Assessing Environmental Control Strategy of Tuberculosis Infection in Thai Hospitals: Perspective from Architect

摘要

At hospital, inpatients and health-care workers (HCWs) are at particularly high risk of TB infection because of frequent exposure to patients with infectious TB disease. To minimize TB infection, WHO and US CDC have proposed three-level hierarchy of control including administrative control, environmental control and personal respiratory protection. While many HCWs are able to effectively implement the first and third strategies, the majority of HCWs, however, have difficulty implementing environmental control strategy. Therefore, the objective of this research are to gain more understanding on current environmental control practice in Thailand and to provide policy and technical proposal that foster environmental control implementation from a perspective of a non-health related profession. The research described in this paper is a part of a larger study on enhancing occupational health surveillance in Thai Hospitals which was funded by the Global Fund (Round 8) for fighting AIDS, Tuberculosis and Malaria and Thailand-US Centers for Disease Control and Prevention. To achieve the objectives, infection control practice of ten hospitals Thailand was surveyed during November 2009 - December 2012. Architectural and ventilation data were also collected from TB-related departments to confirm infection control practice. Results from gap analysis showed that common weaknesses lie at the lack of effective environmental control procedure and inappropriate operation/maintenance of hospitals' architectural features. The aforementioned weaknesses were found to be an impediment to developing necessary environmental control practices that address effective healthy indoor environmental quality. For conclusion, this research proposes an integrated approach to environmental control best practice involving consideration of the relationship between the building and environmental infection control practice which requires knowledge sharing between architect, engineer, and HCW.