1. Novel approaches to TB infection control in private general hospitals in Georgia T Gabunia1, I Khonelidze, N Solomonia, T Merabishvili, M Makharadze, G Kuchukhidze, M Danelia2 1. University Research Co. LLC 2. National Center for Disease Control and Public Health, Georgia October 13, 2017
1University Research Co., LLC, Tbilisi, Georgia, 2National Center for Disease Control and Public Health, Tbilisi, Georgia, 3National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia

2. Georgia: Country Background
Population: 3.7 million
3,311 cases notified in 2016 (50% decrease over the last decade)
Estimated proportion of TB case with MDR/RR:
Among new cases 9.8%
Among retreatment cases 40.1%
RR-TB treatment success rate 44% (range : 56%-44%, 2013 cohort)
XDR-TB treatment success 21% (range : 39%-21%, 2013 cohort)

3. Risk of TB transmission in health care settings in Georgia
Occupational exposure to TB is a major health risk for healthcare workers in Georgia that is not addressed adequately through national policies and programmatic interventions
In Georgia, TB related hospitalization remains common with 30% of patients with Drug Sensitive TB hospitalized and a vast majority of M/XDR TB patients spending on average days in inpatient facilities
LTBI Prevalence among Health Care Workers in TB facilities in Georgia is 55% and is 31% in non-TB facilities1
Annual risk of TB infection among HCW is unknown
(1) Whitaker et al. PLOS Medicine 2013

4. Novel approaches to TB infection control implemented by the National Center for Disease Control and Public Health in Georgia with the USAID and Global Fund TB Project support
Environmental controls
Personal protection
Administrative controls

5. FAST Strategy Finding TB cases Actively Separating safely
A focused tuberculosis transmission control strategy that prioritizes the administrative components of traditional TB infection control: rapid diagnosis and effective treatment.
FAST stands for
Finding TB cases
Actively
Separating safely
Treating effectively.

6. FAST implementation in General Hospital Settings in Georgia
Initial Assessment:
High patient flow
Commitment of hospital leadership
Access to quality TB diagnostics
GeneXpert
Lab training
Referal to treatment and care
Reorganize Patient's admission Protocol
FAST protocol
Training
Measure FAST
Foster Public-Private Partnership
MOU between private hospitals and NCDC
Joint implementation

7. FAST cascade in two general hospitals (18 months)
Active cough surveillance at an entry point in a general hospital
Immediate access to GeneXpert testing
1,565 patients tested with GeneXpert
188 patients (12%) MTB positive
35 patients (2%) were found with Rifampicin Resistance
FAST contribution to the National Case Finding Efforts at two hospitals in 2016:
3.5%
Link the patient to TB treatment services within the National TB Program

8. Where does FAST fit into the overall quality framework?
SAFE
EFFECTIVE
EFFICIENT
TIMELY
EQUITABLE
PATIENT-CENTERED
Institute of Medicine Report, 2001

9. Lessons learned
This experience showed that general hospitals are at increased risk of TB transmission
Active TB case finding should be in place targeted at patients with cough and chronic lung conditions
Policy support and sustainable funding can be obtained through demonstrating results of successful pilot
NCDCPH decided to roll out the FAST in high volume district hospitals for country wide coverage.

10. Conclusion
The FAST , as an effective strategy for preventing nosocomial transmission of TB, should be considered as a basic safety standard and incorporated into the national quality framework for all public and private hospitals through licensing or certification.
NCDC supports country wide roll out of FAST by making GeneXpert a point of care diagnostic test at a vast majority of general district hospitals.

11. Conflict of interest disclosure
This event is accredited for CME credits by EBAP and speakers are required to disclose their potential conflict of interest going back 3 years prior to this presentation. The intent of this disclosure is not to prevent a speaker with a conflict of interest (any significant financial relationship a speaker has with manufacturers or providers of any commercial products or services relevant to the talk) from making a presentation, but rather to provide listeners with information on which they can make their own judgment. It remains for audience members to determine whether the speaker’s interests or relationships may influence the presentation. Drug or device advertisement is strictly forbidden.
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