Tuberculosis Infection Control in the Era of Expanding HIV Care and Treatment Addendum to WHO 1999,

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Tuberculosis Infection Control in the Era of
Expanding HIV Care and TreatmentAddendum to
WHO 1999, Guidelines for the Prevention of
Tuberculosis in Health Care Facilities in
Resource-Limited Settings
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Contributors

• Writing committee
• WHO Alasdair Reid, Pierre-Yves Norval, Paul
  Nunn
• The Union Riitta Dlodlo
• CDC Bess Miller, Wanda Walton, Naomi Bock
• Others
• Paul Jensen, Bill Coggin, Hans Rieder, Elizabeth
  Corbett, Eric Ikoona, Barbara Marston, Mary
  Catlin

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• Why
• What
• How

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Why

• To help management and staff minimize the risk of
  TB transmission at facilities in resource-limited
  settings
• Where HIV-infected persons receive care
• Where there is a high prevalence of HV infection
  both known and undiagnosed

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Supplements 1999 WHO Guidelines

• Does not address inpatient facilities
• Does provide expanded tools for implementation of
  infection control
• Increases emphasis on health care workers and
  staff knowing their HIV status and administrative
  policies to protect those who are PLWHA

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What Issues Addressed

• TB transmission in facilities providing services
  to PLWHA
• Infection control procedures to reduce the risk
  of TB transmission
• Protection of of health care workers and staff
  through HIV voluntary counseling and testing and
  increasing awareness of TB in staff, and
  appropriate action

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What Issues Addressed

• Importance of TB infection control in drug
  rehabilitation centers, prisons, jails other
  congregate facilities
• Special issues of multidrug resistant TB
• Operational research priorities

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How HIV Care Settings Can Reduce the Risk of
Spreading TB

• Work practice and administrative control measures
• Environmental control measures
• Personal respiratory protection
• Protection of health care workers and staff thru
  VCT and awareness of TB

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Work Practice and Administrative Controls

• Infection control plan
• Administrative support for procedures in the plan
• Education of staff and clients
• Coordination and communication between the
  HIV/AIDS and TB program

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Components of TB Infection Control Plan

• Screen clients to identify persons with symptoms
  of TB disease or on treatment for current TB
• Educate on TB in general and on cough hygiene
  provide face masks or tissues to symptomatic
  (suspect) or known cases
• Expedite TB suspect/case receipt of services
• Investigate on site or refer TB diagnostic
  services and treatment

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Infection control plan (2)

• Use and maintain environmental control measures
• Train and motivate staff to recognize TB disease
  in themselves
• Train and educate staff on TB and the TB
  infection control plan
• Monitor and improve plans implementation

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Environmental Control Measures

• Goal reduce droplet nuclei containing M.
  tuberculosis in the air
• Means maximize controlled natural ventilation
• Design of waiting areas, special exam rooms for
  those with symptoms
• Fans and fixed open windows and doors

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Protection of Health Care Workers and Staff

• Increasing awareness of TB in health care workers
  and staff
• Promoting HIV VCT in HCW and staff
• Increasing confidentiality/reducing stigma
• Assuring access to ARV and other HIV treatment
• Reducing workplace exposure risk

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Operational Research Priorities

• Screening tools and algorithms to quickly
  identify potentially infectious TB patients
  presenting for HIV services
• Mechanisms for referrals and linkages between HIV
  and TB services
• Increasing proportion of HCW/staff who know their
  HIV status and access care
• Role of prolonged/chronic IPT for
  immunocompromised HCW/staff
• Designs for enhancing air flow via controlled
  natural ventilation

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Tools Provided - Annexes

• Sample infection control plan
• Sample monitoring tools
• Training material for staff
• Education materials for clients
• Information on ventilation and fans
• Resources for further information