TB infection control
Started by Catherine Boulanger on 27 Jan 2010
Last edited by Julia Fischer-Mackey on 12 May 2010
Good afternoon
I was hoping you could help me. The University of Miami has put up a tent hospital with air-conditioning in Port-au-Prince. There has been a concern about spreading tuberculosis. Would you have any ideas about environmental control measures. Thank you in advance for your help
I will attempt to get you a diagram of the project as soon as possible
Catherine Boulanger M.D.
305 243 4598
Keywords: Haiti
Edward Nardell, MD
Catherine,
It would be great to see the tent or setup when you have more information from your colleagues on the ground. Are you concerned about patient to patient TB transmission in recovery, etc. or patient to HCW transmission in the OR, or both?
As you probably know, the environmental controls that we have are ventilation, mechanical or natural; UV air disinfection; and air filtration. For an air conditioned operating room tent there are not many options. Do you know how many ACH are called for in the vent specs of the tent? I suspect that information is not handy. I presume the mechanical ventilation system providing the AC produces positive pressure in the tent relative to the outside, as with regular ORs. This is designed to protect the operating environment, not people working within it.
Natural ventilation is out since that would lead to uncontrolled air direction and potential contamination at the operative site.
UVGI could help but is not readily adapted to an OR tent due to precise wall placement, etc. High humidity in Haiti is another concern with UV.
Air filtration machines could be used in a tent, but will draw a lot of energy and are only as good as the numbers of equivalent air changes they generate in the tent.
Finally, there are personal respirators for HCWs and surgical masks for suspect TB patients. These cannot be worn continuously and their overall efficacy is unclear, but for protecting oneself, not a bad solution when effective environmental controls are lacking.
I am not sure any of this provides the assurance that you would like. It is an extremely timely question. I hope that in the future this online discussion may serve as a resource to others responding to similar humanitarian crises around the world.
Ed
Edward A. Nardell, MD
Associate Professor
Harvard Medical School (Medicine; Global Health and Social Medicine)
Harvard School of Public Health (Environmental Health; Immunology and Infectious Diseases)
12:23 PM, 27 Jan 2010 | Permalink