NATIONAL TUBERCULOSIS,

LEPROSY AND LUNG DISEASE

PROGRAM

TUBERCULOSIS (TB)
ISOLATION POLICY

February 2018

MINISTRY OF HEALTH
 NATIONAL TUBERCULOSIS, LEPROSY AND LUNG DISEASE PROGRAM

TUBERCULOSIS (TB) ISOLATION POLICY

DATE: FEBRUARY 2018

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ACKNOWLEDGEMENT
ACKNOWLEDGEMENT

The Ministry of Health through the National Tuberculosis, Leprosy and Lung
The Ministry of Health through the National Tuberculosis, Leprosy and
Lung Disease Program (NTLD-P), continue to provide the necessary
technical
Disease Program (NTLD-P), continue to provide the necessary technical
assistance as well as developing policy guidelines documents for TB
assistance as well as developing policy guidelines documents for TB
prevention, treatment and care. As part of giving policy direction on
treatment
prevention, treatment and care. As part of giving policy direction on
treatment of patients who interrupt or refuse to take medication, the
Ministry of health
of patients who interrupt or refuse to take medication, the Ministry of health
has developed TB isolation policy guidelines for admission of TB patients
as
has developed TB isolation policy guidelines for admission of TB patients
as part of promoting and protecting the human right and the dignity of the
part of promoting and protecting the human right and the dignity of the
patients. The realization of development this document was due consorted
patients. The realization of development this document was due consorted
effort of various stakeholders’ contribution and determination to ensure that
effort of various stakeholders’ contribution and determination to ensure that
we end TB transmission emitting from those who refuse to take medication
or
we end TB transmission emitting from those who refuse to take medication
or interrupt the treatment.
interrupt the treatment.

The ministry of health through NTLD-P wishes to acknowledge the immerse

The ministry of health through NTLD-P wishes to acknowledge the
immerse contribution of various organization listed below and the entire
writing team
contribution of various organization listed below and the entire writing team
see the attached list. I take note of the following and appreciate their
see the attached list. I take note of the following and appreciate their
contributions.
contributions.
• All staff of the National Tuberculosis, Leprosy and Lung Disease
• All staff of the National Tuberculosis, Leprosy and Lung Disease
program
program
• World Health organization (WHO)
• World Health organization (WHO)
• Centre for Disease Prevention and Control (CDC)
• Centre for Disease Prevention and Control (CDC)
• Sop TB partnership
• Sop TB partnership
• Centre for Health Solution (CHS)
• Centre for Health Solution (CHS)
• KELIN
• KELIN
• Health strats
• Health strats
• MSF
• MSF
• The county governments
• The county governments
• Former TB patient
• Former TB patient
• All the CECs, COs, CDHs, CHMTs and other Health care workers from
• All the CECs, COs, CDHs, CHMTs and other Health care workers
from Hombay, Kirinyaga, Mombasa Nairobi and Nandi.
Hombay, Kirinyaga, Mombasa Nairobi and Nandi.
• And appreciate the TB isolation consultant
• And appreciate the TB isolation consultant
 Thank you all.
Thank you all.

Dr. Kamene kimenye Mariita,

Dr. Kamene kimenye Mariita,
HEAD: NATIONAL TUBERCULOSIS, LEPROSY AND LUNG DISEASE
PROGRAMHEAD: NATIONAL TUBERCULOSIS, LEPROSY AND LUNG
DISEASE PROGRAM

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FOREWORD
FOREWORD

Tuberculosis (TB) remains a major public health problem despite it being a

Tuberculosis (TB) remains a major public health problem despite it being a
preventable, treatable and curable disease. It remains the leading killer of
preventable, treatable and curable disease. It remains the leading killer of
people living with HIV. TB is a contagious airborne disease, and just like
the
people living with HIV. TB is a contagious airborne disease, and just like
the common cold, it spreads through the air. Only people who are sick with
active
common cold, it spreads through the air. Only people who are sick with
active TB in their lungs (pulmonary TB) are infectious. When people with
active
TB in their lungs (pulmonary TB) are infectious. When people with active
pulmonary TB cough, sneeze, talk or spit, they propel TB germs, known as
pulmonary TB cough, sneeze, talk or spit, they propel TB germs, known as
bacilli, into the air. A person who needs only to inhale a small number of
these
bacilli, into the air. A person who needs only to inhale a small number of
these bacilli to be infected.
bacilli to be infected.

Apart from implementation of TB infection Prevention and Control measures,

Apart from implementation of TB infection Prevention and Control
measures, treatment of those with active TB of the lungs is key in
preventing the spread
treatment of those with active TB of the lungs is key in preventing the
spread of the TB bacilli. The Public Health Act CAP 242, section 17
classify TB as
of the TB bacilli. The Public Health Act CAP 242, section 17 classify TB
as notifiable infectious disease and under section 26 as part of
prevention and
notifiable infectious disease and under section 26 as part of prevention
and control of infectious diseases, those exposed or suffer from the
notifiable
control of infectious diseases, those exposed or suffer from the notifiable
infectious diseases should be isolated in designated place and detained
while
infectious diseases should be isolated in designated place and detained
while taking medication until in the assessment of the Medical officer of
health
taking medication until in the assessment of the Medical officer of health
confirm that the person is free from infection or able to be discharged
without
confirm that the person is free from infection or able to be discharged
without danger to public health. Previous the TB patients who refused to
take
danger to public health. Previous the TB patients who refused to take
medication by the order of the magistrates there being confined in
prison
medication by the order of the magistrates there being confined in prison
while under taking their treatment. TB patients were being confined in
prison
while under taking their treatment. TB patients were being confined in
prison and not in the health facilities.
and not in the health facilities.

The High Court of Kenya, however on 24th March 2016 annulled the
The High Court of Kenya, however on 24th March 2016 annulled the
detention in prisons of patients who default on anti-TB medication. Due to
detention in prisons of patients who default on anti-TB medication. Due to
this, the court gave directive to the Ministry of Health to issue a circular on
this, the court gave directive to the Ministry of Health to issue a circular on
confining of infectious patients in health facilities other than prisons. In
order
confining of infectious patients in health facilities other than prisons. In
order to comply with this directive, the Tuberculosis Interagency
Coordinating
to comply with this directive, the Tuberculosis Interagency Coordinating
Committee (TBICC) appointed and mandated a taskforce to spearhead the
Committee (TBICC) appointed and mandated a taskforce to spearhead the
development of TB isolation policy.
development of TB isolation policy.

The taskforce developed the road map for the policy and clearly outlined the
The taskforce developed the road map for the policy and clearly outlined
the key milestones and deliverables required to realize development of
isolation
key milestones and deliverables required to realize development of
 isolation policy and its implementation. Among the activities which were
undertaken
policy and its implementation. Among the activities which were undertaken
included Key informant Interview (KII) with CECs, COH, CDHs, selected
included Key informant Interview (KII) with CECs, COH, CDHs, selected
health care workers and Focused Group Discussions (FGDs) with the
County
health care workers and Focused Group Discussions (FGDs) with the
County Health management teams, TB patients, Prisoners and Prison
wardens in the
Health management teams, TB patients, Prisoners and Prison wardens in
the five selected Counties namely Nairobi, Nandi, Homabay, Mombasa &
five selected Counties namely Nairobi, Nandi, Homabay, Mombasa &
Kirinyaga.
Kirinyaga.

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The isolation policy outline the procedures to be followed in isolation and
The isolation policy outline the procedures to be followed in isolation and
admission of TB patients who interrupt TB treatment and refusing to take
anti
admission of TB patients who interrupt TB treatment and refusing to take
anti TB medicine. The TB isolation policy offered two type of isolation,
voluntary
TB medicine. The TB isolation policy offered two type of isolation,
voluntary and involuntary isolation. In both, the isolation of TB patient
will follow the
and involuntary isolation. In both, the isolation of TB patient will follow
the laid down procedures as well as promoting human right and
protecting the
laid down procedures as well as promoting human right and protecting
the dignity of the patient and also protecting the public from the
infectious
dignity of the patient and also protecting the public from the
infectious disease.
disease.

The isolation policy therefore is a milestone in TB prevention, treatment and

The isolation policy therefore is a milestone in TB prevention, treatment
and care. Failure to adherence to anti TB medication, the patient will
continue
care. Failure to adherence to anti TB medication, the patient will
continue spreading tuberculosis among the healthy part of Kenya
population. This TB
spreading tuberculosis among the healthy part of Kenya population. This
TB isolation policy document will give the basis under which those who
interrupt
isolation policy document will give the basis under which those who
 interrupt treatment (default) in taking anti-TB medication will be admitted
in
treatment (default) in taking anti-TB
medication will be admitted in
designated isolation rooms in the
health facilities both public and
private.
designated isolation rooms in the health facilities both public and private.

Dr. Kioko Jackson K., OGW, MBS

Dr. Kioko Jackson K., OGW, MBS
DIRECTOR OF MEDICAL SERVICES,
DIRECTOR OF MEDICAL SERVICES,
MINISTRY OF HEALTH, KENYA
MINISTRY OF HEALTH, KENYA

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TABLE OF CONTENT
TABLE OF CONTENT
1. BACKGROUND...............................................................................................................................6 1.
BACKGROUND...............................................................................................................................6 1.1.
Introduction..............................................................................................................................6 1.1.
 Introduction..............................................................................................................................6 1.2.
Justification for the policy development ..................................................................................7 1.2.
Justification for the policy development ..................................................................................7 1.3. Broad
objective........................................................................................................................8 1.3. Broad
objective........................................................................................................................8 1.4. Scope of
policy........................................................................................................................9 1.4. Scope of
policy........................................................................................................................9 1.5. Links to other
policies............................................................................................................11 1.5. Links to other
policies............................................................................................................11 2.
GOVERNANCE.............................................................................................................................12 2.
GOVERNANCE.............................................................................................................................12 2.2
National Level........................................................................................................................12 2.2 National
Level........................................................................................................................12 2.3 Training
Institutions and Regulatory Bodies .........................................................................12 2.3 Training
Institutions and Regulatory Bodies .........................................................................12 2.4 County and Sub
County Levels.............................................................................................12 2.4 County and Sub County
Levels.............................................................................................12 2.5 Health Care
Facility...............................................................................................................12 2.5 Health Care
Facility...............................................................................................................12 2.6 Health Care Providers
(HCP)................................................................................................12 2.6 Health Care Providers
(HCP)................................................................................................12 2.7 Community and Community
Representatives.......................................................................13 2.7 Community and Community
Representatives.......................................................................13 3 APPLICATION OF TB IPC IN THE
ISOLATION FACILITIES ......................................................14 3 APPLICATION OF TB IPC IN THE
ISOLATION FACILITIES ......................................................14 3.1 Principles of infection control
measures ...............................................................................14 3.1 Principles of infection control
measures ...............................................................................14 3.2 Standard/specification/location of
isolation rooms to be followed.........................................14 3.2 Standard/specification/location of isolation
rooms to be followed.........................................14 4. MANAGEMENT AND CARE OF PATIENTS AT
ISOLATION FACILITIES..................................17 4. MANAGEMENT AND CARE OF PATIENTS AT
ISOLATION FACILITIES..................................17 4.1
Isolation .................................................................................................................................17 4.1
Isolation .................................................................................................................................17 4.2
Transmission risk assessment..............................................................................................17 4.2
Transmission risk assessment..............................................................................................17 4.3 Criteria for
Isolation ...............................................................................................................17 4.3 Criteria for
Isolation ...............................................................................................................17 4.4 Patient
Education/Counselling ..............................................................................................18 4.4 Patient
Education/Counselling ..............................................................................................18 4.5 Nutritional
services................................................................................................................18 4.5 Nutritional
services................................................................................................................18 4.6 Clinical
management.............................................................................................................19 4.6 Clinical
management.............................................................................................................19 4.7 Contact
Tracing.....................................................................................................................19 4.7 Contact
Tracing.....................................................................................................................19 4.8 Visitors to Patients
in Isolation ..............................................................................................19 4.8 Visitors to Patients in
 Isolation ..............................................................................................19 5. LEGAL REQUIREMENT,
PATIENT RIGHTS AND RESPONSIBILITIES ....................................20 5. LEGAL REQUIREMENT,
PATIENT RIGHTS AND RESPONSIBILITIES ....................................20 5.1 Legal and Policy
framework ..................................................................................................20 5.1 Legal and Policy
framework ..................................................................................................20 5.2 International and regional
legal and policy framework..........................................................20 5.2 International and regional legal and
policy framework..........................................................20 5.3 Domestic Legal and Policy
Framework.................................................................................21 5.3 Domestic Legal and Policy
Framework.................................................................................21 5.4 The Health Act
2017 .............................................................................................................23 5.4 The Health Act
2017 .............................................................................................................23 5.5 Justification for TB
Isolation ..................................................................................................24 5.5 Justification for TB
Isolation ..................................................................................................24 5.6 Patients’ Rights And
Responsibilities....................................................................................25 5.6 Patients’ Rights And
Responsibilities....................................................................................25 6. REVIEW PLAN AND
MONITORING AND EVALUATION FOR THIS POLICY DOCUMENT......29 6. REVIEW PLAN AND
MONITORING AND EVALUATION FOR THIS POLICY DOCUMENT......29 7.
ANNEXES .....................................................................................................................................30 7.
ANNEXES .....................................................................................................................................30 7.1
Annex 1: Key Informant Interview and Focus group discussion guides ...............................30 7.1 Annex 1:
Key Informant Interview and Focus group discussion guides ...............................30 7.2 Annex 2: Key
Informant interview report...............................................................................32 7.2 Annex 2: Key Informant
interview report...............................................................................32 7.3 Annex 3: Focus Group Discussion
report .............................................................................37 7.3 Annex 3: Focus Group Discussion
report .............................................................................37 7.4 Annex 4: Sample
designs .....................................................................................................41
7.4 Annex 4: Sample designs .....................................................................................................41 7.5
Annex 5: Sample designs.............................................................................................44
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7.6 Annex 6: MOH Circular..................................................................................................46

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1. BACKGROUND
1. BACKGROUND

1.1. Introduction
1.1. Introduction
Tuberculosis (TB) remains a major public health problem despite it being a
Tuberculosis (TB) remains a major public health problem despite it being a
preventable, treatable and curable disease. It remains the leading killer of people
preventable, treatable and curable disease. It remains the leading killer of people
living with HIV. TB is a contagious airborne disease, and just like the common
living with HIV. TB is a contagious airborne disease, and just like the common
cold, it spreads through the air. Only people who are sick with active TB in their
cold, it spreads through the air. Only people who are sick with active TB in their
lungs (pulmonary TB) are infectious. When people with active pulmonary TB
lungs (pulmonary TB) are infectious. When people with active pulmonary TB
cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A
cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A
person needs only to inhale a small number of these bacilli to be infected.
person needs only to inhale a small number of these bacilli to be infected.

TB is caused by a bacterium called Mycobacterium tuberculosis that can affect all

TB is caused by a bacterium called Mycobacterium tuberculosis that can affect all
parts of the body except teeth, hair and nails. TB is transmitted from one person
parts of the body except teeth, hair and nails. TB is transmitted from one person to
another through the air when a person with TB of the lungs coughs sneezes or
to another through the air when a person with TB of the lungs coughs sneezes or
sings. TB affects those with low body defense systems e.g. those suffering from
sings. TB affects those with low body defense systems e.g. those suffering from
chronic illnesses like diabetes, cancers or those living with HIV and amongst
chronic illnesses like diabetes, cancers or those living with HIV and amongst
people who abuse drugs . TB attacks people of all age groups but mostly those
people who abuse drugs . TB attacks people of all age groups but mostly those
aged between 15-49 years. However, TB of the lungs, i.e., pulmonary TB, is the
aged between 15-49 years. However, TB of the lungs, i.e., pulmonary TB, is the
most common form. The common symptoms of TB include persistent cough
most common form. The common symptoms of TB include persistent cough
lasting for more than one week or more, loss of weight, fever, excessive night
lasting for more than one week or more, loss of weight, fever, excessive night
sweats, tiredness and loss of appetite.
sweats, tiredness and loss of appetite.

The World Health Organization (WHO) estimates that 9 million people develop
The World Health Organization (WHO) estimates that 9 million people develop
tuberculosis (TB) annually, a sixth of who die as a result. In 2014, this translated
tuberculosis (TB) annually, a sixth of who die as a result. In 2014, this translated to
1.6 million deaths, of which more than 90% were in developing countries.
to 1.6 million deaths, of which more than 90% were in developing countries.

In 2016, Kenya reported 75,896 cases of all forms of TB with 8.7 % of all cases
In 2016, Kenya reported 75,896 cases of all forms of TB with 8.7 % of all cases
notified being children below 15 years of age. The case notification rate is
notified being children below 15 years of age. The case notification rate is
170/100,000 population. In the last 5 years, Kenya has reported an annual
170/100,000 population. In the last 5 years, Kenya has reported an annual decline
in the number of reported TB cases at a rate of 1%. There has been
decline in the number of reported TB cases at a rate of 1%. There has been a
general increase in the proportion of bacteriologically confirmed cases with the
a general increase in the proportion of bacteriologically confirmed cases with the
advent of increasing utilization of MTB/RIF assay (gene Xpert) testing in the
advent of increasing utilization of MTB/RIF assay (gene Xpert) testing in the
country.
country.

Drug-resistant TB (DR-TB) continues to be a major public health challenge in

Drug-resistant TB (DR-TB) continues to be a major public health challenge in
Kenya with an increasing case notification of different forms of drug resistance
Kenya with an increasing case notification of different forms of drug resistance TB
cases every year. Globally, it is estimated that 480,000 cases developed
TB cases every year. Globally, it is estimated that 480,000 cases developed
multidrug-resistant (MDR-TB) in 2014, i.e., TB that is resistant to first-line
multidrug-resistant (MDR-TB) in 2014, i.e., TB that is resistant to first-line
medicines isoniazid and rifampicin. This is approximately 5% of all TB cases. In
medicines isoniazid and rifampicin. This is approximately 5% of all TB cases. In
2016, a total of 445 DR TB cases were diagnosed and enrolled on treatment.
2016, a total of 445 DR TB cases were diagnosed and enrolled on treatment.
Surveillance of DR TB has continued to be strengthened with the use of gene
Surveillance of DR TB has continued to be strengthened with the use of gene
Xpert testing to diagnose tuberculosis and identify Rifampicin resistance.
Xpert testing to diagnose tuberculosis and identify Rifampicin resistance.

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In Kenya, TB is among the notifiable diseases under the public health Act cap
In Kenya, TB is among the notifiable diseases under the public health Act cap
242. During the course of treatment about 5% of TB cases interrupt treatment,
242. During the course of treatment about 5% of TB cases interrupt treatment,
wherein a health care worker may seek the court’s intervention to ensure that the
wherein a health care worker may seek the court’s intervention to ensure that the
patient complete their TB treatment.
patient complete their TB treatment.

A policy on isolation of persons suffering from infectious diseases is the last

A policy on isolation of persons suffering from infectious diseases is the last resort
and will provide a framework within which persons with an infectious
resort and will provide a framework within which persons with an infectious
disease may be isolated in a manner that respects their human rights. Further,
disease may be isolated in a manner that respects their human rights. Further, the
policy would serve the public health purpose of protecting the public while
the policy would serve the public health purpose of protecting the public while
using a patient-centered and rights-based approach to TB prevention, treatment
using a patient-centered and rights-based approach to TB prevention, treatment
and management. The policy will also guide health care workers to ensure that
and management. The policy will also guide health care workers to ensure that
there is proper handling of TB patients. This policy will also properly guide the
there is proper handling of TB patients. This policy will also properly guide the
health care worker on instances where isolation would be recommended and the
health care worker on instances where isolation would be recommended and the
steps to take. This policy outlines the two models of isolation in Kenya: voluntary
steps to take. This policy outlines the two models of isolation in Kenya: voluntary
and involuntary.
and involuntary.

Isolation should never be implemented as a form of punishment. Isolation should

Isolation should never be implemented as a form of punishment. Isolation should
always be implemented in an ethical, non-discriminatory way that conforms to
always be implemented in an ethical, non-discriminatory way that conforms to
patients’ human rights. Patients who decline treatment and who pose a risk to
patients’ human rights. Patients who decline treatment and who pose a risk to
 others should be made aware in advance that their continued refusal may result
others should be made aware in advance that their continued refusal may result in
compulsory isolation. An individual that is deemed to require isolation has the
in compulsory isolation. An individual that is deemed to require isolation has the
right to appeal the decision in an appropriate adjudicatory setting, including
right to appeal the decision in an appropriate adjudicatory setting, including before
an administrative, judicial or quasi-judicial body.
before an administrative, judicial or quasi-judicial body.

Patients who are in isolation should receive treatment and all the clinical and
Patients who are in isolation should receive treatment and all the clinical and
social supports necessary to minimize the burden of isolation in their lives to the
social supports necessary to minimize the burden of isolation in their lives to the
greatest extent possible. If isolated patients refuse treatment, their informed
greatest extent possible. If isolated patients refuse treatment, their informed
refusal should be respected, as they no longer present a public health risk.
refusal should be respected, as they no longer present a public health risk.
Forcing these patients to undergo treatment would require a repeated invasion of
Forcing these patients to undergo treatment would require a repeated invasion of
bodily integrity, however, the right to health of other members of society cannot
bodily integrity, however, the right to health of other members of society cannot be
ignored. The state has a responsibility to protect the public from unnecessary
be ignored. The state has a responsibility to protect the public from unnecessary
risks of contracting airborne diseases and thus must balance involuntary
risks of contracting airborne diseases and thus must balance involuntary
confinement of people lost-to-follow up with public health protection of the wider
confinement of people lost-to-follow up with public health protection of the wider
population.
population.

1.2. Justification for the policy development

1.2. Justification for the policy development
The High Court of Kenya on 24th March 2016 annulled the confinement of TB
The High Court of Kenya on 24th March 2016 annulled the confinement of TB
patients who interrupt their anti-TB medication in prison and declared that it is
patients who interrupt their anti-TB medication in prison and declared that it is
unlawful and unconstitutional, to confine TB patients in prisons. The court
unlawful and unconstitutional, to confine TB patients in prisons. The court directed
the Ministry of Health to take the following measures, which should be
directed the Ministry of Health to take the following measures, which should be
applied with immediate effect:
applied with immediate effect:
1. Confinement of patients suffering from infectious diseases for the purposes of
1. Confinement of patients suffering from infectious diseases for the purposes of
treatment shall not be done in prison facilities.
treatment shall not be done in prison facilities.
2. Where despite all reasonable efforts, patients with infectious disease are
2. Where despite all reasonable efforts, patients with infectious disease are
unwilling or unable to comply with treatment; court orders may be sought to
unwilling or unable to comply with treatment; court orders may be sought to
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compel isolation, confinement or detention as referred to in section 27 of the
compel isolation, confinement or detention as referred to in section 27 of the
Public Health Act, CAP 242 or any other law in place at the time to address
Public Health Act, CAP 242 or any other law in place at the time to address
this issue.
this issue.
3. The isolation can be done at a health facility in adherence to infection control
3. The isolation can be done at a health facility in adherence to infection control
measures and for the purpose of ensuring that patients adhere to the course
measures and for the purpose of ensuring that patients adhere to the course of
treatment for the public interest and their own interest.
of treatment for the public interest and their own interest.
4. The Ministry of Health in consultation with county governments, shall in due
4. The Ministry of Health in consultation with county governments, shall in due
course issue further policy direction on the involuntary confinement of persons
course issue further policy direction on the involuntary confinement of persons
with TB and other infectious diseases.
with TB and other infectious diseases.

WHO suggests that interfering with freedom of movement when instituting

WHO suggests that interfering with freedom of movement when instituting
quarantine or isolation for a communicable disease such as TB could be
quarantine or isolation for a communicable disease such as TB could be
legitimate, but involuntary isolation should only be used as a last resort.
legitimate, but involuntary isolation should only be used as a last resort. Countries
have a responsibility to develop an isolation policy, which aligns with
Countries have a responsibility to develop an isolation policy, which aligns with
their constitution and international instruments on human rights law. In Kenya,
their constitution and international instruments on human rights law. In Kenya, 5%
(2015) of the loss-to-follow up among drug susceptible is attributed to
5% (2015) of the loss-to-follow up among drug susceptible is attributed to
adherence issues. Treatment interruption is the cause of continuous TB
adherence issues. Treatment interruption is the cause of continuous TB
transmission and results in increase in incidence of drug resistant TB cases.
transmission and results in increase in incidence of drug resistant TB cases.
These challenges will be addressed in this policy. As such, it is essential that TB
These challenges will be addressed in this policy. As such, it is essential that TB
patients receive adequate information to ensure they understand the health
patients receive adequate information to ensure they understand the health
implications of non-adherence, are aware of potential side effects of TB
implications of non-adherence, are aware of potential side effects of TB
medication, and have adequate nutritional, psycho-social and other support to
medication, and have adequate nutritional, psycho-social and other support to
promote treatment adherence.
promote treatment adherence.

1.3. Broad objective

1.3. Broad objective
This policy document provides details of the standards required for isolation care
This policy document provides details of the standards required for isolation care
 of TB patients who interrupt their anti TB medicine or those patients who cannot
of TB patients who interrupt their anti TB medicine or those patients who cannot
be treated using ambulatory or community based models due to their infectious
be treated using ambulatory or community based models due to their infectious
conditions and provide rationale for the use of isolation facilities. The policy
conditions and provide rationale for the use of isolation facilities. The policy
includes guidelines on indication for isolation procedures and procedures for the
includes guidelines on indication for isolation procedures and procedures for the
infection control management of patients in isolation facility.
infection control management of patients in isolation facility.

1.3.1. Specific objectives

1.3.1. Specific objectives
The objectives of this policy are
The objectives of this policy are
1. To ensure the rights of TB patients are protected and to encourage their
1. To ensure the rights of TB patients are protected and to encourage their
continuation of treatment in an appropriate medical setting.
continuation of treatment in an appropriate medical setting.
2. To ensure that the spread of TB disease is contained by application of
2. To ensure that the spread of TB disease is contained by application of
infection control measures
infection control measures
3. To outline the structural requirement of designing, renovating and
3. To outline the structural requirement of designing, renovating and
constructing isolation facility
constructing isolation facility

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1.4. Scope of policy
1.4. Scope of policy
The policy is based on the following core values; leadership and integrity; good
The policy is based on the following core values; leadership and integrity; good
governance; public participation and ownership; respect of human rights and social
governance; public participation and ownership; respect of human rights and social
justice; sustainability of benefits; and advocacy. This is in line with the values and
justice; sustainability of benefits; and advocacy. This is in line with the values and
principles laid out in article 10 of the Constitution of Kenya 2010.
principles laid out in article 10 of the Constitution of Kenya 2010.
1.4.1. Purpose
1.4.1. Purpose
The policy describes a set of elements that will guide the health management teams
The policy describes a set of elements that will guide the health management teams
at National and County levels to provide an isolation facility for eligible TB patients.
at National and County levels to provide an isolation facility for eligible TB patients.
The policy will focus on activities at the health facility level and will be used as a
The policy will focus on activities at the health facility level and will be used as a
reference to guide the design, renovation and construction of TB isolation facilities.
reference to guide the design, renovation and construction of TB isolation facilities.

1.4.2. Financing
1.4.2. Financing
The TB isolation policy makes it clear that sustained political, institutional and
The TB isolation policy makes it clear that sustained political, institutional and
financial commitment is crucial. This therefore necessitates that discussions on
financial commitment is crucial. This therefore necessitates that discussions on
isolation should feature during development of various activities including but not
isolation should feature during development of various activities including but not
limited to county work plans, strategic plans, public participation forums and
limited to county work plans, strategic plans, public participation forums and
development of county budgets.
development of county budgets.
1.4.3. Roles and responsibilities
1.4.3. Roles and responsibilities
• Ministry of Health officials – ensure active participation of all stakeholders
• Ministry of Health officials – ensure active participation of all stakeholders in
TB control during development of the policy, perform oversight role and
in TB control during development of the policy, perform oversight role and
facilitate implementation of the policy (Printing, dissemination,
facilitate implementation of the policy (Printing, dissemination, communication
and advocacy, technical assistance, monitoring and
communication and advocacy, technical assistance, monitoring and
evaluation and policy review).
evaluation and policy review).
• County Governments – these include County Health Management Team
• County Governments – these include County Health Management Team
(CHMT), Sub County Health Management Team (SCHMT) and Health
(CHMT), Sub County Health Management Team (SCHMT) and Health
Management Team (HMT). Budgetary allocation for development and
Management Team (HMT). Budgetary allocation for development and
sustainability of isolation facilities, Document printing skilled staffing
sustainability of isolation facilities, Document printing skilled staffing
requirements, support supervision, monitoring and evaluation, human rights
requirements, support supervision, monitoring and evaluation, human rights
trainings and capacity building to ensure strict adherence to the policy.
trainings and capacity building to ensure strict adherence to the policy. •
Stakeholders – These include Civil Society Organizations (CSOs),
• Stakeholders – These include Civil Society Organizations (CSOs),
implementing partners, development partners, Community Based
implementing partners, development partners, Community Based
Organizations (CBOs), patients’ groups, Faith Based Organizations (FBOs),
Organizations (CBOs), patients’ groups, Faith Based Organizations (FBOs),
and human right groups. They facilitate the implementation of the policy,
and human right groups. They facilitate the implementation of the policy,
dissemination, printing, support construction/renovation of isolation facilities,
dissemination, printing, support construction/renovation of isolation facilities,
monitoring and evaluation, oversight role, advocacy and communication.
 monitoring and evaluation, oversight role, advocacy and communication. • Health
facilities – These include HMT and health care workers. Their main
• Health facilities – These include HMT and health care workers. Their main role
is on infrastructure or space for construction of isolation facilities;
role is on infrastructure or space for construction of isolation facilities; provide
health services, strict adherence to treatment, resource mobilization.
provide health services, strict adherence to treatment, resource mobilization.
Collaboration with development partners is encouraged to support future
Collaboration with development partners is encouraged to support future
review of the policies.
review of the policies.

1.4.4. Phases of policy cycle

1.4.4. Phases of policy cycle
• Development of the policy- the policy will be developed by the collaborative
• Development of the policy- the policy will be developed by the collaborative
efforts of Ministry of Health officials and all Stakeholders who are involved in
efforts of Ministry of Health officials and all Stakeholders who are involved in
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TB control. This will also entail communication and advocacy to create
TB control. This will also entail communication and advocacy to create
awareness on the existence and scope of the policy.
awareness on the existence and scope of the policy.
• Enforcement - The Ministry of Health and the County Governments are
• Enforcement - The Ministry of Health and the County Governments are
responsible for the enforcement of the TB policy.
responsible for the enforcement of the TB policy.
• Implementation - Health care providers in close collaboration with the Health
• Implementation - Health care providers in close collaboration with the Health
management teams (HMT, SCHMT, and CHMT) will be responsible for
management teams (HMT, SCHMT, and CHMT) will be responsible for prompt
identification of patients (according to the criteria for isolation) and
prompt identification of patients (according to the criteria for isolation) and
instituting appropriate measures.
instituting appropriate measures.
• Monitoring, evaluation and feedback - This will happen at all levels; hospital
• Monitoring, evaluation and feedback - This will happen at all levels; hospital
management, sub-county, county and national level.
management, sub-county, county and national level.

1.4.5. Criteria for isolation of patients

1.4.5. Criteria for isolation of patients
A patient centred approach should be advocated for during the entire course of
A patient centred approach should be advocated for during the entire course of
treatment. This can be complemented by the community where treatment supporters
treatment. This can be complemented by the community where treatment supporters
are roped in to assist the patient in drug adherence and provide holistic care
are roped in to assist the patient in drug adherence and provide holistic care
(psychological, spiritual and social support).
(psychological, spiritual and social support).
Isolation for TB may be applied in the following situations, however in all cases
Isolation for TB may be applied in the following situations, however in all cases
voluntary isolation is preferable and patients should be counselled and given
voluntary isolation is preferable and patients should be counselled and given
adequate information and support and community-based care should be attempted
adequate information and support and community-based care should be attempted
first:
first:

• A known TB patient who has refused effective treatment and all reasonable
• A known TB patient who has refused effective treatment and all reasonable
measures (counselling, health education, community support) to ensure
measures (counselling, health education, community support) to ensure
adherence have been attempted and proven unsuccessful
adherence have been attempted and proven unsuccessful
• A known TB patient who has agreed to ambulatory treatment but lacks the
• A known TB patient who has agreed to ambulatory treatment but lacks the
capacity to institute infection control at home. This includes TB patients who
capacity to institute infection control at home. This includes TB patients who
are infectious.
are infectious.
• A known TB patient who has other comorbidities and/or severe health
• A known TB patient who has other comorbidities and/or severe health condition
that require in-patient care. This includes MTR TB, pre-XDR-TB and
condition that require in-patient care. This includes MTR TB, pre-XDR-TB and
XDR-TB and drug users
XDR-TB and drug users

1.4.6. Policy Review

1.4.6. Policy Review
The isolation policy will be reviewed every three years or earlier if there is law reform
The isolation policy will be reviewed every three years or earlier if there is law reform
before then, by the isolation taskforce to assess progress, utilization and
before then, by the isolation taskforce to assess progress, utilization and
implementation of the policy. It will also incorporate best practices across different
implementation of the policy. It will also incorporate best practices across different
settings and build on new evidence. This process will be ratified by the TB ICC.
settings and build on new evidence. This process will be ratified by the TB ICC.
1.4.7. Structure of the policy
1.4.7. Structure of the policy
The details of this policy are presented in a number of chapters as follows: (i)
The details of this policy are presented in a number of chapters as follows: (i)
Introduction (ii) Governance (iii) Principles: Application of isolation facilities (iv)
Introduction (ii) Governance (iii) Principles: Application of isolation facilities (iv)
Management and care of patients at Isolation facilities (v) Legal requirements,
Management and care of patients at Isolation facilities (v) Legal requirements, patient
rights/responsibility and statutory notification (vi) Review plan for the policy
patient rights/responsibility and statutory notification (vi) Review plan for the policy
document and annexes are attached to this policy.
document and annexes are attached to this policy.

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1.5. Links to other policies
1.5. Links to other policies
The policy will be hinged on existing policies such as:
The policy will be hinged on existing policies such as:

• National TB treatment guideline

• National TB treatment guideline
• DR-TB guidelines
• DR-TB guidelines
• National TB IPC policy – the three principles of infection control will be the
• National TB IPC policy – the three principles of infection control will be the
backbone of designing the isolation facilities
backbone of designing the isolation facilities
• Public Health Act Cap 242: which was established as an act of parliament to
• Public Health Act Cap 242: which was established as an act of parliament to
make provision for securing and maintaining health and explicitly section 27
make provision for securing and maintaining health and explicitly section 27
focuses on isolation of persons who have been exposed to infection. This
focuses on isolation of persons who have been exposed to infection. This
section however lacks clear grounds that isolation should be enforced and
section however lacks clear grounds that isolation should be enforced and
does not provide guidance on the next steps.
does not provide guidance on the next steps.
• Bill of Rights which is enshrined in the constitution of Kenya which outlines the
• Bill of Rights which is enshrined in the constitution of Kenya which outlines the
human rights whose purpose is to preserve dignity of individuals and
human rights whose purpose is to preserve dignity of individuals and
communities and to promote social justice
communities and to promote social justice
• Ethics guidance for the implementation of END TB strategy – defines the
• Ethics guidance for the implementation of END TB strategy – defines the
ethically acceptable circumstances when TB patients should be confined
ethically acceptable circumstances when TB patients should be confined
• Health Act 2017
• Health Act 2017
• The Patients’ Charter for TB Care
• The Patients’ Charter for TB Care
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2. GOVERNANCE
2. GOVERNANCE
2.1 Responsibility and Authority in Isolation
2.1 Responsibility and Authority in Isolation
There are various levels of responsibility and authority for IPC and isolation in
There are various levels of responsibility and authority for IPC and isolation in
health care facilities and settings.
health care facilities and settings.

2.2National Level
2.2National Level
At the national level, the Ministry of Health has the ultimate responsibility and
At the national level, the Ministry of Health has the ultimate responsibility and
authority for ensuring the availability, dissemination and use of IPC and Isolation
authority for ensuring the availability, dissemination and use of IPC and Isolation
policies and guidelines. The National Infection Prevention and Control Committee
policies and guidelines. The National Infection Prevention and Control Committee
(NIPCC) within the Ministry of health in collaboration with relevant departments and
(NIPCC) within the Ministry of health in collaboration with relevant departments and
stakeholders shall be responsible for monitoring, reviewing, and updating the IPC
stakeholders shall be responsible for monitoring, reviewing, and updating the IPC
and isolation guidelines.
and isolation guidelines.

2.3Training Institutions and Regulatory Bodies

2.3Training Institutions and Regulatory Bodies
Training institutions and regulatory bodies, such as the Medical and Dental
Training institutions and regulatory bodies, such as the Medical and Dental
Practitioners Board, the Nursing Council, the Clinical Officers Council, and other
Practitioners Board, the Nursing Council, the Clinical Officers Council, and other
Allied Health Professional regulatory bodies, are responsible for ensuring that each
Allied Health Professional regulatory bodies, are responsible for ensuring that each
respective pre- and in-service curriculum reflects adequate and appropriate content
respective pre- and in-service curriculum reflects adequate and appropriate content
on IPC.
on IPC.

2.4County and Sub County Levels

2.4County and Sub County Levels
The County and Sub-county health management teams (C/SCHMTs) shall be
The County and Sub-county health management teams (C/SCHMTs) shall be
responsible for monitoring the facilities under their control for use of and
responsible for monitoring the facilities under their control for use of and compliance
with Isolation practices. The CHMT is also responsible for ensuring that
compliance with Isolation practices. The CHMT is also responsible for ensuring that
adequate and appropriate resources are available for support of IPC and Isolation
adequate and appropriate resources are available for support of IPC and Isolation
 practices within these facilities. In coordination with the community representatives,
practices within these facilities. In coordination with the community representatives,
the county and sub-county levels should raise awareness in the communities about
the county and sub-county levels should raise awareness in the communities about
the isolation policy.
the isolation policy.

2.5Health Care Facility

2.5Health Care Facility
At the individual health care facility level, the implementation of Isolation is linked to
At the individual health care facility level, the implementation of Isolation is linked to
the general IPC and TB IPC guidelines initiatives. The Facility IPC Committee
the general IPC and TB IPC guidelines initiatives. The Facility IPC Committee
through the leadership of the IPC focal person should monitor, coordinate, and
through the leadership of the IPC focal person should monitor, coordinate, and
evaluate its implementation. The IPC Focal person should ensure: adequate supply
evaluate its implementation. The IPC Focal person should ensure: adequate supply
of IPC equipment and commodities, on-the-job training of other HCWs in the health
of IPC equipment and commodities, on-the-job training of other HCWs in the health
care facility, Monitoring IPC practices and reporting IPC activities to the Sub
care facility, Monitoring IPC practices and reporting IPC activities to the Sub County.
County.

2.6Health Care Providers (HCP)

2.6Health Care Providers (HCP)
Each HCP at the individual level is responsible and accountable for effective and
Each HCP at the individual level is responsible and accountable for effective and
efficient implementation of the IPC and Isolation policies and guidelines at all times
efficient implementation of the IPC and Isolation policies and guidelines at all times
in her/ his duty station. Health care providers should collaborate in the timely and
in her/ his duty station. Health care providers should collaborate in the timely and

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appropriate application of isolation. Nursing personnel should be responsible for
appropriate application of isolation. Nursing personnel should be responsible for the
following:
the following:
• Informing the patient’s clinician when a patient’s condition warrants
• Informing the patient’s clinician when a patient’s condition warrants
isolation
isolation
• Verifying the clinician‘s order to institute isolation
• Verifying the clinician‘s order to institute isolation
• Explaining procedures and the need for isolation to the patient and
• Explaining procedures and the need for isolation to the patient and
family
family
• Preparing a well-ventilated room or area for isolation with all the
 • Preparing a well-ventilated room or area for isolation with all the
necessary equipment
necessary equipment
• Notifying the IPC lead person of the patient in isolation within 24 hours
• Notifying the IPC lead person of the patient in isolation within 24 hours
of the suspicion or confirmation of an infectious disease
of the suspicion or confirmation of an infectious disease
• Displaying a STOP sign clearly in the patient’s isolation area
• Displaying a STOP sign clearly in the patient’s isolation area • The
clinician is the one responsible for instituting isolation. In the
• The clinician is the one responsible for instituting isolation. In the
absence of a clinician, the nurse-in-charge institutes isolation
absence of a clinician, the nurse-in-charge institutes isolation

2.7Community and Community Representatives

2.7Community and Community Representatives
Individual members of communities have a responsibility for complying with IPC
Individual members of communities have a responsibility for complying with IPC
practices and TB community dialogues at the community level. Community
practices and TB community dialogues at the community level. Community
representatives should collaborate with relevant departments to enhance
representatives should collaborate with relevant departments to enhance
compliance through identification and referral of patients in need of isolation.
compliance through identification and referral of patients in need of isolation.

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3 APPLICATION OF TB IPC IN THE ISOLATION FACILITIES
3 APPLICATION OF TB IPC IN THE ISOLATION FACILITIES

3.1Principles of infection control measures

3.1Principles of infection control measures
The World Health Organization defines Tuberculosis infection prevention and control
The World Health Organization defines Tuberculosis infection prevention and control
(IPC) as a combination of measures aimed at minimizing the risk of TB transmission
(IPC) as a combination of measures aimed at minimizing the risk of TB transmission
within populations. There are three levels of TB infection control measures:
within populations. There are three levels of TB infection control measures:
1. Administrative (Managerial) control measures
1. Administrative (Managerial) control measures
2. Environmental control measures
2. Environmental control measures
3. Personal protective equipment (respiratory protection)
3. Personal protective equipment (respiratory protection)
Administrative control measures are the most important among the three levels.
Administrative control measures are the most important among the three levels.
Environmental control measures and personal protective equipment (respiratory
Environmental control measures and personal protective equipment (respiratory
protection) will not work in the absence of solid administrative controls.
protection) will not work in the absence of solid administrative controls.
3.1.1. Administrative control measures
3.1.1. Administrative control measures
It is the managerial or work practices (e.g., early diagnosis, prompt separation of
It is the managerial or work practices (e.g., early diagnosis, prompt separation of
presumptive TB patients, prompt initiation of appropriate anti-tuberculosis treatment
presumptive TB patients, prompt initiation of appropriate anti-tuberculosis treatment
and diagnosis to minimize aerosol-generating procedures) to significantly reduce the
and diagnosis to minimize aerosol-generating procedures) to significantly reduce the
risk of TB transmission by preventing the generation of and limiting exposure to
risk of TB transmission by preventing the generation of and limiting exposure to
droplet nuclei.
droplet nuclei.

3.1.2. Environmental Control Measures

3.1.2. Environmental Control Measures
Environmental control measures refer to the use of engineering technologies to help
Environmental control measures refer to the use of engineering technologies to help
prevent and reduce the concentration of infectious droplet nuclei in the air.
prevent and reduce the concentration of infectious droplet nuclei in the air.
The following are the four main principles of environmental control measures
The following are the four main principles of environmental control measures
1. Dilution (e.g. Ventilation systems)
1. Dilution (e.g. Ventilation systems)
2. Filtration (e.g. HEPA filters)
2. Filtration (e.g. HEPA filters)
3. Purification (e.g. UVGI Systems)
 3. Purification (e.g. UVGI Systems)
4. Disinfection (e.g. chemical, thermal.)
4. Disinfection (e.g. chemical, thermal.)

3.1.3. Personal Protective Equipment (PPE)

3.1.3. Personal Protective Equipment (PPE)
PPE includes surgical mask for the patients and respirators (N95) for visitors and
PPE includes surgical mask for the patients and respirators (N95) for visitors and
health care workers. Gowns are provided for health care workers who manage the
health care workers. Gowns are provided for health care workers who manage the
patient.
patient.

3.2Standard/specification/location of isolation rooms to be followed

3.2Standard/specification/location of isolation rooms to be followed There are
two types of isolation rooms both classified as AIA-Airborne infection
There are two types of isolation rooms both classified as AIA-Airborne infection
Isolation room; 1) Atmospheric type-naturally ventilated and 2) Negative pressure
Isolation room; 1) Atmospheric type-naturally ventilated and 2) Negative pressure
isolation room-mechanically ventilated.
isolation room-mechanically ventilated.

3.2.1 Standard
3.2.1 Standard
The structural standards are from NUFURT Architectural data
The structural standards are from NUFURT Architectural data
General configuration
General configuration
1. single patient rooms without ante room-not self-contained (recommended size
1. single patient rooms without ante room-not self-contained (recommended size
12 m squared)
12 m squared)

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2. single patient room with ante room-self-contained (recommended size13 M
2. single patient room with ante room-self-contained (recommended size13 M
square)
square)
3. single patient room with ante room- has assisted bath (22m square)
3. single patient room with ante room- has assisted bath (22m square)

Room Fittings and finishes

Room Fittings and finishes
1. Medical Wash hand basin recommended
1. Medical Wash hand basin recommended
2. Medical gases, Oxygen and vacuum
2. Medical gases, Oxygen and vacuum
3. Recommended non-porous glazed floor for ease of cleaning and
3. Recommended non-porous glazed floor for ease of cleaning and
 decontamination
decontamination
4. Walls smooth and non-porous for ease of cleaning and decontamination
4. Walls smooth and non-porous for ease of cleaning and decontamination
5. Recommended ceilings should be non-porous to avoid fungal growth
5. Recommended ceilings should be non-porous to avoid fungal growth 6.
Recommended windows should be double glazed for temperature and noise
6. Recommended windows should be double glazed for temperature and noise
control
control
7. Recommended to use antifungal and antibacterial paints
7. Recommended to use antifungal and antibacterial paints

Ventilation
Ventilation
Ventilation recommended should be of 12 air changes per hour (ACH) or better
Ventilation recommended should be of 12 air changes per hour (ACH) or better The
standard is ASHRAE/CDC/OSHA-American Standards for heat refrigeration and
The standard is ASHRAE/CDC/OSHA-American Standards for heat refrigeration and
air-conditioning
air-conditioning

Negative Pressure Isolation Rooms

Negative Pressure Isolation Rooms
a) Air Flow Volume differentials -minimum requirement is 50 CFM/cubic feet per
a) Air Flow Volume differentials -minimum requirement is 50 CFM/cubic feet per
minute or 10% of supply air whichever is the greater
minute or 10% of supply air whichever is the greater
b) Negative pressure differentials - 0.001''/inches of water gauge
b) Negative pressure differentials - 0.001''/inches of water gauge
c) Negative pressure monitoring should be continuous
c) Negative pressure monitoring should be continuous
d) Ante room pressurization to be positive to Isolation room
d) Ante room pressurization to be positive to Isolation room
e) Ante room ventilation at least 10 ACH
e) Ante room ventilation at least 10 ACH
f) Minimum air velocity under the door is 100FPM/feet per minute
f) Minimum air velocity under the door is 100FPM/feet per minute g) Air
distribution- recommended supply from ceiling (clean air) and exhausted
g) Air distribution- recommended supply from ceiling (clean air) and exhausted
near the floor the floor (dirt air)
near the floor the floor (dirt air)
h) Exhaust discharge is recommended to be on roof 25ft from air supplies and
h) Exhaust discharge is recommended to be on roof 25ft from air supplies and
openings or to be HEPA filtered
openings or to be HEPA filtered
• HEPA filters are recommended for both supply and exhaust
• HEPA filters are recommended for both supply and exhaust

3.2.2 Specification
3.2.2 Specification
3.2.3 Location
3.2.3 Location
i. Atmospheric type-naturally ventilated
i. Atmospheric type-naturally ventilated
• Should be standalone-detached from the other buildings
• Should be standalone-detached from the other buildings
• Distance between the isolation rooms from the neighbouring structure
• Distance between the isolation rooms from the neighbouring structure
should be not less than the height of the tallest neighbouring structure
should be not less than the height of the tallest neighbouring structure
• Openable windows not less than 20% of floor area
• Openable windows not less than 20% of floor area
• Openable windows should be aligned to the prevailing wind flow
• Openable windows should be aligned to the prevailing wind flow
ii. Negative pressure isolation room-mechanically ventilated
ii. Negative pressure isolation room-mechanically ventilated
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• Can be located in any part of the facility
• Can be located in any part of the facility
• key thing is patient flow patterns are put in place to avoid cross
• key thing is patient flow patterns are put in place to avoid cross
infections, nosocomial transmission including to HCW and visitors and
infections, nosocomial transmission including to HCW and visitors and
overcrowding and assisting segregation of patients.
overcrowding and assisting segregation of patients.
iii. Standards for Ultraviolet germicidal irradiation (UVGI) fittings
iii. Standards for Ultraviolet germicidal irradiation (UVGI) fittings UVGI is
recommended for both natural and mechanical ventilated but not to
UVGI is recommended for both natural and mechanical ventilated but not to
replace ventilation
replace ventilation
• Upper Room UVGI
• Upper Room UVGI
✔ To be fitted at least not less than 12 ft from the floor
✔ To be fitted at least not less than 12 ft from the floor
✔ Ceiling to have special paint non-reflective to UVGI (reflectivity
✔ Ceiling to have special paint non-reflective to UVGI (reflectivity
<10%)
<10%)
✔ Air humidity <65%
✔ Air humidity <65%
✔ UVGI fittings to have parabolic mirrors or shields to avoid
✔ UVGI fittings to have parabolic mirrors or shields to avoid
scattering
scattering
✔ UVGI lamp fittings to have OZONE filter at 185 nanometres
✔ UVGI lamp fittings to have OZONE filter at 185 nanometres
✔ The lamp to produce 254 nanometre UVC intensities
✔ The lamp to produce 254 nanometre UVC intensities
approximately 50 microwatts per centimetre square at one metre
 approximately 50 microwatts per centimetre square at one metre
• Lower Room UVGI
• Lower Room UVGI
✔ To be fitted not more than 2 feet from floor level
✔ To be fitted not more than 2 feet from floor level
✔ All the above apply except for the paint
✔ All the above apply except for the paint
• Induct UVGI
• Induct UVGI
✔ Recommended for both supply and exhaust
✔ Recommended for both supply and exhaust
✔ To be the unshielded type
✔ To be the unshielded type

Note: Adequate safety notices to be placed at appropriate

placesNote: Adequate safety notices to be placed at appropriate
places

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4. MANAGEMENT AND CARE OF PATIENTS AT ISOLATION FACILITIES 4.
MANAGEMENT AND CARE OF PATIENTS AT ISOLATION FACILITIES 4.1
Isolation
4.1 Isolation
Isolation is the creation of a barrier—mechanical or spatial—to prevent the
Isolation is the creation of a barrier—mechanical or spatial—to prevent the
transmission of infectious diseases to or from a patient and to reduce the risk of
transmission of infectious diseases to or from a patient and to reduce the risk of
transmission to other patients, HCWs, and visitors. Isolation is used to prevent the
transmission to other patients, HCWs, and visitors. Isolation is used to prevent the
transmission of infectious diseases that are spread by both contact and airborne
transmission of infectious diseases that are spread by both contact and airborne
routes.
routes.
Types of Isolation
Types of Isolation
Protective Isolation (reverse barrier nursing): This is where the patient requires
Protective Isolation (reverse barrier nursing): This is where the patient requires
protection i.e. they are immunocompromised
protection i.e. they are immunocompromised

Source isolation: This is designed to prevent the spread of pathogens from an

Source isolation: This is designed to prevent the spread of pathogens from an
infected patient to other patients, hospital personnel and visitors. The need for
infected patient to other patients, hospital personnel and visitors. The need for
isolation is determined by the way the organism or disease is transmitted. Examples
isolation is determined by the way the organism or disease is transmitted. Examples
of organisms requiring source isolation includes Pulmonary Tuberculosis, Certain
of organisms requiring source isolation includes Pulmonary Tuberculosis, Certain
specific organisms will require negative pressure side rooms or specialized care from
specific organisms will require negative pressure side rooms or specialized care from
the Infectious Disease Unit i.e. Drug resistant pulmonary tuberculosis.
the Infectious Disease Unit i.e. Drug resistant pulmonary tuberculosis.

4.2 Transmission risk assessment

4.2 Transmission risk assessment
Risk assessment is the assessment of the factors that influence the transmission of
Risk assessment is the assessment of the factors that influence the transmission of a
pathogen and its impact. It enables staff to prioritize the use of isolation facilities
a pathogen and its impact. It enables staff to prioritize the use of isolation facilities

4.3 Criteria for Isolation

4.3 Criteria for Isolation
The use of isolation should be strictly limited to the infectious period; once patients
The use of isolation should be strictly limited to the infectious period; once patients
are on effective treatment and are no longer infectious, there is no need for isolation.
are on effective treatment and are no longer infectious, there is no need for isolation.
Before isolation is sort, all other means including community based interventions
Before isolation is sort, all other means including community based interventions
should be utilized first.
should be utilized first.
Patients who qualify for isolation include the following;
Patients who qualify for isolation include the following;
a) Involuntary
a) Involuntary
In rare circumstances, efforts to persuade and enable patients to accept voluntary
In rare circumstances, efforts to persuade and enable patients to accept voluntary
isolation may fail. If this is the case, based on WHO ethical guidelines, involuntary
isolation may fail. If this is the case, based on WHO ethical guidelines, involuntary
isolation may be considered where ALL of the following conditions are met including:
isolation may be considered where ALL of the following conditions are met including:
I. Isolation is necessary to prevent the spread of TB AND
I. Isolation is necessary to prevent the spread of TB AND
II. There is evidence that isolation is likely to be effective in this case AND
II. There is evidence that isolation is likely to be effective in this case AND III. The
patient refuses to remain in isolation despite being adequately
III. The patient refuses to remain in isolation despite being adequately informed
of the risks, the meaning of being isolated, and the reasons for
informed of the risks, the meaning of being isolated, and the reasons for
isolation AND
isolation AND
IV. The patient’s refusal puts others at risk AND
IV. The patient’s refusal puts others at risk AND
V. All less restrictive measures have been attempted prior to forcing isolation,
V. All less restrictive measures have been attempted prior to forcing isolation,
AND
AND

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VI. all other rights and freedoms (such as basic civil liberties) besides that of
VI. all other rights and freedoms (such as basic civil liberties) besides that of
movement are protected AND
movement are protected AND
VII. Due process and all relevant appeal mechanisms are in place AND
VII. Due process and all relevant appeal mechanisms are in place AND
VIII. Patient has, at least, basic needs met AND
VIII. Patient has, at least, basic needs met AND
IX. The isolation time given is the minimum necessary to achieve its goals
IX. The isolation time given is the minimum necessary to achieve its goals AND
AND

If the nine listed conditions are met, the following groups of patients
If the nine listed conditions are met, the following groups of patients may
be isolated involuntarily:
may be isolated involuntarily:

• Non-adherence patient despite counselling intervention

• Non-adherence patient despite counselling intervention
• Uncontrolled mental illness without family support
• Uncontrolled mental illness without family support
• Religious faith who don’t take medications
• Religious faith who don’t take medications

b) Voluntary Isolation based on medical/social conditions

b) Voluntary Isolation based on medical/social conditions
 • Patients with multiple comorbidities who require specialized inpatient
• Patients with multiple comorbidities who require specialized inpatient care
care
• Patient with adverse drug reaction from TB treatment who require
• Patient with adverse drug reaction from TB treatment who require
specialized care
specialized care
• Homeless (Street populations)
• Homeless (Street populations)
• Inmates with pulmonary TB
• Inmates with pulmonary TB
• Patients without social support
• Patients without social support
• Extensively and Total drug resistance TB patients
• Extensively and Total drug resistance TB patients

4.4 Patient Education/Counselling

4.4 Patient Education/Counselling
All TB patients and caregivers should receive focused education about TB care and
All TB patients and caregivers should receive focused education about TB care and
prevention to empower them to succeed in management of the infection. Self
prevention to empower them to succeed in management of the infection. Self
management is critical to the successful treatment of TB. Key messages for TB
management is critical to the successful treatment of TB. Key messages for TB
education and adherence counselling are described below;
education and adherence counselling are described below;
• Patient and caregiver must be adequately informed on the rationale for
• Patient and caregiver must be adequately informed on the rationale for isolation
isolation
• Patient rights and responsibilities
• Patient rights and responsibilities
• Infection Prevention Control (IPC) practices
• Infection Prevention Control (IPC) practices
• Treatment adherence counselling
• Treatment adherence counselling
• The detail of Adverse Drug Reactions (ADRs) and what actions to take if they
• The detail of Adverse Drug Reactions (ADRs) and what actions to take if they
encounter.
encounter.
• Psychological and wellbeing of patient should be evaluated daily
• Psychological and wellbeing of patient should be evaluated daily • Family
counselling is important for the patients to successfully complete the
• Family counselling is important for the patients to successfully complete the
treatment
treatment

4.5 Nutritional services

4.5 Nutritional services
All Patients admitted in Isolation facility should be assessed for nutritional needs,
All Patients admitted in Isolation facility should be assessed for nutritional needs,
counselling provided and appropriate interventions given.
counselling provided and appropriate interventions given.
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4.6 Clinical management
4.6 Clinical management
All TB patients placed in isolation should be managed in line with the National
All TB patients placed in isolation should be managed in line with the National
treatment guidelines. DOTS should be provided by the Health Care providers.
treatment guidelines. DOTS should be provided by the Health Care providers.
Systems should be in place to ensure prompt identification and reporting of ADRs as
Systems should be in place to ensure prompt identification and reporting of ADRs as
per laid down Pharmacovigilance procedures. The isolation facility will be linked to
per laid down Pharmacovigilance procedures. The isolation facility will be linked to the
TB clinic for notification and follow up of patients. Patients requiring other
the TB clinic for notification and follow up of patients. Patients requiring other disease
condition management for example HIV and other conditions may benefit
disease condition management for example HIV and other conditions may benefit
from treatment in the isolation wards.
from treatment in the isolation wards.

4.7 Contact Tracing

4.7 Contact Tracing
All efforts should be made to identify and screen all contacts for TB if contact tracing
All efforts should be made to identify and screen all contacts for TB if contact tracing
was not done. All identified contacts must be recorded in the facility TB contacts
was not done. All identified contacts must be recorded in the facility TB contacts
register. The following contact will be initiated on Isoniazid Preventive Therapy (IPT);
register. The following contact will be initiated on Isoniazid Preventive Therapy (IPT);
Children under 5 years screening negative for TB irrespective of HIV status.
Children under 5 years screening negative for TB irrespective of HIV status.

4.8 Visitors to Patients in Isolation

4.8 Visitors to Patients in Isolation
Classification of Patients;
Classification of Patients;
a. Infectious patients - No visitors will be allowed.
a. Infectious patients - No visitors will be allowed.
b. Non- infectious patients - one visitor at a time. Maximum visitation is one hour.
b. Non- infectious patients - one visitor at a time. Maximum visitation is one hour. The
following rules and guidelines apply to visitors of patients in isolation:
The following rules and guidelines apply to visitors of patients in isolation: • Visitors
must report to the Health care provider (HCP)-in-charge prior to
• Visitors must report to the Health care provider (HCP)-in-charge prior to entering
the isolation area
entering the isolation area
• Only one person at a time is allowed to visit for one hour and only during
 • Only one person at a time is allowed to visit for one hour and only during visiting
hours
visiting hours
• Where applicable, the visitor can meet the patient in a designated open area
• Where applicable, the visitor can meet the patient in a designated open area •
Visitors must wear PPE (N95 respirators)
• Visitors must wear PPE (N95 respirators)

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5. LEGAL REQUIREMENT, PATIENT RIGHTS AND RESPONSIBILITIES 5.
LEGAL REQUIREMENT, PATIENT RIGHTS AND RESPONSIBILITIES 5.1
Legal and Policy framework
5.1 Legal and Policy framework
An increasing amount of evidence suggests that individual vulnerability to TB is
An increasing amount of evidence suggests that individual vulnerability to TB is
determined by risk factors that are often related to a person’s social and economic
determined by risk factors that are often related to a person’s social and economic
position. This association has led some commentators to label TB as “traditionally a
position. This association has led some commentators to label TB as “traditionally a
disease of the poor.”
disease of the poor.”
TB is associated with being malnourished, smoking, alcohol abuse, exposure to
TB is associated with being malnourished, smoking, alcohol abuse, exposure to
indoor air pollution, and living or working in crowded and poorly ventilated conditions.
indoor air pollution, and living or working in crowded and poorly ventilated conditions.
TB prevalence is also high among individuals confined in prisons. There is
TB prevalence is also high among individuals confined in prisons. There is
considerable evidence that people in lower socioeconomic groups are, on average,
considerable evidence that people in lower socioeconomic groups are, on average,
more likely to possess these risk factors or determinants, including those living in
more likely to possess these risk factors or determinants, including those living in
developed countries. Consequently, although context-specific differences may exist,
developed countries. Consequently, although context-specific differences may exist,
overall, TB is more common in developing countries, where poverty, poor housing
overall, TB is more common in developing countries, where poverty, poor housing
conditions, and indoor air pollution are more frequent, and expenditure on health is
conditions, and indoor air pollution are more frequent, and expenditure on health is
low.
low.
Incarceration and detention approaches to patients who interrupt their treatment
Incarceration and detention approaches to patients who interrupt their treatment
curtail the rights to health, informed consent, privacy, and freedom from non
curtail the rights to health, informed consent, privacy, and freedom from non
consensual treatment, freedom from inhumane and degrading treatment, and
consensual treatment, freedom from inhumane and degrading treatment, and
freedom of movement of people lost to follow-up. Detention could also worsen social
freedom of movement of people lost to follow-up. Detention could also worsen social
inequalities and lead to a paradoxical increase in TB incidence.
inequalities and lead to a paradoxical increase in TB incidence.
The solution is incorporation of less intrusive solutions in legislation and policies.
The solution is incorporation of less intrusive solutions in legislation and policies.
These include strengthening health systems to reduce dependency on prisons as
These include strengthening health systems to reduce dependency on prisons as
isolation spaces, decentralizing TB treatment to communities, enhancing treatment
isolation spaces, decentralizing TB treatment to communities, enhancing treatment
education, Community education and dialogues, implementing infection prevention
education, Community education and dialogues, implementing infection prevention
and control measures and addressing socioeconomic and structural determinants
and control measures and addressing socioeconomic and structural determinants
associated with TB incidence and loss to follow-up.
associated with TB incidence and loss to follow-up.

On 24 March 2016, the High Court declared that the practice of confining TB patients
On 24 March 2016, the High Court declared that the practice of confining TB patients
in prisons for purposes of treatment is unconstitutional. Justice Mumbi Ngugi, in a
in prisons for purposes of treatment is unconstitutional. Justice Mumbi Ngugi, in a
judgment delivered on the said date, ruled that such incarceration of TB patients is
judgment delivered on the said date, ruled that such incarceration of TB patients is
unlawful, unconstitutional and a violation of their fundamental human rights. The
unlawful, unconstitutional and a violation of their fundamental human rights. The court
ordered an immediate stop to this practice.
court ordered an immediate stop to this practice.

The court therefore ordered the Cabinet Secretary for Health to develop a policy on
The court therefore ordered the Cabinet Secretary for Health to develop a policy on
the involuntary confinement of individuals with tuberculosis that is compliant with the
the involuntary confinement of individuals with tuberculosis that is compliant with the
Constitution and that incorporates principles from the international guidance on the
Constitution and that incorporates principles from the international guidance on the
involuntary confinement of individuals with TB. The judgment has set precedence in
involuntary confinement of individuals with TB. The judgment has set precedence in
the region, setting stage for the first judicial interpretation on involuntary confinement
the region, setting stage for the first judicial interpretation on involuntary confinement
of TB patients.
of TB patients.

5.2 International and regional legal and policy framework

5.2 International and regional legal and policy framework
TB approaches and responses at the international level are anchored in international
TB approaches and responses at the international level are anchored in international
and regional human rights instruments. These laws recognize that all human beings
and regional human rights instruments. These laws recognize that all human beings
have equal rights regardless of their nationality, ethnic origin, sex, race, religion, or
have equal rights regardless of their nationality, ethnic origin, sex, race, religion, or
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any other status and are built around core human rights principles. By virtue of
any other status and are built around core human rights principles. By virtue of Article
2 (6) of the Constitution of Kenya, international instruments that Kenya has
Article 2 (6) of the Constitution of Kenya, international instruments that Kenya has
ratified form part of the Laws of Kenya. These international instruments provide a
ratified form part of the Laws of Kenya. These international instruments provide a
sound framework and basis for holding the government accountable where gaps
sound framework and basis for holding the government accountable where gaps exist
at the domestic level.
exist at the domestic level.

5.3 Domestic Legal and Policy Framework

5.3 Domestic Legal and Policy Framework
5.3.1 The Constitution of Kenya
5.3.1 The Constitution of Kenya
The Constitution is the supreme law of the Republic and binds all persons and all
The Constitution is the supreme law of the Republic and binds all persons and all
State organs at both levels of government. It sets out the standards that all laws,
State organs at both levels of government. It sets out the standards that all laws,
policies, guidelines, operational standards and programs must conform with.
policies, guidelines, operational standards and programs must conform with. The
Constitution of Kenya has an expansive and progressive Bill of Rights that sets
The Constitution of Kenya has an expansive and progressive Bill of Rights that sets
out the stage for the promotion and protection of the rights of all persons, including
out the stage for the promotion and protection of the rights of all persons, including
persons with TB.
persons with TB.
5.3.2 Importance of Bill of Rights
5.3.2 Importance of Bill of Rights
The importance of the bill of rights cannot be understated. Article 19 (1) provides that
The importance of the bill of rights cannot be understated. Article 19 (1) provides that
the Bill of Rights is an integral part of Kenya’s democratic state and is the framework
the Bill of Rights is an integral part of Kenya’s democratic state and is the framework
for social, economic and cultural policies. The rights and fundamental freedoms in
for social, economic and cultural policies. The rights and fundamental freedoms in the
Bill of Rights further belong to each individual and are not granted by the State.
the Bill of Rights further belong to each individual and are not granted by the State.
Some of the relevant rights, as contained in various international legislative
Some of the relevant rights, as contained in various international legislative
instruments, that closely affect the TB response, and should be relied upon in the
instruments, that closely affect the TB response, and should be relied upon in the
protection of TB patients, include:
protection of TB patients, include:
(i) Right to Life: The argument is that people with TB have the right to access
(i) Right to Life: The argument is that people with TB have the right to access
lifesaving diagnostics and treatment.
lifesaving diagnostics and treatment.
In the event that such treatment is denied then the right to life is threatened. In
In the event that such treatment is denied then the right to life is threatened. In
Kenya, the practice of incarceration of TB patients (that was declared
Kenya, the practice of incarceration of TB patients (that was declared
unconstitutional and unlawful) potentially infringed on this right where the
unconstitutional and unlawful) potentially infringed on this right where the
required medical attention is not given while in prison. The right to life is
required medical attention is not given while in prison. The right to life is
defined internationally by the International Covenant on Civil and Political
defined internationally by the International Covenant on Civil and Political
Rights (ICCPR) (Article 6(1).
Rights (ICCPR) (Article 6(1).
(ii) Right to the highest attainable standard of health: People with TB have
(ii) Right to the highest attainable standard of health: People with TB have
the right to enjoy the highest attainable standard of health encompassing
the right to enjoy the highest attainable standard of health encompassing
availability, acceptability, accessibility and quality of diagnostics and
availability, acceptability, accessibility and quality of diagnostics and treatment.
The right imposes an obligation on governments to prevent, treat,
treatment. The right imposes an obligation on governments to prevent, treat,
and control epidemic, endemic, occupational and other diseases.
and control epidemic, endemic, occupational and other diseases. It is defined
by Article 12(1) of International Covenant on Economic, Social
It is defined by Article 12(1) of International Covenant on Economic, Social and
Cultural Rights (ICESCR).
and Cultural Rights (ICESCR).
(iii) Right to Non-Discrimination and Equality: This right provides a
(iii) Right to Non-Discrimination and Equality: This right provides a
framework for equal protection before the law.
framework for equal protection before the law.

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 Therefore, this right protects persons with TB from discrimination in both
Therefore, this right protects persons with TB from discrimination in both public
and private settings, including but not limited to, health care,
public and private settings, including but not limited to, health care,
employment, education and access to social and religious services. This may
employment, education and access to social and religious services. This may
also be relied upon to address the issues of stigma and discrimination.
also be relied upon to address the issues of stigma and discrimination. It is
defined by International Covenant on Civil and Political Rights ICCPR
It is defined by International Covenant on Civil and Political Rights ICCPR
(Article 26), Convention on the Rights of People with Disabilities (CRPD)
(Article 26), Convention on the Rights of People with Disabilities (CRPD)
(Article 5(2)), and International Convention on the Elimination of All Forms of
(Article 5(2)), and International Convention on the Elimination of All Forms of
Racial Discrimination (ICERD) (Article 5(e)(iv))
Racial Discrimination (ICERD) (Article 5(e)(iv))
(iv) Right to privacy: This is critical in the protection of information related to
(iv) Right to privacy: This is critical in the protection of information related to
an individual’s TB status, and privacy in treatment of TB patients. The right is
an individual’s TB status, and privacy in treatment of TB patients. The right is
exercised considering a delicate balance of individual rights versus protection
exercised considering a delicate balance of individual rights versus protection
of the public interest.
of the public interest.
(v) Right to be free from torture or cruel, inhuman or degrading
(v) Right to be free from torture or cruel, inhuman or degrading treatment
or punishment: This right is specifically relevant for persons with
treatment or punishment: This right is specifically relevant for persons with
TB in an institutional setting such as hospital, prison or isolation facility and
TB in an institutional setting such as hospital, prison or isolation facility and
would be relied upon to ensure there is appropriate TB testing, treatment, and
would be relied upon to ensure there is appropriate TB testing, treatment, and
good sanitary and hygienic conditions. It is defined by the Convention against
good sanitary and hygienic conditions. It is defined by the Convention against
Torture and other Cruel, Inhuman or Degrading Treatment or Punishment
Torture and other Cruel, Inhuman or Degrading Treatment or Punishment CAT
(Article 16(1)).
CAT (Article 16(1)).
(vi) Right to informed consent: (verbal and/or written) prior to treatment of
(vi) Right to informed consent: (verbal and/or written) prior to treatment of
persons, including those with TB, and to be free from non-consensual,
persons, including those with TB, and to be free from non-consensual,
compulsory treatment under all circumstances.
compulsory treatment under all circumstances.
(vii) Right to freedom of movement: that would protect people with TB from
(vii) Right to freedom of movement: that would protect people with TB from
travel restrictions within and outside their countries. It is provided for by Article
travel restrictions within and outside their countries. It is provided for by Article
12 of ICCPR.
12 of ICCPR.
(viii) Right to information: that would guarantee persons with TB the right to
(viii) Right to information: that would guarantee persons with TB the right to
access information about the nature of the disease, preventive measures,
access information about the nature of the disease, preventive measures,
transmission and treatment. This is as provided by ICCPR Art. 19(2); and
transmission and treatment. This is as provided by ICCPR Art. 19(2); and
WHO Guidance on Ethics of TB prevention, care and control
WHO Guidance on Ethics of TB prevention, care and control (ix) Right to
freedom from arbitrary arrest and detention: that is relied
(ix) Right to freedom from arbitrary arrest and detention: that is relied
upon to protect persons with TB against arbitrary detention or involuntary
upon to protect persons with TB against arbitrary detention or involuntary
isolation unless as provided by law – and respecting the Siracusa Principles.
isolation unless as provided by law – and respecting the Siracusa Principles.
The United Nations Economic and Social Council has issued Principles on the
The United Nations Economic and Social Council has issued Principles on the
Limitation and Derogation.
Limitation and Derogation.
Provisions in the International Covenant on Civil and Political Rights (the
Provisions in the International Covenant on Civil and Political Rights (the
Siracusa Principles), which are the leading international framework for
Siracusa Principles), which are the leading international framework for
determining whether involuntary confinement for public health purposes is
determining whether involuntary confinement for public health purposes is
justified under the International Covenant on Civil and Political Rights (to
justified under the International Covenant on Civil and Political Rights (to which
Kenya is a State Party). They provide that involuntary confinement for
which Kenya is a State Party). They provide that involuntary confinement for
public health purposes will be legitimate only where:
public health purposes will be legitimate only where:
(a) The restriction is provided for and carried out in accordance with the law
(a) The restriction is provided for and carried out in accordance with the law
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(b) The restriction is in the interest of a legitimate objective of general interest
(b) The restriction is in the interest of a legitimate objective of general interest
(c) The restriction is strictly necessary in a democratic society to achieve the
(c) The restriction is strictly necessary in a democratic society to achieve the
objective
objective
(d) There are no less intrusive and restrictive means available to reach the
(d) There are no less intrusive and restrictive means available to reach the
same objective, and
same objective, and
(e) The restriction is based on scientific evidence and not drafted or imposed
 (e) The restriction is based on scientific evidence and not drafted or imposed
arbitrarily or in an unreasonable or otherwise discriminatory manner.
arbitrarily or in an unreasonable or otherwise discriminatory manner. The
African Charter on Human and Peoples’ Rights is important at the
The African Charter on Human and Peoples’ Rights is important at the regional
level. Article 16 of the African Charter on Human and Peoples’ Rights
regional level. Article 16 of the African Charter on Human and Peoples’ Rights
provides:
provides:
a) Every individual shall have the right to enjoy the best attainable state of
a) Every individual shall have the right to enjoy the best attainable state of
physical and mental health
physical and mental health
b) State Parties to the present Charter shall take the necessary measures to
b) State Parties to the present Charter shall take the necessary measures to
protect the health of their people and to ensure that they receive
protect the health of their people and to ensure that they receive medical
attention when they are sick
medical attention when they are sick

5.4 The Health Act 2017

5.4 The Health Act 2017

The Health Act 2017 was enacted primarily to align the health sector to the
The Health Act 2017 was enacted primarily to align the health sector to the
Constitution. The Act aims to:
Constitution. The Act aims to:
• Establish a national health system that facilitates a progressive and equitable
• Establish a national health system that facilitates a progressive and equitable
manner the highest attainable standard of health services
manner the highest attainable standard of health services
• Protect, respect, promote and fulfil the health rights of all persons in Kenya
• Protect, respect, promote and fulfil the health rights of all persons in Kenya
including rights of children to basic nutrition and health care services, and
including rights of children to basic nutrition and health care services, and
rights of vulnerable groups as defined in Article 21(3) of the Constitution
rights of vulnerable groups as defined in Article 21(3) of the Constitution The Act is

important in the TB response as it affirms the Constitutional duty of the

The Act is important in the TB response as it affirms the Constitutional duty of the
State to observe, respect, protect, promote and fulfil the right to the highest
State to observe, respect, protect, promote and fulfil the right to the highest
attainable standard of health. The Act further provides that the right to heath
attainable standard of health. The Act further provides that the right to heath
includes:
includes:
(i) Progressive access for provision of promotive, preventive, curative, palliative
(i) Progressive access for provision of promotive, preventive, curative, palliative
and rehabilitative services
and rehabilitative services
 (ii) Right to be treated with dignity, respect and have their privacy respected
(ii) Right to be treated with dignity, respect and have their privacy respected
(iii) Right to health information
(iii) Right to health information
(iv) Right to informed consent
(iv) Right to informed consent
(v) Right to privacy and confidentiality, among others
(v) Right to privacy and confidentiality, among others
Health providers on the other hand have, among other rights, the right to a safe
Health providers on the other hand have, among other rights, the right to a safe
working environment that minimizes the risk of disease transmission. This is
working environment that minimizes the risk of disease transmission. This is
important in protection of Health Care Workers in the TB response. The
important in protection of Health Care Workers in the TB response. The
affirmation of the rights in this Act makes it fairly progressive.
affirmation of the rights in this Act makes it fairly progressive.
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5.5 Justification for TB Isolation
5.5 Justification for TB Isolation
A summary of ethical guidance on TB isolation is provided in the World Health
A summary of ethical guidance on TB isolation is provided in the World Health
Organization (WHO) Ethics Guidance for the Implementation of the End TB Strategy,
Organization (WHO) Ethics Guidance for the Implementation of the End TB Strategy,
which is fully aligned with that of the framework for the Sustainable Development
which is fully aligned with that of the framework for the Sustainable Development
Goals (SDGs).
Goals (SDGs).

The TB isolation policy ensures that the implementation adheres to ethical and legal
The TB isolation policy ensures that the implementation adheres to ethical and legal
standards that protect the rights of all infected and non-infected individuals. The
standards that protect the rights of all infected and non-infected individuals. The state
has a legal and ethical obligation to ensure that non-infected and infected
state has a legal and ethical obligation to ensure that non-infected and infected
persons living with TB are only involuntarily isolated when all other treatment and
persons living with TB are only involuntarily isolated when all other treatment and
voluntary isolation efforts have been exhausted. Involuntary isolation shall not
voluntary isolation efforts have been exhausted. Involuntary isolation shall not
become a routine part of TB programmes and will be used when interests of the
become a routine part of TB programmes and will be used when interests of the
public justify efforts to isolate the patient involuntarily.
public justify efforts to isolate the patient involuntarily.

The policy is transparent in explanation of when and how involuntary isolation is

The policy is transparent in explanation of when and how involuntary isolation is
allowed. Involuntary isolation should be limited and programs that encounter
allowed. Involuntary isolation should be limited and programs that encounter frequent
refusals of treatment or significant treatment adherence issues should
frequent refusals of treatment or significant treatment adherence issues should review
and evaluate its implementation and application of a patient-centred approach
review and evaluate its implementation and application of a patient-centred approach
in an effort to avoid involuntary isolation of patients.
in an effort to avoid involuntary isolation of patients.

The following are guidelines for implementation in policy concerning prevention and
The following are guidelines for implementation in policy concerning prevention and
justification of TB isolation:
justification of TB isolation:

5.5.1 It is ethical to ask persons with active TB to voluntary isolate

5.5.1 It is ethical to ask persons with active TB to voluntary isolate themselves.
themselves.
The least restrictive isolation measures should be taken at all times. Basic
The least restrictive isolation measures should be taken at all times. Basic
respiratory, voluntary isolation measures include asking a patient with active TB to
respiratory, voluntary isolation measures include asking a patient with active TB to
wear a mask, to remain at home or in the hospital when contagious with active TB.
wear a mask, to remain at home or in the hospital when contagious with active TB.

5.5.2 Isolation of TB patients is necessary only after all measures have been
5.5.2 Isolation of TB patients is necessary only after all measures have been
exhausted.
exhausted.
The Harm principle states that all persons are free to act as they choose as long it
The Harm principle states that all persons are free to act as they choose as long it
does not affect another non-consenting person, the principle also justifies
does not affect another non-consenting person, the principle also justifies
involuntary isolation. This policy includes conditions necessary to justify
involuntary isolation. This policy includes conditions necessary to justify involuntary
isolation. Conditions that must be met before involuntary isolation
involuntary isolation. Conditions that must be met before involuntary isolation
include:
include:
a. Isolation is necessary to prevent the spread of TB
a. Isolation is necessary to prevent the spread of TB
b. Evidence supports isolation will be effective
b. Evidence supports isolation will be effective
c. Patient refuses to remain in voluntary isolation despite being informed of
c. Patient refuses to remain in voluntary isolation despite being informed of
risks, the reasons and meaning for isolation
risks, the reasons and meaning for isolation
d. Patients refusal to be in isolated places and puts others and the public at
d. Patients refusal to be in isolated places and puts others and the public at
risk
risk
e. Less restrictive measures have been attempted before forcing isolation
e. Less restrictive measures have been attempted before forcing isolation
f. Rights and freedoms, besides movement, are protected
f. Rights and freedoms, besides movement, are protected
 g. Due process and relevant appeal mechanisms are in place
g. Due process and relevant appeal mechanisms are in place
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h. Patient has the basic needs met
h. Patient has the basic needs met
i. Isolation time given is the minimum needed to achieve goals
i. Isolation time given is the minimum needed to achieve goals

5.5.3 The state must protect the rights and interests of any persons with TB
5.5.3 The state must protect the rights and interests of any persons with TB
who are subject to voluntary or involuntary isolation.
who are subject to voluntary or involuntary isolation.
Their dignity and respect should be ensured, and they should receive all
Their dignity and respect should be ensured, and they should receive all necessary
clinical and social support to minimize burdens due to isolation.
necessary clinical and social support to minimize burdens due to isolation. Patients
who refuse treatment, must be made aware, in advance, that continued
Patients who refuse treatment, must be made aware, in advance, that continued
refusal may result in compulsory isolation. National policy shall contain safeguards
refusal may result in compulsory isolation. National policy shall contain safeguards
for implementing involuntary isolation. Involuntary isolation shall be a last resort
for implementing involuntary isolation. Involuntary isolation shall be a last resort and
applied within a medical setting in a least restrictive manner. The right to an
and applied within a medical setting in a least restrictive manner. The right to an
appeal in a judicatory setting shall be provided.
appeal in a judicatory setting shall be provided.

5.5.4 The state must prevent the unethical isolation of persons with TB.
5.5.4 The state must prevent the unethical isolation of persons with TB.
It is unethical to isolate if:
It is unethical to isolate if:
• The individual is not infectious
• The individual is not infectious
• Isolation does not provide clear medical benefits
• Isolation does not provide clear medical benefits
• Isolation of individuals where treatment is inaccessible or unavailable,
• Isolation of individuals where treatment is inaccessible or unavailable,
efficient infection control measures and humane living conditions (shelter,
efficient infection control measures and humane living conditions (shelter,
sanitation, food water or communication) are not met
sanitation, food water or communication) are not met
• Involuntary detention in a non-medical setting, like a prison cell or general
• Involuntary detention in a non-medical setting, like a prison cell or general
prison population is also unethical
prison population is also unethical
• Isolation is being implemented as a form of punishment
• Isolation is being implemented as a form of punishment

It is also unethical to compel treatment of involuntary isolated patients. Patients

 It is also unethical to compel treatment of involuntary isolated patients. Patients
shall still be offered opportunity to receive treatments, but their informed refusal
shall still be offered opportunity to receive treatments, but their informed refusal
shall be respected. However, efforts to convince the patient to engage in
shall be respected. However, efforts to convince the patient to engage in treatment
should not be abandoned.
treatment should not be abandoned.

5.6 Patients’ Rights And Responsibilities

5.6 Patients’ Rights And Responsibilities
5.6.1 The Patients’ Charter for TB Care (2006)
5.6.1 The Patients’ Charter for TB Care (2006)
The Patients’ Charter, was informed by the need for patients in Kenya to be aware
The Patients’ Charter, was informed by the need for patients in Kenya to be aware
of their rights and responsibilities. It enumerates the rights of patients, including,
of their rights and responsibilities. It enumerates the rights of patients, including,
the right to access health care, the highest attainable standard of health services,
the right to access health care, the highest attainable standard of health services,
the right to information, right to informed consent, and right to confidentiality,
the right to information, right to informed consent, and right to confidentiality,
among others.
among others.
It provides guidance on rights and responsibilities of patients and would be critical
It provides guidance on rights and responsibilities of patients and would be critical
in expounding on Constitutional rights. It is useful in protection of the rights of TB
in expounding on Constitutional rights. It is useful in protection of the rights of TB
patients in a health care setting as most of the rights contained therein are in line
patients in a health care setting as most of the rights contained therein are in line
with the Constitution and International Framework.
with the Constitution and International Framework.
According to The International Standards for TB Care (ISTC) also known as the
According to The International Standards for TB Care (ISTC) also known as the
Patients’ charter the patients’ have the following rights.
Patients’ charter the patients’ have the following rights.

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5.6.1.1 The right to care
5.6.1.1 The right to care

• The right to free and equitable access to tuberculosis care, from diagnosis
• The right to free and equitable access to tuberculosis care, from diagnosis through
treatment completion, regardless of resources, race, gender, age,
through treatment completion, regardless of resources, race, gender, age,
language, legal status, religious beliefs, sexual orientation, culture, or having
language, legal status, religious beliefs, sexual orientation, culture, or having
another illness
another illness

• The right to receive medical advice and treatment which fully meets the new
• The right to receive medical advice and treatment which fully meets the new
International Standards for Tuberculosis care, focused on patient needs,
International Standards for Tuberculosis care, focused on patient needs, including
those with multidrug-resistant tuberculosis (MDR-TB) or tuberculosis
including those with multidrug-resistant tuberculosis (MDR-TB) or tuberculosis
human immunodeficiency virus (HIV) coinfections and preventative treatment for
human immunodeficiency virus (HIV) coinfections and preventative treatment for
young children and others considered to be at high risk
young children and others considered to be at high risk

• The right to benefit from proactive health sector community outreach, education,
• The right to benefit from proactive health sector community outreach, education,
and prevention campaigns as part of comprehensive care programs
and prevention campaigns as part of comprehensive care programs
5.6.1.2 The right to dignity
5.6.1.2 The right to dignity

• The right to be treated with respect and dignity, including the delivery of
• The right to be treated with respect and dignity, including the delivery of services
without stigma, prejudice, or discrimination by health providers and
services without stigma, prejudice, or discrimination by health providers and
authorities
authorities

• The right to quality healthcare in a dignified environment, with moral support

• The right to quality healthcare in a dignified environment, with moral support
from family, friends, and the community
from family, friends, and the community
5.6.1.3 The right to information
5.6.1.3 The right to information

• The right to information about what healthcare services are available for
• The right to information about what healthcare services are available for
tuberculosis and what responsibilities, engagements, and direct or indirect
tuberculosis and what responsibilities, engagements, and direct or indirect
costs are involved
costs are involved

• The right to receive a timely, concise, and clear description of the medical
• The right to receive a timely, concise, and clear description of the medical
condition, with diagnosis, prognosis (an opinion as to the likely future course
condition, with diagnosis, prognosis (an opinion as to the likely future course of
the illness), and treatment proposed, with communication of common risks
of the illness), and treatment proposed, with communication of common risks
and appropriate alternatives
and appropriate alternatives

• The right to know the names and dosages of any medication or intervention to
• The right to know the names and dosages of any medication or intervention to
be prescribed, its normal actions and potential side-effects, and its possible
be prescribed, its normal actions and potential side-effects, and its possible
impact on other conditions or treatments
impact on other conditions or treatments
 • The right of access to medical information which relates to the patient’s
• The right of access to medical information which relates to the patient’s
condition and treatment and to a copy of the medical record if requested by
condition and treatment and to a copy of the medical record if requested by the
patient or a person authorized by the patient
the patient or a person authorized by the patient

• The right to meet, share experiences with peers and other patients and to
• The right to meet, share experiences with peers and other patients and to
voluntary counselling at any time from diagnosis through treatment completion
voluntary counselling at any time from diagnosis through treatment completion

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5.6.1.4 The right to choice
5.6.1.4 The right to choice

• The right to a second medical opinion, with access to previous medical

• The right to a second medical opinion, with access to previous medical records
records

• The right to accept or refuse surgical interventions if chemotherapy is possible

• The right to accept or refuse surgical interventions if chemotherapy is possible
and to be informed of the likely medical and statutory consequences within
and to be informed of the likely medical and statutory consequences within the
context of a communicable disease
the context of a communicable disease

• The right to choose whether or not to take part in research programs without
• The right to choose whether or not to take part in research programs without
compromising care
compromising care
5.6.1.5 The right to confidence
5.6.1.5 The right to confidence

• The right to have personal privacy, dignity, religious beliefs, and culture
• The right to have personal privacy, dignity, religious beliefs, and culture
respected
respected

• The right to have information relating to the medical condition kept confidential
• The right to have information relating to the medical condition kept confidential
and released to other authorities contingent upon the patient’s consent
and released to other authorities contingent upon the patient’s consent
5.6.1.6 The right to justice
5.6.1.6 The right to justice

• The right to make a complaint through channels provided for this purpose by
• The right to make a complaint through channels provided for this purpose by the
health authority and to have any complaint dealt with promptly and fairly
the health authority and to have any complaint dealt with promptly and fairly • The
 right to appeal to a higher authority if the above is not respected and to
• The right to appeal to a higher authority if the above is not respected and to be
informed in writing of the outcome
be informed in writing of the outcome
5.6.1.7 The right to organization
5.6.1.7 The right to organization

• The right to join, or to establish, organizations of people with or affected by

• The right to join, or to establish, organizations of people with or affected by
tuberculosis and to seek support for the development of these clubs and
tuberculosis and to seek support for the development of these clubs and
community-based associations through the health providers, authorities, and
community-based associations through the health providers, authorities, and
civil society
civil society

• The right to participate as “stakeholders” in the development, implementation,

• The right to participate as “stakeholders” in the development, implementation,
monitoring, and evaluation of tuberculosis policies and programs with local,
monitoring, and evaluation of tuberculosis policies and programs with local,
national, and international health authorities.
national, and international health authorities.
5.6.1.8 The right to security
5.6.1.8 The right to security

• The right to job security after diagnosis or appropriate rehabilitation upon

• The right to job security after diagnosis or appropriate rehabilitation upon
completion of treatment
completion of treatment

• The right to nutritional security or food supplements if needed to meet

• The right to nutritional security or food supplements if needed to meet treatment
requirements
treatment requirements

5.6.1.9 Patients’ Responsibilities

5.6.1.9 Patients’ Responsibilities
A patient has the responsibility to:
A patient has the responsibility to:
a) Share Information
a) Share Information

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• The responsibility to provide the healthcare giver as much information as
• The responsibility to provide the healthcare giver as much information as
possible about present health, past illnesses, any allergies, and any other
possible about present health, past illnesses, any allergies, and any other
relevant details
relevant details
 • The responsibility to provide information to the health provider about
• The responsibility to provide information to the health provider about
contacts with immediate family, friends, and others who may be vulnerable
contacts with immediate family, friends, and others who may be vulnerable
to tuberculosis or may have been infected by contact
to tuberculosis or may have been infected by contact

b) Follow Treatment
b) Follow Treatment
• The responsibility to follow the prescribed and agreed treatment plan and
• The responsibility to follow the prescribed and agreed treatment plan and to
conscientiously comply with the instructions given to protect the
to conscientiously comply with the instructions given to protect the patient’s
health, and that of others
patient’s health, and that of others
• The responsibility to inform the health provider of any difficulties or
• The responsibility to inform the health provider of any difficulties or problems
with following treatment or if any part of the treatment is not
problems with following treatment or if any part of the treatment is not
clearly understood
clearly understood

c) Contribute to Community Health

c) Contribute to Community Health
• The responsibility to contribute to community well-being by encouraging
• The responsibility to contribute to community well-being by encouraging
others to seek medical advice if they exhibit the symptoms of tuberculosis
others to seek medical advice if they exhibit the symptoms of tuberculosis •
The responsibility to show consideration for the rights of other patients and
• The responsibility to show consideration for the rights of other patients and
healthcare providers, understanding that this is the dignified basis and
healthcare providers, understanding that this is the dignified basis and
respectful foundation of the tuberculosis community
respectful foundation of the tuberculosis community

d) Show Solidarity
d) Show Solidarity
• The moral responsibility of showing solidarity with other patients, marching
• The moral responsibility of showing solidarity with other patients, marching
together towards cure
together towards cure
• The moral responsibility to share information and knowledge gained during
• The moral responsibility to share information and knowledge gained during
treatment and to pass this expertise to others in the community, making
treatment and to pass this expertise to others in the community, making
empowerment contagious
empowerment contagious
• The moral responsibility to join in efforts to make the community
• The moral responsibility to join in efforts to make the community tuberculosis
free.
tuberculosis free.
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6. REVIEW PLAN AND MONITORING AND EVALUATION FOR THIS POLICY
6. REVIEW PLAN AND MONITORING AND EVALUATION FOR THIS POLICY
DOCUMENT
DOCUMENT
The isolation policy will be reviewed every three years or earlier as need be, by the
The isolation policy will be reviewed every three years or earlier as need be, by the
isolation taskforce to assess progress, utilization and implementation of the policy. It
isolation taskforce to assess progress, utilization and implementation of the policy. It
will also incorporate best practices across different settings and build on new
will also incorporate best practices across different settings and build on new
evidence. This process will as mentioned will be ratified by the TB ICC.
evidence. This process will as mentioned will be ratified by the TB ICC.

Periodical monitoring and evaluation of the implementation shall be undertaken by all

Periodical monitoring and evaluation of the implementation shall be undertaken by all
interested parties and the findings shall be presented to TB isolation task force and
interested parties and the findings shall be presented to TB isolation task force and
TB ICC ratification and onwards transmission to County government.
TB ICC ratification and onwards transmission to County government.
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7. ANNEXES
7. ANNEXES

7.1 Annex 1: Key Informant Interview and Focus group discussion guides 7.1
Annex 1: Key Informant Interview and Focus group discussion guides

NATIONAL TUBERCULOSIS, LEPROSY AND LUNG DISEASE PROGRAM

NATIONAL TUBERCULOSIS, LEPROSY AND LUNG DISEASE
PROGRAM TUBERCULOSIS (TB) ISOLATION POLICY
TUBERCULOSIS (TB) ISOLATION POLICY
KEY INFORMANT INTERVIEW GUIDE
KEY INFORMANT INTERVIEW GUIDE

Introduction
Introduction
The National TB Program is currently developing the TB isolation policy. The TB program is
The National TB Program is currently developing the TB isolation policy. The TB program is
interviewing Key Stakeholders to collect their views on the isolation policy. The following key
interviewing Key Stakeholders to collect their views on the isolation policy. The following key
informants will be interviewed:
informants will be interviewed:
✔ County officials-Chief Officer for Health (COH), County Director for Health (CDH), /County
✔ County officials-Chief Officer for Health (COH), County Director for Health (CDH), /County
Executive Committee Member for Health (CEC)
Executive Committee Member for Health (CEC)
✔ Planning-CEC, COH, CDH
✔ Planning-CEC, COH, CDH
✔ Patients with adherence issues
✔ Patients with adherence issues
✔ TB ambassadors- former patient
✔ TB ambassadors- former patient
✔ Prison commandant
✔ Prison commandant
✔ International Organization of Migration (IOM)
✔ International Organization of Migration (IOM)
✔ MSF France
✔ MSF France
Please allow us to ask you a few questions
Please allow us to ask you a few questions

1 In your view, do you think TB is a public health problem? And why?

. In your view, do you think TB is a public health problem? And why? Probe: do you think
1 the problem is because of its mode of transmission or identification of
. Probe: do you think the problem is because of its mode of transmission or identification of
signs and symptoms for TB or both? Please explain
signs and symptoms for TB or both? Please explain

2 What is your understanding of isolation in the context of TB?

. What is your understanding of isolation in the context of TB?
2 Probe 1: in your view are there different types of isolation?
. Probe 1: in your view are there different types of isolation?
Probe 2: is TB isolation feasible in Kenya? Please explain
Probe 2: is TB isolation feasible in Kenya? Please explain

3 Have you heard about the court ruling on TB isolation that occurred on 24 th march
. Have you heard about the court ruling on TB isolation that occurred on 24 th march
3 2016?
. 2016?
 Probe: please expound on your understanding of the ruling
Probe: please expound on your understanding of the ruling

4 In view of the court ruling what are your thoughts on creating isolation facilities?
. In view of the court ruling what are your thoughts on creating isolation
4 facilities? Probe 1: what do you think of the isolation policy that is being created?
. Probe 1: what do you think of the isolation policy that is being created?
Probe 2: would you be willing to include isolation facilities in future plans and how?
Probe 2: would you be willing to include isolation facilities in future plans and
how? Probe 3: are there plans now, to create isolation facilities?
Probe 3: are there plans now, to create isolation facilities?

5 As a patient, or healthcare worker what would be the ideal conditions for an isolation
. As a patient, or healthcare worker what would be the ideal conditions for an isolation
5 ward?
. ward?
Probe 1: what do you think about the duration of visitation?
Probe 1: what do you think about the duration of visitation?
Probe 2: what do you think about the distance from other health facilities/wards etc
Probe 2: what do you think about the distance from other health facilities/wards
etc Probe 3: what else can be done to improve the environment?
Probe 3: what else can be done to improve the environment?

6 What do you think of the isolation policy that is being created?

. What do you think of the isolation policy that is being created?
6 Probe 1: in your view, what kind of patients should be eligible for isolation?
. Probe 1: in your view, what kind of patients should be eligible for
isolation? Probe 2: how will the rights of those patients who get isolated
be protected
Probe 2: how will the rights of those patients who get isolated be protected Probe 3: what
practical and ethical ways can be implemented in your setting- county/health
Probe 3: what practical and ethical ways can be implemented in your setting- county/health
facility - to provide isolation for TB patients for both voluntary and in-voluntary isolation?
facility - to provide isolation for TB patients for both voluntary and in-voluntary isolation?

7 What do you think are the benefits of isolation?

. What do you think are the benefits of isolation?
7
.

8 What do you foresee as the challenges of isolation

. What do you foresee as the challenges of isolation
8 Probe: what are the possible solutions to these challenges?
. Probe: what are the possible solutions to these challenges?

END
END

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NATIONAL TUBERCULOSIS, LEPROSY AND LUNG DISEASE PROGRAM
NATIONAL TUBERCULOSIS, LEPROSY AND LUNG DISEASE
PROGRAM TUBERCULOSIS (TB) ISOLATION POLICY
TUBERCULOSIS (TB) ISOLATION POLICY
FOCUS GROUPS (FGDS) INTERVIEW GUIDE
FOCUS GROUPS (FGDS) INTERVIEW GUIDE

Introduction
Introduction
The National TB Program is currently developing the TB isolation policy. The TB program is
The National TB Program is currently developing the TB isolation policy. The TB program is
interviewing Key Stakeholders in a form of focus group discussion (FGD) to collect their views on
interviewing Key Stakeholders in a form of focus group discussion (FGD) to collect their views on
the isolation policy. The following will be the stakeholders who will form the FGD groups:
the isolation policy. The following will be the stakeholders who will form the FGD groups:
✔ Heath care workers – doctors, nurses, clinicians, PHOs
✔ Heath care workers – doctors, nurses, clinicians, PHOs
✔ Patients: TB and DR TB patients
✔ Patients: TB and DR TB patients
✔ Prisoners
✔ Prisoners
✔ Community Units
✔ Community Units
The following counties will participate in the FGDs. The criteria for selecting counties was based on
The following counties will participate in the FGDs. The criteria for selecting counties was based on
High TB burden, high rates of detention in prisons, low adherence levels, high treatment
High TB burden, high rates of detention in prisons, low adherence levels, high treatment
interrupters, High TB/HIV burden, presence of isolation facility and the county where the court ruling
interrupters, High TB/HIV burden, presence of isolation facility and the county where the court ruling
took place.
took place.
✔ Homabay: Community units and DR TB patients
✔ Homabay: Community units and DR TB patients
✔ Mombasa: Community units and prisoners
✔ Mombasa: Community units and prisoners
✔ Kirinyaga: healthcare workers and DS TB patients
✔ Kirinyaga: healthcare workers and DS TB patients
✔ Nandi: Prisoners and Healthcare workers
✔ Nandi: Prisoners and Healthcare workers
✔ Nairobi: DR TB patients and DS TB patients
✔ Nairobi: DR TB patients and DS TB patients
Please allow us to ask you a few questions
Please allow us to ask you a few questions

1 What do you think about TB care that is offered by the ministry of health
. What do you think about TB care that is offered by the ministry of
1 health Probe 1: what is your view on the duration of treatment?
. Probe 1: what is your view on the duration of treatment?
Probe 2: what is your view on prevention measures in relation to the mode of transmission of
Probe 2: what is your view on prevention measures in relation to the mode of transmission of
TB?
TB?
Probe 3: can the community play a role? Please explain
Probe 3: can the community play a role? Please explain

2 Taking TB medication as required can be difficult. What are some of the challenges that
. Taking TB medication as required can be difficult. What are some of the challenges that
2 make adhering to TB medication difficult?
. make adhering to TB medication difficult?
Probe: what practical ways do you suggest to keep TB patients adherent on
treatment?Probe: what practical ways do you suggest to keep TB patients adherent on
treatment?

3 Have you heard about the court ruling on TB isolation that occurred on 24 th march
. Have you heard about the court ruling on TB isolation that occurred on 24 th march
3 2016?
. 2016?
Probe 1: please expound on your understanding of the ruling
Probe 1: please expound on your understanding of the ruling
 Probe 2: what is your understanding of TB isolation
Probe 2: what is your understanding of TB isolation

4 As a patient, or healthcare worker what would be the ideal conditions for an isolation
. As a patient, or healthcare worker what would be the ideal conditions for an isolation
4 ward?
. ward?
Probe 1: what do you think about the duration of visitation?
Probe 1: what do you think about the duration of visitation?
Probe 2: what do you think about the distance from other health facilities/wards etc
Probe 2: what do you think about the distance from other health facilities/wards etc
Probe 2: what else can be done to improve the environment?
Probe 2: what else can be done to improve the environment?

5 What do you think of the isolation policy that is being created?

. What do you think of the isolation policy that is being created?
5 Probe 1: in your view, what kind of patients should be eligible for isolation?
. Probe 1: in your view, what kind of patients should be eligible for isolation?
Probe 2: how will the rights of those patients who get isolated be protected?
Probe 2: how will the rights of those patients who get isolated be protected? Probe 3: what
practical and ethical ways can be implemented in your setting- county/health
Probe 3: what practical and ethical ways can be implemented in your setting- county/health
facility - to provide isolation for TB patients for both voluntary and in-voluntary isolation?
facility - to provide isolation for TB patients for both voluntary and in-voluntary isolation?

END
END

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7.2 Annex 2: Key Informant interview report
7.2 Annex 2: Key Informant interview report
The report is summarised per question.
The report is summarised per question.
i. In your view, do you think TB is a public health problem? And why?
i. In your view, do you think TB is a public health problem? And why? All
respondents agreed that TB is a public health problem that is made worse
All respondents agreed that TB is a public health problem that is made worse
by malnutrition and poverty. It therefore becomes a social problem if looked
by malnutrition and poverty. It therefore becomes a social problem if looked at
from this perspective. Since it is airborne it can be spread easily and
at from this perspective. Since it is airborne it can be spread easily and
resources should be spent to reduce transmission. Treatment has been
resources should be spent to reduce transmission. Treatment has been
shortened from 8 months to 6 months.
shortened from 8 months to 6 months.

ii. What is your understanding of isolation in the context of TB?

ii. What is your understanding of isolation in the context of TB?
Understanding
Understanding
Previously it meant incarceration but, it now seeks to protect patient rights.
Previously it meant incarceration but, it now seeks to protect patient rights. The
goal of isolation is to avoid transmission, improve adherence and TB
 The goal of isolation is to avoid transmission, improve adherence and TB
management.
management.

Types of isolation
Types of isolation
The following were listed by the respondents as types of isolation
The following were listed by the respondents as types of isolation
• Confinement: separated from the rest of the population
• Confinement: separated from the rest of the population
• Voluntary: the patient consents to be isolated
• Voluntary: the patient consents to be isolated
• Smear positive TB patients
• Smear positive TB patients
• MDR TB patients
• MDR TB patients
• Ordinary patients, for first few weeks of treatment
• Ordinary patients, for first few weeks of treatment
• Newly confirmed
• Newly confirmed
Feasibility in Kenya
Feasibility in Kenya
It was largely felt that it will be feasible in Kenya since there is good will.
It was largely felt that it will be feasible in Kenya since there is good will.
Sensitization however is key to its success. There is also need to understand
Sensitization however is key to its success. There is also need to understand
ways and means of isolating different types of patients
ways and means of isolating different types of patients

iii. Have you heard about the court ruling on TB isolation that occurred on
iii. Have you heard about the court ruling on TB isolation that occurred on 24th
march 2016?
24th march 2016?
Most had heard. Those who had heard were happy with the recommendation
Most had heard. Those who had heard were happy with the recommendation
for isolation. Counselling will be needed to make the patients why isolation
for isolation. Counselling will be needed to make the patients why isolation
would be important. They found an isolation ward more humane than prison.
would be important. They found an isolation ward more humane than prison.
Despite patient rights, those with MDR should be isolated to protect the
Despite patient rights, those with MDR should be isolated to protect the public.
Health care workers should be part of the team of court user’s forums
public. Health care workers should be part of the team of court user’s forums a
meeting where the prisons department and judiciary usually meet. Nutrition
a meeting where the prisons department and judiciary usually meet. Nutrition
and psychosocial support should be part of the isolation program. Community
and psychosocial support should be part of the isolation program. Community
gatekeepers like local administration on the importance of isolation and
gatekeepers like local administration on the importance of isolation and
handling TB cases should be engaged in all processes.
handling TB cases should be engaged in all processes.
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iv. In view of the court ruling what are your thoughts on creating isolation
iv. In view of the court ruling what are your thoughts on creating isolation
facilities?
facilities?
Some counties have already set aside some money to build TB isolation
Some counties have already set aside some money to build TB isolation wards
eg. Kirinyanga County have set 10M 2017/2018 for isolation ward in
wards eg. Kirinyanga County have set 10M 2017/2018 for isolation ward in
Kerugoya. In the next 5 years they want to set up 3 isolation facilities in 3
Kerugoya. In the next 5 years they want to set up 3 isolation facilities in 3
hospital. It will be a 15-20 bed facility.
hospital. It will be a 15-20 bed facility.

Shimolatewa maximum prison has been implementing isolation for TB

Shimolatewa maximum prison has been implementing isolation for TB patients
within the facility and it is an example of best practices within a prison
patients within the facility and it is an example of best practices within a prison
setting. Those who are also drug abusers are treated for both TB and drug
setting. Those who are also drug abusers are treated for both TB and drug
abuse. The prisons have written to the courts to allow TB patients complete
abuse. The prisons have written to the courts to allow TB patients complete
treatment before they are sentenced to make sure incarceration does not
treatment before they are sentenced to make sure incarceration does not
affect their treatment. Health workers are screened annually for TB. Infection
affect their treatment. Health workers are screened annually for TB. Infection
prevention is observed. Some are of the view that the prisons department
prevention is observed. Some are of the view that the prisons department
should have isolation wards as well to avoid moving prisoners.
should have isolation wards as well to avoid moving prisoners.

Some partners like International Organization of Migration are willing to

Some partners like International Organization of Migration are willing to partner
to help build isolation wards.
partner to help build isolation wards.

It was strongly recommended that regional based isolation facilities to be

It was strongly recommended that regional based isolation facilities to be
created to reduce cost of construction and operation.
created to reduce cost of construction and operation.

v. As a patient, or healthcare worker what would be the ideal conditions for

v. As a patient, or healthcare worker what would be the ideal conditions for an
isolation ward?
an isolation ward?
The following were suggested as the ideal conditions for isolation wards:
The following were suggested as the ideal conditions for isolation wards:
• There should be a distance from other wards
• There should be a distance from other wards
• Rooms should be well ventilated and spacious
• Rooms should be well ventilated and spacious
• Should be fenced, with open air circulation and grounds where patients
• Should be fenced, with open air circulation and grounds where patients
can relax
can relax
• Should have a separate open bay for visitations
• Should have a separate open bay for visitations
• Provide biological respiratory masks for health workers who visit the
• Provide biological respiratory masks for health workers who visit the
patients often
patients often
• Should have negative pressure, expose to UV light, inpatients should
• Should have negative pressure, expose to UV light, inpatients should
have time to rest outside the ward
have time to rest outside the ward
• Provide protective gear of the health workers and visitors
• Provide protective gear of the health workers and visitors
• Should observe infection prevention practices
• Should observe infection prevention practices
• Should have high level isolation equipment to accommodate other
• Should have high level isolation equipment to accommodate other
communicable diseases that require isolation such as Cholera, Ebola,
communicable diseases that require isolation such as Cholera, Ebola,
SARS.
SARS.
• Health care providers should be trained to manage the isolation ward
• Health care providers should be trained to manage the isolation ward •
Should have nutrition support
• Should have nutrition support
• Visiting hours should be short, one hour or two (other said 5 minutes
• Visiting hours should be short, one hour or two (other said 5 minutes
others 20 others 30 minutes), and should not be everyday
others 20 others 30 minutes), and should not be everyday
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• Should have sporting and entertainment provisions
• Should have sporting and entertainment provisions
• Sensitize and educate the community
• Sensitize and educate the community
• Unstable patients should be separated from stable patients
• Unstable patients should be separated from stable patients
• Should be 20-30 meters from other facilities/wards
• Should be 20-30 meters from other facilities/wards
• Should be able to categorize patients with their resistance patterns to
• Should be able to categorize patients with their resistance patterns to
avoid cross infection
avoid cross infection
• Every patient should have their own room
 • Every patient should have their own room

The following were suggested as ways to improve the environment:

The following were suggested as ways to improve the environment:
• Spacious
• Spacious
• A lot of windows
• A lot of windows
• Air filters
• Air filters
• Patients visited with IPC guidelines for about 30 minutes
• Patients visited with IPC guidelines for about 30 minutes
• About 50 meters from other buildings
• About 50 meters from other buildings
• Clean toilets and bathroom facilities
• Clean toilets and bathroom facilities

vi. What do you think of the isolation policy that is being created? vi.
What do you think of the isolation policy that is being created?

The following were suggested as eligibility for isolation:

The following were suggested as eligibility for isolation:
a. Non-compliant patients
a. Non-compliant patients
b. Non-adherent patients
b. Non-adherent patients
c. TB patients who don’t not have adequate nutritional, economic or
c. TB patients who don’t not have adequate nutritional, economic or
psycho-social support
psycho-social support
d. Patients with psychosocial issues e.g. alcoholics, drug addicts
d. Patients with psychosocial issues e.g. alcoholics, drug addicts
e. Patients with co-morbidities
e. Patients with co-morbidities
f. TB patients who are prisoners
f. TB patients who are prisoners
g. Confirmed MDR patients
g. Confirmed MDR patients
h. Newly diagnosed in the 1st month of treatment when they are infectious
h. Newly diagnosed in the 1st month of treatment when they are infectious i.
Defaulters
i. Defaulters
j. DR TB patients
j. DR TB patients
k. Other contagious diseases
k. Other contagious diseases
l. Critically ill patients
l. Critically ill patients
m. Smear unstable positive patients
m. Smear unstable positive patients
n. Patients whose sputum has not converted at month 2
n. Patients whose sputum has not converted at month 2
 The following were suggested as ways to Protect patient rights during
The following were suggested as ways to Protect patient rights during
isolation:
isolation:
a. Isolation is protection of human rights in itself
a. Isolation is protection of human rights in itself
b. Counselling
b. Counselling
c. Education
c. Education
d. Allow movement in a restricted area e.g. They can bath in the sun or
d. Allow movement in a restricted area e.g. They can bath in the sun or play
a sport
play a sport
e. Informed consent
e. Informed consent
f. Use trained health care providers
f. Use trained health care providers
g. A clinician should not see more than 20 patients a day
g. A clinician should not see more than 20 patients a day
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h. Patients should be allowed to continue with their activities in the
h. Patients should be allowed to continue with their activities in the isolation
area
isolation area
i. Relatives to be allowed to bring home made food and groom their
i. Relatives to be allowed to bring home made food and groom their
patients
patients
j. Collaboration with law makers, human rights groups and health care
j. Collaboration with law makers, human rights groups and health care
workers
workers
k. Approved court orders
k. Approved court orders

vii. What do you think are the benefits of isolation?

vii. What do you think are the benefits of isolation?
The following were suggested as benefits of isolation:
The following were suggested as benefits of isolation:
a) The public is protected from infectious disease
a) The public is protected from infectious disease
b) Quality of treatment will improve
b) Quality of treatment will improve
c) It’s a win win both from a public health and human rights perspective
c) It’s a win win both from a public health and human rights perspective
d) Will help reduce transmission of disease
d) Will help reduce transmission of disease
e) Will improve adherence
e) Will improve adherence
 f) Nutritional support can be provided
f) Nutritional support can be provided
g) Protect the public
g) Protect the public
h) Ultimately it will reduce cost
h) Ultimately it will reduce cost

viii. What do you foresee as the challenges of isolation

viii. What do you foresee as the challenges of isolation
The following were suggested as challenges of isolation:
The following were suggested as challenges of isolation:
a) Patients will feel discriminated against
a) Patients will feel discriminated against
b) Resistance from staff to work in the isolation facilities
b) Resistance from staff to work in the isolation facilities
c) Stigma
c) Stigma
d) Lack of resources to built infrastructure and human
d) Lack of resources to built infrastructure and human
resources for health
resources for health
e) Lack of trained personnel
e) Lack of trained personnel
f) Lack of policy and guidelines
f) Lack of policy and guidelines
g) Lack of political will
g) Lack of political will
h) Community resistance to isolation
h) Community resistance to isolation
i) Negative attitudes towards isolation
i) Negative attitudes towards isolation
j) May not be feasible in cases where the individual is a bread
j) May not be feasible in cases where the individual is a bread
winner
winner
k) Lack of political will
k) Lack of political will
l) Defaulting by those who are substance abusers due to
l) Defaulting by those who are substance abusers due to
withdrawal symptoms
withdrawal symptoms
m) Having isolation in prisons may be a challenge
m) Having isolation in prisons may be a challenge

The following were suggested as ways to mitigate challenges:

The following were suggested as ways to mitigate challenges:
a) Sensitization and awareness
a) Sensitization and awareness
b) Advocacy at high level with stakeholders and partners
b) Advocacy at high level with stakeholders and partners
c) Adequate human resource for health
c) Adequate human resource for health
d) Budget for the isolation units
d) Budget for the isolation units
e) Advocacy from policy makers for sustained funding
e) Advocacy from policy makers for sustained funding
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f) Training and mentorship of health care providers
f) Training and mentorship of health care providers
g) Policy to be put in place
g) Policy to be put in place
h) Involve human rights groups
h) Involve human rights groups
 Page 36 of 47
Page 36 of 47
Page 36 of 47
7.3 Annex 3: Focus Group Discussion report
7.3 Annex 3: Focus Group Discussion report
The report is summarised per question.
The report is summarised per question.
i. What do you think about TB care that is offered by the ministry of health
i. What do you think about TB care that is offered by the ministry of health
Most thought TB care offered by the ministry of health is good. The
Most thought TB care offered by the ministry of health is good. The
shortcomings noted were limited laboratory follow up, inconsistent availability
shortcomings noted were limited laboratory follow up, inconsistent availability
of nutritional supplements, small consolation rooms and that TB in children
of nutritional supplements, small consolation rooms and that TB in children still
remain a big challenge.
still remain a big challenge.

Most thought that adherence is good since most of them turn sputum negative
Most thought that adherence is good since most of them turn sputum negative
after 2 months. They however recommended giving incentives to those who
after 2 months. They however recommended giving incentives to those who
complete treatment like branded T shirts. Some treatment centres were
complete treatment like branded T shirts. Some treatment centres were
applauded for being friendly, making adherence even easier.
applauded for being friendly, making adherence even easier.

On duration of treatment, most appreciate that its now 6 months for drug
On duration of treatment, most appreciate that its now 6 months for drug
sensitive TB which is relatively shorter. They however wished that it can even
sensitive TB which is relatively shorter. They however wished that it can even
be made shorter. They think that MDR TB treatment takes too long with very
be made shorter. They think that MDR TB treatment takes too long with very
severe side effects.
severe side effects.

On clinic visits, most suggested a reduction of the number of visits during the
On clinic visits, most suggested a reduction of the number of visits during the
intensive pause from the current weekly to biweekly, because its a challenge
intensive pause from the current weekly to biweekly, because its a challenge
for those with formal employment.
for those with formal employment.

On transmission of Tb, they all agreed it is a public health problem that is

On transmission of Tb, they all agreed it is a public health problem that is
preventable. There is a need for sensitization, awareness and contact tracing.
preventable. There is a need for sensitization, awareness and contact tracing.
Ventilation in the wards and all clinical areas is wanting and urgent
Ventilation in the wards and all clinical areas is wanting and urgent
improvement needed. Infection prevention practices should be observed by
improvement needed. Infection prevention practices should be observed by
patients, care givers and health care providers. Infection prevention practices
 patients, care givers and health care providers. Infection prevention practices
should also be implemented in public transport vehicles.
should also be implemented in public transport vehicles.

The following were the suggested role of the community:

The following were the suggested role of the community:
• Sensitization and awareness
• Sensitization and awareness
• Prevent stigmatization
• Prevent stigmatization
• Assist in cases of emergencies
• Assist in cases of emergencies
• CHVs should have knowledge on early screening
• CHVs should have knowledge on early screening
• Community gate keepers like chiefs should be utilized
• Community gate keepers like chiefs should be utilized
• Involve community health workers for contact tracing
• Involve community health workers for contact tracing
• Strengthen community strategy
• Strengthen community strategy

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ii. Taking TB medication as required can be difficult. What are some of the
ii. Taking TB medication as required can be difficult. What are some of the
challenges that make adhering to TB medication difficult?
challenges that make adhering to TB medication difficult?

The following were suggested causes of non-adherence to treatment

The following were suggested causes of non-adherence to treatment
a. Treatment takes long
a. Treatment takes long
b. The side effects are horrible
b. The side effects are horrible
c. Going to hospital daily is tedious, once a week refills would be
c. Going to hospital daily is tedious, once a week refills would be preferable
preferable
d. Poor nutrition
d. Poor nutrition
e. Stigma
e. Stigma
f. Some special groups like alcoholics need tailor-made follow up since
f. Some special groups like alcoholics need tailor-made follow up since they
may forget to take their medications
they may forget to take their medications
 g. Inadequate counseling
g. Inadequate counseling
h. Some follow up clinics for refills fall in public holidays or weekends
h. Some follow up clinics for refills fall in public holidays or weekends when
the clinics are closed
when the clinics are closed
i. Psychosocial problems like alcoholics and drug addicts
i. Psychosocial problems like alcoholics and drug addicts
j. Poor socio-economic status e.g. those residing in informal settlements
j. Poor socio-economic status e.g. those residing in informal settlements k.
Pill burden
k. Pill burden

The following were suggested ways to improve adherence

The following were suggested ways to improve adherence
a. Monitoring and follow up by CHV’s
a. Monitoring and follow up by CHV’s
b. Nutritional support
b. Nutritional support
c. Psycho-social support from peers and families
c. Psycho-social support from peers and families
d. Counseling
d. Counseling
e. Follow-up visits using Locator forms by CHV’s
e. Follow-up visits using Locator forms by CHV’s
f. Give enough medication, and not isoaltion
f. Give enough medication, and not isoaltion

iii. Have you heard about the court ruling on TB isolation that occurred on
iii. Have you heard about the court ruling on TB isolation that occurred on 24th
march 2016?
24th march 2016?
Some had heard about the ruling, but not aware of the ruling. Those who had
Some had heard about the ruling, but not aware of the ruling. Those who had
heard were positive about the idea of not being jailed. They were however
heard were positive about the idea of not being jailed. They were however
worried that isolation will restrict freedom of movement and socialization but at
worried that isolation will restrict freedom of movement and socialization but at
the same time not isolating leads to transmission. It was suggested that there
the same time not isolating leads to transmission. It was suggested that there
is a need of a delicate balance here that may include home based treatment,
is a need of a delicate balance here that may include home based treatment,
where its more friendly, familiar, has psycho-social support and reduces
where its more friendly, familiar, has psycho-social support and reduces
stigma. There was a worry that isolation can lead to depression.
stigma. There was a worry that isolation can lead to depression.
 Page 38 of 47
Page 38 of 47
Page 38 of 47
iv. As a patient, or healthcare worker what would be the ideal conditions for
iv. As a patient, or healthcare worker what would be the ideal conditions for an
isolation ward?
an isolation ward?

The following were suggested as ideal conditions for an isolation ward

The following were suggested as ideal conditions for an isolation ward
a) Visiting hours up to one hour
a) Visiting hours up to one hour
b) Detached from other wards but should be in the same setting as the b)
Detached from other wards but should be in the same setting as the facility
to avoid stigma. Others thought that it should be in a place that’s facility to
avoid stigma. Others thought that it should be in a place that’s equidistant
from all other TB facilities in the County. Hence one per equidistant from all
other TB facilities in the County. Hence one per county
county
c) Well equipped with diagnostics
c) Well equipped with diagnostics
d) Good, tasty nutritious meals
d) Good, tasty nutritious meals
e) Homely environment
e) Homely environment
f) Entertainment units- TV, Radio, Music
f) Entertainment units- TV, Radio, Music
g) Protective gear
g) Protective gear
h) Visitors allowed to bring food
h) Visitors allowed to bring food
i) Comfortable with clean beddings
i) Comfortable with clean beddings
j) Well ventilated
j) Well ventilated
k) Not congested
k) Not congested
l) Stipend for patients, because they are care givers
l) Stipend for patients, because they are care givers
m) Educate visitors on infection prevention practices
m) Educate visitors on infection prevention practices
n) Community involvement is key to avoid resistance
n) Community involvement is key to avoid resistance

v. What do you think of the isolation policy that is being created?

v. What do you think of the isolation policy that is being created? Most thought
that it is a good policy, it will improve adherence, nutritional
Most thought that it is a good policy, it will improve adherence, nutritional
status and reduce transmission.
status and reduce transmission.

The following were suggestions on patients eligible for isolation

The following were suggestions on patients eligible for isolation
a) Non-adherent patients
a) Non-adherent patients
b) Infectious patients
b) Infectious patients
c) Defaulters
c) Defaulters
d) Those with side effects of medication
d) Those with side effects of medication
e) Those in need of nutritional support
e) Those in need of nutritional support
f) MDR not responding to medication
f) MDR not responding to medication
g) Very sick patients
g) Very sick patients
h) Alcoholics
h) Alcoholics

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Page 39 of 47
i) Those from low income families e.g. homeless or residing in informal i)
Those from low income families e.g. homeless or residing in informal
settlements, street children
settlements, street children
j) Patients who offer themselves voluntarily for isolation
j) Patients who offer themselves voluntarily for isolation

The following were suggestions on how rights of patients will be protected

The following were suggestions on how rights of patients will be protected
a) Allow access for human rights organizations to monitor
a) Allow access for human rights organizations to monitor
b) Sensitize patients on their rights
b) Sensitize patients on their rights
c) Should not be forced of coerced
c) Should not be forced of coerced
d) Give the patients the right information
d) Give the patients the right information
e) Provide treatment, healthy conditions and basic utilities
 e) Provide treatment, healthy conditions and basic utilities
f) Should not be discriminated up on or stigmatized
f) Should not be discriminated up on or stigmatized
g) Should be treated like any other patient
g) Should be treated like any other patient
h) Train health care providers
h) Train health care providers
i) Involve the family and community
i) Involve the family and community
j) Educate patients
j) Educate patients
k) Ensure confidentiality
k) Ensure confidentiality

The following were suggestions on what should be included as the policy is

The following were suggestions on what should be included as the policy is
being implemented
being implemented
a) Counselling
a) Counselling
b) Voluntary
b) Voluntary
c) Meet eligibility criteria
c) Meet eligibility criteria
d) Sensitization
d) Sensitization
e) Create isolation wards in prisons
e) Create isolation wards in prisons
f) Have nutritional support
f) Have nutritional support
g) Consumer education
g) Consumer education
h) Community engagement and linkages
h) Community engagement and linkages

Page 40 of 47
 Page 40 of 47
Page 40 of 47
7.4 Annex 4: STANDARDS FOR AIRBORNE INFECTION
7.4 Annex 4: STANDARDS FOR AIRBORNE INFECTION ISOLATION ROOMS
(AI/AIR) ROOMS
ISOLATION ROOMS (AI/AIR) ROOMS

A) TYPES
A) TYPES

1) Atmospheric Isolation or Natural Ventilation AI Rooms

1) Atmospheric Isolation or Natural Ventilation AI Rooms
These employ natural ventilation or natural ventilation assisted with air propeller fans.
These employ natural ventilation or natural ventilation assisted with air propeller fans.

2) Negative pressure or mechanical ventilation AI Rooms

2) Negative pressure or mechanical ventilation AI Rooms
These employ mechanical air-moving equipment to generate and maintain ventilation
These employ mechanical air-moving equipment to generate and maintain ventilation in
the Isolation Rooms.
in the Isolation Rooms.

B) SIZES
B) SIZES

The following are minimum recommended sizes for various configurations or designs
The following are minimum recommended sizes for various configurations or designs of
Isolation Rooms.
of Isolation Rooms.

1) Basic AI Room without ante-room, not self-contained. (Without dedicated bathroom) 1)

Basic AI Room without ante-room, not self-contained. (Without dedicated bathroom) 10m 2
plinth area.
10m2 plinth area.

2) Basic AI Room without anteroom, self-contained (with dedicated bathroom) 12m 2 2)

Basic AI Room without anteroom, self-contained (with dedicated bathroom) 12m 2 plinth
area.
plinth area.

3) AI Room self-contained (with dedicated bathroom) with ante room – 22m 2 3)

AI Room self-contained (with dedicated bathroom) with ante room – 22m 2

C) VENTILATION RATE
C) VENTILATION RATE

Minimum total air-changes per hour (ACH) > 12

Minimum total air-changes per hour (ACH) > 12

D) MINIMUM NEGATIVE PRESSURE AI STANDARDS

D) MINIMUM NEGATIVE PRESSURE AI STANDARDS

1) ROOM PRESSURE DIFFERENTIAL

1) ROOM PRESSURE DIFFERENTIAL
Minimum > 0.01” W.G (water gauge)
Minimum > 0.01” W.G (water gauge)

2) MINIMUM EXHAUST AIR EXCESS AIRFLOW (OFFSET)

2) MINIMUM EXHAUST AIR EXCESS AIRFLOW (OFFSET)
Recommended air volume flow differentials exhaust is to be 10% more than supply.
Recommended air volume flow differentials exhaust is to be 10% more than supply. Air
Minimum differential to be 50 CFM.
Air Minimum differential to be 50 CFM.

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3) TOTAL ACH SHOULD NOT INCLUDE HEPA RE-CIRCULATION
3) TOTAL ACH SHOULD NOT INCLUDE HEPA RE-CIRCULATION

4) UPPER-ROOM OR IN-DUCT UVGI

4) UPPER-ROOM OR IN-DUCT UVGI
This can be employed but not in lieu of ventilation.
This can be employed but not in lieu of ventilation.

5) AIR DISTRIBUTION
5) AIR DISTRIBUTION
Supply air from clean (High, ceiling) and exhaust from less clean (low, near floor)
Supply air from clean (High, ceiling) and exhaust from less clean (low, near floor)

6) HEPA FILTERED RE-CIRCULATION

6) HEPA FILTERED RE-CIRCULATION
To other areas not recommended
To other areas not recommended

7) EXHAUST DISCHARGE
7) EXHAUST DISCHARGE
Recommended to be on roof minimum 25 feet (8meters) high away from openings
Recommended to be on roof minimum 25 feet (8meters) high away from openings and
fresh air intakes.
and fresh air intakes.
 8) MONITORING OF NEGATIVE PRESSURE
8) MONITORING OF NEGATIVE PRESSURE
Recommended to be continuous and alarmed.
Recommended to be continuous and alarmed.

Minimum, check daily when Room is in use.

Minimum, check daily when Room is in use.

9) ANTE-ROOM ACH
9) ANTE-ROOM ACH
Recommended 10 ACH.
Recommended 10 ACH.

10) ANTE-ROOM PRESSURISATION

10) ANTE-ROOM PRESSURISATION
Positive to Isolation Room, negative to Corridor.
Positive to Isolation Room, negative to Corridor.
11) VARIABLE AIR-VOLUME ((VAV) VENTILLATION)
11) VARIABLE AIR-VOLUME ((VAV) VENTILLATION)
May be employed but maintain minimum code ACH and pressurizations.
May be employed but maintain minimum code ACH and pressurizations.

E) UVGI INSTALLATIONS:
E) UVGI INSTALLATIONS:

1) Recommended fittings to be installed 12 feet high from floor for upper room UVGI 1)
Recommended fittings to be installed 12 feet high from floor for upper room UVGI and 2
feet high from floor for lower room UVGI.
and 2 feet high from floor for lower room UVGI.
Minimum Installation Height for upper room UVGI > 9 ft.
Minimum Installation Height for upper room UVGI > 9 ft.

2) UVGI to be shielded type for room installations, but un-shielded type for in-duct 2)
UVGI to be shielded type for room installations, but un-shielded type for in-duct
installations.
installations.
3) Ceiling Reflectivity to UVGI not more than 10%.
3) Ceiling Reflectivity to UVGI not more than 10%.

4) Recommended regular monitoring with a Radiometer to maintain dosage levels 4)

Recommended regular monitoring with a Radiometer to maintain dosage levels and
control exposure.
and control exposure.

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Page 42 of 47
F) MEDICAL GASES:
F) MEDICAL GASES:
 It is recommended AI rooms to be installed with oxygen and vacuum medical gases It is
recommended AI rooms to be installed with oxygen and vacuum medical gases
installations.
installations.

G) SAMPLE ROOMS:
G) SAMPLE ROOMS:

Attached are sample A1 Room configurations/drawings.

Attached are sample A1 Room configurations/drawings.

REFERENCES:
REFERENCES:

ASHRAE -American Society of Heating, Refrigeration and air-conditioning Engineers’

ASHRAE -American Society of Heating, Refrigeration and air-conditioning Engineers’

AIA -American Institute of Architects

AIA -American Institute of Architects

CDC -Centre for Disease Control

CDC -Centre for Disease Control

TERMS
TERMS

ACH -Air Changes per hour

ACH -Air Changes per hour

CFM -Cubic Feet per minute

CFM -Cubic Feet per minute

FPM -Feet per minute

FPM -Feet per minute

HEPA -High efficiency Particulate air filters

HEPA -High efficiency Particulate air filters

UVGI -Ultraviolet germicidal irradiation

UVGI -Ultraviolet germicidal irradiation

VAV -Variable air volume

VAV -Variable air volume

“W.G.” -Water gauge

“W.G.” -Water gauge
 Page 43 of 47
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7.5 Annex 5: Sample designs
7.5 Annex 5: Sample designs
 Page 44 of 47
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 Page 45 of 47
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7.6Annex 6: MOH circular
7.6Annex 6: MOH circular
 Page 46 of 47
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47Page 47 of

47

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National Tuberculosis, Leprosy and Lung Disease Program First Floor,

Afya Annex,
Kenyatta National Hospital Grounds
P.O. Box 20781 – 00202 Nairobi
Telephone: +254 773 977 440
Email: [email protected]
www.nltp.co.ke