Guidelines for safe sputum collection - Revision history

Tkumirai at 07:05, 19 October 2020

2020-10-19T07:05:55Z

← Older revision		Revision as of 09:05, 19 October 2020
Line 131:		Line 131:

	===='''Maintenance of LEV devices and sputum collection room'''====		===='''Maintenance of LEV devices and sputum collection room'''====
	The required maintenance activities, interval, responsible person are detailed in Table 3.		The required maintenance activities, interval, responsible person are detailed in Table below.
	{\| class="wikitable"		{\| class="wikitable"
	\|Maintenance activity		\|Maintenance activity
Line 170:		Line 170:

	===Outdoor sputum collection site===		===Outdoor sputum collection site===
	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~~.		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 />

Tkumirai at 07:01, 19 October 2020

2020-10-19T07:01:47Z

← Older revision		Revision as of 09:01, 19 October 2020
Line 9:		Line 9:

	===Local exhaust ventilation devices===		===Local exhaust ventilation devices===
	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.]]		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.]]
	[[File:Mechanical sputum booth.jpg\|none\|thumb\|Mechanical sputum booth]]~~Table 1 gives a comparison~~ between enclosure and exterior LEV devices.<br />		[[File:Mechanical sputum booth.jpg\|none\|thumb\|Mechanical sputum booth]]Comparison between enclosure and exterior LEV devices is shown in Table below.<br />


	~~Table 1.~~ Comparison between enclosure and exterior LEV devices		Comparison between enclosure and exterior LEV devices
	{\| class="wikitable"		{\| class="wikitable"
	\|'''Local Exhaust Ventilation device'''		\|'''Local Exhaust Ventilation device'''
Line 21:		Line 21:
	\|'''''Enclosure'''''		\|'''''Enclosure'''''

	Contaminants are released from inside the LEV device. Example is ~~a booth as illustrated in Figure 1~~.		Contaminants are released from inside the LEV device. Example Mechanical sputum booth is shown above.
	\|		\|
	*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" />.		*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" />.
Line 36:		Line 36:
	\|'''''Exterior'''''		\|'''''Exterior'''''

	Contaminants are released from outside the LEV device. Example is illustrated ~~in Figure 2~~.		Contaminants are released from outside the LEV device. Example exterior LEV is illustrated above.<br />
	<br />
	\|		\|
	*Cost is relatively low compared to complete enclosures.		*Cost is relatively low compared to complete enclosures.

Tkumirai at 06:33, 19 October 2020

2020-10-19T06:33:13Z

← Older revision		Revision as of 08:33, 19 October 2020
Line 176:		Line 176:
	===Factors to consider when procuring sputum booth===		===Factors to consider when procuring sputum booth===
	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 />		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 />
	[[File:Process to follow when procuring sputum collection facility.jpg\|thumb\|548x548px\|Process to follow when procuring sputum collection facility]]		[[File:Process to follow when procuring sputum collection facility.jpg\|thumb\|548x548px\|Process to follow when procuring sputum collection facility\|alt=\|left]]

Tkumirai: MINOR

2020-10-18T19:17:03Z

MINOR

← Older revision		Revision as of 21:17, 18 October 2020
Line 183:		Line 183:


	~~[[File:Process to follow when procuring sputum collection facility.jpg\|thumb\|548x548px\|Process to follow when procuring sputum collection facility]]~~

Tkumirai: minor

2020-10-18T15:34:26Z

minor

← Older revision		Revision as of 17:34, 18 October 2020
Line 11:		Line 11:
	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.]]		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.]]
	[[File:Mechanical sputum booth.jpg\|none\|thumb\|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br />		[[File:Mechanical sputum booth.jpg\|none\|thumb\|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br />


	Table 1. Comparison between enclosure and exterior LEV devices		Table 1. Comparison between enclosure and exterior LEV devices
Line 174:		Line 175:

	===Factors to consider when procuring sputum booth===		===Factors to consider when procuring sputum booth===
	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.		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 />
			[[File:Process to follow when procuring sputum collection facility.jpg\|thumb\|548x548px\|Process to follow when procuring sputum collection facility]]






			[[File:Process to follow when procuring sputum collection facility.jpg\|thumb\|548x548px\|Process to follow when procuring sputum collection facility]]











	~~<br />~~

	===References===		===References===

Tkumirai: Minor

2020-10-16T15:39:31Z

Minor

← Older revision		Revision as of 17:39, 16 October 2020
Line 9:		Line 9:

	===Local exhaust ventilation devices===		===Local exhaust ventilation devices===
	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~~.		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.]]
	[[File:Mechanical sputum booth.jpg\|none\|thumb\|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br />		[[File:Mechanical sputum booth.jpg\|none\|thumb\|Mechanical sputum booth]]Table 1 gives a comparison between enclosure and exterior LEV devices.<br />

Line 173:		Line 173:
	<br />		<br />

	=== Factors to consider when procuring sputum booth ===		===Factors to consider when procuring sputum booth===
	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.		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.

Tkumirai: minor

2020-10-13T10:13:43Z

minor

← Older revision		Revision as of 12:13, 13 October 2020
Line 2:		Line 2:

	==Introduction==		==Introduction==
	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.		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.
	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.		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.

Line 169:		Line 169:
	\|}		\|}

	===~~Location of '''LEV devices and~~ sputum collection ~~room'''~~===		===Outdoor sputum collection site===
			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 />

	===~~Operation procedure and waiting time between usage: '''LEV devices and~~ sputum ~~collection room'''~~===		=== Factors to consider when procuring sputum booth ===
			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.

	~~==='''Outdoor naturally ventilated sputum collection site'''===~~

	~~===Location of outdoor site===~~

	~~====Privacy====~~
	<br />		<br />

	~~===Decision chart for procurement===~~

	===References===		===References===

Tkumirai: Table 3

2020-08-07T10:15:16Z

Table 3

← Older revision		Revision as of 12:15, 7 August 2020
Line 139:		Line 139:
	\|-		\|-
	\|Visual inspection of pressure gauges for HEPA and pre-filters		\|Visual inspection of pressure gauges for HEPA and pre-filters
	\|		\|Enclosure and exterior LEV and sputum room
	\|		\|Daily
	\|		\|Facility maintenance personnel
	\|-		\|-
	\|Check fan failure		\|Check fan failure
	\|		\|Enclosure and exterior LEV and sputum room
	\|		\|Weekly
	\|		\|Facility maintenance personnel
	\|-		\|-
	\|Replace fan		\|Replace fan
	\|		\|Enclosure and exterior LEV and sputum room
	\|		\|As needed according to manufacturer's maintenance manual
	\|		\|Qualified engineering specialist
	\|-		\|-
	\|Replace HEPA filter		\|Replace HEPA filter
	\|		\|Enclosure and exterior LEV and sputum room
	\|		\|When HEPA filter pressure gauge above 500Pa
	\|		\|Qualified engineering specialist
	\|-		\|-
	\|Replace pre filter		\|Replace pre filter
	\|		\|Enclosure and exterior LEV and sputum room
	\|		\|When filter pressure gauge is above 250Pa
	\|		\|Qualified engineering specialist
	\|-		\|-
	\|Replace pressure gauges		\|Replace pressure gauges
	\|		\|Enclosure and exterior LEV and sputum room
	\|		\|As needed according to manufacture's maintenance manual
	\|		\|Qualified engineering specialist
	\|}		\|}

Tkumirai: new section

2020-08-07T10:05:56Z

new section

← Older revision		Revision as of 12:05, 7 August 2020
Line 51:		Line 51:
	This room should meet the following requirements:		This room should meet the following requirements:

	* It should be mechanically ventilated.		*It should be mechanically ventilated.
	* It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.		*It should be designed with negative air pressure with respect to adjacent spaces so that air flows from adjacent spaces into the room.
	* The ventilation rate of the room should be at least 12 ACH.		*The ventilation rate of the room should be at least 12 ACH.

	<br />		<br />
Line 63:		Line 63:
	\|Sputum Induction Rooms		\|Sputum Induction Rooms

	The room should meet all the requirements stated in ~~sectionxxxxx~~		The room should meet all the requirements stated in section 2.2.
	\|		\|
	* Provides complete separation between staff and patients		*Provides complete separation between staff and patients
	* If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.		*If a negative pressure isolation room is available, sputum induction can be done in this room with no additional ventilation equipment.
	\|		\|
	* Separate designated room required		*Separate designated room required
	* 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.		*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.
	* Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.		*Airborne particle clearance times will be high due to lower ACH rates when compared to enclosure LEV devices.
	* Room ventilation system must be monitored to ensure proper operation		*Room ventilation system must be monitored to ensure proper operation
	* Most expensive option if an existing negative pressure isolation room is not available		*Most expensive option if an existing negative pressure isolation room is not available
	\|}		\|}

Tkumirai: Sputum collection room info

2020-08-07T10:04:27Z

Sputum collection room info

@@ Line 49: / Line 49: @@
 ==='''Sputum collection room'''===
 <br />
 ==='''Testing of LEV devices and sputum collection room'''===