https://thehillside.info/api.php?action=feedcontributions&user=Tkumirai&feedformat=atomThe HILLSIDE - User contributions [en-gb]2024-03-28T13:00:03ZUser contributionsMediaWiki 1.34.1https://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5903Guidelines for safe sputum collection2020-10-19T07:05:55Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown below as Mechanical sputum booth. The Mechanical sputum booth was designed by the Infrastructure Innovation unit of the CSIR . [[Technical specifications for CSIR designed sputum booth|Technical specifications for CSIR designed sputum booth.]]<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Comparison between enclosure and exterior LEV devices is shown in Table below.<br /><br />
<br />
<br />
Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example Mechanical sputum booth is shown above.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example exterior LEV is illustrated above.<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table below.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Annexure 2 of the [[TB Services|TB services guideline.]]<br />
<br /><br />
<br />
===Factors to consider when procuring sputum booth===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br /><br />
[[File:Process to follow when procuring sputum collection facility.jpg|thumb|548x548px|Process to follow when procuring sputum collection facility|alt=|left]]<br />
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<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5902Guidelines for safe sputum collection2020-10-19T07:01:47Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown below as Mechanical sputum booth. The Mechanical sputum booth was designed by the Infrastructure Innovation unit of the CSIR . [[Technical specifications for CSIR designed sputum booth|Technical specifications for CSIR designed sputum booth.]]<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Comparison between enclosure and exterior LEV devices is shown in Table below.<br /><br />
<br />
<br />
Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example Mechanical sputum booth is shown above.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example exterior LEV is illustrated above.<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Appendix B.<br />
<br /><br />
<br />
===Factors to consider when procuring sputum booth===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br /><br />
[[File:Process to follow when procuring sputum collection facility.jpg|thumb|548x548px|Process to follow when procuring sputum collection facility|alt=|left]]<br />
<br />
<br />
<br />
<br />
<br />
<br />
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<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5901Guidelines for safe sputum collection2020-10-19T06:33:13Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. [[Technical specifications for CSIR designed sputum booth|Technical specifications for CSIR designed sputum booth.]]<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Appendix B.<br />
<br /><br />
<br />
===Factors to consider when procuring sputum booth===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br /><br />
[[File:Process to follow when procuring sputum collection facility.jpg|thumb|548x548px|Process to follow when procuring sputum collection facility|alt=|left]]<br />
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<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5900Guidelines for safe sputum collection2020-10-18T19:17:03Z<p>Tkumirai: MINOR</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. [[Technical specifications for CSIR designed sputum booth|Technical specifications for CSIR designed sputum booth.]]<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Appendix B.<br />
<br /><br />
<br />
===Factors to consider when procuring sputum booth===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br /><br />
[[File:Process to follow when procuring sputum collection facility.jpg|thumb|548x548px|Process to follow when procuring sputum collection facility]]<br />
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<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Technical_specifications_for_CSIR_designed_sputum_booth&diff=5899Technical specifications for CSIR designed sputum booth2020-10-18T15:59:22Z<p>Tkumirai: </p>
<hr />
<div>===General===<br />
Where reference is made to Contractor, it shall be read to mean the successful bidder appointed to execute the contract.<br />
<br />
===Materials and workmanship===<br />
All apparatus, components parts, fittings and materials supplied and/or installed whether especially specified herein or not shall conform in respect of quality, manufacture, tests and performance with the requirements of the appropriate current South African (SABS) or British Standard Specifications (BS).<br />
<br />
All materials and workmanship which may, in the opinion of the CSIR, be inferior to that specified for the work shall be condemned. All condemned material and workmanship must be replaced or rectified as the case may be, to the satisfaction of the CSIR.<br />
<br />
=== Performance specifications ===<br />
<br />
==== Supply Air flow rate ====<br />
Supply air flow rate shall be at least 2100 m<sup>3</sup>/h measured as specified herein<br />
<br />
==== Air exchange rate ====<br />
The sputum collection booth ventilation rate shall be at least 800 Air Changes per Hour (ACH).<br />
<br />
==== Booth internal air pressure requirements ====<br />
The booth shall maintain a negative air pressure with respect to adjacent spaces during operation. No outward airflow is permitted during closed door operation.<br />
<br />
==== Aerosol filtration requirements ====<br />
The HEPA filter shall achieve a filtration efficiency of not less than 99.95% when tested as per section 6.4.1 – 6.4.3.<br />
<br />
==== Noise levels ====<br />
Acoustical noise levels shall be compliant with §'''Error! Reference source not found.''' when tested in accordance with ISO 3743-1 and ISO 3743-2<br />
<br />
=== Design specifications ===<br />
<br />
==== Booth dimensions ====<br />
Booth inner dimensions (mm) shall be 1600Lx734Wx1900H.<br />
<br />
Booth outer dimensions (mm) shall be 2000Lx740Wx2000H.<br />
<br />
==== Configuration of aerosol filtration system and fan ====<br />
Aerosol filtration system (pre and HEPA filters) and fan shall be configured as shown in the schematic diagram of Figure 2.<br />
<br />
==== Internal booth surfaces ====<br />
The internal surfaces of the booth shall be impervious (no gaps or voids), able to withstand regular and vigorous cleaning, washable and easily disinfected.<br />
<br />
==== Filtration housing ====<br />
Filtration housing for the Pre and HEPA filter shall be N G™ filter duct housings.<br />
<br />
==== Plenum ====<br />
The plenum shall be detachable from the booth See Figure 3.<br />
<br />
4 lockable or retractable wheels shall be provided to the plenum for mobility.<br />
<br />
==== Inlet air filtration ====<br />
A G4 air filter matt shall be situated over the fresh-air intake screen.<br />
<br />
==== Location of supply air grill ====<br />
The perforated supply air grille shall be located on the ceiling of the booth and shall have an open area of not less than 50% and a hole shape aspect ratio of 1:1.<br />
<br />
The grille shall be configured to ensure an even supply airflow distribution throughout the sputum collection booth.<br />
<br />
The thickness of the grille shall be at least 0.8 mm.<br />
<br />
==== High Efficiency Particulate Air (HEPA) filter ====<br />
An EN 1822 H13 Grade HEPA filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
==== Fan ====<br />
Fan shall be an automatic step less variable speed fan.<br />
<br />
==== Pre Filter ====<br />
An F9 filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
==== Booth lighting ====<br />
LED lighting strips shall be installed along the inside gloss white walls above head height.<br />
<br />
==== Sputum cup holder ====<br />
The sputum cup holder shall be installed along the inside wall of the booth below the window as shown in Figure 3.<br />
<br />
The material of the cup holder shall be Perspex or Stainless steel.<br />
<br />
==== Seat ====<br />
The seat shall be foldable and able to withstand a dynamic load of 150 kg.<br />
<br />
==== Window ====<br />
A window shall be installed as per schematic diagram of Figure 2.<br />
<br />
==== Pressure gauges ====<br />
Pressure gauges with a maximum range of 500 Pa shall be installed across the HEPA filter and the pre filter.<br />
<br />
==== Automatic door lock system ====<br />
Automatic door lock system shall be installed.<br />
<br />
The control logic for the door shall be as per Figure 1.<br />
<br />
==== Electrical Supply and Safety ====<br />
The booth power shall be supplied by standard IEC Type M 230V 50Hz single phase power outlet<br />
<br />
The fan and fan controller shall comply with the safety requirements of SANS 60335-2-80:2016 “Particular requirements for fans”.<br />
<br />
The requirements of SANS 60335-2-65:2015 “Particular requirements for air-cleaning appliances” shall apply<br />
<br />
The requirements of SANS 60335-1:2018 “Household and similar electrical appliances – Safety” shall apply<br />
<br />
=== DRAWINGS ===<br />
Figures 2&3 are presented for general arrangement purposes.<br />
<br />
The contractor shall prepare shop drawings which shall show in detail the construction of all the parts, method of assembly where applicable, materials and connections, sealants, fastenings and all other necessary details.<br />
<br />
=== Installation ===<br />
<br />
==== Indoor location of booth ====<br />
The sputum booth shall not be located close to open windows and doors.<br />
<br />
The sputum booth shall not align with commonly viewed items such as notice boards, monitors, televisions etc.<br />
<br />
The CEOs or infection control managers of the facilities shall allocate the exact installation location within the facility.<br />
<br />
The contractor shall allow in his tender price for the transportation costs of booths to installation sites.<br />
<br />
=== Commissioning ===<br />
<br />
==== Testing responsibility ====<br />
The contractor shall allow in his tender price for the services of appropriately certified commissioning technicians or engineers.<br />
<br />
==== Airflow direction tests ====<br />
Airflow direction tests to confirm negative booth pressure shall be conducted as per ISO 14644:3 section B8.<br />
<br />
==== Booth ventilation rate ====<br />
Booth ventilation rate shall be tested as per ISO 14644:3 for non-unidirectional airflow system. The test shall be conducted at the exhaust air terminal.<br />
<br />
==== HEPA Filter integral efficiency test ====<br />
HEPA Filter integral efficiency test shall be as per ISO 14644:3.<br />
<br />
Challenge aerosol particle size shall be as per ISO 14644:3 section B.6.2.2<br />
<br />
Challenge aerosol concentration in the booth shall be as per ISO 14644:3 section B.6.2.3.<br />
<br />
=== MAINTENANCE AND PERFORMANCE MONITORING ===<br />
The contractor shall maintain good working order of the sputum collection booth for 2 years after installation.<br />
<br />
Fully comprehensive two year maintenance and monitoring plan including all costs shall be provided by the contractor.<br />
<br />
The maintenance plan shall include maintenance activities and performance monitoring.<br />
<br />
=== GUARANTEE PERIODS ===<br />
The contractor shall guarantee that spare parts will be available for the expected lifetime of the sputum collection booth and for a period of at least ten years from procurement date.<br />
<br />
The guarantee must cover all items against manufacturing defects, installation, commissioning, materials and workmanship. Should manufacturing defects be detected within a 30-day period, the supplier shall replace the equipment with a new one.<br />
<br />
Contractors are obliged to refund, repair or replace the failed, unsafe and defective goods.<br />
<br />
=== Documentation ===<br />
The following reports and records shall be provided upon handover:<br />
<br />
1) Manual including:<br />
<br />
a) Operating instructions<br />
<br />
b) Maintenance schedule and instructions<br />
<br />
c) Shop drawings<br />
<br />
d) All tests reports<br />
<br />
e) Material data sheets<br />
<br />
f) Equipment data sheets<br />
<br />
g) Decommissioning and disposal plan<br />
<br />
=== TRAINING ===<br />
Training of onsite maintenance personnel and sister in charge by the contractor in the operation, dismantling and cleaning of the sputum collection booth shall be included in the offer.</div>Tkumiraihttps://thehillside.info/index.php?title=Technical_specifications_for_CSIR_designed_sputum_booth&diff=5898Technical specifications for CSIR designed sputum booth2020-10-18T15:43:07Z<p>Tkumirai: </p>
<hr />
<div>===General===<br />
<br />
==== Where reference is made to Contractor, it shall be read to mean the successful bidder appointed to execute the contract. ====<br />
<br />
===Materials and workmanship===<br />
<br />
==== All apparatus, components parts, fittings and materials supplied and/or installed whether especially specified herein or not shall conform in respect of quality, manufacture, tests and performance with the requirements of the appropriate current South African (SABS) or British Standard Specifications (BS). ====<br />
All materials and workmanship which may, in the opinion of the CSIR, be inferior to that specified for the work shall be condemned. All condemned material and workmanship must be replaced or rectified as the case may be, to the satisfaction of the CSIR.<br />
<br />
Performance specifications<br />
<br />
Supply Air flow rate<br />
<br />
Supply air flow rate shall be at least 2100 m<sup>3</sup>/h measured as specified herein<br />
<br />
Air exchange rate<br />
<br />
The sputum collection booth ventilation rate shall be at least 800 Air Changes per Hour (ACH).<br />
<br />
Booth internal air pressure requirements<br />
<br />
The booth shall maintain a negative air pressure with respect to adjacent spaces during operation. No outward airflow is permitted during closed door operation.<br />
<br />
Aerosol filtration requirements<br />
<br />
The HEPA filter shall achieve a filtration efficiency of not less than 99.95% when tested as per section 6.4.1 – 6.4.3.<br />
<br />
Noise levels<br />
<br />
Acoustical noise levels shall be compliant with §'''Error! Reference source not found.''' when tested in accordance with ISO 3743-1 and ISO 3743-2<br />
<br />
<br />Design specifications<br />
<br />
Booth dimensions<br />
<br />
Booth inner dimensions (mm) shall be 1600Lx734Wx1900H.<br />
<br />
Booth outer dimensions (mm) shall be 2000Lx740Wx2000H.<br />
<br />
Configuration of aerosol filtration system and fan<br />
<br />
Aerosol filtration system (pre and HEPA filters) and fan shall be configured as shown in the schematic diagram of Figure 2.<br />
<br />
Internal booth surfaces<br />
<br />
The internal surfaces of the booth shall be impervious (no gaps or voids), able to withstand regular and vigorous cleaning, washable and easily disinfected.<br />
<br />
Filtration housing<br />
<br />
Filtration housing for the Pre and HEPA filter shall be N G™ filter duct housings.<br />
<br />
Plenum<br />
<br />
The plenum shall be detachable from the booth See Figure 3.<br />
<br />
4 lockable or retractable wheels shall be provided to the plenum for mobility.<br />
<br />
Inlet air filtration<br />
<br />
A G4 air filter matt shall be situated over the fresh-air intake screen.<br />
<br />
Location of supply air grill<br />
<br />
The perforated supply air grille shall be located on the ceiling of the booth and shall have an open area of not less than 50% and a hole shape aspect ratio of 1:1.<br />
<br />
The grille shall be configured to ensure an even supply airflow distribution throughout the sputum collection booth.<br />
<br />
The thickness of the grille shall be at least 0.8 mm.<br />
<br />
High Efficiency Particulate Air (HEPA) filter<br />
<br />
An EN 1822 H13 Grade HEPA filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Fan<br />
<br />
Fan shall be an automatic step less variable speed fan.<br />
<br />
Pre Filter<br />
<br />
An F9 filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Booth lighting<br />
<br />
LED lighting strips shall be installed along the inside gloss white walls above head height.<br />
<br />
Sputum cup holder<br />
<br />
The sputum cup holder shall be installed along the inside wall of the booth below the window as shown in Figure 3.<br />
<br />
The material of the cup holder shall be Perspex or Stainless steel.<br />
<br />
Seat<br />
<br />
The seat shall be foldable and able to withstand a dynamic load of 150 kg.<br />
<br />
Window<br />
<br />
A window shall be installed as per schematic diagram of Figure 2.<br />
<br />
Pressure gauges<br />
<br />
Pressure gauges with a maximum range of 500 Pa shall be installed across the HEPA filter and the pre filter.<br />
<br />
Automatic door lock system<br />
<br />
Automatic door lock system shall be installed.<br />
<br />
The control logic for the door shall be as per Figure 1.<br />
<br />
Electrical Supply and Safety<br />
<br />
The booth power shall be supplied by standard IEC Type M 230V 50Hz single phase power outlet<br />
<br />
The fan and fan controller shall comply with the safety requirements of SANS 60335-2-80:2016 “Particular requirements for fans”.<br />
<br />
The requirements of SANS 60335-2-65:2015 “Particular requirements for air-cleaning appliances” shall apply<br />
<br />
The requirements of SANS 60335-1:2018 “Household and similar electrical appliances – Safety” shall apply<br />
<br />
DRAWINGS<br />
<br />
Figures 2&3 are presented for general arrangement purposes.<br />
<br />
The contractor shall prepare shop drawings which shall show in detail the construction of all the parts, method of assembly where applicable, materials and connections, sealants, fastenings and all other necessary details.<br />
<br />
Installation<br />
<br />
Indoor location of booth<br />
<br />
The sputum booth shall not be located close to open windows and doors.<br />
<br />
The sputum booth shall not align with commonly viewed items such as notice boards, monitors, televisions etc.<br />
<br />
The CEOs or infection control managers of the facilities of sections 5.1.3 shall allocate the exact installation location within the facility.<br />
<br />
The contractor shall allow in his tender price for the transportation costs of booths to installation sites.<br />
<br />
Commissioning<br />
<br />
Testing responsibility<br />
<br />
The contractor shall allow in his tender price for the services of appropriately certified commissioning technicians or engineers.<br />
<br />
Airflow direction tests<br />
<br />
Airflow direction tests to confirm negative booth pressure shall be conducted as per ISO 14644:3 section B8.<br />
<br />
Booth ventilation rate<br />
<br />
Booth ventilation rate shall be tested as per ISO 14644:3 for non-unidirectional airflow system. The test shall be conducted at the exhaust air terminal.<br />
<br />
HEPA Filter integral efficiency test<br />
<br />
HEPA Filter integral efficiency test shall be as per ISO 14644:3.<br />
<br />
Challenge aerosol particle size shall be as per ISO 14644:3 section B.6.2.2<br />
<br />
Challenge aerosol concentration in the booth shall be as per ISO 14644:3 section B.6.2.3.<br />
<br />
MAINTENANCE AND PERFORMANCE MONITORING<br />
<br />
The contractor shall maintain good working order of the sputum collection booth for 2 years after installation.<br />
<br />
Fully comprehensive two year maintenance and monitoring plan including all costs shall be provided by the contractor.<br />
<br />
The maintenance plan shall include maintenance activities and performance monitoring.<br />
<br />
<br />
GUARANTEE PERIODS<br />
<br />
The contractor shall guarantee that spare parts will be available for the expected lifetime of the sputum collection booth and for a period of at least ten years from procurement date.<br />
<br />
The guarantee must cover all items against manufacturing defects, installation, commissioning, materials and workmanship. Should manufacturing defects be detected within a 30-day period, the supplier shall replace the equipment with a new one.<br />
<br />
Contractors are obliged to refund, repair or replace the failed, unsafe and defective goods.<br />
<br />
Documentation<br />
<br />
The following reports and records shall be provided upon handover:<br />
<br />
1) Manual including:<br />
<br />
a) Operating instructions<br />
<br />
b) Maintenance schedule and instructions<br />
<br />
c) Shop drawings<br />
<br />
d) All tests reports<br />
<br />
e) Material data sheets<br />
<br />
f) Equipment data sheets<br />
<br />
g) Decommissioning and disposal plan<br />
<br />
<br />
TRAINING<br />
<br />
Training of onsite maintenance personnel and sister in charge by the contractor in the operation, dismantling and cleaning of the sputum collection booth shall be included in the offer.</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5897Guidelines for safe sputum collection2020-10-18T15:34:26Z<p>Tkumirai: minor</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. [[Technical specifications for CSIR designed sputum booth|Technical specifications for CSIR designed sputum booth.]]<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Appendix B.<br />
<br /><br />
<br />
===Factors to consider when procuring sputum booth===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br /><br />
[[File:Process to follow when procuring sputum collection facility.jpg|thumb|548x548px|Process to follow when procuring sputum collection facility]]<br />
<br />
<br />
<br />
<br />
<br />
<br />
[[File:Process to follow when procuring sputum collection facility.jpg|thumb|548x548px|Process to follow when procuring sputum collection facility]]<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=File:Process_to_follow_when_procuring_sputum_collection_facility.jpg&diff=5896File:Process to follow when procuring sputum collection facility.jpg2020-10-18T15:30:35Z<p>Tkumirai: </p>
<hr />
<div>Process to follow when procuring sputum collection facility</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5895Guidelines for safe sputum collection2020-10-16T15:39:31Z<p>Tkumirai: Minor</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. [[Technical specifications for CSIR designed sputum booth|Technical specifications for CSIR designed sputum booth.]]<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Appendix B.<br />
<br /><br />
<br />
===Factors to consider when procuring sputum booth===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br />
<br />
<br />
<br />
<br /><br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Technical_specifications_for_CSIR_designed_sputum_booth&diff=5888Technical specifications for CSIR designed sputum booth2020-10-15T16:58:03Z<p>Tkumirai: Minor</p>
<hr />
<div>=== General ===<br />
<br />
===== Where reference is made to Contractor, it shall be read to mean the successful bidder appointed to execute the contract. =====<br />
<br />
=== Materials and workmanship ===<br />
All apparatus, components parts, fittings and materials supplied and/or installed whether especially specified herein or not shall conform in respect of quality, manufacture, tests and performance with the requirements of the appropriate current South African (SABS) or British Standard Specifications (BS).<br />
<br />
All materials and workmanship which may, in the opinion of the CSIR, be inferior to that specified for the work shall be condemned. All condemned material and workmanship must be replaced or rectified as the case may be, to the satisfaction of the CSIR.<br />
<br />
Performance specifications<br />
<br />
Supply Air flow rate<br />
<br />
Supply air flow rate shall be at least 2100 m<sup>3</sup>/h measured as specified herein<br />
<br />
Air exchange rate<br />
<br />
The sputum collection booth ventilation rate shall be at least 800 Air Changes per Hour (ACH).<br />
<br />
Booth internal air pressure requirements<br />
<br />
The booth shall maintain a negative air pressure with respect to adjacent spaces during operation. No outward airflow is permitted during closed door operation.<br />
<br />
Aerosol filtration requirements<br />
<br />
The HEPA filter shall achieve a filtration efficiency of not less than 99.95% when tested as per section 6.4.1 – 6.4.3.<br />
<br />
Noise levels<br />
<br />
Acoustical noise levels shall be compliant with §'''Error! Reference source not found.''' when tested in accordance with ISO 3743-1 and ISO 3743-2<br />
<br />
<br />Design specifications<br />
<br />
Booth dimensions<br />
<br />
Booth inner dimensions (mm) shall be 1600Lx734Wx1900H.<br />
<br />
Booth outer dimensions (mm) shall be 2000Lx740Wx2000H.<br />
<br />
Configuration of aerosol filtration system and fan<br />
<br />
Aerosol filtration system (pre and HEPA filters) and fan shall be configured as shown in the schematic diagram of Figure 2.<br />
<br />
Internal booth surfaces<br />
<br />
The internal surfaces of the booth shall be impervious (no gaps or voids), able to withstand regular and vigorous cleaning, washable and easily disinfected.<br />
<br />
Filtration housing<br />
<br />
Filtration housing for the Pre and HEPA filter shall be N G™ filter duct housings.<br />
<br />
Plenum<br />
<br />
The plenum shall be detachable from the booth See Figure 3.<br />
<br />
4 lockable or retractable wheels shall be provided to the plenum for mobility.<br />
<br />
Inlet air filtration<br />
<br />
A G4 air filter matt shall be situated over the fresh-air intake screen.<br />
<br />
Location of supply air grill<br />
<br />
The perforated supply air grille shall be located on the ceiling of the booth and shall have an open area of not less than 50% and a hole shape aspect ratio of 1:1.<br />
<br />
The grille shall be configured to ensure an even supply airflow distribution throughout the sputum collection booth.<br />
<br />
The thickness of the grille shall be at least 0.8 mm.<br />
<br />
High Efficiency Particulate Air (HEPA) filter<br />
<br />
An EN 1822 H13 Grade HEPA filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Fan<br />
<br />
Fan shall be an automatic step less variable speed fan.<br />
<br />
Pre Filter<br />
<br />
An F9 filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Booth lighting<br />
<br />
LED lighting strips shall be installed along the inside gloss white walls above head height.<br />
<br />
Sputum cup holder<br />
<br />
The sputum cup holder shall be installed along the inside wall of the booth below the window as shown in Figure 3.<br />
<br />
The material of the cup holder shall be Perspex or Stainless steel.<br />
<br />
Seat<br />
<br />
The seat shall be foldable and able to withstand a dynamic load of 150 kg.<br />
<br />
Window<br />
<br />
A window shall be installed as per schematic diagram of Figure 2.<br />
<br />
Pressure gauges<br />
<br />
Pressure gauges with a maximum range of 500 Pa shall be installed across the HEPA filter and the pre filter.<br />
<br />
Automatic door lock system<br />
<br />
Automatic door lock system shall be installed.<br />
<br />
The control logic for the door shall be as per Figure 1.<br />
<br />
Electrical Supply and Safety<br />
<br />
The booth power shall be supplied by standard IEC Type M 230V 50Hz single phase power outlet<br />
<br />
The fan and fan controller shall comply with the safety requirements of SANS 60335-2-80:2016 “Particular requirements for fans”.<br />
<br />
The requirements of SANS 60335-2-65:2015 “Particular requirements for air-cleaning appliances” shall apply<br />
<br />
The requirements of SANS 60335-1:2018 “Household and similar electrical appliances – Safety” shall apply<br />
<br />
DRAWINGS<br />
<br />
Figures 2&3 are presented for general arrangement purposes.<br />
<br />
The contractor shall prepare shop drawings which shall show in detail the construction of all the parts, method of assembly where applicable, materials and connections, sealants, fastenings and all other necessary details.<br />
<br />
Installation<br />
<br />
Indoor location of booth<br />
<br />
The sputum booth shall not be located close to open windows and doors.<br />
<br />
The sputum booth shall not align with commonly viewed items such as notice boards, monitors, televisions etc.<br />
<br />
The CEOs or infection control managers of the facilities of sections 5.1.3 shall allocate the exact installation location within the facility.<br />
<br />
The contractor shall allow in his tender price for the transportation costs of booths to installation sites.<br />
<br />
Commissioning<br />
<br />
Testing responsibility<br />
<br />
The contractor shall allow in his tender price for the services of appropriately certified commissioning technicians or engineers.<br />
<br />
Airflow direction tests<br />
<br />
Airflow direction tests to confirm negative booth pressure shall be conducted as per ISO 14644:3 section B8.<br />
<br />
Booth ventilation rate<br />
<br />
Booth ventilation rate shall be tested as per ISO 14644:3 for non-unidirectional airflow system. The test shall be conducted at the exhaust air terminal.<br />
<br />
HEPA Filter integral efficiency test<br />
<br />
HEPA Filter integral efficiency test shall be as per ISO 14644:3.<br />
<br />
Challenge aerosol particle size shall be as per ISO 14644:3 section B.6.2.2<br />
<br />
Challenge aerosol concentration in the booth shall be as per ISO 14644:3 section B.6.2.3.<br />
<br />
MAINTENANCE AND PERFORMANCE MONITORING<br />
<br />
The contractor shall maintain good working order of the sputum collection booth for 2 years after installation.<br />
<br />
Fully comprehensive two year maintenance and monitoring plan including all costs shall be provided by the contractor.<br />
<br />
The maintenance plan shall include maintenance activities and performance monitoring.<br />
<br />
<br />
GUARANTEE PERIODS<br />
<br />
The contractor shall guarantee that spare parts will be available for the expected lifetime of the sputum collection booth and for a period of at least ten years from procurement date.<br />
<br />
The guarantee must cover all items against manufacturing defects, installation, commissioning, materials and workmanship. Should manufacturing defects be detected within a 30-day period, the supplier shall replace the equipment with a new one.<br />
<br />
Contractors are obliged to refund, repair or replace the failed, unsafe and defective goods.<br />
<br />
Documentation<br />
<br />
The following reports and records shall be provided upon handover:<br />
<br />
1) Manual including:<br />
<br />
a) Operating instructions<br />
<br />
b) Maintenance schedule and instructions<br />
<br />
c) Shop drawings<br />
<br />
d) All tests reports<br />
<br />
e) Material data sheets<br />
<br />
f) Equipment data sheets<br />
<br />
g) Decommissioning and disposal plan<br />
<br />
<br />
TRAINING<br />
<br />
Training of onsite maintenance personnel and sister in charge by the contractor in the operation, dismantling and cleaning of the sputum collection booth shall be included in the offer.</div>Tkumiraihttps://thehillside.info/index.php?title=Technical_specifications_for_CSIR_designed_sputum_booth&diff=5887Technical specifications for CSIR designed sputum booth2020-10-15T16:44:29Z<p>Tkumirai: Minor</p>
<hr />
<div>General<br />
<br />
Where reference is made to Contractor, it shall be read to mean the successful bidder appointed to execute the contract.<br />
<br />
Materials and workmanship<br />
<br />
All apparatus, components parts, fittings and materials supplied and/or installed whether especially specified herein or not shall conform in respect of quality, manufacture, tests and performance with the requirements of the appropriate current South African (SABS) or British Standard Specifications (BS).<br />
<br />
All materials and workmanship which may, in the opinion of the CSIR, be inferior to that specified for the work shall be condemned. All condemned material and workmanship must be replaced or rectified as the case may be, to the satisfaction of the CSIR.<br />
<br />
Performance specifications<br />
<br />
Supply Air flow rate<br />
<br />
Supply air flow rate shall be at least 2100 m<sup>3</sup>/h measured as specified herein<br />
<br />
Air exchange rate<br />
<br />
The sputum collection booth ventilation rate shall be at least 800 Air Changes per Hour (ACH).<br />
<br />
Booth internal air pressure requirements<br />
<br />
The booth shall maintain a negative air pressure with respect to adjacent spaces during operation. No outward airflow is permitted during closed door operation.<br />
<br />
Aerosol filtration requirements<br />
<br />
The HEPA filter shall achieve a filtration efficiency of not less than 99.95% when tested as per section 6.4.1 – 6.4.3.<br />
<br />
Noise levels<br />
<br />
Acoustical noise levels shall be compliant with §'''Error! Reference source not found.''' when tested in accordance with ISO 3743-1 and ISO 3743-2<br />
<br />
<br />Design specifications<br />
<br />
Booth dimensions<br />
<br />
Booth inner dimensions (mm) shall be 1600Lx734Wx1900H.<br />
<br />
Booth outer dimensions (mm) shall be 2000Lx740Wx2000H.<br />
<br />
Configuration of aerosol filtration system and fan<br />
<br />
Aerosol filtration system (pre and HEPA filters) and fan shall be configured as shown in the schematic diagram of Figure 2.<br />
<br />
Internal booth surfaces<br />
<br />
The internal surfaces of the booth shall be impervious (no gaps or voids), able to withstand regular and vigorous cleaning, washable and easily disinfected.<br />
<br />
Filtration housing<br />
<br />
Filtration housing for the Pre and HEPA filter shall be N G™ filter duct housings.<br />
<br />
Plenum<br />
<br />
The plenum shall be detachable from the booth See Figure 3.<br />
<br />
4 lockable or retractable wheels shall be provided to the plenum for mobility.<br />
<br />
Inlet air filtration<br />
<br />
A G4 air filter matt shall be situated over the fresh-air intake screen.<br />
<br />
Location of supply air grill<br />
<br />
The perforated supply air grille shall be located on the ceiling of the booth and shall have an open area of not less than 50% and a hole shape aspect ratio of 1:1.<br />
<br />
The grille shall be configured to ensure an even supply airflow distribution throughout the sputum collection booth.<br />
<br />
The thickness of the grille shall be at least 0.8 mm.<br />
<br />
High Efficiency Particulate Air (HEPA) filter<br />
<br />
An EN 1822 H13 Grade HEPA filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Fan<br />
<br />
Fan shall be an automatic step less variable speed fan.<br />
<br />
Pre Filter<br />
<br />
An F9 filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Booth lighting<br />
<br />
LED lighting strips shall be installed along the inside gloss white walls above head height.<br />
<br />
Sputum cup holder<br />
<br />
The sputum cup holder shall be installed along the inside wall of the booth below the window as shown in Figure 3.<br />
<br />
The material of the cup holder shall be Perspex or Stainless steel.<br />
<br />
Seat<br />
<br />
The seat shall be foldable and able to withstand a dynamic load of 150 kg.<br />
<br />
Window<br />
<br />
A window shall be installed as per schematic diagram of Figure 2.<br />
<br />
Pressure gauges<br />
<br />
Pressure gauges with a maximum range of 500 Pa shall be installed across the HEPA filter and the pre filter.<br />
<br />
Automatic door lock system<br />
<br />
Automatic door lock system shall be installed.<br />
<br />
The control logic for the door shall be as per Figure 1.<br />
<br />
Electrical Supply and Safety<br />
<br />
The booth power shall be supplied by standard IEC Type M 230V 50Hz single phase power outlet<br />
<br />
The fan and fan controller shall comply with the safety requirements of SANS 60335-2-80:2016 “Particular requirements for fans”.<br />
<br />
The requirements of SANS 60335-2-65:2015 “Particular requirements for air-cleaning appliances” shall apply<br />
<br />
The requirements of SANS 60335-1:2018 “Household and similar electrical appliances – Safety” shall apply<br />
<br />
DRAWINGS<br />
<br />
Figures 2&3 are presented for general arrangement purposes.<br />
<br />
The contractor shall prepare shop drawings which shall show in detail the construction of all the parts, method of assembly where applicable, materials and connections, sealants, fastenings and all other necessary details.<br />
<br />
Installation<br />
<br />
Indoor location of booth<br />
<br />
The sputum booth shall not be located close to open windows and doors.<br />
<br />
The sputum booth shall not align with commonly viewed items such as notice boards, monitors, televisions etc.<br />
<br />
The CEOs or infection control managers of the facilities of sections 5.1.3 shall allocate the exact installation location within the facility.<br />
<br />
The contractor shall allow in his tender price for the transportation costs of booths to installation sites.<br />
<br />
Commissioning<br />
<br />
Testing responsibility<br />
<br />
The contractor shall allow in his tender price for the services of appropriately certified commissioning technicians or engineers.<br />
<br />
Airflow direction tests<br />
<br />
Airflow direction tests to confirm negative booth pressure shall be conducted as per ISO 14644:3 section B8.<br />
<br />
Booth ventilation rate<br />
<br />
Booth ventilation rate shall be tested as per ISO 14644:3 for non-unidirectional airflow system. The test shall be conducted at the exhaust air terminal.<br />
<br />
HEPA Filter integral efficiency test<br />
<br />
HEPA Filter integral efficiency test shall be as per ISO 14644:3.<br />
<br />
Challenge aerosol particle size shall be as per ISO 14644:3 section B.6.2.2<br />
<br />
Challenge aerosol concentration in the booth shall be as per ISO 14644:3 section B.6.2.3.<br />
<br />
MAINTENANCE AND PERFORMANCE MONITORING<br />
<br />
The contractor shall maintain good working order of the sputum collection booth for 2 years after installation.<br />
<br />
Fully comprehensive two year maintenance and monitoring plan including all costs shall be provided by the contractor.<br />
<br />
The maintenance plan shall include maintenance activities and performance monitoring.<br />
<br />
<br />
GUARANTEE PERIODS<br />
<br />
The contractor shall guarantee that spare parts will be available for the expected lifetime of the sputum collection booth and for a period of at least ten years from procurement date.<br />
<br />
The guarantee must cover all items against manufacturing defects, installation, commissioning, materials and workmanship. Should manufacturing defects be detected within a 30-day period, the supplier shall replace the equipment with a new one.<br />
<br />
Contractors are obliged to refund, repair or replace the failed, unsafe and defective goods.<br />
<br />
Documentation<br />
<br />
The following reports and records shall be provided upon handover:<br />
<br />
1) Manual including:<br />
<br />
a) Operating instructions<br />
<br />
b) Maintenance schedule and instructions<br />
<br />
c) Shop drawings<br />
<br />
d) All tests reports<br />
<br />
e) Material data sheets<br />
<br />
f) Equipment data sheets<br />
<br />
g) Decommissioning and disposal plan<br />
<br />
<br />
TRAINING<br />
<br />
Training of onsite maintenance personnel and sister in charge by the contractor in the operation, dismantling and cleaning of the sputum collection booth shall be included in the offer.</div>Tkumiraihttps://thehillside.info/index.php?title=Technical_specifications_for_CSIR_designed_sputum_booth&diff=5886Technical specifications for CSIR designed sputum booth2020-10-15T16:41:44Z<p>Tkumirai: Minor</p>
<hr />
<div>===General===<br />
<br />
===='''Where reference is made to Contractor, it shall be read to mean the successful bidder appointed to execute the contract.'''====<br />
<br />
===Materials and workmanship===<br />
<br />
====All apparatus, components parts, fittings and materials supplied and/or installed whether especially specified herein or not shall conform in respect of quality, manufacture, tests and performance with the requirements of the appropriate current South African (SABS) or British Standard Specifications (BS).====<br />
<br />
===All materials and workmanship which may, in the opinion of the CSIR, be inferior to that specified for the work shall be condemned. All condemned material and workmanship must be replaced or rectified as the case may be, to the satisfaction of the CSIR.===<br />
<br />
===Performance specifications===<br />
<br />
===Supply Air flow rate===<br />
<br />
===Supply air flow rate shall be at least 2100 m<sup>3</sup>/h measured as specified herein===<br />
<br />
===Air exchange rate===<br />
<br />
===The sputum collection booth ventilation rate shall be at least 800 Air Changes per Hour (ACH).===<br />
<br />
===Booth internal air pressure requirements===<br />
<br />
===The booth shall maintain a negative air pressure with respect to adjacent spaces during operation. No outward airflow is permitted during closed door operation.===<br />
<br />
===Aerosol filtration requirements===<br />
<br />
===The HEPA filter shall achieve a filtration efficiency of not less than 99.95% when tested as per section 6.4.1 – 6.4.3.===<br />
<br />
===Noise levels===<br />
<br />
===Acoustical noise levels shall be compliant with §'''Error! Reference source not found.''' when tested in accordance with ISO 3743-1 and ISO 3743-2===<br />
<br />Design specifications<br />
<br />
Booth dimensions<br />
<br />
Booth inner dimensions (mm) shall be 1600Lx734Wx1900H.<br />
<br />
Booth outer dimensions (mm) shall be 2000Lx740Wx2000H.<br />
<br />
Configuration of aerosol filtration system and fan<br />
<br />
Aerosol filtration system (pre and HEPA filters) and fan shall be configured as shown in the schematic diagram of Figure 2.<br />
<br />
Internal booth surfaces<br />
<br />
The internal surfaces of the booth shall be impervious (no gaps or voids), able to withstand regular and vigorous cleaning, washable and easily disinfected.<br />
<br />
Filtration housing<br />
<br />
Filtration housing for the Pre and HEPA filter shall be N G™ filter duct housings.<br />
<br />
Plenum<br />
<br />
The plenum shall be detachable from the booth See Figure 3.<br />
<br />
4 lockable or retractable wheels shall be provided to the plenum for mobility.<br />
<br />
Inlet air filtration<br />
<br />
A G4 air filter matt shall be situated over the fresh-air intake screen.<br />
<br />
Location of supply air grill<br />
<br />
The perforated supply air grille shall be located on the ceiling of the booth and shall have an open area of not less than 50% and a hole shape aspect ratio of 1:1.<br />
<br />
The grille shall be configured to ensure an even supply airflow distribution throughout the sputum collection booth.<br />
<br />
The thickness of the grille shall be at least 0.8 mm.<br />
<br />
High Efficiency Particulate Air (HEPA) filter<br />
<br />
An EN 1822 H13 Grade HEPA filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Fan<br />
<br />
Fan shall be an automatic step less variable speed fan.<br />
<br />
Pre Filter<br />
<br />
An F9 filter shall be installed as per arrangement shown in the schematic diagram Figure 2.<br />
<br />
Booth lighting<br />
<br />
LED lighting strips shall be installed along the inside gloss white walls above head height.<br />
<br />
Sputum cup holder<br />
<br />
The sputum cup holder shall be installed along the inside wall of the booth below the window as shown in Figure 3.<br />
<br />
The material of the cup holder shall be Perspex or Stainless steel.<br />
<br />
Seat<br />
<br />
The seat shall be foldable and able to withstand a dynamic load of 150 kg.<br />
<br />
Window<br />
<br />
A window shall be installed as per schematic diagram of Figure 2.<br />
<br />
Pressure gauges<br />
<br />
Pressure gauges with a maximum range of 500 Pa shall be installed across the HEPA filter and the pre filter.<br />
<br />
Automatic door lock system<br />
<br />
Automatic door lock system shall be installed.<br />
<br />
The control logic for the door shall be as per Figure 1.<br />
<br />
Electrical Supply and Safety<br />
<br />
The booth power shall be supplied by standard IEC Type M 230V 50Hz single phase power outlet<br />
<br />
The fan and fan controller shall comply with the safety requirements of SANS 60335-2-80:2016 “Particular requirements for fans”.<br />
<br />
The requirements of SANS 60335-2-65:2015 “Particular requirements for air-cleaning appliances” shall apply<br />
<br />
The requirements of SANS 60335-1:2018 “Household and similar electrical appliances – Safety” shall apply<br />
<br />
DRAWINGS<br />
<br />
Figures 2&3 are presented for general arrangement purposes.<br />
<br />
The contractor shall prepare shop drawings which shall show in detail the construction of all the parts, method of assembly where applicable, materials and connections, sealants, fastenings and all other necessary details.<br />
<br />
Installation<br />
<br />
Indoor location of booth<br />
<br />
The sputum booth shall not be located close to open windows and doors.<br />
<br />
The sputum booth shall not align with commonly viewed items such as notice boards, monitors, televisions etc.<br />
<br />
The CEOs or infection control managers of the facilities of sections 5.1.3 shall allocate the exact installation location within the facility.<br />
<br />
The contractor shall allow in his tender price for the transportation costs of booths to installation sites.<br />
<br />
Commissioning<br />
<br />
Testing responsibility<br />
<br />
The contractor shall allow in his tender price for the services of appropriately certified commissioning technicians or engineers.<br />
<br />
Airflow direction tests<br />
<br />
Airflow direction tests to confirm negative booth pressure shall be conducted as per ISO 14644:3 section B8.<br />
<br />
Booth ventilation rate<br />
<br />
Booth ventilation rate shall be tested as per ISO 14644:3 for non-unidirectional airflow system. The test shall be conducted at the exhaust air terminal.<br />
<br />
HEPA Filter integral efficiency test<br />
<br />
HEPA Filter integral efficiency test shall be as per ISO 14644:3.<br />
<br />
Challenge aerosol particle size shall be as per ISO 14644:3 section B.6.2.2<br />
<br />
Challenge aerosol concentration in the booth shall be as per ISO 14644:3 section B.6.2.3.<br />
<br />
MAINTENANCE AND PERFORMANCE MONITORING<br />
<br />
The contractor shall maintain good working order of the sputum collection booth for 2 years after installation.<br />
<br />
Fully comprehensive two year maintenance and monitoring plan including all costs shall be provided by the contractor.<br />
<br />
The maintenance plan shall include maintenance activities and performance monitoring.<br />
<br />
<br />
GUARANTEE PERIODS<br />
<br />
The contractor shall guarantee that spare parts will be available for the expected lifetime of the sputum collection booth and for a period of at least ten years from procurement date.<br />
<br />
The guarantee must cover all items against manufacturing defects, installation, commissioning, materials and workmanship. Should manufacturing defects be detected within a 30-day period, the supplier shall replace the equipment with a new one.<br />
<br />
Contractors are obliged to refund, repair or replace the failed, unsafe and defective goods.<br />
<br />
Documentation<br />
<br />
The following reports and records shall be provided upon handover:<br />
<br />
1) Manual including:<br />
<br />
a) Operating instructions<br />
<br />
b) Maintenance schedule and instructions<br />
<br />
c) Shop drawings<br />
<br />
d) All tests reports<br />
<br />
e) Material data sheets<br />
<br />
f) Equipment data sheets<br />
<br />
g) Decommissioning and disposal plan<br />
<br />
<br />
TRAINING<br />
<br />
Training of onsite maintenance personnel and sister in charge by the contractor in the operation, dismantling and cleaning of the sputum collection booth shall be included in the offer.</div>Tkumiraihttps://thehillside.info/index.php?title=Technical_specifications_for_CSIR_designed_sputum_booth&diff=5885Technical specifications for CSIR designed sputum booth2020-10-15T15:24:56Z<p>Tkumirai: Minor</p>
<hr />
<div>=== General ===<br />
<br />
==== '''Where reference is made to Contractor, it shall be read to mean the successful bidder appointed to execute the contract.''' ====<br />
<br />
=== Materials and workmanship ===<br />
<br />
==== All apparatus, components parts, fittings and materials supplied and/or installed whether especially specified herein or not shall conform in respect of quality, manufacture, tests and performance with the requirements of the appropriate current South African (SABS) or British Standard Specifications (BS). ====<br />
<br />
=== 1.2.2 All materials and workmanship which may, in the opinion of the CSIR, be inferior to that specified for the work shall be condemned. All condemned material and workmanship must be replaced or rectified as the case may be, to the satisfaction of the CSIR. ===<br />
<br />
= 2 Performance specifications =<br />
<br />
== 2.1 Supply Air flow rate ==<br />
<br />
=== 2.1.1 Supply air flow rate shall be at least 2100 m<sup>3</sup>/h measured as specified herein ===<br />
<br />
== 2.2 Air exchange rate ==<br />
<br />
=== 2.2.1 The sputum collection booth ventilation rate shall be at least 800 Air Changes per Hour (ACH). ===<br />
<br />
== 2.3 Booth internal air pressure requirements ==<br />
<br />
=== 2.3.1 The booth shall maintain a negative air pressure with respect to adjacent spaces during operation. No outward airflow is permitted during closed door operation. ===<br />
<br />
== 2.4 Aerosol filtration requirements ==<br />
<br />
=== 2.4.1 The HEPA filter shall achieve a filtration efficiency of not less than 99.95% when tested as per section 6.4.1 – 6.4.3. ===<br />
<br />
== 2.5 Noise levels ==<br />
<br />
=== 2.5.1 Acoustical noise levels shall be compliant with §'''Error! Reference source not found.''' when tested in accordance with ISO 3743-1 and ISO 3743-2 ===<br />
<br /><br />
<br />
= 3 Design specifications =<br />
<br />
== 3.1 Booth dimensions ==<br />
<br />
=== 3.1.1 Booth inner dimensions (mm) shall be 1600Lx734Wx1900H. ===<br />
<br />
=== 3.1.2 Booth outer dimensions (mm) shall be 2000Lx740Wx2000H. === <br />
<br />
== 3.2 Configuration of aerosol filtration system and fan ==<br />
<br />
=== 3.2.1 Aerosol filtration system (pre and HEPA filters) and fan shall be configured as shown in the schematic diagram of Figure 2. ===<br />
<br />
== 3.3 Internal booth surfaces ==<br />
<br />
=== 3.3.1 The internal surfaces of the booth shall be impervious (no gaps or voids), able to withstand regular and vigorous cleaning, washable and easily disinfected. ===<br />
<br />
== 3.4 Filtration housing ==<br />
<br />
=== 3.4.1 Filtration housing for the Pre and HEPA filter shall be N G™ filter duct housings. ===<br />
<br />
== 3.5 Plenum ==<br />
<br />
=== 3.5.1 The plenum shall be detachable from the booth See Figure 3. ===<br />
<br />
=== 3.5.2 4 lockable or retractable wheels shall be provided to the plenum for mobility. ===<br />
<br />
== 3.6 Inlet air filtration ==<br />
<br /><br />
<br />
=== 3.6.1 A G4 air filter matt shall be situated over the fresh-air intake screen. ===<br />
<br />
== 3.7 Location of supply air grill ==<br />
<br />
=== 3.7.1 The perforated supply air grille shall be located on the ceiling of the booth and shall have an open area of not less than 50% and a hole shape aspect ratio of 1:1. ===<br />
<br />
=== 3.7.2 The grille shall be configured to ensure an even supply airflow distribution throughout the sputum collection booth. ===<br />
<br />
=== 3.7.3 The thickness of the grille shall be at least 0.8 mm. ===<br />
<br />
== 3.8 High Efficiency Particulate Air (HEPA) filter ==<br />
<br />
=== 3.8.1 An EN 1822 H13 Grade HEPA filter shall be installed as per arrangement shown in the schematic diagram Figure 2. ===<br />
<br />
== 3.9 Fan ==<br />
<br />
=== 3.9.1 Fan shall be an automatic step less variable speed fan. ===<br />
<br />
== 3.10 Pre Filter ==<br />
<br />
=== 3.10.1 An F9 filter shall be installed as per arrangement shown in the schematic diagram Figure 2. ===<br />
<br />
== 3.11 Booth lighting ==<br />
<br />
=== 3.11.1 LED lighting strips shall be installed along the inside gloss white walls above head height. ===<br />
<br />
== 3.12 Sputum cup holder ==<br />
<br />
=== 3.12.1 The sputum cup holder shall be installed along the inside wall of the booth below the window as shown in Figure 3. ===<br />
<br />
=== 3.12.2 The material of the cup holder shall be Perspex or Stainless steel. ===<br />
<br />
== 3.13 Seat ==<br />
<br />
=== 3.13.1 The seat shall be foldable and able to withstand a dynamic load of 150 kg. ===<br />
<br />
== 3.14 Window ==<br />
<br />
=== 3.14.1 A window shall be installed as per schematic diagram of Figure 2. ===<br />
<br />
== 3.15 Pressure gauges ==<br />
<br />
=== 3.15.1 Pressure gauges with a maximum range of 500 Pa shall be installed across the HEPA filter and the pre filter. ===<br />
<br />
== 3.16 Automatic door lock system ==<br />
<br />
=== 3.16.1 Automatic door lock system shall be installed. ===<br />
<br />
=== 3.16.2 The control logic for the door shall be as per Figure 1. ===<br />
<br /><br />
{| class="wikitable"<br />
|Figure 1. Control logic diagram for the door.<br />
|}<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br /><br />
<br />
== 3.17 Electrical Supply and Safety ==<br />
<br />
=== 3.17.1 The booth power shall be supplied by standard IEC Type M 230V 50Hz single phase power outlet ===<br />
<br />
=== 3.17.2 The fan and fan controller shall comply with the safety requirements of SANS 60335-2-80:2016 “Particular requirements for fans”. ===<br />
<br />
=== 3.17.3 The requirements of SANS 60335-2-65:2015 “Particular requirements for air-cleaning appliances” shall apply ===<br />
<br />
=== 3.17.4 . The requirements of SANS 60335-1:2018 “Household and similar electrical appliances – Safety” shall apply ===<br />
<br /><br />
<br />
= 4 DRAWINGS =<br />
<br />
=== 4.1.1 Figures 2&3 are presented for general arrangement purposes. ===<br />
<br />
=== 4.1.2 The contractor shall prepare shop drawings which shall show in detail the construction of all the parts, method of assembly where applicable, materials and connections, sealants, fastenings and all other necessary details. ===<br />
<br />
<br />
{| class="wikitable"<br />
|Figure 2. General arrangement of booth<br />
|} <br />
<br />
<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Detachable plenum<br />
|}<br />
Figure 3. General arrangement of sputum booth<br />
<br />
= 5 Installation =<br />
<br />
== 5.1 Indoor location of booth ==<br />
<br />
=== 5.1.1 The sputum booth shall not be located close to open windows and doors. ===<br />
<br />
=== 5.1.2 The sputum booth shall not align with commonly viewed items such as notice boards, monitors, televisions etc. ===<br />
<br />
=== 5.1.3 The CEOs or infection control managers of the facilities of sections 5.1.3 shall allocate the exact installation location within the facility. ===<br />
<br />
=== 5.1.4 The contractor shall allow in his tender price for the transportation costs of booths to installation sites. ===<br />
<br /><br />
<br />
= 6 Commissioning =<br />
<br />
== 6.1 Testing responsibility ==<br />
<br />
=== 6.1.1 The contractor shall allow in his tender price for the services of appropriately certified commissioning technicians or engineers. ===<br />
<br />
== 6.2 Airflow direction tests ==<br />
<br />
=== 6.2.1 Airflow direction tests to confirm negative booth pressure shall be conducted as per ISO 14644:3 section B8. ===<br />
<br />
== 6.3 Booth ventilation rate ==<br />
<br />
=== 6.3.1 Booth ventilation rate shall be tested as per ISO 14644:3 for non-unidirectional airflow system. The test shall be conducted at the exhaust air terminal. ===<br />
<br />
== 6.4 HEPA Filter integral efficiency test ==<br />
<br />
=== 6.4.1 HEPA Filter integral efficiency test shall be as per ISO 14644:3. ===<br />
<br />
=== 6.4.2 Challenge aerosol particle size shall be as per ISO 14644:3 section B.6.2.2 ===<br />
<br />
=== 6.4.3 Challenge aerosol concentration in the booth shall be as per ISO 14644:3 section B.6.2.3. ===<br />
<br />
= 7 MAINTENANCE AND PERFORMANCE MONITORING =<br />
<br />
=== 7.1.1 The contractor shall maintain good working order of the sputum collection booth for 2 years after installation. ===<br />
<br />
=== 7.1.2 Fully comprehensive two year maintenance and monitoring plan including all costs shall be provided by the contractor. ===<br />
<br />
=== 7.1.3 The maintenance plan shall include maintenance activities and performance monitoring. ===<br />
<br />
= 8 GUARANTEE PERIODS =<br />
<br />
=== 8.1.1 The contractor shall guarantee that spare parts will be available for the expected lifetime of the sputum collection booth and for a period of at least ten years from procurement date. ===<br />
<br />
=== 8.1.2 The guarantee must cover all items against manufacturing defects, installation, commissioning, materials and workmanship. Should manufacturing defects be detected within a 30-day period, the supplier shall replace the equipment with a new one. ===<br />
<br />
=== 8.1.3 Contractors are obliged to refund, repair or replace the failed, unsafe and defective goods. ===<br />
<br />
= 9 Documentation =<br />
<br />
=== 9.1.1 The following reports and records shall be provided upon handover: ===<br />
1) Manual including:<br />
<br />
a) Operating instructions<br />
<br />
b) Maintenance schedule and instructions<br />
<br />
c) Shop drawings<br />
<br />
d) All tests reports<br />
<br />
e) Material data sheets<br />
<br />
f) Equipment data sheets<br />
<br />
g) Decommissioning and disposal plan<br />
<br />
= 10 TRAINING =<br />
<br /><br />
<br />
=== 10.1.1 Training of onsite maintenance personnel and sister in charge by the contractor in the operation, dismantling and cleaning of the sputum collection booth shall be included in the offer. ===</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=5884Guidelines for safe sputum collection2020-10-13T10:13:43Z<p>Tkumirai: minor</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref name=":3">Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Outdoor sputum collection site===<br />
The outdoor naturally sputum collection site should be located away from people and open doors. The TB services guideline<ref name=":3" /> recommends a distance of at least 4m away from the buildings. An example outdoor sputum collection site is shown in Appendix B.<br />
<br /><br />
<br />
=== Factors to consider when procuring sputum booth ===<br />
This guideline proposes an initial sputum collection risk assessment to be conducted before procuring a new sputum collection facility. The decision chart below can be used to establish the necessity for the procurement of a sputum collection facility and for the procurement of an appropriate sputum collection device.<br />
<br />
<br />
<br />
<br /><br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4952Guidelines for safe sputum collection2020-08-07T10:15:16Z<p>Tkumirai: Table 3</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|Enclosure and exterior LEV and sputum room<br />
|Daily<br />
|Facility maintenance personnel<br />
|-<br />
|Check fan failure<br />
|Enclosure and exterior LEV and sputum room<br />
|Weekly<br />
|Facility maintenance personnel<br />
|-<br />
|Replace fan<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacturer's maintenance manual<br />
|Qualified engineering specialist<br />
|-<br />
|Replace HEPA filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When HEPA filter pressure gauge above 500Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pre filter<br />
|Enclosure and exterior LEV and sputum room<br />
|When filter pressure gauge is above 250Pa<br />
|Qualified engineering specialist<br />
|-<br />
|Replace pressure gauges<br />
|Enclosure and exterior LEV and sputum room<br />
|As needed according to manufacture's maintenance manual<br />
|Qualified engineering specialist<br />
|}<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4951Guidelines for safe sputum collection2020-08-07T10:05:56Z<p>Tkumirai: new section</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
*It should be mechanically ventilated.<br />
*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
*The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in section 2.2.<br />
|<br />
*Provides complete separation between staff and patients<br />
*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
*Separate designated room required<br />
*If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
*Room ventilation system must be monitored to ensure proper operation<br />
*Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|<br />
|<br />
|<br />
|-<br />
|Check fan failure<br />
|<br />
|<br />
|<br />
|-<br />
|Replace fan<br />
|<br />
|<br />
|<br />
|-<br />
|Replace HEPA filter<br />
|<br />
|<br />
|<br />
|-<br />
|Replace pre filter<br />
|<br />
|<br />
|<br />
|-<br />
|Replace pressure gauges<br />
|<br />
|<br />
|<br />
|}<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4950Guidelines for safe sputum collection2020-08-07T10:04:27Z<p>Tkumirai: Sputum collection room info</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
This room should meet the following requirements:<br />
<br />
* It should be mechanically ventilated.<br />
* It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.<br />
* The ventilation rate of the room should be at least 12 ACH.<br />
<br />
<br /><br />
{| class="wikitable"<br />
|Engineering control measure<br />
|Advantages<br />
|Disadvantages<br />
|-<br />
|Sputum Induction Rooms<br />
<br />
The room should meet all the requirements stated in sectionxxxxx<br />
|<br />
* Provides complete separation between staff and patients<br />
* If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.<br />
|<br />
* Separate designated room required<br />
* If a negative pressure isolation room is not available, these rooms require installation of dedicated exhaust systems or HEPA filtration systems prior to recirculation of air.<br />
* Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.<br />
* Room ventilation system must be monitored to ensure proper operation<br />
* Most expensive option if an existing negative pressure isolation room is not available<br />
|}<br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|<br />
|<br />
|<br />
|-<br />
|Check fan failure<br />
|<br />
|<br />
|<br />
|-<br />
|Replace fan<br />
|<br />
|<br />
|<br />
|-<br />
|Replace HEPA filter<br />
|<br />
|<br />
|<br />
|-<br />
|Replace pre filter<br />
|<br />
|<br />
|<br />
|-<br />
|Replace pressure gauges<br />
|<br />
|<br />
|<br />
|}<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4934Guidelines for safe sputum collection2020-08-07T07:56:38Z<p>Tkumirai: Added maintenance section</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
The required maintenance activities, interval, responsible person are detailed in Table 3.<br />
{| class="wikitable"<br />
|Maintenance activity<br />
|Engineering control<br />
|Time interval<br />
|Responsible person<br />
|-<br />
|Visual inspection of pressure gauges for HEPA and pre-filters<br />
|<br />
|<br />
|<br />
|-<br />
|Check fan failure<br />
|<br />
|<br />
|<br />
|-<br />
|Replace fan<br />
|<br />
|<br />
|<br />
|-<br />
|Replace HEPA filter<br />
|<br />
|<br />
|<br />
|-<br />
|Replace pre filter<br />
|<br />
|<br />
|<br />
|-<br />
|Replace pressure gauges<br />
|<br />
|<br />
|<br />
|}<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4933Guidelines for safe sputum collection2020-08-07T07:41:55Z<p>Tkumirai: Test methods</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.4.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.4.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
==='''Test Methods'''===<br />
<br />
===='''Air pressure difference test'''====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
===='''Total air flow rate measurement'''====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
===='''Airflow direction and visualisation'''====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
===='''Installed HEPA filter system leakage'''====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4932Guidelines for safe sputum collection2020-08-07T07:39:36Z<p>Tkumirai: Test methods</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.3.1.1<br />
|'''Electronic micromanometer, mechanical differential pressure gauge (magnehelic gauge)'''<br />
|'''Greater than -2.5Pa'''<ref name=":2">Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R, Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004.</ref>'''.'''<br />
|-<br />
|Total air flow rate measurement<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.3.1.2<br />
|'''Flowhood with flowmeter or a combination of flowhood and anemometer (thermal or vane)'''<br />
|'''Greater than or equal to 12 ACH for sputum induction room'''<ref name=":2" />'''.'''<br />
|-<br />
|Airflow direction and visualisation<br />
|'''Sputum induction room, Enclosure LEV'''<br />
|'''Daily inspection'''<br />
|2.3.1.3<br />
|'''Silk thread, Smoke Tubes, nicotine free electronic cigarettes.'''<br />
|'''Air should flow into the room and into LEV'''<ref name=":2" /><br />
|-<br />
|Installed HEPA filter system leakage<br />
|'''Enclosure LEV'''<br />
|'''Once every 6 months'''<br />
|2.3.1.4<br />
|'''Aerosol generator as per ISO 14644:3 section C.6.3 and aerosol photometer'''<br />
|'''Filter penetration should not exceed 0,05% as per EN1822 standard.'''<br />
|}<br />
<br />
=== '''Test Methods''' ===<br />
<br />
==== '''Air pressure difference test''' ====<br />
The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.<br />
<br />
==== '''Total air flow rate measurement''' ====<br />
Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.<br />
<br />
==== '''Airflow direction and visualisation''' ====<br />
The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.<br />
<br />
==== '''Installed HEPA filter system leakage''' ====<br />
The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=4931Guidelines for safe sputum collection2020-08-07T07:22:01Z<p>Tkumirai: Added test methods</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing of LEV devices and sputum collection room'''===<br />
Testing and monitoring of the LEV devices and sputum collection rooms is done to ensure correct continued operation of the systems.<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Air pressure difference<br />
|<br />
|<br />
|2.3.1.1<br />
|<br />
|<br />
|-<br />
|Total air flow rate measurement<br />
|<br />
|<br />
|2.3.1.2<br />
|<br />
|<br />
|-<br />
|Airflow direction and visualisation<br />
|<br />
|<br />
|2.3.1.3<br />
|<br />
|<br />
|-<br />
|Installed HEPA filter system leakage<br />
|<br />
|<br />
|2.3.1.4<br />
|<br />
|<br />
|}<br />
'''Test Methods'''<br />
<br />
'''Air pressure difference test'''<br />
<br />
'''The test is perfomed to verify the capability of the enclosure LEV and sputum induction room to maintain the specified pressure difference with respect to adjacent spaces. The test should be done with all doors closed. Permanent measuring points should be installed.''' <br />
<br />
'''Total air flow rate measurement'''<br />
<br />
'''Measurement of total airflow rate is carried out to calculate the clean air volume supplied to the Sputum induction room and Enclosure LEV per unit time, and this value can be used to calculate the air changes per unit time and airborne particle clearance times.''' <br />
<br />
'''Airflow direction and visualisation'''<br />
<br />
'''The purpose of airflow direction tests and visualisation is to confirm that the airflow direction conform to the design and performance specification and also to test for stagnant zones of sputum induction room and Enclosure LEV.''' <br />
<br />
'''Installed HEPA filter system leakage'''<br />
<br />
'''The test is perfomed to confirm that the HEPA filter is properly installed by verifying the absence of bypass leakage in the installation and that the filter is free of defects (small holes and damages in the filter medium and frame seal). The test is perfomed by introducing a 0.5µm to 0.7µm (as per ISO 14644:3 section B.6.2.2) aerosol upstream and scanning downstream of the filter.'''<br />
<br />
<br />
===='''Maintenance of LEV devices and sputum collection room'''====<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
===Operation procedure and waiting time between usage: '''LEV devices and sputum collection room'''===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
====Privacy====<br />
<br /><br />
<br />
===Decision chart for procurement===<br />
<br />
===References===<br />
<references /><br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:Infection Prevention and Control]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2357Guidelines for safe sputum collection2020-06-18T21:51:59Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing and monitoring of LEV devices and sputum collection room'''===<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Airflow direction<br />
|<br />
|<br />
|2.3.1.1<br />
|<br />
|<br />
|-<br />
|Air pressure difference test<br />
|<br />
|<br />
|2.3.1.2<br />
|<br />
|<br />
|-<br />
|Airflow test<br />
|<br />
|<br />
|2.3.1.3<br />
|<br />
|<br />
|-<br />
|HEPA Filter integral efficiency<br />
|<br />
|<br />
|2.3.1.4<br />
|<br />
|<br />
|-<br />
|Filter pressure<br />
|<br />
|<br />
|2.3.1.5<br />
|<br />
|<br />
|}<br />
<br />
===='''Test Methods'''====<br />
<br />
=====Airflow direction=====<br />
<br />
=====Air pressure difference=====<br />
<br />
=====Airflow test=====<br />
<br />
=====HEPA Filter integral efficiency=====<br />
<br />
=====Filter pressure=====<br />
<br />
==='''Maintenance of LEV devices and sputum collection room'''===<br />
<br />
===Location of '''LEV devices and sputum collection room'''===<br />
<br />
=== Operation procedure and waiting time between usage: '''LEV devices and sputum collection room''' ===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
===Location of outdoor site===<br />
<br />
==== Privacy ====<br />
<br /><br />
<br />
=== Decision chart for procurement ===<br />
<br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2356Guidelines for safe sputum collection2020-06-18T21:37:55Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing and monitoring of LEV devices and sputum collection room'''===<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Airflow direction<br />
|<br />
|<br />
|2.3.1.1<br />
|<br />
|<br />
|-<br />
|Air pressure difference test<br />
|<br />
|<br />
|2.3.1.2<br />
|<br />
|<br />
|-<br />
|Airflow test<br />
|<br />
|<br />
|2.3.1.3<br />
|<br />
|<br />
|-<br />
|HEPA Filter integral efficiency<br />
|<br />
|<br />
|2.3.1.4<br />
|<br />
|<br />
|-<br />
|Filter pressure<br />
|<br />
|<br />
|2.3.1.5<br />
|<br />
|<br />
|}<br />
<br />
===='''Test Methods'''====<br />
<br />
=====Airflow direction=====<br />
<br />
=====Air pressure difference=====<br />
<br />
=====Airflow test=====<br />
<br />
=====HEPA Filter integral efficiency=====<br />
<br />
=====Filter pressure=====<br />
<br />
=== '''Maintenance of LEV devices and sputum collection room''' ===<br />
<br />
=== Location of '''LEV devices and sputum collection room''' ===<br />
<br />
==='''Outdoor naturally ventilated sputum collection site'''===<br />
<br />
=== Location of outdoor site ===<br />
<br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2355Guidelines for safe sputum collection2020-06-18T21:18:06Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing and monitoring of LEV devices and sputum collection room'''===<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Airflow direction<br />
|<br />
|<br />
|2.3.1.1<br />
|<br />
|<br />
|-<br />
|Air pressure difference test<br />
|<br />
|<br />
|2.3.1.2<br />
|<br />
|<br />
|-<br />
|Airflow test<br />
|<br />
|<br />
|2.3.1.3<br />
|<br />
|<br />
|-<br />
|HEPA Filter integral efficiency<br />
|<br />
|<br />
|2.3.1.4<br />
|<br />
|<br />
|-<br />
|Filter pressure<br />
|<br />
|<br />
|2.3.1.5<br />
|<br />
|<br />
|}<br />
<br />
===='''Test Methods'''====<br />
<br />
=====Airflow direction=====<br />
<br />
=====Air pressure difference=====<br />
<br />
=====Airflow test=====<br />
<br />
=====HEPA Filter integral efficiency=====<br />
<br />
=====Filter pressure=====<br />
<br /><br />
<br />
=== '''Outdoor naturally ventilated sputum collection site''' ===<br />
<br /><br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2354Guidelines for safe sputum collection2020-06-18T21:08:12Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing and monitoring of LEV devices and sputum collection room'''===<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Airflow direction<br />
|<br />
|<br />
|2.3.1.1<br />
|<br />
|<br />
|-<br />
|Air pressure difference test<br />
|<br />
|<br />
|2.3.1.2<br />
|<br />
|<br />
|-<br />
|Airflow test<br />
|<br />
|<br />
|2.3.1.3<br />
|<br />
|<br />
|-<br />
|HEPA Filter integral efficiency <br />
|<br />
|<br />
|2.3.1.4<br />
|<br />
|<br />
|-<br />
|Filter pressure<br />
|<br />
|<br />
|2.3.1.5<br />
|<br />
|<br />
|}<br />
<br />
===='''Test Methods'''====<br />
<br />
=====Airflow direction=====<br />
<br />
=====Air pressure difference=====<br />
<br />
=====Airflow test=====<br />
<br />
===== HEPA Filter integral efficiency =====<br />
<br />
===== Filter pressure =====<br />
<br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2353Guidelines for safe sputum collection2020-06-18T21:02:22Z<p>Tkumirai: </p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
==='''Testing and monitoring of LEV devices and sputum collection room'''===<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Airflow direction<br />
|<br />
|<br />
|2.3.1.1<br />
|<br />
|<br />
|-<br />
|Air pressure difference test<br />
|<br />
|<br />
|2.3.1.2<br />
|<br />
|<br />
|-<br />
|Airflow test<br />
|<br />
|<br />
|2.3.1.3<br />
|<br />
|<br />
|-<br />
|<br />
|<br />
|<br />
|2.3.1.4<br />
|<br />
|<br />
|}<br />
<br />
===='''Test Methods'''====<br />
<br />
=====Airflow direction=====<br />
<br />
=====Air pressure difference=====<br />
<br />
=====Airflow test=====<br />
<br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2352Guidelines for safe sputum collection2020-06-18T20:59:50Z<p>Tkumirai: Tets</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
==='''Sputum collection room'''===<br />
<br /><br />
<br />
=== '''Testing and monitoring of LEV devices and sputum collection room''' ===<br />
{| class="wikitable"<br />
|+<br />
!Test<br />
!Engineering control<br />
!Recommended frequency of testing<br />
!Test method<br />
!Apparatus<br />
!Perfomance specification guideline/ standard<br />
|-<br />
|Airflow direction<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|-<br />
|Air pressure difference test<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|-<br />
|Airflow test<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|-<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|<br />
|}<br />
<br />
==== '''Test Methods''' ====<br />
<br />
===== Airflow direction =====<br />
<br />
===== Air pressure difference =====<br />
<br />
===== Airflow test =====<br />
<br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2351Guidelines for safe sputum collection2020-06-18T18:46:15Z<p>Tkumirai: Addeded more references</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum collection/induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref name=":0">Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref name=":1">Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan <ref name=":1" />. Burgess, et al.,<ref name=":0" /> identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior <ref name=":0" />.<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control <ref name=":0" />.<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device <ref name=":0" />.<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum collection rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room.<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as exterior LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust <ref name=":0" />.<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured <ref name=":0" />.<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures.<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br />
=== '''Sputum collection room''' ===<br />
<br />
<br />
===References===<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2350Guidelines for safe sputum collection2020-06-18T16:09:29Z<p>Tkumirai: Addeded more references</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities <ref>Infrastructure Unit Support Systems (IUSS), 2014. IUSS HEALTH FACILITY GUIDES: TB Services. South Africa. National Department of Health.</ref>. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space <ref>Burgess, W.A., Ellenbecker, M.J., and Treitman, R.D. 2004. Ventilation for control of the work environment. Second edition. New Jersey USA. John Wiley & Sons</ref><ref>Heinsohn, P. 1996. Tuberculosis resources guide CEC Report CR 106146. Carlifonia. USA. Heinsohn Consulting services.</ref>. The basic components of an LEV device are hood, ductwork, air cleaner and fan [5]. Burgess, et al., [4] identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior [4].<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control [4].<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device [4].<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room regardless of room ventilation system<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as external LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust [4].<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured [4].<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br /><br />
==References==<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2349Guidelines for safe sputum collection2020-06-18T15:56:26Z<p>Tkumirai: Added title to table 1</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities [3]. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space [4,5]. The basic components of an LEV device are hood, ductwork, air cleaner and fan [5]. Burgess, et al., [4] identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br /><br />
<br />
Table 1. Comparison between enclosure and exterior LEV devices<br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
*Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior [4].<br />
*Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control [4].<br />
*An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device [4].<br />
*Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum rooms.<br />
*Devices with HEPA-filtered exhaust can be used in any room regardless of room ventilation system<br />
*Can be moved to accommodate room function changes.<br />
|<br />
*Cost is higher than external LEV device approximately R125 000.<br />
*Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
*Booths are not as portable as external LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
*Cost is relatively low compared to complete enclosures.<br />
*Portable, small enough to be used at patient’s bedside.<br />
|<br />
*Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust [4].<br />
*Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured [4].<br />
*Does not provide complete physical separation between patient and staff.<br />
*Requires more supervision of patient to ensure proper placement than complete enclosures<br />
*Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br /><br />
==References==<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2348Guidelines for safe sputum collection2020-06-18T15:53:10Z<p>Tkumirai: I have added Table 1</p>
<hr />
<div>{{Expand|reason=Article still under active review}}<br />
<br />
==Introduction==<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities [3]. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection.<br />
<br />
==Engineering control measures for sputum collection==<br />
There are two main types of engineering methodologies that can be utilized for sputum collection; local exhaust ventilation devices and sputum induction rooms.<br />
<br />
===Local exhaust ventilation devices===<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space [4,5]. The basic components of an LEV device are hood, ductwork, air cleaner and fan [5]. Burgess, et al., [4] identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]<br /><br />
{| class="wikitable"<br />
|'''Local Exhaust Ventilation device'''<br />
|'''Advantages'''<br />
|'''Disadvantages'''<br />
|-<br />
|'''''Enclosure'''''<br />
<br />
Contaminants are released from inside the LEV device. Example is a booth as illustrated in Figure 1.<br />
|<br />
* Complete physical separation between patient and staff which ensures negligible exposure to contaminants hence providing the greatest protection when compared to exterior [4].<br />
* Conserves energy when compared to the external LEV since it requires least amount of airflow to ensure adequate control [4].<br />
* An exhaust airflow is chosen sufficient to create a negative air pressure inside the LEV; this ensures that contaminated air will not escape from the device [4].<br />
* Contaminants are quickly captured due to high air change rates. Therefore shorter contaminants clearance times when compared to sputum rooms.<br />
* Devices with HEPA-filtered exhaust can be used in any room regardless of room ventilation system<br />
* Can be moved to accommodate room function changes.<br />
|<br />
* Cost is higher than external LEV device approximately R125 000.<br />
* Requires routine maintenance such as changing the HEPA filter and pre-filter.<br />
* Booths are not as portable as external LEV device.<br />
|-<br />
|'''''Exterior'''''<br />
<br />
Contaminants are released from outside the LEV device. Example is illustrated in Figure 2.<br />
<br /><br />
|<br />
* Cost is relatively low compared to complete enclosures.<br />
* Portable, small enough to be used at patient’s bedside.<br />
|<br />
* Exterior LEV devices are susceptible to cross-drafts which may completely disrupt their performance by disrupting the airflow patterns between the point of contaminant release and the exhaust [4].<br />
* Since the contaminants are released into the air surrounding an exterior LEV device and then captured, it is possible for a healthcare worker to be in the path between the contaminant source and the device, and be exposed to the contaminants before they are captured [4].<br />
* Does not provide complete physical separation between patient and staff.<br />
* Requires more supervision of patient to ensure proper placement than complete enclosures<br />
* Open windows or doors, or people moving in the area can create drafts, which disrupt the capture of airborne particles.<br />
|}<br />
<br /><br />
==References==<br />
<references /><br />
[[Category:Sputum Collection]]<br />
[[Category:Ventilation]]<br />
[[Category:Airborne Contamination Control]]<br />
[[Category:Articles to be expanded]]<br />
[[Category:TB-IPC]]</div>Tkumiraihttps://thehillside.info/index.php?title=File:Inside_view_of_booth.jpg&diff=2340File:Inside view of booth.jpg2020-06-18T15:16:01Z<p>Tkumirai: </p>
<hr />
<div>Inside view of booth</div>Tkumiraihttps://thehillside.info/index.php?title=Guidelines_for_safe_sputum_collection&diff=2339Guidelines for safe sputum collection2020-06-18T15:01:38Z<p>Tkumirai: </p>
<hr />
<div>==Guidelines for safe sputum collection: Healthcare facilities==<br />
<br />
==='''Introduction'''===<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis <ref>Hansen, D. J., 1993. The Work Environment: Healthcare, Laboratories and Biosafety, Volume 2. Lewis publishers: USA.</ref>; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly <ref>Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17).</ref>; therefore, there is need to administer sputum collection safely in healthcare facilities [3]. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection. <br />
<br />
==='''Engineering control measures for sputum collection'''===<br />
There are two main types of engineering methodologies that can be utilised for sputum collection; local exhaust ventilation devices and sputum induction rooms.<br />
<br />
Local exhaust ventilation devices<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space [4,5]. The basic components of an LEV device are hood, ductwork, air cleaner and fan [5]. Burgess, et al., [4] identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.<br />
[[File:Mechanical sputum booth.jpg|none|thumb|Mechanical sputum booth]]<br />
<references /></div>Tkumiraihttps://thehillside.info/index.php?title=Talk:Main_Page&diff=2329Talk:Main Page2020-06-18T07:53:40Z<p>Tkumirai: </p>
<hr />
<div>== Guidelines for safe sputum collection: Healthcare facilities ==<br />
<br />
'''Introduction'''<br />
<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis [1]; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly [2]; therefore, there is need to administer sputum collection safely in healthcare facilities [3]. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission. <br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. Although there is a three level hierarchy of control measures; administrative controls, engineering controls and personal respiratory protection to prevent transmission of TB, this guideline is limited to engineering control measures for sputum collection. <br />
<br />
'''Engineering control measures for sputum collection'''<br />
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There are two main types of engineering methodologies that can be utilised for sputum collection; local exhaust ventilation devices and sputum induction rooms.<br />
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Local exhaust ventilation devices<br />
Local exhaust ventilation devices capture of airborne contaminants at or near the source before they are dispersed into the work space [4,5]. The basic components of an LEV device are hood, ductwork, air cleaner and fan [5]. Burgess, et al., [4] identifies two major categories of LEV devices; enclosures and exterior. The major difference between these two is that for enclosures, contaminants are released from inside the device whereas for exterior contaminants are released outside the device. A sputum booth is considered as an example of an enclosure LEV device. Illustrations of an enclosure and exterior LEV devices are shown in Figures 1 and 2 respectively. Figure 1 shows a CSIR designed sputum booth. Technical specifications for the booth that can be used for procurement are included in Appendix A.</div>Tkumiraihttps://thehillside.info/index.php?title=Talk:Main_Page&diff=2219Talk:Main Page2020-06-17T10:55:16Z<p>Tkumirai: </p>
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<div>== Guidelines for safe sputum collection: Healthcare facilities ==<br />
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Introduction<br />
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Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis [1]; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly [2]; therefore, there is need to administer sputum collection safely in healthcare facilities [3]. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission.<br />
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This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. It covers the appropriate engineering control measures.</div>Tkumiraihttps://thehillside.info/index.php?title=Talk:Main_Page&diff=2218Talk:Main Page2020-06-17T10:53:42Z<p>Tkumirai: /* Guidelines for safe sputum collection: Healthcare facilities */ new section</p>
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<div>== Guidelines for safe sputum collection: Healthcare facilities ==<br />
<br />
Introduction<br />
<br />
Sputum specimen examination is the main diagnostic procedure for pulmonary Tuberculosis [1]; however, the medical procedure (patient coughing) that is used for sputum collection increases the potential for transmission of M. Tuberculosis significantly [2]; therefore, there is need to administer sputum collection safely in healthcare facilities [3]. The CSIR’s Infrastructure Innovation research group has conducted many TB risk assessments in South African public healthcare facilities for over 10 years. A common finding was that engineering controls for sputum collection were not always adequate, maintained or monitored. Sputum was observed to be collected from toilets, consulting rooms and counselling rooms which implies increased risk of TB transmission.<br />
<br />
This guideline provide guidance on conducting sputum collection safely for suspected or known infectious TB patients. It covers the appropriate administrative and engineering control measures.</div>Tkumirai