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4 Transmission and Infection Control
4 Transmission and Infection Control
Pages 31-42
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From page 31... ...
• Health care workers are at particular risk for contracting TB and need much higher levels of education and environmental protection than they currently receive. • Household contacts of active TB cases, vulnerable populations in poorly ventilated congregate settings (such as prisons and drug treat ment programs)
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From page 32... ...
facility in Witbank, Mpumalanga Province, South Africa, examined both the infectivity of MDR TB and the question of whether transmission can be interrupted. The infectivity experiment, which involved 360 guinea pigs exposed to 26 MDR TB patients, revealed that some infecting MDR and XDR TB strains may be immunogenic but not sufficiently virulent to cause progressive disease in guinea pigs and that guinea pigs may be clearing TB infection.
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From page 33... ...
She noted that future studies planned for the AIR facility will address the efficacy of surgical masks for patients; novel interventions, such as inhaled antibiotics; transient TB infection, strain variation, and XDR TB transmission; and determination of when MDR and XDR TB patients become noninfectious. INFECTION CONTROL IN HOSPITAL AND OTHER HEALTH CARE SETTINGS The 2006 study of 53 patients with XDR TB in Tugela Ferry described in Chapter 2 provided evidence for nosocomial3 transmission (Gandhi et al., 2006)
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From page 34... ...
Infection Control Practices Reported by Health Care Workers in Five Primary Care Sites4 Shean reported on the preliminary results of an ongoing study of latent and active TB in 267 health care workers at five primary care sites, conducted by Dr. Shahieda Adams.
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From page 35... ...
test, and 57 percent were positive on the T-SPOT.TB test.6 • Shean reported that active TB was found in five of the health care workers. Infection Control Practices at Church of Scotland Hospital7 Friedland spoke about important work on transmission performed at the Church of Scotland Hospital (CoSH)
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From page 36... ...
-- Voluntary counseling and testing was promoted for staff and inpatients, with provision for antiretroviral therapy and the option for health care workers to transfer discreetly to lower risk areas. In addition, a series of simple and inexpensive evaluations was performed, including • assessment of lengths of stay and admissions by review of TB ward/ hospital registers, • cough officer program results, • unannounced audits of ventilation and open windows, • unannounced audits of N95 respirator use by health care workers, • voluntary counseling and testing of staff and patients, and • screening of health care workers for TB.
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From page 37... ...
The model also showed that of the estimated 1,300 new cases of XDR TB, 3 percent would be among health care workers, and that 75 percent of those new cases among health care workers could be prevented through the use of natural ventilation; the use of N95 respirators; and voluntary counseling and testing for HIV, with redeployment of HIV-positive staff. The model showed further that the provision of antiretrovirals to eligible HIV-positive individuals would avert 24 percent of new XDR TB cases.
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From page 38... ...
In Tugela Ferry, for example, health care workers have been visiting the households of MDR and XDR TB index cases to offer TB screening and education about the disease and its prevention, demonstrating the feasibility of household contact investigation.9 The household contact investigation and infection control strategy applied in Tugela Ferry, which started in 2006, involves • visiting the homes of all index MDR and XDR TB patients; • taking the global positioning system (GPS) coordinates of each home; and • screening all household contacts by obtaining a TB symptom his tory, collecting sputum from all sputum producers, bringing all suspected TB cases to CoSH for evaluation by a medical doctor, 8 This section is based on the presentation of Claudio Marra, Tugela Ferry Care and Research Collaboration (TF CARES)
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From page 39... ...
PARTICULAR CHALLENGES FOR HEALTH CARE WORKERS10 In her presentation, Shean observed that sub-Saharan Africa has 11 percent of the world's population, 25 percent of the global burden of disease, and just 3 percent of the world's health care workers. This limited number of health care workers presents one of the greatest challenges to health care systems in the region.
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From page 40... ...
And according to Shean, the national policy of admitting all XDR TB patients to the hospital until they are smear negative has added to the challenge of providing access to affordable and appropriate infection control in health care facilities. Very few data are available on the incidence and treatment-related outcomes of XDR TB in health care workers.
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From page 41... ...
In addition, Lesotho contributes more than 50,000 migrant workers to the South African mining industry, and thousands of migrant workers stay and work illegally in South Africa. Thotolo stressed that in fighting TB, it is necessary to address the cross-border movement of migrant workers.
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From page 42... ...
These data have been interpreted to imply that the treatment of patients with standardized regimens for MDR TB inadvertently leads to the emergence of XDR TB. It could not, however, be discerned whether transmission occurred in the household, in the compounds where the miners lived, in the hospitals, or in the mines.
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