TB IC job Aid
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Transcript of TB IC job Aid
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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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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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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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