TB Infection Control

Dear Esther, This is a very interesting question. CDC TB screening risk classifications are low risk, medium risk and potential ongoing transmission (or high risk). In this classification,
Low risk should be applied only to settings where HCW are not expected to finds persons with TB disease and therefore exposure to M. tuberculosis is unlikely. Medium risk applies to settings where HCW will or possibly will be exposed to persons with TB disease or to clinical specimens that might contain M. tuberculosis. Ongoing transmission should be temporarily applied to any setting or facility (or situation) where there is suggestive evidence that transmission is occurring. For example, CDC risk classification suggests that for a inpatient setting with < 200 beds, if you have = or > than 3 TB patients a year, you a MEDIUM risk. The number of TB patients who are seen in a HCF can be used as a proxy measure of risk for TB transmission. Obviously for a country with a high burden of TB, it is very common to have > than 3 inpatients a year in an inpatient setting, so, I would risk in general is high. I think one important issue for high burden countries is to be ...

Dear Esther, This is a very interesting question. CDC TB screening risk classifications are low risk, medium risk and potential ongoing transmission (or high risk). In this classification,
Low risk should be applied only to settings where HCW are not expected to finds persons with TB disease and therefore exposure to M. tuberculosis is unlikely. Medium risk applies to settings where HCW will or possibly will be exposed to persons with TB disease or to clinical specimens that might contain M. tuberculosis. Ongoing transmission should be temporarily applied to any setting or facility (or situation) where there is suggestive evidence that transmission is occurring. For example, CDC risk classification suggests that for a inpatient setting with < 200 beds, if you have = or > than 3 TB patients a year, you a MEDIUM risk. The number of TB patients who are seen in a HCF can be used as a proxy measure of risk for TB transmission. Obviously for a country with a high burden of TB, it is very common to have > than 3 inpatients a year in an inpatient setting, so, I would risk in general is high. I think one important issue for high burden countries is to be attentive to the the number of patients who visited/stayed in a facility/setting when evaluating TB risk and compliance with TBIC. Some settings will be high risk, others medium and probably very few low risk. I would love to hear more from other people on this subject.
Luciana

Sorry, Esther, the CDC classification I talked about is presented in the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.
Luciana

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-----Original Message-----
From: "GHDonline (Esther Buregyeya)" <>
Date: Fri May 25 09:19:23 GMT 2012
To: "Isabel Ochoa Delgado" <>
CC:
Subject: [TB Infection Control] Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility

Esther Buregyeya added a new discussion to the TB Infection Control community.

Title: Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility

Discussion contents:
"Dear Colleagues,
Kindly help me with this question. How is the risk of TB transmission in a facility assessed based the number TB patients evaluated at a facility. And what are the cut off numbers for the different risks i.e low, medium and high?
Thank you"

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Dear Esther
I don't think it has to do with the number of patients per se although these do contribute- it is to do with the IPC facilities and how these are implemented.
At our hospital we have managed to reduce occupationally acquired TB from 32 per year down to 4- still a lot but now the TB-IPC is enforced and it has improved the situation- the number of TB cases remain unchanged.
Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Control Africa Network (ICAN)
Extraordinary Professor
Div of Community Health, Fac of Health Sciences, Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
4th ICAN Conference, Cape Town, 27th to 29th Nov, 2012
Visit the Infection Control Africa Network (ICAN) website on
http://www.ICANetwork.co.za


-----Original Message-----
From: GHDonline (Esther Buregyeya) [mailto:]
Sent: 25 May 2012 11:19 AM
To: Mehtar, S, Prof <>
Subject: [TB Infection Control] Assessment of the risk of tuberculosis transmission based on number of patients ...

Dear Esther
I don't think it has to do with the number of patients per se although these do contribute- it is to do with the IPC facilities and how these are implemented.
At our hospital we have managed to reduce occupationally acquired TB from 32 per year down to 4- still a lot but now the TB-IPC is enforced and it has improved the situation- the number of TB cases remain unchanged.
Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Control Africa Network (ICAN)
Extraordinary Professor
Div of Community Health, Fac of Health Sciences, Stellenbosch Uni
PO Box 19063,
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
http://www.sun.ac.za/uipc
4th ICAN Conference, Cape Town, 27th to 29th Nov, 2012
Visit the Infection Control Africa Network (ICAN) website on
http://www.ICANetwork.co.za


-----Original Message-----
From: GHDonline (Esther Buregyeya) [mailto:]
Sent: 25 May 2012 11:19 AM
To: Mehtar, S, Prof <>
Subject: [TB Infection Control] Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility

Esther Buregyeya added a new discussion to the TB Infection Control community.

Title: Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility

Discussion contents:
"Dear Colleagues,
Kindly help me with this question. How is the risk of TB transmission in a facility assessed based the number TB patients evaluated at a facility. And what are the cut off numbers for the different risks i.e low, medium and high?
Thank you"

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E-pos vrywaringsklousule

Hierdie e-pos mag vertroulike inligting bevat en mag regtens geprivilegeerd wees en is slegs bedoel vir die persoon aan wie dit geadresseer is. Indien u nie die bedoelde ontvanger is nie, word u hiermee in kennis gestel dat u hierdie dokument geensins mag gebruik, versprei of kopieer nie. Stel ook asseblief die sender onmiddellik per telefoon in kennis en vee die e-pos uit. Die Universiteit aanvaar nie aanspreeklikheid vir enige skade, verlies of uitgawe wat voortspruit uit hierdie e-pos en/of die oopmaak van enige lêers aangeheg by hierdie e-pos nie.

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Probability plays a big role in TB transmission. A minority of highly
infectious patients account for most of the transmission when this has been
looked at carefully. There is no such thing as "average infectiousness".
The numbers of patients admitted, on a ward, or in a clinic waiting room
has a double impact: 1) The greater the number, the greater the chance that
one or more will be highly infectious, and 2) the greater the number of
people exposed. The cut-offs in the CDC guidelines are not applicable to
high-burden settings but really trying to identify low-burden sites in the
US where no precautions can be justified by the very low TB incidence. I
would no get caught up in any fixed numbers, but in planning take into
account the general priniciple that smaller units of patients are better
than larger units from a transmission perspective.

Ed

On Fri, May 25, 2012 at 5:18 AM, GHDonline (Esther Buregyeya) <
> wrote:

> Esther Buregyeya added a new discussion to the TB Infection Control
> community.
>
> Title: Assessment of the risk of tuberculosis transmission based on number
> of patients seen in a health facility
>
> Discussion contents:
> "Dear Colleagues,
> Kindly help me ...

Probability plays a big role in TB transmission. A minority of highly
infectious patients account for most of the transmission when this has been
looked at carefully. There is no such thing as "average infectiousness".
The numbers of patients admitted, on a ward, or in a clinic waiting room
has a double impact: 1) The greater the number, the greater the chance that
one or more will be highly infectious, and 2) the greater the number of
people exposed. The cut-offs in the CDC guidelines are not applicable to
high-burden settings but really trying to identify low-burden sites in the
US where no precautions can be justified by the very low TB incidence. I
would no get caught up in any fixed numbers, but in planning take into
account the general priniciple that smaller units of patients are better
than larger units from a transmission perspective.

Ed

On Fri, May 25, 2012 at 5:18 AM, GHDonline (Esther Buregyeya) <
> wrote:

> Esther Buregyeya added a new discussion to the TB Infection Control
> community.
>
> Title: Assessment of the risk of tuberculosis transmission based on number
> of patients seen in a health facility
>
> Discussion contents:
> "Dear Colleagues,
> Kindly help me with this question. How is the risk of TB transmission in a
> facility assessed based the number TB patients evaluated at a facility. And
> what are the cut off numbers for the different risks i.e low, medium and
> high?
> Thank you"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/assessment-of-the-risk-of-tuberculosis...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/edward-nardell-md/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline.
>
>

Agree!
S

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Extraordinary Professor, Div Community Health, Fac Health Sciences
Stellenbosch University

Chair of Infection Control Africa Network (ICAN)
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
Want to know what is happening in Africa in infection control?
Visit Infection Control Africa Network (ICAN)
http://www.ICANetwork.co.za
Dates for your diary!
4th ICAN conference: 26-29th November, 2012, Cape Town

-----Original Message-----
From: GHDonline (Edward Nardell, MD) [mailto:]
Sent: 27 May 2012 18:45
To: Mehtar, S, Prof <>
Subject: Re: [TB Infection Control] Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility

Edward Nardell, MD replied to the discussion "Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility" in the TB Infection Control community.

Reply contents:
"Probability plays a big role in TB transmission. A minority of highly infectious patients account for most of the transmission when this has been looked at carefully. There is no such thing as "average infectiousness".
The numbers ...

Agree!
S

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Extraordinary Professor, Div Community Health, Fac Health Sciences
Stellenbosch University

Chair of Infection Control Africa Network (ICAN)
Tygerberg 7505, Cape Town
Tel: +27 21 938 5051
Fax: + 27 21 938 5065
Mobile: +27 82 852 3697
Want to know what is happening in Africa in infection control?
Visit Infection Control Africa Network (ICAN)
http://www.ICANetwork.co.za
Dates for your diary!
4th ICAN conference: 26-29th November, 2012, Cape Town

-----Original Message-----
From: GHDonline (Edward Nardell, MD) [mailto:]
Sent: 27 May 2012 18:45
To: Mehtar, S, Prof <>
Subject: Re: [TB Infection Control] Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility

Edward Nardell, MD replied to the discussion "Assessment of the risk of tuberculosis transmission based on number of patients seen in a health facility" in the TB Infection Control community.

Reply contents:
"Probability plays a big role in TB transmission. A minority of highly infectious patients account for most of the transmission when this has been looked at carefully. There is no such thing as "average infectiousness".
The numbers of patients admitted, on a ward, or in a clinic waiting room has a double impact: 1) The greater the number, the greater the chance that one or more will be highly infectious, and 2) the greater the number of people exposed. The cut-offs in the CDC guidelines are not applicable to high-burden settings but really trying to identify low-burden sites in the US where no precautions can be justified by the very low TB incidence. I would no get caught up in any fixed numbers, but in planning take into account the general priniciple that smaller units of patients are better than larger units from a transmission perspective.

Ed

On Fri, May 25, 2012 at 5:18 AM, GHDonline (Esther Buregyeya) < > wrote:

> Esther Buregyeya added a new discussion to the TB Infection Control
> community.
>
> Title: Assessment of the risk of tuberculosis transmission based on
> number of patients seen in a health facility
>
> Discussion contents:
> "Dear Colleagues,
> Kindly help me with this question. How is the risk of TB transmission
> in a facility assessed based the number TB patients evaluated at a
> facility. And what are the cut off numbers for the different risks i.e
> low, medium and high?
> Thank you"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/assessment-of-the-risk-of-tuber
> culosis-transmissio/?id=10004&format=text&type=instant
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/edward-nardell-md/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this
> e-mail; it will be shared with all community members and posted as is.
> Files cannot be added via email attachment and must be uploaded directly to GHDonline.
>
>"

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E-pos vrywaringsklousule

Hierdie e-pos mag vertroulike inligting bevat en mag regtens geprivilegeerd wees en is slegs bedoel vir die persoon aan wie dit geadresseer is. Indien u nie die bedoelde ontvanger is nie, word u hiermee in kennis gestel dat u hierdie dokument geensins mag gebruik, versprei of kopieer nie. Stel ook asseblief die sender onmiddellik per telefoon in kennis en vee die e-pos uit. Die Universiteit aanvaar nie aanspreeklikheid vir enige skade, verlies of uitgawe wat voortspruit uit hierdie e-pos en/of die oopmaak van enige lêers aangeheg by hierdie e-pos nie.

E-mail disclaimer

This e-mail may contain confidential information and may be legally privileged and is intended only for the person to whom it is addressed. If you are not the intended recipient, you are notified that you may not use, distribute or copy this document in any manner whatsoever. Kindly also notify the sender immediately by telephone, and delete the e-mail. The University does not accept liability for any damage, loss or expense arising from this e-mail and/or accessing any files attached to this e-mail.

This is to thank you all who contributed to my question. It is now very clear that in a high TB prevalent/transmission setting like Uganda, where I come from, these numbers don't mean anything.
Esther

Indeed in high prevalence settings the risk is omnipresent and therefore the need for active screening of patients. Cough monitors to identify suspects, quick lab work up, and effective treatment reduces the risk