Report on assessment of infection control for TB in Arua Regional Referral Hospital Back ground information about the RRH.

The hospital is located in The Northwest region of Uganda and is the main regional referral hospital in the region serving over six districts as a referral point. The hospital is government owned with heavy presence of a NGO partner MSF which has helped in the treatment and care of patients s!ffering from T". The ma#or !tilities li$e water are present and strategically located o!tside all wards and the la%oratories the only pro%lem with !tilities is the rampant electricity load shedding and the hospital as a whole s!ffers considera%ly. MSF only avails a generator for their related activities which is positive %!t we wo!ld li$e to see that help extend to other areas of the hospital. Overall objective &ssess the ris$ of T" transmission in &r!a 'egional 'eferral (ospital so as to recommend ways of red!cing the ris$ of transmission to health wor$ers patients and comm!nity. Specific Objectives ). *etermine the n!m%er of health care providers ever s!ffered from T" in &r!a 'egional 'eferral hospital. +. .. /. 0. ,dentify the existing T",- practices of health care providers in &r!a 'eferral hospital &ssess the n!m%er of T" ,- training ever received %y health care wor$ing in &r!a 'egional 'eferral hospital. 'egional providers

&ssess the design of &r!a 'egional 'eferral hosp regarding ris$ of T" transmission. *escri%e the flow of T" patients within &r!a 'egional 'eferral hospital.

E pected Outputs & report on T" infection control in &r!a 'egional 'eferral hospital incl!ding $ey recommendations. *issemination1 The report will %e disseminated to the staff of hospitals assessed Mo(2NT34 and 4artners.

!ethodolog" The T" ,- assessment involved a systematic approach of data collection %y three teams on T",- in O4* in5patient wards and la%oratory. (ealth care providers were interviewed !sing a standardi6ed chec$list. 7!alitative and 8!alitative data was collected analy6ed and compiled into a draft report whose res!lts are shown %elow. Results #$O%& Strengths Administrative control measures Separated color coded waist %ins for separation of waist this intervention is f!lly initiated and emphasi6ed %y the administration 'eaknesses Administrative control measures No Triage of or for co!ghers No T" ,- plan g!idelines and SO4 Staff not trained in ,- for T" No visi%le display of ,- materials No T" ,- focal person at the facility *!e to the patient flow organi6ed in the O4* there are extremely high chances of losing patients d!e to delays in receiving la% res!lts Respirator" (ontrol measures 94atient with clinician: sitting position is not according to the flow of air. The flow is from the patient who sits near the door towards the clinician -rowded waiting area posing a ris$ of infection f!rther enhanced ca!se there is no triaging of co!ghers to separate them from others patients 4atients who are fo!nd to %e with T" do not wear mas$s N;0 mas$s not !sed at the facility %y either staff or patients

Recommendations ). Administrative (ontrol measures) & system of patient triaging wo!ld help red!ce the ris$ of infection greatly this is something the administration sho!ld p!sh for Train staff in T" ,- to strengthen h!man reso!rce to %etter manage T" ,- this is something that sho!ld not re8!ire a wor$shop format. The 6onal is already trained so passing on the information to the staff sho!ld %e an in ho!se arrangement 'e5organise the flow of patients so they are registered %efore they visit the la% in order to note who are s!spects for T" this is cr!cial to avoid the loss of patients +. Respirator" %rotection E*uipment) <ns!re that if patients are T" s!spects mas$s sho!ld %e worn %y %oth the s!spect and the clinician handling the patient

+$,npatients Strengths) Administrative control measures Separate rooms for different categories of T" infection &de8!ately staffed and staff are dedicated to their wor$ 4re5disinfected containers for sp!t!m collection is practiced the containers are sealed 'o!tine (ealth ed!cation of staff and this incl!des ,- tho!gh ,- is not fre8!ent ,nformal SO4 and g!idelines not written %!t comm!nicated and f!lly !nderstood

Environmental control measures) =indows and doors in the ward are constantly left open %oth day and night ens!ring flow of air thro!gh the ward Respirator" (ontrol measures Use of n;0 mas$s %y the medical staff and the act!al patients admitted Use of s!rgical mas$s %y T" s!spects

'eakness-(hallenges) Administrative control measures No written g!idelines ,- plan or SO4 for T" ,Environmental control measures) The ventilation space is extremely little for the ventilation o!tlets Respirator" (ontrol measures 'o!tine screening for Mo( is not done for T" the screening is only done for msf staff

Recommendations) Administrative control measures =or$ on written g!idelines ,- plan and SO4 for the facility 'e5location of the staff d!ty room it is directly opposite the ward so the flow of air from the ward ends !p directly at the staff d!ty room

.$/aborator" Strengths) Administrative control measures &de8!ate staff in the la%oratories Msf staff do ro!tine screening Environmental control measures) *oors are reg!larly open and the windows are open the feel of free flowing air is present

'eaknesses-(hallenges) Administrative control measures 3ac$ of a written ,- plan g!idelines and SO4 3a% staff are not trained in T" ,-

There is no designated waiting area for patients who have come for investigation leading to congestion in the la%oratory Respirator" (ontrol measures 3ac$ of protective gear li$e the n;0 mas$s for the staff which is extremely dangero!s the patients who are T" s!spects do not wear protective gear also

Recommendations) Administrative (ontrol measures) *esignated open waiting area for the patients who floc$ the la% for investigation prefera%ly o!tside the la% since there is ade8!ate space The la% has to have a written down ,- plan ,- g!idelines and SO4 Training of la% personnel in T" ,- meas!res is very important Respirator" (ontrol measures The health wor$ers need to %e provided with n;0 mas$s while investigating possi%le T" s!spects and T" patients &ll patients who are s!spected of T" sho!ld %e provided with n;0 mas$s while they visit the la% to improve on infection control in the la%oratories

0$Targeted Recommendations Hospital !anagers &dopt the vario!s recommendations listed a%ove for specific areas to help improve !pon the T" ,- in the hospital !inistr" of Health -1T/%-A(% Follow thro!gh with meetings with the respective hospital management and responsi%le officials within the hospital to ens!re that the recommendations are adopted in a timely and organised manner. "rief the *istrict health leadership of the findings and recommendations so there is s!pport from the district leadership in maintaining proper and safe wor$ing environment for %oth the staff and the patients

%artners <xtend the coverage of extra help s!ch as reg!lar screening for T to c!t across all health wor$ers in the T" ward not #!st the ones !nder MSF MSF sho!ld wor$ with the infection control officer of the hospital to help train staff reg!larly and come !p with the g!idelines and ,- plans in a timely manner

(onclusion ,n concl!sion the in patient wards O4* rooms and la%oratories are ade8!ately ventilated %asing on the scientific calc!lations carried o!t. &s a whole the wor$ %eing carried o!t %y the hospital in relation to infection control is impressive relating to the vario!s meas!res that are in place in the wards in partic!lar. There sho!ld #!st %e more ro!tine ed!cation on the vario!s g!idelines for T" ,- to help refresh and ca!tion staff on proper medical practice to prevent infection and f!rther that effort to other $ey areas of the hospital li$e the la%oratories