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Improving natural ventilation in hospital waiting and consulting rooms to reduce nosocomial tuberculosis transmission risk in a low resource setting

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dc.contributor.author Escombe, A.R.
dc.contributor.author Ticona, E.
dc.contributor.author Chávez-Pérez, V.
dc.contributor.author Espinoza, M.
dc.contributor.author Moore, D.A.J.
dc.date.accessioned 2019-07-04T17:00:16Z
dc.date.available 2019-07-04T17:00:16Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/6830
dc.description.abstract Background: TB transmission in healthcare facilities is an important public health problem, especially in the often-overcrowded settings of HIV treatment scale-up. The problem is compounded by the emergence of drug resistant TB. Natural ventilation is a low-cost environmental control measure for TB infection control where climate permits that is suited to many different areas in healthcare facilities. There are no published data on the effect of simple structural modifications to existing hospital infrastructure to improve natural ventilation and reduce the risk of nosocomial TB transmission. The purpose of this study was to measure the effect of simple architectural modifications to existing hospital waiting and consulting rooms in a low resource setting on (a) improving natural ventilation and (b) reducing modelled TB transmission risk. Methods: Room ventilation was measured pre- and post-modification using a carbon dioxide tracer-gas technique in four waiting rooms and two consulting rooms in two hospitals in Lima, Peru. Modifications included additional windows for cross-ventilation (n = 2 rooms); removing glass from unopenable windows (n = 2); creation of an open skylight (n = 1); re-building a waiting-room in the open air (n = 1). Changes in TB transmission risk for waiting patients, or healthcare workers in consulting rooms, were estimated using mathematical modelling. Results: As a result of the infrastructure modifications, room ventilation in the four waiting rooms increased from mean 5.5 to 15; 11 to 16; 10 to 17; and 9 to 66 air-changes/hour respectively; and in the two consulting rooms from mean 3.6 to 17; and 2.7 to 12 air-changes/hour respectively. There was a median 72% reduction (inter-quartile range 51-82%) in calculated TB transmission risk for healthcare workers or waiting patients. The modifications cost <US$75 in four rooms, and US$1000 and US$7000 in the remaining two rooms. Conclusions: Simple modifications to existing hospital infrastructure considerably increased natural ventilation, and greatly reduced modelled TB transmission risk at little cost. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartof urn:issn:1471-2334
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Peru en_US
dc.subject Humans en_US
dc.subject Tuberculosis en_US
dc.subject Tuberculosis, Pulmonary en_US
dc.subject tuberculosis en_US
dc.subject Health Personnel en_US
dc.subject Hospitals en_US
dc.subject Cross Infection en_US
dc.subject human en_US
dc.subject Article en_US
dc.subject lung tuberculosis en_US
dc.subject risk factor en_US
dc.subject procedures en_US
dc.subject infection risk en_US
dc.subject health care cost en_US
dc.subject health care personnel en_US
dc.subject health care facility en_US
dc.subject hospital en_US
dc.subject health care planning en_US
dc.subject bacterial transmission en_US
dc.subject hospital admission en_US
dc.subject Airborne transmission en_US
dc.subject air conditioning en_US
dc.subject Ventilation en_US
dc.subject consultation en_US
dc.subject cross infection en_US
dc.subject hospital infection en_US
dc.subject Natural ventilation en_US
dc.subject Nosocomial transmission en_US
dc.subject Tuberculosis transmission en_US
dc.subject Waiting room en_US
dc.subject room ventilation en_US
dc.title Improving natural ventilation in hospital waiting and consulting rooms to reduce nosocomial tuberculosis transmission risk in a low resource setting en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12879-019-3717-9
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08

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