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Control of tuberculosis transmission in health care settings. Joint statement. Lutte contre la transmission de la tuberculose dans les etablissements de soins. Declaration conjointe.
CANADA COMMUNICABLE DISEASE REPORT. 1994 Jan 15; 20(1):3-5.This statement represents the position taken by the World Health Organization Tuberculosis Program and the International Union against Tuberculosis and Lung Disease on treatment, environmental control, and protection of health care workers. The guidelines are appropriate for program managers and applicable even if multi-drug resistance is not present. These guidelines pertain to reasonably effective measures for countries with limited resources. Transmission of tuberculosis is enhanced when tuberculosis patients have pulmonary disease and are sputum positive. Smear negative patients are less efficient transmitters. Those with extrapulmonary tuberculosis are not infectious. The initial phase of treatment requires supervision. Ambulatory treatment contributes to prevention of nosocomial infections. Hospital patients with smear positive pulmonary tuberculosis must be isolated from other infectious tuberculosis patients and from other patients without tuberculosis. Persons with symptomatic respiratory tuberculosis and persons with a cough of more than three weeks duration should be tested promptly with a sputum smear. Immunosuppressed patients and infants should be kept from contact with tuberculosis patients. Suspected HIV/AIDS tuberculosis patients should be admitted to any tuberculosis ward, until the disease is confirmed and treatment is begun. Short-term therapy in smear positive patients and release is dependent on a negative smear sample. Proper ventilation is a requirement for reducing transmission, either with exhaust fans or open doors and windows. Fans should exhaust air to the outside and not to other wards. Outpatient clinics seeing tuberculosis patients should also be well ventilated. Sputum samples should be collected in areas away from waiting rooms and analyzed according to published guidelines. Ultraviolet lights may reduce transmission. Health staff require education about tuberculosis. Health workers with HIV infection should not work with tuberculosis patients. Movement of tuberculosis patients requires that patients wear tight fitting masks that filter 1-5 micron particles. Surgical masks are inexpensive but not as effective. Children staying with hospitalized mothers require a daily dose of 5 mg/kg of isoniazid regardless of breast feeding status.
Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1979. 283 p.From 1965 to 1978, the author made numerous formal addresses in conjunction with his duties as the World Health Organization's (WHO) Regional Director for Africa. The addresses provide a theoretical and practical foundation for the development of a health care strategy and are grouped in sections concerning general policy, ways and means, health services delivery and development, disease control, and training and development of health team personnel. Health development in African nations demands planning for the implementation of health services to meet local community needs and appropriate training and utilization of health care personnel. The ultimate goal of health development is social justice, defined as the proper amount of health care available to all. The benefits will be realized in increased labor productivity and economic development, better quality of life, and self reliance in African nations. To achieve social justice, African nations must abandon foreign concepts of medical care and develop their own solutions to health problems that are realistic for their populations. Through the application of the techniques of scientific management and the development of cooperative international forums, these solutions can be discovered. Planning, aided by the development of information systems, research, and regional cooperation, is vital to assure both curative and preventive health programs are delivered that meet the health services needs of the population. Disease control is important to the economic development of African nations. Preventive action can be realized through planning and organized delivery of health services, including immunization programs, which enhance the population's general health status. Where prevention is not possible, early detection followed by swift response is an objective of effective health services. Training of health care and service personnel should focus on preparing professionals to contribute to the welfare of the community and to African development. The development of the health care team, which encompasses traditional and nontraditional personnel, adequately utilizes available resources and is responsive to both curative and preventive health needs.