TB Infection Control

Dear Pietie,

There are some guidelines on transport but I don't have those references in my head. There may be some specifically for South Africa.

Here are a couple of my own responses:
If they are TB patients on EFFECTIVE therapy they are unlikely to be infectious. EFFECTIVE therapy means that they are on drugs likely to work and are responding by reduced cough, etc. With the advent of rapid drug susceptibility testing this may become easier to know early on in every case, but often there is unsuspected drug resistance and treatment is not effective at the time of transport. My point is that EFFECTIVELY treated patients are rapidly non-infectious and no special precautions are needed. Knowing for sure that treatment is effective is the key issue. If this cannot be assured, then it is reasonable to assume that transmission is possible. The only real options are maximum ventilation in the transport vehicle and, possibly, respiratory protection for the driver. if multiple patients are transported, cross infection is another concern, especially if HIV co-infection is common as it is in South Africa. Opening windows is a problem when it is cold or raining, but the vent system of ...

Dear Pietie,

There are some guidelines on transport but I don't have those references in my head. There may be some specifically for South Africa.

Here are a couple of my own responses:
If they are TB patients on EFFECTIVE therapy they are unlikely to be infectious. EFFECTIVE therapy means that they are on drugs likely to work and are responding by reduced cough, etc. With the advent of rapid drug susceptibility testing this may become easier to know early on in every case, but often there is unsuspected drug resistance and treatment is not effective at the time of transport. My point is that EFFECTIVELY treated patients are rapidly non-infectious and no special precautions are needed. Knowing for sure that treatment is effective is the key issue. If this cannot be assured, then it is reasonable to assume that transmission is possible. The only real options are maximum ventilation in the transport vehicle and, possibly, respiratory protection for the driver. if multiple patients are transported, cross infection is another concern, especially if HIV co-infection is common as it is in South Africa. Opening windows is a problem when it is cold or raining, but the vent system of the vehicle may or may not be adequate - and is not easily assessed. If this is a regular practice, outfitting a vehicle with a physical barrier between the driver and passengers could be done on most cars and mini buses, but this protects only the driver. High volume air filtration (or UV air disinfection) could be effective in the small volume of a vehicle, but I am not aware of anyone selling a device for this purpose and its efficacy would depend entirely on the details (clean air delivery rate, distribution, etc). I don't think there is a role for upper room UV in the small compartments of transport vehicles. I am interested in what Paul and others have to say.

Thanks,

Ed

Greetings!

Agree with Ed . . . Get patients under appropriate TB treatment!!! Or step #1 in the TB IC hierarchy . . . Administrative controls . . . Stop TB Strategy!!!

I'm a strong believer is the KISS Principle . . . Keep It Simple & Sane (that's a slight modification of the original definition)!

Many years ago with colleagues from CDC/NIOSH, I was involved in a study of the "clearance" of an artificially generated aerosol in an ambulance, while driving around the streets of Newark, New Jersey, USA. Our mission was to compare the efficacy of a room air cleaner (w/ HEPA filter) to the classic small fan above the door in the back. Guess which one was more more efficient is clearing the air? The SiMPLE solution. I will have to go back to find the report of the exact level of clearance/air exchange. I do recall that we did it both with the driver's window open and with the "vent" system on (i.e., not recirculating) so that air was supplied from the front and exhausted in the back.

Any air exchange would be great for AIRBORNE IPC (infection prevention and control) . . . Not just TB.

And as far as UVGI goes, there are probably ...

Greetings!

Agree with Ed . . . Get patients under appropriate TB treatment!!! Or step #1 in the TB IC hierarchy . . . Administrative controls . . . Stop TB Strategy!!!

I'm a strong believer is the KISS Principle . . . Keep It Simple & Sane (that's a slight modification of the original definition)!

Many years ago with colleagues from CDC/NIOSH, I was involved in a study of the "clearance" of an artificially generated aerosol in an ambulance, while driving around the streets of Newark, New Jersey, USA. Our mission was to compare the efficacy of a room air cleaner (w/ HEPA filter) to the classic small fan above the door in the back. Guess which one was more more efficient is clearing the air? The SiMPLE solution. I will have to go back to find the report of the exact level of clearance/air exchange. I do recall that we did it both with the driver's window open and with the "vent" system on (i.e., not recirculating) so that air was supplied from the front and exhausted in the back.

Any air exchange would be great for AIRBORNE IPC (infection prevention and control) . . . Not just TB.

And as far as UVGI goes, there are probably more potential problems than benefits in this particular situation. What do I mean? Obviously, cannot use unshielded or shielded UVGI without potential for over exposure. A room air cleaner w/ UVGI would have the same drawbacks as a room air cleaner w/ HEPA.

Regards,

Paul J

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

Dear Pietie,

just a little addition to what have already been told until now: concerning reference materials on this subject, you can find a short document in the Francis J. Curry web site called “What precautions should be taken when transporting a TB Patient?” (http://www.nationaltbcenter.edu/abouttb/tbcontrol_faqs/14_precautions_transpo...)

greetings
Thea Zuccotti