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1. An easy tool to assess ventilation in health facilities as part of air-borne transmission prevention: a cross-sectional survey from Uganda

Author

Miranda Brouwer, Achilles Katamba, Elly Tebasoboke Katabira, and Frank van Leth

Subjects
Ventilation, Infection control, Tuberculosis, Uganda, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background No guidelines exist on assessing ventilation through air changes per hour (ACH) using a vaneometer. The objective of the study was to evaluate the position and frequency for measuring air velocity using a vaneometer to assess ventilation with ACH; and to assess influence of ambient temperature and weather on ACH. Methods Cross-sectional survey in six urban health facilities in Kampala, Uganda. Measurements consisted of taking air velocity on nine separate moments in five positions in each opening of the TB clinic, laboratory, outpatient consultation and outpatient waiting room using a vaneometer. We assessed in addition the ventilation with the “20% rule”, and compared this estimation with the ventilation in ACH assessed using the vaneometer. Results A total of 189 measurements showed no influence on air velocity of the position and moment of the measurement. No significant influence existed of ambient temperature and a small but significant influence of sunny weather. Ventilation was adequate in 17/24 (71%) of all measurements. Using the “20% rule”, ventilation was adequate in 50% of rooms assessed. Agreement between both methods existed in 13/23 (56%) of the rooms assessed. Conclusion Most rooms had adequate ventilation when assessed using a vaneometer for measuring air velocity. A single vaneometer measurement of air velocity is adequate to assess ventilation in this setting. These findings provide practical input for clear guidelines on assessing ventilation using a vaneometer. Assessing ventilation with a vaneometer differs substantially from applying the “20% rule”.

Published
2017
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2. Results from early programmatic implementation of Xpert MTB/RIF testing in nine countries

Author

Lucica Ditiu, Jacob Creswell, Ahmed Bedru, Emmanuel André, Miranda Brouwer, E. Jane Carter, Sayera Banu, Rajendra-Prasad Yadav, Mark A. Micek, Andrew J. Codlin, Lucie Blok, Suvanand Sahu, Bishwa Rai, Andrei Mosneaga, UCL - SSS/IREC/MBLG - Pôle de Microbiologie médicale, UCL - (SLuc) Service de microbiologie, and Other departments

Subjects
Adult, Pathology, medicine.medical_specialty, Tuberculosis, Internationality, Rifampicin resistant, Xpert MTB/RIF, Convenience sample, Rifampicin resistance, Sensitivity and Specificity, Health Services Accessibility, Drug Resistance, Bacterial, medicine, Humans, Medical physics, Innovation, Antibiotics, Antitubercular, Tuberculosis, Pulmonary, Case detection, Project staff, business.industry, Drug resistant tuberculosis, New diagnostics, Mycobacterium tuberculosis, Research findings, medicine.disease, Infectious Diseases, Molecular Diagnostic Techniques, Case finding, Rifampin, business, Algorithms, Research Article
Abstract

Background The Xpert MTB/RIF assay has garnered significant interest as a sensitive and rapid diagnostic tool to improve detection of sensitive and drug resistant tuberculosis. However, most existing literature has described the performance of MTB/RIF testing only in study conditions; little information is available on its use in routine case finding. TB REACH is a multi-country initiative focusing on innovative ways to improve case notification. Methods We selected a convenience sample of nine TB REACH projects for inclusion to cover a range of implementers, regions and approaches. Standard quarterly reports and machine data from the first 12 months of MTB/RIF implementation in each project were utilized to analyze patient yields, rifampicin resistance, and failed tests. Data was collected from September 2011 to March 2013. A questionnaire was implemented and semi-structured interviews with project staff were conducted to gather information on user experiences and challenges. Results All projects used MTB/RIF testing for people with suspected TB, as opposed to testing for drug resistance among already diagnosed patients. The projects placed 65 machines (196 modules) in a variety of facilities and employed numerous case-finding strategies and testing algorithms. The projects consumed 47,973 MTB/RIF tests. Of valid tests, 7,195 (16.8%) were positive for MTB. A total of 982 rifampicin resistant results were found (13.6% of positive tests). Of all tests conducted, 10.6% failed. The need for continuous power supply was noted by all projects and most used locally procured solutions. There was considerable heterogeneity in how results were reported and recorded, reflecting the lack of standardized guidance in some countries. Conclusions The findings of this study begin to fill the gaps among guidelines, research findings, and real-world implementation of MTB/RIF testing. Testing with Xpert MTB/RIF detected a large number of people with TB that routine services failed to detect. The study demonstrates the versatility and impact of the technology, but also outlines various surmountable barriers to implementation. The study is not representative of all early implementer experiences with MTB/RIF testing but rather provides an overview of the shared issues as well as the many different approaches to programmatic MTB/RIF implementation.

Published
2014

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