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TB infection control measures

By Dr. Sachin Atre | 17 Nov, 2015

Dear Dr. Nardell,

We are conducting a study on TB and diabetes at Sassoon Hospitals in Pune, India. We want to adapt proper infection control measures in the study ward. Could you please advise on best possible measures and approximate costs required? Thanks. Dr. Sachin Atre

Replies

 

Nicaise NSABIMANA Replied at 3:37 AM, 18 Nov 2015

Dear Dr
As a line scientific discussion
Your research on DM and TB infection control is one combined topic or you
are doing both separately. Can you tell as which aspect or how your
research is formulated. Dr Nicaise Nsabimana internist and junior lecturer
in medicine faculty Gitwe University Rwanda

Dr. Sachin Atre Replied at 4:04 AM, 18 Nov 2015

It involves both TB and DM patients (Co-morbidity). It is an observational study. It involves interviews with patients and their sputum sample collection.

Shankar Dapkekar Replied at 10:30 AM, 20 Nov 2015

Dear Dr Sachin,

Myself Dr Shankar, working with RNTCP Maharashtra. Will be happy to help you on AIC for your study. Please connect to me on 8806402111.

Dr. Sachin Atre Replied at 11:24 AM, 20 Nov 2015

Dear Dr. Shankar,

Many thanks for your message. I will call you soon.

Regards,
Sachin

Edward Nardell, MD Moderator Replied at 2:33 PM, 20 Nov 2015

Sounds like you have an offer of help. Just a few general comments, since
"proper" infection control depends on the exact situation as determined by
a risk analysis. The problem is, what do you measure? Measuring risk of
transmission is really not possible routinely. The WHO TB IC Policy lists
all of the recommendations from administrative, environmental, and
respiratory protection, but does not really prioritize, which is essential,
since few institutions are able to incorporate all levels of protection.

As we have recently published, the single highest priority in TB infection
control is identifying unsuspected TB patients and known TB patients with
unsuspected drug resistance. Either can transmit while attention is
mis-directed to known patients on effective therapy. This intensified,
refocused approach of intensified active case finding and rapid, effective
treatment at the institutional level we call "FAST": Find cases Actively
(through cough surveillance and rapid molecular diagnostics), Separate
temporarily, and Treat effectively based on molecular DST. This is being
widely implemented in various settings. However, having been in many
crowded ambulatory waiting areas in high burden settings, it is hard to
imagine how this will work when cough is common and diagnostic resources
limited. In those situations, the next priority is environmental - triage,
separation, ventilation, UV air disinfection, optimal patient flow to avoid
crowding. While all of this costs money for human and other resources,
building renovations, reconfiguration, etc, it should be clear that no one
can put a number on it. It all depends on the situation and how much can
be funded, since there are no limits to improvements. Some personnel
issues are - who will do cough surveillance, assure that specimens reach
the lab quickly, and that results are known as soon as possible? Who will
pay for extra molecular testing? Some institutions are finding the
resources and some countries, Vietnam for example, plan to implement FAST
widely.

Ed

Hal Levin Replied at 4:04 PM, 20 Nov 2015

Ed,
Another very excellent post. Far down on your list are the "who will do...? questions that I would like to make more specific.
A couple of things to add to  your list of "who will do...? items in building design and operation controls, is who will ensure that ventilation (natural or otherwise) is actually happening and that UV systems are working properly:
* In the case of natural ventilation, there are window, door, skylight, and possibly other openings to be managed.
* In the case of mechanical ventilation, to confirm that fans are running and airflow is in the right direction.
* in the case of UV, that the correct lamps are installed and operating, that air distribution is effectively moving air to the UV radiation area, and that occupant exposure is within established limits.

Dr. Sachin Atre Replied at 8:57 PM, 20 Nov 2015

Dear Dr. Ed,

Many thanks for your advice. This is really helpful to think through. As you rightly pointed out, we first need some expert to see the setting and then based on available resources, we can go for reasonable measures for infection control.

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