Criteria for installation of upperroom UVGI systems in ambulatory TB treament locations
I would like to open a discussion on what criteria to use before deciding to install upper room UVGI in ambulatory TB treatment settings. Previously we were considering to install in all locations with more than 20 TB patients and then we lowered that to 10. Here is some info on the context.
1. Most of these locations do not have patients present 24 hours a day, in fact, the majority of them will only have them in the mornings.
2. Segregation is difficult given lack of HR capacity (usually there is only one nurse to deliver treatment, which makes segregation difficult even if you have the space). So there is quite a bit of mixing between DS, DR, S-ve and S+. (yes, we are working on this, no it is not possible to get some patients to come in the afternoons)
3. We have commitment for regular maintenance and cleaning.
4. We have SEVERE winters, gas shortages, lack of heat. As a result most facilities seal windows with plastic, completely eliminating natural ventilation. It is not possible to change this; it is so cold in our treatment locations that it is already an adherence issue. All of this makes UVGI one of our ONLY options for environmental measures during winter months.
5. Although these locations will not have TB suspects, they often start their treatment from these locations from the very 1st day of treatment. That said, we also have a fair amount of adherence issues, treatment failures, and patients slow to convert, although I don’t have stats off the top of my head (other than our 25% defaulter rate for DR…)
6. All patients have had DST and are on appropriate treatment.
7. We have a separate plan for TB hospitals and I would prefer not discuss it in this discussion.
8. Patients take anywhere between 20 minutes and 1 hour to take their medications. (which are administered to 3 patients at a time so that is correctly observed.)
10. We currently support approximately 80 of these ambulatory sites, which is why we need to develop criteria, as we cannot afford to install it everywhere. However, if I can provide good justifications, budget is not that big of a problem.
11. All sites consist of between 1 and 3 rooms which are separate (with their own entrance) from all other non-TB health services.
12. Mechanical ventilation is not an option for these locations for various reasons that I don’t want to go into in this post.
So my biggest issue is if upper room UVGI is justified for 10 patients who are likely on effective treatment but for whom there are only a few other IC measures in place and natural ventilation is not possible for 4 months of the year.
What criteria do you think I should use to choose locations for installation?
Susan Adolph, RN
ICO MSF Uzbekistan/Tajikistan