t © Tobias Arhelger - Fotolia/Adobe Stock.
INFECTION PREVENTION
Tackling the threat of tuberculosis
The World Health Organization is calling for increased efforts and investment to end one of the world’s oldest and deadliest diseases. But have we become complacent about the threat posed by TB in the UK? Are healthcare workers prepared for the risk of outbreaks and what are they doing to protect themselves and their patients? Louise Frampton reports.
According to figures from Public Health England, there has been a year-on-year decline in the incidence of TB in England and a reduction of one-third since a peak in 2011.1
The number and proportion of TB cases with multi-drug resistance/rifampicin resistance has also decreased since 2011. While this offers some good news for the UK population, at present, an expert on infection outbreaks recently warned that, with the “world on the move”, we cannot afford to be complacent and must be prepared to tackle the threat posed by TB – including nosocomial transmission in UK hospitals.2 The World Health Organization (WHO) has also called for greater efforts to reduce deaths and cases of TB on a global scale, highlighting the considerable inequalities in access to cost-effective diagnosis and treatment interventions that can accelerate the rate of decline in TB worldwide.
Is nosocomial TB a problem?
Speaking at the Infection Prevention Society’s annual conference, Dr Evonne Curran commented that, although the risk of transmission of TB in UK hospitals is currently low, it is a significant threat to those infected, requiring lengthy treatment. This can be prolonged even further if the infection is drug resistant. If the “ducks are in a row, TB is a high risk to everybody,” she warned, adding that “the ducks are
Given the right conditions, TB could become a significant problem and cause of mortality in our hospitals.
FEBRUARY 2017
starting to come into alignment.” Previously the lead on the outbreak programme of work at Health Protection Scotland, Dr Evonne Curran is an independent nurse consultant at Infection Control Nursing Consultancy. She commented that she felt like “a single red tulip in a field of white tulips” when raising concerns over the risk posed by hospital-acquired TB. The subject is not the focus of attention for many and there is a tendency for people to bring their own biases to the discussion. Some of the biases that people exhibit include: ‘it’s not a significant problem in the UK’; ‘it is a disease of the poor, undernourished and those living in cramped conditions’; ‘it is a disease of people with hazardous lifestyles’ or ‘it is not a nosocomial disease because I’ve been nursing TB patients for years and I’ve never caught it’. Dr Curran commented that the “greatest predictor of future behaviour is past behaviour” and this also applies to organisms. Given the right conditions, TB could become a significant problem and cause of mortality in our hospitals, she argued.
Prevalence
Public Health England figures for 2015 show that the number of cases of TB to be down to 10.5 per 100,000 of the population (5,758 cases) in 2015.1
While prevalence is
not increasing in the UK, the demographic is changing and there needs to be greater awareness, said Dr Curran. She pointed out that the distribution of cases, geographically, is not ‘even’ – across the country, with cases concentrated in some cities. The burden of TB, globally, is also unevenly distributed. TB is a significant problem across the
world, particularly in lower and middle income countries. Six countries account for 60% of the total burden, with India bearing the brunt, followed by Indonesia, China, Nigeria, Pakistan and South Africa. While the UK is not a ‘top ten country for TB’, it is a top ten cause of death in some countries. In some areas, there is a high incidence of TB, a high level of drug resistance and a high incidence of HIV. “TB is perhaps less of a problem for the UK, compared to some countries,” said Dr Curran, “However, the world moves and
WWW.CLINICALSERVICESJOURNAL.COM I 27
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
