Download TB infection Control Plan Document N° 8.1 TB Infection Control

Unit 4.
Managerial activities
TB Infection Control Training for
Managers
at National and Subnational Level
Objectives
After this unit, participants will be able to:
• Define managerial activities needed for
infection control at the national and facility
level.
• Identify types of partner organizations for a
national infection control (IC) coordinating
body
• Identify factors to consider in assessing the
risk of TB transmission in a facility
• Describe the elements that should go into a
TB infection control plan
2
Outline
Managerial activities at the national level
1. Coordinating body, plan
2. Health facility design and use
3. Surveillance and assessment
4. Advocacy, communication, social mobilization
5. Monitoring and evaluation
6. Operation research
IC plan for national or facility level
Managerial activities at the facility level
3
What are managerial activities?
Activities used by program managers to
support and facilitate the
• implementation,
• operation, maintenance and
• evaluation
of TB infection control at the national,
sub-national and facility levels
4
Managerial activities at national
and subnational levels (1)
1. Identify and strengthen a coordinating
body, and develop an IC plan
2. Ensure health facility design,
construction, renovation and use are
appropriate
3. Conduct surveillance of TB disease
among health care workers, and
assessment of health and
settings at all levels
5
Managerial activities at national
and subnational levels (2)
4. Address advocacy, communication and
social mobilization (ACSM)
5. Conduct monitoring and evaluation of
the set of IC measures
6. Enable and conduct
research
6
1. Identify a coordinating body to:
• Adopt a national TB IC policy (after
reviewing existing protocols and policies)
• Assess the risk of TB transmission in
health facilities and congregate settings
• Develop a national TB infection control
plan to include
– A budget to reflect the costs of implementing
the plan
– Plans to develop human resource capacity
7
Think beyond the TB programme
Is there an existing national infection control
policy or group?
– Such as for prevention of influenza,
SARS, blood borne pathogens,
hospital infections
What organizations in your country care
about infection control?
How can (or did) you get them involved?
8
Potential stakeholders
•
Government agencies responsible for:
– Health facilities (construction, licensing)
– Medical services (hospitals, clinics, labs)
– Prisons, Jails
– Occupational Health, Labour, Finance
– Standards, norms and codes
• Civil society: professional associations, unions,
NGO’s, patient groups, health sciences
universities, HIV care providers
• Private sector
9
Coordinating body
• Establish or strengthen coordinating body
• Identify members, including IC focal person in
the national TB programme (NTP)
• Include expertise in infection control,
epidemiology, engineering, laboratory,
occupational health, clinical medicine
• Determine roles, terms of reference, budget
• Responsibility and authority should be delegated
to a specific person or leader of the coordinating
body
10
2. Health facility design,
construction, renovation and use
• Identify facilities conducive to TB
transmission
– Crowded TB, MDR-TB wards
– Enclosed out-patient waiting areas with poor
ventilation
– Spaces reserved for high-risk aerosol
generating procedures (sputum collection,
bronchoscopy rooms, autopsy suites)
• Consider redesign or reuse of space to
decrease transmission
11
3. Assess risk of TB transmission
Where are people with infectious TB likely
to expose others?
• Health facilities
• Other facilities where people come
together (congregate): homeless
shelters, prisons, refugee camps,
dormitories, military barracks
Identify facilities
12
Homeless shelter
13
Surveillance
• Review TB epidemiology
– TB prevalence
– drug resistant TB
– TB/HIV prevalence
• Conduct surveillance of TB disease
among health care workers
– define responsibilities
– establish a register
14
Assign higher priority
to settings where:
• TB is drug resistant (MDR, XDR)
• A larger number of people are exposed
(crowded)
• There is failure to suspect TB
• Exposure is of longer duration (length of
stay in the facility, diagnostic delays)
• Control measures are lacking
• Exposed people are especially vulnerable
(see next slide)
15
Groups especially vulnerable:
• To developing TB disease if infected
with M. tuberculosis
• To dying, if develop TB
Examples
• People living with HIV
• Young children
16
HIV prevalent settings
• Health care facilities that provide
chronic HIV care, such as ART clinics
• Counselling and testing sites
• Support clubs for people living with
HIV/AIDS
• Prisons and jails
• Substance abuse treatment centres
17
Overcrowding in prisons
18
Examples of at risk settings
• Vary by geography, climate, socioeconomic status
• Inner city
• Urban slums
• Specialty hospitals (MDR, XDR-TB
facilities)
• Nursing homes
High risk areas for TB
transmission in health facilities
• TB or Medical wards
• Emergency rooms
• Clinics to which people with known or
suspected infectious TB are referred
• Aerosol-generating procedures
– Sputum collection
– Bronchoscopy
– Use of high speed devices during lung
surgery or autopsy
• Laboratories performing culture
20
Review information from facility
assessments
• How many infectious TB patients seen per
year, by area of the facility? (MDR, HIV+)
• Patient and specimen flow: how much time
spent in each area?
• Are high risk procedures performed?
• Is there an infection control plan, coordinating
body, responsible person?
• Are administrative, environmental and
respiratory protection controls in use?
21
4. Advocacy, communication and
social mobilization (ACSM)
22
Why enlist civil society and other
stakeholders?
• Leverage resources, enlist expertise and
perspectives of affected communities
• Increase sense of urgency and ownership
• Build a stake in implementing and
sustaining effective measures
• Create demand for safe health facilities to
expedite implementation
23
ACSM plans should include:
• Strategies for behaviour change targeting
multiple target audiences
– Policy makers
– Donors
– Health care workers
– Patients
– Families
• Patient-centred messages, balancing the
interests of individuals and the wider community
24
5. Monitoring and evaluation
• Develop IC performance indicators
• Establish a system for monitoring and
evaluation
• Use the indicators during supervisory visits
– What’s going well and should be reinforced
and replicated elsewhere?
– What needs improvement and how can the
gaps be addressed?
• Collaborate across programmes
25
Examples of IC indicators
• Number and percent of clinics with written
procedures for identifying and separating
coughing patients
• Number and percent of health care
workers that developed TB during a given
period
26
6. Operational research
• Can help evaluate effectiveness of specific
IC measures or combinations
• Can assess impact (for example, by
detecting TB infection or disease in health
care workers)
• Can identify problem areas to be
addressed
• Needs to be planned, prioritised and
budgeted within a national plan
27
Infection control plan
development
• Assign responsibility
• Base plan on surveillance, epidemiological
data, and risk assessment results
• Prioritize TB infection control measures
based on epidemiology and risk
assessment
• Draft the plan
Prioritization of TB IC
interventions
• Base the set of measures on degree of risk:
give highest priority to interventions with most
impact and lowest cost
• Low- and medium-risk settings: administrative
controls and selected environmental controls
• High-risk settings: administrative controls,
enhanced environmental
controls, and respiratory
protection
29
Draft the plan
• Make plan specific to the country situation
• Base plan on level of risk
• Put plan and procedures in writing, easy to
understand and accessible
• Make the plan Practical, Affordable,
Comprehensive and Creative
30
Elements of a TB IC plan—
national or facility
•
•
•
•
•
•
Responsible authority
List highest risk settings and how defined
Recommended set of IC measures
Policies
Human resource development
Advocacy, communication, social
mobilization
• Monitoring and evaluation indicators
• Budget
31
Evaluating the TB IC Plan
• Develop IC performance indicators
• Establish a system for monitoring and
evaluation, including supervision
• Repeat risk assessment
• Evaluate compliance with the plan
• Seek input from staff
• Identify impediments to implementation
• Monitor status of implementation of control
measures
32
Revise TB IC plan as needed
•
•
•
•
•
•
Enlist input from health care workers (HCW)
Verify resources available
Evaluate any changes in risk
Evaluate changes in function or need
Deal with problems encountered
Re-educate HCW (and continue education of
patients and visitors)
33
Lifecycle of IC plan
Develop
Implement
Monitor,
evaluate
Revise
34
Lifecycle of IC plan
Develop
Educate
Implement
Educate
Monitor,
evaluate
Educate
Educate
Revise
35
Managerial activities at the
facility level
• Identify and strengthen local IC coordinating
bodies, develop a facility plan
• Rethink the use of available spaces
• Conduct on-site surveillance of TB among
health workers, assess the facility
• Address ACSM
• Monitor and evaluate the set of TB IC
measures
• Participate in research efforts
36
Set of measures for TB infection
control at the facility level
• Managerial
• Administrative
• Environmental
• Personal protective equipment
37
Summary (1)
• Managerial activities support and facilitate TB
infection control at the national and facility levels
• Potential stakeholders to involve in IC include
civil society and the private sector, in addition to
government organizations
• Factors to consider in assessing the risk of TB
transmission include the frequency of TB, drug
resistant TB and HIV in the community and in
the facility; implementation of IC measures;
whether aerosol generating procedures are
performed; and the occurrence of TB cases in
employees
38
Summary (2)
• Infection control plans should be based on
a risk assessment
• For low and medium risk areas, the plan
should focus on administrative controls
and selected environmental controls
• High risk areas will require administrative
controls, enhanced environmental
controls, and respiratory protection
39