Infection Control

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.

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)

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 sets forth requirements to equipment of special sites and rooms for sputum sampling. Compliance with these requirements is inspected in the course of monitoring visits to all health care facilities.

Funds for technical maintenance of mechanical ventilation and equipment at biosafety laboratory must be envisaged in local TB infection control plans at each health care facility. Compliance with this requirement is inspected in the course of monitoring visits. However, funds are provided partially due to limitations of the facilities` budgets.

Section 8.2. “Criteria of Infection Control Quality” (page 22 and further) 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 sets forth the following criteria of infection control effectiveness:
- share of health care centres where breathing masks are used (95 % and up) in high risk zones/during high risk procedures – included as indicators of incidence rate among health care professionals to the draft National M&E Plan (document is now pending approval);
- number of health care professionals that were tested for breathing masks fit during a year (99 %) – an indicator of a checklist under ”Infection Control” component.
In the course of monitoring visits, the inspectors check whether the IC Plan provides for funds intended for procurement of breathing masks and respirators, whether the need for such masks is calculated correctly and in accordance with the number of employees and patients who must wear them, and whether enough funds are allocated for this budget line. At the same time, actual use of breathing masks by the facilities employees in the high-risk TB infection zones is inspected during monitoring visits. Under the Global Fund grant, breathing masks were procured for each region, as well as fit-tests for annual analysis of respirator fit.