8.6. Social and sanitary tuberculosis prevention


The basic principles of realization of tuberculosis control are based on state character of struggle with tuberculosis as with social disease. All treatment and preventive establishments of public health services participate along with specialized anti-tuberculosis system in organization of struggle with tuberculosis.

The purpose of tuberculosis control:

  1. To warn MBT infection of the healthy people;
  2. To limit and to safe contact with the active tuberculosis patient (is (especially MBT sputum positive) of the healthy people living together or at work.

Major component of sanitary prevention is the realization of social, epidemiological and medical measures in the place of tubercular infection, i.e. in family and in the residence (infection focal point) of tuberculosis patient. The realization of preventive measures in the infection focal point begins with visiting by the divisional phthisiatrist, epidemiologist and medical nurse of the local dispensary immediately from the moment of revealing of the MBT sputum positive patient or detection in lung of the destructive tuberculosis. Depending on the examination results in the infection focal point the plan of its improvement (sanitation) is made.

The plan should reflect:

  1. disinfection of the focal point;
  2. treatment of the patient;
  3. isolation of children;
  4. to register inhabitances in dispensary;
  5. frequency and extent of regular examinations of all members of a family, realization of chemotherapy prevention, supply by disinfectants.

The criteria of epidemic danger the infection focal point are:

  1. massiveness and constancy of MBT expectoration by the patient;
  2. patient’s conditions of life;
  3. behavior, general standards of cultural habits and sanitary awareness of the patient and persons surrounding him.

On the basis of these criteria the infection focal points on a degree of epidemic danger divide into three groups. According to this grouping volume and contents of preventive measures are defined in the infection focal point.

The 1-st group of infection focal point – most adverse:

  1. the patient with chronic destructive tuberculosis constantly allocates MBT, lives at bad housing conditions;
  2. in family of the patient there are children, teenagers, pregnant;
  3. the patient and the persons around him do not observe hygienic rules of behavior.

The 2-nd group of the infection focal point – comparatively unsuccessful:

  1. the patient has poor bacterial excretion, stable tubercular process, lives at satisfactory housing conditions;
  2. among the families of the patient , only adult are absent as adverse factors;
  3. the patient and the persons around him do not observe hygienic rules of behavior.

The 3-rd group of the infection focal point – potentially dangerous:

  1. the patient is conditional MBT expectorator;
  2. in family of the patient there are only adults;
  3. the patient and the persons, around him, carry out all necessary sanitary – hygienic measures of tuberculosis prevention.

Realization of preventive measures in the infection focal point.

The important section of the plan is training the patient and members of his family to sanitary – hygienic skills. In a room of the patient it is daily necessary to carry out cleaning, current disinfection daily. At departure of the patient from a house for treatment in a hospital, in a sanatorium or in case of his death, sanitary – epidemiological service should carry out final disinfection. It is very important to train the patient to correct manipulations with sputum, plates and dishes, subjects of personal usage that practically makes him safe for persons around him.
The MBT expectorator should have spittoon for sputum collection, which contents necessary to be boiled daily with the purpose of destruction of MBT, it is possible to take advantage chloride of lime.
The linen of the patient and especially handkerchiefs, towels, it is necessary to collect in a separate bag, before washing and dip for night in 5 % of chloramin solution and to boil in 2 % a solution of soda during 30 mines.

Plates and dishes of the patient are washed and are wiped by a separate towel.
The top clothes of the tuberculosis patient as soon as possible air on the sun, weekly ironing and disinfect not less often than 2 times per year in steam or in steam-formalin chambers. The cleaning of clothes should occur outside of an inhabited room.
The floor cleaning must be conducted by a damp way with 2 % soda solution.

All these measures are stacked in concept of the current disinfection, which is carried out by the patient or adult members of his family under a management and control of the medical sister tuberculosis dispensary.

Measures on tuberculosis prevention among persons, being in contact to the tuberculosis patients and working in tubercular establishments.

In anti-tuberculosis establishments the personnel communicates with the tuberculosis patients, including with bacterial excretors This contact takes place on out-patient reception of the patients, at service them in clinics and in the apartments, where the transmission of the infection is possible through dust, contact, drops and alimentary ways. Incidence of tuberculosis among medical staff of anti-tuberculosis establishments at 8-10 of time is higher, than in all population. In every anti-tuberculosis establishment there are rules which purpose to minimize the danger of infection by tuberculosis and creation of the most favorable working conditions for the personnel. These rules should be strictly observed.

Individual means of breath organs protection.

The general regulations.
Individual means of breath organs protection (respirators, gauze bandages) serve for medical workers as «last boundary of a defense» against concomitant MBT distribution.

Respirator’s use is limited of sites of high risk, namely:

  1. in boxing rooms for the tuberculosis patients or ТБ-MDR-TB;
  2. at stimulation of sputum expectoration or other procedures causing cough;
  3. at bronсhoscopy;
  4. at section halls;
  5. at spirometry;
  6. during emergency surgery on the potentially infectious tuberculosis patients.

Surgical masks.
Between a surgery mask and respirator there are important distinctions. Surgical masks (made of cloth or of paper):

  1. really provide prevention of distribution of microorganisms from their source (for example, tuberculosis patient) to other persons by deduction of large particles separated near a nose and a mouth;
  2. do not provide protection of the user (for example, medical worker, patient, member of family) from inhalation suspended in air droplets containing the infectious agent.

Means and methods of disinfection.
Means of disinfection. Now there is a wide spectrum of disinfectants. However at application it is necessary to check their activity to disinfect contaminated MBT material. From preparations for this purpose in Russian Federation are most widely used chloride of lime and chloramin.

  1. Chloride of lime – white powder containing 28,0-35,0 % of active chlorine.
  2. Chloramin B and XB – powder of cream color, contents of active chlorine 27,0-28,0 %.

For preparation of 5 % chloramin disinfectant solutions 500 g. of chloramin powder dissolve in 10 liters of water.

Disinfection of decontamination objects.

Spittoons. Plates and dishes with the rests of food. The rests of food. Wash stand, urinals, lavatory pans, cranes of a bowl. Subjects of patient’s care: bedpans, urinals, tips for clysters.

Methods of disinfection.

  1. Boiling in soda solution.
  2. Immersing in a pan with a cover containing chloramin solution.
  3. Autoclaving.
  4. To cover with chloride of lime.

Service rooms (wall, floor, doors, furniture) in wards, in procedure units, in places of common usage.

Methods of disinfection.

  1. Wiping with tatters moistened in the activated solutions of chloramin.
  2. Washing with hot sop-soda solution.
  3. Immersing in a vessel with a cover containing solution of chloramin.
  4. To cover with chloride of lime.

Linen (bed, from dining rooms, underwear, furniture cases, gauze masks, respirators, handkerchiefs, personal linen and bed cloths).

Methods of disinfection.

  1. Boiling in soda solution.
  2. Ironing by a hot iron.
  3. Disinfection in gas-chamber.

Soft furniture. Fine subjects of use, toy (metal, rubber, wooden, plastic). Books, notes, paper and etc.

Methods of disinfection.

  1. Immerse in disinfection solutions and disinfect according to regimes.
  2. The subjects of little value burn, and valuable subjects disinfect in gas chamber.
  3. Clean by a brush moistened in one of disinfectant solutions.

In anti-tuberculosis hospitals at reception of the patients, and then regularly sanitary – educational work with the patients should be carried out. With the purposes of protection of the personnel from infection the special attention should be directed on rules of behavior, obligatory for the patients. At discharged a patient must receive explanations about the rules of his behavior at his place of living and in public places warning infection by tuberculosis of the surrounded persons.

Sanitary education is one of parts of preventive work a dispensary. In the plan epidemiological measures directed on struggle with tuberculosis, anti-tuberculosis propagation should be in one of the central places. The sanitary – educational work is necessary for carrying out first of all among the tuberculosis patients. It is very important, that the personnel of various children’s establishment, where there is a constant gatherings of children and teenagers and where there can be an unrecognized tubercular patient allocating MBT, was regularly surveyed on presence of tuberculosis. The propagation of knowledge about an origin of tubercular disease, its sources, and distribution is the important part of struggle with this illness. The knowledge of methods of personal and public preventive maintenance of tuberculosis has the large practical importance for the population.

Anti-tuberculosis activity of general medical establishment network.

Prevention of tuberculosis and tuberculosis patient revealing in population is function of treatment-preventive establishments of a general medical network. This work is carried out under organizational and methodical management of the tuberculosis dispensary and organs of sanitarian-epidemiological surveillance.

The basic tasks of general medical establishment of polyclinic type are the qualified examination of the tuberculosis suspect and duly direction him to tuberculosis dispensary.

The polyclinics of common profile carry out, at examination of the tuberculosis suspects, a clinical minimum (lung flurography, sputum examination for MBT, tuberculin test, analysis of blood and urine.

Measures of sanitarian and epidemiological surveillance on preventive maintenance and revealing of tuberculosis.

The work of committee of sanitarian and epidemiological surveillance and its divisions on prevention of tuberculosis in territory of their responsibility includes the following:

  1. specific prevention, early and duly detection of tuberculosis, improvement of bacteriological service for improvement the effectiveness of epidemiological situation on tuberculosis;
  2. control sanitary situation of the industrial enterprises, children’s and teenage establishments, epidemiological regime in anti-tuberculosis establishments and in the focuses of tubercular infection;
  3. carrying out retrospective epidemiological forecast and participation in planning anti-tuberculosis measures.

Share this Article: