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TUBERCLOSIS IN HEALTH CARE SETTING
INTRODUCTION
TB transmission can be in any setting including homes and worksites. However, TB transmission is most likely to occur in health care setting. Unsuspected TB patient who is not receiving prescribed treatment and not isolated easily transmits the virus, to patients and health care workers. This paper describes the factors that determine the infectiousness of a tuberculosis (TB) patient; explains the main goals of a TB infection control program; discusses the three levels of an effective TB infection control program; explains the purpose and the characteristics of a TB airborne infection isolation room; and describe the circumstances when respirators and surgical masks should be used in the listed order as follows;
One of factors determining TB infectiousness from a host patient is the number of droplet nuclei carrying M. tuberculosis, expelled into the air. When a person inhales the M. tuberculosis droplet nuclei and it traverse nasal passages, upper respiratory tract, and bronchi to reach the alveoli of the lungs, infection occurs. Presence of sputum, cough, cavity in the lungs and not receiving required treatment increases infectiousness. In most cases children are less infectious since they rarely produce sputum when coughing. When the prescribed treatment is adhired to, the infectious rate decline which is different in various patients.

The main goals for TB control program include; to reduce the transmission of TB to healthcare workers patients and other staff through administrative control program. The other goal is to reduce the transmission of infection by priotizing diagnosis and treatment of vulnerable group. The United Center for Disease Control and Prevention and WHO, recommends administrative control measures such as; timely identification of people showing TB signs, seclusion of infectious individual patients, pathogen spread control and spending much less time in healthcare facilities. Series of screening for hidden TB infection in Health Care Workers by use of inereferon gamma release assay which is more advantageous, but has serious shortcomings compered to tuberculin skin test.
The three levels for effective TB infection program, the administrative control measures by WHO policy are as discussed below. First, quick identification of people with TB symptoms. It is by suspecting people having TB infection, separating them for diagnosis. The second step is the separation of patients who are infectious. People confirmed to be having TB and with drug resistance likelihood should isolated on their specific conditions. Finally, the Control of spread of pathogens. This is done by practicing etiquette while coughing. Covering the mouth and the nose bars the droplet nuclei from spreading. Minimizing the stay at health care facility avoids TB transmission, except in complicated medical state which requires admission as in patient. The stay away from poorly refreshed area and overpopulated area should be reduced with Help of health care workers.
The need for having the TB airbone infection isolation room is to reduce on number of infectious molecules in the air. Local exhaust Ventilation (LEV) is a technique used in absorbing the airborne infections before they are expelled into surrounding air. The two types of LEV are partial enclosures and complete exposures. Partial type e.g., hoods are not fully enclosed, the air drawn across patients breathing zone, filtered using HEPA, recirculate back into the room or expelled directly in to the air. The complete type on the other hand air from there is HEPA- filtered, expelled out into the air or recycled into the room. The complete enclosure is the most preferred. The isolation room referred to as Negative Pressure isolation room (NIIR) is designed for a single TB patient. The NIIR provides a negative pressure in the room so that air flow is from cleaner area to isolation rooms which are less clean. This prevents the contaminants from spreading, and direct release of infectious air from the room. The expelled air from the room can be recirculated through a HEPA filter before returning to circulation.
Surgical masks are designed to protect health care workers, and other staff who handle TB patients, from inhaling droplet nuclei. They reduce on the number of infectious molecules from being exhaled into the environment and surrounding air. The patients occasionally talk, cough, and even sneeze and encouraging them to use surgical masks as respirators, minimize the chances of depositing droplet nuclei into fresh and clean air. It should be understood that the surgical masks do not eliminate but reduce on the risk of exposure.
In conclusion, Clinicians should be aware that TB transmission takes place in healthcare setting, after exposure near TB patients. In addition, the more the number of droplet nuclei carrying M. tuberculosis exhaled in the air, the greater the extent to which the TB patient is infectious. TB is only transmitted through air when TB patients cough but not in physical contact. Infectiousness of TB patients reduces when they are exposed to the adequate and appropriate treatment. Reducing the risk of exposure, controlling the spread and use of protective equipment, are the steps followed in TB infection control program.












References
Kyung - Wook Jo, M. (2016). Preventing the Transmission of Tuberculosis in Health Care Settings: administrative control. Tuberclosis & respiratory Diseases, 21 - 26.




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