TB Infection Control

You have outlined all the issues quite correctly. Although we think
of children as not very infectious, some children do develop
adult-type TB as evidenced by the smear positive cases that you alude
to. While the risk is greatly reduced outdoors, with close contact
the near field concentration may be transiently high. The bottom line
is that it is hard to dispel fear once established, and impossible to
say that transmission can not occur. Therefore, after explaining that
the risk is probably low, I would let staff wear respirators outside
if that makes them feel safer. IF they are using them inside anyway,
how much more psychological damage to the children can they be doing?

Ed

On Sat, Jun 30, 2012 at 3:58 PM, GHDonline (Susan Adolph)
<> wrote:
> Susan Adolph added a new discussion to the TB Infection Control community.
>
> Title: Should HCWs wear respirators when playing with children (with TB) outside?
>
> Discussion contents:
> "Hello, I have received a question from some adherence counsellors in a pediatric TB facility. The facility has children of all ages (1-15 years old), both DS and DRTB, both smear positive and smear negative. When the counsellors play with the children ...

You have outlined all the issues quite correctly. Although we think
of children as not very infectious, some children do develop
adult-type TB as evidenced by the smear positive cases that you alude
to. While the risk is greatly reduced outdoors, with close contact
the near field concentration may be transiently high. The bottom line
is that it is hard to dispel fear once established, and impossible to
say that transmission can not occur. Therefore, after explaining that
the risk is probably low, I would let staff wear respirators outside
if that makes them feel safer. IF they are using them inside anyway,
how much more psychological damage to the children can they be doing?

Ed

On Sat, Jun 30, 2012 at 3:58 PM, GHDonline (Susan Adolph)
<> wrote:
> Susan Adolph added a new discussion to the TB Infection Control community.
>
> Title: Should HCWs wear respirators when playing with children (with TB) outside?
>
> Discussion contents:
> "Hello, I have received a question from some adherence counsellors in a pediatric TB facility. The facility has children of all ages (1-15 years old), both DS and DRTB, both smear positive and smear negative. When the counsellors play with the children outside, they do not want to remove their respirators. The counsellors are very ‘hands-on’, giving lots of hugs close contact with the children. They state this close contact is the reason they do not want to remove their respirators, despite the respirators impacting the psychosocial aspects of their work.
>
> I’m at a loss as to what to recommend for them considering the following
> 1.      When outside, they sometimes share breathing space with the children because of the ‘close contact’ nature of their work.
> 2.      Children are not generally infectious (pacaubacilliary, weak cough etc..)
> 3.      Respirators impact the social aspects of their work
> 4.      The counsellors have a lot of fear that they will catch TB from the children despite receiving lots of education about TB and transmission
> 5.     Many of the children are too young to practice cough hygiene.
>
>
> Thoughts?
>
> Thanks,
> Susan Adolph, RN
> ICO MSF Uzbekistan/Tajikistan"
>
> --
> View this post online:
> <http://www.ghdonline.org/ic/discussion/should-hcws-wear-respirators-when-play...>
>
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> <http://www.ghdonline.org/users/edward-nardell-md/edit/>
>
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>
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>

Hi Ed, thanks for this comment; I have heard "it makes them feel safer' a lot. I am not sure I agree with the rationale; I am not sure it relies on evidence.... And I am not sure of the message (I acknowledge the following sentence in the post though); what I have noticed is that because HCWs,MDs... have been exposed to this type of message, when trained on IC they are actually surprised by the low level of risk reduction produced by the 'make them feel good' mask...... when the highest risk for them occurs before the tratment initiation and the best risk reduction for them is actually to detect and treat TB earlier. Note this is my opinion....We probably do not need a 1000 posts exchange on this...... Just a comment...

Of course, I should have added as you pointed out, that on effective treatment TB patients, especially children, are unlikely to be infectious at all - unless MDR is unsuspected and "treatment" is not really effective. I accept your point that that is a more important message than wearing a respirator to "feel" safer. Thanks, Ed

Sent from my iPhone

On Jul 1, 2012, at 6:22 AM, "GHDonline (Francoise NYWAGI LOUIS)" <> wrote:

> Francoise NYWAGI LOUIS replied to the discussion "Should HCWs wear respirators when playing with children (with TB) outside?" in the TB Infection Control community.
>
> Reply contents:
> "Hi Ed, thanks for this comment; I have heard "it makes them feel safer' a lot. I am not sure I agree with the rationale; I am not sure it relies on evidence.... And I am not sure of the message (I acknowledge the following sentence in the post though); what I have noticed is that because HCWs,MDs... have been exposed to this type of message, when trained on IC they are actually surprised by the low level of risk reduction produced by the 'make them feel good' mask...... when the highest risk for them occurs before the ...

Of course, I should have added as you pointed out, that on effective treatment TB patients, especially children, are unlikely to be infectious at all - unless MDR is unsuspected and "treatment" is not really effective. I accept your point that that is a more important message than wearing a respirator to "feel" safer. Thanks, Ed

Sent from my iPhone

On Jul 1, 2012, at 6:22 AM, "GHDonline (Francoise NYWAGI LOUIS)" <> wrote:

> Francoise NYWAGI LOUIS replied to the discussion "Should HCWs wear respirators when playing with children (with TB) outside?" in the TB Infection Control community.
>
> Reply contents:
> "Hi Ed, thanks for this comment; I have heard "it makes them feel safer' a lot. I am not sure I agree with the rationale; I am not sure it relies on evidence.... And I am not sure of the message (I acknowledge the following sentence in the post though); what I have noticed is that because HCWs,MDs... have been exposed to this type of message, when trained on IC they are actually surprised by the low level of risk reduction produced by the 'make them feel good' mask...... when the highest risk for them occurs before the tratment initiation and the best risk reduction for them is actually to detect and treat TB earlier. Note this is my opinion....We probably do not need a 1000 posts exchange on this...... Just a comment..."
>
> --
> View this post online:
> <http://www.ghdonline.org/ic/discussion/should-hcws-wear-respirators-when-play...>
>
> 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.

In chidrens' facilities in India the N 95 masks are yet to catch on , but
the crux of your scenario is a psychological barrier with the nursing
staff. And they are not supposed to hug them so much?
Too much of cuddling and hugging doesnt always make the children feel
secure - moreover they may be repelled actually.
We may think of some questionnings regarding their perceptions and
importance of wearing the mask. Rapid testing is really needed but that
happening may take some time.
Wish we could help them! Now as well.
On Sun, Jul 1, 2012 at 1:28 AM, GHDonline (Susan Adolph)
<:

> Susan Adolph added a new discussion to the TB Infection Control community.
>
> Title: Should HCWs wear respirators when playing with children (with TB)
> outside?
>
> Discussion contents:
> "Hello, I have received a question from some adherence counsellors in a
> pediatric TB facility. The facility has children of all ages (1-15 years
> old), both DS and DRTB, both smear positive and smear negative. When the
> counsellors play with the children outside, they do not want to remove
> their respirators. The counsellors are very ‘hands-on’, giving lots of hugs
> close contact with the children. They ...

In chidrens' facilities in India the N 95 masks are yet to catch on , but
the crux of your scenario is a psychological barrier with the nursing
staff. And they are not supposed to hug them so much?
Too much of cuddling and hugging doesnt always make the children feel
secure - moreover they may be repelled actually.
We may think of some questionnings regarding their perceptions and
importance of wearing the mask. Rapid testing is really needed but that
happening may take some time.
Wish we could help them! Now as well.
On Sun, Jul 1, 2012 at 1:28 AM, GHDonline (Susan Adolph)
<:

> Susan Adolph added a new discussion to the TB Infection Control community.
>
> Title: Should HCWs wear respirators when playing with children (with TB)
> outside?
>
> Discussion contents:
> "Hello, I have received a question from some adherence counsellors in a
> pediatric TB facility. The facility has children of all ages (1-15 years
> old), both DS and DRTB, both smear positive and smear negative. When the
> counsellors play with the children outside, they do not want to remove
> their respirators. The counsellors are very ‘hands-on’, giving lots of hugs
> close contact with the children. They state this close contact is the
> reason they do not want to remove their respirators, despite the
> respirators impacting the psychosocial aspects of their work.
>
> I’m at a loss as to what to recommend for them considering the following
> 1. When outside, they sometimes share breathing space with the
> children because of the ‘close contact’ nature of their work.
> 2. Children are not generally infectious (pacaubacilliary, weak cough
> etc..)
> 3. Respirators impact the social aspects of their work
> 4. The counsellors have a lot of fear that they will catch TB from
> the children despite receiving lots of education about TB and transmission
> 5. Many of the children are too young to practice cough hygiene.
>
>
> Thoughts?
>
> Thanks,
> Susan Adolph, RN
> ICO MSF Uzbekistan/Tajikistan"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/should-hcws-wear-respirators-when-play...
> >
>
> 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.
>
>

true
When can we regain the psychological status? Difficult to articulate
actually



On Sun, Jul 1, 2012 at 9:07 AM, GHDonline (Edward Nardell, MD) <
> wrote:

> Edward Nardell, MD replied to the discussion "Should HCWs wear respirators
> when playing with children (with TB) outside?" in the TB Infection Control
> community.
>
> Reply contents:
> "You have outlined all the issues quite correctly. Although we think
> of children as not very infectious, some children do develop
> adult-type TB as evidenced by the smear positive cases that you alude
> to. While the risk is greatly reduced outdoors, with close contact
> the near field concentration may be transiently high. The bottom line
> is that it is hard to dispel fear once established, and impossible to
> say that transmission can not occur. Therefore, after explaining that
> the risk is probably low, I would let staff wear respirators outside
> if that makes them feel safer. IF they are using them inside anyway,
> how much more psychological damage to the children can they be doing?
>
> Ed
>
> On Sat, Jun 30, 2012 at 3:58 PM, GHDonline (Susan Adolph)
> <> wrote:
> > Susan Adolph added a new discussion to the TB Infection Control
> community.
> >
> > Title ...

true
When can we regain the psychological status? Difficult to articulate
actually



On Sun, Jul 1, 2012 at 9:07 AM, GHDonline (Edward Nardell, MD) <
> wrote:

> Edward Nardell, MD replied to the discussion "Should HCWs wear respirators
> when playing with children (with TB) outside?" in the TB Infection Control
> community.
>
> Reply contents:
> "You have outlined all the issues quite correctly. Although we think
> of children as not very infectious, some children do develop
> adult-type TB as evidenced by the smear positive cases that you alude
> to. While the risk is greatly reduced outdoors, with close contact
> the near field concentration may be transiently high. The bottom line
> is that it is hard to dispel fear once established, and impossible to
> say that transmission can not occur. Therefore, after explaining that
> the risk is probably low, I would let staff wear respirators outside
> if that makes them feel safer. IF they are using them inside anyway,
> how much more psychological damage to the children can they be doing?
>
> Ed
>
> On Sat, Jun 30, 2012 at 3:58 PM, GHDonline (Susan Adolph)
> <> wrote:
> > Susan Adolph added a new discussion to the TB Infection Control
> community.
> >
> > Title: Should HCWs wear respirators when playing with children (with TB)
> outside?
> >
> > Discussion contents:
> > "Hello, I have received a question from some adherence counsellors in a
> pediatric TB facility. The facility has children of all ages (1-15 years
> old), both DS and DRTB, both smear positive and smear negative. When the
> counsellors play with the children outside, they do not want to remove
> their respirators. The counsellors are very ‘hands-on’, giving lots of hugs
> close contact with the children. They state this close contact is the
> reason they do not want to remove their respirators, despite the
> respirators impacting the psychosocial aspects of their work.
> >
> > I’m at a loss as to what to recommend for them considering the following
> > 1. When outside, they sometimes share breathing space with the
> children because of the ‘close contact’ nature of their work.
> > 2. Children are not generally infectious (pacaubacilliary, weak
> cough etc..)
> > 3. Respirators impact the social aspects of their work
> > 4. The counsellors have a lot of fear that they will catch TB from
> the children despite receiving lots of education about TB and transmission
> > 5. Many of the children are too young to practice cough hygiene.
> >
> >
> > Thoughts?
> >
> > Thanks,
> > Susan Adolph, RN
> > ICO MSF Uzbekistan/Tajikistan"
> >
> > --
> > View this post online:
> > <
> http://www.ghdonline.org/ic/discussion/should-hcws-wear-respirators-when-play...
> >
> >
> > 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/should-hcws-wear-respirators-when-play...
> >
>
> 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.
>

Dear TB Infection Control Colleagues,

Again need some advice.

For the collection of sputum a busy laboratory agreed to built a sputum booth/cubical in Karachi.

As per plan this booth will be constructed at the end of a building, 2 walls will remain attached to that building, so there will be no ventilation through these walls.
Cross ventilation will be achieved by remaining 2 walls. Lower 2/3 of these walls will be solid (to maintain the privacy at the time of sputum collection). Entire top 1/3 of the other two walls will remain open. To avoid entry of birds in this area, grill made up of iron or steel rods will be used. One wash basin and 1-2 shelves will be placed to address hygiene and other logistic issues.

Due to paucity of space, this booth will be located near to some office area. The distance between booth and to those offices will be about 10 feet in the open air.

During the discussion, a query was raised about the safety "free of mycobacterial zone around the booth" for those personnel moving around.

I advised them to cultivate bushes and plants around the booth (10 feet area ...

Dear TB Infection Control Colleagues,

Again need some advice.

For the collection of sputum a busy laboratory agreed to built a sputum booth/cubical in Karachi.

As per plan this booth will be constructed at the end of a building, 2 walls will remain attached to that building, so there will be no ventilation through these walls.
Cross ventilation will be achieved by remaining 2 walls. Lower 2/3 of these walls will be solid (to maintain the privacy at the time of sputum collection). Entire top 1/3 of the other two walls will remain open. To avoid entry of birds in this area, grill made up of iron or steel rods will be used. One wash basin and 1-2 shelves will be placed to address hygiene and other logistic issues.

Due to paucity of space, this booth will be located near to some office area. The distance between booth and to those offices will be about 10 feet in the open air.

During the discussion, a query was raised about the safety "free of mycobacterial zone around the booth" for those personnel moving around.

I advised them to cultivate bushes and plants around the booth (10 feet area) so any person moving in that vicinity will remain away from this cubical. I believe dilutional effect will be fine. I would be grateful if get some opinion and suggestions.

Kind Regards

Afia Zafar


________________________________

This e-mail may contain information that is privileged or confidential. If you are not the intended recipient, please delete the e-mail and any attachments and notify us immediately.

Please Afia
Please do not let the patients get demotivated as soon as they see the
cagey effect of such structures. In fact if it is just open, it works
out fine out in the sunshine....catering to IC we began such practices
and at the end of a few months patients dwindled bec they were singled
out , stigmatised on the basis of attending the caged facility . This
happened in 2008 in a NGO facility in eastern India
Just the walls would be fine may be .....I just shared the concern.
No hard feelings !!

On 7/6/12, GHDonline (Afia Zafar) <> wrote:
> Afia Zafar replied to the discussion "Should HCWs wear respirators when
> playing with children (with TB) outside?" in the TB Infection Control
> community.
>
> Reply contents:
> "Dear TB Infection Control Colleagues,
>
> Again need some advice.
>
> For the collection of sputum a busy laboratory agreed to built a sputum
> booth/cubical in Karachi.
>
> As per plan this booth will be constructed at the end of a building, 2 walls
> will remain attached to that building, so there will be no ventilation
> through these walls.
> Cross ventilation will be achieved by remaining 2 walls. Lower 2/3 of ...

Please Afia
Please do not let the patients get demotivated as soon as they see the
cagey effect of such structures. In fact if it is just open, it works
out fine out in the sunshine....catering to IC we began such practices
and at the end of a few months patients dwindled bec they were singled
out , stigmatised on the basis of attending the caged facility . This
happened in 2008 in a NGO facility in eastern India
Just the walls would be fine may be .....I just shared the concern.
No hard feelings !!

On 7/6/12, GHDonline (Afia Zafar) <> wrote:
> Afia Zafar replied to the discussion "Should HCWs wear respirators when
> playing with children (with TB) outside?" in the TB Infection Control
> community.
>
> Reply contents:
> "Dear TB Infection Control Colleagues,
>
> Again need some advice.
>
> For the collection of sputum a busy laboratory agreed to built a sputum
> booth/cubical in Karachi.
>
> As per plan this booth will be constructed at the end of a building, 2 walls
> will remain attached to that building, so there will be no ventilation
> through these walls.
> Cross ventilation will be achieved by remaining 2 walls. Lower 2/3 of these
> walls will be solid (to maintain the privacy at the time of sputum
> collection). Entire top 1/3 of the other two walls will remain open. To
> avoid entry of birds in this area, grill made up of iron or steel rods will
> be used. One wash basin and 1-2 shelves will be placed to address hygiene
> and other logistic issues.
>
> Due to paucity of space, this booth will be located near to some office
> area. The distance between booth and to those offices will be about 10 feet
> in the open air.
>
> During the discussion, a query was raised about the safety "free of
> mycobacterial zone around the booth" for those personnel moving around.
>
> I advised them to cultivate bushes and plants around the booth (10 feet
> area) so any person moving in that vicinity will remain away from this
> cubical. I believe dilutional effect will be fine. I would be grateful if
> get some opinion and suggestions.
>
> Kind Regards
>
> Afia Zafar
>
>
> ________________________________
>
> This e-mail may contain information that is privileged or confidential. If
> you are not the intended recipient, please delete the e-mail and any
> attachments and notify us immediately."
>
> --
> View this post online:
> <http://www.ghdonline.org/ic/discussion/should-hcws-wear-respirators-when-play...>
>
> 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.
>