Infection control in a developing world

 The rapid emergence of multi-drug resistant TB, and its association with hospital-based outbreaks, have highlighted the role that healthcare facilities inadvertently may play in maintaining TB transmission, and the vital importance of attaining good TB infection control. James Elston, a specialist physician in infectious diseases and general internal medicine, who recently returned from a second stint in Swaziland, says many of the region’s healthcare facilities are outdated, poorly ventilated, and were not designed for their current purpose. Here he describes how UK-based architects and healthcare engineers responded to an urgent call for assistance and, via close collaboration, and using novel design software, empowered healthcare workers to dramatically and rapidly improve their TB inpatient facilities, and protect the health of patients and staff.

Tuberculosis (TB) is caused by a bacterium (Mycobacterium tuberculosis) and most commonly affects the lungs. TB is transmitted from person to person via inhalation of droplets containing bacteria that are produced by an infected person, for example during coughing or sneezing. The disease is second only to HIV as the greatest killer worldwide due to a single infective agent, with 8.7 million people having developed TB disease, and 1.4 million deaths having been caused by TB, in 2011.1 HIV increases the likelihood of developing TB disease, and tuberculosis is the leading cause of death for people living with HIV; thus the worldwide HIV epidemic has led to a resurgence in TB in many countries worldwide, particularly in sub-Saharan Africa. Furthermore, drug-resistant TB is increasingly prevalent, and multidrugresistant TB (MDR-TB, resistant to two of the first line anti-TB drugs) is associated with markedly worse outcomes.

TB and infection control in healthcare facilities