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Guidelines for Prevention of TB

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Guidelines for Prevention of TB Centers for Disease Control & Prevention Administrative Controls Infection Control Policies and Procedures Risk Assessment/HCW ... – PowerPoint PPT presentation

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Title: Guidelines for Prevention of TB


1
Guidelines for Prevention of TB
  • Centers for Disease Control Prevention

2
Administrative Controls
  • Infection Control Policies and Procedures
  • Risk Assessment/HCW Screening
  • Investigation of HCW TST Conversions

3
TB Infection Control Policies Procedures 1
  • High index of suspicion for TB
  • Prompt triage
  • Prompt initiation of respiratory isolation
  • AII room under negative pressure (monitored)
  • UVGI and HEPA filtration as necessary
  • Limit movement of patient outside AII room
  • Prompt initiation of appropriate treatment

4
TB Infection Control Policies Procedures 2
  • Personal respiratory protection during exposure
    (N-95 respirators)fit testing req.
  • Limit employee and visitor exposure
  • Monitor clinical status by symptoms, laboratory
    and CXR to ensure appropriate duration of
    airborne precautions
  • Appropriate discharge to the community

5
Respiratory Protection
  • The ability to filter 1um in size with a filter
    efficiency of gt95
  • Fit test to insure face seal leakage of lt10
  • Making respirators available in at least three
    sizes
  • Reuse of Respirators

6
Why do we place patients in isolation?
  • Patients who are immunocompromised are placed in
    a protective environment
  • Patients who have communicable diseases are
    placed in airborne infection isolation(AII)
  • Patients who have both problems are put in a room
    with a combination of controls but always protect
    the staff, visitors and other patients

7
Protective Environment
8
Protective Environment
  • Install central or point-of-use HEPA filters for
    incoming air
  • Maintain gt 12 air changes per hour (ACH)
  • Maintain positive pressure (gt 2.5 Pa) in relation
    to corridor
  • Ensure that rooms are well sealed
  • Properly constructed windows, doors and intake
    and exhaust ports
  • Maintain ceilings that are smooth and free of
    fissures, open joints and crevices
  • Monitor for leakage

9
Airborne Spread of Smallpox in the Meschede
Hospital
Fenner. 1988.Fig. 4.9
10
AII Rooms
11
AII Rooms
  • Maintain continuous negative pressure (2.5 Pa) in
    relation to the air pressure in the corridor and
    ensure monitoring
  • Ensure that rooms are well sealed
  • Provide ventilation to ensure gt 12 ACH for new
    and renovated rooms and gt 6 ACH for existing
    rooms
  • Direct exhaust air to the outside, away from air
    intake and populated areas. If this is not
    practical, air from the room can be recirculated
    after passing through a HEPA filter, ?UVGI

12
Guidelines
  • 2001 AIA Guidelines for Design and Construction
    of Hospital and Health Care Facilities - ????NEW
    July 2006
  • 2003 CDC Guidelines for Environmental Infection
    Control in Health-Care Facilities
  • 2004 JCAHO Environment of Care Essentials for
    Health Care Fourth Edition

13
What about an anteroom?
  • AIA Guidelines Section 7.2.C Airborne Infectious
    Isolation Rooms does not require anterooms. The
    requirement for an anteroom was dropped in the
    1996-97 edition of the Guidelines on the basis of
    a study.
  • CDC Guideline Does not require anteroom. For
    Viral Hemorrhagic Fever and Smallpox, use AII
    preferably with an anteroom if not available
    use industrial-grade HEPA filters to provide
    additional ACH
  • JCAHO EC Standard No reference to anterooms

14
ASHRAEs Design Manual (American Society of
Heating, Refrigeration, and Air-conditioning
Engineers) HVAC Design Manual for Hospitals and
Clinics 2003
15
Chapter 12 Room Design
  • On negative air pressure, as is required for
    Airborne Infectious Isolation Rooms
  • Through dilution, a 500 cubic feet anteroom
    (for example) with an AVM of 50 cubic feet would
    experience a 90 percent reduction in the
    transmission of contaminated air to and from the
    isolation room. An anteroom is recommended as a
    means of controlling airborne contaminant
    concentration via containment and dilution of the
    migrating air.

16
Why add an anteroom or airlock?
  • To provide a barrier against loss of
    pressurization, and against entry/exit of
    contaminated air into/out of isolation room when
    the door to the airlock is opened
  • To provide a controlled environment in which
    protective garments can be donned without
    contamination before entry into and exit out of
    room
  • To provide a controlled environment in which
    equipment and supplies can be transferred fro the
    isolation room without contaminating the
    surrounding area

17
Anterooms
18
Creating Isolation Rooms
  • Funding by governmental agencies to increase
    isolation capacity
  • Many healthcare facilities have upgraded or
    retrofitted existing negative pressure isolation
    rooms
  • Many healthcare facilities have purchased quick
    fixes to increase isolation capacity

19
Whats out there?
Source Control Local Exhaust/Ventilation
20
Whats out there?
Source Control Local Exhaust/Ventilation
21
Disclaimer
  • Following are illustrations of actual products
    available to healthcare facilities. These are
    being used for educational purposes only and are
    not meant to endorse or criticize any individual
    company or product. I have no financial interest
    in any healthcare products.

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Whats out there?
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29
Key Points
  • There needs to be a clear understanding by all of
    our goals when using isolation rooms who are we
    trying to protect and why.
  • There needs to be a clear understanding of how to
    appropriately use the equipment/resources
    available to accomplish our goals.
  • There needs to be a clear understanding of how to
    minimize risks and maximize benefits to patients
    and health care workers by using the
    equipment/resources.

30
Key Points
  • A portable HEPA device will not create a negative
    pressure room unless exhaust can be discharged
    directly to the outside.
  • Trying to connect a HEPA unit into a return duct
    to create negative pressure would pressurize the
    return duct and result in blowback into adjacent
    rooms.
  • If the unit is vented directly to the outside,
    return air grilles must be sealed off remember
    to take into account the direction of flow into
    the attached bathroom.

31
Key Points
  • All personnel must understand the use of these
    devices housekeeping, nursing.
  • The portable air filtration device should not be
    plugged into a power strip or extension cord.
    Consider using an emergency power outlet.
  • The HEPA unit must not create an obstruction that
    would interfere with the proper delivery of
    health care.
  • The placement of the device needs to be
    pre-determined to maximize air mixing for better
    air scrubbing.

32
Key Points
  • The intake of the device should be placed as
    close to the suspected source of contamination.
  • The device should be placed so that it does not
    draw contaminated air past the breathing zone of
    the caregiver.
  • The air flowing out of the device must not be
    directed in a way that would cause discomfort to
    patients, visitors and staff.

33
Key Points
  • The air flow needs to be appropriate for the size
    of the room to give the desired air exchanges per
    hour. Consider a locked panel to prevent a
    change in the air flow controls.
  • Rooms in which the devices may be utilized should
    be chosen beforehand ensuring that the noise
    created is not disruptive to others.
  • If the unit is ducted to the outside or into the
    existing ventilation system, ensure that an
    appropriately fitting interface is available.

34
Key Points
  • Place HEPA filters over exhaust grilles that
    cannot be blocked.
  • The use of the portable filtration devices should
    be guided by a written policy that is
    facility-specific with appropriate reviews and
    approvals from infection control, administration,
    clinical and facility engineering and the
    departments in which the units will be used.
  • Healthcare facilities should have a checklist
    establishing the proper room use.

35
Key Points
  • Based on manufacturers recommendation and any
    additional suggested protocol from facility
    maintenance, a standard routine maintenance
    procedure should be developed for the unit. This
    should include
  • Changing of pre-filters. Be sure to include
    details of PPE and proper disposal of filters.
  • Operational check for proper operation.
  • Interior cleaning of the unit
  • Changing of UV lamp
  • General electrical and mechanical safety check

36
Key Points
  • Clinical and/or facility engineering should check
    the machine on a daily basis while in use and
    measure the degree of negative pressure between
    the room in which it is situated and
    adjacent/affected areas.

37
Key Points
  • The HEPA device must be leak tested and
    certified. This should be done initially when
    the equipment is received, at least annually
    thereafter, and every time the HEPA filter is
    changed. The frequency of changing the HEPA
    filter should be based upon manufacturers
    recommendation.

38
Key Points
  • Policies and procedures should specify
    recommended PPE when performing maintenance of
    the unit.
  • Maintenance should be performed in an area away
    from patient care.

39
Monitoring Negative Air Pressure
  • Pressure-measuring devices
  • Measure pressure at the bottom of the door
  • Audible warning with a time delay
  • Check continuous monitoring devices at least
    monthly using smoke tubes

40
Smoke Test
  • Checked daily
  • Hold 2 inches from bottom of door
  • If room air cleaners are used they should be
    running
  • Door must be closed

41
UV Radiation
  • Used to supplement other engineering controls
  • Duct Irradiation
  • To recirculate air from an isolation room back
    into the room.
  • Used in general use areas where air is
    recirculated back into general ventilation
  • Upper Room Air Irradiation
  • Mounted on ceiling or wall

42
Effectiveness of UV Systems
  • Intensity of UVGI
  • Duration of contact
  • Relative humidity

43
UV Safety Issues
  • Short Term Exposure
  • Education
  • Labeling
  • Maintenance
  • Monitoring

44
Operating Room
  • Place bacterial filter on
  • patient endotracheal tube
  • Expiratory side of breathing circuit of a
  • Ventilator
  • Anesthesia equipment
  • No anterooms
  • Keep doors closed
  • Control traffic
  • If possible schedule case at end of day

45
Postoperative recovery
  • Private room
  • Negative air pressure

46
Autopsy rooms
  • Negative air Pressure
  • 12 ACH
  • Increase ventilation if possible using HEPA
    filtered air or UVGI recirculation systems
  • Exhausted directly to outside
  • Respiratory protection
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