Infection Control and Tuberculosis in Perú Lessons Learned

Transcription

1 Infection Control and Tuberculosis in Perú Lessons Learned Dr. Martin Yagui Moscoso (Dr. Paul Arthur Jensen)

2 1. Perú Area: 1,285,215 km 2 Population: 27 million

3 1. Health Services Health Service Hospitals Health Centers Post Centers TOTAL Number 486 1,778 5,237 7,501

4 2. TB in Perú: Epidemiology

5 3. TB Transmission in Health Services in Perú 2000: A Study in Callao-Peru using tuberculin skin test (TST) among residents, measured incidence of TST conversion Of 98 residents that had been evaluated, 59% had a positive TST before the study Of 36 residents that were initially negative TST, 6 converted to positive TST Annual rate of TST conversion: 17%) Bonifacio N.; Saito M., Gillman R et al. High Risk for Tuberculosis in Hospital Physicians, Peru. Letter in Emerg Infect. Dis. 8:

6 3. TB Outbreak in Health Services in Peru Outbreak in Almenara Hospital in health workers with TB infection. TB incidence 1994: 167 x 100,000 TB incidence 1997: Laboratory: 6,977 x 100,000 Medicine: 932 x 100,000 Alonso Echanobe J et al. Transmision of M tuberculosis in Healthcare Workers University Hospital in Lima Peru Clin Infec Dis 2001;33:

7 3. TB Outbreak in Health Services in Peru 36 health workers with confirmed TB Multivariate analysis: Independent risk factor for TB infection in laboratory health workers was the use of common areas Alonso Echanobe J et al. Transmission of M tuberculosis in Healthcare Workers University Hospital in Lima Peru Clin Infec Dis 2001;33:

8 Susceptibility and Resistance of M. tuberculosis in Health Workers. Peru Pan-susceptible Pan-resistance MDR Poly or mono-resistance Non-culturable or contaminated TOTAL Results # %

9 4. Chronology of IC in Perú Beginning of Activities of General IC The first guideline of IC TB in Peru The first course for engineers Updated TB Guidelines Organization and improvement of NTP Beginning of the IC TB trainings IC TB plans In 10 Health Centers and hospitals Global Fund finance IC TB Plans in 18 hospitals

10 5. Peruvian Guidelines of IC 1998: First Infection Control Guidelines (in general): Surveillance of Nosocomial infections (NI) Control and prevention of NI Sterilization Hospital Solids residues

11 5. Peruvian Guidelines of TB IC 2002: Specific guidelines for TB IC Isolation Guideline (2002) Manual de prevenciòn de la transmisiòn de TB al interior de establecimientos de salud (2004) Manual de doctrina detb (2006)

12 6. Training in Infection Control Since 1997: 70 hospitals were trained in surveillance of nosocomial infections, control and prevention, isolation and sterilization : More than 2,000 health workers were training in general and specifics aspects of infection control.

13 6. Training in Infection Control 2002: Training in TB IC for health workers of Lima and Callao: Doctors and nurses of TB programs Laboratorians Hospital directors Doctors and nurses of emergency, ICU and medicine departments Engineers and architects

14 6. Training in Infection Control The content of those courses included: general concepts about TB transmission, administrative controls, engineering controls (natural and mechanical ventilation, UV Light, HEPA filters) and respiratory protection (fit testing) Time: 4 or 5 days.

15 7. Implementation of TB IC Plans TB IC Plan implementation was subsequent to the training courses. We helped participants develop a TB IC Plan in the last day of the course and then selected the best TB IC Plans for presentation & expansion.

16 7. Implementation of TB IC Plans Criteria for selection are: 3 control levels (administrative, engineering, respiratory protection) political commitment of authorities of the hospital Health services that have high rates of TB and MDR Amount of money for each TB IC Plan: Health centers: $5,000 Hospitals: $15,000 20,000

17 Example of TB IC Plans in Lima Before - After

18 9. Biosafety in Mycobacteria Laboratories 1996: National Health Institute of Peru developed the norms of biosafety for TB laboratories 2006: Norms were updated With the support of the State Laboratory of Massachusetts courses have been developed to train certifiers of biological safety cabinets

19 10. Future Activities in TB IC The Global Fund TB Project has planned Infection Control activities for 18 hospitals at national level, these include: Trainings for health workers in 18 hospitals Financing the implementation of 18 TB Infection Control Plans.

20 12. Lessons Learned: Guidelines The existence of local and national guidelines on general aspects of Infection Control facilitates the introduction of TB IC measures

21 12. Lessons Learned: Guidelines It's important to be careful in adopting recommendations of other countries with different prevalence of TB, more resources, etc.

22 12. Lessons Learned: Elaboration and Implementation of TB IC Plans In many hospitals aspects of environmental controls and respiratory protection are prioritized neglecting the implementation of administrative controls.

23 12. Lessons Learned: Training Frequent rotation of health workers forces to National TB program to have constant trainings in infection control

24 12. Lessons Learned: Training It is important to include to engineers and architects who work in health services in these trainings.

25 12. Lessons Learned: Donors National TB programs must be able to supervise construction or remodeling TB areas (inpatient, laboratories, etc.) not to increase the risk of transmission Donors not necessarily know about IC

26 Acknowledgements Peruvian National Tuberculosis Program Peruvian National Institute of Health CDC Socios en Salud (PIH) Harvard Medical School Brigham and Women s Hospital Massachusetts State Laboratory Institute

27 Martin Yagui Moscoso, MD THANK YOU!!!