There are many things health facilities and crowded places need to do to reduce the spread of TB. This is called infection control.
Without proper infection control, busy waiting rooms in health facilities like this one can cause the spread of TB.
TB is caused by a bacterium called Mycobacterium tuberculosis (M. tuberculosis). When individuals are infected with TB in their lungs, they can release tiny particles containing M. tuberculosis into the air by coughing or sneezing. Inhaling these particles can lead to an individual being infected with TB, especially in places with little or no ventilation or in susceptible populations (e.g. children, immune-suppressed individuals like those with HIV). The goal of TB infection control is to reduce the risk of respiratory droplets from coming into contact with those who are not infected.
TB infection control interventions focus on settings where there is a high risk of TB being spread such as health-care facilities (i.e. nosocomial infection), congregate settings (e.g. correctional facilities, homeless shelters), and households.
Administrative control measures are the core set of practices that should at the very least be implemented in any setting despite the availability of resources (see the Box). These activities prevent droplets containing M. tuberculosis from being in the air in the first place thereby reducing the exposure of staff and patients to TB.
Why is TB infection control important?
In 2010 alone, 8.8 million people became newly infected with TB around the world.i What is more, drug resistant forms of TB (ie. multidrug-resistant TB [MDR-TB] and extensively drug-resistant TB [XDR-TB]) are emerging and being spread as well.
TB is becoming increasingly associated with HIV. TB is the most common life-threatening opportunistic disease and leading cause of death in those living with HIV/AIDS.ii In many parts of the world, TB is fueling an already devastating HIV epidemic. TB is estimated to be between 20-37 times greater in people living with HIV than among those without HIV.iii
Infection control measures enforced nationally and implemented locally are important to halt the spread of TB and it's detrimental effects on individuals and societies. Millions of people worldwide are needlessly infected and suffer the detrimental health consequences. TB infection control is a critical part in the global fight to end that suffering.
TB Infection Control Interventions
TB infection control interventions are an important component of any global or national TB prevention and control programme.. There are many guideline documents found around the world for TB infection control; some are national strategic plans, others are from international agencies such as the WHO and CDC.
Common to them is the recognition of the three main TB infection control measures (administrative, environmental and personal protective equipment) and their hierarchy of priority for implementation.
Because the incidence of TB in health-care facilities far exceeds that of the general population, millions of health-care workers are put at risk for TB everyday. For this reason, TB control measures are more rigorous and are a matter of urgency in health-care facilities.
Health-Care Facility Infection Control Measures
Administrative control measures 1st Priority
The most important control measures to be implemented in any setting. Highlighted here are some of the most critical interventions for minimizing exposure to TB.
Environmental Control Measures 2nd priority
Environmental control measures can be added to administrative control measures to reduce the concentration of infectious particles in the air. Ideally though, risk of exposure to those particles should be eliminated through administration control measures.
Personal Protective Equipment 3rd priority
This can supplement administrative and environmental control measures, but are not intended to replace them. When properly implemented, they can reduce the risk of inhaling infectious particles for health-care workers (HCWs) and other non-infected patients.
Congregate settings are places where there is a high concentration of people in a shared space such as correctional facilities, military barracks, homeless shelters, refugee camps, dormitories and nursing homes. The TB infection control recommendations for congregate settings overlap greatly with those of health-care facilities. However, they tend to be less specific due to the diversity of congregate settings. Reduction of overcrowding in any congregate setting, especially in correctional services, is one of the most important measures for decreasing the transmission of TB in these settings. Also of importance are administrative control measures which focus on:
- Cough etiquette and respiratory hygiene,
- Early identification followed by
- Separation of patient and initiation of appropriate treatment
Households have a vital role in reducing TB transmission in the community. Community awareness and education campaigns should promote basic infection control behaviour-changes. These include:
- Early identification of TB by going to a clinic to get screened and tested,
- Adherence to treatment,
- Education on and implementation of proper TB infection control measures (e.g. cough etiquette and respiratory hygiene) in the household,
- Proper ventilation of homes,
- Encouraging TB patients to spend as much time as possible outside, spend as little time as possible in congregate settings and public transportation, and
- Sleeping alone in an adequately ventilated room if possible.
i WHO report 2011: Global Tuberculosis Control http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf
iii The Three I's for HIV/TB http://www.who.int/hiv/topics/tb/3is/en/