Tuberculosis Study Guide - M.M. Savula 2002

Prevention
Sanitary prevention

Sanitary Prevention aims to prevent the infection of healthy individuals from humans or animals with tuberculosis, and to eliminate the pathogen in the environment. It involves the sanitation of epidemic foci, sanitary and veterinary surveillance, and health education.

An epidemic focus of tuberculosis infection includes: a patient shedding Mycobacterium tuberculosis, the premises where the excretor lives, and the individuals residing with them. Bacterial excretors (patients with active tuberculosis) are defined as individuals in whose sputum or other biological material Mycobacterium tuberculosis has been detected. Preventive work in the focus is carried out according to its epidemic hazard level, which is determined by a phthisiologist and an epidemiologist. It depends on:

- the intensity of bacterial shedding;

- the sanitary conditions in which the patient lives;

- the presence of children or adolescents in the family who are highly susceptible to tuberculosis infection.

Preventive work in the foci is planned by the district phthisiologist and epidemiologist, and in rural areas by a paramedic, in accordance with their instructions. Anti-epidemic work in the focus is carried out by the district (visiting) nurse of the TB dispensary, and in villages by the medical staff of the feldsher-midwife station (FAP). Foci vary in their epidemiological hazard level.

♦ Group 1 foci are considered the most dangerous, where a patient with massive bacterial shedding (detected by simple smear Cell/15.html">Microscopy) or with scanty bacterial shedding (detectable only by culture) resides, but there are children or adolescents in the family, or aggravating circumstances exist: poor housing conditions, violations of hygiene rules, or alcohol abuse by the patient. The district visiting nurse must visit such foci monthly to carry out anti-epidemic measures.

♦ Group 2 includes foci where a patient with scanty bacterial shedding resides and all family members are adults, or the patient is classified as a formal bacterial excretor (shedding has ceased, but they are still under surveillance), but there are children and adolescents in the family, or at least one of the aforementioned aggravating factors is present. The nurse visits such foci once every 2 months.

♦ Group 3 includes foci where only adults reside, the patient is a formal bacterial excretor, and there are no aggravating circumstances. This group also includes families whose livestock has been diagnosed with tuberculosis. The visiting nurse visits these foci once every six months.

According to the epidemiological hazard group, the visiting nurse draws up a sanitation plan for the focus in accordance with the instructions of the phthisiologist and epidemiologist.

Anti-epidemic measures in a tuberculosis infection focus include:

1) disinfection (terminal and concurrent);

2) examination at a TB dispensary of individuals who have been in contact with the patient (upon detection of the patient, and subsequently once every 6 months);

3) Chemoprophylaxis for contact persons, and revaccination of uninfected children based on epidemiological indications;

4) Sanitary and hygienic education of patients and their family members;

5) improving the living conditions of the family of the tuberculosis patient.

All measures taken are recorded in the visiting nurse's chart. Sanitation begins with the hospitalization of the patient, submitting a notification of the detected case to the sanitary-epidemiological station, and performing terminal disinfection in the home by the disinfection service. If the patient categorically refuses hospitalization (which occurs more frequently in chronic forms of tuberculosis), children and adolescents must be placed in a specialized health resort institution (sanatorium, boarding school), and concurrent disinfection must be carried out regularly in the focus. The visiting nurse is obliged to explain the rules of hygienic behavior to the patient and their family. If possible, the patient should be allocated a separate room. It is essential that they have their own dishes, towel, and bed linen for personal use.

Sputum is a highly hazardous infectious material, so it must be collected in an individual spittoon with a lid and thoroughly disinfected. To disinfect sputum, the open spittoon is placed in a closed enameled container and boiled in a 2 % soda solution for 15 min or soaked in a 5 % chloramine solution for 5-6 hours. In rural areas, sputum can be poured onto paper and burned in a stove. The patient's dishes are disinfected by boiling for 15 min in a 2 % soda solution or by immersing them vertically for 5-6 hours in a 5 % chloramine solution. If possible, it is advisable to use disposable tableware followed by its incineration. Food scraps are disinfected in a closed container by boiling for 30 min from the moment of boiling. Afterward, they can be used for animal feed. Linen is boiled for 15 minutes in a 2 % soda solution.

The patient's room should only be wet-cleaned using a soap-soda solution. Sputum stains are removed with a cloth soaked in a 5 % chloramine solution. Vacuum cleaning is also used. The room where the patient is located should not be cluttered with carpets or unnecessary items. Upholstered furniture should be covered with cotton slipcovers that are easy to wash. The premises are systematically ventilated; bedding and mattresses are shaken out while wearing a gauze mask. It is beneficial to hang the patient's bedding and clothes in the sun, as MTB are rapidly killed by solar radiation. Ultraviolet irradiation (quartz lamp Treatment) is an effective disinfection method. A quartz lamp is used to irradiate rooms and valuable items that could be damaged by disinfectant solutions.

In common areas, floors, panels, washbasins, and toilets are wiped with a 0.25 % activated chlorinated lime solution or a 0.5 % activated chloramine solution. Cleaning items (cloths) are disinfected by boiling for 15 minutes.

Preparation of disinfectant solutions

Preparation of chlorinated lime solution. Place 1 kg of dry chlorinated lime in an enameled bucket, crush it with a wooden spatula, and add Water up to 10 l. Cover with a lid and let it stand for 24 hours in a cool, dark place. After that, the clarified 10 % solution is poured into a dark bottle with a lid and used to prepare working solutions (for up to 10 days).

To prepare a 0.25 % activated chlorinated lime solution, take 250 ml of the 10 % solution, add water up to 10 l, and add 6 g of ammonium salt.

To prepare a 5 % chloramine solution, add 500 g of chloramine B or HB to 10 l of water and stir until completely dissolved.

To prepare a 0.5 % activated chloramine solution, dissolve 50 g of chloramine in 10 l of water (stir until completely dissolved) and add 13 g of ammonium salt.

Activated solutions are prepared immediately prior to use.

The tuberculosis dispensary nurse is responsible for ensuring the availability of disinfectants in the focus of TB infection and instructs the patient and their family members on how to prepare these solutions.

Immediately upon identifying a tuberculosis patient, all individuals who have been in contact with them are screened at the TB dispensary. Contact adults and adolescents undergo chest photofluorography, while children receive a chest X-ray. Additionally, children and adolescents undergo unscheduled Mantoux testing with 2 TU. All contact persons are registered under Group IV of dispensary surveillance, prescribed isoniazid chemoprophylaxis, and re-examined at the TB dispensary once every 6 months. The TB dispensary sends confidential notifications regarding each newly diagnosed patient to the local outpatient clinic.

If a case is detected in a childcare facility, all children and staff undergo X-ray screening, and children additionally receive a Mantoux test with 2 TU. The premises where the patient was present must be disinfected.

Healthcare professionals of all levels (including paramedics and nurses) participate in health education. This is conducted through educational talks, local radio broadcasts, and the distribution of health education literature. The focus of this work differs between the general healthy population and active tuberculosis foci.

For the general healthy population, it is essential to promote a healthy lifestyle and explain the harms of alcohol and smoking, as well as Structure/19.html">The Importance of BCG Vaccination for TB prevention, and chest photofluorography and tuberculin Skin testing as Methods for early detection. It should also be emphasized that individuals must seek medical attention at the onset of even minimal symptoms, as early Diagnosis is key to achieving a complete cure within a relatively short period.

In a tuberculosis focus, the visiting nurse or paramedic educates the patient and their family members on TB transmission routes and prevention, explains the necessity of hygiene practices, and teaches them how to perform routine disinfection. They emphasize that children are particularly vulnerable to tuberculosis; therefore, they should not share a room with the patient and, where appropriate, should be placed in children's sanatoriums or boarding schools. They also explain the importance of screening all family members (including children) at the TB dispensary and the necessity of completing the preventive treatment prescribed by the TB specialist.