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PROPOSAL FOR TUBERCULOSIS INFECTION CONTROL (TB-IC) POLICIES

I. Administrative Controls

eas!res "#i$# aim to %revent t#e &eneration o' in'e$tio!s dro%let n!$lei and

red!$e t#e %o%!lations e%os!re to it.

TB Triage

Prom%t assessment 'or %res!m%tive TB s#o!ld *e done in a$$ordan$e to t#eNational T!*er$!losis Control Pro&ram (NTCP). Consider t#e 'ollo"in&+

A,ULTS

a. Co! o' at least t"o () "ees d!ration/ "it# or "it#o!t t#e 'ollo"in& s0m%toms+- Si&ni'i$ant and !nintentional "eit loss

- Fever - 1emo%t0sis- C#est2*a$ %ains not re'era*le to an0 m!s$!loseletal disoders- Eas0 'ati&a*ilit0 or malaise- Nit s"eats- SOB or ,OB

*. Une%lained $o! o' an0 d!ration in+- A $lose $onta$t o' a no"n a$tive TB $ase- 1i-ris $lini$al &ro!%s (e.&. 1I32AI,S/ ,/ ESR,/ $an$er/ $onne$tive

tiss!e diseases/ a!toimm!ne diseases/ sili$osis/ %atients "#o !nder"ent

&astre$tom0 or solid or&an trans%lantation and %atients on %rolon&eds0stemi$ steroids)- 1i-ris %o%!lations (elder0/ !r*an %oor/ inmates and ot#er $on&re&ate

settin&s)

$. C4R 'indin&s s!&&estive o' PTB/ "it# or "it#o!t s0m%toms.

d. Pres!m%tive etra-%!lmonar0 TB ma0 #ave an0 o' t#e 'ollo"in&+- 5i**!s/ es%e$iall0 o' re$ent onset (res!lt 'rom verte*ral TB)- Non-%ain'!l enlar&ed $ervi$al l0m%#adeno%at#0 "it# or "it#o!t 'ist!la

'ormation- Ne$ sti''ness (or n!$#al ri&idit0) and2or dro"siness s!&&estive o' menin&itis

t#at is not res%ondin& to anti*ioti$ treatment/ "it# a s!*-a$!te onset or raisedintra$ranial %ress!re

- Ple!ral e''!sion- Peri$ardial e''!sion- ,istended a*domen (i.e. *i& liver and s%leen) "it# as$ites- Non-%ain'!l/ enlar&ed 6oint

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- Si&ns o' t!*er$!lin #0%ersensitivit0 (e.&. %#l0$ten!lar $on6!n$tivitis/ er0t#emanodos!m)

PE,IATRICS

a. At least t#ree (7) o' t#e 'ollo"in& $lini$al $riteria s#o!ld *e $onsidered+- Co!in&2"#ee8in& o' "ees or more/ es%e$iall0 i' !ne%lained- Une%lained 'ever o' "ees or more a'ter $ommon $a!ses (e.&. s!$# as

malaria or %ne!monia) #ave *een e$l!ded- Loss o' "eit2'ail!re to &ain "eit2"eit 'alterin&2loss o' a%%etite- Fail!re to res%ond to "ees o' a%%ro%riate anti*ioti$ t#era%0 'or LRTI- Fail!re to re&ain %revio!s state o' #ealt# "ees a'ter a viral in'e$tion or

eant#ema- Fati&!e/ red!$ed %la0'!lness/ or let#ar&0

*. An0 one (9) o' t#e a*ove $lini$al $riteria in a $#ild "#o is a $lose $onta$t o' a

no"n a$tive TB $ase

$. C4R 'indin&s s!&&estive o' PTB/ "it# or "it#o!t s0m%toms.

ISOLATION AND COHORTING

Stri$t isolation %re$a!tion s#o!ld *e im%lemented 'or %res!m%tive a$tive TB %atients.

Pres!m%tive a$tive TB %atients s#o!ld %re'era*l0 *e %la$ed in a sin&le room "it#"indo"s t#at $o!ld *e o%ened 'or t#e %rovision o' ade:!ate ventilation (Private

Room).

One (9) sta'' %oli$0 (e:!i%%ed "it# an N;< res%irator) is #il0 re$ommended 'or%res!m%tive and $on'irmed TB $ases.

I' t#is $o!ld not *e done 'or "#atever reason/ %ro%er $o#ortin& s#o!ld *e done ('or"ard settin&).

- A %res!m%tive a$tive TB %atient s#o!ld *e %la$ed a"a0 'rom $lean $ases/and in area "#ere "indo"s $o!ld *e o%ened 'or $ontrollin& air'lo". (Air'lo"s#o!ld &o to"ards t#e "indo"s)

- A %res!m%tive a$tive TB %atient s#o!ld *e %rovided "it# a s!r&i$al mas sot#at s%read o' dro%let n!$lei $an *e $ontrolled

- A $on'irmed a$tive TB %atient s#o!ld #ave limited visitors/ and desi&nated$om%anions s#o!ld *e %rovided "it# at least a s!r&i$al mas.

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COUGH ETIQUETTE

Posters en$o!ra&in& %ro%er $o! eti:!ette s#o!ld *e disseminated t#ro!o!t t#e#os%ital es%e$iall0 areas "it# a #i vol!me o' %atients (Emer&en$0 Room/O!t%atient ,e%arment).

II. Environmental Controls

Are met#ods and te$#nolo&ies desi&ned 'or t#e removal and ina$tivation o'in'e$tio!s air*orne %at#o&ens. It is t#e se$ond line o' de'ense in %reventin& t#es%read o' TB.

- Use o' 'ans to dire$t air'lo" to o%en "indo"s.- Ne&ative air %ress!re rooms/ i' a$$essi*le2availa*le2%ossi*le.

III. Res%irator0 Controls

Pertains to t#e last line o' de'ense a&ainst s%read o' TB "#i$# 'o$!ses on t#e%rote$tion o' sta'' $arin& 'or %res!m%tive a$tive and $on'irmed a$tive TB %atients.

- Involves sta'' trainin& on #o" to "ear/ $are 'or/ maintain and dis%ose N;