CHALLENGES IN PREVENTION AND CONTROL OF TUBERCULOSIS

In contemporary society, healthcare-associated infection diseases have raised their number. Many clinical conditions can also be affected by different patients regarding the loss of their age. For the government, what they need to do is provide some useful ways for society to reduce the transmission of infectious diseases to provide a better quality of life to Hong Kong citizens. It is suggested that tuberculosis, is the most invasive disease in Hong Kong and other countries in Asia, ranging from Japan, Singapore, and China. The death rate is high, ranging from more than 4000 people will get infected, and over 200 people will die because of tuberculosis every year. As stated by the Hong Kong Department of Health, school outbreaks of tuberculosis are very common; around ten schools would have the outbreak. It is suggested that for tuberculosis, this disease not only will be transmitted through adults, but it also has a higher possibility to transmit among children. Due to the highest infection rate of tuberculosis, the government also has provided a lot of measures to control the spread of tuberculosis, ranging from providing contraceptives, vaccinations to facilitating screening, doing counseling with the doctors, and providing education at school or other organization to control the risk of the infection of tuberculosis (El Kamel et al., 2014).

One of the biggest topics of public health management would be infection control. It can be a great source of learning for us to understand more about the historical development and public health management significance. Take tuberculosis as a starting point which it’s the top disease that kills the most men and women in our society. It’s a disease that spreads through the air, and in a packed city such as Hong Kong, it could cause a lot of danger to our citizen’s living. It’s related to our livelihood and a really good entry point for us to understand more about public health control and management method through the study of managing tuberculosis. The main aim of the essay is to achieve the following set of objectives.

Objectives

I explained the nature of the micro-organisms that cause tuberculosis and how the TB infection is spread among human beings.
Address the measures involved in prevention and controlling the spread of TB.
Address the organizational issues underlying the policies involved in TB prevention and control and also the particular practices in Hong Kong.

Thus in fulfilling the above objectives, the essay will have fulfilled its aim of examining TB-causing micro-organismsmicro-organisms, addressing measures involved in prevention and controlling TB, and examining the organizational issues underpinning such policies.

Summary information of how organizations control TB infections in their specific workplaces and Hong Kong government in general.

As stated by the World Health Organization (2006), the workplace or other areas need to follow some standard precautions to lower the risk of having tuberculosis transmission. If we do not control well, it will increase the rate of infectious diseases. It is suggested that having infection control in the workplace is crucial because it could help reduce infectious diseases. To control the spread of tuberculosis, it is suggested that the management could set up some policies to make sure the employees could follow some strict guidelines to control the spread of tuberculosis. Having a safe climate in the workplace is very important too. The organization could use posters to allow the colleagues to understand the preventing means of tuberculosis. This could help increase the conformity with the designated preventive methods and lower the risk of tuberculosis being transmitted in the workplace. Some senior staff could also help ensure the safety climate in their organization by providing leadership training to the workers and spreading the messages to other colleagues. By preventing tuberculosis from spreading to the public, it is suggested that the government has enforced the public health law to the citizens to protect the citizen’s health.

For example, for the newborn’s measures to primary school students, all of them can enjoy the free immunization program to protect their health. Because the government has set up public health laws to protect the health of the citizens, the citizen’s health could be protected. Also, since the government could have the authorized power to set up some public health laws to enforce the citizens to do the protective measures, this could prevent the diseases’ spread. The citizens are strictly required to follow the public health law for the public’s sake. This could ensure that all the children, regardless of their age, gender, and race, all have equal opportunities to do the vaccination; this can allow the children to have received better protection and reduce their rate of having diseases.

Moreover, some access has been launched to ensure the citizens could take the education and screen counseling to know about their risk level of having tuberculosis. It is because the government has enforced the public law to the public. Therefore they can act as a reactive role to authorize the public health authorities and provide support access to the treatment. Thus, this can help reduce contact with the infectious person and show their emergency powers to tackle the disease’s outbreaks. Take the colorectal cancer screen pilot program as an example. The government has provided these screening measures to the elderly to determine if they have colorectal cancer earlier and take the early treatment.

The nature of the specific micro-organize micro-organism and how the infection may be spread.

Regarding the nature of tuberculosis, it is suggested that tuberculosis can be caused by different bacteria, such as the Mycobacterium tuberculosis and the Tubercle bacillus (Globan & Fyfe, 2010). These bacteria can be fatal because they will affect the lungs and infect other body organs, such as the kidneys, brain, lymph nodes, bones, and the vertebral spine. The disease will spread through personal content with others and transmitted via the air for the spreading ways of tuberculosis. There are two types of tuberculosis, namely active tuberculosis and latent tuberculosis. For active tuberculosis, will infect our body organs. However, this tuberculosis will not show any symptoms yet could suddenly change to an active one for latent tuberculosis. According to Yew et al. (2011), he has stated that most citizens would have good personal immunity. Therefore only less than 6% of the people infected by tuberculosis would have tuberculosis-linked diseases; these patients are infected by active tuberculosis. The other population will carry latent tuberculosis in their bodies, which will stay dormant and not transmit to the other citizens. Yet, not all latent tuberculosis is safe, and it will also have a 10% rate for turning into active tuberculosis. If an individual’s body did not have good immunity, it would be more easily infected.

For the patients, if they have active tuberculosis, their saliva will have a high chance of transmitting tuberculosis to other people. For instance, via cough, spit, or sneeze, the tuberculosis bacteria will stick to the air. If someone is unfortunately infected by tuberculosis, they will mainly suffer from weight loss, chest pain, fever, or cough. However, not all the patients witness that they will have a chance to have tuberculosis, therefore this might lead to a delay to find a doctor for help, in which the patients would have more time to spread the bacteria into the society. If someone has infected tuberculosis, they need to immediately seek medical treatment because up to two-thirds of the infected people will die.

Some of the patients will take ineffective treatment because they cannot take drugs. This will lower the overall outcome of the main tuberculosis prevention efforts. Since tuberculosis is a disease with a high transmission rate, therefore it will increase the number of citizens infected by each infectious person. Some Hong Kong places will have a higher infection rate, such as the hospital and the community center. Since most hospital people have different diseases, when someone has coughed, it will have a great chance to release the saliva droplets into the air, and the air will transmit the virus to the others. Once a healthy person passes by a tuberculosis patient without wearing a mask, they will have a greater chance to breathe the virus into the body.

The government and the Health Department of Hong Kong have always done promotions on the Internet, offline advertisements to remind Hong Kong citizens to wear masks when they need to go to the hospitals or visit a clinic. Not only can this prevent them from getting infected with diseases, but this could also help protect the other citizens around them as well. As a result, if you have spotted someone who has a high chance of having tuberculosis in an organization or your office area, you can suggest the infected person go into some isolated place such as the meeting room on his own, without letting him or her contact the other colleagues. If we visit the hospital, we also need to keep our distance from the tuberculosis patients and avoid contacting them. They should also stay in the isolated ward to curb the disease’s spread to the whole hospital and the society.

Figure 1.The rate at which TB cases are reported, 1961-2016

Infection, Prevention and Control (IPC) Protocols of TB

According to DoH (2019), TB is caused by Mycobacterium tuberculosis which mainly affects the lungs. Other body parts that are prone to infections are joints, kidneys, lymph nodes, and bones. Estebesova (2013) assessed that TB symptoms are composed of fatigue, persistent coughs, night sweats, weight loss, low fever, and sputum blood. In some cases, the patient loses weight. TB is an airborne disease, thereby easily spread when an infected person sneezes or coughs and another healthy person inhales. It is controlled by the use of antibiotics which lessen the infections. TB infected people should seek medical attention urgently to be put under drug therapies that usually last for at least six months. The bacteria can be eradicated if the patient is faithful to medication and doctors’ instructions. DoH (2019) assessed that that is usually not the case. Thereby some patients make the infection a lifestyle disease putting other people at the risk of infection. Some of the prevention mechanisms involve the maintenance of personal and environmental hygiene. Healthy lifestyle involving healthy diets and seeking immediate treatments in case of TB signs, and receiving BCG immunization.

The impact of infection

For the infection’s impact, it is believed that tuberculosis will mainly affect adults, with a smaller chance to infect the children (Caws et al., 2015). Tuberculosis is a disease that can spread elsewhere when the patient who has the disease keeps spreading their saliva to others or the community. Since tuberculosis is an infectious disease, with a high death rate around the whole world, the World Health Organization has counted the disease to be with a high death rate, and the whole world should prevent tuberculosis. Over 95% of tuberculosis infection cases are arising in developing countries, which implies that there will be a large infection in some of the poor countries like Kenya because they do not have clear water or food, which will increase the chance of having the infection. Tuberculosis has raised global concern because it has become a global threat. The disease will be hard to treat because humans are starting to grow resistant to curable drugs. Therefore, this has implied that the disease will be much more difficult to get cured. According to the World Health Organization (2011), tuberculosis has also contributed to the economic downturn, which will raise the cycle of poverty in various countries. For the financial impact, the curing cost of tuberculosis will be expensive because the treatment will take over six months to over three years; the whole world, therefore, need to pay 16.7 trillion dollars by 2050 for the treatment cost of tuberculosis.

According to Tan et al. (2013), when an individual has been infected by tuberculosis, they will have a chance to severely impact their body. For instance, they may need to get isolated for 14 days or longer for the first stage. From the social aspect, this will negatively affect one’s social health because this will limit their social time with their friends and family.

Audit, surveillance, and risk management as processes to prevent and prevent surgical site infection and control the TB infection spread.

For the audit, surveillance, and risk management, it is crucial to have audit infection control. Through the audit of infection control, this could ensure proper infection control means in different environments with different patients (Van Cutsem et al., 2016). According to the Department of Health (2019), some of the checklists have been provided to the public to understand how to monitor the outpatient clinic and the hospital. From the checklist, we can see that areas including the personal protection equipment, decontamination of TB patient care tools like the sterilization and the disinfection for the chemical wastes, the safe injection habits, linen management, environment control, waste management, employee health, specimen handling, and training. For example, to protect an individual from preventing the spread of getting infected by tuberculosis, people should wear a mask when they visit the hospital or clinic and wash their hands using alcohol 70-80%. In this sense, maintaining a high level of personal hygiene could ensure all the citizens can be protected from tuberculosis.

Since the medical staff always need to contact the patients, they may have a higher risk of getting infected by tuberculosis (Margineanu et al., 2020). As such, they can protect themselves in various ways. For example, by wearing N95 masks, wear surgery gloves, and wearing full protective gear to treat tuberculosis patients to prevent them from contracting the virus. By wearing the protective measures, it can set a barrier to help protect the medical staff from contacting the patient. Also, the surgical mask they have wear and the safety goggles they have wear could help prevent the patient’s saliva from getting into the healthy person’s body. Therefore, this can help stop the transmission of tuberculosis and prevent the transmission of infectious secretions from other patients to healthy persons. To sum up, before we contact the tuberculosis patients in the workplace, we need to get all these protective measures ready and follow the infection control supervisors’ instructions to make sure all of the employees are safe and will not get infected.

For the surveillance, stated by the Prevent and Control of Disease Ordinance, once the suspected or confirmed cases have been found, the registered medical practitioners are required to notify the Central Notification Office to let the authorized department do some preventive measures first. Some data are required to analyze the tuberculosis-related data, help the Department of Health plan, get the implementation plan, and evaluate the spread of the tuberculosis virus. Therefore, it is suggested that monitoring the tuberculosis virus is very important (Ditah et al., 2020). The government also has the responsibility to regularly check the statistic linked to the increasing or decreasing rate of tuberculosis, which refers to the death rate, drug assistance rate, and the rate to illustrate whether the treatment is successful.

Risk management is also one of the most important factors to prevent the spread of tuberculosis (Sia & Wieland, 2011). Unfortunately, if Hong Kong has a great outbreak of tuberculosis, most of the infected people are required to send to the hospital and get isolated. The government needs to provide isolation measures or send those infected people to a central camp and restrict their moving areas to prevent the disease’s spread. Suppose some medical staff must go inside the isolated place to give some medicine or essentials to the isolated person. In that case, they are strictly required to wear full protective clothing and must be disposed of in the designated place after contacting the isolated person. Also, to purify the air quality, it is believed that the hospital can also staff a high-efficiency particulate air filtration unit to help remove the infected air particles and to make sure the people in the hospital are safe if they do not contact with the infected tuberculosis patients. Thus, this could reduce the chance of spreading tuberculosis in the hospital or other indoor areas (Noertjojo et al., 2012).

The organizational issues that support policies and practices used to prevent and control TB in Hong Kong.

Public policy could serve as a good guideline and control to prevent the infection since it can unify the action of different parties to make sure a standard procedure on decreasing the chance of infection and transmission of the diseases. It can serve as a guideline for not only hospital measures to prevent contact of the patient to others, but also can unify different action between the different department, for example, a protocol between clinical and hospital, potential maybe can get direct access to the hospital once they diagnosed with the diseases, and also an instant lockdown on the clinical can be applied to make sure minimizing the risk of an outbreak. Also, public policy could unify a protocol of emergency plan, which could be a plan that makes sure the communication between departments is well-coordinated. The access of medical personnel can be saving lives and giving patients the most efficient treatment. It also controls the moving of the public or dangerous zones such as hospitals to minimize the risk of transmission.

Conclusion

We have seen the effort from the public sector. For example, the government is huge; their control of preventing the spread to standard compliance procedures is very systematic. From the prevention stage, there would be a collection of data on tuberculosis for forecasting and evaluation on the measure, and to plan for the containing measures as well as assessing the risk of an outbreak. While for the patient’s environment, there are also standard compliance measures to ensure infection control against the spread of tuberculosis. Public education also plays a huge role in preventing the spread; the health organizations are also trying to let the citizens know that they should isolate themselves from the public if they have tuberculosis. Also, their sanitizing habit of handwashing and wearing surgical masks is well educated.

Law could also be the ultimate measure for wider awareness and strict enforcement to prevent people from being infected with tuberculosis if the situation worsens. Last but not least, communication is the key to preventing infection, and easy way of communication, for example, a hotline to set up for citizen to easy report any case, as well as central coordination from the health department, could lower the public risk of infecting with tuberculosis – since a good communication can let the health department to well prepare before it turns into an outbreak.

Recommendation

To prevent the high spread of Tb in Hong Kong, various actions and practices should be improved. The government and health care department should develop evidence-based policies, standards, and strategies aimed at TB prevention, control, and care of the already infected people. Also, they should regularly monitor the TB situation in the country, adjusting policies to suit the new situation from time to time. The Hong Kong government should increase its partnership with different organizations to reinforce the financial assistance needed to curb TB. It is the second killer after HIV/AIDs in the infections caused by single pathogens.

Reference

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