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TUBERCULOSIS INFECTION

PREVENTION PROCEDURES

JOB AID

THE SCIENCE OF IMPROVING LIVES

SEPT 2012 , NDOLA DISTRICT

Ministry o Health

TBCARE

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Tuberculosis Infection Prevention Control Procedures JOB AID

Sept 14, 20122

The Ministry o Health, Permanent Secretary Dr. Peter Mwaba

authorized the implementation o the TB inection control (TB IC)

Ndola Demonstration Project. The National TB Control Program,through the leadership o Dr. Nathan Kapata has provided

oversight or the TB IC project under the guidance o the

Permanent Secretary. The Provincial Medical Ocer, Dr. Chandwa

Ngambi, the District Medical Ocer, Dr. Mathildah Kakungu

Simpungwe and the District Oce Community liaison, Ms. Lynette

Maambo have provided daily support or project implementation

with district acility sta members. Dr. Max Meis rom KNCV

Tuberculosis Foundation coordinated the process o this job aiddevelopment in collaboration with FHI360 sta, including Mr.

Dickens Mutumbisha providing project management oversight

in Ndola District. The editing, layout and cover design was done

by Tristan Bayly rom KNCV Tuberculosis Foundation

The Global Health Bureau, Oce o Health, Inectious Disease

and Nutrition (HIDN), US Agency or International Development,

nancially supports this publication through TB CARE I under theterms o Agreement No. AID-OAA-A-10-00020. This publication is

made possible by the generous support o the American people

through the United States Agency or International Development

(USAID). The contents are the responsibility o TB CARE I and do

not necessarily refect the views o USAID or the United States

Government.

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Tuberculosis Infection Prevention Control Procedures JOB AID

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Health acilities are places o healing and hope, yet they can also

put patients and health care workers at risk. In crowded waiting

areas o health centers patients are at risk o contracting airbornediseases, in particular tuberculosis (TB), rom patients around

them.

This job aid lists eective procedures how you can reduce the

risk o the transmission o TB, at your workplace. Select those

procedures which are applicable in your work setting and

incorporate them in your routine work practices.

You and your colleagues should aim to improve your routine

work practices and to adhere to (selected) procedures at all times.

By doing this, you will contribute to achieving the ollowing

objectives o the Tuberculosis Inection Prevention Control

policy:

To identiy individuals with TB symptoms promptly

To separate inectious and presumed inectious individuals

rom others

To enorce compliance with cough etiquette

To minimize the time or diagnosis, onset o treatment and

the time spent in the acility by inectious patients and

patients suspected to have TB

To prevent sta rom acquiring and developing TB and

support those who have contracted TB

To ensure that building design and use are appropriate or

the buildings intended use and ease o operation

To ensure sucient air exchange and controlled airfow

direction where necessary

To acilitate community-based inection control measures

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Triage Assigned Cough monitor responsible1.

Identiy patients with current cough, upon enteringa.acility

Any client and their amily member with current

cough that lasted two weeks or more

Direct patients with current cough to an outsideb.

sputum collection area FIRST to provide a sputum

sample

Use a sputum container with a screw cap

Explain to them how to provide a sputum samplc. e

Take precautions i you assist with sputum

collection

Instruct them where to bring the sputum sampled.

A place outside the laboratory

When they return direct them immediately to ae.designated well ventilated waiting area

Away rom regular patients where they can wait

until they can be seen

List all TB suspects into the TB Suspects Register.

Document, evaluate and report the number og.

conrmed sputum smear positive patients against the

total number o patients suspected o having TB

Document, evaluate and report in the Patient bookh.

the (average ) number o days between submission

o sputum, dispatch o sputum results and the day o

commencing treatment at the end o each quarter

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Separation Assigned member o staf responsible2.

Separate patients with current cough rom othersa.

Separate diagnosed TB patients rom other patientsb. by

giving them a specic time slot or visiting the TB clinic,

i they have not yet started treatment

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Cough etiquette Assigned Cough Monitor responsible3.

Display cover-your-cough posters at waiting areasa. andexamination room, where patients cannot miss to see

them (directly in ront o them at eye-level and not on

a back wall)

Provide health education on cough etiquette asb. part o

one-on-one counseling or as part o pre-clinic health

talks

cover mouth and nose when coughing orsneezing

turn head away rom others

do not spit on the foor

wash hands requently

I available, provide disposable surgical masks toc.

all conrmed inectious PTB patients and patients

suspected o having TBI surgical masks are not available, provide paper

tissues or serviettes

Instruct them to discard the surgical masks andd. paper

tissues in a plastic bag and then in a trash bin

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Minimize time or diagnosis, onset o treatment, and time4.

spent in enclosed areas Entire team responsible

Move patients with current cough to the ront o thea.waiting queue to be seen with priority

I a well-ventilated waiting area is not available

Document in the Patient book the date on which:b.

Laboratory tests were dispatched and received

- Ideally, the turn-around time or sputum

examination is 48hours

The patient received results and medications- Ideally, the patient is started on treatment

within the same day o receiving the results

Evaluate and report delays in:c.

The average time or diagnosis

The average time between diagnosis and onset

o treatment

Educate patients to minimize contact with others ind.

enclosed areas

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Tuberculosis Infection Prevention Control Procedures JOB AID

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TB screening o all staf and TB treatment supporters In-5.

charge responsible

Be aware o the occupational risk to acquire TBa.

Be amiliar with the TB Inection Prevention Controlb.

policy and procedures o the clinic to ensure that

the workplace practice conorms to the national

guidelines

A copy o the TB IC national guidelines and the

HCW TB Screening Protocol should be available

at the clinic

Be alert to signs and symptoms o TB and seek carec.

promptly in case o signs and symptoms

Symptoms are: 1) cough that lasts longer than

2-3 weeks; 2) more than 10% unintended weight

loss; 3) night sweats; 4) ever; 5) productive blood

stained cough; and 6) TB history

I symptomatic, tests are: 1) sputum examination;2) X-ray; 3) culture; and 4) GeneXpert, i available

I you notice a colleague with prolonged cough,

encourage him/her to seek care

Get screened at least annually (periodic TBd. screening)

Know your HIV statuse.

Have a HIV test done annually, i you are HIV

negative

Get HIV prevention and treatment, i you are HIV

positive

Know that medical inormation is kept condential.

Data on sta screened or TB and HIV

Data on sta diagnosed with TB disease

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Natural ventilation Assigned member o staf6.

responsible

Do not allow patients to sit in crowded hallways ora.waiting areas

Create a designated waiting area or patients withb.

current cough

At the general waiting area o the OPD

At the TB clinic and ART clinic

Ensure that doors and windows are kept openc. duringconsultation hours in all exam rooms

Signage must be installed directing HCWs to keep

doors and windows open

Place urniture in examination rooms such thatd. sta-

patient interactions occur with air fow passing between

patient and sta, rather than rom patient to sta

Sketch a foor plan or each room

Display the (laminated) foor plans at the inside

o the door

Maintain moving parts o windows, especially thee.

stays, to allow or maximum opening and adequate air

exchange

Keep a log to document the date and what was. done:

1) checking; 2) servicing; 3) replacement o part, repairRecord the date when the windowsshould be

checked again

Have deciencies repaired as soon as possible

Allocate adequate resources (budget and stang)

or maintenance

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Mixed-mode ventilation Assigned member o staf7.

responsible

Install extractor ans in enclosed areas deemeda.necessary by the inection prevention control

committee

Service ventilation equipment on a regular scheduleb.

Administrative controls regarding the operation

o the ans should be in place to guarantee a

fawless unctioning

Keep a log to record the date and what was done: 1)c.

checking; 2) cleaning; 3) replacement o part, repair

Record the date when the equipment should be

serviced again

Have deciencies repaired as soon as possible

Allocate adequate resources (budget and stang)

or maintenance

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Notes

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