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  • Prevention of TB in facilities caring for HIV-infected persons

    Learning Objectives

    Give an account of various steps in HIV care settings for the prevention of TB. Triage, fast-tracking patients with cough, provision of masks, etc. Give specific administrative, environmental and structural recommendations to HIV care settings for preventing TB and other airborne infections

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Content

With a high burden of TB patients in close proximity to large numbers of vulnerable patients frequently visiting the ART centre, there is an increased risk of TB transmission. Factors like overcrowding, inadequate natural ventilation and re-circulating air-conditioners add to this risk.

ART centres are required to initiate the following measures aimed at reducing the exposure of HIV-infected patients to M. tuberculosis:

1. Infection control activities

  • All the team members of ART centre shall be trained in universal workplace precautions, waste segregation and disposal and Airborne Infection Control (AIC) practices, with special reference to tuberculosis.
  • Conduct TB risk assessment in collaboration with National TB Elimination Programme (NTEP) and National AIDS Control Organisation (NACO).
  • Develop a written TB infection control plan by the Hospital infection control committee and ART nodal officer. This may be incorporated into the facility infection control plan.
  • Hospital infection control committee and ART nodal officer should be assigned the responsibility for TB infection control at ART centres.
  • Display proper IEC material on cough and hand hygiene practices in the hospital, hospital waiting area, ART centre, and particularly the waiting area of the ART centre. Notice to be put up that patients with cough shall be seen on a priority.
  • Make surgical masks, tissues, and appropriate no-touch disposal receptacles available.

 

2. ART centres with specific location and design

  • ART centres should be located at a distance from chest clinics, Direct Microscopy Centres (DMCs), or DOT Centres, with no shared waiting areas.
  • There should be a well-ventilated waiting & seating area. Open outdoor roofed additional waiting areas are encouraged.
  • There should be a separate, well-ventilated waiting area for respiratory symptomatic wherever possible (particularly in busier ART centres).
  • Adhere to ventilation standards for airborne infection control (>15 air exchanges per hour [ACH] throughout). Where natural ventilation is of concern, augmenting ventilation through the well-planned use of exhaust fans may be considered. Installation should be properly designed and maintained, and electrical power must be consistently available.
  • Any cooling/ heating systems should be implemented in a way that adheres to ventilation standards (>15 ACH). Use of re-circulating (split) air conditioners should be avoided.

 

3. Screening of clients for respiratory symptoms

  • Care coordinators or nurses should screen all clients arriving at the ART centre as early as possible for respiratory symptoms. Patients with respiratory symptoms should be educated on cough hygiene, kept in a separate, well-ventilated waiting area if possible, and fast-tracked through their visit.
  • Educate people with respiratory symptoms on cough hygiene.
  • Educate Healthcare Workers (HCWs), patients, family members, and visitors on the importance of cough etiquette to help prevent the transmission of airborne infections (both TB and respiratory viruses). Instruct patients about covering their mouth and nose with a tissue when coughing and dispose of used tissue in waste containers.
  • Provide a disposable surgical mask to coughing patients.

 

4. Fast-tracking of known pulmonary TB patients and persons with respiratory symptoms

  • Fast-tracking of patients with respiratory symptoms is critical in reducing the time the patient is in the facility to reduce possible contamination of air and spread of disease.
  • Care coordinator or nurse of the ART centre shall facilitate the fast-tracking of patients with respiratory symptoms. These patients will be helped by the nurse to get them counselled by the counsellors, examined by the doctors and provided with the drugs quickly, without making them wait in the regular queue.
  • Presumptive TB shall be referred to the DMC/ DOTS centre for their sputum smear examination as a part of Intensified Case Finding (ICF). This will facilitate early recognition and identification of possible pulmonary TB patients.
  • A signboard display of the fast-tracking policy within the ART centre should be visible to avoid confusion among waiting patients.

 

References

 

Assessment

Question Answer 1 Answer 2 Answer 3 Answer 4 Correct Answer Explanation Page ID

Part of Pre-test

 

Part of Post-test

 
Which of the following is true? The ART centre should be ideally located adjacent to the NTEP clinic. Patients attending ART clinic should be served on a ‘first come, first serve’ basis irrespective of symptoms. PLHIV are equally at risk of catching TB and dying from it, compared to the general population. ART centres are high transmission settings for TB. 4

1- ART centres should be located at a distance from chest clinics, Direct Microscopy Centres, or DOT Centres, with no shared waiting areas.

2- Patients who are symptomatic of TB should be fast-tracked.

3 – PLHIV are at higher risk of getting TB infection and dying from it, compared to the general population.

 3262 Yes Yes
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Comments

Mariyam Wed, 14/09/2022 - 14:31

ART centres are frequented by large numbers of HIV-infected persons, who are at high risk for TB infection and disease. The risk of active TB is 16–27 times higher in PLHIV compared to those who are HIV negative. TB is the leading cause of deaths among PLHIV. In 2019, TB accounted for an estimated 30% of the 690 000 AIDS-related deaths in the world. With a high burden of TB patients in close proximity to large numbers of vulnerable patients frequently visiting the ART centre, there is high risk of TB transmission. Factors like over-crowding, inadequate natural ventilation and re-circulating air-conditioners add to this risk.

ART centres are required to initiate the following measures aimed at reducing exposure of HIV-infected patients to M. Tuberculosis:

1. Infection control activities

  • All the team members of ART Centre shall be trained in Universal Workplace Precautions, Waste segregation and disposal and Airborne Infection Control Practices, with special reference to tuberculosis
  • Conduct TB risk assessment, in collaboration with RNTCP and NACO
  • Develop a written TB infection control plan by Hospital infection control committee and ART nodal officer. This may be incorporated into the facility infection control plan
  • Hospital infection control committee and ART nodal officer should be assigned the responsibility for TB infection control at ART centres
  • Display proper IEC material on cough and hand hygiene practices in the hospital, hospital waiting area, ART centre, and particularly the waiting area of the ART centre. Notice to be put up that patients with cough shall be seen on priority
  • Make surgical masks, tissues, and appropriate no-touch disposal receptacles available

2. Location and design of ART centres

  • ART centres should be located separately from Chest clinics, Direct Microscopy Centres, or DOT Centres, with no shared waiting areas.
  • There should be a well ventilated waiting & seating area. Open outdoor roofed additional waiting areas are encouraged.
  • There should be a separate, well-ventilated waiting area for respiratory symptomatic wherever possible (particularly busier ART Centres).
  • Adhere to ventilation standards for airborne infection control (>15 air exchanges per hour [ACH] throughout). Where natural ventilation is of concern, augment ventilation through well-planned use of exhaust fans may be considered. Installation should be properly designed and maintained, and electrical power must be consistently available.
  • Any cooling/heating systems should be implemented in a way that does adheres to ventilation standards (>15 ACH). Use of re-circulating (split) air conditioners should be avoided.

3. Screening of clients for respiratory symptoms

  • Care coordinators or nurses should screen all clients arriving at ART centre as early as possible for respiratory symptoms. Patients with respiratory symptoms should be educated on cough hygiene, kept in a separate well-ventilated waiting area if possible, and fast-tracked through their visit.
  • Education on cough Hygiene for persons with respiratory symptoms
  • Educate HCWs, patients, family members, and visitors on the importance of cough etiquette to help prevent the transmission of airborne infections (both TB and respiratory viruses). Instruct patients about covering their mouth and nose with a tissue when coughing and dispose of used tissue in waste containers;
  • Provide a disposable surgical mask to coughing patients.

4. Fast Tracking of known pulmonary TB patients and persons with respiratory symptoms

  • Fast-tracking of patients with respiratory symptoms is critical to reduce the time the patient is in the facility, so to reduce possible contamination of air and spread of disease
  • Care coordinator or nurse of the ART Centre shall facilitate the fast-tracking of patients with respiratory symptoms.These patients will be helped by the nurse to get them counselled by the counsellors, examined by the doctors and provided with the drugs quickly, without making them waiting in the regular queue.
  • TB suspects shall be referred to the DMC / DOTS centre for their sputum smear examination as a part of Intensified Case finding. This will facilitate early recognition and identification of possible pulmonary TB patients.
  • Signboard display of the fast-tracking policy within the ART centre should be visible to avoid confusion among waiting patients.