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

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

Outline

1. The problem

2. The solution

3. Conclusions

The Problem…

Is there an additional risk of TB to…

– Health workers?– Prisoners?– Household members of TB patients?

Increased risk of TB in Increased risk of TB in highhigh risk populationsrisk populations

Prisoners

Health care workers

Household Members

PopulationPopulation

High income

Low income

High income

Low income

High income

Low income

SettingsSettings

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

Can you transmit MDR/XDR TB?

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

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.

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.

The solution….

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

What is needed to implement the policy?

• Leadership

• Technical expertise

• Financial and human resources

LeadershipWho? Ministries of Health

• Policies, guidelines• Systems developed to provide direction,

oversight, training, M & E• Assignment of responsible bodies• A campaign

Technical expertiseWho? Countries, technical agencies

• Infection control nurses (and other clinical staff)

• Architects, engineers • Community advocates

Financial and human resourcesWho? Ministries of Finance,

Infrastructure, Justice, Donors

• Infrastructure - hospitals, clinics• Commodities - supply chain management• Maintenance of equipment• Human resource development

A critical piece…

• Infection control elements need to be line items in National MDR TB action plans.

Safer health facilities for all.

We can do better!

TB Infection Control: What do we need to do? - who.int · TB Infection Control: What do we need to...

Documents

HIV & TB Co-Infection - sntc.medicine.ufl.edu€¦ · Pathogenesis- HIV & TB Co-Infection It has also been suggested that TB patients have a microenvironment that facilitates HIV

Training on TB Infection Prevention and Control in Health ...etoolkits.dghs.gov.bd/sites/default/files/training_on_tb_infection_prevention_and...This training package for “TB Infection

TB (Infection) or not TB? Who should we screen and treat?

TB screening in a Dialysis Unit: detecting latent TB infection is … FIS PDF... · 2013-12-12 · TB screening in a Dialysis Unit: detecting latent TB infection is only half the

TB Infection Preventionnid]/5...TB Infection Prevention Objectives Identify 3 of 6 contributing factors to possible TB transmission. Name two new practices you can add for safely collecting

TB and HIV co-infection in the EU/EEA - Terviseinfoof the TB-HIV co-infection situation in Europe. •A comprehensive, systematic review of the current literature on TB-HIV co-infection

Tuberculosis Infection Prevention and Control in Ghana · specific Standard Operating Procedures (SOPs) for TB Infection Control and prevention Global Policy on TB infection Control

Management of Latent TB infection in Indonesia

Targeted Testing and Diagnosis of Latent TB Infection · Targeted Testing and Diagnosis of Latent TB Infection 1 Targeted Testing and Diagnosis of Latent TB Infection Chris Spitters,

COVID-19 & Tuberculosis€¦ · There are two types of TB — latent TB infection & active TB disease. If you have latent TB infection, you can't spread it to others. If left untreated,

Screening for TB Infection in Santa Clara County · Screening for TB Infection in Santa Clara County Author: SCC TB Prevention & Control Keywords: TB, list of clinics, santa clara

National Guidelines FOR TB INFECTION Control COVER · NatioNal GuideliNes for tB iNfectioN coNtrol 2015 9 6. Ensuring appropriate staff training in infection control and safety. 7

Nurse Case Management: It’s What We Do! 1 TB Nurse Case Management: It’s What We Do! TB Nurses Training Norfolk, VA 2011 Debbie Staley, RN Denise Dodge, RN through effective infection

TB and NTM infection - RCP London

Ocular manifestations of tb infection

TB VACCINES PIPELINE - Stop TB Partnership · TB vaccines under development could work in several ways: 1) Prevent infection 2) Prevent primary disease 3) Prevent latent infection

PowerPoint PresentationTB infection occurs when a person has breathed in the TB germ, but the person is not sick. TB disease can develop in a person with TB infection if they do not

Infection Control TB

Infection Control Overview: TB Session 1: Infection Control Basics

Latent TB Infection in the WHO European Region · Latent TB Infection in the WHO European Region ... the global TB epidemic as stated in the WHO’s End TB Strategy. ... 2015 data