Transcript اداره كنترل سل و جذام نشست سالانه برنامه كنترل سل مازندران

‫اداره كنترل سل و جذام‬
‫نشست ساالنه برنامه كنترل سل‬
‫مازندران ‪ -‬بابلسر‬
‫‪1 | 12/12/1386‬‬
‫‪General concepts on‬‬
‫‪TB infection control‬‬
‫اداره كنترل سل و جذام‬
‫نشست ساالنه برنامه كنترل سل‬
‫مازندران ‪ -‬بابلسر‬
‫‪2 | 12/12/1386‬‬
Presentation outline
 Transmission of TB
 Hierarchy of Infection Controls
 Administrative Infection Controls
 Environmental Controls
 Personal Respiratory protection
 HCW protection
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
The purpose of infection control Program
 To reduce the risk of Mycobacterium
tuberculosis transmission to health care
workers, patients, and others in the health
care facility
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Mycobacterium tuberculosis
 Generated by coughing, sneezing,
speaking
 Remains airborne and spreading air
currents
 Aerobic, desiccation-resistant
 1-100 organisms may infect
 Droplet nuclei, 1-5 
 Most exposed persons do not become
infected
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
“At risk” health care worker
 Nurses
 Physicians, specialists in internal medicine
 specialists in respiratory medicine (extra risk
providing bronchoscopy, caring ventilated patients in
ICU)
 Pathologists
 Laboratory staff
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Fundamentals of Infection Control (1)
Hierarchy of Infection Control
Administrative Controls
Environmental Controls
Respiratory Protection
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Administrative Controls
 Prevention of droplet nuclei containing M.
tuberculosis from being generated;
 Prevention of TB exposure to staff and patients; and
 Implementation of rapid and recommended
diagnostic investigation and appropriate
treatment for patients and staff suspected or known
to have TB.
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Administrative Controls
 Assign responsibility for TB infection control (IC)
 Conduct TB risk assessment and develop written TB
IC plan, including AII precautions
 Ensure timely lab processing and reporting
 Implement effective work practices for managing TB
patients
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Administrative Controls
 Test and evaluate HCWs at risk for TB or for
exposure to M. tuberculosis
 Train HCWs about TB infection control
 Ensure proper cleaning of equipment
 Use appropriate signage advising cough etiquette
and respiratory hygiene
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Assignment of responsibilities
 Supervisory responsibility should be delegated to a
specific person or infection control team with a leader
 Should include experts in:
- infection control
- hospital epidemiology
- clinician
- engineering
 IC team responsible for all aspects of the IC program
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
TB Risk Classifications (1)
All settings should perform risk classification as part of
risk assessment to determine need for and frequency
of an HCW testing program, regardless of likelihood of
encountering persons with TB disease.
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
TB Risk Classifications (2)
 Low risk – Persons with TB disease not expected to
be encountered; exposure unlikely
 Medium risk – HCWs will or might be exposed to
persons with TB disease
 Potential ongoing transmission – Temporary
classification for any settings with evidence of
person-to-person transmission of M. tuberculosis
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
TB Risk Classifications (3)
Inpatient
Settings
Low
Medium
<200 beds
<3 TB
patients/yr
>3 TB
patients/yr
Potential
Ongoing
Transmission
Evidence of ongoing
transmission,
regardless of setting
≥200 beds
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<6 TB
patients/yr
>6 TB
patients/yr
‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
TB Risk Classifications (4)
Outpatient
Settings
Low
Medium
Potential Ongoing
Transmission
TB treatment
facilities,
medical offices,
ambulatory
care settings
<3 TB
patients/yr
>3 TB
patients/yr
Evidence of ongoing
transmission,
regardless of setting
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Implement effective work practices for managing TB patients
 Infection control plan (including TB) specific to each area within facility,
and HCW group based on level of risk
 Put all procedures in writing plan including:
– Early detection isolation and treatment of infectious TB patients
– Patient education
– Decreasing of cough induction procedures
 Administrative support for procedures in the plan, including quality
assurance;
 Educate staff about the plan - organization, rationale, and what is
expected of them
 TB screening program for health care workers
 Education of patients and increasing community awareness; and
 Coordination and communication between the TB and HIV programs.
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Ensure early identification, diagnostic evaluation, isolation and
treatment (2)
 Focus on high risk groups:
–
–
–
–
contacts,
HIV+,
positive medical history,
People with social and epidemiologic factors)
 Use appropriate diagnostic methods for TB/MDR-TB
 Following Isolation protocols and procedures
 Being sure about adequate effective treatment
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Administrative control measures
Isolation procedures
 Designate high-risk areas (isolation rooms) for TB
and MDR-TB patients or suspects
 Establish rules and regulations for isolation (eg.
Starting & interruption of isolation, target group, …)
 Patient education, signed informed consent*
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Environmental Controls
 Second defense in TB IC program, after
administrative controls,
 Control of infection source
 Dilute and remove contaminated air
 Control airflow
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Environmental Controls
UV lamps
HEPA filters
Ventilation systems
Natural airflow
Technologies for removing or inactivating M. tuberculosis
consist of Local exhaust ventilation, General ventilation
Air-cleaning methods, e.g., high-efficiency particulate air
(HEPA) filtration, ultraviolet germicidal irradiation (UVGI)
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Local Exhaust Ventilation
 Source-control method for capturing airborne
contaminants
– Enclosing device: fully or partially enclosed source;
include tents, booths, and biologic safety cabinets
(BSCs)
– External device: source near but outside enclosure
 Should remove at least 99% of particles before next
patient or HCW enters
 Use
– for cough-inducing and aerosol-producing
procedures
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
General Ventilation
 Systems that dilute and remove contaminated air and control
airflow patterns in a room
 Single-pass system preferred for AII rooms
 Maintain AII rooms under negative pressure
– Existing settings: ≥6 air changes/hr (ACH)
– New or renovated settings: ≥12 ACH
 Recirculation (HEPA filtration, UV irradiation)
 Engineers must look after function of ventilation system, to
determine airflow and air exchange per hour
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Ventilation Airflow
In places with
highest risk of
infection
•TB isolation
rooms;
•Bronchoscopy
rooms
•Aerosol rooms
•Sputum induction
rooms
•TB patient
admission rooms
• Bacteriological
laboratory
wrong
Wright
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
‫‪Air flow measurements‬‬
‫اداره كنترل سل و جذام‬
‫نشست ساالنه برنامه كنترل سل‬
‫مازندران ‪ -‬بابلسر‬
‫‪24 | 12/12/1386‬‬
‫‪Natural ventilation‬‬
‫اداره كنترل سل و جذام‬
‫نشست ساالنه برنامه كنترل سل‬
‫مازندران ‪ -‬بابلسر‬
‫‪25 | 12/12/1386‬‬
Air-Cleaning Methods
HEPA filters
 Use as supplement to ventilation
 Used to filter infectious droplet nuclei from the air
 Must be used
– When discharging air from local exhaust ventilation booths directly
into surrounding room
– When discharging air from an AII room into the general ventilation
system
 Can be used to clean air that is exhausted to outside
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
HEPA Filter
Use of filters
Replacement of filter depends on:
- volume and type of exposition
- environmental condition
- Airflow rate
- type of filter
- place of ventilation system
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Air-Cleaning Methods
UVGI
 Kills or inactivates M. tuberculosis
 Use as supplement to ventilation
 Not substitute for negative pressure rooms
 Not substitute for HEPA filtration when air recirculated from AII
room into other areas
 Emphasis on safety and maintenance
 Occupational exposure limits:
– Overexposure can cause damage to skin, eyes
– UVGI systems must be properly installed and maintained
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
UVGI - cleaning
‫‪UVGI - measurements‬‬
‫اداره كنترل سل و جذام‬
‫نشست ساالنه برنامه كنترل سل‬
‫مازندران ‪ -‬بابلسر‬
‫‪30 | 12/12/1386‬‬
Respiratory Protection
General
 Third level in the IC hierarchy
 Should be used by persons
– Entering rooms of suspected/confirmed TB patients
– Around cough / aerosol-producing procedures
– In settings where administrative and environmental controls will
not prevent the inhalation of infectious droplet nuclei
 Decision on use of respiratory protection (RP) in labs should
be made on case-by-case basis
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
Respiratory Protection (RP)
Controls
 Implement RP program
 Train HCWs on RP
 Train patients on respiratory hygiene
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬
‫‪Personal protective equipment‬‬
‫‪Masks‬‬
‫اداره كنترل سل و جذام‬
‫‪vs.‬‬
‫نشست ساالنه برنامه كنترل سل‬
‫مازندران ‪ -‬بابلسر‬
‫‪Respirators‬‬
‫‪34 | 12/12/1386‬‬
Periodic screening of health workers
to detect disease at an early stage
 Each year for employees
 Medical questionnaire
 Chest x-ray, PPD test
 Sputum exam if cough > 2-3 weeks
 Special consideration for employees with
increased individual risk
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‫نشست ساالنه برنامه كنترل سل‬
‫ بابلسر‬- ‫مازندران‬
‫اداره كنترل سل و جذام‬