Guidelines for TB Infection Control in High-HIV HIV Burden Settings

Transcription

1 Guidelines for TB Infection Control in High-HIV HIV Burden Settings Paul A. Jensen, PhD, PE Centers for Disease Control and Prevention Coordinating Center for Infectious Diseases National Center for HIV, STD, and TB Prevention Division of Tuberculosis Elimination Atlanta, Georgia USA

2 healthcare/pdf/who pdf

3 Tuberculosis Infection Control in the Era of Expanding HIV Care and Treatment Addendum to WHO Guidelines for the Prevention of Tuberculosis in Health Care Facilities in Resource- Limited Settings, 1999 CDC: WHO: IUATLD: Naomi Bock, Paul Jensen, Wanda Walton, Michael Iademarco,, Bess Miller Alasdair Reid, Pierre-Yves Norval, Paul Nunn Riitta Dlodlo

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5 Why were Guidelines Developed? People living with HIV/AIDS receive diagnosis, care, treatment, and/or support; and High prevalence of HIV infection, both known and undiagnosed, in settings such as prisons, jails, other detention centers, and drug rehabilitation centers.

6 Number and size of organisms liberated Wells 1934, Duguid 1945, Wells/Riley 1953, et al. Number of Organisms Liberated: Talking Coughing Sneezing Bacteria bearing droplets < Ø100 µm Jennison [1942] Size of Droplets (Fcn( of air velocity): Sneeze ~ 300 m/s Ø100µm ~ 100 m/s 75 % ~ Ø10 µm

7 Fate of Droplets Large droplets fall to ground relatively fast. ThefateoftheSmaller droplets will depend on the relative humidity of the air in the space. With evaporation of droplet, crystallisation crystallisation will occur, resulting in Droplet Nucleation,,withthe nucleus containing the infectious organism(s). A1.0µm Droplet Nucleus will settle at a rate of cm/s or 3 m in 24 hours!

8 What is Infection Control? Prevention of Transmission Patient to: Worker Patient Visitor Worker to: Worker Patient Visitor Visitor to: Worker Patient Visitor

9 It may seem a strange principal to enunciate as the very first requirement of a hospital is that it should do the sick no harm. Florence Nightingale. Notes on Hospitals, 1863

10 Hierarchy of Infection Controls Hierarchy of Infection Controls Worker Administrative Patient Facility Environmental Respiratory protection

11 How can we decrease the risk?

12 Hierarchy of Infection Controls Administrative controls to reduce risk of exposure, infection, and disease through policy and practice; Environmental (engineering) controls to reduce concentration of infectious bacilli in air in areas where contamination of air is likely; and Respiratory protection to protect personnel who must work in environments with contaminated air

13 Administrative Controls Prevention of droplet nuclei containing M. tuberculosis from being generated; Prevention of TB exposure to staff and patients; and Implementation of rapid and recommended diagnostic investigation and appropriate treatment for patients and staff suspected or known to have TB.

14 Administrative Control Program Infection control plan (including TB); Administrative support for procedures in the plan, including quality assurance; Training of staff; Education of patients and increasing community awareness; and Coordination and communication between the TB and HIV programs.

15 Five Proposed Steps for Patient Management to Prevent Transmission of TB in HIV Care Settings

16 What is Ventilation? Movement of air Pushing and/or pulling of particles and vapors Preferably in a controlled manner

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18 Ventilation Control Types of ventilation Natural Local General

19 Natural Ventilation

20 Natural Ventilation

21 Natural Ventilation

22 Natural Ventilation

23 Natural Ventilation

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25 Filters Filters Filters Filters Filters Filters

26 Room Air Cleaners

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28 Evaluation of Room Air Cleaners 1,000 Colony Forming Units (CFUs) Off On Position 1 Position 2 Position 3 Position 4 Position 5 Position 6 Position 7 Position 8 Position 9 Linear Elapsed Time (hours)

29 Ultraviolet Germicidal Irradiation

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32 Respiratory Protection Respirators can protect health workers; Frequently, they are unavailable in resource- limited settings; Respirator use should encouraged in high risk areas of hospitals and referral centers (e.g., bronchoscopy and MDR-TB); A CDC/NIOSH-certified N95 (orgreater)orcen- certified FFP2 (or greater) respirator should be used; and Use of a face mask does not protect health care workers, other staff, patients, or visitors against inhalation of TB.

33 Respirator vs. Face Mask Respirator has only tiny pores which block droplet nuclei and relies on an air tight seal around the entire edge Face mask has large pores and lacks air tight seal around edges

34 Ray s Take-Home Message We can immediately start implementing Infection Control measures by Thinking TB