Maximizing tuberculosis prevention in the workplace

“When you protect the employees, you protect economic productivity,” said Dr. Marilou Renales, a member of the National Board of Directors of the Philippine College of Occupational Medicine. According to Dr. Renales, “it shall be mandatory for all private establishments, workplaces and worksites to formulate and implement a TB prevention and control policy program” as stated in the  Department Order (DO) 73-05 – Guidelines for the Implementation of Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace by the Department of Labor and Employment (DOLE).

TB status
The WHO has reported that 9 million people get sick with TB every year.  TB is curable, but despite the efforts to increase awareness, detection, diagnosis and treatment compliance, the world continues to bear its burden. The number of cases of multidrug-resistant TB has risen to 450,000 in 2012.

According to the study “Barriers of Early TB Diagnosis among the Poor in Highly Urbanized Areas in the Philippines” by Reyes Amores [Philippine Institute for Development Studies Discussion Paper No. 2014-18] , one of the important factors contributing to the high rates of TB cases in poor communities is the patient’s delaying to visit the doctor. Reyes and Amores noted other factors contributing to delayed diagnosis: lack of knowledge, financial constraints, inaccessibility of healthcare services and facilities, and stigma-related factors.

Approach to TB
There are advantages of conducting prevention programs in the workplace, emphasized Dr. Renales. The workers report on a regular if not on a daily basis. The communication systems and organizational structure are in place, which are essential to maximizing the scope of the program. Existing facilities such as the office, meeting rooms, conference halls and other common areas can be utilized to convene an assembly. Quite appropriately, the employers and other key office personnel have the skills and systems needed to organize, facilitate and monitor TB control activities.

Meanwhile, environmental conditions may enhance transmission, such as small enclosed and poorly ventilated spaces. Installation of directional airflow ventilation system, use of air disinfection devices and air filtration systems, as well as simply opening windows and doors to maximize air circulation can be done. Proper evaluation should be done to check for adequate ventilation and space based on the standard Occupational Safety and Health requirements. Policies should be drafted, and environmental controls and other associated interventions implemented to prevent airborne transfer from unsuspected and diagnosed cases to non-infected workers.

Workers should be thoroughly screened during pre-employment to prevent introduction of infection in the workforce. Unfortunately at present, “most companies still rely on chest x-rays,” said Dr. Renales. Proper diagnosis and management should be ensured by referring to specialists and TB DOTS centers. Patients on therapy are monitored to reinforce compliance, and assistance during treatment should be provided. Benefits can be extended to employees such as sick leave and health claims, and in some instances, extension of employer responsibility to the employees’ families and communities.

There are still misconceptions about TB among employees and employers alike. Fair policies on confidentiality and discrimination should be developed and implemented. The patients are protected when medical conditions and medical records are kept confidential. A company-wide awareness campaign can decrease the stigma associated with TB. Dr. Renales emphasized that “when a safe workplace environment is created, employees who think they have TB, as well as those who are diagnosed cases will be encouraged to come forward.” It is vital that workers understand and respect the program. Senior management commitment will increase the likelihood of success of the program.

The National TB Program (NTP)
The program is underutilized due to lack of awareness about DO 73-05. Despite the limitations of medical services outsourced to third party providers, the Occupational Health and Safety Committees of companies should seek input from an Occupation Medicine physician as they have the skill set and knowledge of the workplace and the associated health issues.

Training of company clinic staff and other office personnel can be conducted with support from different medical institutions and professional societies. The DOLE’s Occupational Safety and Health Center may be consulted to help jumpstart a corporate TB program, and a company may work closely with the Bureau of Working Conditions. Linkage with the NTP is a crucial step in the quest to resolve the multi-factorial problem that is tuberculosis, noted Dr. Renales.