The most valuable lesson for Kerala from last year’s outbreak of Nipah virus infection was the importance of adequate infection control practices in health facilities, especially airborne infection control measures.
The epidemiological analysis of Nipah outbreak revealed that of the 23 cases of NiV reported, 18 persons (patients, staff or visitors) had contracted it from two hospitals where the index case (the first infectious case to be documented) had been admitted. Apart from the lack of personal protection measures such as masks or gloves, crowded hospital environment and ill-ventilated settings were what had fuelled disease transmission.
TB and H1NI
These lessons have great relevance when it comes to the transmission of other airborne infectious diseases like tuberculosis and H1N1. On World TB Day on March 24, Kerala is focussing on the prevention and control of airborne infections in all its health facilities.
“Even though the National Airborne Infection Control (AIC) guidelines were adopted in India in 2010, our infection control practices continue to be restricted to biomedical waste management,” points out P. S. Rakesh, State’s WHO consultant for Revised National Tuberculosis Control Programme (RNTCP).
In the post-Nipah scenario, the Health Department has now initiated a major drive to up airborne infection control strategies in all its hospitals.
As part of the State TB Risk Elimination Plan, a health facility risk assessment for airborne infections is being undertaken in all hospitals. Medical colleges, are however, yet to catch up.
“Natural ventilation is very effective in reducing infectious particles in the air but we found that in most of our public hospitals, despite good cross ventilation facilities, the windows are seldom opened or these are restricted by huge cupboards. We are now helping these hospitals make engineering changes wherever possible and educating them on maximising the natural ventilation,” Dr. Rakesh says.
Directions have already gone out to screen patients coming into emergency rooms with respiratory symptoms and to send them to ‘Cough corners,’ where they will be given three-layer protective masks and all instructions regarding why and how the masks should be worn.
Training is already on for all health-care workers on the importance of infection control measures and the proper use of personal protection equipment (PPE) and when they should be using the N 95 high protection masks .
The department is also planning to launch a major community awareness campaign, titled ‘Handkerchief Revolution,’ to promote cough etiquette and to deliver the message on how small behavioural changes can have a huge impact in the community.