Disposal of sputum for home infection control in MDR TB treatment
Started by Philipp Du Cros on 12 Jan 2010
Last edited by Sophie Beauvais on 17 Mar 2010
Hello,
I am wondering what members who are treating MDR TB advise patients for the home infection control management of sputum while patients are still infectious. Do you treat this as medical waste or are patients simply advised to use tissues and dispose in plastic bags that would then be disposed in normal garbage collection or burnt?
Thanks
Philipp
Keywords: Personal Respiratory Protection, TB IC Guidelines, home sputum disposal MDR-TB
Edward Nardell, MD
We should be encouraging community-based TB care, including MDR treatment, and household infection control issues deserve considerable thought and debate, given that there is not likely to be any data.
There is data that it is relatively difficult to re-aerosolize sputum into respirable size particles from hard surfaces like floors and walls, and even more difficult to re-aerosolize from porous surfaces like tissues. Eating utensiles, I hope we can agree, pose no threat whatsoever since Mtb is not contracted through the GI tract, generally, and certainly not from such miniscule doses.
My unsupported opinion is that household medical waste can be put into plastic bags, tied, and disposed of with normal garbage. I am certainly open to other views.
Ed Nardell
9:45 AM, 12 Jan 2010 | Permalink
Sandeep Ahuja
Our patients are advised to collect the sputum in a tin container throughout the day. In the evening they are advised to add a little water and boil the contents for 20 minutes. Then dispose off in running water.
This has been advised by the public hospitals involved in TB control.
Sandeep Ahuja
CEO, Operation ASHA
Fighting Tuberculosis Worldwide
www.opasha.org
Member, Coordinating Board, Stop TB Partnership
A partnership housed by the World Health Organization
10:40 AM, 12 Jan 2010 | Permalink
Edward Nardell, MD
That is certainly another approach, but I worry about an open container of sputum sitting around the house, with children running around, etc. and the potential for spillage and aerosolization from that spillage, however unlikely. Again, probably no data existing or fortcoming to help in these decisions.
Another point is the Madras data suggesting that most household contacts are infected before treatment starts. Presumably we are talking about after treatment starts when the risk, even for MDR, should be deminishing. How much more risk could be added by decisions on the disposal of sputum is unclear, but I would guess, not much.
Ed
10:55 AM, 12 Jan 2010 | Permalink
Sandeep Ahuja
Of course I should have mentioned that the container is kept covered and at a height so it does not spill with a someone hitting it etc.
Sandeep Ahuja
11:39 AM, 12 Jan 2010 | Permalink
MUHAMMED AFOLABI
This is a thought-provoking discourse. It has the potential of controlling the spread of MDR-TB in resource-poor African homes. I am aware Sodium hypochlorite is an effective biocide for Mycobacteria. There is however a need to establish the effectiveness of Sodium hypochlorite in sterilizing the sputum before disposal at home..... Afolabi Muhammed, Research Clinician, MRC, The Gambia
9:42 AM, 13 Jan 2010 | Permalink
Ifunanya Igbojekwe
Dear all,
Discussions on TB Infection control erupts interesting line of thoughts. I
am wondering if and what the role of temperature aerosolization of sputum
collected in a container would be when the patients reopens the container
for subsequent sputum deposition? Or are they being asked to use fresh
containers for each sputum deposition? this question is bearing in mind that
in Hot regions, the sputum in the container may be warmed up relative to the
environment; absolutely dependent on where it is kept.
i am aware it had been mentioned in this community that there isn't much
data on the effect of temperature on TB transmission.
regards
11:43 AM, 16 Feb 2010 | Permalink
Edward Nardell, MD
Brief response: It is common to have patients open and close sputum
containers. Although aerosolization is theoretically possible, the
sputum is not concentrated like a pure culture and as a source of
airborne infection, it is probably much less significant than the act of
coughing (ie, aerosolization) that the cup is opened to accommodate.
Both coughing and opening should be done in a well-ventilated
environment. Within the temperature range of most clinics, I doubt
temperature is a major determinant. Organisms are quite cold tolerant,
but heat could dry them out.
Ed
Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and
Infectious Diseases)
Brigham and Women's Hospital
Division of Global Health Equity
FXB Building, 709c
651 Huntington Ave.
Boston, MA 02115
4:37 PM, 19 Feb 2010 | Permalink
Grace Egos, RMT, MSPH
sorry but I didn't quite get it:
*patients reopens the container for subsequent sputum deposition? Or are
they being asked to use fresh containers for each sputum deposition?*
**
1. are we talking here of new sputum collected and reused sputum container?
2. or is it just during the process of one time collection where there is an
interval of sputum deposition?
3. agree with Dr. Ed Nardell : aerosolization is possible - I
am more concerned with the collection area which is critical
Is this an open air type of sputum collection booth? HOw far is this from
the congregate setting? Where is this located in relation to the prevailing
wind direction?
Grace
Grace E. Egos, MSPH
Manager - PMDT Laboratory Expansion
Tropical Disease Foundation
Philippine Institute of Tuberculosis
10:33 PM, 21 Feb 2010 | Permalink