Tb cont. prog.

Role of Tuberculosis Hospitals/Sanatoria in TB control in India Background
TB Hospitals vs Sanatoria
• Classic studies of TRC, Chennai showed that • Current Indian population = 1 billion • Approximately 20 lakh new cases/year TB Hospitals/Sanatoria
TB Hospitals/Sanatoria
Recent Survey
• 94 hospitals, cumulative beds: 21,960 • Questions about diagnosis, treatment, • Number of doctors involved: 841 (2500 • Sent to 104 larger TB hospitals (>100 • Number of staff involved: 9702 (about • 94 responses received (33% of total TB TB Hospitals/Sanatoria
Diagnostic Quantity
Recent Survey: Diagnosis
T B H o sp itals/S an atoria
Practices
• T reatm en t reg im en s: 6 2 % o f th e h osp ita ls u sed in ap p rop riate reg im en s w ith rifa m p icin in th e • 36% hospitals admitted all SS+ patients • 67.5% would wait for smear conversion – N il b y 4 5 % o f th e h os p ita ls • 2 hospitals keep the patient till he is • N o or little s ystem atic in fo rm ation on p a tien t TB Hospitals/Sanatoria
TB Hospitals/Sanatoria
Recent Survey: Observations
• Annual expenditure of 71 institutions – Cumulative annual expenditure: .101.2 crore • 300 crore for country
• Approximate cost per patient admitted: • Very low rates of treatment completion • Poor coordination with outpatient system TB Hospitals/Sanatoria
TB Hospitals/Sanatoria
Advantages
Disadvantages
• Costly (budget is 3 times national TB • Medically necessary for proportion of patients • Risk of spread of tuberculosis among • Useful as specialized centres for complicated • Patients lost to follow up after discharge T B H osp itals/S a n a to ria:
TB Hospitals/Sanatoria:
In d ica tion s fo r A dm issio n
Indications for Admission
• M ed ica l em erg en cies (m a s s iv e h em op tys is , p n eu m oth ora x, la rg e b ila t era l p leu ra l e ffu s io n , etc.) • D es titu te p a tien ts• D iffi cu lt g e og ra p h ic a r ea s /clim a t es• S eriou s n on - T B c on d itio n s req u irin g Not all patients with positive AFB smears • T r ea tm en t o f s e v e re a d v ers e d ru g rea ction s• S p e cia liz ed tr ea tm en t o f M D R T B TB Hospitals/Sanatoria:
TB Hospitals/Sanatoria:
Diagnosis
Indications for Discharge
• Good quality examination with policy as per Patients do not require to remain hospitalized sulfamethoxazole) in patients with negative TB Hospitals/Sanatoria:
Treatment
• Treatment regimens as per government • Except in RNTCP areas, no rifampicin in • Every dose of medicine ingested should be directly observed by the hospital staff T B H o sp itals/S an atoria: R ecord 19
TB Hospitals/Sanatoria:
Follow-up
• T reatm en t ca rd s o f R N T C P sh ou ld b e u sed • Patients should be admitted for the minimum • H osp itals m u s t k e ep a reg iste r o f a ll p a tien ts • Patients who are not admitted should preferably not started on trea tm en t an d th eir ou tc om es be given medicines, but should be diagnosed and d o cu m en ted as p er R N TC P d efin ition s referred back to peripheral facility for initiation of • T ra n sfe r form s sh ou ld b e g iven to th e p a tien t an d a lso sen t to th e p erip h eral fa cility (T B • Admitted patients on discharge should receive the medical regimen used in their district of residence • Hospitals are responsible for monitoring the • P erip h e ra l fa cilities sh ou ld in form h osp itals o f outcomes of every patient started on treatment p atien t fo llow -u p (T B T ran s fer F o rm ) TB Hospitals/Sanatoria: Reducing risk
of nosocomial spread of TB in HIV-
TB Hospitals/Sanatoria
infected persons
Appropriate roles
• Admit only as medically essential and discharge promptly• If possible, maintain separate wards for – 1. Patients with suspected tuberculosis
• Case detection, then refer patient back to – 2. Patients on treatment for tuberculosis for the first
local provider for initiation of treatment – 3. Patients who are smear-positive and who have been
• Treatment should generally not be started • Use only recommended regimens and ensure direct • Educate patients on the need to cover all coughs • Coordinate closely with outpatient care T B B ed R eq u irem en t
– 2 0 0 ca ses p e r la k h p e r yea r req u ir e – A t m os t 1 0 % o f ca ses req u ire h os p ita liza tion– A v era g e len g th o f sta y 6 w e ek s • Th en p er m illion p op u la tion a b ou t 2 5 b ed s • M a y in c rea s e som ew h a t w ith H IV a n d M D R TB beds in State
B eds per million popu

Source: http://ntiindia.kar.nic.in/docs/nwmc/PAGES/Role%20of%20Tuberculosis%20Hospitals.pdf