Hello from beautiful Cape Town. Today is the annual core group meeting of the Stop TB infection control sub-working group, led by Max Meis. I recently created a pilot survey about TB transmission at http://fast-tb.org. So far about 50 people have responded. If you haven’t completed the survey, please take a few minutes and do it. The questions and a few selected answers are below.
TB is believed to spread most efficiently in congregate settings such as hospitals, clinics, prisons and refugee camps. The well publicized transmission of extensively drug-resistant TB (XDR-TB) in rural South Africa, and the six-fold higher risk of multidrug-resistant TB (MDR-TB) reported among hospitalized, adherent, drug-susceptible patients in Tomsk, Siberia, are two compelling examples of hospital transmission of drug-resistant TB in very different parts of the world. What are the biggest barriers to scaling up TB infection control activities globally?
- Hospitals in South Africa have serious design flaws that do not allow natural ventilation. So I feel we should priorities TB infection control in every single facility. Globally I think TB infection control does not get the attention it needs – we focus on vaccines and treatment, but if we can reduce transmission we will be able to work upstream.
- Lack of education/training + poor facility infrastructure
- Money. money to train, money to enforce healthy practices.
- That TBIC is unlikely to make anybody any money. That the TBIC field is dominated by healthcare workers who don’t prioritise building design. That nobody has done RCTs showing, definitively, that it works.
What is THE single most important action that could reduce the risk of nosocomial TB transmission in hospitals in high-burden settings?
What suggestions do you have for reducing nosocomial TB transmission globally?
- Focus and attention needed more on administrative controls rather than on personal protective equipment
- Advocacy, education about risk and reduction of stigma
- Improved ventilation
- Implementation teams trained to teach and help implement going from one hospital/clinic/prison to another and back again, as per Atul Gwande’s Sharing Slow Ideas article in the New Yorker.
- It’s crucial to get attention– you need an Elton John of TB infection control
Thanks so much for visiting my website! Writing and reading blog posts does take time and we all know that time is in short supply. You and I will both get much more out of this blog if it leads to dialogue. If you found my post useful and wouldn’t mind leaving a brief comment or sharing on social media, I would be grateful. Or if you’re shy about Tweeting but are willing to email me a comment that I can post anonymously or send an anonymous Surveymonkey, that would be great. My posts are generally written quickly, so if you find any factual or grammatical errors, please do let me know. Best regards, Philip Lederer