The project was implemented by a team of experts in TB-IC
from the Netherlands and Romania working together with
the NTP of Romania. The project was an implementation
study using two methods of evaluation: (1) a cross sectional
questionnaire study; and (2) collection of information, during
the training, on challenges related to infection control and to
the project's implementation. The team used a descriptive
cross sectional study design to assess the use of the TB-IC
template, using a self-administered questionnaire. The challenges
with TB infection control and problems encountered
with the implementation of the project were discussed during
the plenary sessions of the training and recorded in a report.
The project started with an inception phase, during which the
main stakeholders in the country refined the project's objectives
and agreed on the methods. These stakeholders included
the NTP manager, coordinators of the NTP departments (MDRTB,
surveillance, drug management) and TB coordinators from
Bucharest. All activities and steps of the project are reflected
in Fig. 1. The next step of the project consisted of the development
of a TB facility IC plan template divided into several
sections. The project team experts together with the NTP
designed the template in a participatory way and in line with
the guidelines of the World Health Organisation (WHO)8 and
Centers for Disease Control and Prevention (CDC).9
The latest (2009) WHO policy on TB infection control in
health-care facilities, congregate settings and households8
and the framework ‘Implementing the WHO policy on TB
infection control in health care facilities, congregate settings
and households’10 both give guidance for TB-IC at national
level. However, detailed step-by-step guidance regarding the
development of a TB-IC plan at the level of a facility was not
available. Such step-by-step guidance was needed to translate
the national level TB-IC policy into managerial activities,
administrative and environmental controls and measures of
personal respiratory protection at the level of a facility. At the
same time international guidance needed to be adapted to the
local setting to be in line with the country's legal and regulatory
framework, to reflect the local situation and available
resources, and to be suitable for the local patients' and staff's
behaviour. The team therefore developed a facility TB-IC plan
template tailor-made to the Romanian environment. The
template contains various sections that need to be filled-in by
relevant staff at each facility; this could be a TB-IC committee
representative, a nosocomial infections committee representative
or a TB-IC responsible person. The template consists of
the following sections: IC commission,e TB risk assessment in
the facility, managerial activities, administrative controls,
environmental controls, personal respiratory protection, TBIC
in TB laboratories, monitoring and evaluation (M&E) of
TB-IC and budget related to TB-IC activities. Each section of
the facility TB-IC plan template includes a succinct background,
presenting the theory to underpin the planning process.
Only the sections of the facility TB-IC plan that are
relevant for the health care facility according to the results of
the risk assessment need to be filled-in. The sections consist
mainly of tables and forms that altogether, when filled-in,
comprise the facility TB-IC plan tailored to the specific situation
of each facility, the needs and capacity.
The first section of the template gives guidance about the
setup of the IC commission, its composition and responsibilities.
At facilities where nosocomial infection control
commissions are already established, functional and cover
TB-IC, this step can be omitted. The second section outlines
how to conduct the risk assessment inside the health care
facility (Fig. 2), including risk mapping. To develop this section
the project team made use of the materials developed by the
International Council of Nurses on risk reduction and interprofessional
collaboration for TB infection control11 and the
classification of health units and procedures, based on risk
categories.8 The subsequent template sections reflect TB-IC
control activities e managerial controls, administrative controls,
environmental controls and personal respiratory
A TB-IC Commission comprises of a group of experts nominated
by the management of each hospital and is aimed at
coordinating TB-IC activities of the different sections of the TB
facility. This commission is a multidisciplinary group, consisting
of an epidemiologist, the coordinator of the TB activities in the
facility, the head of each department and nurses from each clinic
section. Including the facility manager and representatives from
administration and accounting services enables a better monitoring
and budgeting of this activity. Ideally this commission
should be integra