1. INFECTION CONTROL MEASURES DOTS PLUS STRATEGY LRS Institute of Tuberculosis & Respiratory Diseases Sri Aurobindo Marg, New Delhi - 110030

2. INFECTION CONTROL MEASURES DOTS PLUS THE NEED MDR-TB is infectious MDR TB patient : –Delay in establishing the diagnosis. –Visits more number of times - (approx 180 to 270 visits in a regimen IP of 6 to 9m) –More number specimen collected - (12 to 18 specimen in IP 18 specimen in CP) –More laboratory interventions (each specimen 4 interventions smear, culture, Identification & sensitivity test) –More HCWs interact with the MDR-TB patient

3. WHAT IS EXISTING IN RNTCP Administrative measures –Objectives well defined –Training of HCWs well established –IEC - important component Environmental measures –Emphasis given on proper disposal of sputum specimen –Waste management guidelines - implemented Personal Protection –Training

4. THE DEFICIENCIES –Not much –No periodic reviews

5. THE PROPOSAL –Constitute an infection control committee –Training manuals / Programmes –Periodic reviews / assessment of IC plans –Development of IEC materials. Highlighting the DOTS treatment / duration / benefits –Reduction in lab infection control plans Administrative Measures

6. THE PROPOSAL (Contd.) Environmental measures: –Maximize the natural ventilation (6-12 Air changes / Hour) –Efficiency 99.9% Droplet Nuclei gets removed in - 69 to 35 minutes –Mechanical ventilation Fixing exhaust system

7. ENVIRONMENTAL MEASURES: –Establishment of TB isolation wards with single pass air system with HEFA filtration / UVGI –LRSI - MDR TB Wards

8. THE PROPOSAL Personal Respiratory Protection measures –Emphasize on HCW –Training in infection control measures –Practice of Infection Control measures –Review of Infection control measures at every opportunity by the supervisor –MDR Patients and suspects can be provided with masks

9. CONCLUSION Infection control in DOTS plus can be implemented through Administrative measures Environmental measures Personal respiratory protection measures

10. Thank You