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Tuberculosis (TB) is a dangerous disease that can be transmitted in a diversity of ways in any setting. Healthcare professionals should be aware of the measures that they should take to prevent exposure and spread of TB. Patients who have not received appropriate treatment or those who have not been isolated during their therapeutic procedures represent the biggest threat to the health of nurses and other healthcare staff. Detection of TB and implementation of effective precautionary measures should be the focus of training and education of personnel. Infectiousness of tuberculosis, goals of the TB infection control program and its levels, goals, and characteristics of a TB airborne infection isolation room, and the usage of masks and respirators are the main elements of the guide supporting the protection of both patients and healthcare personnel.
Infectiousness of tuberculosis (TB) patients is associated with the number of tubercle bacilli that the patient expels in the air when coughing. Another person is infected when droplet nuclei with M. tuberculosis that he or she inhales reach alveoli (Centers for Disease Control and Prevention [CDC], 2013). The factors that define the infectiousness of a TB patient include coughing, acid-fast bacilli, a cavity in the lungs, absence of appropriate treatment, cough-inducing procedures, and presence of positive cultures of sputum (CDC, 2013). Among TB patients, children are less likely to spread infection since they rarely produce sputum. However, it is possible to reduce the infectiousness of TB patients by designing and implementing effective therapy and medication (Pardeshi, 2015). Pulmonary TB patients should undergo a thorough examination to define an appropriate strategy to reduce their infectiousness and help them to feel relief.
A TB infection control program pursues three main goals, which include identification of contagious patients, treatment of TB patients or individuals suspected of having the disease, and airborne precautions. Healthcare settings focus their performance not only on the achievement of the aforementioned goals but also on the provision of all necessary resources for the treatment of the disease and its prevention. For example, it may be necessary to isolate patients with TB to ensure that the disease will not affect other patients. Nevertheless, effective treatment is the core of the TB infection control program since all activities are useless without appropriate therapy and medication.
The TB infection control program consists of three hierarchical levels, which include administrative, environmental, and respiratory-protection controls. Administrative controls reduce risks associated with exposure to the disease, while environmental controls aim to minimize penetration and spread of droplet nuclei (CDC, 2013). Respiratory-protection controls focus on the prevention of TB spread under specific circumstances and in special areas. Administrative controls have a complex nature and imply a continuous assessment of the setting and defining risks associated with the spread of TB infection (CDC, 2013). Also, administrative controls ensure the availability of laboratory testing and processing, which contributes to reliable results associated with TB disease. Testing should also involve control of the employee's health condition to prevent the spread of TB. Environmental controls include primary and secondary tools for controlling the source of infection and airflow (Pardeshi, 2015). Natural airflow and its control ensure the prevention of TB spread and have a positive influence on treatment. Finally, respiratory-protection controls imply using training and education of healthcare workers to prevent the spread of the disease.
The purpose of the TB airborne infection isolation room (AIIR) lies in effective control of the disease by containing airborne particles in the room and reducing their concentration. All patients with TB should be placed in AIIRs that healthcare facilities should have to ensure effective treatment of the patients. After conducting a risk assessment of the setting, there may be a need to allocate additional rooms for patients. The main characteristic feature of an AIIR lies in the negative pressure that should support the flow of air from the corridor to the room and have a direct exhaust to the outside (Pardeshi, 2015). It is important to make AIIRs for a single patient since the placement of several patients in an AIIR will contribute to the development of new diseases and deterioration of old ones.
Situations that represent a high risk associated with TB require wearing protective equipment. To minimize risks associated with exposure to TB infection, it is necessary to design and implement a program with respiratory protection measures, train personnel on respiratory protection, and enhance knowledge of patients on respiratory hygiene along with cough etiquette. Healthcare employees and TB patients must wear masks to reduce the risk of exposure during tests or examinations. Patients should be aware of the importance of following measures to protect others from TB and have a chance to recover from the disease fast. Healthcare workers normally use respirators, while TB patients wear surgical masks (CDC, 2013). The purpose of such distinction lies in the prevention of exhalation of droplet nuclei by patients and their inhalation by healthcare workers. It is impossible to use masks and respirators differently since it will have no efficiency.
A brief discussion of the basic elements of TB prevention and treatment allowed shaping the perception of the disease with a diversity of risks and threats. It is crucial to understand the nature of the disease to design an appropriate treatment strategy and organize healthcare settings according to the patient's needs. They discussed measures that are effective for reducing exposure to TB and enhancing the efficiency of the treatment process.