TB Infection Control

An interesting practical dilemma

Started by S. Mehtar on 25 Nov 2009
Last edited by Sophie Beauvais on 03 Dec 2009

Dear Network
Here is a practical problem which I would like you all to consider and please advise
In LMI countries, the high prevalence of TB cases and respiratory disease transmission (H1N1 etc) has led to awareness of transmission based precautions to supplement the administrative and engineering controls.

It is recommended that surgical masks be used by healthcare workers for examining suspected cases of TB. Also, surgical masks are used in low and middle risk areas and procedures. Family and relatives are advised to use surgical masks.
For MDR-(and XDR) TB, N95 respirators or FFP3 respirators are recommended. As the are for high risk procedures on any patient such as bronchoscopy, induction of sputum etc.
For H1N1, it is recommended that surgical masks be used unless carrying out an high risk procedure in which case respirators are indicated.

Now, when writing general IPC protocols especially for transmission based precautions, Droplet precautions = surgical mask; airborne precautions = respirators. But, there is a dialemma when one suggests N95 respirators in H1N1 which is actually included in the droplet precaution protocol and therefore surgical masks are indicated. Similarly for airborne precautions which mean the use of respirators and therefore surgical masks are generally used unless there is a high risk procedure or MDR-TB patient.
What are other people's thoughts? Are we confusing the folks who rely on us for sound IPC advice?
Regards
Shaheen




Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital & Stellenbosch Uni

Keywords: General Resources