Airborne Infection Control Measures Research Articles

Airborne Infection Control measures among Government and Private Health Facilities in a hilly district of North India

Introduction: Guidelines for Airborne Infection Control in Health Care Settings were published in the 2010 to reduce Airborne Infections in health service providers and visitors to health facilities. Objectives: To evaluate healthcare facilities regarding implementation of Guidelines for Airborne Infection Control in Health Care Settings. Methods: An analytic, cross- sectional, health care facility-based study in the district Solan of Himachal Pradesh. A total 53 health care facilities from both public and private sectors were assessed and compared. Results: The implementation of these guidelines was unsatisfactory. Government health care facilities were better implementing the guidelines, compared to the private sector. Conclusion: The guidelines are over a decade old and implementation is not optimal. Efforts and emphasis are required to be put into implementation of these guidelines in health care facilities. An update of policy with stringent penalties are advocated for better compliance in the private sector.

Knowledge, attitude, implementation and satisfaction levels regarding availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic

Implementing airborne infection control measures as per guidelines are very important in preventing the spread of airborne infections. Therefore the purpose of this study was to evaluate the gaps in knowledge, attitude, implementation and satisfaction levels regarding the availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic. A cross-sectional survey was done in which 109 nurses participated. This self-administrable questionnaire contained five parts (General information, knowledge, attitude, implementation and satisfaction regarding available resources) and was distributed to the participants. The correct responses as per the National airborne infection control guideline, Ministry of Health and family Welfare, Government of India, 2010 (NAIC) were scored and assessed. The mean age of the participants was 28.9 + 3.02 years. The mean scores out of total score of 10 were 5.48 + 1.2 for knowledge, 6.78 +1.0 for attitude, 5.21 + 1.1 for implementation, and 4.28 + 0.9 for satisfaction of available resources. The knowledge was adequate in 46.8%, the attitude was positive in 89.9 %, the guideline implementation was adequate in 45.9% and the resource satisfaction was only in 9.2% of study participants. Although the nurses had a positive attitude to airborne infection control practices, the overall knowledge and implementation of NAIC were barely adequate and the majority of subjects felt gaps in the availability of resources in implementations of these guidelines. Therefore, it is recommended to enforce their training, ensuring better availability of resources and strict monitoring from hospital administrations for better implementation of NAIC.

Implementation Status of Airborne Infection Control Measures in Primary and Secondary Public Health Facilities, Puducherry: A Mixed-Methods Study.

Poor ventilation in healthcare settings is a concern for airborne infections, particularly in light of the potential for coronavirus disease 2019 (COVID-19) transmission. This study aimed to assess the implementation status of airborne infection control (AIC) measures in primary and secondary public healthcare facilities (HCFs) and to explore the facilitating factors and barriers in the implementation of AIC measures. A mixed-methods approach was adopted, which includes a cross-sectional descriptive study using a checklist to collect data on the implementation of AIC measures in 22 primary and two secondary public HCFs in Puducherry, South India, between October 2020 and February 2021. Further, key informant interviews (KIIs) were conducted among medical officers (MOs). The qualitative data were manually analyzed, and transcripts created from handwritten notes and audio recordings were deductively evaluated. Of the twenty-four health facilities visited, 54.2% had infection control (IC) committees. Annual IC training was held for housekeeping staff, MOs, nurses, and laboratory technicians in 23 (95.8%), 21 (87.5%), 20 (83.4%), and 14 (58.4%) facilities, respectively. Respiratory symptomatic patients were counseled on cough etiquettes in 22 (91.6%) facilities. Adequate cross-ventilation was present in outpatient departments in 16 (66.6%) institutions. N95 masks and face shields were provided in 21 (87.5%) facilities. Training through the KAYAKALP program and the presence of a separate sputum collection area were facilitators of IC, while lack of patient adherence and delays in fund release were found as barriers. Overall, the AIC measures were well-implemented, but improvements are needed in infrastructure development for patient segregation in outpatient departments and dedicated AIC training for all healthcare personnel.

Implementation status of national airborne infection control guidelines in the health care facilities of a North Indian State: A mixed method study

ObjectiveHealthcare-acquired infection (HCAIs), have become a significant cause of morbidity as well as mortality among the hospitalized patients and health care workers. The implementation of air-borne infection control measures play an important role in prevention of health care acquired infections (HCAIs). Hence, this study was planned to assess the implementation status of National Airborne Infection Control Guidelines in the health care settings of a North Indian State. Study designA mixed method study was planned in all the 13 health facilities of Himachal Pradesh having both the Anti-Retroviral Therapy (ART) Centre and Directly observed Treatment Short course (DOTS) for TB center in the same facility. MethodsThe implementation of airborne infection control measures was evaluated using a Standardized Health Care Facility Airborne Infection Risk Assessment Tool and an observational checklist. In-depth interviews are conducted with hospital staff. At all health facilities, risk assessment and implementation of airborne infection control was evaluated by using a pretested semi-structured questionnaire. The qualitative data was analyzed manually and transcripts prepared from hand written notes and audio tape records were analyzed thematically. ResultsOnly 5 out of 13 health facilities were having specially designated airborne infection control committee. The incidence of tuberculosis among hospital staff was 2.32% at secondary level health care facilities and 0.35% at tertiary care level health facilities. Among the tuberculosis cases, maximum were nursing staff (59.5%) as compared to other categories of health care workers. Improper functioning of health care system and individual factors were main reasons for deficiencies in the implementation of air-borne infection control measures. ConclusionThe health care facilities were not implementing the infection control measure to the fullest both at secondary and tertiary care health facilities. There is a need to set up the surveillance of airborne infections in the hospital and especially the passive surveillance of tuberculosis among health care workers.

Are healthcare workers safe? Facility assessment of airborne infection control measures in public hospitals of Kerala

Background: Nosocomial transmission of airborne infection is a major peril to health care providing community and has been linked to poor adherence to airborne infection control practices. The present study was conducted to assess the gaps in health care facilities and practices for prevention and control of transmission of air borne infections among healthcare workers in government district level hospitals of Kerala.Methods: A cross sectional survey including observation was done in 24 facilities. The tool for the survey and the check list for observation were developed based on national airborne infection control guidelines and assessment tool for prevention and control of infection by centre for disease control. The data were analysed using IBM SPSS version 23.Results: The functioning of airborne infection control system was found to be suboptimal in most of the institutions. Implementation of environmental control measures was poor when compared to administrative control and personal protection measures. Adequate ventilation was not present in more than half of the institutions (60%). All institutions had infection control committees in place but were not functioning well. Personal protective equipment’s were not available at point of use in more than half of the institutions (62.5%). Out of the 16 self-reported hospital acquired respiratory infections among the staff, pulmonary tuberculosis was predominant.Conclusions: Several barriers were identified at different levels for prevention and control of airborne infections among healthcare workers. The findings reinforce the need to implement strict guidelines to prevent occupation induced airborne infections among health workers in public health system.

Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study.

BackgroundPrimary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial.ObjectiveThe aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India.MethodsWe conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care.ResultsA total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic.ConclusionsExisting PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.

Conversion Rate of Tuberculin Skin Test among Medical Students in Songklanagarind Hospital

OBJECTIVE: Airborne and Tuberculosis (TB) control measures have been implemented in Songklanagarind hospital. The infection control unit of the hospital has provided a voluntary two-step tuberculin skin test (TST) for pre-clinical medical students and serial TST for clinical medical students. This study aimed to determine the incidence of negative outcome and booster phenomenon from two-step TST as well as the TST conversion rate from serial TST among medical students in the hospital. MATERIALS AND METHODS: Percentages of negative cases and boosting phenomenon were calculated from the two-step TST records. Conversion rates of each year were calculated from serial TST data. Then the TST conversion rates were predicted based on the Jointpoint model. RESULTS: Two-step TSTs performed from 2001 to 2016 showed 40 to 100% of negative cases and zero to 14% of boosting phenomenon among 2,271 medical students. Serial TSTs from 2002 to 2016 among 665 medical students showed 60 conversion cases. Conversion rates varied from zero to 13.6%. The decline of conversion rates after the year 2006 is demonstrated in 1-Joinpoint model with statistical significance (p = 0.0129). The model corresponded with the timeline data of airborne infection control measures which were mostly implemented after 2006. CONCLUSIONS: A decline in TST conversion rate was shown after 2006. This coincided with airborne infection control measures at the institute. Keywords: tuberculin skin test, conversion rate, medical student, Songklanagarind hospital Address Correspondence to author: Sarinpant Pongpant, MD. Occupational health unit, Department of family medicine and preventive medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand. email: jibpongpant@gmail.com Received: May 25, 2018 Revision received: May 31, 2018 Accepted after revision: July 3, 2018 BKK Med J 2018;14(2): 17-21. DOI: 10.31524/bkkmedj.2018.09.004

Natural ventilation as a means of airborne tuberculosis infection control in minibus taxis

Airborne infection control measures are used extensively in health-care settings to curtail the spread of airborne infectious diseases. Few such measures are applied in public congregate spaces outside health facilities, such as those associated with public transport. In minibus taxis – a popular form of public transport in South Africa – poor ventilation creates conditions that allow for transmission of airborne diseases, particularly tuberculosis. In this study, we focused on developing quantitative ventilation profiles for the 16-seater Toyota Quantum Ses’fikile model commonly used in the Cape Town metropole. We studied the ventilation rates achievable in an occupied taxi under varying operational conditions, such as driving speed and open window configurations, which were based on observations made during preliminary taxi journeys. Two open-window configurations were found to provide ventilation rates close to or exceeding WHO recommended per-person requirements for high-risk clinical areas and are therefore likely to be effective in reducing the risk of tuberculosis transmission.&#x0D; Significance:&#x0D; &#x0D; The results obtained augment the limited data available on the role that natural ventilation can play in reducing TB transmission in minibus taxis.&#x0D; Ventilation rates were shown to depend on both the taxi speed and specific open window configuration, countering the notion that simply opening a random selection of windows provides adequate reduction in the transmission risk.&#x0D;

\u201cWho has to do it at the end of the day? Programme officials or hospital authorities?\u201d Airborne infection control at drug resistant tuberculosis (DR-TB) centres of Karnataka, India: a mixed-methods study

BackgroundDrug resistant tuberculosis (DR-TB) centers admit patients with DR-TB for initiation of treatment and thereby concentrate the patients under one setting. It becomes imperative to assess the compliance of DR-TB centres to national airborne infection control (AIC) guidelines and explore the provider perspectives into reasons for unsatisfactory compliance.MethodsThis mixed methods study (triangulation design) was carried out across all the six DR-TB centers of Karnataka state, India, between November 2016 and April 2017. Non-participant observation using a structured format was carried out at the DR-TB wards (n = 6), outpatient departments (n = 6), patient waiting areas outside outpatient departments (n = 6) and culture and drug susceptibility testing laboratories (n = 3). Structured interviews of admitted patients (n = 30) were done to assess the knowledge on cough hygiene and sputum disposal. Key informant interviews (KIIs) of health care providers (n = 20) were done. Manual descriptive content analysis was done to analyse the transcripts of KIIs.ResultsThe findings related to compliance in non-participant observation were corroborated by KIIs. All the laboratories were consistently implementing the AIC guidelines. Compliance to hand hygiene, wet mopping and ventilation measures were satisfactory in four or more DR-TB wards. The non-availability of N95 masks in wards as well as outpatient departments was staggering. Sputum disposal without prior disinfection and the lack of display materials on cough hygiene and patient education was common. Patient fast tracking in outpatient department waiting areas and visitor restrictions in wards were lacking. Trainings on AIC measures were uncommon. About half and one-third of patients admitted had satisfactory knowledge regarding sputum disposal and situations demanding mask respectively. The reasons for unsatisfactory compliance to AIC guidelines were poor coordination between programme and hospital authorities leading to lack of ownership; ineffective or non-existent infection control committees; vacant posts of medical officers; and attitudes of health care delivery staff.ConclusionCompliance with AIC guidelines in DR-TB centers of Karnataka was sub-optimal. The reasons identified require urgent attention of the programme managers and hospital authorities.

Awareness of health care workers, patients and visitors regarding air borne infection control – A descriptive study from a Tertiary Care Centre in Kerala, southern India

Airborne infections are major public health concern especially in hospitals and public spaces in a highly populated country like India. Generating awareness about good infection control practices among common man and health care workers are important steps in curtailing transmission of air borne infections. In this study we were trying to assess the awareness of airborne infection control measures among patients, bystanders and healthcare workers in a tertiary care hospital at Kochi, Kerala. Self-administered questionnaire which included 10 questions for health care staff and 12 questions for lay men prepared on the basis of NAIC and NCDC guideline were given to the study participants. 143 health care staff and 332 laymen were participated in the study. In both groups majority of the responses were correct. However, only a small proportion of health care staff correctly answered fast tracking of a patient with TB (14.7%) and minimum air exchanges in air-conditioned settings (15.4%). Among laymen only a few correctly identified ideal place for sputum collection (43.3%) and role of hand washing in preventing flu (36.4%). Overall more intervention needed in improving awareness about good infection control practices among both health care staff and laymen.

Innovative practical approaches for preventing the transmission of tuberculosis in resource limited health care settings

Airborne infection control at health care settings remains a low priority especially in public health settings in India. Recent events of upsurge in cases of tuberculosis (TB), Drug resistant Tuberculosis (DRTB) and reported occurrence of health care workers (HCW) diagnosed with TB and DRTB in Maharashtra have highlighted the need to implement airborne infection control practices. Airborne infection control (AIC) guidelines in India recommend administrative control, environmental control, and personal respiratory protection measures. Public and private tertiary care institutes face many challenges to implement the airborne infection control measures in their settings. Practical solutions are needed to address these challenges. An innovative approach was implemented in tertiary care facility in Nagpur, Maharashtra. The approach included use of “Sunrise model” tool for implementing AIC activities with practical innovative approach of decompression & segregation of crowd in waiting areas using coloured coupons and re-organisation of spaces to reduce the risk of transmission in the hospital setting. Initial risk assessment of the facility was conducted by state airborne infection control committee members using a checklist as per the National Airborne infection guidelines and six month follow-up on recommendations of committee was done.Practices of airborne infection control were improved with the use of ‘Sun rise model ‘as a tool and innovative approaches used for decompression of waiting area are feasible having potential for scale-up in other resource poor health care settings.

Exploring the role of drug resistant tuberculosis center in the programmatic management: An Indian perspective

Global tuberculosis control report – 2012 has revealed that 3.7% of new cases and 20% of retreated cases are estimated to have multi-drug resistant (MDR) TB worldwide. Specific strategies have been implemented under the Programmatic Management of Drug Resistant TB in India (PMDT) to address the MDR-TB problem. Considering the long duration of treatment, PMDT recommends that treatment of drug resistant forms of TB should be decentralized. However, to supervise and guide the health care providers in the complex medical needs, an expert resource center called as Drug-resistant TB (DR-TB) center has been proposed. A DR-TB center plays a crucial role at different levels in the management of drug resistant forms of TB such as pre-treatment evaluation; initiation of treatment; maintenance of hospital wards & airborne infection control measures; management of severe adverse drug reactions; modification in the choice of drugs based on the drug sensitivity test results; and as a clinical expert resource for guidance to the program managers and the health care providers. To conclude, DR-TB center plays a defining role in the overall integrated model of care in RNTCP-PMDT services.

Relevance of Latent TB Infection in Areas of High TB Prevalence

About one-third of the world population has latent TB infection (LTBI), the majority of which is distributed in 22 high-burden countries. Early diagnosis and treatment of active TB remains the top priority in resource-poor countries with high TB prevalence. Notwithstanding, because LTBI contributes significantly to the pool of active TB cases later on, its diagnosis and treatment is essential, especially in high-risk groups. The lack of a gold standard and several limitations of currently available tools, namely the tuberculin skin test and interferon-γ release assays, are major constraints for LTBI diagnosis. In areas with high TB prevalence, interferon-γ release assays have not shown superiority over the conventional tuberculin skin test and are yet to be systematically studied. Decisions regarding LTBI treatment with isoniazid preventive therapy should be made, keeping in mind the high prevalence of isoniazid resistance in these settings. Although efforts to shorten the LTBI treatment duration are encouraging, most trials have focused on adherence and toxicity. Future trials on short-duration regimens in high-burden settings should address drug efficacy issues as well. LTBI management, therefore, should comprise a targeted screening approach and individualization of LTBI treatment protocols. In addition, efforts should focus on airborne infection control measures in high-burden countries. A high prevalence of drug-resistant TB, the HIV epidemic, and delays in the diagnosis of active TB cases are other major concerns in areas of high TB prevalence. There is ample space for further research in these countries, whose outcomes may strengthen future national guidelines.

Indicadores relacionados ao retardo no diagnóstico e na instituição das precauções para aerossóis entre pacientes com tuberculose pulmonar bacilífera em um hospital terciário

INTRODUÇÃO: Há risco de transmissão de tuberculose em instituições de cuidados à saúde. OBJETIVO: Avaliar indicadores relacionados ao risco de transmissão entre pacientes com tuberculose pulmonar bacilífera atendidos em um hospital universitário. MÉTODO: Estudo retrospectivo, descritivo, de 01/1997 a 09/1999. Foram estudados os pacientes internados com tuberculose pulmonar bacilífera no Hospital de Clínicas da Universidade Estadual de Campinas. Foram avaliados três intervalos: entre admissão e coleta da pesquisa de BAAR no escarro; entre admissão e instituição das precauções para aerossóis; entre coleta do escarro e início do tratamento. RESULTADOS: Foram incluídos 63 casos. Associação ao vírus da imunodeficiência humana ocorreu em 31,7%. Quarenta pacientes foram admitidos pelo pronto-socorro (63,5%). Suspeita de tuberculose esteve presente na admissão em 42 pacientes (66,7%). O intervalo entre admissão e coleta de escarro excedeu 12 horas em 27,5% dos casos admitidos pelo pronto-socorro e em 30,4% dos internados nas enfermarias (p = 0,803). Retardo no isolamento respiratório ocorreu em 31 casos (49,2%). Os fatores associados ao retardo de isolamento foram ausência de tuberculose no diagnóstico de admissão (p &lt; 0,000) e carga bacilar mais baixa no escarro (p = 0,032). Infecção pelo vírus da imunodeficiência humana (p = 0,530), enfermaria de hospitalização (p = 0,284) e presença de co-morbidades (p = 0,541) não foram associados ao retardo de isolamento. O intervalo entre coleta e início de tratamento foi superior a 24 horas em 15,9% dos casos. CONCLUSÃO: Observou-se retardo de isolamento em muitos casos. São necessárias políticas de educação continuada, sobretudo nas áreas de maior risco.