The facility tuberculosis (TB) infection prevention and control (IPC) plan given in this annex is based on a publication from the United States Centers for Disease Control and Prevention (CDC) (1).
- Name of facility:
- TB IPC committee chair:
- TB IPC focal person:
- IPC committee members (e.g. nursing services, radiology, laboratory, medical records, community representative, TB clinical lead and HIV clinical lead):
- Schedule of IPC committee meetings (e.g. first Wednesday of each month), updates on TB IPC will be a standing agenda item:
Background
- Type of health facility:
- Patient visits per year (outpatients, inpatients):
- Type of health services available (e.g. outpatient, HIV and anti-retroviral therapy [ART], TB screening and follow-up, prenatal, maternity, paediatric and laboratory services including rapid TB diagnostics and X-ray):
- Estimated TB burden in the catchment area of the health facility:
- Type of TB services available (e.g. screening, diagnosis, treatment and TB preventive treatment [TPT]):
Purpose
An infection prevention and control programme requires a plan for identifying and separating patients, providing appropriate treatment and other measures to reduce the risk for TB transmission to patients and health care workers. The plan should be based on the findings from the facility risk assessment and be consistent with the national TB IPC policy and latest guidelines from the World Health Organization (WHO).
Authority statement
The designated TB IPC focal person should have the authority to assess, implement and ensure compliance with this plan, including the authority to use measures to minimize the risk of TB transmission to patients, visitors and health care workers.
Responsibilities
The facility IPC committee has the authority to adapt the plan as needed to maintain the safety and health of patients, visitors and staff members. The TB IPC focal person, with the support of the facility administration and IPC committee, will ensure implementation of the plan as outlined in the following sections for administrative and environmental controls, and respiratory protection.
Administrative controls
The TB IPC focal person will monitor the implementation of activities such as the following:
- TB IPC training of staff;
- educating staff on the TB IPC plan;
- providing educational information on TB IPC to patients, visitors and staff;
- performing TB IPC risk assessment and analysis, and developing a performance improvement plan at least annually;
To reduce the risk of TB transmission, the facility will be responsible for ensuring that:
- visitors are routinely asked about cough upon the entering facility;
- individuals who cough will be separated and fast-tracked for diagnosis;
- all patients diagnosed with TB are started on TB treatment immediately;
- signage for cough etiquette is displayed at strategic locations;
- all staff are trained to provide education on cough etiquette;
- a confidential log is maintained of staff members diagnosed with TB;
- all staff members receive evaluation for TB at least annually, HIV test and ART when positive and TPT as per national guidelines; and
- HIV-infected staff are reassigned if they request reassignment.
Environmental controls
Engineering and maintenance department staff are responsible for ensuring compliance with the following measures:
- monitoring of natural and mechanical airflow daily in the waiting room, consultation rooms and wards;
- conducting regular maintenance, and keeping a log kept on all directional and extractor fans, and any other special equipment (e.g. germicidal ultraviolet light [GUV] lamps);
- preventing overcrowding in hallways or waiting areas and providing alternative seating arrangements, as required; and
- installing signage directing health care workers to keep doors and windows open.
Respiratory protection
Personal protective equipment (PPE), when used in tandem with other TB IPC measures, can reduce the risk of TB transmission. Apart from making sure that appropriate PPE is available to staff, the clinic will budget for and ensure uninterrupted availability of items such as:
- tissues and medical masks for coughing patients;
- N-95 or FFP2 respirators for staff working in high-risk areas;
- fit-testing kits; and
- educational material.
