Download Infection Control Scenarios: What would you do

3 I’s scenarios: IPT, IC, ICF
How would you use the 3 I’s strategies to reduce the risk of TB transmission and disease
progression in these scenarios
Group 1
Clinic X is located in a resource constrained tropical country where the HIV prevalence
rate hovers around 34% among TB patients. The clinic has a TB DOTS, sputum
collection center, HIV testing and counseling, and an ART clinic. Because the clinic is in
a rural area, many of the clients have to travel long distances and wait in long lines to be
seen (the average wait time is 90 minutes). The waiting area is dark and not well
ventilated and is often full of clients. Health care workers, some of whom are HIV
positive, have about 10 minutes per patient, and must fill out 3 pages of forms for each
HIV encounter and 3 forms for each TB encounter.
o Please identify at least four risk factors for TB transmission?
o If you were to devise an Infection Control plan, what would some of its
components be? (Describe at least 3 strategies)
o Would IPT be a useful strategy in this situation? If so, who would you target?
o How could you improve the identification and diagnosis of suspected TB cases?
Group 2
You are a District Coordinator of a PLWHA support group in a developing country that
meets in the basement of a small church. From time to time a support group member
develops a chronic cough and after a few weeks realizes that they have TB. One of the
persons who had developed TB did not improve even after being put on TB medications
and died three weeks later. There is a great deal of fear among support group members
about TB. About two months after the death of the group member, another member
develops a cough and is so afraid of losing his one source of social and emotional support
that he tries his best to hide his illness from the others.
o What might you identify as risk factors for TB transmission? (List at least 3)
o What are some steps that can be taken to reduce these risk factors?
o Would IPT be a useful strategy in this situation? If so, who would you target?
o How could you improve the identification and diagnosis of suspected TB cases?
Group 3
At a rural hospital where the TB/HIV coinfection rate is at least 40%, patients who are
admitted with a wide range of health issues are put in a common ward. On this ward
there are patients who are suspected of having TB as well as patients who are suspected
of being HIV positive. To test for TB, sputum is collected from the patients on the
common. While waiting for the TB and HIV test results, all patients are kept in the same
ward. Because the hospital is located in the mountains, it gets quite cold at night, and so
the windows are often shut, as a result the air in the ward does not circulate well. Many
of the nurses and the doctors in the hospital don't wear masks as they are concerned that
they will make the patients feel stigmatized.
If you were in charge of this ward of the hospital:
o What might you identify as risk factors for TB transmission? (at least 4)
o If you were to devise an infection control plan, what would some of its
components be? (Describe at least 3 strategies)
o Would IPT be a useful strategy in this situation? If so, who would you target?
o How could you improve the identification and diagnosis of suspected TB cases?
Group 4
You are the supervisor of community-based treatment support program for TB patients in
av urban township with high HIV prevalent rate, many of the participants in your
program are retreatment cases. Because the lab is not able to do culture, DST (drug
susceptibility testing) is not standard procedure, therefore none of these cases have been
confirmed as having drug-susceptible or drug-resistant TB. Virtually all of the patients in
your program live in tin shacks with family members (average family size is 5) of all
ages. At least 50% of your patients are HIV positive (average CD4 count is 250) and
only 10% of them are on ARTs. The national government has written a policy
recommending IPT for all LTBI cases, but the doctors are hesitant to implement it
because they fear the development of resistance to INH. All of the community health
promoters in your program (those who dispense the medication at the participant’s home)
are former TB patients from the community, and a number of them are HIV positive.
o What might you identify as at least four risk factors for TB transmission?
o What steps could be taken to reduce these factors?
o Would IPT be a useful strategy in this situation? If so, who would you target?
o How could you improve the identification and diagnosis of TB cases?