Practical TB Infection Control for Community-based TB Programs Kevin Fennelly, MD, MPH Center for Emerging & Re-emerging Pathogens Interim Director Division.

Slides:



Advertisements
Similar presentations
Implementing a TB-Control Program in Prisons: The Basics Dr. Mayra Arias.
Advertisements

Contact Evaluation Your name Institution/organization Meeting Date International Standard 16.
TB Disease and Latent TB Infection
Purpose of 2005 Guidelines Update and replace 1994 Mycobacterium tuberculosis infection control (IC) guidelines Further reduce threat to health-care workers.
Tuberculosis 101 JAMES R. GINDER, MS, WEMT,PI, CHES
Infection Control Presented on behalf of the Infection Control Department, Gold Cost District Health Service January 2012.
Disease Transmission Good morning..
Process and Products of TB/HIV Operational Research Chiang Rai, Thailand Jintana Ngamvithayapong-Yanai, PhD. JSPS-Fellow, Research Institute of Tuberculosis,
TB Contact Investigation
Medical Fitness Services Department – Dubai Health Authority
INFECTION CONTROL MEASURES DOTS PLUS STRATEGY LRS Institute of Tuberculosis & Respiratory Diseases Sri Aurobindo Marg, New Delhi
Unit 7.1. Respiratory protection TB Infection Control Training for Managers at National and Subnational Level Photo courtesy of WHO/Dominic Chavez.
TB Presentation for Healthcare Students
OSHA Blood Borne Pathogen and Tuberculosis Training PART II Tuberculosis Author: Maxine Edwards, RN, ICP ECU Infection Control Presented by: Patti Goetz,
TB Infection Control: Principles, Pitfalls, and Priorities Kevin P. Fennelly, MD, MPH Interim Director Division of Pulmonary & Critical Care Medicine Center.
Infection Control Overview: TB Session 1: Infection Control Basics.
Anders Chen, MD Internal Medicine R3 4/5/2011.  TB infection control (TB IC): Background  WHO Policy recommendations  Literature review  Practical.
Project 8: Numerical Simulation of Pandemic Flu Dispersal in Airborne Infection Isolation Rooms (AIIR) Mentor: Urmila Ghia Computational Fluid Dynamics.
1 Identifying Cases of MDR-TB Session 3. USAID TB CARE II PROJECT Old WHO recommendations RegimenIndications 4HREZ/2HR (Category I) New cases 2SHREZ/1HREZ/5HRE.
Unit 3. Infection control (IC) basics and the WHO set of measures for TB IC TB Infection Control Training for Managers at National and Subnational Level.
Overview of Enforcement for Occupational Exposure to Tuberculosis (TB)
Mary Foote MD, MPH 1 Infectious Disease Fellow Anne Spaulding MD, MPH 1,2 1 Emory University Schools of Medicine and 2 Public Health Atlanta, Georgia Georgia.
Staff Health Care Infectious Disease view Jameel Adnan, MD. Community & Primary Health Care KAAU- RABEG BRANCH.
TB. Areas of Concern TB cases continue to be reported in every state Drug-resistant cases reported in almost every state Estimated million persons.
1 Novel Influenza A H1N1 Outbreak: The Florida Response Infection Control Considerations: Focus on Personal Protective Equipment.
West Virginia’s Tuberculosis Control Program Hx and Epi MissionTransmissionRequirements Channels of Communication.
Unit 4: Infection Control and Prevention of Tuberculosis
Module 12: Infection Control in Health Care Settings
TB Infection Control: Engineering (Environmental) Controls Kevin P. Fennelly, MD, MPH Division of Pulmonary & Critical Care Medicine Center for Emerging.
Unit 3 – Overview of TB Disease
Understanding and Preventing Tuberculosis Health, healing and hope.
Culture Conversion and Self- Administered Therapy in Privately Managed Tuberculosis Patients Melissa Ehman MPH, Jennifer Flood MD MPH, Pennan Barry MD.
1385 / 5 / 15 نشست سالانه برنامه كنترل سل شهريور Tuberculosis & Air Travel.
Standard and Expanded Precautions
ABSTRACT INTRODUCTION, CONTINUED RESULTS, CONTINUED REFERENCES RESULTS INTRODUCTION This was a secondary analysis of the Rapid Empiric Treatment with Oseltamivir.
Policy update on TB infection control Fabio Scano STB, WHO TBIC TBIC.
1 SESSION 6: Field Safety and Infection Control. DOT Curriculum Session 62 Transmission of M. Tuberculosis 1. TB is transmitted through the air by a person.
Tuberculosis What is tuberculosis?.
Guidance on TB infection control Fabio Scano Stop TB, WHO.
12/12/ |1 | اداره كنترل سل و جذام نشست سالانه برنامه كنترل سل مازندران - بابلسر.
Ferris State University Michigan Department of Career Development 1 Mycobacterium Tuberculosis Answer Key.
Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division.
Module 2 - Epidemiology of Tuberculosis
Mycobacterium Tuberculosis Decline During 2000, a total of 16,377 cases of tuberculosis (TB) (5.8 cases per 100,000 of population) were reported to.
Mycobacterium Tuberculosis. Decline During ,377 cases of TB (5.8/100,000 of U.S. population) were reported to CDC 7% dec from 1999 39% dec.
HIV/TB – Case Studies David Schlossberg, MD, FACP Medical Director, TB Control Program Philadelphia Department of Health.
Welcome to I-TECH HIV/AIDS Clinical Seminar Series November 19, 2009 Tuberculosis in Persons with HIV/AIDS: Opportunities for Prevention Charles Nolan,
Module 2 TB Disease Transmission & Prevention. Pulmonary Tuberculosis Extra -Pulmonary TB an infectious disease caused by a microorganism called Mycobacterium.
Improving Tuberculosis Infection Control
Infection Control in Tanzania Dr. Peter C. Mgosha (MPH,) MINISTRY OF HEALTH AND SOCIAL WELFARE NATIONAL AIDS COTROL PROGRAMME P.O.BOX DAR Es SALAAM.
Severe Acute Respiratory Syndrome (SARS) and Preparedness for Biological Emergencies 27 April 2004 Jeffrey S. Duchin, M.D. Chief, Communicable Disease.
Communicability Patient factors Not infectious prior to symptoms Increases with increased severity of disease Increases post-onset symptoms (peak at day.
TB Transmission What is TB? aTB is a disease caused by infection with a bacteria called Mycobacterium tuberculosis.
Introduction to Contact Investigation Process Amy Schmitt, BSN, RN Public Health Grand Rounds Tuberculosis November 19, 2015.
TB Prevention and Control in Correctional and Detention Facilities Mark Lobato, MD Division of TB Elimination Centers for Disease Control and Prevention.
Tuberculosis in Children and Young Adults
Case Discussion 2 - TB IN CHILDREN by Dr. Jeyaseelan P. Nachiappan & Dr. Suryati Adnan 1 Picture of CPG Cover.
Treatment of latent TB in tuberculosis control Turkish Thoracic Society Antalya, 27 April 2007.
TB infection control in the era of MDR and XDR TB Haileyesus Getahun Stop TB Department WHO/HQ.
Transmission and Pathogenesis
Infection Control and Preventions
Post transplant lung infection – Environmental pollution ? Association
Types of Isolation.
Transmission-based isolation precautions
This is an archived document.
مدیریت نمونه های آزمایشگاهی ، حمل و نقل ایمن و امن نمونه
Transmission-based isolation precautions
Implementing a TB-Control Program in Prisons: The Basics
University of Washington
Shared Air – Ventilation for Airborne Infection Control
Presentation transcript:

Practical TB Infection Control for Community-based TB Programs Kevin Fennelly, MD, MPH Center for Emerging & Re-emerging Pathogens Interim Director Division of Pulmonary & Critical Care Medicine UMDNJ-New Jersey Medical School 11 June 2008

Objectives To help identify situations in which there is an increased risk of TB transmission – people (patients) and places (settings) To recommend practical solutions –for programs to help protect staff principles and provisions – for staff knowledge is power … and prevention !!

Areas I will NOT cover Abundant evidence that HCWs are at increased risk for occupational TB infection (and disease) –HCW= anyone exposed to patients Risk assessment –Would consider most environments in TB- endemic countries at high risk

from Sol Permutt, 2004

TB is transmitted by aerosols (NOT sputum)

*NOT organism size Particle size* & suspension in air Particle size & deposition site –100  –20  –10  – upper airway –1 - 5  – alveolar deposition Time to fall the height of a room –10 sec –4 min –17 min –Suspended indefinitely by room air currents from Sol Permutt, 2004

Estimates of Mtb Aerosol Production (quanta per hour) TB ward: pt on Rx Cavitary TB: no Rx Laryngeal TB Bronchoscopy/ETT Autopsy Fennelly KP. Int J Tuberc Lung Dis 1998; 2: S103

Who is Infectious? Sputum smear + > smear – –AFB 3-4+ > AFB 1-2+ Cavitary > non-cavitary Close > casual contact Prolonged > brief contact Men > women Young > old Borgdorff MW et al. Am J Epidemiol 2001; 154:934 HIV+ = HIV – Cruciani M et al. Clin Infect Dis 2001; 33:1922 MDR vs. DS: ?

Where are Patients Most Infectious? Congregate settings –Hospitals –Correctional facilities –Bars –Choirs –Airplanes, ships Indoors >> outdoors –Increased with crowding & proximity –But no data on UV-A or UV-B effects

When are Patients Most Infectious? Coughing > Singing > Talking Loudon RG et al. Am Rev Respir Dis 1969;100:165 Aerosol producing procedures: intubation, bronchoscopy, sputum induction Sepkowitz KA. Clin Infect Dis 1996;23:954 Not on treatment –Unrecognized/undiagnosed –Drug-resistant on standard therapy

Loudon RG Am Rev Respir Dis 1969, 99: 109. Cough Frequency & Infectiousness

What is Infectious? Dogma: 1-5 micron infectious droplet nuclei (Wells, 1955) –Risk associated with prolonged exposures Reality: Wells estimated particle size distribution based on experimental nebulization of bacillary suspensions in lab –No data from patient-generated aerosols –Wells calculated droplets less than 25 microns dessicated to size of infectious droplet nuclei in less than one second

Cough Aerosol Sampling System - Fennelly KP et al. Am J Resp Crit Care Med 2004; 169; 604-9

Six-stage Andersen cascade impactor Andersen AA. J Bacteriol 1958;76:471.

Cough-generated aerosols of M.tb National Jewish Medical & Research Center - Fennelly KP et al. Am J Resp Crit Care Med 2004; 169; 604-9

Cough Aerosol Sampling System

Frequency Distribution of Cough-generated Aerosols of M. tuberculosis and Relation to Sputum Smear Status

Cough-generated Aerosols of M. tuberculosis: Normalized Particle Sizes Lower limit of size range(µ) Deposition Upper airway - bronchi -- alveoli Abstract, ATS International Conference, 2004.

Cough Aerosol Production: Multivariate Analysis Best model in logistic regression –Bacillary concentration: BACTEC™ < 4 days to positive (OR=11.35, p=0.02) and –strong cough (OR=5.41, p=0.04) Cough strength is associated with performance score (physical health) (Chi-square, p=0.004). –Cough strength tends to be associated with CD4 counts (less advanced HIV infection) (Chi-square, p=0.07). –CD4 counts and performance scores drop out of multivariate models probably due to correlation with cough strength. These data suggest that healthier patients are more likely to be infectious than very ill patients.

Aerosol CFUs Predict Infectivity in Mice Abstract, Keystone Symposium on Tuberculosis, 2005.

Assumptions: Homogenous distribution of infectious aerosol over 10 hours; uniform susceptibility. - Fennelly KP & Nardell EA. Infect Control Hosp Epidemiol 1998; 19;754 Wells-Riley Mathematical Model of Airborne Infection

Summary: Principles TB-IC for Community Programs The most infectious TB patients are those who are not on appropriate therapy –Undiagnosed, i.e., unrecognized –Drug resistant TB is transmitted by aerosols –Coughing and bacillary load important –Healthier patients may be more infectious Poorly ventilated indoor environments the highest risk

Summary: Practices TB-IC for Community Programs Best administrative control: –Suspect and separate until diagnosed –Surveillance of HCWs with TST (and/or IGRAs) and rapid treatment of LTBI if conversions occur Best environmental control: Ventilation –Do as much as possible outdoors –Use directional airflow when possible Natural breeze or fans: HCW ‘upwind’; patient ‘downwind’ Personal respiratory protection –N95 respirators when indoors or very close (procedures) –Surgical masks on patients to control source