This winter has already seen harsh pollution spikes first in Harbin, and recently in Shanghai and eastern China. By coincidence I had been taking the train from Shanghai to Beijing during one of those days, and I sat mesmerized as we barreled through endless vistas of ghostly cities disappearing into the shroud. Online stores are flooded with anti-pollution products; chat rooms and coffee shop conversations are filled with personal comments about their adventures with masks. This question is deadly relevant to me and my family, as well as to the hundreds of patients and readers who have asked me this question over the years.
Persons who use tobacco or alcohol 40,41illegal drugs, including injection drugs and crack cocaine 42—47might also be at increased risk for infection Preventing pollution case review disease.
However, because of multiple other potential risk factors that commonly occur among such persons, use of these substances has been difficult to identify as separate risk factors.
Health-care settings should be particularly aware of the need for preventing transmission of M.
Persons infected with HIV who are already severely immunocompromised and who become newly infected with M. Because the risk for disease is particularly high among HIV-infected persons with M. Vaccination with BCG probably does not affect the risk for infection after exposure, but it might decrease the risk for progression from infection with M.
Exposure to TB in small, enclosed spaces.
Inadequate local or general ventilation that results in insufficient dilution or removal of infectious droplet nuclei. Recirculation of air containing infectious droplet nuclei. Inadequate cleaning and disinfection of medical equipment.
Improper procedures for handling specimens. The magnitude of the risk varies Preventing pollution case review setting, occupational group, prevalence of TB in the community, patient population, and effectiveness of TB infection-control measures.
Health-care—associated transmission of M. Factors contributing to these outbreaks included delayed diagnosis of TB disease, delayed initiation and inadequate airborne precautions, lapses in AII practices and precautions for cough-inducing and aerosol-generating procedures, and lack of adequate respiratory protection.
Multiple studies suggest that the decline in health-care—associated transmission observed in specific institutions is associated with the rigorous implementation of infection-control measures 11,12,18—20,23,95— Because various interventions were implemented simultaneously, the effectiveness of each intervention could not be determined.
After the release of the CDC infection-control guidelines, increased implementation of recommended infection-control measures occurred and was documented in multiple national surveys 13,15,98, A survey of New York City hospitals with high caseloads of TB disease indicated 1 a decrease in the time that patients with TB disease spent in EDs before being transferred to a hospital room, 2 an increase in the proportion of patients initially placed in AII rooms, 3 an increase in the proportion of patients started on recommended antituberculosis treatment and reported to the local or state health department, and 4 an increase in the use of recommended respiratory protection and environmental controls Reports of increased implementation of recommended TB infection controls combined with decreased reports of outbreaks of TB disease in health-care settings suggest that the recommended controls are effective in reducing and preventing health-care—associated transmission of M.
Less information is available regarding the implementation of CDC-recommended TB infection-control measures in settings other than hospitals. One study identified major barriers to implementation that contribute to the costs of a TST program in health departments and hospitals, including personnel costs, HCWs' time off from work for TST administration and reading, and training and education of HCWs Outbreaks have occurred in outpatient settings i.
CDC-recommended TB infection-control measures are implemented in correctional facilities, and certain variations might relate to resources, expertise, and oversight — In the United States, the problem of MDR TB, which was amplified by health-care—associated transmission, has been substantially reduced by the use of standardized antituberculosis treatment regimens in the initial phase of therapy, rapid drug-susceptibility testing, directly observed therapy DOTand improved infection-control practices 1.
DOT is an adherence-enhancing strategy in which an HCW or other specially trained health professional watches a patient swallow each dose of medication and records the dates that the administration was observed.
All health-care settings need a TB infection-control program designed to ensure prompt detection, airborne precautions, and treatment of persons who have suspected or confirmed TB disease or prompt referral of persons who have suspected TB disease for settings in which persons with TB disease are not expected to be encountered.
Such a program is based on a three-level hierarchy of controls, including administrative, environmental, and respiratory protection 86, Administrative Controls The first and most important level of TB controls is the use of administrative measures to reduce the risk for exposure to persons who might have TB disease.
Administrative controls consist of the following activities: HCWs with TB disease should be allowed to return to work when they 1 have had three negative AFB sputum smear results — collected 8—24 hours apart, with at least one being an early morning specimen because respiratory secretions pool overnight; and 2 have responded to antituberculosis treatment that will probably be effective based on susceptibility results.
Consideration should also be given to the type of setting and the potential risk to patients e. Environmental Controls The second level of the hierarchy is the use of environmental controls to prevent the spread and reduce the concentration of infectious droplet nuclei in ambient air.
Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation e.
Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source AII rooms and cleaning the air by using high efficiency particulate air HEPA filtration or UVGI. Respiratory-Protection Controls The first two control levels minimize the number of areas in which exposure to M.
These control levels also reduce, but do not eliminate, the risk for exposure in the limited areas in which exposure can still occur. Because persons entering these areas might be exposed to M.
Use of respiratory protection can further reduce risk for exposure of HCWs to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease see Respiratory Protection.
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Air pollution is a key concern for the construction industry due to the sector’s considerable impact on air quality. Less than a quarter of all air pollution-related deaths are in London, so it is clear that air pollution is everyone’s problem.
Pollution-induced skin damage is a global problem with particular relevance in China and India. • Ambient particulate matter exposure contributes to premature skin aging.