1. Infection Control Institutional Individual Community

2. Topics Infection control basics –What is it –Transmission Risks Institutional Infection Control (IC) Community IC Individual IC

3. Transmission To Catch website: : www.tocatch.info/en/Tuberculosis.htmwww.tocatch.info/en/Tuberculosis.htm

4. Transmission NLM website: http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19099.jpg Just by breathing…

5. Transmission

6. What is infection control?

7. Infection Control is: Measures to prevent transmission of infectious germ from a source to others It’s a primary prevention method to keep those who are uninfected free from infection

8. Good IC Practices should Be done in the context of providing access to care. IC without access to care will lead to stigma Always respect human rights and dignity of patients Be seen as a shared responsibility, not primarily something that needs to be imposed upon patients/community

9. Infection Control Measures Looking at three levels –Institutional –Community –Individual All methods that follow can be done where we live and work –Low-resource settings –Areas of HIV prevalence

10. Institutional IC Health care settings should have a plan How to do: –Have a plan that entails Patient flow Health care worker and patient education Mechanical tools to reduce infection –Make coordination and responsibilities clear –Crisis management for when plans don’t flow

11. Institutional IC Earlier case detection and treatment How to do: –Don’t rely on poor diagnostics We can use symptom screen algorithms –Proper training for staff (looking for smear (-) TB, making TB priority for PLH) –Must include strengthening of TB program to reduce defaulting

12. Institutional IC Administrative cohorting or isolation with rapid evaluation for TB and MDR TB How to do: –Develop a patient flow strategy for limited space –Requires HCW to be on alert for TB patients not responding to 1 st line treatment –Requires 2 nd -line drugs –Requires adequate space for TB suspects to be evaluated

13. TB Triage – PIH (Haiti) Community based TB treatment Hospitalized patients General ward Sm -, HIV +/- TB Pavilion Sm+, HIV- 6 isolation rms SM+ and HIV+

14. TB Pavilion Fenestrated walls Louvered windows UV lamp High ceilings Overcrowded TB Pavilion Fenestrated walls Louvered windows UV lamp High ceilings Overcrowded

15. Institutional IC Regularly screen health care workers Have IC tools available How to do: –Provide regular screening for TB for ALL health care workers (including lay counselors) –Provide staff support for TB services –Equip staff with fans, masks, and uv whenever possible

16. Institutional IC Germicidal uv radiation http://pic3.ohpy.com/up/elbbs/2007/11/26/93009/851902899/mid_44503kowalski12_00000020268.jpg

17. Community IC Patient/community education How to do education for TB: –Training for health care workers to use IC tools (masks, fans, windows, etc) –Skin testing for TB and prevention –Signs and symptoms –Treatment literacy

18. Community IC

19. Anti-stigma Education How to do: –The NO FEAR tactic –Quarantine and scary stories can inhibit patients desire to seek care –This can increase TB in the community! –Main Message—TB can be cured!

20. Community IC continued.. Look for infection control in your clinics Are the windows open? Can the waiting room be outside? Ask for infection control measures to be implemented

21. Individual IC Personal respiratory protection Know the signs and symptoms of TB Look for TB in our communities Educate, educate, educate

22. WHO Recommended 10 Steps for Infection Control Include Patients & Community in Advocacy for IC Develop an IC Plan Ensure Safe Sputum Collection Promote Cough Etiquette & Hygiene People with symptoms suspected to be TB should be triaged to be fast tracked/ separated

23. 10 Steps for IC (Contd) Assure Rapid Diagnosis & Treatment Improve Room Air Ventilation Protect Health Care Workers Build Capacity of Health Institutions for IC Monitoring IC practices