organize patient flow to minimize exposure to infectious patients 3. Maximize natural ventilation

13 Reducecrowding Module3 StopTB TB infection control for national managers, 2009

14 Organizepatient/clientflowto minimizeexposureto infectioustb Module 3

15 Mixingof clients/patientsand staff Module 3

16 Separationof clients/patientsand staff Module 3 Topic 3.1 Infection control indoors

17 Investigate the possibilities for outdoor waiting area Module 3

18 Sputumcollectionin a safeplace Module 3 Topic 3.1 Infection control indoors DON T USE GOOD

19 Administrative controls Module 3

20 Develop policies and practices for patient management to prevent transmission of TB Module 3 Topic 3.1 Infection control indoors Identify clients with TB symptoms Separate them from others Time to expose others is minimized fast track Cough etiquette

21 Promotecoughetiquette; educate, useposters Module 3 Clients, staff and visitors Do not cough against other persons. Cover your mouth and nose with tissue when coughing or sneezing Youmaybeaskedto puton a surgical mask to protect others Put used tissue in the waste basket Wash your hands

22 Protectionof CBO personnel Module3 1. Appropriate information and training 2. Encourage HIV testing 3. Encourage TB diagnostic investigation

23 Environmental controls Module3 engineering technologies to prevent spread and reduce the concentration of infectious droplet nuclei in air - Natural ventilation - Mechanical ventilation o local, general - Air cleaning methods (supplementary measures) o Ultraviolet Germicidal Irradiation (UVGI) o Room air cleaners (HEPA filtration)

24 What is ventilation? Module3 Movement of air in a building and replacement of air in the building with air from the outside Pushing and/ or pulling of particles and vapours Preferably in a controlled manner

25 Natural ventilation Module 3 Topic 3.1 Infection control indoors wind Created by use of external airflows created by natural forces such as wind temperature Relies on open doors and windows to bring in air from the outside

26 How ventilation reduces the risk? Module 3 When air enters it dilutes the concentration of airborne particles in room air Removal occurs when contaminated room air is either exhausted outdoors to a safe place filtered or irradiated to trap or inactivate droplet nuclei containing M tuberculosis The more effective the mixing of air, the better the dilution of infectious particles.

27 Working location Where should the worker sit? Wind Wind

28 Direction of wind changes? What would you do now? Wind Wind

29 Good compromise Wind Wind

30 Cross ventilation and shape

31 Cross ventilation Module3

32 Poorair mixing, littleair exchange Wind

33 Fanscanbeusedto distributeair Module3

34 Photos: Varvara Ivanchenko, TB IC course, St. Petersburg 2012

35 Naturalventilation Module3 Use natural ventilation when possible by opening windows and doors. Use fans to distribute air. Locate the worker (or other clients) near the clean air source. Locate the person who may be infectious near a place where the air is exhausted away.

36 Respiratory protection controls Module3 protect personnel who must work in environments with contaminated air planning how, when and where respirators are used training HCWs in respiratory protection educating patients in cough etiquette and respiratory hygiene

37 Surgicalmasks Module3 Reduce the spread of microorganisms from the wearer to others, by capturing large wet particles when the person exhales Do not protect the wearer from inhaling small infectious aerosols.

38 Usesurgicalmasksfor personswith suspectedorconfirmed infectioustb disease Module3

39 Surgicalmasksdonotprotectstaff fromtb Module 3 Topic 3.2 Cough etiquette and personal respiratory protection

40 Particulaterespiratorsfor staff Module3 Protect the wearer from inhaling droplet nuclei Filter out infectious aerosols Fit closely to the face to prevent leakage around the edges

41 Particulaterespiratorssuitablefor TB work, there are other models too Module 3 Topic 3.2 Cough etiquette and personal respiratory protection N95 (USA) Filter out > 95% of particles FFP2, FFP3 (Europe) Filter out > 94-98% of particles

42 Promotecoughetiquette Module3 Waiting areas Consultation rooms During examinations During transportation

43 Summary Module3 The foundation of TB infection control is early and rapid diagnosis of TB separation of infectious cases and effective treatment. The better ventilated the area, the lower risk of transmission of TB. When used with administrative and environmental controls respirators provide additional protection

44 Thankyoufor your attention