17.2 TB infection control measures at community health facility level
The control measures — or interventions — that need to be brought into play at the level of the health facility fall into the four broad categories shown in Box 17.1. They begin with managerial activities and under that heading a range of national and sub-national interventions are listed that help give managerial order and direction to what happens at the level of the health facility to enable effective TB infection control. The other categories give similar detail on what happens by way of administrative controls, environmental controls and also at the level of the individual health worker.
Describing TB control measures using the headings in Box 17.1 is a useful way of explaining their importance to you as a health worker. We will introduce each of these categories in turn — you will then have a sound understanding of how each intervention operates at a particular point in the airborne TB transmission process. In a later section, we’ll use the same four headings to describe the interventions that are appropriate for places where people gather (congregate settings) in the community and at the level of the household.
Box 17.1 Interventions for TB infection control in health-care settings
- Identify and strengthen coordinating bodies, and develop a comprehensive human resources plan for planning and implementation at all levels
- Conduct surveillance and assessment at all levels of the health system
- Engage civil society and promote communication and social mobilisation
- Conduct monitoring and evaluation
- Enable and conduct operational research.
- Develop strategies to promptly identify potentially infectious cases (triage), separate them, control the spread of pathogens (cough manners) and minimise time in healthcare settings.
- Natural ventilation
- Mechanical ventilation
- Ultraviolet germicidal irradiation (UVGI) fixtures
- Health facility design and renovation.
Personal protective interventions
- Package of prevention and care for healthcare workers, including isoniazid preventive therapy (IPT) for HIV-positive health-care workers.