Administrative measures for AIC at a Health Facility

The administrative measures at a health care facility play an important role in preventing the spread of TB in health care settings. It includes Administrative controls for outpatient and inpatient settings

Administrative measures at Outpatient(OPD) settings
1. Screen for respiratory symptoms as early as possible upon patient’s arrival at the health care facility thereby reducing the overall stay of such patients in the healthcare facility

• screening at registration counter itself by asking simple questions related to chronic respiratory symptoms, and those suspected to have TB can be prioritized for further management
• screening when patients are in waiting area- by volunteers/health staff

2. Provide patient education and counseling on cough hygiene and sputum disposal

• paramedical staff or volunteers should educate and reinforce cough etiquette while the patient is in the waiting area
• educate patients on availability of bins with disinfectants for disposal of sputum
• display of posters on cough hygiene and sputum disposal in the waiting areas

3. Segregate patients with respiratory symptoms

• having separate waiting area for chest symptomatics within the overall outpatient area
• implement a patient flow control mechanism so that screened chest symptomatics are diverted to special area rather than the common waiting area
• well ventilated waiting areas to reduce overall risk of airborne transmission

4. Fast-track patients with respiratory symptoms

• fast-track patients for clinical and laboratory evaluation
• fast track chest radiography and sputum examination with priority slips/referrals

Administrative measures at Inpatient (IPD) setting
1. Minimize hospitalization of TB patients

• whenever possible, manage patients entirely as outpatients thereby avoiding hospitalization and the risk of exposing other patients and staff

2. Establish separate rooms, wards, or areas within wards for TB patients

• patients with TB should be physically separated in different rooms/wards from other patients so that others are not exposed to the infectious droplet nuclei
• separation of TB patients from vulnerable and immune-compromised patients is essential

3. Educate and counsel inpatients on cough hygiene and provide adequate sputum disposal

• educate and display posters on cough hygiene and safe disposal of sputum in bins with disinfectants
• provide masks to all admitted patients and educate on proper use of masks

4. Establish safe radiology procedures for TB patients

• schedule inpatient chest radiography for non-busy times
• provide priority service to minimize the length of time spent in the department

Resources

1. Guidelines on Airborne Infection Control in Healthcare and Other Settings.
2. Tuberculosis Infection Control.