TB Infection Control

Dear Doug,


I believe, as far as separate access is provided it is safe. Potentially infectious air from
the new ward will be safely discharged at highest elevation and in my
opinion it poses no threat to the lower floor non-TB patients. But, the way visitors approach the new facility should be clear. Sometimes separating the access only may not solve the problem of people wandering in an effort to find their way within the premises of the facility.


Points for consideration before implementing this idea might be:- access for physically weak or handicap (ramp of the right inclination or even better elevator), structural integrity of the existing structure to receive additional load (was it originally designed for vertical expansion ?), assess if the existing sanitary, electrical and other engineering or utility provisions are enough to accommodate the additional functions.

Merid Girma
(Architect)

Dear Doug,

I fully agree with Merid. Although I haven't seen the building, adding an additional story is always an hassle and costly exersize.

Saying we will save cost because we don't have to clear side or built new foundation is not based on facts. Proper calculation, cost estimate has to be made to establish actual cost, no assumptions. If existing building has been designed as single story only, cost will be higher. That is why there are local architects and quantity surveyors.

In addition to this, design is limited as new ablutions need to be connected to existing once on the floor below. Movement of patients will be limited; balconies and verandas on first floor might increase cost. Services in current roof space might need to be relocated, existing extraction systems over roof now need to run through new added floor, etc.

Use of floor below might be limited during construction, casting of new floors, labourers and a constant noise of machinery will affect patients / people working on floor below.
The cost of small units build on ground level are most of times much more cost effective and flexible than trying to add them on top of ...

Dear Doug,

I fully agree with Merid. Although I haven't seen the building, adding an additional story is always an hassle and costly exersize.

Saying we will save cost because we don't have to clear side or built new foundation is not based on facts. Proper calculation, cost estimate has to be made to establish actual cost, no assumptions. If existing building has been designed as single story only, cost will be higher. That is why there are local architects and quantity surveyors.

In addition to this, design is limited as new ablutions need to be connected to existing once on the floor below. Movement of patients will be limited; balconies and verandas on first floor might increase cost. Services in current roof space might need to be relocated, existing extraction systems over roof now need to run through new added floor, etc.

Use of floor below might be limited during construction, casting of new floors, labourers and a constant noise of machinery will affect patients / people working on floor below.
The cost of small units build on ground level are most of times much more cost effective and flexible than trying to add them on top of other buildings.

Hans Mulder

Doug'
As an architect also , I would say my colleagues there have given the pros and cons of the situation you find yourself in. I agree wholeheartedly with their comments and would advise to instigate a extensive survey of that building and clear your conscience, and like Hans says, a small unit on ground level in a separate site will prove much more manageable in terms of cost and construction.

Gobe Gaotlolwe..

If I can add to the comments above, it is essential to research on how the patients and their attendants, plus the service providers in the main (lower) level of the hospital would view and react to the TB floor upstairs. No matter how much precaution is undertaken to prevent transmission, the psychological response and consequent results (fear, avoidance, and shrinking patient admission rates in the lower floor) should be considered, in my estimation. I fully acknowledge that fear and stigma should not exist, but that happens in an ideal setting. In the context of a rural (?) setting in Nepal I would suggest factoring this psychological component into the decision-making process.

The data that has been circulating is very fragile and it is there just because of some presentations had to be made ..... Sorry Only suggestion is PLEASE look at the way the WIND blows......It should blow away .....so that bad air should not mix Lighting an incense stick and following the flow of air movement will give an idea.... The windows should be on the opposite walls and the breeze must be from the feet end towards the head end and this air must not mix with the room air flows where other patients are admitted.... Good luck !

I would like to add a bit to the comment of Dr Shanta Ghatak. Although the intention of taking wind direction in consideration, we still talking natural ventilation and wind will and can come from all directions, especially in the mountains. Using an incense stick will just give you the airflow at that specific moment and should not be used for design of a building; statistics from a meteorological station indicating prevailing wind direction are more accurate. But we still talking natural ventilation.
Another problem to be addressed in general is the fact that there is not a thing as just a presentation. Too often I have encountered the fact that buildings are constructed from just a presentation and that funding has been based on just a presentation. If you want to construct something, get a professional local team involved, so building costs and design are real and based on local experience. Running out of funding happens more often than we want and the reason of it being the fact that no real cost estimates has been made.

Hans Mulder

So very true ! Yes . In reality the cost estimates needs to be worked out with a team ( cost accountant and the builder in presence of the doctor who would be able to get them see what he and the patients really need .....) AND of course the DONOR if possible ... It has helped me recently while planning a shelter for HIV patients Thanks !

And we need to remember that natural ventilation may be:

1. Horizontal (wind-driven)
2. Vertical (buoyancy-/temperature-/density-driven)
3. A combination of the two.

There are also "mixed-mode" systems that combine natural ventilation and mechanical ventilation.

Unfortunately, we often only hear of wind-driven natural ventilation and its misapplication and the over estimation of its effectiveness. Trust me, I am a proponent of well-designed natural ventilation. I believe well-deigned AND maintain natural ventilation systems can provide significant air exchange/dilution. However, we must remember that without good administrative controls, natural ventilation may have limited impact on TB transmission and TB control!

Regards,

Paul J

--------------------------
Sent from my BlackBerry . . . Please excuse my fumbling thumbs!

I find the discussions very informative.
My question is, is there a time frame for the monitorium that is taking place?
Can anyone give an answer to this.


Robert Spiteri
Aerobiological Tech-Eng
Ozone Purification Technology

Dear Paul
I hoped to be there for this course that you have as I am currently looking
at 6 community care centers and other areas ...could you get me in ? It
would do loads of good for the comunity ( IDUs, FSWs, TIs Truckers', HIV
shelters ) that I am working for in my own capacity for a relatively small
but extremely well networked organisation in India?
I am building the support systems from a scratch and it would have really
really helped? I applied but didnt get the scholarship that I require for
doing the prestigious course that you run?
Wishing to see you there if possible ....?

Shanta

Dear Shanta:

Please e-mail me at .

Regards,

Paul J

--------------------------
Sent from my BlackBerry . . . Please excuse my fumbling thumbs!


----- Original Message -----
From: GHDonline (Dr Shanta Ghatak) [mailto:]
Sent: Tuesday, April 17, 2012 10:49 PM
To: Jensen, Paul A. (CDC/OID/NCHHSTP)
Subject: Re: [TB Infection Control] MDR TB Isolation

Dr Shanta Ghatak replied to the discussion "MDR TB Isolation" in the TB Infection Control community.

Reply contents:
"Dear Paul
I hoped to be there for this course that you have as I am currently looking
at 6 community care centers and other areas ...could you get me in ? It
would do loads of good for the comunity ( IDUs, FSWs, TIs Truckers', HIV
shelters ) that I am working for in my own capacity for a relatively small
but extremely well networked organisation in India?
I am building the support systems from a scratch and it would have really
really helped? I applied but didnt get the scholarship that I require for
doing the prestigious course that you run?
Wishing to see you there if possible ....?

Shanta
On Sat, Apr 14, 2012 at 4:49 PM, GHDonline (Paul A. Jensen, PhD, PE, CIH) <

Dear Shanta:

Please e-mail me at .

Regards,

Paul J

--------------------------
Sent from my BlackBerry . . . Please excuse my fumbling thumbs!


----- Original Message -----
From: GHDonline (Dr Shanta Ghatak) [mailto:]
Sent: Tuesday, April 17, 2012 10:49 PM
To: Jensen, Paul A. (CDC/OID/NCHHSTP)
Subject: Re: [TB Infection Control] MDR TB Isolation

Dr Shanta Ghatak replied to the discussion "MDR TB Isolation" in the TB Infection Control community.

Reply contents:
"Dear Paul
I hoped to be there for this course that you have as I am currently looking
at 6 community care centers and other areas ...could you get me in ? It
would do loads of good for the comunity ( IDUs, FSWs, TIs Truckers', HIV
shelters ) that I am working for in my own capacity for a relatively small
but extremely well networked organisation in India?
I am building the support systems from a scratch and it would have really
really helped? I applied but didnt get the scholarship that I require for
doing the prestigious course that you run?
Wishing to see you there if possible ....?

Shanta
On Sat, Apr 14, 2012 at 4:49 PM, GHDonline (Paul A. Jensen, PhD, PE, CIH) <
> wrote:

> Paul A. Jensen, PhD, PE, CIH replied to the discussion "MDR TB Isolation"
> in the TB Infection Control community.
>
> Reply contents:
> "And we need to remember that natural ventilation may be:
>
> 1. Horizontal (wind-driven)
> 2. Vertical (buoyancy-/temperature-/density-driven)
> 3. A combination of the two.
>
> There are also "mixed-mode" systems that combine natural ventilation and
> mechanical ventilation.
>
> Unfortunately, we often only hear of wind-driven natural ventilation and
> its misapplication and the over estimation of its effectiveness. Trust me,
> I am a proponent of well-designed natural ventilation. I believe
> well-deigned AND maintain natural ventilation systems can provide
> significant air exchange/dilution. However, we must remember that without
> good administrative controls, natural ventilation may have limited impact
> on TB transmission and TB control!
>
> Regards,
>
> Paul J
>
> --------------------------
> Sent from my BlackBerry . . . Please excuse my fumbling thumbs!
>
>
> ----- Original Message -----
> From: GHDonline (Dr Shanta Ghatak) [mailto:]
> Sent: Sunday, April 01, 2012 08:57 PM
> To: Jensen, Paul A. (CDC/OID/NCHHSTP)
> Subject: Re: [TB Infection Control] MDR TB Isolation
>
> Dr Shanta Ghatak replied to the discussion "MDR TB Isolation" in the TB
> Infection Control community.
>
> Reply contents:
> "So very true ! Yes . In reality the cost estimates needs to be worked out
> with a team ( cost accountant and the builder in presence of the doctor who
> would be able to get them see what he and the patients really need .....)
> AND of course the DONOR if possible ...
> It has helped me recently while planning a shelter for HIV patients
> Thanks !
>
> On Sun, Apr 1, 2012 at 9:15 PM, GHDonline (Hans Mulder) <
> >wrote:
>
> > Hans Mulder replied to the discussion "MDR TB Isolation" in the TB
> > Infection Control community.
> >
> > Reply contents:
> > "I would like to add a bit to the comment of Dr Shanta Ghatak. Although
> > the intention of taking wind direction in consideration, we still talking
> > natural ventilation and wind will and can come from all directions,
> > especially in the mountains. Using an incense stick will just give you
> the
> > airflow at that specific moment and should not be used for design of a
> > building; statistics from a meteorological station indicating prevailing
> > wind direction are more accurate. But we still talking natural
> ventilation.
> > Another problem to be addressed in general is the fact that there is not
> a
> > thing as just a presentation. Too often I have encountered the fact that
> > buildings are constructed from just a presentation and that funding has
> > been based on just a presentation. If you want to construct something,
> get
> > a professional local team involved, so building costs and design are real
> > and based on local experience. Running out of funding happens more often
> > than we want and the reason of it being the fact that no real cost
> > estimates has been made.
> >
> > Hans Mulder"
> >
> > --
> > View this post online:
> > <
> >
> http://www.ghdonline.org/ic/discussion/mdr-tb-isolation/#reply-4317-2?id=1477...
> > >
> >
> > 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.
> >"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/mdr-tb-isolation/#reply-4318-2?id=1002...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/paul-a-jensen-phd-pe-cih/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/mdr-tb-isolation/#reply-4484-2?id=1477...
> >
>
> 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.
>"

--
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