TB Infection Control

Dear Grigory
On any one day we have between 24 to 30 patients with TB admitted to my hospital. The Unit for IPC has declared TB as an alert organism since 1st June. This means that each case of TB will be followed up and intensively contained.
We have identified wards and areas as high, medium and low risk and procedures which are similarly graded. In the high risk areas, the staff have been fit tested when they go to work there, to the TYPE of N95 respirators available either cone or duckbill to fit their face type. When a case of MDR/XDR-TB is admitted, the member of staff will use the appropriate N95 respirator for his or her face. Staff has been taught how to check for a tight fit and to look after the N95 respirator for a week's reuse. The IPC Team will follow up and ensure safe practice.
Everyone else will use face masks (surgical grade) when dealing with TB (sensitive strain) for 2 weeks after appropriate therapy. I don't know if this helps at all.
It works for us but not be universally applicable. We have to balance IPC and cost to ...

Dear Grigory
On any one day we have between 24 to 30 patients with TB admitted to my hospital. The Unit for IPC has declared TB as an alert organism since 1st June. This means that each case of TB will be followed up and intensively contained.
We have identified wards and areas as high, medium and low risk and procedures which are similarly graded. In the high risk areas, the staff have been fit tested when they go to work there, to the TYPE of N95 respirators available either cone or duckbill to fit their face type. When a case of MDR/XDR-TB is admitted, the member of staff will use the appropriate N95 respirator for his or her face. Staff has been taught how to check for a tight fit and to look after the N95 respirator for a week's reuse. The IPC Team will follow up and ensure safe practice.
Everyone else will use face masks (surgical grade) when dealing with TB (sensitive strain) for 2 weeks after appropriate therapy. I don't know if this helps at all.
It works for us but not be universally applicable. We have to balance IPC and cost to maximum effect- the outcome of this policy has proven to be most effective.
Thanks
Shaheen



Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital & 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

Dear all
Thanks for your contriburions. I would like to know from Shaheen what criteria have been used to identify wards, areas and procedures as high, medium and low risk.
Miranda Brouwer, Mozambique

Hello Miranda
The criteria were simply based on our high patient load areas such as internal medicine admissions, wards and respiratory ICU, bronchoscopy and sputum production areas, mortuary and paediatrics. It is now part of our TB-IPC policy and the criteria also may change based on the implementation of improved ventilation systems.
I hope this helps.
Regards
Shaheen

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital & 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

Hi
Fit test kit & saccrin is available from 3M in South Africa , and is used in
our rural hospital in Kwazulu-Natal , Ok , all of us have seen someone else
wear an N95 all wrong with , beards or gaping gaps leaving you
wondering, why bother? We find the fit test certainly helps staff of all
categories understand and focus on the principle of a good seal, and the
mask acting as a filter for every drop of air that you breath in. At the fit
test we say "can you smell or taste the TB germs?" Yuk . This is important
coming form a hospital where we have 9 documented staff deaths from
MDRTB. So its worth it. Is it affordable ?, yes ,we got ours free from 3M.
Whats more difficult is to get time in the busy schedule to routinely test.
Tony Moll , Tugela Ferry

--
Dr A P Moll
ARV Program Manager
Church of Scotland Hospital
Tugela Ferry KZN 3010 South Africa