Various strategies can be employed to keep tuberculosis (TB) infection under control in a health center or hospital setting. They include three levels of infection control measures which include personal protective equipment, administrative and workplace control measures, and environmental control measures (Berba et al., 2018). Each of these levels is designed in such a way that it operates at a different stage of the transmission chain or process. The administrative and workplace control measures are aimed at reducing staff and patients’ exposure to tuberculosis while the environmental control measures are aimed at reducing the concentration of airborne infectious TB droplet nuclei (Berba et al., 2018). Where it is not possible to significantly reduce the concentration of these infectious droplets using workplace/administrative and environmental control measures, the hospital staff is adequately protected from TB infection in specific settings using personal protective equipment such as masks.
Administrative/Workplace Control Measures
These measures are the most effective in the prevention of the transmission of TB infection (Berba et al., 2018). They are the first line of defense against tuberculosis spread in a hospital setting. The two main goals of employing these measures are to protect patients and staff from exposure to TB and reducing the spread of TB infection (Berba et al., 2018). The spread of the TB infection is reduced by carrying out prompt and recommended diagnosis and treatment on suspected staff and patients and confirmed TB patients and staff.
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The ideal administrative/workplace control measures comprise of 5 components namely: infection control plan, patient education, increased community awareness, administrative support for the infection control plan procedures and quality assurance, healthcare and support staff training, and TB control programme communication and coordination (Berba et al., 2018).
Environmental control measures
This represents the second line of defense against the spread of tuberculosis in a hospital setting (Berba et al., 2018). Environmental control measures cannot be relied upon to eliminate the risk where the administrative and workplace controls have been rendered inadequate. Due to their cost and complex nature, these measures are practically available in larger hospitals. They include ventilation, ultraviolet germicidal irradiation, and filtration.
Personal protective equipment
This involves the use of respirators and protective masks to attain respiratory protection at a personal level (Berba et al., 2018). In addition, it involves providing training to individuals on respirators selection and use. Personal protective equipment should not be used as an alternative to environmental and administrative/workplace controls to ensure healthcare providers are not exposed to TB. They should be used in combination with these other control measures for better TB control outcomes. They are mainly unavailable in hospitals with unlimited financial resources because they are expensive as they require the use of specialized equipment. This ensures that they are only areas considered high-risk within hospital settings.
What procedure would be followed if there were an outbreak/exposure to tuberculosis within the hospital?
In the event of TB outbreak within the hospital the following procedure is recommended:
Administrative and workplace controls: This involves rapid employment of workplace/administrative controls which may include prompt identification and subsequent isolation of individuals (patients or staff) with pulmonary TB (Berba et al., 2018).
Engineering: This ensures the employment of appropriate ventilation in isolation areas and rooms in negative pressure rooms, sputum induction booths, extraction fans, and laminar airflow. This can be reinforced by the use of high-efficiency particulate air (HEPA) filtration or ultraviolet germicidal irradiation (Berba et al., 2018).
Personal protective equipment: Healthcare providers should wear respiratory protective equipment such as respirator and masks to minimize exposure to M. tuberculosis, the causative agent of TB.
Other guidelines involve strict enforcement of isolation policies which ensure sputum induction on carried out in isolation areas/rooms, and initial tuberculosis therapy with 4 drugs (Berba et al., 2018).
Isolation is stopped only after 3 negative smears for acid-fast bacilli (Berba et al., 2018).
Have there been outbreaks/exposures to the disease in a hospital? Give examples from outside sources and events from the past.
There have been several examples of TB outbreaks in various hospitals. Some of the examples of these outbreaks are TB outbreak in a cancer ward in Katsuhiro KUWABARA, a highly specialized medical center where two healthcare staff and 8 hospitalized patients were involved (Lai et al., 2016). Another 61 cases were reported from a TB outbreak in Hiroko Yoshikawa NIGORIKAWA in Japan (Lai et al., 2016).
References
Agustin, R. D. D., Lucero, J. A. C., & Berba, R. P. (2018). Evaluation of tuberculosis Infection control Strategies at the Philippine General Hospital. Acta Medica Philippina, 52(1), 54.
Lai, C. C., Hsieh, Y. C., Yeh, Y. P., Jou, R. W., Wang, J. T., Pan, S. L., & Chen, H. H. (2016). A pulmonary tuberculosis outbreak in a long-term care facility. Epidemiology & Infection, 144(7), 1455-1462.
