TB Infection Control in Health Care Settings
A tuberculosis (TB) infection control plan is part of a general infection control program designed to ensure the following:
- prompt detection of infectious TB patients,
- airborne precautions, and
- treatment of people who have suspected or confirmed TB disease.
In all health care settings, particularly those in which people are at high risk for exposure to TB, policies and procedures for TB control should be developed, reviewed periodically, and evaluated for effectiveness to determine the actions necessary to minimize the risk for transmission of TB.
The TB infection control program should be based on a three-level hierarchy of control measures and include:
- Administrative measures
- Environmental controls
- Use of respiratory protective equipment
On May 17, 2019, the Centers for Disease Control and Prevention (CDC) and the National Tuberculosis Controllers Associationexternal icon (NTCA) released updated recommendations on the frequency of TB screening, testing, and treatment for health care personnel. For guidance on facility risk assessments and infection control practices please continue to refer to the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.
Administrative controls are the first and most important level of the hierarchy. These are management measures that are intended to reduce the risk or exposure to persons with infectious TB. These control measures consist of the following activities:
- Assigning someone the responsibility for TB infection control in the health care setting;
- Conducting a TB risk assessment of the setting;
- Developing and implementing a written TB infection-control plan;
- Ensuring the availability of recommended laboratory processing, testing, and reporting of results;
- Implementing effective work practices for managing patients who may have TB disease;
- Ensuring proper cleaning, sterilization, or disinfection of equipment that might be contaminated (e.g., endoscopes);
- Educating, training, and counseling health care personnel, patients, and visitors about TB infection and TB disease;
- Screening, testing, and evaluating personnel who are at risk for exposure to TB disease;
- Applying epidemiology-based prevention principles, including the use of setting-related TB infection-control data;
- Using posters and signs to remind patients and staff of proper cough etiquette (covering mouth when coughing) and respiratory hygiene; and
- Coordinating efforts between local or state health departments and high-risk health-care and congregate settings.
The second level of the hierarchy is the use of environmental controls to prevent the spread and reduce the concentration of infectious droplet nuclei. This includes two types of environmental control.
- Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation.
- Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation (AII) rooms; and cleaning the air by using high efficiency particulate air (HEPA) filtration, or ultraviolet germicidal irradiation.
The third level of the hierarchy is the use of respiratory-protection control. It consists of the use of personal protective equipment in situations that pose a high risk of exposure to TB disease.
Use of respiratory protection equipment can further reduce risk for exposure of health care personnel to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease. The following measures can be taken to reduce the risk for exposure:
- Implementing a respiratory protection program;
- Training health care personnel on respiratory protection; and
- Educating patients on respiratory hygiene and the importance of cough etiquette procedures.