Infection control strategies:
There are three levels of infection control (IC) measures: administrative (managerial), environmental, and personal respiratory protection. Administrative controls are the most important since environmental controls and personal respiratory protection will not work in the absence of solid administrative control measures. Each level operates at a different point in the transmission process: • Administrative controls reduce HCW and patient exposure
• Environmental controls reduce the concentration of infectious droplet nuclei • Personal respiratory protection protects HCWs in areas where the concentration of droplet nuclei cannot be adequately reduced by administrative and environmental controls.
1st Priority Administrative Controls
2nd Priority Environmental Controls
3rd Priority Personal Respiratory Protection
Administrative (managerial) controls:
The first and most important level of control is the use of administrative controls to prevent droplet nuclei from being generated and thus reducing the exposure of HCWs and patients to M. tuberculosis. Ideally, if the risk of exposure can be eliminated, no further controls are needed. Unfortunately, the risk usually cannot be eliminated, but it can be significantly reduced with proper administrative measures. Important administrative measures include early diagnosis of potentially infectious TB patients, prompt separation or isolation of infectious TB patients, and the prompt initiation of appropriate anti-tuberculosis treatment. Other important measures include an assessment of the risk of transmission in the facility, the development of an IC plan that details in writing the measures that should be taken in a given facility, and adequate training of HCWs to implement the plan. It is essential that one individual be assigned responsibility and accorded authority to monitor the implementation of the IC plan. Administrative measures for the district and referral levels are more thoroughly presented in Chapter 4. Personal respiratory protection
The third recommended control measure is the protection of the HCW from inhaling infectious droplets through the use of personal respiratory protective devices which are designed to fit over the mouth and nose and filter out infectious TB particles. The type of surgical masks (cloth, paper) commonly used by HCWs do not filter out infectious droplet nuclei, although they may be of some use if placed on patients to prevent the generation of such nuclei. Personal respiratory protective devices for HCWs that are capable of adequately filtering out infectious particles are more expensive than surgical masks and are the least effective of the three IC measures. They should not supplant more effective, less expensive, IC measures. Therefore, they should only be used in specialized settings. ADMINISTRATIVE CONTROL MEASURES
Administrative (Managerial) Control Measures
The development of administrative TB control measures should take precedence over all other interventions to reduce nosocomial M. tuberculosis transmission. Without effective administrative controls, environmental measures and personal respiratory protection are of limited value.
As mentioned in the introduction, these guidelines are written to address IC for two levels of health care facilities: district (aid posts, dispensaries, health centers, and hospitals) and referral (regional or national and university hospitals). In most situations, this categorization holds true, however, there may be some difficulties in classifying some health facilities. For example, a district hospital may actually be quite large, have specialized services and therefore more closely approximate a referral level health care facility. With this in mind, the critical elements of TB administrative controls for the two levels are presented. It should be noted, however, that each successive level of...