Infection Control Guidelines in Tuberculosis Dr. NAHLA ABDEL KADERوMD, PhD. INFECTION CONTROL CONSULTANT, MOH INFECTION CONTROL CBAHI SURVEYOR Infection Control Director, KKH.

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2.  The
aim today is to cover three focus areas
1stArea
MANAGEMENT OF SUSPECTED /
CONFIRMED CASES OF INFECTIOUS
TUBERCULOSIS
2ndArea
3rdArea
Tracing HCWs exposed to patient
with active pulmonary
tuberculosis
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3.  Spread
of infection within the hospital
requires three essential elements, a source
of infecting organisms, a susceptible host
and a mode of transmission. Each element
is being equated to a link in a chain.
 This
chain analogy is used to represent the
series of interactions which are necessary
to produce an infection process. To
prevent transmission of infection, it is
important to understand the role each
element (link) plays.
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4. How are infections transmitted?
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6. Standard Precautions
Expanded Precaution
Primary strategy for
preventing transmission
of microorganisms to
patients, They are
applied to all patients
Hand hygiene &
Appropriate use of
PPE
Transmission Based
Precautions for patient
with suspected or
confirmed
communicable
disease
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7. MDR
Pulmonary TB
Meseals
Chickenpox
Meningitis
Influenza A
H1N1
Mumps
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8. TB
TB
TB
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9. MANAGEMENT OF SUSPECTED / CONFIRMED CASES OF
INFECTIOUS TUBERCULOSIS
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10. 
Identify patients who have active TB at the time of triage. HCWs who
are the first point of contact in facilities that serve populations at
risk for TB should be trained to ask questions that will facilitate
identification of patients with signs and symptoms suggestive of TB.

Evaluate promptly patients with signs or symptoms suggestive of TB
to minimize the amount of time spent in the Emergancy Room or
Ambulatory Care areas.

Follow airborne TB precautions while the diagnostic evaluation is
being conducted for such patients. These precautions include:

Placing such patients in a separate area apart from other
patients, and not in open waiting areas ( ideally, in a room or
enclosure meeting TB isolation requirements).
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11. Provide patient with surgical masks to wear and
instructing them to keep their masks on.
 Giving these patients tissues and instructing them to
cover their mouths and nose with the tissue when
coughing or sneezing.
 Schedule appointments for such patients for health
care clinics in order to avoid exposing other patients
and HCWs.
 Place patient in appropriate room, i.e negative
pressure room.
Ideally, ambulatory- care setting in which patients
with TB are frequently examined or treated should
have a TB isolation room(s) available.

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12. 





Place patient in a single, negative pressure room.
Maintain patient in his/ her room at all times. If must
leave the room he/she must wear a mask, see
comments for type of mask.
Ensure that doors and windows are closed at all
times to maintain negative pressure.
Limit number of individuals entering the room.
Use N 95 filter mask prior to entering the room.
Educate HCWs and visitors regarding the importance
of adherence to these policies.
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16. How to Don a Particulate Respirator
•
•
•
•
•
•
Select a fit tested respirator
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with elastic
Adjust to fit
Perform a fit check –
 Inhale – respirator should collapse
 Exhale – check for leakage around face
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17. Removing a Particulate Respirator
• Lift the bottom elastic
over your head first
• Then lift off the top
elastic
• Discard
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18. How to Don a Gown
• Select appropriate type and
•
•
•
size
Opening should be in the back
Secure at neck and waist
If gown is too small, use two
gowns
 Gown #1 ties in front
 Gown #2 ties in back
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19. Removing Isolation Gown
• Unfasten ties
• Peel gown away from
•
•
•
neck and shoulder
Turn contaminated
outside toward the inside
Fold or roll into a bundle
Discard
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20. HAND HYGIENE
Dr. Nahla Moustafa
MD, PhD. Public Health
Infection Control Director, MCH ,Najran
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21. Waterless Hand Rub
“alcohol-based hand
rub
Routine Hand
Washing
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22. Wet hands, apply
soap and rub for
>10 seconds.
Rinse, dry & turn
off faucet with
paper towel.
Apply to palm;
rub hands until
dry
~ Use soap and water for visibly soiled hands ~
~ Do not wash off alcohol handrub ~
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25. Isolation Precautions
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26. D.TRANSPORTING PATIENTS ON
AIREBORNE ISOLATION PRECAUTIONS
In The Receiving Department
•Maintain patient with protective apparel in place.
•Expedite procedure to minimize patient stay.
•Observe specific isolation techniques.
•Wash hands before and after contact with patient.
•Arrange for patient’s return to ward as soon as possible.
•Change linen, clean equipment and environmental surfaces
as indicated before the next patient.
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27. D.TRANSPORTING PATIENTS ON
AIREBORNE ISOLATION PRECAUTIONS
•Notify the department to which the patient is to be transported of the
isolation precautions that are in effect.
•Instruct the patient of ways he/she can assist in maintaining
appropriate precautions to prevent transmission of the infection.
•Dress wounds with impervious dressings as required.
•Dress the patient in a clean gown.
•Explain to the patient the need for the protective apparel he/she is
required to wear.
•Put a mask on the patient who is in Airborne isolation.
•Place the patient on a stretcher/wheelchair as appropriate and cover
wheelchair/ stretcher with a sheet.
•Cover the patient with a clean sheet.
•Transport the patient to the area as required.
•Return the patient to the isolation room as soon as circumstances
allow.
•Clean and disinfect wheelchair or strecher with the approved
disinfectant.
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28.  Once
active disease has been ruled out
OR
 If diagnosed with active disease, must be
on adequate therapy, recovering clinically,
and
 has had 3 negative sputum for AFB on 3
separate days.
Consult with Infection Control Director
prior to discontinuing isolation
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29.  Elective
operative procedures on
patients who have TB should be delayed
until the patient is no longer infectious.
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30.  Perform
procedures if possible, in operating rooms
that have anterooms. For operating rooms without
anterooms, the doors to the operating room should
be closed, and traffic into and out of the room
should be minimal to reduce the frequency of
opening and closing the door.
 Attempts should be made to perform the
procedure at a time when other patients are not
present in the operative suite and when a minimum
number personnel are present (e.g, at the end of
the day).
 Place a bacterial filter on the patients endotracheal
tube.
 Recover patient in the operating room.
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31. 




In general Sitters are not allowed for patients who are being
treated in isolation for airborne, communicable or contagious
diseases. Exception to this policy will only be allowed after
consultation and upon approval of the Director, Infection
Prevention and Control Program or designee.
Every patient and allowed sitter in isolation will follow isolation
precautions.
It is the responsibility of every patient and his/her allowed sitter
to abide with all infection control rules and regulations at
his/her sign.
It is the responsibility of the Hospital Staff to educate the patient
in isolation and his/her allowed sitter about all infection control
rules and recommendations.
It is the responsibility of the Hospital Staff to monitor the
compliance of the patient in isolation and his/her allowed sitter
with infection control isolation recommendations.
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32. Employee Health
Tracing of Exposed HCWs
What
the risk of exposure?
How we can prevent the
exposure?
If the exposure is already
done, what is the exposure
management plan?
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33. 1.All employees must comply with the Employee
Health tuberculosis screening program.
2.All employees must report to Employee Health
if they have any symptoms suggestive of
tuberculosis infection or if they have
experienced exposure to smear-positive
patients.
3. BCG will not be given to those who are PPD
test negative.
4.PPD Conversion Rate should be calculated
annually
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34. Exposure Control
PLAN
Confirm TB
Exposure
MANGEMENT OF
TB
EXPOSED STAFF
TRANING IN EMPLYEE
HAELTH & SAFTY
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35. The single most effective
measure to control the
transmission of Open
Pulmonary TB:
Airborne Precautions
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36. MANAGING MYCOBACTERIUM
TUBERCULOSIS EXPOSURES
1. Incubation Period
2-10 weeks from exposure to detection of positive Purified Protein
Derivative (PPD); risk of developing active disease is greatest in first 2
years after exposure.
2. Exposure Criteria
Spent time in a room with a person who has active disease without
wearing an N95 respirator; packing or irrigating wounds infected with
M. tuberculosis without wearing an N95 respirator.
3. Period of Communicability
Persons whose smears are AFB-positive are 20 times more likely to
cause secondary infection than persons who are smear-negative;
children with primary pulmonary TB are rarely contagious.
4. Employee Health
Obtain baseline PPD if not done recently and if HCW previously
negative; perform post exposure PPD at 12 weeks; prescribe
prophylaxis if postexposure PPD is positive.
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37. MANAGING MYCOBACTERIUM
TUBERCULOSIS EXPOSURES
5.Work Restrictions
a.Exposed
None for persons whose PPD becomes positive.
b.Infected
Restrict HCWs with active TB until after they have taken
2-3 week of effective antituberculosis chemotherapy and
they have had 3 negative sputum samples for AFB on 3
separate days.
6. Prophylaxis
Isoniazid 300 mg daily for 6 mo, or 12 mo for HIV-infected
persons and pyridoxine 20-40 mg daily.
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38. Pe rs o n id e ntifi e d w th
i
p o s s ib le
a c tiv e
M y c o ba c te riu m tu be rc u lo s is
Ye s
No tify I CP&
I n iti a te a i rb o rn e
is o la ti on
Pre c a utio n s S
Co nfirm d ia gn o s i s .
W a s M T B o r AF B fo u nd i n re s p i ra to ry
s e c re ti on s o r w u nd d ra in a g e ?
o
No
Stop
Ye s
As s e s s if HCW
e x p os e d . Di d HCW s h a re a ir s p a c e w
ith
c o n firm e d c a s e w
hi le n ot w a rin g a
e
re s p ira tor?
No
Stop
Ye s
ICP a n d in v o lv e d
a re a (s ) g e n e ra te c o nta c t li s of e x p o e d HCW
t
s
Su p e rv i s o r
d ire c ts
e x pos e d
HCW
to
Em p lo y e e He a lth
Ab b re v i a tio n s :
Em pl oy e e He a lth a s s e s s e
s
HCW , a d m i ni s te rs b a s e lin e PPD, re pe a ts
PPD i n 1 2 w e k s , p re s c ri be s p ro p h l a i s
e
y x
fo r PPD c o n v e rs io n
AF B
Ac id -fa s t ba c il li
HCW
He a lthc a r W o rk e r
ICP
In fe c tio n Con tro l
Profe s s io n a l
Ig G
Im m u n og lu b ul in G
Ig M
Im m u n og lu b ul in M
Pt
PHN
a nd re po rts
Pu b lic h e a l th n u rs e
M TB
Co m pl e te d oc u m e n ta tio n
Pa ti e n t
M y c o ba c te riu m
T u b e rc u lo s is
PPD
De ri v a ti v e
Pu ri fie d Pro te in
*
Se e Ex p la n a tio n
a s n e c e s s a ry
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