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    250 Bedded TB Hospital Arsaful Vai 07

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    250 Bedded TB Hospital Arsaful Vai 07

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    meherimamehmed459
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    250 Bedded TB Hospital arsaful vai 07

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    4 views9 pages

    250 Bedded TB Hospital Arsaful Vai 07

    Uploaded by

    meherimamehmed459

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 9

    A VISIT TO 250 BEDDED TB HOSPITAL

    Group-A

    Group-B
    Date of visit: 30/11/2021(Group-B) & 1/12/2021(Group-A)

    Location: Shyamoli, Dhaka, Bangladesh.

    Supervising Teacher:

    Dr.Priyanka Barua
    Assistant Professor,Dr.Sirajul Islam Medical College
    Dr.Anika Tasnim
    Assistant Professor,Dr.Sirajul Islam Medical College
    Dr.Israt Jahan Khan
    Lecturer,Dr.Sirajul Islam Medical College

    Dr.Jannat Mahzabeen
    Lecturer, Dr.Sirajul Islam Medical College
    Dr. Janifar Zaman
    Lecturer, Dr. Sirajul Islam Medical College
    Dr. Zarin Tasnim Tamanna
    Lecturer, Dr. Sirajul Islam Medical College
    Objectives of our visit:

     To acquire knowledge about the institute.


     To know about the activities of the institute.
     To know the implementation of the treatment on the patients.

    Background:

    It was established as a T.B. Hospital in 1995. In 1962, it was upgraded as Institute of Chest
    and Cardiac Hospital. First it initiated Post-graduation Degree and then, in 1992, a
    Development Project was added.
    In 2002, it was further upgraded as National Institute of Disease of the Chest and Cardiac
    Hospital.

    In 2005, an additional service was added. Thus it has another sector named National Asthma
    Centre.

    Objectives:

     Early diagnosis and treatment of Tuberculosis.


     To control Tuberculosis in Bangladesh.
     To interrupt transmission of communicable Tuberculosis in the community.
     To reduce morbidity and prevent mortality.
     To reduce complications of traumatic lung accidents.

    Structure of the T.B. Control Centre:

    1. The patient department has 250 beds.


    2. Diagnostic Services:
    Laboratory Services:
     Sputum smear for Acid Fast Bacilli (AFB)
     Sputum culture for AFB
     Fine needle aspiration cytology (FNAC)
     Tissue histopathology
     Hematology
     Biochemistry
    Other services:

     Spirometry
     FEV1
     Allergy and Broncho-provocational test
     Rigid Bronchoscopy
     Mediastinoscopy
     Lung biopsy
     Radiology and Imaging
     Bronchogram
    3. Out-patient Service Department.
    4. Directly Observed Treatment, Short-course (DOTS) Centre.
    5. Asthma Centre.

    Asthma Centre

    Research:

    The institute also provides some individual services and collaborative studies.
    Treatment:

     To cure the patients.


     To interrupt transmission of T.B.
     To prevent occurrence of Lung Fibrosis.

    Program Strategy:

    The program initially adopted the WHO-DOTS strategy which consisted of the five
    components of strong political will and administrative commitment, diagnosis by quality
    assured sputum smear microscopy, uninterrupted supply of quality assured Short Course
    chemotherapy drugs, Directly Observed Treatment (DOT) and systematic monitoring and
    Accountability. The DOTS strategy achieved and sustained the target detection rate of 70%
    of all estimated cases and a cure rate of 85% in new cases and led to the decrease in incidence
    of TB in the country.

    With progress in achieving objectives outlined in the DOTS Strategy of the 11th Five year
    Plan, the program defined the new targets of Universal Access to TB care. Under the 12th
    Five Year Plan of Government of Bangladesh as the National Strategic Plan for 2012–17, the
    plan hopes to achieve detection of at-least 90% the total estimated cases and a cure rate of
    90% in new and 85% in re-treatment cases.

    Following are the key components:

    Case finding and diagnostics:

     Early identification of all infectious TB cases. Improved integration with the general
    health system, and leverage field staff for home-based case finding.
     Improve communication and outreach
     Screening clinically and socially vulnerable risk groups for TB.
     Develop improved sputum collection and transportation systems.
     Deployment of higher-sensitivity diagnostic tests for TB suspects (and incorporate
    new tests) and decentralized Drug Susceptibility Testing (DST) services
     Catch patients already diagnosed through notification from all sources, improved
    referral for treatment mechanisms, and deployment of laboratory and private provider
    notification.

    Patient friendly treatment services:

     Promptly and appropriately treating TB, increasingly guided by DST.


     Making DOTS more patient-friendly through increased immunitization of DOT; pilot
    incentives/offsets for patient costs to help patients complete their treatment and better
    monitoring through information technology.
     Improving partnerships between public and private sector—establish 'Bangladesh
    Standards for TB Care' which can be used to engage providers using existing private
    treatment and improve care with some public sector support and supervision.
     Research will guide improvements in regimens and delivery systems.
     National Treatment Committee for regular review of regimens, all treatment related
    technical guidance.

    Scale-up of Programmatic Management of Drug-resistant TB (PMDT):

     Developing network of C&DST laboratories and strengthening of reference


    laboratories.
     Decentralized DST at district level for early Multi-drug resistant TB (MDR–TB)
    detection.
     Improved information system for PMDT.
     Manpower support for additional workload.
     Improved drug management of second-line anti-TB drugs.

    Scale-up of joint TB-HIV collaborative activities:

     Activities will aim at early, rapid TB diagnosis with high sensitivity tests for HIV-
    infected TB suspects and Antiretroviral Therapy (ART) for all HIV-infected TB
    patients, with transport support.
    Integration with health systems:

     Integrating the Revised National Tuberculosis Control Program (RNTCP) with the
    overall health system will increase effectiveness and efficiencies of TB care and
    control which has been depicted in the picture.
     In rural areas the RNTCP can focus integration through the National Rural Health
    Mission.
     In urban areas the RNTCP can integrate through the private sector and the evolving
    National Urban Health Mission.

    Control TB: compared to today's activities, success will:

     Accelerate decline in incidence and prevent 22 lakhs TB cases


     Reduce TB deaths by 75%, and save 17 lakhs lives from TB
     Contain MDR–TB: avert 1 lakh MDR cases and reduce incidence by 50%
     Quicker diagnosis of more TB patients, more effective treatment in future direct
    economic expenditure on TB cases prevented and
     Leadership for Bangladesh: Sustain Bangladesh's global leadership in TB treatment
    and control.

    Treatment Categories and Drug Regimens:

    Based on results from a recent study, RNTCP has issued guidelines to states on daily
    treatment for tuberculosis. The daily regimen will replace the existing alternate day (thrice
    weekly) regimen from January - February 2016 in selected states. The daily regimen has
    shown to be effective in reducing relapse rates and drug-resistance.

    Standardized treatment regimens are one of the pillars of the DOTS strategy. Isoniazid,
    Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin are the primary anti-tubercular
    drugs used. Most DOTS regimens have thrice-weekly schedules and typically last for six to
    nine months, with an initial intensive phase and a continuation phase.

    Based on the nature/severity of the disease and the patient's exposure to previous anti-
    tubercular treatments, RNTCP classifies tuberculosis patients into two treatment categories–

    New* Previously treated**


     New sputum smear-positive  Sputum smear-positive relapse
     New sputum smear-negative  Sputum smear-positive failure
     New extra-pulmonary tuberculosis  Sputum smear-positive treatment
    after default
     Sputum smear-negative
     Extra-pulmonary disease who can
    have recurrence or resonance

    2H3R3Z3E3 + 4H3R3 2H3R3Z3E3S3 + 1H3R3Z3E3 + 5H3R3E3

    2 months intensive phase + 4 months 3 months intensive phase + 5 months


    continuation phase continuation phase

    Four drugs at Thrice-weekly Schedule for Five drugs at thrice-weekly Schedule for
    2 months Intensive phase Two drugs at initial 2 months followed by Four drugs for
    Thrice-Weekly Schedule for remaining 4 next 1 month Intensive phase. Three drugs
    months continuation phase. at Thrice-weekly Schedule for remaining 5
    months continuation phase.

    Drug of Tuberculosis
    :FIXED DOSE COMBINATION TABLET FOR TUBERULOSIS

    H: Isoniazid (300 mg), R: Rifampicin (450 mg), Z: Pyrazinamide (1500 mg), E: Ethambutol
    (1200 mg), S: Streptomycin (750 mg)

    1. Patients who weigh 60 kg or more receive additional Rifampicin 150 mg.


    2. Patients who are more than 50 years old receive Streptomycin 500 mg. Patients who
    weigh less than 30 kg receive drugs as per Pediatric weight band boxes according to
    body weight.

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