Currently Skimming:
7 Global Perspectives on Transmission and Infection Control
7 Global Perspectives on Transmission and Infection Control
Pages 63-78
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From page 63... ...
Speakers discussed general findings on the transmissibility of DR TB and implications for infection control, as well as specific issues in the context of individual countries, particularly relating to the need to protect health care workers from infection. Many speakers and participants recognized in their remarks a common theme echoed throughout the workshop, that MDR TB is acquired more often by transmission than by incomplete or inappropriate treatment.
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From page 64... ...
Most TB control programs in hospitals at the time relied on smear microscopy, which cannot reveal drug susceptibility or resistance; the result was delays in diagnosing drug resistance. Delays in performing culture and DST added more time to the process.
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From page 65... ...
These conditions resulted in significant transmission to health care workers. In many settings, health care workers' tuberculin skin test (TST)
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From page 66... ...
Halting transmission therefore needs to be a critical element of efforts to address the epidemic of DR TB. To this end, a comprehensive strategy is required that includes the redesign of health care facilities and rapid diagnosis and early treatment of DR TB.
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From page 67... ...
a This box is based on the presentation by Liang Li, Director, Administration Office, Clinical Center on Tuberculosis, China CDC; Vice-Director, Chinese Tuberculosis Society; Chief Director, Beijing Chest Hospital. Infection Control Challenges for Health Care Workers in China2 Chinese hospitals tend to be large and crowded, some having between 500 and 1,000 beds, said Carol Rao, Chief of Epidemiology Section, International Emerging Infections Program, Global Disease Detection, U.S.
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From page 68... ...
N95 respirators or gauze masks are issued intermittently to the health care workers, but with little training in their use. The focus of infection control is on engineering controls and personal protective equipment, said Rao, as opposed to administrative and managerial practices.
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From page 69... ...
Infection Control challenges for Health Care Workers in South Africa4 Health care workers are at increased risk of both latent and active TB (Joshi et al., 2006; Menzies et al., 2007)
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From page 70... ...
A retrospective cohort analysis of the data collected through employee medical records compared the incidence of TB among those health care workers who worked in a TB ward and those who did not. Based on just more than 1,300 charts that included work location information, a higher percentage of those who worked in TB wards had been diagnosed with TB.
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From page 71... ...
In addition, effective infection control measures are needed in all wards, not just in TB or MDR TB wards. And all health care workers need to receive HIV counseling and testing, which will require reducing the stigma associated with HIV and TB and alleviating concerns about confidentiality.
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From page 72... ...
The average active TB notification rate for health care workers in the Vladimir Oblast TB Dispensary was 1,080 cases per 100,000 population in the 10 years before the program began (Volchenkov et al., 2004)
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From page 73... ...
Professionals from almost all the countries of the former Soviet Union have taken these courses, and the center has supported TB infection control programs in many of these countries, as well as elsewhere. A safe TB control program is no more expensive than a traditional one, said Volchenkov.
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From page 74... ...
• The Vladimir Center of Excellence for TB Infection Control pro vided support to several countries for the development of national guidelines on TB infection control. Volchenkov also listed the specific infection control challenges Russia has faced, some of which may apply to other BRICS countries as well: • A cold climate requires mechanical ventilation in areas with high risk TB patients.
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From page 75... ...
And infection control programs need expert support. Finally, policy makers and politicians should understand that infection control interventions save considerable resources by reducing the incidence of DR TB.
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From page 76... ...
The greater problem is unsuspected TB patients or unsuspected drug resistance. Nardell cited research from Arzobispo Loayza Hospital in Lima, Peru, where 250 of 349 patients admitted to one female ward in 1997 were screened for TB using sputum, a chest X-ray, a medical history, and a physical exam ( illingham W et al., 2001)
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From page 77... ...
This approach requires political will and resources, but it can stop transmission in facilities and provides for effective assessment through process indicators and monitoring of cases in health care workers.
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