Tuberculosis (TB) is one of the leading causes of death in South Africa, and has led to over 60 000 deaths notified in the country in 2010.
Since TB bacteria are spread via droplets, workplaces can be the perfect settings for people to become infected.
Directly Observed Therapy (DOT) is one of the most effective ways of managing TB. It can form the basis of a comprehensive treatment and prevention plan.
DOT underlines one of the three principles of TB control namely treatment and cure. The other principles are: prevention targeted at high-risk workplaces and individuals; prompt identification and diagnosis of TB; and regular and correct treatment and cure.
Prevention is crucial in managing the spread of TB among the workforce. Developing a workplace infection control plan is a consistent and sustainable way of ensuring businesses are equipped to deal with infection, should it occur.
Elements of a workplace infection control programme include:
- developing an infection control plan based on a risk assessment.
- relevant training for administrators and healthcare workers in the company.
- collecting sputum samples in a safe manner.
- identifying workers at high risk of TB infections for prompt diagnosis, and treatment if required.
- implementing environmental controls like adequate ventilation, cough hygiene for coughing patients and the use of ultraviolet light-air disinfection.
Identify and Diagnose
The employer could create opportunities to screen for TB as part of annual or bi-annual health examinations. It can:
- prompt individuals to seek care;
- compensate for instances where individuals have sought care but was not investigated by health services;
- provide assistance for those seeking care who are unable to access it.
If TB is suspected, a minimum of two sputum specimens should be collected from employees and examined as soon as possible, in line with the National TB control guidelines.
Tuberculosis is a notifiable disease. This means that if an employee is diagnosed the healthcare provider is legally obliged to notify the department of health.
Treatment and Cure
A well thought through infection control plan will:
- maintain clear management policies on confidentiality, discrimination, medical leave etc.
- gives access to good quality diagnostic services, an uninterrupted supply of good quality, free drugs and psychologic support for the patient.
- implements environmental control measures that minimise the risk of transmission to other employees.
- implements awareness and education campaigns to reduce the stigma of having TB and increase awareness among employees.
- assigns a DOT provider who is acceptable and accessible to the patient, willing, trained and accountable to health services to monitor whether treatment is completed or not.
- systemic monitoring and standardised reporting, such as monitoring of body weight and adjusting dosages to medication which are done during each clinic visit.
DOT increases the likelihood of successful treatment and reduces the risk of drug-resistant TB.
The workplace clinic provides the ideal opportunity to screen for TB so that you and your workforce are protected. If you are not in the position to have a clinic on site, patients could be screened at any primary care clinic.
An important function in the pharmacy is targeted counselling on various aspects of TB, such as dosage and directions of drugs used in treatment, importance of treatment completion, side effects, nutrition and the importance of follow-up appointments.
Detecting TB early is a crucial element to providing full and regular treatment. There are easy to use, affordable point of care tests available to detect TB in the pharmacy clinic setting.
More and more medical aids are including a TB test as part of their Wellness offering to their members and Allegra’s WellScreen module offers this functionality to funders in the form of a questionnaire that could be used when screening for the disease. Funders can then decide whether or not they want to include TB screening as part of their service offering. For more information please contact: firstname.lastname@example.org
Links / References:
The South African Labour Guide – TB, what employers should know. Retrieved from http://www.labourguide.co.za/health-and-safety/1374-tb-what-employers-should-know
frontshop Pharmacy Magazine – New TB vaccines needed. (22 February 2016). Retrieved from http://www.frontshop.co.za/new-tb-vaccines-needed/