TB KaSPar
Feedback
Class I BSCs work by drawing unfiltered room air in through a front opening, passing it over the work surface, and then expelling it through an exhaust duct.
Class I BSCs protect workers but do not protect work products (such as specimens or cultures) against contamination because unsterilized room air is drawn over the work surface.
The two types of BSCs described below are best suited for use in moderate-risk laboratories and in high-risk laboratories (TB-containment laboratories).
Class I
• This type of BSC provides personal and environmental protection but does not offer product protection. This lack of product protection may contribute to increased contamination rates, especially when preparing and inoculating liquid cultures (see Figure 1).
Class II
To address specific potential risks, the following biosafety requirements¹⁴ ¹⁵ should be established in a low-risk TB laboratory.
1. Use of bench spaces: The bench used to process specimens for direct sputum-smear microscopy or the Xpert MTB/RIF assay should be separate from areas used to receive specimens and from administrative areas used for paperwork and telephones.
The WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment include recommendations for the four milestones in the cascade of preventive care, namely identification of risk groups, TB screening and ruling out TB, testing for TBI, and choice and administration of the TPT regimen. The second edition of the TPT guidelines will have the same scope.
Overall, serious adverse events leading to death or requiring withdrawal of TPT occur rarely. It is nevertheless critical to identify any sign of drug toxicity as soon as possible and to manage it immediately, particularly because people on TPT are usually healthy. Unmanaged drug toxicity may not only harm individuals but can also damage the reputation of a programme and result in widescale suspension of TPT due to loss of public confidence. As in any preventive action, health-care providers must weigh the risks and benefits of TPT for each individual.
Giving TPT to someone who has TB disease can delay resolution of disease and favour the emergence of drug resistance. Excluding TB disease before initiating preventive treatment is one of the critical steps in the TBI care pathway. This section proposes approaches for ruling out TB disease and diagnosing TBI in people at risk of TB according to HIV status, symptoms, household contact, other risk factors, age, TBI test results and abnormality on CXR (Fig.1).
The Global Tuberculosis Programme of the World Health Organization (WHO) gratefully acknowledges the contributions that many individuals and organizations (listed in Web Annex A) have made to the development of these guidelines.
Individuals receiving TPT should be monitored at every contact with health-care providers. It is important to determine non-adherence as early as possible in order to take corrective action. Monitoring is particularly important at the beginning of treatment, when people are getting used to the routine and their medication. Afterwards, monitoring may be done monthly or more frequently as required for care of people on TPT or as per national policy.
Laboratory staff should be trained to remove their gloves by following these steps:
1. peel one glove off by grasping it under the cuff and rolling the glove off the hand so that it comes off inside out. This keeps most of the contamination inside;
2. hold the used glove in the opposite still-gloved hand. Carefully slip exposed fingers under the cuff of the gloved hand, being careful not to touch the surface of the contaminated glove. Peel the glove off, inside out, rolling it over the other used glove to form a bag of used gloves with contamination inside.