Post on 13-Jan-2016
12/12/13861 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
12/12/13862 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
General concepts on
TB infection control General concepts on
TB infection control
12/12/13863 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Transmission of TB
Hierarchy of Infection Controls
Administrative Infection Controls
Environmental Controls
Personal Respiratory protection
HCW protection
Presentation outlinePresentation outline
12/12/13864 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
The purpose of infection control ProgramThe 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
12/12/13865 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Mycobacterium tuberculosisMycobacterium 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
12/12/13866 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
“At risk” health care worker“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
12/12/13867 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Respiratory Protection
Administrative Controls
Environmental Controls
Fundamentals of Infection Control (1)Hierarchy of Infection Control
Fundamentals of Infection Control (1)Hierarchy of Infection Control
12/12/13868 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
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.
Administrative control measures
Administrative ControlsAdministrative control measures
Administrative Controls
12/12/13869 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
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
Administrative control measures
Administrative ControlsAdministrative control measures
Administrative Controls
12/12/138610 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
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
Administrative control measures
Administrative ControlsAdministrative control measures
Administrative Controls
12/12/138611 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
Assignment of responsibilitiesAdministrative 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
12/12/138612 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
TB Risk Classifications (1)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.
12/12/138613 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
TB Risk Classifications (2)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
12/12/138614 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
TB Risk Classifications (3)Administrative control measures
TB Risk Classifications (3)
Inpatient Settings LowLow Medium
Potential Ongoing
Transmission
<200 beds<3 TB
patients/yr>3 TB
patients/yrEvidence of ongoing
transmission,regardless of setting
≥200 beds<6 TB
patients/yr>6 TB
patients/yr
12/12/138615 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Outpatient Settings LowLow 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
Administrative control measures
TB Risk Classifications (4)Administrative control measures
TB Risk Classifications (4)
12/12/138616 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
Implement effective work practices for managing TB patients 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.
12/12/138617 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
Ensure early identification, diagnostic evaluation, isolation and treatment (2)
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
12/12/138618 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Administrative control measures
Isolation proceduresAdministrative 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*
12/12/138619 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Second defense in TB IC program, after administrative controls,
Control of infection source
Dilute and remove contaminated air
Control airflow
Environmental ControlsEnvironmental Controls
12/12/138620 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
UV lampsUV lamps
HEPA filters
Ventilation systems
Natural airflow
Environmental Controls
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)
12/12/138621 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Local Exhaust VentilationLocal 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
12/12/138622 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
General VentilationGeneral 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)
EngineersEngineers must look after function of ventilation system, to determine airflow and air exchange per hour
12/12/138623 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Ventilation AirflowVentilation 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
12/12/138624 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Air flow measurementsAir flow measurements
12/12/138625 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Natural ventilationNatural ventilation
12/12/138626 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Air-Cleaning MethodsHEPA filters
Air-Cleaning MethodsHEPA 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
12/12/138627 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
HEPA FilterHEPA 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
12/12/138628 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Air-Cleaning MethodsUVGI
Air-Cleaning MethodsUVGI
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
UVGI - cleaningUVGI - cleaning
12/12/138630 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
UVGI - measurements
12/12/138631 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Respiratory ProtectionGeneral
Respiratory ProtectionGeneral
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
12/12/138632 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Respiratory Protection (RP) Controls
Respiratory Protection (RP) Controls
Implement RP program
Train HCWs on RP
Train patients on respiratory hygiene
12/12/138634 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Respirators vs. MasksRespirators vs. Masks
Personal protective equipmentPersonal protective equipment
12/12/138635 | اداره كنترل سل و جذام
نشست ساالنه برنامه كنترل سل
مازندران - بابلسر
Periodic screening of health workers to detect disease at an early stage
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