Infection Control

Status of implementation of recommendations for section Infection Control

Recommendations Status Implementation Institution responsible for implementation Deadlines
Infection Control
General recommendations        

1. TB infection control measures should be urgently implemented in the civilian and penal TB, HIV/AIDS and general health care services. The high level of nosocomial TB transmission and the growing epidemic of drug-resistant TB in high-HIV-prevalence settings (such as in Ukraine) make it imperative to prioritize the introduction of administrative, environmental and individual control measures based on risk assessments of the facilities.

Not implemented

The Order of the Ministry of Health of Ukraine No. 684 dated 18.08.2010 approved “Standard for TB infection control at health care centres, places of long stay of people and residence of TB patients”, which sets forth the conditions for implementation of infection control measures at tuberculosis facilities. However, in practice, infection control measures are being taken partially; not only insufficient financing is observed but incompliance with the relevant regulations as well. In 2012, monitoring groups on the national and regional levels were expanded and now include an infection control specialist who inspects during his/her visits all components of the infection control and provides respective recommendations as for their improvement.

UCDC
The State Penitentiary Service of Ukraine
31.12.14
Special recommendations        

2. Annual training courses on TB infection control should be organized at national, oblast, rayon and facility levels for hospital administrators, doctors, chief nurses, epidemiologists, laboratory managers and technicians. It is vital to include epidemiologists from the sanitary–epidemiological services in national and international training. There is a good training centre for infection control in Donetsk.

Partially

Under the Global Fund grant, during 2012-2013, trainings in Planning and Arrangement of TB Infection Control were held for 95 specialists (with chief doctors, doctors, medical nurses, laboratory specialists, engineers and other specialists responsible for infection control at tuberculosis facilities among them). Moreover, in 2012-2013, under USAID project “Enhanced TB Control in Ukraine”, trainings in the following directions of the infection control were held:

  • Prevention of hospital-acquired transmission of tuberculosis (training was held in Russia for 5 national specialists);
  • TB infection control at health care facilities in Ukraine (99 specialists were trained).
UCDC
On an ongoing basis

3. An educational programme should be established on the prevention of TB transmission and cough etiquette for TB patients, their relatives and other close contacts, as well as for the general population. Infection control policies, a high-risk standard of operations and infection control educational programmes should be developed and implemented for health care workers, patients and the general population.

Partially

Education program on TB transmission and “cough etiquette” for TB patients, their relatives and other close contacts has not been developed yet. However, some measures in this direction have been taken. In particular, under the awareness-raising campaign of “Stop TB in Ukraine” program, in 2011-2013 awareness-raising posters “Prevention of TB Infection at Hospitals” (interlinking), which provide visual representation of cough etiquette, were developed and distributed among primary care facilities and specialized TB hospitals. Moreover, in 2011 a sub-recipient in “communication” direction – International Non-Governmental Organization “Labor and Health Social Initiatives” (LHSI) – developed and distributed a brochure for patients and their family members titled “What You Should Know about Tuberculosis” (interlinking), which focuses on basic provisions of TB prevention for family members and hygiene of premises where a TB patient stayed or stays. Operational standards under conditions of high risk at TB facilities are provided in the Standard for TB infection control at health care centres, places of long stay of people and residence of TB patients, approved with the Order of the Ministry of Health of Ukraine No. 684 dated 18.08.2010.

UCDC
31.12.14

4. Risk assessments should be organized and TB infection control plans developed for each health care facility, integrated with general infection control measures and taking the available resources into account. These plans need to be updated annually to take account of new evidence-based procedures.

Implemented

All health care centres must outline the structure of infection control measures management, draw up on an annual basis an implementation plan and control its fulfilment in accordance to the Standard for TB infection control at health care centres, places of long stay of people and residence of TB patients, approved with the Order of the Ministry of Health of Ukraine No. 684 dated 18.08.2010. During the monitoring visits, quality of plans and their fulfilment are inspected, and calculation of budget required for infection control measures and their actual volume of financing are analysed for correctness.

5. TB suspects, outpatients and hospitalized patients should be separated according to their symptoms, the results of sputum smear microscopy and drug susceptibility testing (or the risk of drug-resistant TB) and their HIV status, in both the outpatient and inpatient departments. Shortening the overall length of stay in hospitals and adhering to the national requirement for floor area per patient bed (to reduce overcrowding) are contributory factors in the reduction of transmission. This recommendation also applies to penal facilities.

Partially

Section 3.11. “Distribution of Patient Flow” (page 12 and further) of the Standard for TB infection control at health care centres, places of long stay of people and residence of TB patients, approved with the Order of the Ministry of Health of Ukraine No. 684 dated 18.08.2010 specifies that all TB facilities must distribute patient flows based on results of sputum smear microscopy for acid-resistant bacteria and based on data of anti-TB drug sensitivity. Control over the compliance with this condition is exercised in the course of monitoring visits to TB facilities. However, in practice it is not always possible to distribute patient flow as required by the Standard due to the architectural inconformity of TB facility to infection control requirements. For the purposes of reducing in-patient TB transmission, the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis” was amended, with which TB patients without bacterioexcretion may be treated outpatiently (DOT) from the very beginning of therapy (page 75), if the patient’s clinical status allows that. However, in cases of bacterioexcretion, a patient is subject to mandatory hospitalization, which contradicts the latest WHO recommendations (WHO: TB treatment: recommendations. Fourth edition, 2009 (page 105).
Aiming to reduce general duration of stay in a hospital and to comply with the national requirements to area allotted for one patient, the Order of the Ministry of Health of Ukraine No. 584 dated 10.07.2013 “On Approval of Guidelines on Calculation of Bed Capacity at TB Facilities” was developed and approved, upon the initiative of the Charity Foundation “Development of Ukraine”. Pursuant to these guidelines, the existing bed capacity is being revised in all regions of Ukraine for optimization. In accordance with the expert report drawn up in 2012 after evaluation of needs of the State Penitentiary System of Ukraine for the resources intended to ensure effective TB fight at penitentiary and detention facilities, infection control measures were being implemented very slowly and not fully (page 43). (link – the report should be posted on the resource)

UCDC
31.12.14

6. There should be appropriate triage of respiratory symptomatic patients, separation of patients and specimen flows with signage and reallocation of facilities (if needed), and isolation of smear-positive and M/XDR-TB patients.

Partially