TB Infection Control

Dear Regina,
in warm climate settings the safest and least expensive way to collect sputum is outdoor booth. You could find useful recommendations at: http://www.ghdonline.org/ic/discussion/sputum-collection-booth/

If you need pictures, please provide your e-mail address

Regards,

Grigory

Dear Regina,

please find attached the presentation on sputum collection booths with pictures from various settings.

Hope it helps.

Dear Grigory,

Thank you so much for your useful information..it really helps..
We find difficulties to design a sputum booth in overcrowded prisons.
Especially those with small indoor field..
I like it the picture from Peru.

Yours

Regina

email :

dear Regina, please find in attachment some specifications for a sputum collection booth I provided for another warm-climate Country.
hoping this helps :)
best regards
Thea

Thea Zuccotti, Architect
Specialist Consultant in
Health Structure Design and
Infection Control Strategies
TBTEAM Roster Expert

Dear Thea,

Thank you so much for the design and specification of the sputum collection booth you provided.
this is really what i have been looking for..
one question, if i may ask.. do we need a running water / faucet installation, or can we use the instand hand sanitizer instead ?

Yours,

Regina

dear Regina,
there is no need of running water in a sputum booth: the hand sanitizer is fine, even more than fine. in most of the places, foreseen that TB is an airborne diseases and it is not spread by contact (as "infected"-"dirty" hands), there isn't anything to wash hands... anyway it is always good to promote this standard hygiene proceedure in health structures.
greetings
Thea

Thea Zuccotti, Architect
Specialist Consultant in
Health Structure Design and
Infection Control Strategies
TBTEAM Roster Expert

Dear Thea,

Many thanks to your advice...
one more thing, if i may raise another issue.
In prison setting we find difficulties to locate special isolation room for TB patients.
they will usually be kept with other sick prisoners in the clinic.
If there is only one inpatient room, how can we make simple modification to seperate TB patients with others?

Regards,
Regina

Hi Regina,

There are no easy answers to your question. Several responses come to mind:
1) Prison officials need to recognize that isolation capacity is critical in congregate settings, and build or renovate to assure adequate isolation, for TB, but also for influenza. The price of cutting costs on isolation capacity is more and more cases due to transmission in the prison.
2) With one multibed room only, depending on the size, properly installed, well-designed UVGI fixtures with a ceiling paddle fan can produce in the range of 20 equivalent air changes per hour. This much equivalent ventilation can greatly reduce transmission even within one room.
3) if the room is large enough, perhaps it could be subdivided with each part separately ventilated, or with UVGI. You have not given us enough information to make that judgment.
4) if TB patients are rapidly diagnosed and placed on effective treatment (based on DSTs) the older literature and recent observations show that transmission stops ALMOST IMMEDIATELY, making isolation less important even for smear positive patients ON EFFECTIVE TREATMENT. However, without a special effort to expedite sputum processing, employ rapid molecular diagnostics and rapid DSTs, it can often take months to be sure ...

Hi Regina,

There are no easy answers to your question. Several responses come to mind:
1) Prison officials need to recognize that isolation capacity is critical in congregate settings, and build or renovate to assure adequate isolation, for TB, but also for influenza. The price of cutting costs on isolation capacity is more and more cases due to transmission in the prison.
2) With one multibed room only, depending on the size, properly installed, well-designed UVGI fixtures with a ceiling paddle fan can produce in the range of 20 equivalent air changes per hour. This much equivalent ventilation can greatly reduce transmission even within one room.
3) if the room is large enough, perhaps it could be subdivided with each part separately ventilated, or with UVGI. You have not given us enough information to make that judgment.
4) if TB patients are rapidly diagnosed and placed on effective treatment (based on DSTs) the older literature and recent observations show that transmission stops ALMOST IMMEDIATELY, making isolation less important even for smear positive patients ON EFFECTIVE TREATMENT. However, without a special effort to expedite sputum processing, employ rapid molecular diagnostics and rapid DSTs, it can often take months to be sure patients are on effective treatment. However, I believe that time and money invested in rapid diagnosis and effective treatment may turn out to be the most cost-effective form of TB transmission control. I would not be concerned about a smear positive patient on a general ward if I knew for sure that his/her isolates were susceptible to the drugs he was on, regardless of sputum smear status. Others will question this recommendation, and I am happy to supply them with the relevant references on the rapid effect of treatment on TB transmission.

Sincerely,

Ed

Edward A. Nardell, MD (note: new address below, effective immediately)
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
Partners In Health
641 Huntington Avenue, 3A-03
Boston, MA 02115
 
617 432-2080 (academic office)   617 877-9412 (cell)

Sorry to come into this discussion so late, but I was away.
We were asked to investigate TB transmission and incidence in a very overcrowded juvenile prison. One person with TB entered the correctional services facility and within one month we had 16 youths with TB. By the end of 4 months follow up there were no new cases. All these youths were cohort isolated and all the exposed inmates were observed and followed up for 4 months. The infected cases commenced treatment within 24 hours of diagnosis and were only allowed out into the open courtyard and nowhere else in the facility. They had to prevented from attending classes for two weeks. I think we were very fortunate because the healthcare workers were excellent and implemented the IPC-TB protocols we gave them. The ventilation was really poor, there was overcrowding as one can imagine but since they were treated effectively I think they must have become non infectious within a week and we recommended isolation for two weeks- it worked.
I don't know if this helps at all.
S

Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Lon)
Chair of Infection Control Africa Network (ICAN ...

Sorry to come into this discussion so late, but I was away.
We were asked to investigate TB transmission and incidence in a very overcrowded juvenile prison. One person with TB entered the correctional services facility and within one month we had 16 youths with TB. By the end of 4 months follow up there were no new cases. All these youths were cohort isolated and all the exposed inmates were observed and followed up for 4 months. The infected cases commenced treatment within 24 hours of diagnosis and were only allowed out into the open courtyard and nowhere else in the facility. They had to prevented from attending classes for two weeks. I think we were very fortunate because the healthcare workers were excellent and implemented the IPC-TB protocols we gave them. The ventilation was really poor, there was overcrowding as one can imagine but since they were treated effectively I think they must have become non infectious within a week and we recommended isolation for two weeks- it worked.
I don't know if this helps at all.
S

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

Dear Shaheen
Everything is fine. But wouldnt it be much much much better if we could
communicate effectively certain infection control principles at the
educational level of the adolescents? So that the impact of overcrowding
, minimum ventilation and sunlight requirements can be emphsized?
We do awareness programs in prosons , with other facilities etc etc etc
where medicos , non medicos are always involved ....but WHY after so many
years of knowledge and good will , people will suffer for lack of
awareness or minimum knowledge? Can you get something done to promote good
practices in the educational sectors as well ? So that after say a few
years we find some good IC practices percolating in totality at the
community levels?
It is too far and a broad spectrum but if people from your standing doesnt
support and push then who will ever be able to overcome the poor and poor
standards that prevail everywhere ? Because we cannot have "garden
prisons"....but we can have people who will be able to fend for them
effectively only for disease / infection control .
Why I feel for them ? Because their sufferings are unbelievable.
Thanks for sharing though !!

On Fri, May 4, 2012 at 7:32 PM ...

Dear Shaheen
Everything is fine. But wouldnt it be much much much better if we could
communicate effectively certain infection control principles at the
educational level of the adolescents? So that the impact of overcrowding
, minimum ventilation and sunlight requirements can be emphsized?
We do awareness programs in prosons , with other facilities etc etc etc
where medicos , non medicos are always involved ....but WHY after so many
years of knowledge and good will , people will suffer for lack of
awareness or minimum knowledge? Can you get something done to promote good
practices in the educational sectors as well ? So that after say a few
years we find some good IC practices percolating in totality at the
community levels?
It is too far and a broad spectrum but if people from your standing doesnt
support and push then who will ever be able to overcome the poor and poor
standards that prevail everywhere ? Because we cannot have "garden
prisons"....but we can have people who will be able to fend for them
effectively only for disease / infection control .
Why I feel for them ? Because their sufferings are unbelievable.
Thanks for sharing though !!

On Fri, May 4, 2012 at 7:32 PM, GHDonline (S. Mehtar) <:

> S. Mehtar replied to the discussion "sputum collection booth in Prison" in
> the TB Infection Control community.
>
> Reply contents:
> "Sorry to come into this discussion so late, but I was away.
> We were asked to investigate TB transmission and incidence in a very
> overcrowded juvenile prison. One person with TB entered the correctional
> services facility and within one month we had 16 youths with TB. By the end
> of 4 months follow up there were no new cases. All these youths were cohort
> isolated and all the exposed inmates were observed and followed up for 4
> months. The infected cases commenced treatment within 24 hours of diagnosis
> and were only allowed out into the open courtyard and nowhere else in the
> facility. They had to prevented from attending classes for two weeks. I
> think we were very fortunate because the healthcare workers were excellent
> and implemented the IPC-TB protocols we gave them. The ventilation was
> really poor, there was overcrowding as one can imagine but since they were
> treated effectively I think they must have become non infectious within a
> week and we recommended isolation for two weeks- it worked.
> I don't know if this helps at all.
> S
>
> 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 (Regina Loprang) [mailto:]
> Sent: 22 April 2012 06:08 PM
> To: Mehtar, S, Prof <>
> Subject: Re: [TB Infection Control] sputum collection booth in Prison
>
> Regina Loprang replied to the discussion "sputum collection booth in
> Prison" in the TB Infection Control community.
>
> Reply contents:
> "Dear Thea,
>
> Many thanks to your advice...
> one more thing, if i may raise another issue.
> In prison setting we find difficulties to locate special isolation room
> for TB patients.
> they will usually be kept with other sick prisoners in the clinic.
> If there is only one inpatient room, how can we make simple modification
> to seperate TB patients with others?
>
> Regards,
> Regina"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/sputum-collection-booth-in-prison/#rep...
> >
>
> 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
>
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> --
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Dear Shanta
I totally understand where you are coming from. And you are absolutely right. It was not as easy as it sounds- we ran extensive training programmes for the correctional services healthcare workers and managers. They did understand (finally) the benefit of good IPC and it paid dividends. One advantage we have as an expert group( GHDonline) is to design policy and recommendations. I think we should exploit this.
As previously mentioned I have invited some of the experts to come to the ICAN conference in November and produce a position paper on TB-IPC- I think that would be quite useful and lots of fun. Maybe we could do something similar with correctional services?
Regards
S

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 ...

Dear Shanta
I totally understand where you are coming from. And you are absolutely right. It was not as easy as it sounds- we ran extensive training programmes for the correctional services healthcare workers and managers. They did understand (finally) the benefit of good IPC and it paid dividends. One advantage we have as an expert group( GHDonline) is to design policy and recommendations. I think we should exploit this.
As previously mentioned I have invited some of the experts to come to the ICAN conference in November and produce a position paper on TB-IPC- I think that would be quite useful and lots of fun. Maybe we could do something similar with correctional services?
Regards
S

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 (Dr Shanta Ghatak) [mailto:]
Sent: 06 May 2012 04:53 AM
To: Mehtar, S, Prof <>
Subject: Re: [TB Infection Control] sputum collection booth in Prison

Dr Shanta Ghatak replied to the discussion "sputum collection booth in Prison" in the TB Infection Control community.

Reply contents:
"Dear Shaheen
Everything is fine. But wouldnt it be much much much better if we could communicate effectively certain infection control principles at the educational level of the adolescents? So that the impact of overcrowding , minimum ventilation and sunlight requirements can be emphsized?
We do awareness programs in prosons , with other facilities etc etc etc where medicos , non medicos are always involved ....but WHY after so many years of knowledge and good will , people will suffer for lack of awareness or minimum knowledge? Can you get something done to promote good practices in the educational sectors as well ? So that after say a few years we find some good IC practices percolating in totality at the community levels?
It is too far and a broad spectrum but if people from your standing doesnt support and push then who will ever be able to overcome the poor and poor standards that prevail everywhere ? Because we cannot have "garden prisons"....but we can have people who will be able to fend for them effectively only for disease / infection control .
Why I feel for them ? Because their sufferings are unbelievable.
Thanks for sharing though !!

On Fri, May 4, 2012 at 7:32 PM, GHDonline (S. Mehtar) <:

> S. Mehtar replied to the discussion "sputum collection booth in
> Prison" in the TB Infection Control community.
>
> Reply contents:
> "Sorry to come into this discussion so late, but I was away.
> We were asked to investigate TB transmission and incidence in a very
> overcrowded juvenile prison. One person with TB entered the
> correctional services facility and within one month we had 16 youths
> with TB. By the end of 4 months follow up there were no new cases. All
> these youths were cohort isolated and all the exposed inmates were
> observed and followed up for 4 months. The infected cases commenced
> treatment within 24 hours of diagnosis and were only allowed out into
> the open courtyard and nowhere else in the facility. They had to
> prevented from attending classes for two weeks. I think we were very
> fortunate because the healthcare workers were excellent and
> implemented the IPC-TB protocols we gave them. The ventilation was
> really poor, there was overcrowding as one can imagine but since they
> were treated effectively I think they must have become non infectious within a week and we recommended isolation for two weeks- it worked.
> I don't know if this helps at all.
> S
>
> 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 (Regina Loprang) [mailto:]
> Sent: 22 April 2012 06:08 PM
> To: Mehtar, S, Prof <>
> Subject: Re: [TB Infection Control] sputum collection booth in Prison
>
> Regina Loprang replied to the discussion "sputum collection booth in
> Prison" in the TB Infection Control community.
>
> Reply contents:
> "Dear Thea,
>
> Many thanks to your advice...
> one more thing, if i may raise another issue.
> In prison setting we find difficulties to locate special isolation
> room for TB patients.
> they will usually be kept with other sick prisoners in the clinic.
> If there is only one inpatient room, how can we make simple
> modification to seperate TB patients with others?
>
> Regards,
> Regina"
>
> --
> View this post online:
> <
> http://www.ghdonline.org/ic/discussion/sputum-collection-booth-in-pris
> on/#reply-4552-2?id=10209&format=text&type=instant
> >
>
> 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
>
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> 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:
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> >
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>"

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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.

Yes
Would be looking forward ...
Thanks

Dear Ed,
You mentioned you can provide with references
on the rapid effect of treatment on TB transmission.
Is it possible to have the list of references?

Thank you a lot in advance

A.Pasechnikov,
Senior TB Advisor, Az SHIP Project,
Abt Associates Inc.
133 B.Safaroglu, 14th floor, Baku, Azerbaijan, 1009
Tel +994 12 596 58 07 / 596 58 09
Fax +994 12 596 57 90
Mob +99450 235 75 23
A.Pasechnikov,
Senior TB Advisor, Az SHIP Project,
Abt Associates Inc.
133 B.Safaroglu, 14th floor, Baku, Azerbaijan, 1009
Tel +994 12 596 58 07 / 596 58 09
Fax +994 12 596 57 90
Mob +99450 235 75 23

Hi Sasha,

Yes, sorry, I will provide that while preparing a paper for publication on the same. I am on clinical service at the moment, so it will take a little time to organize.

Ed

Edward A. Nardell, MD
Associate Professor
Harvard Medical School
Harvard School of Public Health
Brigham & Women's Hospital
Partners In Health
641 Huntington Avenue
3A-03
Boston, MA 02115
617 432-2080