Infection Control Overview: TB Session 1: Infection Control Basics.

Infection Control Overview: TB

Session 1: Infection Control Basics

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Learning Objectives

This session deals with the control of TB

By the end of the session, participants will be able to protect themselves and others from TB

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Steps to Prevent the Spread of TB to Staff and Patients

Detect infectious patients early

Ensure cross ventilation and wear masks during cough-inducing procedures

Leave windows open and direct air flow from staff to patients

Separate AFB smear positive patients from others

Instruct patients to turn their head and cover their mouth when coughing

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Early Detection and Treatment of TB Protects You!

TB is the greatest hazard nurses face

Most infections are passed from patients, visitors and staff whom no one suspects of having TB

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Our visitor has been coughing for three weeks and is losing weight!

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Doctor, we are sending you a person to be evaluated for TB. Please let us know

when she can come back to the ward

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Have Chronic Coughs Evaluated

A cough greater than 3 weeks should be evaluated whether in you, another staff member, a visitor, a volunteer, family member or patient

Act early!

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Discussion: Tuberculosis and Nurses

What are the tasks that puts you at most risk for contracting TB?

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Cough Producing Procedures that put Health-Care Personnel at Risk

Bronchoscopy

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Cough Producing Procedures that put Health-Care Personnel at Risk (cont’d)

Getting a sputum specimen

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Cough Producing Procedures that put Health-Care Personnel at Risk (cont’d)

Suctioning

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Cough Producing Procedures that put Health-Care Personnel at Risk (cont’d)

Nebuliser treatments

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What are the Risks Involved in these Procedures? Surgery

Placing intercostal drains

Handling mycobacterium cultures

Cleaning suction cups

Post-mortem

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Discussion: High Risk Procedures

Before proceeding for bronchoscopy, what precautions should you follow?

In what way may you be putting yourself or your patients at risk?

How could this be improved?

How is this similar or different from other high-risk procedures?

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TB (N95) Masks

TB masks should be used during high risk procedures:

N95 mask has a filter efficiency of 95%

Can be reused until contaminated or clogged

Must be discarded when breathing becomes difficult

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Do other Masks Help?

A paper or cloth mask can get wet in as little as 10 minutes, allowing bacteria to pass

If mask is not tight over the nose and mouth, unfiltered air will be sucked in around the nose and cheeks

What is more important than masks? Early detection and treatment

Good ventilation

Isolation of pulmonary TB cases

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Other Factors that put Staff at Risk: No cross breeze

Patients care areas without 2 open facing windows

DANGER:

Bronchoscopy suite without windows or outside airflow

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Protect Yourself with Good Ventilation

Open windows

See patients in rooms with a window on each side of the room

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Protect Yourself with Good Ventilation (cont’d)

Health worker Patient Open window

Proper Airflow Direction

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How can you Reduce the Risk of TB for these Staff?

Nurse placing PPD’s in center of the office

Clerical staff entering records behind in office near window

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Instruct Coughing Patients to Turn their Heads, and Cover their Mouths

Cover the mouth with a cloth, a sleeve or a sari to stop germs going into the air

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Protecting Yourself and Others from TB

Separate infectious TB (smear + or smears pending) patients from other patients

Staff who do not work directly with patients should not enter areas with infectious TB patients

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Which is the Most Dangerous Mix of Patients and Why? HIV - and HIV +

Smear + TB and HIV +

MDRTB smear + and HIV+

MDRTB smear + and HIV -

Greatest Risk!

Low risk

High risk

High risk

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Don’t Mix Non-Infectious TB and Infectious TB Patients

Questions for discussion:

When do we consider people non-infectious?

What precautions should we take with patients who are on ARVs?

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MDRTB Patients Should not Mix with other Patients Multiple drug resistant TB (MDRTB) is not

treatable by first line treatment

50% or more who develop MDRTB disease will die

These patients must not be in the same building as uninfected persons

Patients in a hospital can infect more people than at home

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Summary: Steps to Protect Yourself and Others from TB Ensure a cross breeze, open windows and the

direction of air flow from the health care worker to the patient to outside

Separate non-infected patients from patient who are, or might be infectious

Have patients turn their head and cover their mouth when they cough

Keep non-essential staff out of areas with infectious patients or cough-inducing procedures

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Key Points

Preventing the spread of TB includes:

Early detection and treatment

Strict isolation of smear positive patients

Good ventilation

Extra precautions during cough inducing procedures

Attention to patient placement

Teaching cough hygiene

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