Tuberculosis Control Strategies: The Cost of Particulate Respirators

Nettleman, Mary D.; Fredrickson, Mary; Good, Natalie L.; Hunter, Seth

doi:10.7326/0003-4819-121-1-199407010-00007

Cited by 65 publications

(23 citation statements)

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“…In other studies, it has been noted that prohibitive costs in low-income countries in Africa result in failure of widespread use of N95 respirators for healthcare-associated TB prevention and control. 21 , 22 At Maluti Adventist Hospital, it was also noted that in some departments, the use of N95 respirators was limited to areas of perceived high risk for healthcare-associated TB infection only. This could have also contributed to a low percentage of the respondents reporting their usage in the present study.…”

Section: Discussionmentioning

confidence: 99%

Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis

Bhebhe

Rooyen

Steinberg

2014

Afr. j. prim. health care fam. med.

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BackgroundHealthcare-associated tuberculosis (TB) has become a major occupational hazard for healthcare workers (HCWs). HCWs are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Whenever there is a possibility of exposure, implementation of infection prevention and control (IPC) practices is critical.ObjectiveFollowing a high incidence of TB among HCWs at Maluti Adventist Hospital in Lesotho, a study was carried out to assess the knowledge, attitudes and practices of HCWs regarding healthcare-associated TB infection and infection controls.MethodsThis was a cross-sectional study performed in June 2011; it involved HCWs at Maluti Adventist Hospital who were involved with patients and/or sputum. Stratified sampling of 140 HCWs was performed, of whom, 129 (92.0%) took part. A self-administered, semi-structured questionnaire was used.ResultsMost respondents (89.2%) had appropriate knowledge of transmission, diagnosis and prevention of TB; however, only 22.0% of the respondents knew the appropriate method of sputum collection. All of the respondents (100.0%) were motivated and willing to implement IPC measures. A significant proportion of participants (36.4%) reported poor infection control practices, with the majority of inappropriate practices being the administrative infection controls (> 80.0%). Only 38.8% of the participants reported to be using the appropriate N-95 respirator.ConclusionPoor infection control practices regarding occupational TB exposure were demonstrated, the worst being the first-line administrative infection controls. Critical knowledge gaps were identified; however, there was encouraging willingness by HCWs to adapt to recommended infection control measures. Healthcare workers are inevitably exposed to TB, due to frequent interaction with patients with undiagnosed and potentially contagious TB. Implementation of infection prevention and control practices is critical whenever there is a possibility of exposure.

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Section: Discussionmentioning

confidence: 99%

Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis

Bhebhe

Rooyen

Steinberg

2014

Afr. j. prim. health care fam. med.

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“…Further impetus comes from the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA), both of which recommend that National Institute for Occupational Safety and Health (NIOSH)-approved respirators be used to minimize exposures to Mycobacterium tuberculosis (CDC, 1994;Clark, 1993). To control costs in these facilities disposable respirators are sometimes reused numerous times until the fit is compromised (Nettleman et al, 1994;Rivera et al, 1997;Adal et al, 1994;Jackson, 1994;Clark, 1993). The consequences of storage conditions and respirator reuse have not been evaluated and the risk of exposure to organisms released from filter media has not been thoroughly addressed by CDC or OSHA.…”

Section: Introductionmentioning

confidence: 98%

Bacterial Survival on Respirator Filters and Surgical Masks

Brosseau

McCullough

Vesley

1997

Journal of the American Biological Safety Association

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The Centers for Disease Control and Prevention recently developed recommendations for respirators worn to minimize exposures to Mycobacterium tuberculosis. These recommendations include criteria for filters and facial fit, but do not address how respirators are worn or disposed of. Handling may increase the risk of infection if loaded organisms remain viable.Respirator filters were challenged with aerosols containing three bacteria: Mycobacterium abscessus, Staphylococcus epidermidis, and Bacillus subtilis subsp. niger. Elution and surface contact sampling were used to recover organisms from filters after loading and following 5 days storage at 85% RH.Almost all filters showed culturable organisms immediately after loading. After storage, filters showed the least culturability for M abscessus (20% of all filters) followed by S. epidermidis (61%), while B. subtilis remained highly culturable (98%). A slimilar trend was seen for the number of organisms recovered before and after storage (M abscessus demonstrated the least survival and B. subtilis the most).

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“…Lacking a means of quantitatively evaluating the relative merits of different control strategies, it is no surprise that specific CDC recommendations have sparked controversy. Much of the debate has focused on whether health-care workers need to use high-efficiency particle filters for respiratory protection (Decker, 1993;Voelker, 1993;Winters, 1994;Adal et al, 1994;Nettleman et al, 1994;Hodous and Coffey, 1994;Catanzaro, 1995;Jarvis et al, 1995). Another controversial issue is the efficacy and safety of using ultraviolet germicidal irradiation (UVGI) to inactivate airborne bacilli (Macher, 1993;Riley, 1994;Heinsohn, 1996).…”

Section: Introductionmentioning

confidence: 99%

Framework for Evaluating Measures to Control Nosocomial Tuberculosis Transmission

Nazaroff¹,

Nicas

Miller

1998

Indoor Air

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Diverse control measures can be applied to reduce tuberculosis infection risk in health‐care facilities. Selecting optimal controls requires methods for predicting the dependence of infections risk on underlying parameters. A common model for infection risk only explicitly accounts for control by ventilation. This paper proposes a more complete model for evaluating tuberculosis infection control methods in health‐care settings. An infection risk parameter is defined as the probable number of infectious droplet nuclei inhaled by all susceptible persons from a single infectious person. Algebraic model equations are presented for two exposure cases. In one, the susceptible and infectious persons are together in a well‐mixed indoor environment; in the socond, the infectious person is in respiratory isolation. Model equations are used to explore many common tuberculosis control measures: identification, isolation and treatment of tuberculosis cases; surgical masks and treatment booths applied at the source; environmental controls such as ventilation, air filtration, and ultraviolet germicidal irradiation; and respiratory protection for susceptible persons. Experimental data are limited or lacking on some key variables, such as emissions of infectious droplet nuclei by contagious persons and air leakage rates from isolation rooms. Methods are outlined for collecting additional data.

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Tuberculosis Control Strategies: The Cost of Particulate Respirators

Cited by 65 publications

References 0 publications

Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis

Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis

Bacterial Survival on Respirator Filters and Surgical Masks

Framework for Evaluating Measures to Control Nosocomial Tuberculosis Transmission

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