As a healthcare professional,
you have a vital role to play
in tuberculosis infection control in your clinic.
If you see HIV positive patients in your clinic,
you know that they're at increased risk for getting TB
because they're very susceptible to certain infections.
In fact, TB is the leading cause of death
in people with HIV/AIDS.
TB is different from other opportunistic infections
because it's spread by the respiratory route,
and infected patients can spread the disease
to others in crowded clinics, including you.
This video is designed to give you practical information
to help you stop the spread of TB in your clinic
by improving TB infection control practices.
It's based on the World Health Organization Policy
on TB Infection Control in Health-Care Facilities,
Congregate Settings and Households.
Use this video as a supplement
to training you've already received
along with other training materials,
including the guidelines, assessment and planning tools,
posters and monitoring and evaluation forms
included with this video.
Topics include how TB is spread, who's at most risk,
and how to control TB.
We'll give you practical ideas on how to make simple changes
in your clinic set-up and in your practices
that can have a large impact on your health
and the health of your patients.
TB is usually spread when an infected person coughs
and produces small droplets which contain TB bacilli.
The droplets remain suspended in the air for hours.
When someone breathes in these droplets,
he or she can become infected with TB.
There are several factors
that can affect the likelihood of TB transmission:
The number of infected droplets generated by a person with TB,
the amount of time a TB-infected person
is in contact with others,
the amount of ventilation
in the area where the exposure takes place,
and the immune status of the person exposed.
TB is usually spread by coughing patients
who haven't been recognized as having TB
and aren't receiving treatment.
So, it's up to you to notice coughing patients
and get them diagnosed and treated quickly.
At the highest risk of getting TB
are those living with HIV/AIDS,
people living in crowded, poorly ventilated settings
such as correctional facilities,
military barracks or refugee camps,
patients with medical conditions
such as diabetes, cancer or renal failure,
and those taking immunosuppressive medications
like steroids or chemotherapy
and children under the age of five.
Who is most likely to interact with all of these people?
You are!
Because of your job,
you are very likely to come into contact
with many people who have TB
and that puts YOU at high risk of getting TB, too.
To control TB
there are four types of infection control measures:
Managerial Control Measures,
Administrative Control Measures,
Environmental Control Measures
and Personal Protective Equipment, or PPE.
Remember, whatever your role in the clinic,
you are critical in carrying out
these TB infection control measures.
Let's take a closer look how.
Facility administrators and managers
should provide leadership by promoting a culture of safety
and advocating for necessary resources
to conduct infection control measures.
This includes establishing an infection control committee
for the facility that meets regularly,
appointing someone to conduct a facility assessment
and developing an infection control plan and policies.
The basic building blocks of infection control
are the administrative control measures
and should be implemented by all members of the team.
These measures include
prompt identification of coughing patients,
promoting cough etiquette,
separating coughers from other patients,
and "fast-tracking" for prompt diagnosis and treatment.
They also include monitoring the time it takes
to get laboratory results back (such as sputum smear results)
and assuring the routine evaluation of clinic personnel
for TB.
It is the undiagnosed and untreated TB patient
that presents the greatest risk to others.
It's up to you to act as early as possible
to identify people coming into the clinic who might have TB--
and as you know, the most visible sign is coughing.
In a busy clinic,
early identification of coughing patients
may be done by the admissions clerk,
a community health worker, an educator or nurse.
Work with your team to designate the most appropriate staff
for this critical task.
Cough Etiquette refers to the practice
of covering all coughs and sneezes
to contain respiratory secretions.
All patients, visitors, and clinic staff
should be encouraged to cover their coughs and sneezes
with a handkerchief, or a tissue.
When a handkerchief or tissue is not available
coughing or sneezing into the upper arm or elbow
is the preferred technique
for preventing the spread of infection.
This may seem strange,
but infection control experts recommend this technique
as safer than coughing or sneezing into the hands.
Those who cough or sneeze into their hands
should wash them with soap and water
or use an alcohol-based hand rub.
If disposable surgical masks are available,
have coughing or sneezing patients wear them
to contain respiratory secretions.
Ask patients to dispose of masks in the waste bin after use.
A poster on cough etiquette is included
in the materials accompanying this video.
Promote cough etiquette every chance you have in the clinic--
at the entrance, at registration,
and every time you interact with a patient or visitor.
Remember you are a role model for behavior in the clinic,
so cover your own cough, too.
A key method for reducing TB transmission
is to separate coughing patients from non-coughing patients.
A trained clerk, nurse or anyone
that has contact with patients as they enter the clinic
can make this initial separation.
Ideally, coughing patients
should wait in a separate, outdoor area.
This minimizes contact
and takes advantage of natural ventilation.
You should explain to patients
that no one will lose their place in line
and that this is for their own protection.
Once separated, coughing patients should be fast-tracked
or quickly examined for additional symptoms
to determine if TB diagnostic tests are needed.
Finally, as part of administrative control measures,
lab staff and the infection control point person
should monitor the time it takes to get the lab results back,
such as sputum smear results
and assure there is routine evaluation of clinic personnel
for TB.
Environmental Control Measures
are the third major type of infection control measures.
They include the use of natural and mechanical ventilation
and ultraviolet germicidal irradiation.
These measures are used
to reduce the number of infectious droplets in the air.
If your facility is planning a renovation or new construction,
it will be important to consider
these environmental infection control measures
in the building design.
Using natural ventilation
in overcrowded waiting areas and hallways
is a relatively easy way
to decrease the risk of TB transmission.
In warmer climates,
building a covered outdoor waiting area is an inexpensive
and a good way to maximize ventilation
and reduce clinic congestion.
Opening windows and doors to maximize cross-ventilation
reduces the number of infectious TB droplets in the air.
This works in the home settings too,
so instruct patients to do this at home
if a family member is undergoing treatment for TB.
In clinics, consulting rooms should be arranged
so airflow moves away from the clinician
toward the patient to the outside.
Electric fans can be used
to assist in producing this airflow pattern.
Mechanical ventilation systems designed for optimal airflow
with the help of an engineer can reduce TB transmission.
But remember that ordinary air-conditioning units
do not reduce the risk of TB transmission.
Where available, ultraviolet germicidal irradiation
also known as UV lights or lamps
placed in the upper parts of a room
help to clear the air of infectious droplets.
To be effective, UV lamps need to be properly installed
and regularly cleaned and maintained.
There are some environmental control measures you can use
to make sputum collection less risky.
Ideally, sputum collection should be done outside
in a designated location away from other patients.
When performed indoors,
it should be done in a well-ventilated room or booth
designed to extract air to the outside.
Small, poorly ventilated bathrooms
should not be used for sputum collection
because they offer no safety to other patients or staff members.
The last TB infection control measure we'll discuss
is Personal Protective Equipment or PPE,
which refers to the use of particulate respirators
and surgical masks.
Particulate respirators known as N-95's or FFP2's
are worn by healthcare workers
and are different from surgical masks
because they filter out TB-infected droplets
as you breathe in.
If available, respirators should be worn by staff
when doing procedures such as bronchoscopy
and when caring for infectious TB patients or suspects,
especially when multi-drug resistant TB is suspected.
Surgical masks are not effective
in preventing the inhalation of TB droplets,
but when worn by patients
they can contain the majority of droplets
produced by coughs or sneezes,
thus reducing the risk of transmission.
Staff and patients
often have concerns about stigma during triaging
or when using particulate respirators or surgical masks.
It's important for you to be aware of these issues
and discuss ways to approach and communicate with patients
to minimize stigma.
In summary, we've covered the basics of TB infection control
including; how TB is spread, who is at most risk for TB;
and the managerial, administrative, environmental
and personal protective equipment measures
that can be used to control TB.
You personally are very important
in preventing TB transmission --
from one patient to another,
from a patient to a visitor in your clinic,
and to yourself and your family.
If you think you may be infected,
it's important to get screened and seek care immediately.
Although tuberculosis is a serious disease,
it can be treated and cured.
People coming into the clinic look to you
as a knowledgeable health professional.
You are in the best position
to educate them about TB infection control
and to demonstrate good infection control habits.
You CAN make a difference in TB infection control
in your facility, in your community,
and in your country.