TB-Infection Control. International Consultants Training Course February 2008 Gaborone, Botswana

Transcription

1 TB-Infection Control International Consultants Training Course February 2008 Gaborone, Botswana Report by Dr Masoud Dara KNCV Tuberculosis Foundation

2 TABLE OF CONTENTS ACKNOWLEDGEMENTS...2 OUTLINE OF THE TRAINING COURSE...3 METHODOLOGY...4 PROCESS...4 NEXT STEPS...4 COURSE AGENDA...5 SUMMARY OF END-COURSE EVALUATION BY PARTICIPANTS...6 ANNEX I: LIST OF PARTICIPANTS, FACILITATORS AND SECRETARIES... 9 ANNEX II: INFECTION CONTROL ASSESSMENT EXERCISES GOAL ANNEX III: APPLICATION FORM TO PARTICIPATE IN THE COURSE ANNEX IV: TABLE FOR FIELD VISIT

3 Acknowledgements KNCV Tuberculosis Foundation would like to thank the Ministry of Health of Botswana, USAID, Centers for Disease Control and Prevention Botswana, TBCAP partners and participants who contributed to this training course. 2

4 Outline of the Training course Introduction: Transmission of tuberculosis (TB) in health care and congregate settings is a major challenge to TB control and public health. However, many countries lack the institutional capacity to adequately address TB infection control. Recently, the importance of appropriate TB infection control has become increasingly acknowledged due to reports of an extensively drug resistant TB (XDR- TB) outbreak in South Africa which predominantly affected people living with HIV/AIDS. This outbreak had a very high case-fatality rate, included both patients and health care workers and was likely preventable had there been appropriate infection control measures in place. Nonetheless, at present, only a handful of qualified international and national experts are available to provide technical assistance in TB infection control training, planning, implementation and monitoring. Multiple international TB control partners in a coalition with TBCAP including the US Centers for Disease Control and Prevention/American Thoracic Society, the KNCV Tuberculosis Foundation, the World Health Organization, the International Union against TB and Lung Disease, Management Sciences for Health, Family Health International, Japan Anti-TB Association (JATA) among others have acknowledged the importance of capacity development in TB infection control in developing countries. To this end, KNCV Tuberculosis Foundation, of behalf of TBCAP organized a training course in Gaborone, Botswana, February 2008 to increase the number of qualified consultants available to conduct TB infection control assessments and to develop infection control plans, particularly for countries with a high burden of TB, high rates of HIV or high rates of MDR-TB. Criteria for selection and enrollment into this course: Working experience as a consultant or willingness to work as a consultant in health related issues with particular emphasis on TB, HIV and/or airborne infections Availability to participate in a one-week mission as an on-thejob/complementary training with an international TB infection control consultant (within one year after the training course) Be available to conduct two field missions per year and provide requisite offsite follow-up The course focused on teaching following skills: o How to conduct a health facility TB infection control risk assessment o How to develop an infection control plan o How to implement the hierarchy of infection control measures o How to conduct missions as an international consultant (preparation, cultural aspects and safety issues) Course Coordinator: Dr Masoud Dara (KNCV Tuberculosis Foundation) Facilitators: Paul Jensen (CDC/USA), Masoud Dara (KNCV), Rose Pray (WHO-HQ), Nancy Jensen (CDC/USA on leave), Cristi Popa (Institute Pneumolog Romania/Free Lancer), Scano Fabio (WHO-HQ) Secretaries/logistics: Orlanda Graca (KNCV), Susan Makani (Free lancer) 3

5 o o o o o Methodology Presentations by facilitators in the plenary Introductory presentation of each level of Infection control hierarchy Questions and Answers during and after each presentations, sharing country experiences on TB Infection control Field visit to Inpatients and outpatients and facility risk assessment in small groups Reporting observations and recommendation back in the plenary Process The organizing committee (facilitators) prepared an application form and first announcement in December 2007 and sent it around through their network of national and international partners. In total 37 applications were received, based on selection criteria, 33 participants were selected of whom three were self funded and the rest were funded through TBCAP mechanism and its partners. Two participants could not attend due to administrative problems (loss of passport, lack of available paper ticket). 31 participants attended the course. Anonymous pre-test and post-test examinations were carried out so that each participant may assess himself/herself individually. An end-course evaluation by participants was conducted, summary of which you may find in this report. After the course, a rooster Excel sheet was prepared and sent to participants. Most participants indicated their availabilities for mentorship process in order to gain more experience on TB-IC. Next Steps The faculty met after the training course and agreed to do their best to make sure there is a follow-up for the training course. Most participants do not feel competent to conduct TB-IC missions on their own. There will be different types of TB-IC linked missions which vary from technical assessment on programmatic aspects of TB-IC, MDR-TB missions with link to TB-IC and full TB-IC assessment missions with detailed environmental/engineering aspects. The follow-up will be done by different TBCAP partners. The follow-up mechanism will be linked to other TBCAP initiatives, including developing the overall HRD strategy of TB-IC and coordination of mentorship process. 4

6 Course Agenda Time Day 1 18 Feb Unit 1: Welcome by authorities and course organizers /Opening Session (and pre-test) Unit 2: Introduction to TB Day 2 19 Feb 08 Unit 9: Environmental (engineering) controls Day 3 20 Feb 08 Day 4 21 Feb 08 Day 5 22 Feb 08 Unit 12: Field visit 1 Unit 15: Field visit 2 Unit 18: Development and review of TB Infection Control plans Coffee/Tea Coffee/Tea Coffee/Tea Coffee/Tea Coffee/Tea Unit 3: Infection control for TB control Unit 9: continue Unit 12: continue Unit 15: continue Unit 19: Conducting TB Infection Control assessments Unit 4: Administrative controls Lunch Lunch Lunch Lunch Lunch Unit 4: Administrative controls (continued) Unit 9: continue Unit 12: continue Unit 16: Field visit 3 Unit 20: Critical elements to ensure optimal impact as a consultant Unit 5: Infection control plan Unit 6: Introduction to bloodborne pathogens Coffee/Tea Coffee/Tea Coffee/Tea Coffee/Tea Coffee/Tea Unit 7: Respiratory Unit 21: Post-test protection Unit 8: Respirator Fit Testing Unit 10: Virtual tour of selected healthcare settings Unit 11: Logistics and objectives for Field Visit 1 Unit 13: Debrief of Field Visit 1 ` Unit 14: Logistics and objectives for Field Visits 2 & 3 Unit 17: Debrief of Field Visits 2 & 3 ` Unit 22: Course Evaluation and certificates Unit 23: Charge to participants and closure 5

7 Summary of end-course evaluation by participants We received course evaluations from the vast majority of participants (29/31). Twenty-seven participants (93%) indicated that the course met their expectations. However, some feedback for improvement was included (selected two or more participants mentioned this) as follows: The course evaluation must be anonymous as names were asked and this potentially biases the candidness of participants The course should be better guided by evidence and references to such evidence, such as in a course reader for each section. More on what is not know would also be useful. Pre-distribution of the literature CD-rom would be preferable than handing it out at the end of the course. The costing and budgeting for TB-IC to support funding efforts, such as via the Global Fund, should be explicitly instructed The course should have smaller group break out sessions and the first two days did not allow enough interaction. The course, per many participants, should be more focused. The environmental control lectures were not focused enough and more time could be dedicated to this subject area. The clinic visits could have been shortened Provide more details of the writing of an infection control plan and perhaps have a mock infection control plan writing with budgeting The blood-borne pathogens should be shortened or completely deleted from the course. The course days were too long and this was not conducive for learning. The lunch hour could be extended to 2 hours instead of one, for instance. Or the course could end on Friday after lunch. Friday was very packed. Could consider ending the course at 4:30PM per day and possibly extended by another day if the content needs to be made up. Could consider having the field visits for only ½ day. Consider having additional 5 minute breaks. Generally, sessions should not last longer than 1 hour. On overall outline of the course should be given on the 1st day. Overall take home messages: o Could engage the trained consultant so that they do not forget via international missions. Did not focus enough on these possibilities on the last day. o Special website for the TB IC consultant would be beneficial o Need to have objectives for each session and not stray off course from the stated objectives o o Make more use of expertise in the room e.g., with small group sessions Change order of lectures to start more with the big picture, assessment then technical details Other: name tags might be useful, folders for materials, toolkit to take home, evaluations could be done per day instead of at the end, coffee and tea should be provided all day long and perhaps u-shaped seating arrangements are better. 6

8 Participant survey at the End of Training Course TB-IC training course for International consultants Gaborone February 2008 Name: Country: Organization/Institution (if applicable): Now that you have finished the training course, please answer the following questions. 1. Did the training course fulfill your expectations? yes / no (please explain briefly your answer) 27/29 (yes) 2. Was the training course interactive enough? Yes/no. Was enough time given for each session? yes / no (please explain briefly your answers) 28/29 Yes Interactive enough 8/29 said that the sessions were given enough time whereas 11/29 said that there was not enough time given to sessions 3. How do you evaluate the role of facilitators? Please explain Please see summary in the previous page 4. Would you modify the structure/modules of the training course? Yes/no if yes: 18/29 said yes they would modify something, please see the summary in the previous page 4a) What would you add? 4b)What would you delete? 4c) How about the order of the sessions? 14/29 said the order was alright 7

9 5. How did you find the field visits? (In terms of relevancy, usefulness and time-management etc.) 5a) Hospital: please see the summary in the previous page 5b) Clinics: please see the summary in the previous page 6. Would you recommend this sort of international TB-IC training course to other coworkers/colleagues (TB consultants, national partners, engineers/architects/infection control specialists etc.) yes / no, If yes, to whom would you recommend it? If you have name and contacts, please add them below. 27/29 said that they would recommend the course to others and many left recommended names of contacts. Few provided names which will be used to contact 7. Did you have the opportunity to do the fit testing? Yes/no, if no, why? 20/29 had fit testing other mentioned they did not have enough time 8. What else would you need in order to develop further your knowledge and/or skills/competencies in TB infection control assessment/consultancy? Most mentioned they need to be involved in the mentorship process to develop further their skills 9. Please add further comments/take-home message or suggestions you may have. please see the summary in the previous pages 8

10 Annex I: List of participants, facilitators and secretaries Participants FIRST NAME FAMILY NAME COUNTRY Marième Ba Sourang Italy Marijke Bleumink Belgium Mayindo Kagubare USA Grace Egos Philippines Judith Glynn UK Guangxue He China Luc Janssens Belgium Kitty Lambregts-van Weezenbeek The Netherlands Rajeswari Ramachandran India Maria Angélica Salomão Zimbabwe Jerod Scholten The Netherlands Takashi Yoshiyama Japan Seraphine Kabanje Zambia Mustapha Gidado Nigeria Samar Abdel Sattar Egypt Isabel Ochoa Peru Margarita Villafañe Britos Paraguay Nguyet Thu Huyen Mai Vietnam Robin Vincent-Smith South Africa Nii Nortey Hanson-Nortey Ghana Tore Steen Botswana Jeffrey Hafkin Botswana Ezra Tessera Ethiopia Norbert Ndjeka South Africa Godwin Munuo Tanzania Charles Daley USA Samson Haumba Swaziland Oaitse Ipeleng Motsamai Botswana Koobiditse Radisowa Botswana Boingotlo M. Gasennelwe Botswana Robert Makombe Botswana Facilitators First name Last name Institute-Location Paul Jensen CDC/USA Masoud Dara KNCV/Netherlands Rose Pray WHO/Geneva Nancy Jensen CDC/USA Cristi Popa Institute Pneumolog/Romania Fabio Scano WHO/Geneva Secretaries/Logistics First name Last name Institute/Location Orlanda Graca KNCV/Netherlands Susan Makani Botswana 9

11 Annex II: Infection Control Assessment Exercises Infection Control Assessment Exercises 21 February 2008 Goal To conduct snippets of a TB IC assessment of selected settings at Julia Molefhe and Old Naledi Clinics. Procedure All groups will cycle through all four exercise locations. Not all the exercises below will be completed by every group; however, the exercises listed below will be used by you and your facilitators as a general guide. Schedule Please strictly adhere to the time schedule below: Time Background and Patient Flow 08:00-08:30 Group #1&2 DOT Room (Admin & Environ Controls) Julia Molefhe Clinic Future ARV Site (Admin Controls) Peds and Waiting Room (Admin and Environ Controls) Nancy & Cristi Cristi Nancy Nancy/Cristi 08:30-09:30 Group #1 Group #2 09:30-10:30 Group #2 Group #1 10:30-11:30 Group #2 Group #1 11:30-12:30 Transfer to Old Naledi Clinic and Lunch 12:30-13:00 Group #3&4 13:00-14:00 Group #3 Group #4 14:00-15:00 Group #4 Group #3 15:00-16:00 Group #4 Group #3 16:00 Transfer to Gaborone Sun Hotel 10

12 Time Background and Patient Flow Masoud & Isabel 08:00-08:30 Group #3&4 DOT Room (Admin & Environ Controls) Old Naledi Clinic Exam Rooms w/ Small Waiting Area (center) (Admin Controls) Larger Waiting Area (Admin and Environ Controls) Isabel Masoud Masoud/Isabel 08:30-09:30 Group #3 Group #4 09:30-10:30 Group #4 Group #3 10:30-11:30 Group #4 Group #3 11:30-12:30 Transfer to Julia Molefhe Clinic and Lunch 12:30-13:00 Group #1&2 13:00-14:00 Group #1 Group #2 14:00-15:00 Group #2 Group #1 15:00-16:00 Group #2 Group #1 16:00 Transfer to Gaborone Sun Hotel 11

13 Infection Control Assessment Exercises 21 February 2008 Background and Patient Flow Date: 21 February 2008 Time: Location: Julia Molefhe Clinic Room number: Purpose of room: General background information: Number of patients Number of suspect TB patients Number of known TB patients Number increasing, steady, decreasing? Time from registration to: Seeing Nurse Seeing Doctor Sputum collection Sputum results Preliminary diagnosis Admission to TB ward or referral Where do they wait? Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Observe path of patient: Create flowchart of the path of patients in the admission ward (registration, vital signs, waiting, exam, procedures, radiology, sputum collection, other procedures, etc.) Flowchart path of patient: 12

14 Infection Control Assessment Exercises 21 February 2008 Assessment of the DOT Area Date: 21 February 2008 Time: Location: Julia Molefhe Clinic Room number: Purpose of room: General background information: Number of patients Number of suspect TB patients Number of known TB patients Number increasing, steady, decreasing? Time from registration to: Seeing Nurse Seeing Doctor Sputum collection Sputum results Preliminary diagnosis Admission to TB ward or referral Where do they wait? Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Draw the room: 13

15 Room dimensions: Width Depth Ceiling (List all dimensions on drawing) Mark ventilation pipes/grilles on drawing. Label as supply air or exhaust air. Air Exchange Rate Calculations: Dimensions of Window openings: Width (W) m Width (W) m Width (W) m Velocity measurements: Window 1 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Velocity measurements: Window 2 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Pressure differential (smoke test): Room to hallway: Positive Negative Airflow patterns (smoke test): Sketch on the plan 14

16 Infection Control Assessment Exercises 21 February 2008 Design of Proposed ARV Site Date: 21 February 2008 Time: Location: Julia Molefhe Clinic Room number: Purpose of room: General background information (we will make some assumptions): Number of patients Number increasing Perceived risk TB incidence among staff Contact with patients IC policies and procedures in place Other... List functional procedures and space requirements for the potential ARV site Sketch the available rooms Sketch proposed flow of patients and staff Include proposed UV lights, ventilation grilles, air cleaners, beds, doors, elevators, misc rooms, waiting rooms... Estimate room dimensions Draw proposal of new ARV site 15

17 Infection Control Assessment Exercises 21 February 2008 Pediatrics and Waiting Areas Date: 21 February 2008 Time: Location: Julia Molefhe Clinic Room number: Purpose of room: General background information: Number of patients (planned) Composition of patients Number increasing, steady, decreasing Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Observe path of patient through area: Create flowchart of the path of patients in the ward (procedures, medications, radiology, sputum collection, other procedures, etc.) Room dimensions: Width Depth Ceiling (List all dimensions on drawing) Mark ventilation pipes/grilles on drawing. Label as supply air or exhaust air. Air Exchange Rate Calculations: Dimensions of Window openings: Width (W) m Width (W) m Width (W) m Velocity measurements: Window 1 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity 16

18 m 2 m/s s/h m 3 /h Velocity measurements: Window 2 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Pressure differential (smoke test): Room to hallway: Positive Negative Airflow patterns (smoke test): Sketch on plan Alternative procedures and location for waiting area? 17

19 Infection Control Assessment Exercises 21 February 2008 Background and Patient Flow Date: 21 February 2008 Time: Location: Julia Molefhe Clinic Room number: Purpose of room: General background information: Number of patients Number of suspect TB patients Number of known TB patients Number increasing, steady, decreasing? Time from registration to: Seeing Nurse Seeing Doctor Sputum collection Sputum results Preliminary diagnosis Admission to TB ward or referral Where do they wait? Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Observe path of patient: Create flowchart of the path of patients in the admission ward (registration, vital signs, waiting, exam, procedures, radiology, sputum collection, other procedures, etc.) Flowchart path of patient: 18

20 21 February 2008 Assessment of the DOT Area Date: 21 February 2008 Time: Location: Old Naledi Clinic Room number: Purpose of room: General background information: Number of patients (planned) Composition of patients (drug susceptible or drug resistant) Number increasing, steady, decreasing Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Draw the room: Room dimensions: Width Depth Ceiling (List all dimensions on drawing) Mark ventilation pipes/grilles on drawing. Label as supply air or exhaust air. Air Exchange Rate Calculations: Dimensions of Window openings: Width (W) m Width (W) m Width (W) m Velocity measurements: Window 1 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: 19

21 Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Velocity measurements: Window 2 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Pressure differential (smoke test): Room to hallway: Positive Negative Airflow patterns (smoke test): Sketch on the plan 20

22 Infection Control Assessment Exercises 21 February 2008 Assessment of the Exam Rooms in small waiting area Date: 21 February 2008 Time: Location: Old Naledi Clinic Room number: Purpose of room: General background information: Number of patients (planned) Composition of patients (drug susceptible or drug resistant) Number increasing, steady, decreasing Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Draw the room: 21

23 Room dimensions: Width Depth Ceiling (List all dimensions on drawing) Mark ventilation pipes/grilles on drawing. Label as supply air or exhaust air. Air Exchange Rate Calculations: Dimensions of Window openings: Width (W) m Width (W) m Width (W) m Velocity measurements: Window 1 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Velocity measurements: Window 2 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Pressure differential (smoke test): Room to hallway: Positive Negative Airflow patterns (smoke test): Sketch on the plan 22

24 Infection Control Assessment Exercises 21 February 2008 Assessment of the Larger Waiting Area Date: 21 February 2008 Time: Location: Old Naledi Clinic Room number: Purpose of room: General background information: Number of patients (planned) Composition of patients (drug susceptible or drug resistant) Number increasing, steady, decreasing Perceived risk TB incidence among staff Contact with patients IC procedures and policies in place Other... Sketch room. Include main room, anteroom, hallway, UV lights, room air cleaners, other controls windows, doors, bed, and major furniture. Room dimensions: Width Depth Ceiling (List all dimensions on drawing) Mark ventilation pipes/grilles on drawing. Label as supply air or exhaust air. Air Exchange Rate Calculations: Dimensions of Window openings: Width (W) m Width (W) m Width (W) m Velocity measurements: Window 1 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity 23

25 m 2 m/s s/h m 3 /h Velocity measurements: Window 2 Velocity #1 m/s Velocity #2 m/s Velocity #3 m/s Velocity #4 m/s Velocity #5 m/s Velocity #6 m/s Velocity #7 m/s Velocity #8 m/s Velocity #9 m/s Velocity #10 m/s Average Velocity: m/s Average Airflow Rate: Airflow Rate = Area Average Velocity m 2 m/s s/h m 3 /h Pressure differential (smoke test): Room to hallway: Positive Negative Airflow patterns (smoke test): Sketch on the plan Other administrative or environmental controls? 24

26 Annex III: Application form to participate in the course Application Form Please fax or this form along the professional profile form No later than 15 January 2007 Our direct fax number: (attn. Ms Orlanda Graca, Name Participant: Address: Tel.: Fax: For visa purposes: Nationality: Passport number: Date of birth: The organizing committee will review the applications and select the most suitable candidates by 31 January Once participants are selected, KNCV Tuberculosis Foundation will send a confirmation note and assist with travel arrangements. Based on the flight schedule, room reservation will be confirmed. Please indicate the exact title and full name as you would like to appear on your certificate of attendance: Please indicate if you have any special diet: Yes/No If yes please define: Signature Date: 25

27 In order to select the most eligible candidates for this course, may we kindly ask you to fill in the below Short professional profile form: Name (First name and Family name) Sex Current position (indicate your affiliation and responsibility, e.g. NTP officer, HIV/AIDS program officer, Nursing section, occupational health, etc.) Professional background (Medical doctor, nurse, engineer, health officer, etc. ) What are your current tasks and responsibilities in the field of infection control? Have you ever before participated in training on non-tb related infection control? Have you ever received training on TB Infection Control? If so, when and by whom? Yes/No Yes/No, Have you been conducting consultancy missions in the past, if yes since when, in which fields and to which countries/regions Name and contact details of your supervisor/coordinator What are your expectations of the course? Will you be able to commit to 2-4 TB-IC related missions per year? If so to which countries/region(s) 26

28 Annex IV: Table for field visits Prioritization Table for TB IC Assessment & Intervention (1/2) IC Hierarchy Priority Description How to implement? Administrative Controls When to implement? Budget (shortand long-term) What obstacles might you face? 27

29 Prioritization Table for TB IC Assessment & Intervention (2/2) IC Hierarchy Priority Description How to implement? Environmental Controls When to implement? Budget (shortand long-term) What obstacles might you face? Respiratory Protection 28