17.2.2 Administrative controls
This component of TB infection control is more important for you since you need to apply these interventions at the health facility level. As you will read later on, these same interventions are also important in places where people gather and at the level of the household.
Administrative control interventions needed at healthcare facility level are described below:
The term triage refers to the process of identifying of TB suspects and referring them for investigation. People who you suspect of having TB must be separated from other patients and placed in well-ventilated areas, where the movement of the air is in a direction from non-TB suspects to TB suspects. Instruct TB suspects on cough manners, following advice you will learn about in a moment. Once you have separated the TB suspects from those who do not have TB (i.e. reduced the risk of airborne transmission), you should refer them for diagnosis and treatment.
Why do you think it is important that the movement of air should be in a direction from non-TB suspects to TB suspects?
The spread of TB is largely by inhalation of droplet nuclei containing the bacteria. By making sure non-TB suspects are not downwind from TB suspects you reducing the risk of transmission.
Separation of potentially infectious patients needs to continue after the process of triage, isolating suspects or confirmed pulmonary TB cases as much as possible. In particular, patients living with HIV and other forms of immunosuppressive illnesses should be physically separated from those with suspected or confirmed infectious TB. Drug-resistant TB suspects or patients should be separated from other patients, including other TB patients. In general, after providing the immediate services that TB suspects and cases might require, try to shorten their stay in the health facility; send them home as soon as possible, in order to minimise exposure for non-infected patients.
Cough manners (or cough etiquette)
In order to minimise the generation of potentially infective droplet nuclei, any coughing patient with a respiratory disease — in particular TB patients or those suspected of having TB — should be educated on good cough manners. The key points of cough manners are listed below and illustrated in Figure 17.1:
- To cover their nose and mouth when sneezing, coughing or talking by using a gabi, nethela, handkerchief or scarf, piece of cloth, tissue paper and if there is nothing available, place the arm in front of the mouth.
- The same applies to health workers, visitors and families in healthcare (or indeed all places where people gather). Those who cough should cover their mouth and nose with a physical barrier which can be a piece of cloth, a tissue, a surgical mask or an arm placed in front of the mouth.
- The information, education and communication (IEC) activities given at health facilities should strongly focus on cough manners.
- Good respiratory hygiene includes proper disposal of tissue paper, pieces of cloth and masks used for covering the mouth. Proper disposal of sputum should be enforced immediately when a TB suspect is identified. Spitting on floors has to be stopped; collect sputum in a cup and bury it.
Patients and their families should also be educated on the signs and symptoms of TB disease. TB is a treatable disease; explain the risks of not completing treatment. Public health and awareness messages can be delivered as simple posters on the walls and presentations by health educators.