Infection Control

Institutional

Individual

Community

Topics

• Infection control basics

– What is it

– Transmission Risks

• Institutional Infection Control (IC)

• Community IC

• Individual IC

Transmission

To Catch website: : www.tocatch.info/en/Tuberculosis.htm

Transmission

NLM website: http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19099.jpg

Just by breathing…

Transmission

What is infection control?

Infection Control is:

• Measures to prevent transmission of infectious germ from a source to others

• It’s a primary prevention method to keep those who are uninfected free from infection

Good IC Practices should

• Be done in the context of providing access to care. IC without access to care will lead to stigma

• Always respect human rights and dignity of patients

• Be seen as a shared responsibility, not primarily something that needs to be imposed upon patients/community

Infection Control Measures

• Looking at three levels– Institutional– Community– Individual

• All methods that follow can be done where we live and work– Low-resource settings– Areas of HIV prevalence

Institutional IC

• Health care settings should have a plan

• How to do:– Have a plan that entails

• Patient flow• Health care worker and patient education• Mechanical tools to reduce infection

– Make coordination and responsibilities clear– Crisis management for when plans don’t flow

Institutional IC

• Earlier case detection and treatment

• How to do:– Don’t rely on poor diagnostics

• We can use symptom screen algorithms

– Proper training for staff (looking for smear (-) TB, making TB priority for PLH)

– Must include strengthening of TB program to reduce defaulting

Institutional IC

• Administrative cohorting or isolation with rapid evaluation for TB and MDR TB

• How to do:– Develop a patient flow strategy for limited

space– Requires HCW to be on alert for TB patients not

responding to 1st line treatment– Requires 2nd-line drugs– Requires adequate space for TB suspects to be

evaluated

TB Triage – PIH (Haiti)Community based TB treatment

Hospitalized patients

General ward

Sm -, HIV +/-

TB Pavilion

Sm+, HIV-

6 isolation rms

SM+ and HIV+

TB Pavilion•Fenestrated walls•Louvered windows•UV lamp•High ceilings•Overcrowded

TB Pavilion•Fenestrated walls•Louvered windows•UV lamp•High ceilings•Overcrowded

Institutional IC

• Regularly screen health care workers• Have IC tools available

• How to do:– Provide regular screening for TB for ALL

health care workers (including lay counselors)

– Provide staff support for TB services– Equip staff with fans, masks, and uv

whenever possible

Institutional IC

• Germicidal uv radiation

http://pic3.ohpy.com/up/elbbs/2007/11/26/93009/851902899/mid_44503kowalski12_00000020268.jpg

Community IC

• Patient/community education

• How to do education for TB:– Training for health care workers to use

IC tools (masks, fans, windows, etc)– Skin testing for TB and prevention– Signs and symptoms– Treatment literacy

Community IC

Community IC

• Anti-stigma Education

• How to do:– The NO FEAR tactic– Quarantine and scary stories can inhibit

patients desire to seek care– This can increase TB in the community!

– Main Message—TB can be cured!

Community IC continued..

• Look for infection control in your clinics

• Are the windows open? Can the waiting room be outside?

• Ask for infection control measures to be implemented

Individual IC• Personal respiratory protection• Know the signs and symptoms of TB• Look for TB in our communities• Educate, educate, educate

WHO Recommended 10 Steps for Infection Control

• Include Patients & Community in Advocacy for IC

• Develop an IC Plan• Ensure Safe Sputum Collection • Promote Cough Etiquette & Hygiene• People with symptoms suspected to

be TB should be triaged to be fast tracked/ separated

10 Steps for IC (Contd)

• Assure Rapid Diagnosis & Treatment• Improve Room Air Ventilation• Protect Health Care Workers• Build Capacity of Health Institutions

for IC• Monitoring IC practices