Description of TB
Tuberculosis (TB) is a major occupational hazard for healthcare workers across the globe. It is a bacterial infection in the lungs, and if it is not treated in the early stages, it can persist and spread to other body organs through the bloodstream. TB is among leading cause of death in the world. The mortality rate of this hazard is very high in developing countries because they lack enough capital to afford medication to deal with the infection. The infection is very common in the developing countries which have a high rate of HIV according to report done by the World Health Organization (2015). TB is highly infectious because it is airborne. However, it is curable and patients suffering from it should seek medical attention before the disease spreads to other body parts like the kidney, spine and also the brain. Transmission and spread of TB has been reported in a healthcare setting to both the patients and healthcare workers in all parts of the world despite the local TB incidence. Transmission of TB occurs mostly without being recognized or in a situation when it was not appropriately treated. However, the risk of transmission varies from the setting, occupational group, and the patient population. Healthcare workers are exposed to this hazard in the hospitals as they attend to the patient (Orme, 2014). TB was recognized as a health hazard back in the 1950s, and since then effective infection control measures have been implemented to reduce transmission of the infection. Poor implementation of this measure has led to widespread of TB mostly in developing countries. This health hazard is higher among the healthcare workers as indicated in the latest studies which have been conducted.
Just like any other bacteria, TB has its own set of characteristics which differentiates it from other species of bacteria. Mycobacterium causing TB is known as bacillus from its microscopic view which is shaped like a long rod. Not all bacteria cause infections, but since TB is described as mycobacterium, it is caused by a bacteria that spread infections. Scientists have used different criteria to identify and diagnose how this bacteria multiplies in different parts of the body (Studenski et al., 2014). To achieve this they have classified the bacteria into two medium. The first one is the agar-based and the second one is egg-based. As the bacteria multiplies it tends to grow into small groups called colonies and the cells of the bacteria are arranged in a chain formation according to the explanation from scientists. The cell wall is a significant part of the bacterium cell because of its barrier. It is made up of numerous cell which is made up of complex lipids proteins and other complex molecules. The cell wall is made up of three essential lipids (Tanaka, 2013). Mycolic acid is the first lipid whose particles are hydrophobic, and it forms the outer part of the cell. The second one is cord factors which are toxic, and they can harm the cell in the human body and even other mammals. The last one is wax-D which covers the entire cell (Bentsen et al., 2013). With this cover, the cell can resist different antibiotics and thus makes it very hard for physicians to be able to treat this infection. TB is a burning issue mostly in developing countries.
Tuberculosis in healthcare workers
It has been posing major health problems for quite some year as it is a major economic burden because there are no vaccines available yet there are some causative agents which are resistant to drugs. This condition is caused by the members of the bacteria Mycobacterium tuberculosis complex (Delogu et al., 2013). These bacteria have spread through the environment throughout the globe leading to TB pandemics. The Mycobacterium tuberculosis has a doubling time of between 12 to 24 hours and contains a very sophisticated cell wall structure which is impermeable to toxic drugs and thus quite fundamental to its virulence. The pathogenesis of TB develops once some tubercles are dispersed into the air by an active TB infected patients (Samanovic & Darwin, 2016). These tubercles once inhaled ends into the alveoli where macrophages engulf them. When the host immune system cannot clear some of the tubercles, they may spread to different body parts. Some studies performed in non-human primate models have indicated that the metabolically active Mycobacterium tuberculosis in latent infections can divide in the host tissues even in the absence of any symptoms (Neyrolles et al., 2006). In a study carried out by Hernansez-Pando et al., in the year 2000 using lung tissues isolated from patients who had died from different causes and not by TB, in TB endemic regions, it was found that the Mycobacterium tuberculosis DNA materials were present in non-phagocytic cells (Hernandez-Pando et al., 2000)
There are two types TB infections; the latent TB which is asymptomatic, and, the active TB which presents a number of signs and symptoms (Cowan et al., 2012). The most common signs and symptoms of TB are fever, night sweats, coughing, production of phlegm, and loss of weight. Since the development of HIV/AIDS in sub-Saharan Africa, there has been a sharp increase in the cases of TB. This is primarily for the southern African nations leading to a TB pandemic. In 2011, the world incidence rates of TB by the WHO was about 125/100,000, whereby the incidence rate in Africa was 262/100000 of the general population.
Moreover, the incidence rates of TB in South Africa was estimated to be 993/100,000 people (Rossouw et al., 2012). In fact, out of the 8.7 million cases of active TB, in the year 2011, South Africa recorded about 0.5 million TB cases. There are a number of risk factors that are linked to the development of TB. These factors can fall into various classes such as personal and environmental risks (Floyd et al., 2012). Individual risk factors include malnutrition, smoking habits, diabetes, cancer and genetic predisposition among many more. The environmental factors include inadequate ventilation, getting into contact with contaminated sputum, and high levels of airborne bacteria (Mokhtar & Rahman, 2017).
Different people and population which are exposed to tuberculosis
It is commonly argued that there are some communities which are highly vulnerable to contracting TB such as the HIV infected people as well as healthcare workers (Bassett et al., 2016). In South Africa, these risk factors are also common, thus increasing the chances of acquiring these infections. For instance, the exposure factors to TB in South Africa is attributed to several risk factors. The exposure of healthcare workers to TB is due to the high prevalence of this disease condition among the people that they serve as well as the level of contact (McCarthy et al., 2015). The distribution of the risk factors to TB infection is differential in nature in places of work and depends on factors such as age, gender, the number of contact times with the patients and the healthcare departments which these healthcare workers work in. Therefore, it is essential to have a clear understanding of the risk factors that cause TB infections in health care workers in South Africa to effectively control this problem (Tudor et al., 2014). The workplace acquired TB has thus been described as a significant occupational healthcare problem in South Africa. A review was carried out in order to determine the level of acquired TB among healthcare workers. This review involved performing electronic database searches such as EMBASE, Web of Science and MEDLINE among others. The results indicated that out of the sixteen studies that were included in the review, ten of them reported that there was active TB among the healthcare workers (Grobler et al., 2016). This study also indicated the presence of active TB including the drug-resistant form among the South African population. The authors also recommend the need for regular screening of TB among health care workers in South Africa to prevent cross infections.
TB infection is common among a diverse group of individuals such as the elderly. The reason this group of people is more exposed to this health risk is that as individuals grow old, their body cells become weak and they are not able to fight TB bacteria (Getahun, Matteelli, Chaisson & Raviglione, 2015. Old people need instant checkups and diagnosis of TB when they are suspected to be suffering from the infection. Failure to this can lead to adverse condition, and even death leading to the increased mortality rate in most countries. Old people require a lot of attention from their caregivers because their bodies are fragile and so prone to infections and in case they identify any sign of TB they should take them to the hospital to seek medical attention (Anderson et al., 2014). Despite the World Health Organization declaring spread of TB as a global emergency and even implementation of reliable methods to control the spread of the infection, TB infection has been reported to continue spreading and infecting vulnerable population mostly older adults who are above 65years. If the disease is not diagnosed at early stages it may resist medication and treatment and thus lead to a higher rate of morbidity and mortality mostly in developing countries.
The other reason why this population is exposed to this health hazard is that most of them are less exposed to latest updates about things like various infection and some measure which they can take to prevent the spread of the infection. Elderly people are more prone to infections especially of the respiratory tract, and the infection can significantly affect their health as compared to young people (Gao et al., 2015). As the healthcare sector tries to come up with measures and treatment but it very hard to stop the spread mostly to older adults because of age-related changes in the phenotype and function of macrophages which might compromise their role in the protection against TB. This may include reduction of innate immune receptors and reduced tumor necrosis factor.
The second population which is exposed to this hazard is the aboriginals’ people. As the spread of TB rates fell dramatically in developed countries which are stable and be able to afford medication and implement measures which can reduce the range of this health hazard, developing countries are not able to provide this measure and medication and thus the less privileged are not able to access medical services like the aboriginal people. This group of people lives in very remote areas with a harsh climate which may expose their bodies to infections. Healthcare workers may not in most cases be able to reach thus poor because of poor road infrastructure. It may take a lot of time for them to get into these areas which are time-consuming. The hostility of this people has profoundly contributed to the spread of this hazard. This is because they believe that they can only depend on natural herbs from the forest to cure also types of infection.
Due to the fact they live in remote areas, they are not able to get updated on what is going on in the world of various infections and measure which can be put in place to reduce or prevent these infections. The language barrier is another thing which makes it very hard for health care workers to communicate and educate this community on what they should do to reduce the spread of this health hazard. This is because they are only used in their local languages which other communities cannot be able to understand, and they are not used to foreign languages. This group of people leads poor socio-economic conditions which makes it very hard for them to afford the medication of TB. Healthcare centers are very few in this regions, and they are expensive making it hard for the aboriginals to acquire services. It is also tough to cure this infection to the already infected people in the aboriginal’s community. This is because the proper diet is among the measures which are believed to contribute towards the treatment of the infection and this community do not usually have proper nutrition as they depend on some few fruits from the forest for food.
People who are living with HIV are also at high risk of getting infected by TB. People think that TB which is a very infectious disease only affected the lungs, which is not factual as the infection spreads to other body parts when a patient does not seek medical attention and make the whole body weak making it vulnerable to other diseases. The situation worsens when the person is suffering from HIV infection as it makes it very easy for the bacteria to multiply fast throughout the body. When a person is suffering from both TB and HIV is most likely to develop active TB which is very dangerous and can lead to death. A patient having both infections is supposed to have AIDs which is an advanced level of HIV. Due to the limitation of current TB tests, it is not easy to diagnose the infection in HIV positive people. Healthcare workers are classified to be a group of people who are highly exposed to TB infection. This is because they handle patients suffering from the infection and it is airborne so they can easily get infected in crowded hospitals. As healthcare workers develop the psychological defense mechanism to be able to handle their daily tasks every day, it becomes, and they end up getting infected by this health hazard. In the hospital setting where healthcare workers are not provided with equipment and tools which they can use to protect themselves from getting infected it is hazardous as they can also end up getting affected by other infection apart from TB. Some healthcare workers who are ignorant and have the mentality that they have attended TB patients for many years without getting infected tend to ignore preventive measure which is very risky.
People are exposed to TB bacteria if they spent a lot of time with infected patients. This occurs mostly when they are not aware of the health status of the sick people. When the TB bacteria are put into the air by a patient with active or latent TB infection of the lungs or the throat the nearest person can get infected by the bacteria. This happens when the person coughs, sneezes, talks or sings. Different communities have various perception of how TB can be spread. Some people believe that by sharing clothes, toilets and even utensils with an infected person can lead to one been infected, this is not true, and by doing so, the infected person feels isolated by the close people near them. If you think you have been exposed to TB infection maybe by spending time close to a sick relative or friend, it is advisable to seek medical attention for testing to clear the doubt. Only patients who have active and latent TB are capable of spreading the infection to other people. Some people take long before their signs and symptoms and thus they can spread the infection to others without knowing it. Living in crowded places like in prison can lead to the high spread of the infection in case one of the inmates is suffering from this infection. This is because prisoners are forced to spend a lot of their time with each other in locked places which have poor ventilation and sometimes poor hygiene.
People who are in abusive relationships whereby one of the spouse is not faithful may end up been infected by HIV which makes the immune system very weak such that it cannot fight infections thus a person is susceptible to Tb infection. Age is another factor which can make a person more prone to infections. This is because the individual’s body weaken as they age and their bodies are not cable of fighting diseases. People who have been involved in some specific medication such as chemotherapy and biological which are known to weaken the immune system of the body can also be affected by this health hazard. Alcohol and drunk abuse is another practice which can lead to the spread and transmission of TB bacteria. This is because most of the time these people are always in crowded places with the filthy environment, and among them, someone should have active TB. Lifestyle and poverty have also significantly led the spread of this health hazard. People who come from the impoverished background are not able to have a balanced diet, and their immune system weakens making them more susceptible to infections. The severe financial situation also makes them have to spend most of their time in a small hut with a sick relative and thus end up getting infected. Lack of proper protective measures to the healthcare workers as they attend TB patients like the gloves have led to cause and spread of TB bacteria. Apart from HIV/AIDs some other infections such as diabetes mellitus, leukemia, and silicosis which is a respiratory infection caused by inhaling silica dust has also contributed to the spread of TB bacteria.
It is recommendable that patients who have active TB bacteria should get treated right away to avoid spreading it to other people mostly those whom they spend a lot of time with like family members and friends. This requires taking some medication for a period of six to twelve months. Patients are advised to take all the medication even if they feel better because failure to this may cause them getting sick again in the future. If a person has TB germs in the body which are not yet active, doctors call it latent TB and even if not still active you can still spread it to others, this is the reason as to why healthcare professionals recommend that patients should be keen with their medication to keep the germ away from becoming active. To ensure that patients are completely safe from infection and away from spreading the germs to the others they should take all their medication as prescribed by the doctor until the healthcare professionals recommend they should stop taking them.
Patients should also keep in touch with their doctors and other healthcare professionals by attending all the appointments because by doing so they are given instruction and the kind of diets they should take and also the precautionary measures to avoid spreading the infection to other people. People who are infected with TB bacteria should always cover their mouth when coughing or sneezing with a tissue paper, seal it with a plastic bag and throw away where children cannot access them. They are also advised to wash their hands after sneezing or coughing. Sick people should stay away from work, school and other public places which may be crowded to avoid spreading this health hazard. The diagnosis of TB is carried out at primary health care facilities like clinics and hospitals. In other cases, data from a large population can be used to determine the possible TB cases. By preventing the HIV infections, the immune system of a person can be strengthened thus reducing the incidences of possible TB infections. Moreover, therapeutic approaches are used with common drugs being isoniazid and rifampicin among others (Bhatt et al., 2014). It has been observed that in people infected with HIV, the use of antiretroviral therapies reduces the severity of TB infections. Moreover, the accessibility of antiretroviral to South Africans has lowered the prevalence of TB among the people living with HIV.
Families who stay with infected relatives should always use a fan and open window to ensure that there is a flow of fresh air in the house. For people who have the ability to use private means of transportation can do so to avoid getting infected in public means which are very crowded, and the vehicles have poor ventilation, and in case one of the passengers is sick he/she can spread it to other people. In countries with high infection of TB mostly developing countries, World Health Organization recommends that’s children should be given Bacillus Calmette-Guerin vaccine or BCG. Doctors and healthcare workers can also benefit from this vaccine as they spend most of their time around TB patients. There are two type of Tb which are latent and active, and they both require a different kind of medication and treatment to avoid the spread to other people. Depending on the risk factor of this hazard, latent TB can reactivate and cause active infection. Healthcare workers are therefore supposed to prescribe some medication to kill the inactive bacteria to stop it from becoming active. There are three types of medication which can be used. The first one is isoniazid (INH) which is a standard therapy for latent TB, and the patient is expected to take isoniazid antibiotics for nine months. Rifampin is the second medication, it is a form of medicine which a patient is supposed to take for four months daily. It is considered as an option for those patients who are affected by INH. The last one is isoniazid and rifapentine, and a patient is supposed to take both medications for three months under the healthcare worker supervision. To treat active TB patients should take ethambutol, isoniazid, pyrazinamide, and rifampin as recommended by doctors.
Managing health effects of TB bacteria is essential in helping people to complete their TB treatment. Treatment of TB bacteria is significant as it helps minimize the spread of the infection to other people and the impact of the infection on the sick person. The effects of the TB infection in the body depends on the kind of treatment and medication which a patient is taking. Some people are not able to access the healthcare facilities due to the harsh economic condition, and thus their health is significantly affected (Blank et al., 2013). Dealing with the health effects of TB for the first six months is very challenging to the patients because of the infection persistent signs and symptoms. A person who is suffering from TB infection is usually sick and dizzy because the infection makes them weak. When the person’s body is weak, they are not able to perform some other important task. If the patient is a student may not be able to attend school, and this can significantly affect their academic performance. In case the person was the breadwinner of the family, and they are infected they don’t have the energy to go to work and provide for the family. Skin rashes are another health effect of TB. When a person has skin rashes, he or she may be isolated by their friends and relatives which makes them feel so lonely and isolated, and this can lower their self-esteem which can worsen their health status. A person who is under medication and treatment of TB may experience jaundice which is a health condition which leads to yellowing of the skin and the eyes.
It is highly recommended that when a patient recognizes this condition should stop the medication and report it to their doctors. Patients should always discuss the side effect of the infection with their doctor so that they can be given the right medication. Patients with TB should be tested for liver and kidney problems before the doctor start the treatment for the infection. This is because if the patient is suffering from kidney and liver complication they require a lot of attention and failure to this may lead to more complicated issues to the patient. People leaving with HIV may experience more side effects of TB because they have to take two medication at the same time. TB weakens the immune system, and they can expose the patient to other health risks. However with the help of a professional healthcare worker patients can manage the side effect of the infection successfully.
If the disease is not diagnosed and treated it may lead to severe damage to the lungs which may cause severe coughing that may produce blood, difficulties in breathing and chest pain. If these effects persist a patient may not be able to stand them, and it can lead to death. If the infection spreads from the lungs to the brain it may cause meningitis (Landau, Silva, Airimitoaie, Buche & Noe, 2013). A person with TB meningitis may suffer from nausea, unconsciousness and severe headache. If it is not treated, it may lead to muscles paralysis and mental impairment as well as the abnormal behavior of the patient. TB if not treated early in advance may spread to the joints causing Tb arthritis though it occurs in sporadic cases. The most affected joints include wrists, ankle, and the knees. TB arthritis may also cause a patient to have excessive fewer and to sweat especially at night.
Tuberculosis is a very contagious infection that can be very deadly if not treated. It is known to infect the lungs, but if not treated it can spread to other body parts. Scientists have been able to track the infection and found out that it existed from 2400 BC in the spinal fragments of Egyptian mothers and bones which were found in 750 BC. There have been a lot of names associated with this health hazard. Different people from different countries call the infection various names, some call it dread epidemic, white plague, and the king’s evil. With the revolution of industrial development in the 19th century it conflicted with the outbreak of deadly TB which killed a lot of people who were infected by the infection in Europe. With time this infection was spread to the United States as large cities became overpopulated. In the present day, we have over 2 billion who are victims of TB. A study which was conducted by the World Health Organization indicated that there were 1.77 billion deaths which were caused by this health hazard. In the society we live today there are so many potential areas which can lead to the natural spread of this infection. In 2009 the center of disease control (CDC) reported that there were 11,540 TB cases in the United States which was a decrease of 4.2% from 2008. The risk of continuation and spread of TB involves HIV illness, immigration of people from areas which are profoundly affected by this health hazard such as homeless shelters and hospitals to areas with a low infection rate of TB.
These areas have reported cases of the infection resistant in which the infection has become so dominant to treatment and medication leading to rise in mortality rate. Most countries have now implemented the use of epidemiology triad which is a tool that is made up of agent, host, and environment and they are used to explain how the infection is spread throughout the community (Langebeek et al., 2014). It is also used to identify points of intervention which can be used to prevent transmission. Primarily, TB affects the respiratory system, but if not treated it can change other parts like kidneys and the lymph node. TB is known as the leading fatal infection across the globe. In 2009 it killed 1.7 million people who were infected by the health hazard. However, TB death rate has fallen by 35% since 1990 according to research which was conducted by WHO. This infection is transmitted from one person to another through airborne droplets. The smaller the droplet, the longer it takes in the air after the infected person has left the place increasing the chance of it been inhaled by another individual.
There are several methods which have been implemented to manage and control the spread of TB infection. The first one is managing high-risk groups so that they will not be able to spread the disease to people who are not infected (Barrington-Trimis et al., 2015). This method involves identifying a particular population group which is at very high risk of TB infection. After the identification of the group, some strategies are implemented for finding Active TB among patients as well as the identification of latent TB infection. The approach monitors the progress of medication and treatment of the infection results. There are policies which are implemented for the management of high-risk groups as defined by a country or a region by the epidemiological characteristics. Screening for active TB is another method which can be used to manage and control TB infection. Screening should be done regularly for people who are at high risk of getting infected by this health hazard such as infants, elderly people, and HIV victims and aboriginals community. People who are Tb positive should be given some preventive measures to stop them from spreading the infection to others. People who have contact with the infected person like family members and friends should be given the opportunity of TB screening because they are at very high risk of getting infected by TB infection (Ripke et al., 2014). Healthcare workers who attend TB patients should also be screened regularly because they are always in contact with TB infection and not all healthcare institutions have adequate ventilation making it hard for fresh air to circulate in the patient’s rooms. Patients who are at high risk of developing active TB should receive special preventive care.
For a nation to be able to control the spread of TB infection should be capable of managing outbreaks. It should ensure that there are adequate surveillance systems in place to ensure early identification of TB outbreak. DNA fingerprinting and epidemiological analysis of TB are used for confirmation of patient with bacterial stain (Rietveld et al., 2013). Interventions such as control measures should be taken to prevent further transmission of the infection. Isolation is another method which can be used to stop people from moving from areas which have a high incidence of the infection to areas with low rates of the health hazard.
It is the role of each country to implement policies and regulations which are used to manage and control the spread of TB. The first policy is for those who are reluctant and do not want to take medication and treatments. The government and healthcare department recommends that these patients should be isolated from other people. Under TB control law it can highly recommend that these patients be locked in hospitals rooms and be forced to take medication because failure to this can lead to adverse effects to their health and can be fatal because they can spread it to the other people. However, under the U.S Supreme Court, it is a crime to force a patient to undergo treatment without their consent unless it is for minors and mentally challenged individuals. Prevention of TB cases is a policy which has been formulated by the CDC to regulate and establish TB control programs. This is the work of the state government through the differences of this policy (Xu et al., 2013). National policy and legal framework for TB infection control is a policy which is required to control the spread of TB in a healthcare setting. This policy calls for the administrative attention of the hospital to ensure that the environment in which health care workers are working in is safe and does not expose them to this health hazard. It does so by urging the top leaders in the hospital to ensure that patient’s rooms have adequate ventilation and that healthcare workers use protective measures such as respiratory protection and laboratory safety (Churchyard et al., 2014).
Protection of the patients’ and healthcare workers dignity is also another policy which ensures that patients health records and their health condition is not exposed to other people without them been aware. The policy punishes anyone who goes against it. These policies are formulated to ensure that they reduce the risk of spreading TB infection to other non-infected people. These policies also ensure that every individual whether infected or not are treated equally with no discrimination and that healthcare services are made available to everyone in the society even the less fortunate so that they cannot be significantly affected by the hazard. The existing legislation is that there is the integration of HIV and TB care to reduce the prevalence and incidence rates of the two conditions (Loveday & Zweigenthal, 2011). This is true because when the two conditions are managed together, it is possible to control one or both through a sustained immune system. There is a need for more information as well as training concerning the possible methods of TB prevention on a regular basis in various healthcare departments. There also exists some programs for TB control which have been strengthened by the introduction of rifampicin therapies through the DOTS program (Karim et al., 2009). However, the strategic plans in place to control TB infections in South Africa all depend on the ability of the South African government to create sustainable partnerships for the improvement of health care services.
Conclusion
TB infection is a fatal infection which can lead to death if it is not recognized at early stages and treated. People who are at high risk of been infected like family members who stay with an infected patient should be tested of the infection gradually. Healthcare workers are at very high risk of getting infected with TB while hospitals by patients suffering from the infection if they don’t take proper prevention measures. Patients are advised to take medication and treatment of TB seriously and that in case they develop any health complication due to the use of medication should report to their doctors so that the medication can be changed.
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