tb infection control: what do we need to do? - who.int · tb infection control: what do we need to...
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TB Infection Control: What do we need to do?
Bess Miller, M.D. M.Sc.Chair, STOP TB Infection Control Subworking Group
TB/HIV Working Group
Ministerial Meeting of High M/XDR-TB Burden Countries
Beijing, China1-3 April 2009
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Acknowledgements• Fabio Scano• Rose Pray • Ernesto Jaramillo• Paul Nunn• Haileyesus Getahun• Kenneth Castro• Virginia Lipke• Paul Jensen• Ed Nardell• Core Team of TB Infection Control Subworking Group
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Outline
1. The problem
2. The solution
3. Conclusions
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The Problem…
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Is there an additional risk of TB to…
– Health workers?– Prisoners?– Household members of TB patients?
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Increased risk of TB in Increased risk of TB in highhigh risk populationsrisk populations
Prisoners
Health care workers
Household Members
PopulationPopulation
High income
High income
High income
Low income
High income
Low income
High income
Low income
SettingsSettings
18
5
15
37
40
9
15
7
StudiesStudies
21.41TB
2.742.74TB infection
1.99TB
5.715.71TB
10.06TB infection
5.775.77TB infection
3.19TB infection & TB
1.731.73TB infection & TB
Risk RatioRisk RatioOutcomeOutcome
Source: WHO, 2008
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Can you transmit MDR/XDR TB?
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HIV-Associated MDR TB Outbreaks,1988-1995
Evidence of institutional MDRTB transmission
Wells CD, et al. HIV Infection and multidrug-resistant tuberculosis - the perfect storm.
J Infect Dis 2007;196:S86-S107
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The truth is that…
• In these MDR TB outbreaks in NYC hospitals, it was deaths among health workers that brought attention to TB infection control.
• In the recent MDR TB outbreak in southern Africa, 6 health workers died of MDR TB and XDR TB.
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At the global level…
• TB infection control (and infection control overall) has been neglected in health care, prisons, and other congregate settings.
• But now we are all listening.
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The solution….
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WHO Policy on TB Infection Control (2009)
• Promotes combination of controls.• Addresses health facilities, congregate
settings, and households• Adds managerial component • Promotes minimizing time spent as in-patient• Emphasizes community involvement • Promotes integrating TB infection control
with other infection control activities
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What is needed to implement the policy?
• Leadership
• Technical expertise
• Financial and human resources
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LeadershipWho? Ministries of Health
• Policies, guidelines• Systems developed to provide direction,
oversight, training, M & E• Assignment of responsible bodies• A campaign
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Technical expertiseWho? Countries, technical agencies
• Infection control nurses (and other clinical staff)
• Architects, engineers • Community advocates
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Financial and human resourcesWho? Ministries of Finance,
Infrastructure, Justice, Donors
• Infrastructure - hospitals, clinics• Commodities - supply chain management• Maintenance of equipment• Human resource development
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A critical piece…
• Infection control elements need to be line items in National MDR TB action plans.
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Safer health facilities for all.
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We can do better!