Role of Nurse in Infection

Control & Prevention of

Tuberculosis

SRIDEVI R
@ www.iloveppt.org

INTRODUCTION
A team approach to TB prevents & control is very
important in the successful management of TB.
Although each member is concealed an essential
player, nurses play a critical role in the care &
treatment of co infected TB patients.

Back ground
Tuberculosis is one of the oldest diseases
known to affect man. It might involve
almost any part of the body, though to a
variable extent, pulmonary type is the most
frequent.
Pulmonary tuberculosis represents an
important global health problem due to its
close relation to the socio-economic
standard of the population, chronic nature,
and the need for long-term treatment. It
represents the most important form as it is
the most common one and patients with
pulmonary tuberculosis are the principal
sources of other forms of tuberculosis
infection.

Back ground
In the beginning of l980s, tuberculosis was
so well controlled in developed countries.
The progressive decline in the incidence of
tuberculosis suggested that eradication of
the disease was possible. However in 1985,
the steady annual decrease in the number of
cases leveled off, and then the rate began to
rise.
This upside-down change might be
attributed to a range of factors such as the
pandemic of (HIV) infection, population
growth, migration,

Global TB statistics
There were an estimated 8.7 million incident
cases of TB in 2011.
There were an estimated 1.42 million deaths. Of
these 990,000 were among HIV negative people
and there were a further 430,000 deaths among
HIV positive people.
In 2009 there were almost 10 million children
who were orphans as a result of at least one of
their parents dying of TB.2

Statistics for TB in "High Burden"

Countries 2011
Country

India

Incidence

2,200,000

Prevalence
Deaths
Population

3,100,000
300,000
1,241,492,000

TB statistics for "high burden"

countries

Of all the countries that report their TB statistics

to WHO, there are 22 countries that are
sometimes referred to as the TB "high burden"
countries, and they have been prioritized at a
global level since 2000. There are currently 22 of
these countries and between them they
accounted for 82% of all estimated cases of TB
worldwide in 2011.4

WHO
Delay in diagnosis is significant with
regard to not only disease prognosis at
the individual level but also transmission
within the community increased.
The goal of TB control programs is to
arrest transmission within the community.
Achieving this goal takes considerable
time, because most individuals in
endemic areas are already infected,
constituting a reservoir that continuously
contributes to the pool of infectious
cases.

TB elimination could be accomplished

as we know
Etiology
Transmission
Diagnosis
Treatment
Prevention & vaccination
curable

Transmission of TB

@ www.iloveppt.org

MODE of Transmission of TB

The Transmission
of TB Knows No Boundaries
Worker to:
Worker
Visitor
Patient

Patient to:
Worker
Visitor
Patient

Visitor to:
Worker
Visitor
Patient

Procedure for sputum collection

06/18/15

@ www.iloveppt.org

Screening and vaccination

06/18/15

@ www.iloveppt.org

Treatment

prevention

Hierarchy of Infection
Prevention & Control
Administrative controls
Reduce risk of exposure, infection and
disease thru policy and practice
Environmental (engineering) controls
Reduce concentration of infectious bacilli
in air in areas where air contamination is
likely
Personal respiratory protection
Protect personnel who must work in
environments with contaminated air

STANDARD PRECAUTIONS

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Standard precautions

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Transmission of TB

Droplet Precautions

Airborne Precautions

Use hand keys for while cough

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Airborne Precautions
These precautions are implemented when
patients are
known or suspected to be infected with pathogens
that
can be transmitted by the airborne route and are
designed to reduce the risk of airborne
transmission of
infectious agents.

Airborne Precautions
Airborne transmission occurs by dissemination of
either airborne droplet nuclei (small-particle
residue [5
m or smaller in size] of evaporated droplets that
may
remain suspended in the air for long periods of
time) or
dust particles containing the infectious agent.

Environmental Controls:
Ventilation and Air Flow
Ventilation is the movement of air
Should be done in a controlled manner
Types
Natural
Local
General
Simple measures can be effective

Isolation room setting in hospital

General ventilation is used to 1) dilute
and remove contaminated air, 2) control
the direction of airflow in a health-care
setting, and 3) control airflow patterns in
rooms.

Estimated Risk of
Airborne TB Infection
Naturally ventilated, windows closed - 97%
Mechanically ventilated with neg pressure (ACH
12) - 39%
Naturally ventilation, windows and doors fully
open:
Modern (1970-1990) 33%
Old-fashioned (pre-1950) - 11%

Negative Pressure Isolation Rooms

Negative
Pressure
Isolation
Rooms
maintain a flow of air into the room, thus
keeping contaminants and pathogens from
reaching surrounding areas. The most
common application in the health industry
today is for Tuberculosis (TB) Rooms. The
infectivity of TB is extremely high and
these rooms are essential to protect health
workers and other patients.

Environmental Controls (2)

Ultraviolet Light

HEPA (high efficiency

particulate air) filters

Airborne Isolation Rooms

- Characteristics
Anteroom
with sink

Bathroom (off room)

Negative pressure
Requisite air changes (clean or
filtered)
AIR FLOW from staff to patient to
exhaust or filter

Be practical

Bed side care

Monitoring vital signs
Assess respiratory status
Administered oxygen therapy
Iv fluid administration
Drug therapy

Nutritional therapy
Proper nutrition is crucial to treating tuberculosis.
As TB weakens the immunity system, the
recovery process is greatly enhanced through a
well-balanceddiet
While TB drugs are the first line of defence
against this killer disease, a healthy diet rich
in protective nutrients can also play an
important role in improving the outcome.
.

Recommended Supplements
TB being an opportunistic disease the best
defense against it is healthy immune system.
When on Anti-Tubercular Treatment its advised to
do the following.
1. Incorporate a high quality multivitamin in your
diet.
2. Take a good quality antioxidant like Coenzyme
Q 10 to support your immune strength.
3. Take supplemental vitamin C because it is one
of the best antioxidants available in nature.
4. You can take supplements of B complex
because its needed for energy production.

conts
Eat a variety of fruit and vegetables each day.
Choose from all five vegetable sub-groups (dark
green, orange, legumes, starchy vegetables, and
other vegetables several times a week.
Non-dairy calcium-containing alternatives may be
chosen to help meet calcium needs be

Arbor Clinical Nutrition Update

use of vitamin E (alpha-tocopherol, 140mg/day)
and selenium (200ug/day) supplementation for
two months in newly diagnosed TB patients
receiving standard anti-TB therapy. Significant
improvements in antioxidant status of up to 40%
were found in the patients receiving the two
supplements.

INCLUDED DIET

Research findings
A, B1, B2, B6, B12, E, niacin, folic acid and
selenium for up to 43 months had a significantly
lower risk of developing neurological fallout
(peripheral neuropathy) and had a 73% reduction
in the risk of the TB spreading from the lungs into
other organs

Breathing exercises

Stat report in TB control programme in Chennai

* Ranges represent uncertainty in DOTS
slowly putting a full stop to TB
Pushpa Narayan, TNN Jan 16, 2009,
12.28am IST
CHENNAI:
The
Directly
Observed
Treatment Short Course (DOTS) for
eradication of tuberculosis is beginning to
show results.
In the last four years, Chennai has seen a
35% dip in deaths due to tuberculosis.
DOTS is an intensive drug therapy that
lasts up to six months, to reduce the
bacterial load, thereby also reducing the
risk of spreading the infection.

Administrative Controls
Develop and implement written
policies and protocols to ensure:
Rapid identification of TB cases
(e.g., improving the turn-around
time for obtaining sputum results)
Isolation of patients with PTB
Rapid diagnostic evaluation
Rapid initiation treatment
Educate, train, and counsel HCWs
about TB
To the extent possible, avoid mixing
TB patients and HIV patients in the
hospital or clinic setting

Expanding the Role of Nurses in TB

Prevention, Care, and Treatment

06/18/15

Challenges and Strategies in

Expanding the Nursing Role
Human Resource Planning and Shortfalls
Training and Supervision Nursing
Involvement in Health Policy Logistics
and Management Support
Safe Work Environments

Activities of the Tuberculosis A

ssociation of India

The present major activities of the TAI

are :
Providing quality diagnostic and
treatment services through the New
Delhi TB Centre.
Complementing
supplementing
Revised National Tuberclosis Control
Program ( RNTCP ),(Directly Observed
Treatement
ShortCourse)
DOTs
services of Government of India ( GoI
). No new units are to be established
to avoid costs and duplication.

Recent activity of TAI

A three months TB Supervisor Course
commencing from 1st July, 2013 will be organized
by the Tuberculosis Association of India (TAI) This
course is accredited by the RNTCP, Central TB
Division of the Govt. of India. at the New Delhi TB
Centre, New Delhi

TB Prevention & Control

in the Community: MO Role

Begin TB treatment as soon as possible

Screen other people in the household
Ensure that TB patients complete treatment
Minimise crowding in congregate settings
Health education.

TB Prevention & Control in the

Community:
Role
Teach
members of the Community
community to:
Recognize the early symptoms of TB
Minimize crowded living conditions
Allow natural light into buildings and rooms as
ultra-violet rays quickly kill TB bacilli
Open windows to air out rooms to dilute the load
of infectious TB bacilli

TB Prevention & Control in the

Community:
Patient
Role diet to
Patient
should maintain
a well-balanced

keep the immune system strong

Patient should TB patient to stop smoking and
minimize intake of alcohol
Patient should hold a cloth or handkerchief over
mouth when coughing
Patient should not spit on the floor but in a
container (preferably disposable) and dispose of
properly

Florence nightingale award

Honble President, Mrs Pratibha Devisingh Patil
gave away the National Florence Nightingale
Awards to Nursing Personnel at a function held at
Rashtrapati Bhavan on 12 May 2012, on the
occasion of the International Nurses Day. Thirtysix nurses from all over the country received the
awards.

. Agrawal Dinesh Satish Kumar,

Staff Nurse (Male), New Civil
Hospital,
Surat
Satish
is a willing worker
always in forefront to provide

his
services. He did remarkable work during communal riots
(2002), floods (2006), and Bhuj earth quake in 2001. He took
care-of an unknown baby girl (now named Richa) admitted
with serious head injury in Sept. 2010 and later on completed
formalities to get her into the orphan house and is also
bearing the cost of her studies. For the last ten years he is
actively involved in the health education activities on
tuberculosis, and arrangement of blood donation camps. His
mind bent for such philanthropic work motivated him to get
associated with NGO by the name of Manav Seva Trust to
facilitate availability of resources to poor patients.

International Council of Nurses

(ICN),

Eleven Nurses win the 3rd ICN/Lilly Award

for Work in Tuberculosis and Multi-drug
Resistant TB
On the occasion of World TB Day, the
International Council of Nurses (ICN), in
partnership with Eli Lilly and Company, conferred
special awards to the following nurses who have
demonstrated exceptional dedication to the fight
against the scourge of tuberculosis (TB) in their
countries:

conclusion
Managing complex TB patient requires a
comprehensive frame work that take into account
both the clinical & social circumstaces to the
patient.
It requires sound nursing judgments,
,independent, critical thinking, analysis the
Problems & problem solving skills in order to
ensure treatment to cure , protect the public
health & decreases morbidity & mortality.

 Unity is strength when

there is team work &
collaboration, wonderful
things can be achieved

06/18/15

Thank You