TB Infection Control

Here are some thoughts.
1. Compared to HCWs, visitors have a relatively short exposure to
patients, and if their primary exposure is their relatives, they have
likely already been exposed for months before the diagnosis, and any
additional exposure once treatment has started is likely to be
minimal.
2. Once patients are on effective therapy, the risk of transmission is
quickly and profoundly reduced. The greater risk is from the
unsuspected, undiagnosed cases in the community. It is true that
patients on ineffective treatment are likely to remain infectious.
Rather than investing in respirators for visitors, it would make more
sense to invest in rapid diagnostics and rapid DSTs to be sure
patients are diagnosed quickly with a DST.
3. Surgical masks, while not recommended for health care workers, have
been recommended for visitors. The rationale is severalfold. If not
fit tested, which is not possible for visitors, surgical masks may not
offer that much more protection than surgical masks. Surgical masks
are not totally ineffective in protecting the wearer. Instead of
about 80% protection for a respirator, allowing for face seal leak,
the protection might be 50 or 60%. While not optimal, it is far
better than nothing, and ...

Here are some thoughts.
1. Compared to HCWs, visitors have a relatively short exposure to
patients, and if their primary exposure is their relatives, they have
likely already been exposed for months before the diagnosis, and any
additional exposure once treatment has started is likely to be
minimal.
2. Once patients are on effective therapy, the risk of transmission is
quickly and profoundly reduced. The greater risk is from the
unsuspected, undiagnosed cases in the community. It is true that
patients on ineffective treatment are likely to remain infectious.
Rather than investing in respirators for visitors, it would make more
sense to invest in rapid diagnostics and rapid DSTs to be sure
patients are diagnosed quickly with a DST.
3. Surgical masks, while not recommended for health care workers, have
been recommended for visitors. The rationale is severalfold. If not
fit tested, which is not possible for visitors, surgical masks may not
offer that much more protection than surgical masks. Surgical masks
are not totally ineffective in protecting the wearer. Instead of
about 80% protection for a respirator, allowing for face seal leak,
the protection might be 50 or 60%. While not optimal, it is far
better than nothing, and roughly equivalent to doubling ventilation or
other more costly interventions.

Conclusion: I would recommend surgical masks, not respirators, for
visitors and take steps to see that all patients in the hospital are
on effective treatment, i.e, based on a rapid DST.

Ed

On Sat, Jun 30, 2012 at 3:51 PM, GHDonline (Susan Adolph)
<> wrote:
> Susan Adolph added a new discussion to the TB Infection Control community.
>
> Title: How to provide respirators for visitors to TB facilities?
>
> Discussion contents:
> "Hello All,
>
> I was hoping some of you can share your experiences in providing N95 respirators  (or FFP2) to family members visiting TB ward or hospitals. Despite trying to switch to a community based model of care, we still have hundreds of inpatients and various TB facilities. Currently, visitors to these facilities are not provided with respiratory protection. However this will change in the very near future.  So, from an IMPLEMENTATION point of view, how have other programs handled this? A new respirator for every visitor for every visit will not be possible due to the expense. But asking visitors to reuse respirators is complicated. Further complicating things is the lack of staff to instruct visitors on proper donning and care of the respirator.  Placing respirators and signage at entrances is also difficult as they will likely disappear for various reasons.  Access in general to the facilities is poorly controlled.
>
> So given all of these challenges, I’m curious to hear your experiences and suggestions regarding this matter.
>
> Susan Adolph, RN
> ICO for MSF in Uzbekistan/Tajikistan"
>
> --
> View this post online:
> <http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>
>
> 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.
>

May be also "best fitted" surgical mask for the patient....(MSF experience as well, not evaluated)

Dear Susan
We categorically do NOT recommend N95 respirators for anyone but HCWs. There are obvious problems with fit testing all visitors and of course the cost is very high. There really is no indication for the use of N95 respirators- surgical masks will suffice and are easier to handle in the community situation.
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 (Susan Adolph) [mailto:]
Sent: 30 June 2012 09:52 PM
To: Mehtar, S, Prof <>
Subject: [TB Infection Control] How to provide respirators for visitors to TB facilities?

Susan Adolph added a new discussion to the TB Infection Control community.

Title: How to provide respirators for visitors to TB facilities?

Discussion ...

Dear Susan
We categorically do NOT recommend N95 respirators for anyone but HCWs. There are obvious problems with fit testing all visitors and of course the cost is very high. There really is no indication for the use of N95 respirators- surgical masks will suffice and are easier to handle in the community situation.
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 (Susan Adolph) [mailto:]
Sent: 30 June 2012 09:52 PM
To: Mehtar, S, Prof <>
Subject: [TB Infection Control] How to provide respirators for visitors to TB facilities?

Susan Adolph added a new discussion to the TB Infection Control community.

Title: How to provide respirators for visitors to TB facilities?

Discussion contents:
"Hello All,

I was hoping some of you can share your experiences in providing N95 respirators (or FFP2) to family members visiting TB ward or hospitals. Despite trying to switch to a community based model of care, we still have hundreds of inpatients and various TB facilities. Currently, visitors to these facilities are not provided with respiratory protection. However this will change in the very near future. So, from an IMPLEMENTATION point of view, how have other programs handled this? A new respirator for every visitor for every visit will not be possible due to the expense. But asking visitors to reuse respirators is complicated. Further complicating things is the lack of staff to instruct visitors on proper donning and care of the respirator. Placing respirators and signage at entrances is also difficult as they will likely disappear for various reasons. Access in general to the facilities is poorly controlled.

So given all of these challenges, I’m curious to hear your experiences and suggestions regarding this matter.

Susan Adolph, RN
ICO for MSF in Uzbekistan/Tajikistan"

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/s-mehtar/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.


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.

Hello Ed,

Thank you for the response. Let me add some more details that might clarify why we proposed that visitors wear respirators.
We are in the process of scaling up access to DST and consequently DR treatment. So this is already being done. Of course our priorities are what you suggest in your reply, fast diagnosis and initiation of appropriate treatment. However this takes time and in the meantime we feel that reducing risk in all ways possible is a worthwhile effort. The facilities that I’m speaking of have very poor infection control (before anyone comments, yes we working on risk assessments, ICPs etc etc) and have a mix of those with access to DST and those that don’t (yes, working on this too..). Visitors and family members are often the main caregivers and often mix with patients in communal kitchens etc (yes, working on this problem too...). So as an ADJUNT to other ongoing plans and implementations, this is why we would like to provide respirators to visitors. Another reason is that it was recommended in one of the WHO guidelines (actually it was in TBICAP document). Also, we are having a lot of problem getting ...

Hello Ed,

Thank you for the response. Let me add some more details that might clarify why we proposed that visitors wear respirators.
We are in the process of scaling up access to DST and consequently DR treatment. So this is already being done. Of course our priorities are what you suggest in your reply, fast diagnosis and initiation of appropriate treatment. However this takes time and in the meantime we feel that reducing risk in all ways possible is a worthwhile effort. The facilities that I’m speaking of have very poor infection control (before anyone comments, yes we working on risk assessments, ICPs etc etc) and have a mix of those with access to DST and those that don’t (yes, working on this too..). Visitors and family members are often the main caregivers and often mix with patients in communal kitchens etc (yes, working on this problem too...). So as an ADJUNT to other ongoing plans and implementations, this is why we would like to provide respirators to visitors. Another reason is that it was recommended in one of the WHO guidelines (actually it was in TBICAP document). Also, we are having a lot of problem getting staff to wear respirators, they prefer a surgical mask. Giving surgical masks to visitors then creates a mixed a message and it will be doubly hard to get staff to wear them. And lastly, you mentioned that a surgical mask can give 50% protection to the wearer; I thought it reduced transmission by as much 50% when worn by the patient not the HCW, is this incorrect?

We’ve also done a lot of advocacy on this topic and considered it a triumph when Global Fund (in the country) agreed to provide them for visitors.

Please consider that our rates of MDR are 42% among new cases and 79% retreatment (WHO survey not yet confirmed or released). So from my point of view, even though respirators are incredibly infective as a standalone measure, it is part of a much bigger plan, and every little bit helps :)

Lastly, we have done quite a lot of fit testing within this context and will hopefully order a respirator the fits approx 85% population (of course we wouldn't fit test all visitors..)

My question was about the implementation of this. But I am also happy to hear arguments about whether or not this implementation should be recommended. But insight on the practical details of the implementation would also be helpful.

Best regards,
Susan Adolph
ICO MSF Uzbekistan/Tajikistan

Cost escalation , reusability and feeling of discomfort when test fitted as
well especially in hot and humid areas -
are the other areas which we try to address .......

On Sun, Jul 1, 2012 at 8:53 AM, GHDonline (Edward Nardell, MD) <
> wrote:

> Edward Nardell, MD replied to the discussion "How to provide respirators
> for visitors to TB facilities?" in the TB Infection Control community.
>
> Reply contents:
> "Here are some thoughts.
> 1. Compared to HCWs, visitors have a relatively short exposure to
> patients, and if their primary exposure is their relatives, they have
> likely already been exposed for months before the diagnosis, and any
> additional exposure once treatment has started is likely to be
> minimal.
> 2. Once patients are on effective therapy, the risk of transmission is
> quickly and profoundly reduced. The greater risk is from the
> unsuspected, undiagnosed cases in the community. It is true that
> patients on ineffective treatment are likely to remain infectious.
> Rather than investing in respirators for visitors, it would make more
> sense to invest in rapid diagnostics and rapid DSTs to be sure
> patients are diagnosed quickly with a DST.
> 3. Surgical masks, while not recommended for health care workers, have
> been recommended ...

Cost escalation , reusability and feeling of discomfort when test fitted as
well especially in hot and humid areas -
are the other areas which we try to address .......

On Sun, Jul 1, 2012 at 8:53 AM, GHDonline (Edward Nardell, MD) <
> wrote:

> Edward Nardell, MD replied to the discussion "How to provide respirators
> for visitors to TB facilities?" in the TB Infection Control community.
>
> Reply contents:
> "Here are some thoughts.
> 1. Compared to HCWs, visitors have a relatively short exposure to
> patients, and if their primary exposure is their relatives, they have
> likely already been exposed for months before the diagnosis, and any
> additional exposure once treatment has started is likely to be
> minimal.
> 2. Once patients are on effective therapy, the risk of transmission is
> quickly and profoundly reduced. The greater risk is from the
> unsuspected, undiagnosed cases in the community. It is true that
> patients on ineffective treatment are likely to remain infectious.
> Rather than investing in respirators for visitors, it would make more
> sense to invest in rapid diagnostics and rapid DSTs to be sure
> patients are diagnosed quickly with a DST.
> 3. Surgical masks, while not recommended for health care workers, have
> been recommended for visitors. The rationale is severalfold. If not
> fit tested, which is not possible for visitors, surgical masks may not
> offer that much more protection than surgical masks. Surgical masks
> are not totally ineffective in protecting the wearer. Instead of
> about 80% protection for a respirator, allowing for face seal leak,
> the protection might be 50 or 60%. While not optimal, it is far
> better than nothing, and roughly equivalent to doubling ventilation or
> other more costly interventions.
>
> Conclusion: I would recommend surgical masks, not respirators, for
> visitors and take steps to see that all patients in the hospital are
> on effective treatment, i.e, based on a rapid DST.
>
> Ed
>
> On Sat, Jun 30, 2012 at 3:51 PM, GHDonline (Susan Adolph)
> <> wrote:
> > Susan Adolph added a new discussion to the TB Infection Control
> community.
> >
> > Title: How to provide respirators for visitors to TB facilities?
> >
> > Discussion contents:
> > "Hello All,
> >
> > I was hoping some of you can share your experiences in providing N95
> respirators (or FFP2) to family members visiting TB ward or hospitals.
> Despite trying to switch to a community based model of care, we still have
> hundreds of inpatients and various TB facilities. Currently, visitors to
> these facilities are not provided with respiratory protection. However this
> will change in the very near future. So, from an IMPLEMENTATION point of
> view, how have other programs handled this? A new respirator for every
> visitor for every visit will not be possible due to the expense. But asking
> visitors to reuse respirators is complicated. Further complicating things
> is the lack of staff to instruct visitors on proper donning and care of the
> respirator. Placing respirators and signage at entrances is also difficult
> as they will likely disappear for various reasons. Access in general to
> the facilities is poorly controlled.
> >
> > So given all of these challenges, I’m curious to hear your experiences
> and suggestions regarding this matter.
> >
> > Susan Adolph, RN
> > ICO for MSF in Uzbekistan/Tajikistan"
> >
> > --
> > View this post online:
> > <
> http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...
> >
> >
> > 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.
> >"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/dr-shanta-ghatak/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.
>

Hi Susan:
It has been a very interesting discussion and all talented thoughts are very appreciable.
In my opinion providing respirators to visitors may be a risk reducing option considering the country context,burden of TB,resources, and social factors ,as I found real field situations don't cover the standard prescribed recommendations always.Sometimes,It needs something more or less to go through the practicality and reality.
Regards,
Sarder Tanzir Hossain
Microbiologist,NTP,Afghanistan

Respirators are not good for visitors. They are very costly and their efficacy for TB prevention is not proved even in HCWs. I am doing PHD and my topic is masks and respirators in HCWs. So far there is lack of evidence on efficacy of masks and respirators for TB. Most of the studies are done with other control measures, i.e. administrative and environmental measures. Many studies concluded that administrative and environmental measures are more important and TST reduced in HCWs before introduction of respirators. Anyhow till we get more strong evidence, HCWs should take respirators. But no need for visitors.

Dear Abrar
I applaud you! There is some evidence which Ed is gathering on the subject so we should have some idea soon. My greatest contention has been that since face covers are the easiest and most visible to HCW, they use them without discrimination- N95 respirators on patients! Wandering around themselves with masks or respirators around their neck which they place on their face when they see me coming! What I would like to know is this- while we are aware that a well fitting N95 respirator will reduce 90% of aerosols being inhaled and face masks will prevent 50% of expulsion transmission, what is the reduction in inhalation when a face mask is used and when an N96 respirator is used- badly?
I am delighted you are doing your thesis on this subject!
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 ...

Dear Abrar
I applaud you! There is some evidence which Ed is gathering on the subject so we should have some idea soon. My greatest contention has been that since face covers are the easiest and most visible to HCW, they use them without discrimination- N95 respirators on patients! Wandering around themselves with masks or respirators around their neck which they place on their face when they see me coming! What I would like to know is this- while we are aware that a well fitting N95 respirator will reduce 90% of aerosols being inhaled and face masks will prevent 50% of expulsion transmission, what is the reduction in inhalation when a face mask is used and when an N96 respirator is used- badly?
I am delighted you are doing your thesis on this subject!
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 (Abrar Chughtai) [mailto:]
Sent: 06 July 2012 10:12 AM
To: Mehtar, S, Prof <>
Subject: Re: [TB Infection Control] How to provide respirators for visitors to TB facilities?

Abrar Chughtai replied to the discussion "How to provide respirators for visitors to TB facilities?" in the TB Infection Control community.

Reply contents:
"Respirators are not good for visitors. They are very costly and their efficacy for TB prevention is not proved even in HCWs. I am doing PHD and my topic is masks and respirators in HCWs. So far there is lack of evidence on efficacy of masks and respirators for TB. Most of the studies are done with other control measures, i.e. administrative and environmental measures. Many studies concluded that administrative and environmental measures are more important and TST reduced in HCWs before introduction of respirators. Anyhow till we get more strong evidence, HCWs should take respirators. But no need for visitors."

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/s-mehtar/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.

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.

I am not sure what the standards are in rural South Africa but having spent some time in Venda in Limpopo province I have seen virtually no protection for HCW. There is a chronic shortage of masks and HCW are always asking to share ours. We are visiting faculty but end up reusing our masks which we bring with us in order to share with others. The incidence of undiagnosed TB is off the charts . TB patients are isolated only once sputum is back. There is a TB isolation ward but it is full often so the active TB patients stay in a section of the adult medical ward which are not ventilated nor do they have UV lights. Mostly HCW do not use masks even if they are working in the isolation wards. There is a belief that infection rates in HCW is so low that protection is not needed.
Sputum culture and sensitivity tests are usuallly not available in a usable time frame so empiric treatment is usual .
I am confused when I hear this disussion since I know that there is no protection for HCW in rural Venda hospitals. And MDR is alomost impossible to diagnose so ...

I am not sure what the standards are in rural South Africa but having spent some time in Venda in Limpopo province I have seen virtually no protection for HCW. There is a chronic shortage of masks and HCW are always asking to share ours. We are visiting faculty but end up reusing our masks which we bring with us in order to share with others. The incidence of undiagnosed TB is off the charts . TB patients are isolated only once sputum is back. There is a TB isolation ward but it is full often so the active TB patients stay in a section of the adult medical ward which are not ventilated nor do they have UV lights. Mostly HCW do not use masks even if they are working in the isolation wards. There is a belief that infection rates in HCW is so low that protection is not needed.
Sputum culture and sensitivity tests are usuallly not available in a usable time frame so empiric treatment is usual .
I am confused when I hear this disussion since I know that there is no protection for HCW in rural Venda hospitals. And MDR is alomost impossible to diagnose so early diagnosis and treatment is not really feasible for MDR. Is this usual for South Africa or just where I was?

Thanks
Amanda Hill

Clinical Associate Professor,
Div of Geriatric Medicine,
University of British Columbia.
Phone 604 875 4512
________________________________________
From: GHDonline (S. Mehtar)
Sent: Monday, July 09, 2012 5:57 AM
To: Hill , Amanda [VA]
Subject: Re: [TB Infection Control] How to provide respirators for visitors to TB facilities?

S. Mehtar replied to the discussion "How to provide respirators for visitors to TB facilities?" in the TB Infection Control community.

Reply contents:
"Dear Abrar
I applaud you! There is some evidence which Ed is gathering on the subject so we should have some idea soon. My greatest contention has been that since face covers are the easiest and most visible to HCW, they use them without discrimination- N95 respirators on patients! Wandering around themselves with masks or respirators around their neck which they place on their face when they see me coming! What I would like to know is this- while we are aware that a well fitting N95 respirator will reduce 90% of aerosols being inhaled and face masks will prevent 50% of expulsion transmission, what is the reduction in inhalation when a face mask is used and when an N96 respirator is used- badly?
I am delighted you are doing your thesis on this subject!
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 (Abrar Chughtai) [mailto:]
Sent: 06 July 2012 10:12 AM
To: Mehtar, S, Prof <>
Subject: Re: [TB Infection Control] How to provide respirators for visitors to TB facilities?

Abrar Chughtai replied to the discussion "How to provide respirators for visitors to TB facilities?" in the TB Infection Control community.

Reply contents:
"Respirators are not good for visitors. They are very costly and their efficacy for TB prevention is not proved even in HCWs. I am doing PHD and my topic is masks and respirators in HCWs. So far there is lack of evidence on efficacy of masks and respirators for TB. Most of the studies are done with other control measures, i.e. administrative and environmental measures. Many studies concluded that administrative and environmental measures are more important and TST reduced in HCWs before introduction of respirators. Anyhow till we get more strong evidence, HCWs should take respirators. But no need for visitors."

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/s-mehtar/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.

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."

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/amanda-hill/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.

Perhaps I can shed a little light. In South Africa there are very varying levels of awareness and compliance with IPC best practice. Rural areas are often but not inevitably the worst off. We have seen some excellent implementation in some "deep" rural areas where a concentrated effort is made to involve everyone involved in healthcare provision including supply chain management in a coordinated infection prevention and control programme. Limpopo is in a bit of a difficult situation as it is currently under administration by the National Government. This has led to some supply chain disturbances which may or may not explain your experiences (I don't know when you worked there) however there is a lot of work to be done regarding IPC generally in SA and use of personal protective equipment in particular. Sadly budget constraints and lack of awareness sometimes prevent best practice. I think we need to investigate the more widespread use of reusable PPE rather than disposables (since it may be more affordable and just as effective). Incidently, please don't regard UV lights as a silver-bullet solution - our in-situ studies found nearly UVGI 90% ineffective in a South African district study of 43 clinics ...

Perhaps I can shed a little light. In South Africa there are very varying levels of awareness and compliance with IPC best practice. Rural areas are often but not inevitably the worst off. We have seen some excellent implementation in some "deep" rural areas where a concentrated effort is made to involve everyone involved in healthcare provision including supply chain management in a coordinated infection prevention and control programme. Limpopo is in a bit of a difficult situation as it is currently under administration by the National Government. This has led to some supply chain disturbances which may or may not explain your experiences (I don't know when you worked there) however there is a lot of work to be done regarding IPC generally in SA and use of personal protective equipment in particular. Sadly budget constraints and lack of awareness sometimes prevent best practice. I think we need to investigate the more widespread use of reusable PPE rather than disposables (since it may be more affordable and just as effective). Incidently, please don't regard UV lights as a silver-bullet solution - our in-situ studies found nearly UVGI 90% ineffective in a South African district study of 43 clinics. If they are used (there is a moratorium on their purchase) they need to be independently checked and well-maintained.
Regard
Peta
Sent via my BlackBerry from Vodacom - let your email find you!

-----Original Message-----
From: "GHDonline (Amanda Hill)" <>
Date: Mon, 09 Jul 2012 13:29:34
To: Peta de
Reply-To: TB Infection Control <>
Subject: Re: [TB Infection Control] How to provide respirators for visitors to TB
facilities?

Amanda Hill replied to the discussion "How to provide respirators for visitors to TB facilities?" in the TB Infection Control community.

Reply contents:
"I am not sure what the standards are in rural South Africa but having spent some time in Venda in Limpopo province I have seen virtually no protection for HCW. There is a chronic shortage of masks and HCW are always asking to share ours. We are visiting faculty but end up reusing our masks which we bring with us in order to share with others. The incidence of undiagnosed TB is off the charts . TB patients are isolated only once sputum is back. There is a TB isolation ward but it is full often so the active TB patients stay in a section of the adult medical ward which are not ventilated nor do they have UV lights. Mostly HCW do not use masks even if they are working in the isolation wards. There is a belief that infection rates in HCW is so low that protection is not needed.
Sputum culture and sensitivity tests are usuallly not available in a usable time frame so empiric treatment is usual .
I am confused when I hear this disussion since I know that there is no protection for HCW in rural Venda hospitals. And MDR is alomost impossible to diagnose so early diagnosis and treatment is not really feasible for MDR. Is this usual for South Africa or just where I was?

Thanks
Amanda Hill

Clinical Associate Professor,
Div of Geriatric Medicine,
University of British Columbia.
Phone 604 875 4512
________________________________________
From: GHDonline (S. Mehtar)
Sent: Monday, July 09, 2012 5:57 AM
To: Hill , Amanda [VA]
Subject: Re: [TB Infection Control] How to provide respirators for visitors to TB facilities?

S. Mehtar replied to the discussion "How to provide respirators for visitors to TB facilities?" in the TB Infection Control community.

Reply contents:
"Dear Abrar
I applaud you! There is some evidence which Ed is gathering on the subject so we should have some idea soon. My greatest contention has been that since face covers are the easiest and most visible to HCW, they use them without discrimination- N95 respirators on patients! Wandering around themselves with masks or respirators around their neck which they place on their face when they see me coming! What I would like to know is this- while we are aware that a well fitting N95 respirator will reduce 90% of aerosols being inhaled and face masks will prevent 50% of expulsion transmission, what is the reduction in inhalation when a face mask is used and when an N96 respirator is used- badly?
I am delighted you are doing your thesis on this subject!
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 (Abrar Chughtai) [mailto:]
Sent: 06 July 2012 10:12 AM
To: Mehtar, S, Prof <>
Subject: Re: [TB Infection Control] How to provide respirators for visitors to TB facilities?

Abrar Chughtai replied to the discussion "How to provide respirators for visitors to TB facilities?" in the TB Infection Control community.

Reply contents:
"Respirators are not good for visitors. They are very costly and their efficacy for TB prevention is not proved even in HCWs. I am doing PHD and my topic is masks and respirators in HCWs. So far there is lack of evidence on efficacy of masks and respirators for TB. Most of the studies are done with other control measures, i.e. administrative and environmental measures. Many studies concluded that administrative and environmental measures are more important and TST reduced in HCWs before introduction of respirators. Anyhow till we get more strong evidence, HCWs should take respirators. But no need for visitors."

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/s-mehtar/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.

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."

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/amanda-hill/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."

--
View this post online:
<http://www.ghdonline.org/ic/discussion/how-to-provide-respirators-for-visitor...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/peta-de-jager/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.

--
This message is subject to the CSIR's copyright terms and conditions, e-mail legal notice, and implemented Open Document Format (ODF) standard.
The full disclaimer details can be found at http://www.csir.co.za/disclaimer.html.

This message has been scanned for viruses and dangerous content by MailScanner,
and is believed to be clean.

Please consider the environment before printing this email.